Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Malik ◽  
H Chen ◽  
A Cooper ◽  
M Gomes ◽  
V Hejjaji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Optimal Control ◽  
Risk Factor ◽  
Socioeconomic Factors ◽  
Funding Source ◽  
Risk Factor Control ◽  
Cv Disease

Abstract Background In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease. Purpose To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D. Methods DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c <7%, BP <140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control. Results Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c <7%. Conclusions In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country. Proportion of patients at goal Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca

Abstract 261: Global Patterns of Comprehensive Cardiovascular Risk Factor Control in Patients With Type 2 Diabetes Mellitus: Insights From the Global DISCOVER Registry

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Krishna K Patel ◽  
Bernard Charbonnel ◽  
Hungta Chen ◽  
Javier Cid-Rufaza ◽  
Peter Fenici ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Optimal Control ◽  
Type 2 Diabetes Mellitus ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Risk Factor Control

Background: Guidelines recommend optimal control of cardiovascular risk factors such as blood pressure, lipids and smoking in addition to glycemic control to reduce the risk of micro and macro-vascular complications in patients with type 2 diabetes mellitus (T2D). However, the extent of comprehensive cardiovascular risk factor control in T2D internationally is not well-known. Methods: A total of 14,169 T2D patients initiating second-line therapy across 37 countries were enrolled in the DISCOVER registry. Optimal cardiovascular risk factor management at study baseline was defined as control of the following risk factors among eligible patients: 1) Systolic BP <140mmHg for all T2D patients; 2) statin prescription in all T2D patients ≥ 40 years, high-intensity statin for those with T2D and ASCVD; 3) non-smoking status for all T2D patients; 4) treatment with ACE-Inhibitor/Angiotensin Receptor Blocker (ACEI/ARB) in patients with T2D and 5) hypertension (HTN)/albuminuria and secondary ASCVD prevention with low-dose aspirin (ASA) in those with T2D and ASCVD. Global and country specific rates of individual and combined risk factor control were calculated. Inter-country variability was estimated using median odds ratios (MOR). Results: Mean age of the DISCOVER cohort was 56.6 (SD= 11.7) years; 7534 (53.2%) were male, mean BMI was 29.6 (SD= 5.9) kg/m 2 , median duration of T2D was 4.1 (IQR 2.0, 7.8) years. A total of 1643 (11.9%) patients had ASCVD, 7221 (51.0%) had HTN and 606 (4.3%) had albuminuria. Overall, among eligible patients, BP was controlled in 67.2% (9043/13457); statin treatment was prescribed in 38.3% (4977/12987); 85.2% (12,075/14169) were not smoking; ACEI/ARB treatment was prescribed in 53.7% (4917/9151), and ASA for secondary prevention was prescribed in 51.6% (847/1643) patients with ASCVD. Of 13,118 patients with 3 or more risk factors, 5312 (40.5%) had optimal control of at least 3 risk factors with wide inter-country variability. Conclusion: In a global registry of individuals with T2D from 37 countries, comprehensive control of ASCVD risk factors was not achieved in most patients, with wide variability among countries. Better strategies are needed to consistently provide comprehensive cardiovascular risk factor control in patients with T2D to improve long term outcomes.

Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Wienbergen ◽  
A Fach ◽  
S Meyer ◽  
J Schmucker ◽  
R Osteresch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Prevention Program ◽  
Study Endpoint ◽  
Funding Source ◽  
Risk Factor Control ◽  
One Year

Abstract Background The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after &gt;24 months (“prevention boost”) is effective. Methods In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control. In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention. Results At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p&lt;0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p&lt;0.05, Figure 1). A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p&lt;0.05 between the groups, Figure 1). Conclusions IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after &gt;24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)

scholarly journals Cardiovascular outcomes in patients with type 2 diabetes and reduced eGFR and albuminuria: a REWIND post hoc subgroup analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Colhoun ◽  
R Malik ◽  
F Botros ◽  
C Atisso ◽  
H Gerstein
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Risk Reduction ◽  
Subgroup Analysis ◽  
Funding Source ◽  
Private Company ◽  
First Occurrence ◽  
Cv Disease ◽  
Post Hoc

