Cardiovascular Disease studies

Cardiovascular disease continues to be the leading cause of death in the United States and is a major focus of our research efforts in Southern California. Our researchers study the prevention, incidence, treatment, and outcomes of cardiovascular disease, and develop interventions aimed at helping people reduce their risk factors. Our clinicians are also involved in clinical trials to study the efficacy and safety of new treatment options.

Adverse Events Associated with Use of Antihypertensive Medications

The overall objective of this study is to provide real world evidence on the incidence of adverse effects of antihypertensive medications.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Resolve to Save Lives

Funding Years:

2018 - 2020

Ambulatory blood pressure and falls in older treated patients with hypertension

The overall objective of this study is to determine whether having an ambulatory blood pressure that is substantially lower than clinic blood pressure as well has having large fluctuations or labile out-of-clinic blood pressure over 24-hours and with meals is associated with an increased risk of falls among older adults with hypertension and taking antihypertensive medication.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2018 - 2022

An Observational Cohort Study of the Risk of Thromboembolic Events among Adult Patients Treated with KCENTRA® Compared with Plasma for Urgent Reversal of Vitamin K Antagonist Therapy in the Setting of Acute Major Bleeding.

The goal of this study is examine the risk of thromboembolic events among adult patients treated with KCENTRA compared with plasma for urgent reversal of vitamin K antagonist therapy in the setting of acute major bleeding.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

CSL Behring, LLC

Funding Years:

2014 - 2021

Research Categories:

Approaches to Genetic Heterogeneity of Obstructive Sleep Apnea

The main goal of this study is to use state of the art approaches to identify relevant genes based on a very large sample of patients with Obstructive Sleep Apnea (OSA), a common disorder with multiple adverse consequences. It is known that OSA has a genetic basis, but to date no convincing gene variants have been identified. This study uses OSA obtained from multiple institutions in the United States. It is the largest study ever proposed for identifying genes for this common sleep disorder.

Principal Investigator:

Corinna Koebnick, PhD, MSc

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2016 - 2020

Research Categories:

,

Cardiovascular toxicity following aromatase inhibitor use

The aim of this cohort is to assess the risk of cardiovascular disease associated with endocrine treatments for breast cancer.

Principal Investigator:

Reina Haque, PhD, MPH

Funding Source:

California Breast Cancer Research Program (CBCRP)

Funding Years:

2013 - 2017

Clinical Characteristics and Outcomes in Heart Failure Patients with Reduced Ejection Fraction

Despite advances in heart failure (HF) care, there is a poor prognosis for adults with HF. Reduced ejection fraction (EF) is a central factor in HF; however, there are no safe medical therapies to directly improve cardiac function in these patients. Compared to the general population, HF patients have more hospitalizations and emergency department visits. Additionally, adherence to standard of care cardiovascular therapies among patients having HF with reduced EF (HFrEF) is poor. The GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) clinical trial is testing the hypotheses that omecamtiv mecarbil can safely improve symptoms, prevent clinical HF events, and delay cardiovascular death in patients with HF. The goal of this retrospective study is to describe a contemporary population of patients with HFrEF similar to that included in the GALACTIC-HF trial using real-world data.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Amgen, Inc.

Funding Years:

2020 - 2022

Research Categories:

CV Benefits and Safety of Glucose-Lowering Therapies in Adults with Diabetes

The primary goal of this study is to assess the impact of specific glucose-lowering strategies on cardiovascular events and on mortality in order to identify whether some glucose-lowering strategies confer more cardiovascular benefit than others.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2014 - 2018

Research Categories:

,

Database Cohort Study to Assess the Risk of Serious Angioedema in Assocation with Sacubitril/Valsartan use in Black Patients with Heart Failuer in the U.S.

The overall goal of this study is to provide real-world estimates of the incidence of angioedema among both HF patients initiating sacubitril/valsartan and HF patients initiating an ACEI, with a primary focus on Black patients.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Novartis Pharmaceuticals Corporation

Funding Years:

2016 - 2021

Development of a CKD Discordance Index to Identify High Healthcare Utilization

The goals of this pilot project are to develop a chronic kidney disease (CKD) discordance index defined by the presence of chronic conditions and treatments that oppose, contradict, or complicate CKD treatment or worsen kidney function in a subsample of CKD patients from KPSC

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Institute on Aging (NIA)

Funding Years:

2017 - 2018

Diagnosis of Hypertension in Specialty Clinics

High blood pressure can be missed in patients who do not have regular visits with their primary care provider. The goal of the present project is to estimate the efficacy of blood pressure assessments in specialty clinics. We will compare recognition, follow-up, and time-to-treatment between patients first recognized in specialty care to those in primary care.

