Abstract P1-09-09: Role of endocrine therapy in premenopausal patients with hormone receptor-positive metastatic breast cancer, compared with postmenopausal patients: Diachronic analyses from nationwide cohort in Korea (KCSG BR 14-07)

Background

Endocrine therapy (E) has a major role in treatment of hormone receptor (HR)-positive metastatic breast cancer (MBC). However, in contrast to western countries, premenopausal patients (PRE) more prevalent (50% of all breast cancer patients) and have less options of E than postmenopausal patients (POST) in Korea where the use of LHRH agonist in combination aromatase inhibitors (AIs) in PRE is restricted. Recently we have been successfully established nationwide cohort for the patients MBC (575 patients from 26 institutes). This study was designed to evaluate the role of E especially in PRE.

Methods

The patients with MBC were prospectively or retrospectively enrolled between September 2014 and May 2015. Only menopausal status-confirmed patients (296) were analyzed. Postmenopause was defined, based on NCCN guideline. Total duration of treatment was defined as the time from start day of any first treatment to end of any last treatment. Total duration of E was defined as the sum of time duration of each E. Overall survival was calculated from the start day of any treatment for MBC to any causes of death. This work is supported by National Strategic Coordinating Center for Clinical Research (H110C2020).

Results

A total of 296 patients with HR-positive MBC were analyzed [PRE, 169 (57.1%) and POST, 127 (42.9%)]. Except age (mean 44 and 60 years), baseline characteristics including in pathology, HER2 status, initial pathologic stage, de novo metastasis versus recurrence, surgery and adjuvant treatment (chemotherapy, endocrine therapy and radiotherapy) were well balanced. 92 (54.4%) of PRE and 77 (60.6%) of POST received at least one or more E through all treatment course. 41 (24.2%) of PRE and 44 (34.6%) received E as 1st-line treatment (p=0.034). Among PRE who received 1st-line of E, 30 (71.4%) and 9 (21.4%) of PRE received 2nd- and 3rd-line E. 20 (45.4%) and 10 (22.7%) of POST received 2nd- and 3rd- or more line of E. Most of PRE (54%) received tamoxifen+/-goserelin and 32% of PRE received AIs along with ovarian suppression. 71% of POST received AIs. As initial treatment, E was more frequently used in POST than in PRE (34.6% and 24.3%, p=0.053). Overall survival (OS) of all patients was 18.2 months (95% CI, 14.8-21.5). There was no difference in OS between PRE (17.8 months, 10.9-24.8) and POST (18.5 months, 95% CI, 13.2-23.9) (P=0.337). No difference of OS was observed (E, 18.1 moths, 95% CI, 13.0-23.3; chemotherapy 21.2 moths, 95% CI, 16.8-25.5), regardless of initial treatment. Total duration of treatment of PRE and POST were 15.2 and 13.6 months, respectively with no significant difference (p=0.389). PRE (8.3 moths, 95% CI,5.7-10.8) showed the trend toward longer duration of E in comparison with POST (5.5 moths, 95% CI,4.4-6.7), however the difference did not reach statistical significance (p=0.051).

Conclusion

E was more commonly used as 1st-line therapy in POST than in PRE. Although PRE had limited options of E, E was used in long duration of treatment especially in PRE. These findings suggested that E had a role in treatment for PRE with HR-positive MBC and could be used in treatment for PRE with good efficacy.

Citation Format: Kim T-Y, Ahn J-H, Yoon JH, Sohn JH, Kim GM, Lee KH, Park YH, Koh S-J, Lee SE, Chae Y, Lee KS, Lee KE, Won HS, Kim JH, Jeong J, Park KH, Cho EK, Im Y-H, Im S-A, Jung KH. Role of endocrine therapy in premenopausal patients with hormone receptor-positive metastatic breast cancer, compared with postmenopausal patients: Diachronic analyses from nationwide cohort in Korea (KCSG BR 14-07). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-09.

Abstract P1-16-08: Inhibition of β-catenin pathway to overcome endocrine resistance in breast cancer

Background: It is well known that Wnt/β-catenin signaling pathway is involved in hormone receptor negative breast cancer, especially triple-negative breast cancer. In the case of hormone resistant breast cancer cells, they rarely showed hormone receptor expression. So we aimed to investigate whether the β-catenin pathway becomes activated in endocrine-resistant breast cancer cells and inhibition of β-catenin pathway can overcome endocrine resistance.