Abstract Background/Introduction Diabetic kidney disease affects up to 40% of people with diabetes and is associated with higher cardiovascular (CV) risk. REWIND was a multicentre, randomised, double-blind, placebo-controlled trial with a primary outcome of first occurrence of the composite endpoint of CV death, nonfatal myocardial infarction, or nonfatal stroke (Major Adverse Cardiovascular Event [MACE]-3). Dulaglutide treatment reduced the incidence of MACE-3 in patients with type 2 diabetes (T2D) with or without established CV disease. Purpose This REWIND post hoc subgroup analysis evaluated the effect of dulaglutide on MACE-3 in patients with an eGFR&lt;60 and ≥60 mL/min/1.73m2 and patients with micro-/macro-albuminuria (UACR ≥30 mg/g) or normoalbuminuria (UACR &lt;30 mg/g). Methods Eligible patients were those ≥50 years old with T2D who had either a previous CV event or CV risk factors. Patients were randomised (1:1) to dulaglutide 1.5 mg or placebo, both in addition to standard of care. A Cox proportional hazards model with treatment, eGFR subgroup (&lt;60 and ≥60 mL/min/1.73 m2), and treatment by eGFR subgroup interaction was used to analyse time to the first occurrence of MACE-3. These analyses were also conducted for albuminuria subgroups (micro-/macro-albuminuria or normoalbuminuria). Estimates of hazard ratios (HR) with 95% confidence intervals (CI) were calculated for each subgroup. Results At baseline, 2,199 of 9,901 patients (22.2%) had an eGFR &lt;60 mL/min/1.73 m2, 2,676 (27.0%) had microalbuminuria, and 791 (8.0%) had macroalbuminuria. This post hoc subgroup analysis showed that dulaglutide treatment was consistently associated with MACE-3 risk reduction in patients with eGFR &lt;60 and ≥60 mL/min/1.73 m2 (HR [95% CI]: 0.93 [0.76–1.13] and 0.86 [0.75–0.99], respectively; interaction p=0.545). Similarly, MACE-3 risk reduction was consistent in patients with micro-/macro-albuminuria or normoalbuminuria (HR [95% CI]: 0.84 [0.72–0.99] and 0.93 [0.79–1.10], respectively; interaction p=0.374). Conclusions Regardless of baseline eGFR or albuminuria status, dulaglutide reduces MACE-3 outcomes in patients with T2D and established CV disease or multiple CV risk factors. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Eli Lilly and Company

The predictive value of endothelin-1 and type 2 diabetes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Youssri ◽  
M Ohlsson ◽  
V Hamrefors ◽  
O Mellander
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Predictive Value ◽  
Fasting Glucose ◽  
Hazard Ratio ◽  
Funding Source ◽  
Onset Diabetes ◽  
New Onset

Abstract Introduction Endothelin 1 is a potent vasoconstrictor released from mainly vascular endothelial cells and to a lesser extent adipose, muscle and renal tissues. Its involvement in cardiovascular disease is well documented, with increasing ET-1 levels correlated to cardiovascular events. Less is however, known about its role in insulin resistance and type 2 diabetes. Purpose To test if ET-1 plasma levels predict the risk of developing type 2 diabetes independently of known risk factors. Method The Malmo Preventive project is a prospective single centre population-based study which recruited 33 346 inhabitants in Malmo, Sweden between 1974–1992. A follow up study was conducted between 2002 and 2006 on willing participants of which 18 240 accepted. Cardiovascular risk factors were documented along with blood plasma samples frozen to −80°C available for further analysis among approximately 5000 subjects. Record linkage with national and regional diagnoses and drug prescription registries was performed to identify all new onset type 2 diabetes cases in this cohort during a mean follow-up period of nine years. C-terminal proendothelin-1 (proET-1), a stable precursor to ET-1, levels were analysed by a double sandwich immunoassay (ThermoFisher) among 4536 individuals with complete data and without diabetes at baseline. The subjects were divided into quartiles based on proET-1 levels and hazard ratios (HR) for new onset diabetes were calculated by Cox Proportional Hazards Model adjusting for age, gender, smoking, hypertension, body mass index (BMI) and fasting glucose. Results There was a positive relationship between increasing proET-1 quartiles and age (p&lt;0.001), hypertension (p&lt;0.001), BMI (p&lt;0.001) and smoking (p&lt;0.001). There was no significant relationship between ET-1 quartiles and fasting glucose (p=0.08) and gender (p=0.21). In models adjusted for age, gender, smoking, hypertension, fasting glucose and BMI among non-diabetic subjects each 1 standard deviation increment of proET-1 conferred a hazard ratio (95% confidence interval) for new onset diabetes during follow up period of 1.12 (1.00–1.26) (p=0.05). The hazard ratio for incident diabetes in quartile 4 (Q4) vs quartile 1 (Q1) was 1.40 (1.03–1.92) (p=0.03). Of note, the predictive value of proET-1 was markedly higher among individuals without pre-diabetes (fasting glucose &lt;6.1) with a hazard ratio of 1.27 per standard deviation proET-1 (CI 1.09–1.49, p=0.02) and 2.18 (CI 1.41–3.36, p&lt;0.001) when comparing proET-1 Q4 vs Q1. There was no significant relationship between the risk of new onset diabetes and proET-1 levels among pre-diabetic individuals. Conclusion Raised proET-1 levels among non-diabetic individuals independently predict risk of new onset type 2 diabetes. The predictive value is driven by the part of the population without prediabetes, suggesting that proET-1 might identify individuals at “hidden high risk”, i.e. indivduals who do not get medical attention by having prediabetes. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Knut & Alice Wallenberg Foundation Clinical Scholars and Göran Gustafsson Foundation

