BACKGROUND:COVID-19 profoundly impacted First Nation peoples. Historically, records of on- and off-reserve vaccine delivery have been fragmented. For the first time in Canada, we aimed to describe complete immunization rates, on- and off-reserve vaccine delivery, for COVID-19 in Alberta, Canada among First Nations on-reserve. METHODS:Fifteen First Nations in Alberta, Canada participated in this prospective, descriptive cohort study whereby real-time integration (RTI) was deployed to reconcile COVID-19 vaccine delivery records on-reserve (local database) to those reported off-reserve (provincial database) between January 3, 2021-December 1, 2022. Immunization data (individuals ≥ 6 months) were aggregated into 100 one-week intervals. Weekly immunization rates were assessed by age, sex, community size, and location of vaccine administration (on- or off-reserve) using multiple linear regressions and chi2 tests. FINDINGS:50,758 First Nation people were included, approximately 50% of whom were female. RTI data showed that 64% received at least one dose of vaccine with higher rates in older First Nation adults. No sex differences were observed. Nearly half received their first dose off-reserve and would have been missed by local public health on-reserve (local database) without the implementation of RTI. First dose immunization rates rapidly increased with graduated First Nation-specific eligibility and provincial incentives promoting uptake (p < 0.001). INTERPRETATION:We accurately assessed complete immunization rates among First Nation people receiving services on-reserve irrespective of delivery of immunizations on- or off-reserve through deployment of an innovative RTI approach. Without these RTI advances, immunization rates would have been substantially under-reported and may have misdirected public health initiatives around vaccine uptake. RTI should be a priority for all provinces in Canada to ensure accurate coverage rates for First Nation people.

Background:COVID-19 differentially impacted First Nations people due to pre-existing social, racial, and systemic inequities. This study explores life expectancy of First Nations people and the perspectives of First Nations health staff on the observed trends in life expectancy during the pandemic in Alberta, Canada. Methods:All First Nations people in Alberta from a First Nations-identifying dataset (1999-2022) were included in this descriptive study (n = 164,964 in 2017, 49.7% male, 50.3% female, mean age 29.4 years [standard deviation 1.46; range 26.9-31.9 years]). In partnership with First Nations health managers, knowledge users, and using appropriate methods for First Nations people, we examined how the pandemic affected life expectancy in First Nations vs non-First Nations people. First Nations health managers were asked their opinions on observed trends in mortality during the pandemic through individual conversations. Findings:Since 1999, First Nations people consistently had lower life expectancies compared to non-First Nations. In 2019-2021, life expectancy dropped 7.3 years (70.4 [95% confidence interval (CI) 69.48-71.24] to 63.1 [CI 62.28-64.02]) for First Nations people vs 1.4 years (82.8 [CI 82.65-82.92] to 81.4 [CI 81.22-81.51]) for non-First Nations people. Mortality was highest in young adult First Nations females relative to non-First Nations females (∼11-fold increase) during COVID-19. First Nations people had lower life expectancy across most age categories. The 20-50 year age groups had some of the highest relative mortality rates. Health managers observed similar life expectancy trends, perceiving that the pandemic exacerbated existing issues, including delayed access to care, poisonings (i.e., accidental or intentional overdoses), and pre-existing health conditions. Interpretation:First Nations people in Alberta had a substantial drop in life expectancy during the pandemic compared to non-First Nations people. From the perspective of First Nations health managers, the pandemic indirectly exacerbated existing social and health issues, possibly contributing to the trend in life expectancy. Significant initiatives and resources will need to be deployed to assist First Nations communities to close these gaps. Funding:Canadian Institutes of Health research (#PJT-178219).