Methods: We have established an MCF-7-derived tamoxifen-resistant cell line (TamR) by long-term culture of MCF-7 cells with gradually increasing 4-hydroxytamoxifen concentration till 3μM. The levels of protein expression and mRNA transcripts were determined using western blot analysis and real-time quantitative PCR. The transcriptional activity of β-catenin was measured using luciferase activity assay. We used ICG-001 as inhibitor of β-catenin transcription activity.

Results: The expression of estrogen receptor was significantly decreased in TamR cells. On the other hand, the expressions of HER2 and EGFR were increased in TamR cells than in control cells. The active (uncomplexed form) β-catenin level was increased in TamR cells, and also showed a significantly increased β-catenin transcriptional activity. The ICG-001, small-molecular inhibitor of Wnt/β-catenin pathway, treatment significantly reduced β-catenin transcriptional activity in TamR cells. The ICG-001 reduced cell viability fo TamR cells which showed resistance to tamoxifen by 65.3%, and also inhibited target gene cyclin D1 expression. The combination of ICG-001 and mTOR inhibitor, rapamycin reduced cell viability of TamR cells by 81.7% and there was an additive effect of two drugs as a combination index of 1.022.

Conclusions: The β-catenin pathway is activated in endocrine-resistant breast cancer cells and inhibition of that pathway would be a new therapeutic strategy which overcomes endocrine resistance in breast cancer.

Citation Format: Won HS, Lee KE, Lee KM, Nam EM, Mun Y-C, Seong C-M, Lee SN. Inhibition of β-catenin pathway to overcome endocrine resistance in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-16-08.

Abstract P6-10-03: Does participation in clinical trials influence on survival in patients with metastatic breast cancer?

Background

Recently, many clinical trials (TRIAL) especially incorporated with molecular-targeted agents are being conducted in treatment for breast cancer worldwide. However, the relation of participating clinical trials with survival has not been actively studied. This study was designed to evaluate whether participation in clinical trials could improve overall survival (OS) or not in patients with metastatic breast cancer (MBC), compared with conventional treatment.

Method

Korean Cancer Study Group (KCSG) has successfully established Nationwide Cohort in KOREA to conduct diachronic analysis (KCSG BR 14-07). Clinical data for patients with MBC were collected from this Cohort. OS was defined as the time duration from first diagnosis of metastasis to any cause of death. This work is supported by National Strategic Coordinating Center for Clinical Research (H110C2020).

Results

A total of 575 patients with metastatic breast from 26 institutes in KOREA cancer MBC were consequently enrolled between September 2014 and May 2015. 156 (27.1%) of patients were enrolled to at least one or more clinical trials and 419 patients received only conventional treatment (CONV). Age, hormone status, HER2 status, initial pathologic stage, metastasis versus recurrence, adjuvant treatment, ECOG performance status (PS) (0, 1 vs 2 or more) were similar between TRIAL and CONV. 30% of trials were associated with HER2-targeted agents. As initial treatment, chemotherapy was more frequently used in TRIAL (85.9%) than in CONV (79.0%) (P=0.038). Number of regimens of chemotherapy was greater in TRIAL (2.9+/-1.8) than CONV (2.1+/-1.6) (P<0.001). Number of regimens of endocrine therapy (E) was similar between TRIAL (1.4+/-0.6) and CONV (1.5+/-0.7) (P=0.474). Overall survival of all patients was 16.2 months (95% CI, 14.1-18.1). TRIAL showed significant prolongation of survival, compared with CONV [21.1 (95% CI, 17.7-24.6) vs 15.1 months (95% CI, 13.1-17.2); P=0.005]. The differences in OS was constantly observed in HER2-positive [23.8 (16.7-30.9) vs 17.2 months (95% CI, 12.4-21.9); P=0.018] and Triple-negative [15.4 (10.5-20.3) vs 12.0 months (95% CI, 10.2-13.8); P=0.025]. In multivariate analysis, initial metastasis, hormone status, ECOG PS did not influence on OS between TRIAL and CONV (P=0.849)

Conclusion

Participating in clinical trials could be associated with prolongation of survival. This results constantly maintained in HER2-positive and triple-negative MBC. These findings suggested that clinical trials are useful for the patients with MBC, even if the patients do not complete the standard treatment.