Multifactorial intervention and effect on morbidity, preventive medication and mortality in patients with type 2 diabetes within cardiac rehabilitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.M.B Soja ◽  
N Carlson ◽  
H.K Rasmusen ◽  
A Sjoel ◽  
L.C Thygesen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Standard Of Care ◽  
Funding Source ◽  
Multifactorial Intervention ◽  
Preventive Medication

Abstract Background Although studies have reported beneficial impact of cardiac rehabili-ta-tion in the overall population, knowledge from clinical randomized trials of the effect of cardiac rehabilitation in patients with type 2 diabetes is still sparse. Purpose In the randomized DANSUK trial, we aimed to evaluate the short- and long-term effect on cardiovascular disease, hospital readmissions, mortality and use of preventive medication in patients with type 2 diabetes referred to comprehensive cardiac rehabilitation by comparing an intensified, targeted, multifactorial intervention with standard of care. Methods From 2000 to 2004 a total of 151 patients with type 2 diabetes and with ischemic heart disease (53%), heart failure (18%), or high-risk patients with at least three risk factors for ischemic heart disease (29%) were included in the DANSUK trial. The patients were allocated to standard of care (N=76) following current guidelines or comprehensive cardiac rehabilitation during a twelve weeks program with a stepwise implementation of behaviour modification and preventive medication to reach treatment goals (N=75). Clinical outcomes were compared after three and fourteen years of follow-up using national registries. Primary composite outcome measure included overall mortality, myocardial infarction or acute first-time readmission. Results Mean age was 66 years and more than one third of the population were women. After three years of follow-up, no difference in primary outcome was obtained (HR: 0,87; 95% CI: 0,58–1,32), but when hospitalized within the first three years, mean length of stay was significantly reduced by 25% in patients who had attended comprehensive cardiac rehabilitation compared to standard of care (5,8 vs. 7,7 days; p&lt;0.04). After fourteen years of follow-up there was still no difference in the combined endpoint between the two treatment groups. Conclusions Although the DANSUK trial earlier has demonstrated reductions in several risk factors and in the use of preventive medication in patients with abnormal glucose metabolism attending comprehensive cardiac rehabilitation compared to standard of care, these effects did not translate into the primary composite endpoint after three and fourteen years of follow-up in patients with known type 2 diabetes at enrolment. Nevertheless, there was a significant reduction in length of stay when admitted to hospital in the cardiac rehabilitation group compared to standard of care within the first three years of follow-up. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The Danish Heart Foundation

scholarly journals Risk Factor Control and Cardiovascular Event Risk in People With Type 2 Diabetes in Primary and Secondary Prevention Settings

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
pp. 1925-1936
Author(s):  
Alison K. Wright ◽  
Milton Fabian Suarez-Ortegon ◽  
Stephanie H. Read ◽  
Evangelos Kontopantelis ◽  
Iain Buchan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Confidence Interval ◽  
Renal Disease ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Cvd Risk ◽  
Risk Factor Control

Background: To examine the association between the degree of risk factor control and cardiovascular disease (CVD) risk in type 2 diabetes and to assess if the presence of cardio-renal disease modifies these relationships. Methods: A retrospective cohort study using data from English practices from CPRD GOLD (Clinical Practice Research Datalink) and the SCI-Diabetes dataset (Scottish Care Information-Diabetes), with linkage to hospital and mortality data. We identified 101 749 with type 2 diabetes (T2D) in CPRD matched with 378 938 controls without diabetes and 330 892 with type 2 diabetes in SCI-Diabetes between 2006 and 2015. The main exposure was number of optimized risk factors: nonsmoker, total cholesterol ≤4 mmol/L, triglycerides ≤1.7 mmol/L, glycated haemoglobin (HbA1c) ≤53 mmol/mol (≤7.0%), systolic blood pressure <140mm Hg, or <130 mm Hg if high risk. Cox models were used to assess cardiovascular risk associated with levels of risk factor control. Results: In CPRD, the mean baseline age in T2D was 63 years and 28% had cardio-renal disease (SCI-Diabetes: 62 years; 35% cardio-renal disease). Over 3 years follow-up (SCI-Diabetes: 6 years), CVD events occurred among 27 900 (27%) CPRD-T2D, 101 362 (31%) SCI-Diabetes-T2D, and 75 520 (19%) CPRD-controls. In CPRD, compared with controls, T2D participants with optimal risk factor control (all risk factors controlled) had a higher risk of CVD events (adjusted hazard ratio, 1.21; 95% confidence interval, 1.12–1.29). In T2D participants from CPRD and SCI-Diabetes, pooled hazard ratios for CVD associated with 5 risk factors being elevated versus optimal risk factor control were 1.09 (95% confidence interval, 1.01–1.17) in people with cardio-renal disease but 1.96 (95% confidence interval, 1.82–2.12) in people without cardio-renal disease. People without cardio-renal disease were younger and more likely to have suboptimal risk factor control but had fewer prescriptions for risk factor modifying medications than those with cardio-renal disease. Conclusions: Optimally managed people with T2D have a 21% higher CVD risk when compared with controls. People with T2D without cardio-renal disease would be predicted to benefit greatly from CVD risk factor intervention.

Physicians’ Perception of the Relevance of Cardiovascular Risk Factors in Patients with and without Type 2 Diabetes in Peru

2021 ◽  
pp. 1-8
Author(s):  
Jesus Rocca
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
General Practitioners ◽  
Chi Square ◽  
Medical Specialties ◽  
Causes Of Mortality ◽  
On Line ◽  
Cv Disease

Background: Since cardiovascular (CV) disease is one of the principal causes of mortality among Peruvian population, especially in people with type 2 diabetes (T2D), patient´s CV risk factors evaluation should be done as homogenously as possible. The aim of this study was to determinate what was the perception of different specialists in Peru, of CV risk factors in patients with and without T2D. Methods: An on-line questionnaire on a convenient sample of physicians, from different medical specialties, was answered. The questionnaire assessed the physicians’ perception of fourteen CV risk factors in patients with and without T2D, according to three ratings: very important, moderately important, and slightly important. We assessed the differences between medical specialties through graphs and chi-square tests, and also identified the risk factors considered as “very important” with the highest (≥90%) consensus amongst each specialty. Results: A total of 156 physicians responded to the questionnaire, composed by endocrinologists (30%), cardiologists (26%), internists (18%), nephrologists (13%) and general practitioners (13%). In patients with T2D the importance of BMI ≥30, high LDL cholesterol level, triglycerides ≥ 150 mg/dL, and hyperuricemia were statistically different across medical specialties. Likewise In patients without T2D; triglycerides ≥150 mg/dL, hyperuricemia, pre diabetes, and hepatic steatosis. With the exception of general practitioners, consensus on at least one risk factor was attained in all specialties, albeit these risk factors were heterogeneous amongst them. The only risk factor that reached consensus across all specialties was high blood pressure. Conclusion: Hypertension and smoking were the most important CV risk factors in T2D patients valued by the surveyed physicians, followed by levels of LDL-c and albuminuria. Cardiologists as well as endocrinologists, gave the same assessment to CV risk factors. For people without T2D, smoking was recognized as the most important CV risk factor, followed by hypertension and albuminuria.

scholarly journals Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Caro Codon ◽  
T Lopez-Fernandez ◽  
C Alvarez-Ortega ◽  
P Zamora Aunon ◽  
I Rodriguez Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Individual Risk ◽  
Funding Source ◽  
Number Of Patients ◽  
All Cause Mortality

Abstract Background The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Design Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk. Methods A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy. Results At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)]. Conclusions This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)

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