title: Regional variations in ambulatory care and incidence of cardiovascular events.
abstract: BACKGROUND
  Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates.
  
  
  METHODS
  We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province's 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates.
  
  
  RESULTS
  Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of low-rate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits,pvalue for LHIN-level trend = 0.01) and were screened for risk factors more often. Low-rate LHINs were also more likely to achieve treatment targets for hypercholes-terolemia (51.8% v. 49.6% of patients,p= 0.03) and controlled hypertension (67.4% v. 53.3%,p= 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone.
  
  
  CONCLUSIONS
  Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes.
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont. tu@ices.on.ca.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Anna
authors.initials: A
authors.lastname: Chu
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Laura
authors.initials: L
authors.lastname: Maclagan
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Sharon
authors.initials: S
authors.lastname: Johnston
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Cheung
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Booth
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: R Sacha
authors.initials: RS
authors.lastname: Bhatia
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Udell
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: Prosanta
authors.initials: P
authors.lastname: Mondal
authors.affiliation: Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyère Research Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St. Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research Institute (Manuel), Ottawa, Ont.
authors.forename: William
authors.initials: W
authors.lastname: Hogg
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003710:Demography; D003920:Diabetes Mellitus / Q000188:drug therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006903:Hydroxymethylglutaryl CoA Reductases / Q000627:therapeutic use; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006903:Hydroxymethylglutaryl CoA Reductases