About

Munaza Riaz, PharmD., Ph.D., is a Research Assistant Professor in the Department of Pharmacotherapy and Translational Research at the University of Florida College of Pharmacy. A pharmacist by training, she earned her Ph.D. in Pharmaceutical Outcomes and Policy from the University of Florida as a Fulbright Scholar. Her research applies advanced pharmacoepidemiologic and causal inference methods to investigate the comparative effectiveness and safety of medications, with a particular focus on cardiometabolic and sleep disorders. Dr. Riaz leverages administrative claims and electronic health record data to better understand how pharmacologic treatments influence disease trajectories, health care utilization, and patient outcomes. Her current work examines the impact of antiplatelet therapy on cardiovascular health and integrates precision medicine approaches with real-world data to improve care for individuals with chronic conditions.

Research topics

• Internal medicine
• Medicine
• Pediatrics
• Immunology
• Cardiology
• Psychiatry
• Family medicine

Selected publications

• Cardiovascular risk in narcolepsy: Comparison of type 1 and type 2 in a real-world cohort

  Journal of Clinical Sleep Medicine · 2026-04-27

  articleOpen access1st author
  PublisherOA PDFDOI

• 1124 Increased Cardiometabolic Risk in Narcolepsy: Evidence of Early-Life Onset

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Emerging evidence links narcolepsy to major adverse cardiovascular events (MACE). While narcolepsy typically manifests early in life, it remains unclear whether cardiovascular disease (CVD) also develops early. We hypothesized that narcolepsy elevates the risk of cardiometabolic conditions from childhood into later life, potentially explaining the heightened MACE risk in persons with narcolepsy (PWN). Methods We conducted a retrospective cohort study using MarketScan® Commercial and Medicare Supplemental databases (2005-2021). PWN were identified by ≥2 outpatient claims for narcolepsy using International Classification of Diseases–Clinical Modification diagnosis codes. A control group of persons without narcolepsy/hypersomnolence was created using propensity score matching (1:3 ratio). Index date was the first narcolepsy diagnosis for PWN and corresponding encounter date for matched controls. Individuals with pre-existing CVD, MACE, hypertension, hyperlipidemia, diabetes, or metabolic fatty liver disease during the year prior to the index date (baseline period), to ensure balanced demographics, comorbidities, and baseline medication use between with and without narcolepsy groups. Cox regression models assessed the association between narcolepsy and time to incident hypertension, hyperlipidemia, and diabetes, adjusting for baseline and time-varying narcolepsy medication (i.e., wake-promoting agents, stimulants, and oxybate) use. Analyses were stratified by age groups (≤25[pediatric], 26–44[adults], 45–65[middle-aged], and >65yrs[older adults]). Results The cohort included 22,293 PWN and 63,709 without narcolepsy/hypersomnolence. Mean±SD age was 35.5±14.0 years (63.7% female). PWN had a significantly higher risk of hypertension (adjusted hazard ratio[aHR]:1.44, 95% Confidence Interval[CI]:1.34–1.54), hyperlipidemia (aHR:1.48, 95% CI:1.39–1.57), and diabetes (aHR:1.61, 95% CI:1.40–1.83) compared to those without narcolepsy. These outcomes were elevated across all age groups except older adults (>65yrs). Notably, in the pediatric cohort(< 25yrs), PWN showed nearly double the risk of hypertension (aHR:2.01, 95% CI:1.60–2.53), hyperlipidemia (aHR:1.84, 95% CI:1.53–2.23), and diabetes (aHR:2.37, 95% CI:1.66–3.37) compared to those without narcolepsy/hypersomnolence. Conclusion Using a large U.S. claims database, narcolepsy was associated with a significantly increased risk of hypertension, hyperlipidemia, and diabetes across all age groups, with strongest associations observed in younger individuals. Early onset of cardiometabolic risk factors indicate prolonged exposure, potentially increasing the likelihood of MACE later in life and possibly shifting their onset to earlier ages. Support (if any) Funding: Sleep Research Society Foundation (23-FRA-001)

  PublisherOA PDFDOI

• 1123 Risk of Cardiometabolic Outcomes in Individuals with Type 1 and Type 2 Narcolepsy