Citation Format: Kim T-Y, Sohn JH, Kim S-B, Yoon JH, Kim GM, Lee KH, Koh S-J, Park YH, Lee SE, Chae Y, Lee KS, Lee KE, Won HS, Kim JH, Jeong J, Park KH, Cho EK, Im Y-H, Im S-A, Jung KH. Does participation in clinical trials influence on survival in patients with metastatic breast cancer?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-03.

Oxidized Low-Density Lipoprotein and the Incidence of Proliferative Diabetic Retinopathy and Clinically Significant Macular Edema Determined From Fundus Photographs

IMPORTANCE

Studies have shown oxidized low-density lipoprotein to be associated with the incidence of proliferative retinopathy and other complications of type 1 diabetes mellitus. Because low-risk interventions are available to modify oxidized low-density lipoprotein, it is important to examine the relationships between this factor and the incidence of proliferative retinopathy and of macular edema, 2 important causes of visual impairment in people with type 1 diabetes.

OBJECTIVE

To determine the association of oxidized low-density lipoprotein with the worsening of diabetic retinopathy and the incidence of proliferative retinopathy and of macular edema.

DESIGN, SETTING, AND PARTICIPANTS

Of 996 participants with type 1 diabetes in the Wisconsin Epidemiologic Study of Diabetic Retinopathy, 730 were examined up to 4 times (1990-1992, 1994-1996, 2005-2007, and 2012-2014) over 24 years and had assays of oxidized low-density lipoprotein and fundus photographs gradable for diabetic retinopathy and macular edema. Analyses started July 2014 and ended February 2015.

MAIN OUTCOMES AND MEASURES

Worsening of diabetic retinopathy, incidence of proliferative diabetic retinopathy, and incidence of macular edema as assessed via grading of color stereo film fundus photographs. The levels of oxidized low-density lipoprotein collected from serum samples at the time of each examination were measured in 2013 and 2014 from frozen serum.

RESULTS

The cohort at baseline had a mean (SD) level of oxidized low-density lipoprotein of 30.0 (8.5) U/L. While adjusting for duration of diabetes, glycated hemoglobin A1c level, and other factors, we found that neither the level of oxidized low-density lipoprotein at the beginning of a period nor the change in it over a certain period was associated with the incidence of proliferative diabetic retinopathy (hazard ratio [HR], 1.11 [95% CI, 0.91-1.35], P = .30; odds ratio [OR], 1.77 [95% CI, 0.99-3.17], P = .06), the incidence of macular edema (HR, 1.04 [95% CI, 0.83-1.29], P = .74; OR, 1.08 [95% CI, 0.44-2.61], P = .87), or the worsening of diabetic retinopathy (HR, 0.94 [95% CI, 0.83-1.07], P = .34; OR, 1.32 [95% CI, 0.83-2.09], P = .24).

CONCLUSIONS AND RELEVANCE

Our findings do not provide evidence for a relationship between increasing levels of serum oxidized low-density lipoprotein and the incidence of macular edema or the worsening of diabetic retinopathy in persons with type 1 diabetes. The potential increase in the HR for incident proliferative retinopathy, with an increase in oxidized low-density lipoprotein level over the preceding period, warrants further investigation of this relationship.

Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients

OBJECTIVES

We investigated whether systemic lupus erythematosus (SLE) patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients.

METHODS

We enrolled 201 SLE patients with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: juvenile-onset SLE (JSLE, diagnosed at ≤ 18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and late-onset SLE (LSLE, diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings.

RESULTS

Of the 201 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcers, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p < 0.05, < 0.05, 0.001, < 0.05, and < 0.05, respectively). However, Sjögren's syndrome was more frequent in LSLE patients than JSLE or ASLE patients (p < 0.05). Disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p < 0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p < 0.05 and 0.005, respectively) and decreased complement levels were more common in JSLE patients and less common in LSLE patients (p < 0.001, 0.001, and < 0.05, respectively).

CONCLUSIONS

Our results indicate that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have more severe disease activity and more frequent renal involvement and LSLE patients have milder disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset.

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

BACKGROUND AND PURPOSE

Medullary thyroid carcinoma is an uncommon malignancy that is challenging to diagnose. Our aim was to present our experience using core needle biopsy for the diagnosis of medullary thyroid carcinoma compared with fine-needle aspiration.

