Stephen E. Kimmel
University of Pennsylvania · Rehabilitation Medicine
Active 1995–2025
About
Stephen E. Kimmel, MD, MSCE, is an Emeritus Professor of Medicine specializing in Cardiovascular Medicine at the Perelman School of Medicine, University of Pennsylvania. He serves as the Director of the Cardiovascular Epidemiology division within the Department of Medicine and is a Senior Scholar at the Center for Clinical Epidemiology and Biostatistics. Additionally, he is the Director of the Center for Therapeutic Effectiveness Research and a Senior Fellow at the Center for Behavioral Health Research at the University of Pennsylvania. Dr. Kimmel is a member of the American Epidemiological Society and is affiliated with the Graduate Group in Epidemiology and Biostatistics. His research expertise encompasses epidemiology, pharmacoepidemiology, and cardiology, with a focus on cardiovascular epidemiology and the effects of medications on cardiovascular outcomes.
Research topics
- Data Mining
- Computer Science
- Statistics
- Internal medicine
- Genetics
- Medicine
- Mathematics
- Biology
Selected publications
MRI-Derived Body Composition and Breast Cancer Risk in Postmenopausal Women: UK Biobank Study
Cancers · 2025-12-18
articleOpen accessBackground: Obesity is a risk factor for breast cancer mortality in postmenopausal women. However, it remains unclear which specific components of adipose tissue and skeletal muscle are associated with risk. This study assessed the associations between MRI-assessed adiposity, skeletal mass, and breast cancer risk in a population-based cohort. Methods: We analyzed data from 15,669 postmenopausal women in the UK Biobank who underwent MRI for body composition assessment. Age- and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional-hazards regression to evaluate the associations between body composition and breast cancer risk, adjusting for relevant confounders. Sensitivity analyses were conducted by excluding breast cancer cases diagnosed within 2 years of the MRI scan. To explore nonlinear relationships, we applied restricted cubic splines with three knots to model associations between visceral adipose tissue (VAT), muscle-fat infiltration (MFI), and breast cancer risk. Results: The mean age of participants was 58.6 years (SD = 5.2; range = 40–69). Higher VAT was significantly associated with increased breast cancer risk (3rd vs. 1st tertile aHR = 1.24, 95% CI: 1.10–1.45). Elevated MFI was also linked with greater risk (3rd vs. 1st tertile aHR = 1.53, 95% CI: 1.25–1.87). These associations persisted after excluding early cancer cases. We observed a J-shaped relationship between VAT, MFI, and breast cancer risk. Conclusions: Higher levels of VAT and MFI are associated with elevated breast cancer risk in postmenopausal women, suggesting that imaging-derived body composition measures may enhance risk prediction and inform prevention strategies.
Frontiers in Cardiovascular Medicine · 2025-06-30
articleOpen accessObjective To evaluate the effect of different pharmacological therapies for heart failure (HF) between the Black vs. White population. Method We included randomized controlled trials (RCT) of HF pharmacological therapies with explicit strata of Black or White adults in the primary or secondary analysis. We examined three outcomes: (1) the composite of CV death or hospitalization for heart failure (HHF), (2) HHF, and (3) all-cause death. Within each race (White and Black), we calculated the pooled risk ratio (RR) with a 95% confidence interval (CI) of different pharmacological therapies using random-effects models. Within each pharmacological therapies, we assess the differences in the treatment effect by race. Results In 19 RCT reporting eight pharmacological therapies, there was no significant difference between the Black and White groups for using sacubitril/valsartan, angiotensin-converting enzyme inhibitors, calcium-channel blockers, direct renin inhibitors, oral soluble guanylate cyclase, or vasodilators. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) had a different effect in HHF across the White and Black patients (P interaction = .030), with a better treatment effect observed in the Black (RR 0.39, 95% CI 0.19–0.80) compared to the White group (0.90, 0.71–1.14). Beta-blockers had a better treatment effect in the White (0.65, 0.52–0.81) compared to the Black group (1.14, 0.88–1.47) regarding the all-cause death outcome (P interaction = .001). Conclusion Black individuals with HF appeared to obtain a greater benefit of HHF risk reduction from SGLT2i and less benefit for mortality from beta-blockers compared to their White counterparts.
JACC CardioOncology · 2025-01-07 · 2 citations
articleOpen accessBACKGROUND: Prior research suggests that breast cancer patients with a high burden of frailty may face an increased risk of cardiotoxicity. OBJECTIVES: This study sought to examine the association between frailty and cardiotoxicity rates in female breast cancer patients receiving adjuvant therapy after surgery. METHODS: We analyzed data from the OneFlorida+ clinical research network, focusing on breast cancer patients treated with adjuvant chemotherapy and targeted therapy from 2012 to 2022. Cardiovascular rates during adjuvant treatments were calculated based on pre-existing frailty, measured using the cumulative deficit frailty index (electronic health record frailty index). We employed multivariable Gray's method to examine the association between frailty with cardiotoxicity. RESULTS: The final cohort included 2,050 patients (mean age 50.6 years), with 415 (20.2%) experiencing nonfatal adverse cardiovascular events after adjuvant therapy. The incidence of adverse cardiovascular events was 17.8% in robust, 23.2% in prefrail, and 29.4% in frail patients. In multivariable analysis, prefrail (adjusted subdistribution HR [sHR]: 1.35; 95% CI: 1.06-1.71; P = 0.015) and frail (adjusted sHR: 1.70; 95% CI: 1.11-2.61; P = 0.015) patients had a higher likelihood of experiencing adverse cardiovascular events compared with robust patients. Among non-Hispanic White and Black patients, prefrail (adjusted sHR: 1.48; 95% CI: 1.04-2.11; P = 0.031; and adjusted sHR: 1.59; 95% CI: 1.06-2.37; P = 0.024, respectively) and frail (adjusted sHR: 1.96; 95% CI: 1.10-3.50; P = 0.022; and adjusted sHR: 2.13; 95% CI: 1.11-4.10; P = 0.023, respectively) patients were more likely to experience adverse cardiovascular events compared with robust patients. No significant differences were observed in other racial/ethnic groups. CONCLUSIONS: These findings highlight the need for close monitoring of cardiotoxicity in frail breast cancer patients undergoing adjuvant treatments to improve cardiovascular risk management.
Journal of the American Medical Informatics Association · 2025-07-19 · 1 citations
articleOBJECTIVES: By October 1, 2024, over 450,000 COVID-19 manuscripts were published, with 10% posted as unreviewed preprints. While they accelerate knowledge sharing, their inconsistent quality complicates systematic studies. MATERIALS AND METHODS: We propose a 2-stage method to include preprints in meta-analyses. In Stage A, preprints are integrated through restriction or imputation and weighted by a confidence score reflecting their publication likelihood. In Stage B, we assess and adjust for potential publication or reporting biases. RESULTS: This preliminary study employed a 2-stage procedure validated with 2 COVID-19 treatment case studies. For hydroxychloroquine, the relative risk (RR) was 1.06 [95% CI: 0.62, 1.80], suggesting no mortality benefit over placebo. For corticosteroids, the RR was 0.88 [95% CI: 0.62, 1.27], which, while not statistically significant, aligns with evidence supporting a mortality benefit. DISCUSSION: Our research aims to bridge a significant methodological gap by providing a solution for timely evidence synthesis, particularly in the face of the overwhelming number of publications surrounding COVID-19. CONCLUSION: This preliminary study presents a method to efficiently synthesize COVID-19 research, including non-peer-reviewed preprints, to support clinical and policy decisions amidst the information surge.
Neighborhood Deprivation and Racial Disparities in Heart Failure Outcomes
JACC Advances · 2025-06-01 · 2 citations
articleOpen accessBACKGROUND: Heart failure (HF) is a major contributor to hospitalizations and mortality in the United States, with significant racial disparities in care access and clinical outcomes. Social determinants of health (SDoH) play a critical role in shaping these disparities. OBJECTIVES: This study aimed to assess the impact of neighborhood deprivation on racial disparities in HF outcomes and quantify the changes in adverse outcomes if non-Hispanic Black (NHB) patients resided in neighborhoods with SDoH level equal to those of non-Hispanic White (NHW) patients. METHODS: We conducted a retrospective cohort study using electronic health records from the University of Florida, including adults hospitalized for HF between 2016 and 2021. SDoH level was measured using the Area Deprivation Index (ADI). The primary outcome was a composite measure of 1-year readmission and all-cause mortality. A counterfactual framework was applied to estimate how NHB patient outcomes might change if they lived in neighborhoods with ADI distributions equivalent to NHW patients. RESULTS: Among 42,279 patients (mean age 65 ± 14.3 years; 48% women), NHB patients had more 1-year composite outcomes (32.92%) compared to NHW patients (27.69%). Adjusted analyses showed NHB patients had a higher risk of readmission or mortality (aOR: 1.101; 95% CI: 1.063-1.139). Counterfactual modeling showed that if NHB patients resided in neighborhoods with ADI distributions same as NHW patients, their outcome rate would decrease by 1.31% (95% CI: 1.309%-1.311%). CONCLUSIONS: This study highlights racial disparities in HF outcomes attributed to neighborhood deprivation. Improving socioeconomic conditions in deprived neighborhoods could mitigate disparities in HF.
medRxiv · 2025-07-16
preprintOpen accessObjectives: By October 1, 2024, over 450,000 COVID-19 manuscripts were published, with 10% posted as unreviewed preprints. While they accelerate knowledge sharing, their inconsistent quality complicates systematic studies. Materials and Methods: We propose a two-stage method to include preprints in meta-analyses. In Stage A, preprints are integrated through restriction or imputation and weighted by a confidence score reflecting their publication likelihood. In Stage B, we assess and adjust for potential publication or reporting biases. Results: This preliminary study employed a two-stage procedure validated with two COVID-19 treatment case studies. For hydroxychloroquine, the relative risk (RR) was 1.06 [95% CI: 0.62, 1.80], suggesting no mortality benefit over placebo. For corticosteroids, the RR was 0.88 [95% CI: 0.62, 1.27], which, while not statistically significant, aligns with evidence supporting a mortality benefit. Discussion: Our research aims to bridge a significant methodological gap by providing a solution for timely evidence synthesis, particularly in the face of the overwhelming number of publications surrounding COVID-19. Conclusion: This preliminary study presents a method to efficiently synthesize COVID-19 research, including non-peer-reviewed preprints, to support clinical and policy decisions amidst the information surge.
Frontiers in Pharmacology · 2024-05-23 · 6 citations
articleOpen accessObjectives To investigate the risk of atrial fibrillation (AF) with sodium-glucose cotransporter-2 inhibitors (SGLT2is) compared to dipeptidyl peptidase-4 inhibitor (DPP4i) use in older US adults and across diverse subgroups. Methods We conducted a retrospective cohort analysis using claims data from 15% random samples of Medicare fee-for-service beneficiaries. Patients were adults with type 2 diabetes (T2D), no preexisting AF, and were newly initiated on SGLT2i or DPP4i. The outcome was the first incident AF. Inverse probability treatment weighting (IPTW) was used to balance the baseline covariates between the treatment groups including sociodemographics, comorbidities, and co-medications. Cox regression models were used to assess the effect of SGLT2i compared to DPP4i on incident AF. Results Of the 97,436 eligible individuals (mean age 71.2 ± 9.8 years, 54.6% women), 1.01% (n = 983) had incident AF over a median follow-up of 361 days. The adjusted incidence rate was 8.39 (95% CI: 6.67–9.99) and 11.70 (95% CI: 10.9–12.55) per 1,000 person-years in the SGLT2i and DPP4i groups, respectively. SGLT2is were associated with a significantly lower risk of incident AF (HR 0.73; 95% CI, 0.57 to 0.91; p = 0.01) than DPP4is. The risk reduction of incident AF was significant in non-Hispanic White individuals and subgroups with existing atherosclerotic cardiovascular diseases and chronic kidney disease. Conclusion Compared to the use of DPP4i, that of SGLT2i was associated with a lower risk of AF in patients with T2D. Our findings contribute to the real-world evidence regarding the effectiveness of SGLT2i in preventing AF and support a tailored therapeutic approach to optimize treatment selection based on individual characteristics.