Early identification of dyslipidemia in children and youth allows for the prevention of cardiovascular diseases (CVD). Emerging evidence in adults suggests that nonfasting remnant cholesterol (RC) is a significant independent risk factor for CVD. Understanding the applicability of nonfasting RC in youth and children may provide greater options for routine and early identification of CVD risk. The purpose of this review is to provide an overview of guidelines for assessing dyslipidemia in practice and to explore whether nonfasting lipid biomarkers and/or RC have been incorporated for children and youth. The Medline database was used to identify clinical practice guidelines published between 2011 and August 2025 in English for children and/or youth aged 2-20 years. Of an initial 2537 citations, 41 met the inclusion criteria for data extraction. Although there is controversy regarding assessing fasting or nonfasting biomarkers in youth, definitions of normal ranges of lipoproteins were less controversial and are typically defined based on the National Heart, Lung, and Blood Institute recommendations. Most guidelines recommend measuring fasting lipid biomarkers (especially low-density lipoprotein cholesterol) in youth. In contrast, a select number of guidelines and statements recommend assessing nonfasting non-high-density lipoprotein cholesterol as the priority. Currently, no guidelines discuss measuring RC in youth. Evidence suggests that nonfasting non-high-density lipoprotein cholesterol is a reliable, practical biomarker for lipid screening in children and youth; however, most guidelines still suggest fasting measurement of low-density lipoprotein cholesterol. We note that nonfasting RC is an important knowledge gap not addressed in the current guidelines, and increasing awareness of nonfasting RC may be valuable.

Objectives The purpose of this study was to assess changes in diabetes management and healthcare utilisation among First Nations with diabetes in Alberta before and during the COVID-19 pandemic.Design This analysis used a retrospective cohort in a case–control design. Individual-level administrative health datasets (1 April 2018 to 31 March 2022) were linked and data were formatted as a segmented interrupted time series.Setting This study took place in Alberta, Canada using administrative data.Participants Adult First Nations and non-First Nations (matched 1:1) with diabetes and living in Alberta were included (n=28 101; 53% female, 47% male).Primary and secondary outcome measures The primary outcome was the change in incidence rate of general practitioner (GP) visits, emergency department (ED) visits, hospitalisations and diabetes-related drug dispenses during-COVID-19 versus pre-COVID-19, quantified using generalised linear regressions. The secondary outcome was to report the reasons for non-drug outcomes pre-COVID-19 and during-COVID-19, based on primary diagnosis International Statistical Classification of Diseases and Related Health Problems codes.Results Pre-COVID-19, baseline rates of GP visits, ED visits, hospitalisations and drug dispenses were significantly higher among First Nations compared with non-First Nations (rate differences 398.32 (391.97–404.67), 100.58 (98.32–102.84), 14.49 (13.56–15.43), 876.98 (868.72–885.24) per 100 person-years (PY); p<0.0001). This corresponds to rates greater by 33%, 78%, 62% and 45%, respectively (p<0.0001). These disparities generally became greater during COVID-19 (rate differences 437.21 (430.83–443.59), 91.29 (89.28–93.31), 16.90 (16.00–17.80), 1066.55 (1057.74–1075.37) per 100 PY; p<0.0001) and rates higher by 36%, 95%, 86% and 49%, respectively (p<0.0001). Among First Nations during COVID-19, the rate of ED visits and hospitalisations decreased from baseline by 17% and 2%; the rate of GP visits and drug dispenses increased by 0.54% and 15%. Non-First Nations experienced greater comparative drops in GP visits, ED visits and hospitalisations, and a smaller increase in drug dispenses. There were no discernible patterns regarding the secondary outcome.Conclusions Healthcare utilisation was substantially elevated among First Nations compared with non-First Nations peoples before and during COVID-19. While the generalisability of our findings to other health systems and populations may be limited, our findings are clinically applicable among First Nations across Alberta in order to help direct public health programming post-COVID-19.