MATERIALS AND METHODS

Between January 2000 and March 2012, 202 thyroid nodules in 191 patients were diagnosed as medullary thyroid cancer by using sonography-guided fine-needle aspiration, core needle biopsy, or surgery. One hundred eighty-three thyroid nodules in 172 patients were included on the basis of the final diagnosis. We evaluated the sensitivity and positive predictive value of fine-needle aspiration and core needle biopsy for the diagnosis of medullary thyroid cancer. We compared the rate of a delayed diagnosis, a diagnostic surgery, and surgery with an incorrect diagnosis for fine-needle aspiration and core needle biopsy and investigated the factors related to the fine-needle aspiration misdiagnosis of medullary thyroid cancer.

RESULTS

Fine-needle aspiration showed 43.8% sensitivity and 85.1% positive predictive value for the diagnosis of medullary thyroid cancer; 25.7% (44/171) of patients had a delayed diagnosis, while 18.7% (32/171) underwent an operation for accurate diagnosis, and 20.5% (35/171) underwent an operation with an incorrect diagnosis. Core needle biopsy achieved 100% sensitivity and positive predictive value without a delay in diagnosis (0/22), the need for a diagnostic operation (0/22), or an operation for an incorrect diagnosis (0/22). A calcitonin level of <100 pg/mL was the only significant factor for predicting the fine-needle aspiration misdiagnosis of medullary thyroid cancer (P = .034).

CONCLUSIONS

Core needle biopsy showed a superior sensitivity and positive predictive value to fine-needle aspiration and could optimize the surgical management in patients with medullary thyroid cancer. Because the ability of fine-needle aspiration to diagnose medullary thyroid cancer significantly decreases in patients with serum calcitonin levels of <100 pg/mL, core needle biopsy could be indicated for these patients to optimize their surgical management.

Severity of age-related macular degeneration in 1 eye and the incidence and progression of age-related macular degeneration in the fellow eye: the Beaver Dam Eye Study

IMPORTANCE

Previous studies regarding the severity of age-related macular degeneration (AMD) in 1 eye and its prognostic implications for the fellow eye have focused on the incidence of neovascular AMD in the fellow eye of participants with neovascular AMD in the other eye. It is unclear to what extent the severity of AMD in 1 eye affects the incidence, progression, and regression of AMD in its fellow eye across the entire range of AMD severity.

OBJECTIVE

To investigate the effect of the severity of AMD in 1 eye on the incidence, progression, and regression of AMD in the fellow eye.

DESIGN, SETTING AND PARTICIPANTS

The Beaver Dam Eye Study is a longitudinal population-based study of age-related eye diseases conducted in the city and township of Beaver Dam, Wisconsin. Examinations were performed every 5 years over a 20-year period (from the baseline examination in 1988-1990 to 2008-2010). Study participants (n = 4379) were 43 to 86 years of age at the baseline examination. At baseline and in up to 4 subsequent examinations, retinal photographs were taken.

MAIN OUTCOMES AND MEASURES

Incidence, progression, and regression of AMD (assessed by use of the Wisconsin Age-Related Maculopathy Grading System on retinal photographs and adjusted for age, sex, and the Y402H polymorphism in the complement factor H gene on chromosome 1q) and mortality.

RESULTS

More severe AMD in 1 eye was associated with increased incidence of AMD and accelerated progression in its fellow eye (levels 1-2: hazard ratio [HR], 4.90 [95% CI, 4.26-5.63]; levels 2-3: HR, 2.09 [95% CI, 1.42-3.06]; levels 3-4: HR, 2.38 [95% CI, 1.74-3.25]; levels 4-5: HR, 2.46 [95% CI, 1.65-3.66]). Less severe AMD in 1 eye was associated with less progression of AMD in its fellow eye (levels 2-3: HR, 0.42 [95% CI, 0.33-0.55]; levels 3-4: HR, 0.50 [95% CI, 0.34-0.83]). We estimate that 51% of participants who develop any AMD always maintain AMD severity states within 1 step of each other between eyes; 90% of participants stay within 2 steps.

CONCLUSIONS AND RELEVANCE

Using multistate models, we show that AMD severity in 1 eye tracks AMD severity in its fellow eye.

Exome array analysis identifies CAV1/CAV2 as a susceptibility locus for intraocular pressure

PURPOSE

Intraocular pressure (IOP) is an important clinical parameter in the evaluation of ocular health. Elevated IOP is a major risk factor for primary open-angle glaucoma (POAG). The goal of this study was to identify rare and less common variants that influence IOP.

METHODS

We performed an exome array analysis in a subset of 1660 individuals from a population-based cohort, the Beaver Dam Eye Study. Associations with IOP were tested on 45,849 single nucleotide variants and 12,390 autosomal genes across the genome.