  SLEEP · 2025-05-01

  articleOpen access1st authorCorresponding

  Abstract Introduction Narcolepsy, a chronic neurological sleep disorder, has two subtypes: type 1 (NT1), characterized by cerebrospinal fluid (CSF) orexin deficiency, and type 2 (NT2), characterized by normal CSF orexin levels. Both subtypes share symptoms, such as excessive daytime sleepiness (EDS) and fragmented nocturnal sleep, but cataplexy is specific to NT1. Given orexin’s role in autonomic regulation, NT1 is linked to cardiometabolic risks. However, data on cardiometabolic outcomes is limited for both subtypes. Therefore, we assessed the risks of diabetes, hypertension, and hyperlipidemia in patients with NT1 and NT2 compared to individuals without narcolepsy. Methods We conducted a retrospective cohort study using 2005-2021 MarketScan® Commercial and Medicare Supplemental databases. Patients newly diagnosed with narcolepsy (NT1 or NT2) with >2 outpatient claims were identified using International Classification of Diseases – Clinical Modification diagnosis codes (NT1 or NT2 group). A comparison cohort without narcolepsy and hypersomnia (non-narcolepsy group) was matched using propensity score (PS) matching (1:3 ratio) based on baseline demographics, comorbidities, and medication use. We excluded patients with any diagnosis of cardiovascular disease, hypertension, hyperlipidemia, diabetes, and metabolic-associated fatty liver disease during 1-year baseline period. After PS-matching, we used time-dependent Cox regression to compare risks of diabetes, hypertension, and hyperlipidemia between NT1 and non-narcolepsy groups and NT2 and non-narcolepsy groups. Models accounted for baseline use of wake-promoting agents, oxybate, stimulants, and time-varying stimulant use during follow-up period. Results The final cohort included 86,002 patients (18,309 with NT1, 3,760 with NT2, and 63,709 without narcolepsy). The adjusted model shows that NT1 was associated with higher risks for diabetes (adjusted hazard ratio [aHR] 2.21; 95% confidence interval [CI] 1.59-3.07), hypertension (aHR 1.43; 95% CI 1.18-1.73), and hyperlipidemia (aHR 1.74; 95% CI 1.48-2.04), compared to those without narcolepsy. Similarly, NT2 was associated with higher risks of diabetes (aHR 1.44; 95% CI 1.24-1.66), hypertension (aHR 1.39; 95% CI 1.29-1.51), and hyperlipidemia (aHR 1.43; 95% CI 1.33-1.53), compared to those without narcolepsy. Conclusion Using large U.S. claims data, patients with NT1 or NT2 showed increased risks for diabetes, hypertension, and hyperlipidemia compared to those without narcolepsy. EDS and sleep fragmentation may drive these risks. Support (if any) Sleep Research Society Foundation (23-FRA-001)

  PublisherOA PDFDOI

• Narcolepsy Is Associated With Subclinical Cardiovascular Disease as Early as Childhood: A Big Data Analysis

  Journal of the American Heart Association · 2025-04-10 · 8 citations

  articleOpen access

  BACKGROUND: Narcolepsy is linked to adverse cardiovascular disease (CVD) outcomes, but few studies have examined its associations with subclinical CVD, including in children. We assessed the relationship between narcolepsy and subclinical CVD outcomes, including hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. METHODS AND RESULTS: We conducted a retrospective cohort study using MarketScan Commercial and Medicare Supplemental databases from January 1, 2005 to December 31, 2021. Patients included N=22 293 diagnosed with narcolepsy (NT1 and NT2) and N=63 709 propensity-score-matched without. Patients with narcolepsy were identified as those with ≥2 outpatient insurance claims for narcolepsy (type 1 or type 2) within a 1-year interval with 1 claim being nondiagnostic. Main outcomes were diagnosis of hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis following index date, as well as a composite measure for CVD and major adverse cardiovascular events. Compared with propensity-score-matched patients without narcolepsy, patients with narcolepsy had an increased risk for hypertension (hazard ratio [HR], 1.40 [95% CI, 1.34-1.47]), hyperlipidemia (HR, 1.41 [95% CI, 1.35-1.47]), diabetes (HR, 1.50 [95% CI, 1.38-1.64), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (HR, 1.48 [95% CI, 1.28-1.73]), CVD composite (HR,1.61 [95% CI, 1.35-1.47]), and major adverse cardiovascular events (HR,1.69 [95% CI, 1.43-2.00]). Results remained significant following adjustment for narcolepsy medications including stimulants, wake-promoting agents, and oxybates. Results stratified by age groups showed similar findings, including heightened risk for those <25 years old. CONCLUSIONS: Narcolepsy is associated with greater risk of subclinical CVD even in patients as early as childhood. Detection of these outcomes early in the course of narcolepsy could help reduce the burden of adverse cardiovascular events later in life.

  PublisherDOI

• 1156 Risk of Metabolic Associated Fatty Liver Disease (MAFLD) in Patients with Narcolepsy: A Cohort Study

  SLEEP · 2025-05-01

  articleOpen access1st authorCorresponding

  Abstract Introduction Metabolic-associated fatty liver disease (MAFLD) is a major public health concern and is closely linked to cardiometabolic dysfunction. While prior research has investigated the relationship between narcolepsy and cardiovascular disease, no studies have examined whether narcolepsy increases the risk of MAFLD, despite the overlap in known risk factors. This study aimed to determine whether narcolepsy increases the risk of MAFLD. Methods We conducted a retrospective cohort study using the 2005-2021 MarketScan® Commercial and Medicare Supplemental databases. We included patients with &amp;gt;2 outpatient claims for new narcolepsy diagnoses identified using International Classification of Diseases – Clinical Modification diagnosis codes (narcolepsy group). A comparison cohort of patients without narcolepsy and hypersomnia (non-narcolepsy group) was matched in a 1:3 ratio using propensity score (PS) matching based on baseline demographics, comorbidities, and medication use. We excluded patients with any of the following conditions during the 1-year baseline period: cardiovascular disease, hypertension, hyperlipidemia, diabetes, and MAFLD. After PS matching, we used Cox proportional hazard regression to compare risk of MAFLD between the two groups after. We also conducted subgroup analyses based on age, sex, presence of sleep apnea, and narcolepsy type. Results We identified 86,002 patients (22,293 with narcolepsy and 63,709 without; mean age 33.5 ± 14.0 years, 63.7% female). The incidence of MAFLD was 0.42 per 100 person-years in the narcolepsy group and 0.28 per 100 person-years in the non-narcolepsy group. After adjusting for time-fixed and time-varying covariates and relative to non-narcolepsy, narcolepsy was associated with a 48% higher risk of MAFLD (adjusted hazard ratio [aHR] 1.48; 95% confidence interval [CI] 1.28-1.73). These findings remained consistent across all subgroup analyses. Conclusion Compared to well-matched patients without narcolepsy, patients with narcolepsy have a significantly elevated risk of being diagnosed with MAFLD. Support (if any) Sleep Research Society Foundation (23-FRA-001)

  PublisherOA PDFDOI

• Mothers’ Satisfaction Towards Pediatric Nursing Care at District Headquarter Hospital Mirpurkhas

  Indus journal of bioscience research. · 2025-02-28

  articleOpen accessSenior author

  Objective: To assess the quality of pediatric nursing care provided to hospitalized children and the level of mother satisfaction with that care. Methodology: A descriptive Cross-sectional study approach based on non – probability convenience sampling design was used. The data was gathered from respondents between August - October 2019. The study population comprised mothers of children admitted in pediatric ward at district headquarter hospital Mirpurkhas. Data analysis was analyzed using SPSS Version 22. A structured questionnaire was set with the help of Newcastle satisfaction nursing scale consists of 25 questions and was divided into 2 sections. The subjects of the study were mothers of hospitalized children who meet inclusion criteria. A written consent was taken from all respondents. Data were collected from 290 subjects with the help of a pre-translated questionnaire. Results: 78.3% of mothers were satisfied with the information nurses gave them, whereas 21.7% of mothers were not. In addition, 109 (38.7%) of mothers were dissatisfied with the nurses' explanation of the child's condition, whereas 181 (62%) of mothers were satisfied. Conclusion: This study found that mothers were generally satisfied with pediatric nursing care but identified areas needing improvement. Key concerns included waiting times, pharmaceutical services, and hospital environment. While 86.6% of nurses effectively handled medical devices, only 43.8% communicated pleasantly due to workload pressures. Nurses managed emergencies well and ensured patient privacy, but staffing challenges affected care quality. Maintaining an optimal nurse-to-patient ratio is crucial for sustaining high standards and enhancing patient satisfaction.

  PublisherOA PDFDOI

• 1095 Increased Risk of Cardiometabolic Disorders, Including Hypertension, Hyperlipidemia, and Diabetes, in Patients with Narcolepsy

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Emerging evidence suggests narcolepsy is associated with cardiovascular disease (CVD) and major adverse cardiovascular events (MACE). However, its association with cardiometabolic disorders, which contribute to elevated CVD risks, remains poorly understood. In this study, we examined whether narcolepsy is associated with increased risk of cardiometabolic disorders (including hypertension, hyperlipidemia, and diabetes) as well as CVD and MACE. Methods This retrospective cohort study used data from the 2005-2021 MarketScan® Commercial and Medicare Supplemental databases. We identified persons with narcolepsy (PWN) defined as having ≥2 outpatient claims for either NT1 or NT2 narcolepsy subtypes based on ICD-9 and -10 codes. We employed propensity score (PS) matching (1 to up to 3 ratio) to identify a comparison group without narcolepsy and hypersomnolence. The index date was the date of the first narcolepsy diagnosis for the narcolepsy group and the corresponding encounter date for the matched comparison group (non-narcolepsy group). We excluded individuals with CVD, MACE, hypertension, hyperlipidemia, diabetes, and metabolic fatty liver disease during the year prior to the index date (baseline period). PS-matching balanced demographics, comorbidities and use of medications in the baseline period. We employed time-dependent Cox regression proportional hazards models to determine the association between narcolepsy and time to the incidence of outcomes of interest. We controlled for narcolepsy medication use at baseline (i.e., wake-promoting agents, stimulants, and oxybate) and time-varying post-index stimulant use. Results The final cohort included 22,293 PWN and 63,709 without narcolepsy/hypersomnolence. The mean age of the cohort was 35.5 (± 14.0) years, and 63.7% were female. Compared to those without narcolepsy, PWN had a significantly higher risk of developing CVD (adjusted hazard ratio [aHR]=1.97, 95% confidence interval [CI]=1.65-2.36) and MACE (aHR=2.18, 95% CI=1.68-2.83). PWN also had an increased risk for hypertension (aHR=1.44, 95% CI=1.34-1.54), hyperlipidemia (aHR=1.48, 95% CI=1.39-1.57), and diabetes (aHR=1.61, 95% CI=1.40-1.83) compared to those without narcolepsy. Conclusion Using a large representative US claims dataset, narcolepsy was associated with an increased risk of hypertension, hyperlipidemia, and diabetes, further providing compelling evidence that enhances our understanding of how narcolepsy is linked to CVD and MACE. Support (if any) Sleep Research Society Foundation (23-FRA-001).

  PublisherOA PDFDOI

• Narcolepsy and risk of cardiovascular outcomes beyond stimulant use

  SLEEP · 2025-07-14 · 5 citations

  articleOpen access1st authorCorresponding

  STUDY OBJECTIVES: We aimed to assess associations between narcolepsy and cardiovascular disease risk while accounting for stimulant use in clinical practice. METHODS: Using 2005-2021 MarketScan Commercial and Medicare Supplemental databases, we identified patients with newly diagnosed narcolepsy using International Classification of Diseases, Ninth or Tenth, Clinical Modification diagnosis codes, were matched at a ratio of 1:3 patients without narcolepsy or hypersomnia using propensity score matching based on baseline demographics, comorbidities, and medication use. Primary outcomes included time to first (1) composite cardiovascular disease event and (2) major adverse cardiac event. Multivariable Cox proportional hazards regression models were used to compare outcome risks between groups, following PS matching, adjusting for time-fixed and time-varying variables, including stimulant use. Individual outcomes were examined separately and analyses were stratified by age, sex, and selected comorbidities. RESULTS: After PS matching, data from 134967 patients (mean [SD] age, 39.9 [16.8] years; 61.5% female) were included in final analyses. Following adjustment of baseline and time-varying covariates, patients with narcolepsy had increased risks of cardiovascular disease (adjusted hazard ratio, 1.89 [95% CI = 1.71 to 2.09]) and major adverse cardiac event (adjusted hazard ratio,1.95 [95% CI = 1.70 to 2.23]) compared with patients without narcolepsy. Results remained consistent across individual cardiovascular diseases and major adverse cardiac events. Subgroup analyses yielded similar findings. CONCLUSIONS: After adjusting for stimulant use, this cohort study found that patients with narcolepsy experienced increased risk of developing cardiovascular disease compared with patients without narcolepsy. This finding suggests that patients with narcolepsy may benefit from routine screening and monitoring for cardiovascular events. Statement of Significance This study enhances our understanding of the association between narcolepsy and cardiovascular events by employing a robust causal inference framework and adjusting for medications used to manage narcolepsy symptoms, which are known to be associated with cardiovascular risk. The large population-based cohort study included 34 562 patients with narcolepsy and 100 405 propensity score-matched patients without narcolepsy. Patients with narcolepsy had an increased risk of developing cardiovascular events compared to without narcolepsy controls, even after adjusting for medication use, including stimulants. These findings highlight the importance of routine cardiovascular screening and monitoring for patients with narcolepsy to mitigate potential risks.