Introduction:Unhealthy diet and dyslipidemia are major risk factors for cardiovascular disease (CVD). Studies have shown an inverse association between greater n-3 fatty acid (FA) intake and reduced dyslipidemia and CVD risk. We aimed to assess the association of the healthy eating index (HEI) score and n-3 FA intake with CVD incidence and non-fasting RC in the Alberta's Tomorrow Project (ATP) cohort. Methods:This is a prospective study on a subset of ATP study participants (n = 23,248), with the mean age of 50.2 (35-69) years, 36% male and 64% female, and no history of cancer or CVD in Alberta, Canada. Dietary intake was assessed using the Canadian Diet History Questionnaire (CDHQ), from which the Canadian HEI-2005 score and total n-3 FA intake were calculated. Lipid panel markers were measured from non-fasting blood samples, and CVD was defined using the International Statistical Classification of Diseases and Related Health Problems from linked administrative health records. The Cox proportional hazard model, linear regression, and logistic regression were used to assess the association of dietary intakes with CVD incidence, and lipid biomarkers. Results:The mean follow-up was 13.9 years. For every 1 unit increase in the HEI score, the adjusted Hazard Ratio (HR) of developing CVD decreased [HR: 0.98 (95% confidence interval (CI) 0.97-0.98), 0.99 (95%CI 0.98-0.99), and 0.97 (95%CI 0.97-0.98) in females, males, and total cohort, respectively (p < 0.05)]. No significant association was found between absolute n-3 FA intake (g/d) with CVD incidence. However, higher relative intake (i.e., n-3 FA as proportion of energy) increased the risk of developing CVD [HR = 1.42 (95%CI 1.1-1.84), p = 0.006] in males. Adjusted multivariate regression in a subset (n = 8,458) showed no association between n-3 FA (g/d) intake and lipid biomarkers but a significant inverse association between HEI score and non-fasting RC [coefficient: -0.006 (95%CI -0.009--0.003) for females and -0.01 (95%CI -0.018--0.005) for males], and TG levels [-0.01 (95%CI -0.015--0.006) for females and -0.01 (95%CI -0.02--0.006) for males]. Discussion:Higher overall diet quality but not n-3 FA intake was associated with a lower risk of CVD incidence and non-fasting RC.

Background: Certain patients with diabetes and COVID-19 are at high risk of severe outcomes. Identification of risk factors among this group is required to risk-stratify those who may benefit from further surveillance. We aimed to develop machine learning (ML) models predicting severe outcomes among individuals with diabetes and COVID-19 in Alberta, Canada. Methods: Patients with diabetes and COVID-19 determined by PCR test administered in community and/or emergency department (ED) settings (March 2020-March 2021) were included. Outcomes were ED visit, hospitalization or death for those tested in the community (“Community cohort”) and hospitalization or death for those tested in ED (“ED cohort”), and in the combined cohorts (“Community+ED cohort”). Outcomes and features (sociodemographics, drug/healthcare utilization, health history) were identified using healthcare administrative data (2008-2021). Calibration plots, areas under the receiver operating curve, precision-recall curves (AUC, AUPRC), and threshold analyses were used to assess the models. Results: The Community cohort included 11,247 individuals (1,665 ED visits; 756 hospitalizations; 421 deaths). AUCs for models predicting ED/hospitalization/death were 0.65/0.70/0.93. The AUCs for predicting death in ED (1,495 individuals; 169 deaths) and Community+ED (12,410 individuals; 582 deaths) cohorts were 0.82 and 0.93. Models predicting hospitalization in these cohorts performed poorly and are not reported. Of all models, that predicting death from the Community performed best (sensitivity 0.77, specificity 0.91, positive predictive value 0.26, negative predictive value 0.99), and improved the prediction of death at a 10% risk threshold (compared to the pre-test probability, positive likelihood ratio 9.06 and negative likelihood ratio 0.25). Conclusion: Identifying diabetes patients at the highest risk of the worst outcomes would assist in triaging patients to ensure appropriate resource use in times of high demand. Overall, the model predicting death among patients with diabetes and COVID-19 in the community could be useful in identifying who requires additional care.

OBJECTIVES:In this study our aim was to develop a machine learning model that could accurately predict the risk of acquiring COVID-19 in community-dwelling adults with type 1 and/or type 2 diabetes in Alberta, Canada. METHODS:This predictive supervised machine learning study included adults (≥18 years old) living in Alberta, Canada, between April 1, 2019, and March 31, 2021, with pre-existing diabetes (n=372,055, excluding 2,541 due to migration; final sample size 369,514). The outcome of interest was a positive severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) polymerase chain reaction test result between March 1, 2020, and March 1, 2021. Model features were extracted from routinely collected Alberta administrative health data from March 1, 2015, to March 1, 2020. Fifteen algorithms were trained on 67% of the data and the top performer (Light Gradient Boost [LGBoost] model) was validated on the remaining 33%. The model was calibrated and model performance was assessed using area under the receiver-operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), and threshold analyses. RESULTS:Among the 369,514 individuals with diabetes, 140,511 were tested, of whom 13,082 had a positive SARS-CoV-2 test. The LGBoost model incorporated 367 features with AUROC and AUPRC of 0.69 and 0.08, respectively. The model was well-calibrated for common risk thresholds (<0.2 probability) with high specificity (≥0.98 at all thresholds); however, sensitivity and positive predictive values were low at all thresholds (≤0.08 and ≤0.18, respectively). CONCLUSIONS:The LGBoost model lacked the sensitivity to be clinically useful in predicting SARS-CoV-2 infection in Albertans with diabetes. Alternative data sources may be required to improve future COVID-19 prediction models from the community.

Objectives Stimulants are a class of drugs approved for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. However, they are also often used “off-label” as adjunct therapies for the treatment of obesity and depression. The objective of this study is to summarize how stimulant use is globally measured in the literature and to explore rates of stimulant use in Alberta, Canada. Methods A traditional narrative literature review was conducted to summarize global methods of stimulant assessment. Then using definitions guided by the literature and current regulatory bodies in Alberta, we conducted a series of descriptive analyses to assess how frequent stimulant use was in Alberta patients from 2019-2021: 1) number of dispenses by year; 2) average days of drug supply; 3) proportion of days covered (PDC); and 4) defined daily dose (DDDs). Results In the literature review, the most frequently used measures of stimulant drug use were trends over time (prevalence), types of drug use, and dispensations of prescriptions. In all, there is a global trend of increased use of stimulants among both adults and children. In Alberta, 173,789 patients were prescribed stimulant medication in 2019-2021, representing approximately 4% of the entire Alberta population. Overall, 61.1% were between the ages of 10-34 and 46.8% were female. The number of dispensations rose from 713,896 in 2019 to 973,930 in 2021 – with up to 43% being lisdexamfetamine stimulant dispenses. Conclusions Although stimulant use in AB was measured using similar trend estimates as the literature, there is a lack of research to support whether these measures are accurate and effective at the population-level. Future steps to standardize both medical and nonmedical use of prescription stimulants are warranted in efforts to fully quantify both benefits and risks associated with stimulant use.

OBJECTIVE:Monitoring changes in oral morphine equivalents (OMEs) is an important parameter to understand how opioids are being used at the population level. However, changes in opioid doses and tapering have not been well defined. DESIGN:We conducted a population-based exploratory data analysis (EDA) to characterize changes in opioid doses and tapering of opioids among patients in Alberta (AB). A literature review was conducted to assess opioid tapering. SETTING:Using dispense data from 2020 to 2021 provided by the College of Physicians & Surgeons of Alberta (CPSA), we assessed changes in OME per day from baseline to the subsequent quarter. PATIENTS:Patients living in AB. INTERVENTIONS:N/A. MAIN OUTCOME MEASURES:The absolute and relative changes in OME per day were estimated for each assessment. Tapering was considered if an opioid user's OME per day changed from the baseline to zero in the subsequent quarter. The frequency and percentages of patients with different levels of changes in OME per day were summarized per quarter. RESULTS:There were 13 operational definitions of opioid tapering in the literature. Comparatively, our approach at the CPSA differed in the length of the follow-up assessment period. Based on our quarterly assessment of ~390,000 patients, all four periods showed 60 percent of patients had an opioid dose decrease/tapered therapy relative to baseline. However, 21 percent were noted to be new users of opioids. CONCLUSIONS:Based on our approach at the CPSA, 60 percent of patients tapered opioids over a year. Despite no standardized definition of opioid tapering, our EDA demonstrates one approach using population-based drug dispense data to evaluate opioid use.

PURPOSE:Reducing initial exposure of "opioid naïve" patients to opioids is a public health priority. Identifying opioid naïve patients is difficult, as numerous definitions are used. The objective is to summarize current definitions and evaluate their impact on opioid naïve measures in Alberta. METHODS:An exploratory data analysis of the literature was conducted over the last 10 years to identify definitions commonly used in the literature to define opioid naïve. Then, using these definitions as a guide, we descriptively report the proportion of patients in Alberta between 2017 and 2021 who would be considered as opioid naïve using these definitions and all opioid dispensing data. RESULTS:Three categories of definitions were broadly identified: (1) no opioid use within the previous 30 days/6 months/1 year, based on dispensation date; (2) no opioid use based on dispensation date plus days of supply; and, (3) exclusion of codeine from Definitions 1 and 2. Applying these definitions to the Alberta population showed a very wide range in the proportion who would be considered as opioid naïve. Overall, 36.4% of Albertans (n = 1 551 075) had an opioid dispensation in 2017-2021. The average age was 46.6 ± 18.8 and 52.8% were female. The proportion of opioid naïve were most affected by the "opioid free" period, with 97.4%, 83.2%, and 65.6% being classified as opioid naïve using time windows from Definition 1 (30 days, 6 months, 1 year of no prior opioid use). Definitions 2 and 3 did not materially change the results. Further extending the "opioid free" period to 2 years showed only 35% were opioid naïve. CONCLUSIONS:The most convenient definition for "opioid naïve" was the use of an "opioid free" period. The choice of window would depend on how the information may be used to assistant in clinical decisions with longer windows more likely to reflect true opioid naïve patients. Irrespective of definition used, a large proportion of opioid users would be considered opioid naïve in Alberta.

