{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:03:05Z","timestamp":1762430585996},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2012,1,17]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Noninvasive stress testing might guide the use of aspirin and statins for primary prevention of coronary heart disease, but it is unclear if such a strategy would be cost effective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>We compared the status quo, in which the current national use of aspirin and statins was simulated, with 3 other strategies: (1) full implementation of Adult Treatment Panel III guidelines, (2) a treat-all strategy in which all intermediate-risk persons received statins (men and women) and aspirin (men only), and (3) a test-and-treat strategy in which all persons with an intermediate risk of coronary heart disease underwent stress testing and those with a positive test were treated with high-intensity statins (men and women) and aspirin (men only). Healthcare costs, coronary heart disease events, and quality-adjusted life years from 2011 to 2040 were projected. Under a variety of assumptions, the treat-all strategy was the most effective and least expensive strategy. Stress electrocardiography was more effective and less expensive than other test-and-treat strategies, but it was less expensive than treat all only if statin cost exceeded $3.16\/pill or if testing increased adherence from &lt;22% to &gt;75%. However, stress electrocardiography could be cost effective in persons initially nonadherent to the treat-all strategy if it raised their adherence to 5% and cost saving if it raised their adherence to 13%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>When generic high-potency statins are available, noninvasive cardiac stress testing to target preventive medications is not cost effective unless it substantially improves adherence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.111.041293","type":"journal-article","created":{"date-parts":[[2011,12,6]],"date-time":"2011-12-06T05:37:34Z","timestamp":1323149854000},"page":"260-270","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Using Stress Testing to Guide Primary Prevention of Coronary Heart Disease Among Intermediate-Risk Patients"],"prefix":"10.1161","volume":"125","author":[{"given":"Benjamin Z.","family":"Galper","sequence":"first","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); Department..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Moran","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); Department..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela G.","family":"Coxson","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); Department..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark J.","family":"Pletcher","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); Department..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); Department..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence D.","family":"Lazar","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); Department..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Rodondi","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.Z.G.); Division of General Internal Medicine, Columbia University Medsical Center (A.M.), and Mailman School of Public Health (Y.C.W.), Columbia University, New York, NY; Department of Medicine, University of California at San Francisco (P.G.C., M.J.P.); VA Palo Alto Health Care System, Palo Alto, CA (P.H.); Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (L.D.L.); 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