Principal Investigator:

Corinna Koebnick, PhD, MSc

Funding Source:

Kaiser Permanente, Southern California

Funding Years:

2013

HIV Status and Incidence and Outcomes of Heart Failure

The overall goal of this study is to identify optimal treatment strategies to reduce the impact of cardiovascular disease complications in HIV-infected patients, focusing on the understudied diagnosis of heart failure

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2016 - 2020

HMO Research Network Cardiovascular Research Network (CVRN)

The purpose of this program is to establish a collaborative CVRN among 15 member plans of the HMO Research Network to create a unique national resource that leverages the network’s CV expertise, diverse community-based study populations, and rich electronic data systems.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Institutes of Health (NIH)

Funding Years:

2011 - 2013

Research Categories:

Home Blood Pressure and Falls in Older Adults

Healthcare providers must balance the cardiovascular benefits of blood pressure lowering medication with the potential risk for falls among older adults with hypertension. Blood pressure has traditionally been measured in the clinic setting; however, for many people, blood pressure differs when measured inside versus outside of the clinic setting. The proposed study will determine whether self-measured blood pressure by a person in their home, a procedure called home blood pressure monitoring, is useful for identifying older adults taking antihypertensive medication who are at increased risk for falls.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2019 - 2023

Kaiser Permanente Real-world Heart Monitoring StrategY Evaluation, Treatment Patterns and Health Metrics (RHYTHM) Study

The overall goal of this study is to characterize the clinical utility of ZIO® Patch monitoring vs. other monitoring strategies by linking ZIO® Patch data on arrhythmia burden and timing to detailed clinical information.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

iRhythm Technologies, Inc.

Funding Years:

2015 - 2017

Research Categories:

Management of direct oral anticoagulants to lower adverse events in atrial fibrillation (MODL-AF)

The overall objective of this project is to identify the direct oral anticoagulant care model(s) that maximize(s) (1) safety (major bleeding), (2) effectiveness (stroke), and (3) cost.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Agency for Healthcare Research and Quality (AHRQ)

Funding Years:

2018 - 2021

Research Categories:

Moderate Hypertension in Pregnancy: Safety and Effectiveness of Treatment

Evaluating the effect of treating mild-to-moderate hypertension in pregnancy, compare the risks of clinically important outcomes with different medications, and determine whether the benefits and risks vary by maternal race/ethnicity or obesity status.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Institute of Child Health and Human Development (NICHD)

Funding Years:

2015 - 2020

Multimorbidity and Treatment-Related Outcomes in Older Heart Failure Patients

Heart failure (HF) is the most common reason for hospitalization in older adults. Over 85% of all patients hospitalized with HF are 65 years of age or older. Multimorbidity, usually defined as the presence of two or more chronic conditions, greatly increases the risk of hospitalization and mortality among older HF patients. In addition, the presence of multiple chronic conditions can greatly complicate the management of HF, especially with regard to pharmacotherapeutic decision-making. The overall goal of this study is to evaluate the effectiveness and safety of common treatments for patients with HF and multimorbidity—individuals who have been traditionally excluded from clinical trials.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Institute on Aging (NIA)

Funding Years:

2019 - 2023

Optimizing Atrial Fibrillation Management in Chronic Kidney Disease

Atrial fibrillation affects ~25% of patients with kidney disease and is associated with poor clinical outcomes. It remains unknown whether standard therapies for atrial fibrillation are effective and safe in patients with chronic kidney disease. The overall goal of this proposal to study the receipt, safety and efficacy of medications and procedures used in the treatment of atrial fibrillation in patients with kidney disease.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2019 - 2023

Optimizing Risk Stratification and Comparative Effectiveness Research for Atrial Fibrilliation

The major goals of this project was to develop a collaboration of population-based researchers as well as a research platform using a contemporary cohort of about 40,000 adults with atrial fibrillation to improve comparative effectiveness studies, risk stratification of outcomes and the planning and conduct of future observational studies and randomized trials for atrial fibrillation.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Funding Years:

2009 - 2012

Population-based diabetes in youth registry: SEARCH for Diabetes in Youth, Phase 4, California Site

The aims of this study are (1) to ascertain prevalent diabetes cases in calendar year 2017 among youth age <20 years at diagnosis, using cost-efficient approaches that maximize use of information in the electronic health records (EHRs) and administrative databases, (2) to continue to ascertain newly diagnosed (incident 2015-2020) diabetes cases in youth age <20 years, using cost-efficient approaches that maximize use of EHRs and administrative databases, (3) to determine agreement between the etiological classification of diabetes type using biochemical markers and provider assessment; to describe selected clinical characteristics at diagnosis, and to establish an infrastructure that facilitates the development of more detailed ancillary studies by storing biological samples and preserving contact with potential study participants, and (4) To optimize efficiency of SEARCH surveillance activities through targeted Development and Validation (D&V) Projects designed to utilize electronic health data to operationalize each of the three tiers of surveillance to the extent possible. (1U18 DP006133)

Principal Investigator:

Jean M. Lawrence, ScD, MPH, MSSA

Funding Source:

Centers for Disease Control and Prevention (CDC)

Funding Years:

2015 - 2021

RBC Heart Pragmatic Clinical Trial

The objective of the trial is to evaluate the effectiveness of systematic testing and treatment of reduced iron stores vs. usual care on the risk of hospitalization in older patients with heart failure and previously unexplained anemia. The goal of the pilot study is to determine the feasibility of conducting the full trial.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

National Institute on Aging (NIA)

Funding Years:

2018 - 2019

Research Categories:

Risk of Severe Morbidity and Mortality of Coronavirus Disease 2019 (COVID-19) Among Patients Taking Antihypertensive Medications

The primary objective of this study is to determine the risk of COVID-19 infection and severe morbidity and mortality of COVID-19 among patients with taking ACE inhibitors or ARBs compared with patients taking other classes of medications among patients with hypertension. We will also determine patient and clinical characteristics associated with severe COVID-19.