RESULTS

Intraocular pressure was suggestively associated with novel variants located in FAR2 at 12p11.22 (rs4931170, P = 1.2 × 10(-5)), in GGA3 at 17q25.1 (rs52809447, P = 6.7 × 10(-5)), and in PKDREJ at 22q13.31 (rs7291444, P = 7.4 × 10(-5)). Gene-based analysis found suggestive associations between IOP and the genes HAP1, MTBP, FREM3, and PHF12. We successfully replicated the associations with GAS7 (P = 7.4 × 10(-3)) for IOP, and also identified a previously reported POAG locus in the CAV1/CAV2 region to be associated with IOP (P = 3.3 × 10(-3)). This association was confirmed in a meta-analysis with three published genome-wide association studies (Pcombined = 4.0 × 10(-11)).

CONCLUSIONS

Our results suggest that novel genetic variants and genes with multiple, less common variants may play a role in the control of IOP. The implication of the caveolin genes, CAV1/CAV2, as a common genetic factor influencing both IOP variations and POAG may provide new insights of the underlying mechanism leading to glaucoma and glaucomatous visual field loss.

Harmonizing the classification of age-related macular degeneration in the three-continent AMD consortium

PURPOSE

To describe methods to harmonize the classification of age-related macular degeneration (AMD) phenotypes across four population-based cohort studies: the Beaver Dam Eye Study (BDES), the Blue Mountains Eye Study (BMES), the Los Angeles Latino Eye Study (LALES), and the Rotterdam Study (RS).

METHODS

AMD grading protocols, definitions of categories, and grading forms from each study were compared to determine whether there were systematic differences in AMD severity definitions and lesion categorization among the three grading centers. Each center graded the same set of 60 images using their respective systems to determine presence and severity of AMD lesions. A common 5-step AMD severity scale and definitions of lesion measurement cutpoints and early and late AMD were developed from this exercise.

RESULTS

Applying this severity scale changed the age-sex adjusted prevalence of early AMD from 18.7% to 20.3% in BDES, from 4.7% to 14.4% in BMES, from 14.1% to 15.8% in LALES, and from 7.5% to 17.1% in RS. Age-sex adjusted prevalences of late AMD remained unchanged. Comparison of each center's grades of the 60 images converted to the consortium scale showed that exact agreement of AMD severity among centers varied from 61.0-81.4%, and one-step agreement varied from 84.7-98.3%.

CONCLUSION

Harmonization of AMD classification reduced categorical differences in phenotypic definitions across the studies, resulted in a new 5-step AMD severity scale, and enhanced similarity of AMD prevalence among the four cohorts. Despite harmonization it may still be difficult to remove systematic differences in grading, if present.

Lipids, lipid genes, and incident age-related macular degeneration: the three continent age-related macular degeneration consortium

PURPOSE

To describe associations of serum lipid levels and lipid pathway genes to the incidence of age-related macular degeneration (AMD).

DESIGN

Meta-analysis.

METHODS

setting: Three population-based cohorts. population: A total of 6950 participants from the Beaver Dam Eye Study (BDES), Blue Mountains Eye Study (BMES), and Rotterdam Study (RS). observation procedures: Participants were followed over 20 years and examined at 5-year intervals. Hazard ratios associated with lipid levels per standard deviation above the mean or associated with each additional risk allele for each lipid pathway gene were calculated using random-effects inverse-weighted meta-analysis models, adjusting for known AMD risk factors. main outcome measures: Incidence of AMD.

RESULTS

The average 5-year incidences of early AMD were 8.1%, 15.1%, and 13.0% in the BDES, BMES, and RS, respectively. Substantial heterogeneity in the effect of cholesterol and lipid pathway genes on the incidence and progression of AMD was evident when the data from the 3 studies were combined in meta-analysis. After correction for multiple comparisons, we did not find a statistically significant association between any of the cholesterol measures, statin use, or serum lipid genes and any of the AMD outcomes in the meta-analysis.

CONCLUSION

In a meta-analysis, there were no associations of cholesterol measures, history of statin use, or lipid pathway genes to the incidence and progression of AMD. These findings add to inconsistencies in earlier reports from our studies and others showing weak associations, no associations, or inverse associations of high-density lipoprotein cholesterol and total cholesterol with AMD.