Trajectories of Sacubitril/Valsartan Adherence Among Medicare Beneficiaries With Heart Failure
JACC Advances · 2024-05-08 · 10 citations
articleOpen accessBackground: Sacubitril/valsartan, an angiotensin receptor/neprilysin inhibitor (ARNi), improves heart failure (HF) outcomes, yet real-world adherence patterns are not well understood. Objectives: The purpose of this study was to analyze longitudinal patterns of adherence to ARNis in patients with HF and to identify factors associated with adherence patterns. Methods: Using Medicare beneficiaries from 2015 to 2018, we included patients diagnosed with HF who initiated an ARNi. A group-based trajectory model was constructed to identify adherence patterns during follow-up. We used multivariable logistic regression to investigate factors associated with membership in each adherence trajectory group. Results: Among 9,475 eligible beneficiaries (age 77 ± 7 years, 34% female), we identified 5 distinct ARNi adherence trajectories, characterized as: immediate discontinuers, who discontinued treatment within the first 3 months (12%); early discontinuers, who discontinued treatment in months 4 to 7 (10%); late discontinuers, who discontinued treatment in months 7 to 10 (12%); intermittently adherent patients (12%); and consistently adherent patients (54%). The first 4 groups were collectively categorized as nonconsistent adherents. Living in a socioeconomically disadvantaged area, ie, a county with the top 20% of Area Deprivation Index (adjusted OR [aOR]: 1.12 [95% CI: 1.00-1.24]) and Black race (aOR: 1.36, [95% CI: 1.18-1.56]) were associated with a higher likelihood of being nonconsistently adherent. Receiving prescriptions from a cardiologist (aOR: 0.64 [95% CI: 0.57-0.73]) was associated with a lower likelihood of suboptimal ARNi adherence. Conclusions: Half of ARNi users were not consistently adherent to the drug in the first year after treatment initiation. There exist significant racial and socioeconomic inequities in longitudinal adherence to ARNi.
Journal of the American College of Cardiology · 2023-03-01
article2022-03-03 · 2 citations
preprintOpen access<b>BACKGROUND</b> <p>Whether the cardiorenal benefits of <a>sodium glucose co-transporter 2 (SGLT2) inhibitors </a>and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are comparable between White and Asian populations remains unclear. </p> <p><b>PURPOSE</b></p> <p>To compare the cardiorenal benefits of SGLT2 inhibitors and GLP-1RAs between White and Asian populations and to compare the cardiorenal benefits between the two agents in Asian population. </p> <p><b>DATA SOURCES</b></p> <p>Electronic databases were searched up to March 28, 2021.</p> <p><b>STUDY SELECTION</b></p> <p>We included the cardiovascular (CV) and renal outcome trials of SGLT2 inhibitors and GLP-1RAs that reported major adverse cardiovascular events (MACE), CV death/heart failure hospitalization (HHF), or composite renal outcomes stratified by race. </p> <p><b>DATA EXTRACTION AND SYNTHESIS</b></p> <p>We calculated the pooled hazard ratios using random-effects models, tested the treatment effects between Asian and White groups using meta-regression analysis, and compared the treatment effects between SGLT2 inhibitors and GLP-1RAs in Asian population using a network meta-analysis. </p> <p><b>RESULTS</b></p> <p>In 10 SGLT2 inhibitor trials, there was no significant difference between Asian and White populations for MACE (p = 0.55), CV death/HHF (p<sub> </sub>= 0.87), or composite renal outcomes (p = 0.97). In seven GLP-1RA trials, we observed a similar MACE benefit between Asian and White populations (p = 0.10). Our network meta-analysis found a comparable benefit in MACE between SGLT2 inhibitors and GLP-1RAs in Asian population.</p> <p><b>LIMITATIONS</b></p> <p>The data were from stratified analyses.</p> <p><b>CONCLUSIONS</b></p> <p>There appear to be comparable cardiorenal benefits of SGLT2 inhibitors and GLP-1RAs between Asian and White participants enrolled in CV and renal outcome trials; the two therapies seem to have similar CV benefits within Asian population. </p>
Recent grants
Cardiology and Pulmonary Clinical Research Training Program
NIH · $11.7M · 1998–2028
NIH · $438k · 1999
Genomic Medicine Pilot Demonstration Projects Coordinating Center
NIH · $1.2M · 2013–2017
NIH · $3.1M · 2013
NIH · $2.7M · 2002
Frequent coauthors
- 55 shared
Mary Putt
- 52 shared
Sean Hennessy
University of Pennsylvania
- 44 shared
Thomas P. Cappola
University of Pennsylvania Health System
- 39 shared
Bonnie Ky
- 37 shared
James C. Fang
University of Utah
- 37 shared
Radwan Safa
Albany Medical Center Hospital
- 37 shared
Douglas B. Sawyer
Maine Medical Center
- 37 shared
Nancy K. Sweitzer
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