Principal Investigator:

Jaejin An, PhD

Funding Source:

American Heart Association

Funding Years:

2020 - 2021

Research Categories:

,

Risk Trajectory of Comorbidities Across Natural History of Diabetes

The goal of this study is to examine the long-term development of complications over the course of type 2 diabetes and estimate the incidence of complications including cardiovascular disease, chronic kidney disease, end-stage renal disease, neuropathy, diabetic retinopathy to inform strategies to reduce the burden of type 2 diabetes complications.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Merck & Co., Inc.

Funding Years:

2018 - 2020

SEARCH for Diabetes in Youth Cohort (Follow-Up) Study

Site Principal Investigator:

Jean M. Lawrence, ScD, MPH, MSSA

Funding Source:

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Funding Years:

2015 - 2020

Statin Utilization in Patients with Critical Limb Ischemia

The major goal of this project is to assemble and characterize an analytic cohort of Kaiser Permanente Southern California members with incident critical limb ischemia (CLI) and to determine the rate of statin utilization and statin intensity among patients with CLI over time.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Amgen, Inc

Funding Years:

2016

Research Categories:

Stress (Early Childhood and Politically-related) and Health

The overall goal of this study is to determine the association of elections with the incidence of cardiovascular events and deaths from acute cardiovascular causes.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

W.K. Kellogg Foundation (WKKF)

Funding Years:

2019 - 2020

Research Categories:

The ACA Impact on Hypertension Treatment and Control

The major goal of this project is to describe the characteristics of newly enrolled versus established members following implementation or the Affordable Care Act and to examine hypertension prevalence and control rates among new and established members in the Kaiser Permanente Southern California region prior to and following the Affordable Care Act.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Southern California Permanente Medical Group (SCPMG)

Funding Years:

2016 - 2017

Research Categories:

The Comparative effectiveness of Warfarin and New Oral Anticoagulants for the Extended Treatment of Venous Thromboembolism

The overall goal of this project is to provide information on the benefits and harms comparing different treatment options for the extended treatment of VTE, information that can be used by clinicians and patients in deciding on the optimal treatment strategy.
COVID-19-Related Project Enhancement
Recent studies have reported that COVID-19 is associated with abnormal coagulation profiles and may predispose patients to VTE and other types of thrombotic events. The goals of this study are to determine the risk of VTE following COVID-19 hospitalization and whether the risk of post-hospitalization VTE varies by age, prior history of VTE or severity of COVID-19.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Patient-Centered Outcomes Research Institute (PCORI)

Funding Years:

2016 - 2021

The Economic Benefits of Triglyceride Lowering Among Patients with Diabetes and Severe Hypertriglyceridemia

The overall goal of this non-interventional study is to analyze the economic impact of triglyceride lowering and to determine whether this differs among patients who did and did not receive therapy to intentionally lower triglycerides.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

AstraZeneca

Funding Years:

2015 - 2016

Research Categories:

,

The Health Care Burden of Moderately Elevated Triglycerides

The overall goals of this project are to describe the demographic and clinical characteristics of patients with moderately elevated triglycerides and to calculate the burden of disease in this cohort.

Site Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Amarin Corporation

Funding Years:

2016 - 2018

Research Categories:

Trends in Incidence of Hospitalized Acute Myocardial Infarction

The major goal of this project is to examine recent trends in incidence of hospitalized myocardial infarction among members in the Kaiser Permanente Southern California region aged 35 years and older. “
” “COVID-19-Related Project Enhancement
” National surveillance data from the U.S. Centers for Disease Control and Prevention suggest a decline in emergency department visits during the Covid-19 pandemic. The goal of this study is to understand the impact of the stay-at-home orders on health care utilization and delays in care for acute myocardial infarction during the Covid-19 pandemic.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Southern California Permanente Medical Group (SCPMG)

Funding Years:

2015 - 2021

Research Categories:

,

Understanding Screening and Statin Utilization Rates for Patients at Risk for Cardiovascular Disease for Kaiser Permanente Southern California (KPSC)

The overall objective of this study is to examine trends and patterns of lipid screening and statin utilization from 2009 to 2015.

Principal Investigator:

Kristi Reynolds, PhD, MPH

Funding Source:

Regeneron Pharmaceuticals, Inc.

Funding Years:

2015 - 2017

Research Categories: