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When research on a particular compound comes almost exclusively from one geographic region and institutional network, there is inherent risk of confirmation bias, methodological preferences that favor positive findings, and results that may not generalize to other populations or research contexts

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Cardiovascular effects beyond cardiac hypertrophy are poorly characterized for IGF-1 DES specifically, though IGF-1 influences cardiovascular physiology through effects on vascular smooth muscle, endothelial function, blood pressure regulation, and cardiac contractility - chronic perturbation of these processes carries unknown risks

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