Development and Validation of the American Heart Association's PREVENT Equations

doi:10.1161/CIRCULATIONAHA.123.067626

. 2024 Feb 6;149(6):430-449.

doi: 10.1161/CIRCULATIONAHA.123.067626. Epub 2023 Nov 10.

Development and Validation of the American Heart Association's PREVENT Equations

Sadiya S Khan¹, Kunihiro Matsushita², Yingying Sang^{2

3}, Shoshana H Ballew^{2

3}, Morgan E Grams⁴, Aditya Surapaneni⁴, Michael J Blaha⁵, April P Carson⁶, Alexander R Chang⁷, Elizabeth Ciemins⁸, Alan S Go⁹, Orlando M Gutierrez¹⁰, Shih-Jen Hwang¹¹, Simerjot K Jassal¹², Csaba P Kovesdy¹³, Donald M Lloyd-Jones¹⁴, Michael G Shlipak¹⁵, Latha P Palaniappan¹⁶, Laurence Sperling¹⁷, Salim S Virani¹⁸, Katherine Tuttle¹⁹, Ian J Neeland²⁰, Sheryl L Chow²¹, Janani Rangaswami²², Michael J Pencina²³, Chiadi E Ndumele²⁴, Josef Coresh^{2

3}; Chronic Kidney Disease Prognosis Consortium and the American Heart Association Cardiovascular-Kidney-Metabolic Science Advisory Group

Affiliations

¹ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K.).
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., J.C.).
³ Department of Population Health, New York University Grossman School of Medicine, New York, NY (Y.S., S.H.B., J.C.).
⁴ Department of Medicine, Division of Precision Medicine, New York University Grossman School of Medicine, New York, NY (M.E.G., A.S.).
⁵ Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B.).
⁶ University of Mississippi Medical Center, Jackson (A.P.C.).
⁷ Departments of Nephrology and Population Health Sciences, Geisinger Health, Danville, PA (A.R.C.).
⁸ AMGA (American Medical Group Association), Alexandria, VA (E.C.).
⁹ Division of Research, Kaiser Permanente Northern California, Oakland; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco; Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto, CA (A.S,G.).
¹⁰ Departments of Epidemiology and Medicine, University of Alabama at Birmingham (O.M.G.).
¹¹ National Heart, Lung, and Blood Institute, Framingham, MA (S.-J.H.).
¹² Division of General Internal Medicine, University of California, San Diego and VA San Diego Healthcare, CA (S.K.J.).
¹³ Medicine-Nephrology, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (C.P.K.).
¹⁴ Department of Preventive Medicine, Northwestern University, Chicago, IL (D.M.L.-J.).
¹⁵ Department of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, and San Francisco VA Medical Center (M.G.S.).
¹⁶ Center for Asian Health Research and Education and the Department of Medicine, Stanford University School of Medicine, CA (L.P.P.).
¹⁷ Department of Cardiology, Emory University, Atlanta, GA (L.S.).
¹⁸ Department of Medicine, The Aga Khan University, Karachi, Pakistan; Texas Heart Institute and Baylor College of Medicine, Houston (S.S.V.).
¹⁹ Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA; Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Seattle (K.T.).
²⁰ UH Center for Cardiovascular Prevention, Translational Science Unit, Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH (I.J.N.).
²¹ Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (S.L.C.).
²² Washington DC VA Medical Center and George Washington University School of Medicine (J.R.).
²³ Department of Biostatistics, Duke University Medical Center, Durham, NC (M.J.P.).
²⁴ Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.E.N.).

PMID: 37947085
PMCID: PMC10910659 (available on 2025-02-06)
DOI: 10.1161/CIRCULATIONAHA.123.067626

Development and Validation of the American Heart Association's PREVENT Equations

Sadiya S Khan et al. Circulation. 2024.

. 2024 Feb 6;149(6):430-449.

doi: 10.1161/CIRCULATIONAHA.123.067626. Epub 2023 Nov 10.

Authors

Affiliations

¹ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K.).
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., J.C.).
³ Department of Population Health, New York University Grossman School of Medicine, New York, NY (Y.S., S.H.B., J.C.).
⁴ Department of Medicine, Division of Precision Medicine, New York University Grossman School of Medicine, New York, NY (M.E.G., A.S.).
⁵ Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M.J.B.).
⁶ University of Mississippi Medical Center, Jackson (A.P.C.).
⁷ Departments of Nephrology and Population Health Sciences, Geisinger Health, Danville, PA (A.R.C.).
⁸ AMGA (American Medical Group Association), Alexandria, VA (E.C.).
⁹ Division of Research, Kaiser Permanente Northern California, Oakland; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco; Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto, CA (A.S,G.).
¹⁰ Departments of Epidemiology and Medicine, University of Alabama at Birmingham (O.M.G.).
¹¹ National Heart, Lung, and Blood Institute, Framingham, MA (S.-J.H.).
¹² Division of General Internal Medicine, University of California, San Diego and VA San Diego Healthcare, CA (S.K.J.).
¹³ Medicine-Nephrology, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (C.P.K.).
¹⁴ Department of Preventive Medicine, Northwestern University, Chicago, IL (D.M.L.-J.).
¹⁵ Department of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, and San Francisco VA Medical Center (M.G.S.).
¹⁶ Center for Asian Health Research and Education and the Department of Medicine, Stanford University School of Medicine, CA (L.P.P.).
¹⁷ Department of Cardiology, Emory University, Atlanta, GA (L.S.).
¹⁸ Department of Medicine, The Aga Khan University, Karachi, Pakistan; Texas Heart Institute and Baylor College of Medicine, Houston (S.S.V.).
¹⁹ Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA; Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Seattle (K.T.).
²⁰ UH Center for Cardiovascular Prevention, Translational Science Unit, Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH (I.J.N.).
²¹ Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (S.L.C.).
²² Washington DC VA Medical Center and George Washington University School of Medicine (J.R.).
²³ Department of Biostatistics, Duke University Medical Center, Durham, NC (M.J.P.).
²⁴ Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.E.N.).

PMID: 37947085
PMCID: PMC10910659 (available on 2025-02-06)
DOI: 10.1161/CIRCULATIONAHA.123.067626

Erratum in

Correction to: Development and Validation of the American Heart Association's PREVENT Equations.
[No authors listed] [No authors listed] Circulation. 2024 Mar 12;149(11):e956. doi: 10.1161/CIR.0000000000001230. Epub 2024 Mar 11. Circulation. 2024. PMID: 38466792 No abstract available.

Abstract

Background: Multivariable equations are recommended by primary prevention guidelines to assess absolute risk of cardiovascular disease (CVD). However, current equations have several limitations. Therefore, we developed and validated the American Heart Association Predicting Risk of CVD EVENTs (PREVENT) equations among US adults 30 to 79 years of age without known CVD.

Methods: The derivation sample included individual-level participant data from 25 data sets (N=3 281 919) between 1992 and 2017. The primary outcome was CVD (atherosclerotic CVD and heart failure). Predictors included traditional risk factors (smoking status, systolic blood pressure, cholesterol, antihypertensive or statin use, and diabetes) and estimated glomerular filtration rate. Models were sex-specific, race-free, developed on the age scale, and adjusted for competing risk of non-CVD death. Analyses were conducted in each data set and meta-analyzed. Discrimination was assessed using the Harrell C-statistic. Calibration was calculated as the slope of the observed versus predicted risk by decile. Additional equations to predict each CVD subtype (atherosclerotic CVD and heart failure) and include optional predictors (urine albumin-to-creatinine ratio and hemoglobin A1c), and social deprivation index were also developed. External validation was performed in 3 330 085 participants from 21 additional data sets.

Results: Among 6 612 004 adults included, mean±SD age was 53±12 years, and 56% were women. Over a mean±SD follow-up of 4.8±3.1 years, there were 211 515 incident total CVD events. The median C-statistics in external validation for CVD were 0.794 (interquartile interval, 0.763-0.809) in female and 0.757 (0.727-0.778) in male participants. The calibration slopes were 1.03 (interquartile interval, 0.81-1.16) and 0.94 (0.81-1.13) among female and male participants, respectively. Similar estimates for discrimination and calibration were observed for atherosclerotic CVD- and heart failure-specific models. The improvement in discrimination was small but statistically significant when urine albumin-to-creatinine ratio, hemoglobin A1c, and social deprivation index were added together to the base model to total CVD (ΔC-statistic [interquartile interval] 0.004 [0.004-0.005] and 0.005 [0.004-0.007] among female and male participants, respectively). Calibration improved significantly when the urine albumin-to-creatinine ratio was added to the base model among those with marked albuminuria (>300 mg/g; 1.05 [0.84-1.20] versus 1.39 [1.14-1.65]; P=0.01).

Conclusions: PREVENT equations accurately and precisely predicted risk for incident CVD and CVD subtypes in a large, diverse, and contemporary sample of US adults by using routinely available clinical variables.

Keywords: cardiovascular diseases; heart failure; kidney diseases; models, cardiovascular; risk assessment; social determinants of health.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr Coresh reports grants from the National Institutes of Health (NIH) and from the National Kidney Foundation during the conduct of the study and personal fees and other support from Healthy.io outside the submitted work. Dr Khan reports grants from NIH during the conduct of the study (R21 HL165376). Dr Chang reports consulting fees from Novartis, Reata, and Amgen, and grants from Novartis, Novo Nordisk, NIH, and the National Kidney Foundation. Dr Palaniappan reports grants from NIH during the conduct of the study (K24 HL150476). Dr Tuttle reports unpaid support from the American Heart Association and grant support from NIH (01MD014712, OT2OD032581, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, and UM1AI109568); the Centers for Disease Control and Prevention (75D301-21-P-12254), as well as Bayer and Travere, paid to the institution; consulting fees from Eli Lilly, Boehringer Ingelheim, AstraZeneca, Goldfinch Bio, Novo Nordisk, Bayer, and Travere Therapeutics Inc; honoraria from Eli Lilly, AstraZeneca, Novo Nordisk, and Bayer; unpaid participation as a Data Safety and Monitoring Board chair for National Institute of Diabetes and Digestive and Kidney diseases (NIDDK)/NIH and George Clinical Institute; and unpaid participation as a Diabetic Kidney Disease collaborative chair for the American Society of Nephrology. Dr Neeland reports speaker and consulting fees from Boehringer Ingelheim, Eli Lilly and Co, Nestle Health Science, and Bayer Pharmaceuticals. Dr Virani reports grants from NIH, US Department of Veterans Affairs, Tahir and Jooma Family. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services. All other coauthors have nothing to disclose.

Cited by

Big Data, Big Insights: Leveraging Data Analytics to Unravel Cardiovascular Exposome Complexities.
Ibrahim R, Pham HN, Nasir K, Hahad O, Sabharwal A, Al-Kindi S. Ibrahim R, et al. Methodist Debakey Cardiovasc J. 2024 Nov 5;20(5):111-123. doi: 10.14797/mdcvj.1467. eCollection 2024. Methodist Debakey Cardiovasc J. 2024. PMID: 39525379 Free PMC article. Review.
Waist-to-hip ratio as a contributor associated with higher atherosclerotic cardiovascular disease risk assessment in patients with diabetes: a cross-sectional study.
Rafsanjani K, Rabizadeh S, Ebrahimiantabrizi A, Asadibideshki Z, Yadegar A, Esteghamati A, Nakhjavani M, Reyhan SK. Rafsanjani K, et al. BMC Cardiovasc Disord. 2024 Nov 1;24(1):613. doi: 10.1186/s12872-024-04297-w. BMC Cardiovasc Disord. 2024. PMID: 39487436 Free PMC article.
The complete blood count and cardiovascular disease: analyses across six cohorts of 23,370 adults.
Goonewardena SN, Murthy VL. Goonewardena SN, et al. medRxiv [Preprint]. 2024 Oct 18:2024.10.17.24315694. doi: 10.1101/2024.10.17.24315694. medRxiv. 2024. PMID: 39484272 Free PMC article. Preprint.
Risk-enhancing factors and social determinants of health in risk assessment for atherosclerotic cardiovascular disease.
Zhang Y, An J, Xia M, Zhou H, Sun Y, Chung J, Zhou M, Choi SK, Morrissette KL, Muntner P, Safford MM, Isasi CR, Kanaya AM, Bellows BK, Colantonio LD, Reynolds K, Moran AE. Zhang Y, et al. PLoS One. 2024 Oct 25;19(10):e0312756. doi: 10.1371/journal.pone.0312756. eCollection 2024. PLoS One. 2024. PMID: 39453943 Free PMC article.
Longitudinal Changes in Lifestyle Behaviors and Cardiovascular Health During the Transition to Fatherhood: The Dad Bod Study Rationale and Design.
Landry MJ, Pineda JP, Lee JM, Hoyt MA, Edwards KL, Lindsay KL, Gardner CD, Wong ND. Landry MJ, et al. medRxiv [Preprint]. 2024 Sep 27:2024.09.26.24314459. doi: 10.1101/2024.09.26.24314459. medRxiv. 2024. PMID: 39399051 Free PMC article. Preprint.

See all "Cited by" articles

References

1. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Munoz D, Smith SC Jr, Virani SS, Williams KA Sr., Yeboah J and Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646. - PMC - PubMed
1. Goff DC Jr., Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr., Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr. and Tomaselli GF. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–73. - PubMed
1. Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr., Sperling LS, Virani SS and Blumenthal RS. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. Circulation. 2019;139:e1162–e1177. - PubMed
1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS and Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082–e1143. - PMC - PubMed
1. Lloyd-Jones DM. Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation. 2010;121:1768–77. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
- Atypon
- Ovid Technologies, Inc.
Medical
- MedlinePlus Health Information

[1] Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Munoz D, Smith SC Jr, Virani SS, Williams KA Sr., Yeboah J and Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646. - PMC - PubMed

[2] Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Munoz D, Smith SC Jr, Virani SS, Williams KA Sr., Yeboah J and Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646. - PMC - PubMed

[3] Goff DC Jr., Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr., Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr. and Tomaselli GF. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–73. - PubMed

[4] Goff DC Jr., Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr., Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr. and Tomaselli GF. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–73. - PubMed

[5] Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr., Sperling LS, Virani SS and Blumenthal RS. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. Circulation. 2019;139:e1162–e1177. - PubMed

[6] Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr., Sperling LS, Virani SS and Blumenthal RS. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. Circulation. 2019;139:e1162–e1177. - PubMed

[7] Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS and Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082–e1143. - PMC - PubMed

[8] Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS and Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082–e1143. - PMC - PubMed

[9] Lloyd-Jones DM. Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation. 2010;121:1768–77. - PubMed

[10] Lloyd-Jones DM. Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation. 2010;121:1768–77. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Development and Validation of the American Heart Association's PREVENT Equations

Affiliations

Development and Validation of the American Heart Association's PREVENT Equations

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Erratum in

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Medical