  PublisherOA PDFDOI

• 0857 Evidence for an Independent Association of Cardiovascular Disease in Patients with Narcolepsy

  SLEEP · 2024-04-20 · 2 citations

  article

  Abstract Introduction Narcolepsy is a lifelong disabling disorder causing profound daytime sleepiness. Symptoms present as early as childhood and result in marked disturbances in the life course of many persons with narcolepsy (PWN). Further, PWN experience several health conditions, including cardiovascular disease (CVD). Importantly, PWN often present with several co-occurring sleep disorders, including obstructive sleep apnea, which is a prominent risk factor for CVD. This study examined the association between narcolepsy and CVD comprehensively accounting for potential confounders predisposing PWN to CVD. Methods This retrospective cohort study used the 2005-2021 IBM® MarketScan® Commercial and Medicare supplemental databases to identify newly diagnosed PWN from at minimum 2 outpatient claims using the International Classification of Diseases–Clinical Modification (ICD-9/10-CM) diagnosis codes. In addition, we identified a comparison cohort of persons without narcolepsy or other hypersomnolent disorders, using propensity score (PS) matching [1: up to 3 ratios] to balance groups based on underlying demographics, the presence of relevant health conditions, including sleep apnea and diabetes, and other confounders. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (95%CI) to estimate CVD risk outcomes (including major adverse cardiovascular events [MACE], heart failure, stroke, atrial fibrillation, and myocardial infarction [MI]) for PWN compared to non-narcolepsy. Patients were censored at the end of enrollment or up to December 13, 2021. Results Among 134,067 patients included (mean age=40±16.8 years; 62% female), 34,562 were PWN and 100,405 were matched non-narcolepsy patients. Compared to non-narcolepsy patients, PWN were associated with a 77% increased risk of any CVD (HR=1.77, 95%CI=1.65-1.89) and an 82% increased risk of MACE (HR=1.82, 95%CI=1.66-1.99). PWN also were associated with an increased risk of heart failure (HR=1.64, 95%CI=1.47-1.83), any stroke (HR=2.04, 95%CI=1.82-2.29), atrial fibrillation (HR=1.58, 95%CI=1.40-1.77), and MI (HR=1.64, 95%CI=1.37-1.96) compared to non-narcolepsy patients. Conclusion Using a large representative commercial insurance claims database, our study provides evidence that narcolepsy is an independent risk factor of CVD after comprehensive matching and adjustment for relevant confounders, including sleep apnea. Support (if any) This study was supported by the Sleep Research Society Foundation (Grant #: 23-FRA-001).

  PublisherDOI

• Comparative Safety of Long‐Acting vs. Short‐Acting Erythropoiesis‐Stimulating Agents Among Patients Undergoing Hemodialysis

  Clinical Pharmacology & Therapeutics · 2024-04-17 · 6 citations

  article

  Both short-acting (epoetin alfa or beta) and long-acting (darbepoetin alfa or PEG-epoetin) erythropoiesis-stimulating agents (ESAs) are commonly prescribed for patients with kidney failure undergoing maintenance hemodialysis. We compared the risks of major adverse cardiovascular events (MACE) and of all-cause mortality associated with receipt of short- vs. long-acting ESAs. This retrospective cohort analysis included Medicare hemodialysis beneficiaries aged ≥ 18 years in the United States Renal Data System from January 2015 to December 2017. We included adults who survived > 90 days after initiating hemodialysis and received either short- or long-acting ESAs. Outcomes were MACE (first occurrence of stroke, acute myocardial infarction, or cardiovascular-related mortality) and all-cause mortality. After stabilized inverse probability of treatment weighting, Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for each outcome. Of 68,607 patients (mean age: 65 years, 45% females), 33,658 (49%) received long-acting ESAs and 34,949 (51%) received short-acting ESAs. There was no difference in the risk of MACE associated with receipt of short- vs. long-acting ESAs (HR: 1.02 (95% CI: 0.98-1.08)). However, long-acting (vs. short-acting) ESA receipt was associated with a lower risk of all-cause mortality (HR: 0.91 (95% CI: 0.87-0.96)). Compared with short-acting ESAs, long-acting ESAs were associated with a lower risk of all-cause mortality, with no difference in the risk of MACE. Future studies with a longer follow-up are needed to confirm these findings.

  PublisherDOI

Frequent coauthors

• Haesuk Park

  University of Florida

  23 shared

• Steven M. Smith

  University of Florida

  18 shared

• Eric Dietrich

  University of Florida

  12 shared

• Jingchuan Guo

  Center for Drug Evaluation and Research

  12 shared

• David E. Winchester

  University of Florida

  10 shared

• Debbie L. Wilson

  University of Florida

  10 shared

• Christopher N. Kaufmann

  University of Florida

  8 shared

• H. Park

  8 shared