Risk Prediction & Coronary Artery Calcium
Our group has led national and international efforts to advance the science of cardiovascular disease (CVD) risk prediction and the use of the coronary artery calcium (CAC) score for further risk assessment and personalized allocation of preventive pharmacotherapies. Our work has contributed to inform relevant CVD prevention guidelines around the world, which now acknowledge CAC as a powerful aid that can be used to both make a stronger case for chronic preventive statin therapy in patients with high CAC scores, and to safely refrain from certain pharmacotherapies and focus on lifestyle enhancement among individuals with a CAC score of zero. Our group is also leading efforts to characterize the potential utility of the CAC score to inform a personalized, safe allocation of low-dose aspirin, and the societal allocation of novel pharmacotherapies such as GLP-1RA and PCSK9 inhibitors in patients most likely to benefit. Finally, our group has also been highly active evaluating the potential utility of CAC to enrich primary prevention randomized trials with highest-risk participants, and its potential use as a gatekeeper of further testing in the acute, low-risk chest pain setting.
Cardiovascular Disease (CVD) in Ethnic Minorities
We are currently leading several studies in South Asia and the United States aimed at characterizing the burden of CVD in people of South Asian ancestry in 2021. Our work in this space has contributed to increase awareness on the high burden of diabetes, obesity, and coronary heart disease (CHD) among South Asians living in Southern Europe, particularly Pakistanis and Bangladeshis; this data is currently being used by the local health authorities to inform targeted public health interventions. We have also led international calls to action to enhance the prevention of premature CHD in South Asians across Europe, and of premature heart failure in the South Asian continent. Our current work in this space focuses on enhancing cardiovascular disease risk assessment in South Asians living in the United States, and in young South Asian adults, aimed at identifying opportunities to enhance the prevention of cardiovascular disease in its earliest stages.
Type 2 diabetes, dyslipidemia, and non-alcoholic fatty liver disease are linked by their underlying pathophysiology and associated risk of cardiovascular disease. The growing epidemic of obesity highlights the need to further understand these cardiometabolic disease conditions and associated downstream cardiovascular disease risk. Dr. Nasir and our group have examined the relationships between these cardiometabolic conditions and risk of atherosclerotic cardiovascular disease. Our group has examined novel methods for the detection of adiposity and fatty liver, including using clinical information and data from computed topography (CT) scans.
Heart Failure Prevention
We have used information captured from computed topography (CT) CT scans to identify risk of cardiovascular disease events, specifically coronary artery calcium as a marker for risk of myocardial infarction. More recently, other measures from CT scans have been identified as markers of heart failure risk. Dr. Nasir and colleagues are interested in using all data captured by CT scans to identify patients who are at increased risk for developing heart failure and may be more likely to benefit from HF prevention therapies.
Social Determinants of Health
Our social determinants of health (SDOH) portfolio involves multiple national collaboratives to develop, and operationalize an exhaustive SDOH framework. The framework serves as a steppingstone for a holistic understanding of sociodemographic disparities in major cardiovascular disease (CVD) outcomes, including stroke and Atherosclerotic Cardiovascular Disease (ASCVD). Our group is currently partnering with health equity champions locally and nationally to expand the center’s SDOH enterprise. Along with a brilliant team of clinicians and population health scientists, we are currently leading efforts to develop a novel CVD risk prediction tool, based on an individual’s cumulative social disadvantage. We are particularly interested in studying the determinants, and outcomes, of racial/ethnic disparities in CVD in the US, with implications for equitable health services delivery.
Our team is trained extensively in study design, research methods, and data management, and the application of these skills to leading epidemiological issues. We have established a robust analytic framework for examination of SDOH as well as racial/ethnic disparities in large survey databases, including advanced approaches for categorical data analysis, and efficiency/appropriateness of statistical tools for both cross-sectional and longitudinal data analysis. We intend to apply these, and other relevant analytic tools, to study SDOH across claims, survey and clinical databases.
Our group is heavily invested on using the most advanced analytics to provide, through research, the best possible care to patients. Through our Center for Cardiovascular Computational and Precision Health (“C3-PH”), our aim is to improve healthcare delivery and outcomes by leveraging Big Data. Through both internal (e.g. Houston Methodist system) and external (e.g. National Health Interview Survey) sources of data, we allow for systematic data harmonization for rapid knowledge generation and implementation. Examples include personalized interventions to improve cardiovascular health through artificial intelligence applications, sensor and wearable technologies, and improving deep learning to further impact healthcare areas such as health outcomes, health economics, population health, and quality and performance improvement.
Financial toxicity is a relatively new term that encompasses the health- and healthcare-related financial burden that a disease, along with its treatment, can have on an individual. It goes beyond the dollars and cents spent on health and healthcare, but rather focuses on the effect this may have on how patients and their families interact with, and suffer from, the weight of disease. Our team is among the pioneers of studying financial toxicity in patients with cardiovascular disease. Even though cardiovascular disease is known to cause significant expenditures on patients, it has only been until recently that we have helped to describe what the phenomenon really looks like, and how far it reaches. Our efforts have helped to inform how, for example, even with insurance, more than 70% of patients with atherosclerotic cardiovascular disease have difficulty paying their medical bills, and close to 1 in 4 are not able to pay at all. Aligned with strategic partners, we have also been able to show how these issues are much more prevalent among low-income families. Other components under the financial toxicity umbrella include issues like cost-related medication non-adherence, delaying and/or foregoing care due to cost, financial distress (a measure of worry about finances overall), and food insecurity. Our group continues to shed more light on this issue, and we hope to better understand it, so that solutions for fighting it can be delivered at different levels: healthcare providers, healthcare institutions, and health policy.
Coronavirus Disease-2019 (COVID19) & Cardiovascular Disease (CVD)
Our group is collaborating on research efforts at characterizing social determinants of health (SDOH) inequities in adherence to COVID-19 mitigation measures and outcomes, studying trends in health-related quality of life measures, and developing and validating instruments of cumulative social adversity in CVD population. With the supervision of leading CVD researchers, his research draws on SDOH frameworks and nationally representative datasets like the National Health Interview Survey (NHIS), and the Medical Expenditure Panel Survey (MEPS) to evaluate the contributions of health-related social factors to disease outcomes in CVD patients. Characterizing aggregate SDOH burden at the individual level in CVD populations will help improve the value of care.
We are currently leading research in understanding both financial and non-financial barriers to healthcare access among individuals with cardiovascular disease. With abundant evidence in the area of oncology of the utility of physician-patient discussions on cost of care, our research is aimed at understanding cardiologists’ perceptions of cost discussions and barriers preventing them from having these discussions, especially since individuals with cardiovascular disease are not immune to the effects of financial burden brought on by medical bills. This, when completed, will help shape policy at the national level aimed at reducing cost. We are also leading research, using national datasets like the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS) to understand the scope and determinants of non-financial barriers such transportation among individuals with cardiovascular disease. Our understanding of these barriers will guide national efforts aimed at promoting healthcare access among racial, ethnic and gender minorities, who may be particularly vulnerable.