Aims: Non-fasting remnant cholesterol (RC) is a novel marker of cardiovascular disease (CVD) risk, however, data on this relationship in Canadians with diabetes (at high risk of CVD) is lacking. The objective of this analysis was to determine the relationship of RC with CVD in individuals with and without diabetes in the Alberta's Tomorrow Project (ATP) cohort. Methods: Non-fasting lipid data collected as part of the ATP was linked to administrative health records (October 2000-March 2015) to ascertain incident CVD and prevalent diabetes. Participants without prevalent CVD or incident diabetes and who had complete, non--negative non--fasting lipid data collected with triglycerides <4.5 mmol/L were included (n = 13,631). The relationship between non-fasting RC and incident CVD diagnoses was assessed by Cox proportional hazards regression, after stratification by diabetes status. Results: Participants were 69.8% women with a mean age of 61.6 +/- 9.7 years, and 6.5% had prevalent diabetes. Non-fasting RC was higher in participants with diabetes compared to those without (mean 0.94 +/- 0.41 mmol/L vs. 0.77 +/- 0.38 mmol/L, p < 0.0001) and was associated with increased risk of incident CVD among those without diabetes (adjusted hazard ratio (aHR) 1.22, 95% CI 1.03-1.43, p = 0.02). Although a similar trend was observed in participants with diabetes it did not reach statistical significance (aHR 1.31, 95% CI 0.84-2.05, p = 0.23). Conclusions: Elevated non-fasting RC predicted increased CVD risk in middle and older-aged adults without diabetes; similar trends were observed in participants with diabetes and require further testing in a larger sample.

Background: European studies have shown that nonfasting remnant cholesterol can be a strong predictor of cardiovascular disease risk and may contribute to identifying residual risk; however, Canadian data are lacking on nonfasting remnant cholesterol. In this study, we aimed to determine the relation between nonfasting remnant cholesterol, low-density lipoprotein (LDL) cholesterol and cardiovascular disease among people in Alberta. Methods: In this retrospective analysis, we used data from Alberta’s Tomorrow Project, a large prospective cohort that enrolled Albertans aged 35–69 years (2000–2015). Participants with consent to data linkage, with complete nonfasting lipid data and without existing cardiovascular disease were included. The nonfasting remnant cholesterol and LDL cholesterol relation with a composite cardiovascular disease outcome of major incident cardiovascular diagnoses, ascertained by linking to Alberta Health databases, was determined by multivariable logistic regression, adjusting for age, sex, statin use, comorbidities, and LDL cholesterol or remnant cholesterol. Results: The final sample of 13 988 participants was 69.4% female, and the mean age was 61.8 (standard deviation [SD] 9.7) years. Follow-up time was approximately 15 years. Mean remnant cholesterol was significantly higher among individuals with versus without cardiovascular disease (0.87 [SD 0.40] mmol/L v. 0.78 [SD 0.38] mmol/L, standardized mean difference [SMD] −0.24), and mean LDL cholesterol was significantly lower (2.69 [SD 0.93] mmol/L v. 2.88 [SD 0.84] mmol/L, SMD 0.21). The odds of incident composite cardiovascular disease were significantly increased per mmol/L increase in remnant cholesterol (adjusted odds ratio [OR] 1.48, 95% confidence interval [CI] 1.27–1.73) but significantly decreased per mmol/L increase in LDL cholesterol (adjusted OR 0.73, 95% CI 0.68–0.79). Interpretation: In this large Albertan cohort of predominantly older females, nonfasting remnant cholesterol had a positive relation with cardiovascular disease incidence, whereas LDL cholesterol did not. These findings support the clinical utility of measuring non-fasting remnant cholesterol to detect cardiovascular disease risk.

Abstract Context Women with polycystic ovary syndrome (PCOS) have increased incidence of atherogenic dyslipidemia and cardiovascular disease (CVD). Interventions targeting atherogenic dyslipidemia to reduce CVD risk are limited in women with PCOS. Objective This pilot study was conducted to determine the effect of 12 weeks of high dose fish oil (FO), metformin, and FO as an adjunct to metformin (FO-metformin) therapy on fasting and nonfasting plasma lipids and ApoB-remnants in young women with the metabolic syndrome (MetS) and PCOS. Methods In this open-label parallel pilot trial, women with MetS and PCOS (18-30 years of age) were randomized into 1 of 3 interventions: (1) FO; (2) metformin; and (3) FO-metformin. Plasma lipids and ApoB (48 and 100)-lipoproteins and triglycerides (TG) were measured in the fasted and postprandial state following a high-fat meal at baseline and postintervention. Results FO-metformin significantly lowered fasting plasma TG by >40% compared with FO and metformin treatments. Fasting plasma apoB48 was lowered 40% in FO-metformin and 15% in the FO groups from baseline to postintervention. ApoB48 area under the curve (ApoB48AUC), ApoB48 incremental AUC (ApoB48iAUC), ApoB100AUC, and ApoB100iAUC decreased in all groups from baseline to postintervention; however, these findings did not reach statistical significance. Conclusion The findings of this pilot trial show that high dose FO and FO-metformin combination therapy tend to lower fasting and postprandial plasma TG and ApoB-lipoprotein remnants compared with metformin; however, the study is limited by small sample size. These results may be clinically significant in individuals with PCOS for management of atherogenic dyslipidemia.

Abstract Background: Polycystic ovary syndrome (PCOS) is highly associated with the metabolic syndrome (MetS): obesity, insulin resistance and atherogenic dyslipidemia. Women with PCOS-MetS are at higher risk of developing ischemic cardiovascular disease (CVD) and Type-2 Diabetes. First-line intervention in PCOS-MetS includes targeting diet and lifestyle, and metformin is commonly prescribed to treat insulin resistance, however these interventions have shown limited effectiveness to improve dyslipidemia. At present there are limited safe and efficious options to target atherogenic dyslipidemia in young women with PCOS. Fish oil (FO) and Icosapentyl ethyl supplementation have been shown to reduce fasting TG, apoB and to improve ischemic CVD outcomes. The efficacy of FO or as an adjunct therapy to metformin to improve ApoB-remnant lipemia in PCOS-MetS is unknown. The aim of this pilot study was to determine the effect of metformin, FO and FO-metformin combination treatment on fasting and non-fasting plasma TG and apoB-remnant lipoprotein metabolism in patients with PCOS-MetS. Methods: Participants diagnosed with PCOS aged 18-30yrs received dietary counselling and were randomly assigned to receive FO (n=8), metformin (n=7) or FO-metformin (n=12) treatment for 12 wks. Plasma lipids (TG and cholesterol), ApoB48 and ApoB100 lipoprotein metabolism were assessed in the fasting and non-fasting state using a standardized high-fat meal test. Results: At baseline, the fasting plasma TG, ApoB48 and ApoB100 was 238.0 ± 21.0 mg/dL, 9.00 ± 1.12 ug/ml and 290 ± 18.00 mg/dL. FO and FO-metformin decreased fasting plasma TG by 10% and 30% compared to the metformin treatment group (7%). Fasting ApoB48 was reduced 45%, 16% and 19% in FO-metformin, FO and metformin treatment groups, respectively. Non-fasting plasma TG and apoB48 lipoprotein area under the curve were reduced by 30% in the FO-metformin treatment group. Conclusion: These pilot findings demonstrate FO-metformin adjunct therapy may have greater efficacy to improve atherogenic apoB-dyslipidemia compared to metformin or FO alone in high-risk patients with PCOS-MetS. A larger clinical trial is warranted to determine the long term effects of FO-metformin intervention on apoB-dyslipidemia and atherosclerotic cardiovascular disease indices.

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