GWAS identifies an NAT2 acetylator status tag single nucleotide polymorphism to be a major locus for skin fluorescence

AIMS/HYPOTHESIS

Skin fluorescence (SF) is a non-invasive marker of AGEs and is associated with the long-term complications of diabetes. SF increases with age and is also greater among individuals with diabetes. A familial correlation of SF suggests that genetics may play a role. We therefore performed parallel genome-wide association studies of SF in two cohorts.

METHODS

Cohort 1 included 1,082 participants, 35-67 years of age with type 1 diabetes. Cohort 2 included 8,721 participants without diabetes, aged 18-90 years.

RESULTS

rs1495741 was significantly associated with SF in Cohort 1 (p < 6 × 10(-10)), which is known to tag the NAT2 acetylator phenotype. The fast acetylator genotype was associated with lower SF, explaining up to 15% of the variance. In Cohort 2, the top signal associated with SF (p = 8.3 × 10(-42)) was rs4921914, also in NAT2, 440 bases upstream of rs1495741 (linkage disequilibrium r (2) = 1.0 for rs4921914 with rs1495741). We replicated these results in two additional cohorts, one with and one without type 1 diabetes. Finally, to understand which compounds are contributing to the NAT2-SF signal, we examined 11 compounds assayed from skin biopsies (n = 198): the fast acetylator genotype was associated with lower levels of the AGEs hydroimidazolones of glyoxal (p = 0.017).

CONCLUSIONS/INTERPRETATION

We identified a robust association between NAT2 and SF in people with and without diabetes. Our findings provide proof of principle that genetic variation contributes to interindividual SF and that NAT2 acetylation status plays a major role.

Prediction of genetic contributions to complex traits using whole genome sequencing data

Although markers identified by genome-wide association studies have individually strong statistical significance, their performance in prediction remains limited. Our goal was to use animal breeding genomic prediction models to predict additive genetic contributions for systolic blood pressure (SBP) using whole genome sequencing data with different validation designs. The additive genetic contributions of SBP were estimated via linear mixed model. Rare variants (MAF<0.05) were collapsed through the k-means method to create a "collapsed single-nucleotide polymorphisms." Prediction of the additive genomic contributions of SBP was conducted using genomic Best Linear Unbiased Predictor (GBLUP) and BayesCπ. Estimates of predictive accuracy were compared using common single-nucleotide polymorphisms (SNPs) versus common and collapsed SNPs, and for prediction within and across families. The additive genetic variance of SBP contributed to 18% of the phenotypic variance (h(2) = 0.18). BayesCπ had slightly better prediction accuracies than GBLUP. In both models, within-family predictions had higher accuracies both in the training and testing set than didacross-family design. Collapsing rare variants via the k-means method and adding to the common SNPs did not improve prediction accuracies. The prediction model, including both pedigree and genomic information, achieved a slightly higher accuracy than using either source of information alone. Prediction of genetic contributions to complex traits is feasible using whole genome sequencing and statistical methods borrowed from animal breeding. The relatedness of individuals between the training and testing set strongly affected the performance of prediction models. Methods for inclusion of rare variants in these models need more development.

Measures of body shape and adiposity as related to incidence of age-related eye diseases: observations from the Beaver Dam Eye Study

PURPOSE

To examine the effect of obesity on the incidence of age-related eye disease.

METHODS

Participants of the Beaver Dam Eye Study were examined every 5 years over a 20-year period (1988-1990 through 2008-2010). Lens and fundus photographs were used to evaluate presence and severity of cataract and macular degeneration. Height and weight were measured at all examinations. Waist and hip circumference were measured at all examinations beginning at the first follow-up (1993-1995). Models of ocular outcomes over 15 years were stratified by sex and smoking status.

RESULTS

Overall, 2641 participants contributed 5567 person-visits to 15-year incidence analysis. Female nonsmokers had increased risk of late AMD associated with higher body mass index (BMI; hazard ratio [HR] per 2.5 kg/m(2) 1.31, 95% confidence interval [CI] 1.15-1.50, P < 0.001), waist to hip ratio (HR per 0.1 cm/cm 1.95, 95% CI 1.33-2.86, P < 0.001), waist circumference (HR per 5 cm 1.21, 95% CI 1.10-1.34, P < 0.001), and waist to height ratio (HR per 0.1 cm/cm 1.74, 95% CI 1.31-2.31, P < 0.001). Increased BMI was also associated with early AMD in female nonsmokers (HR 1.10, 95% CI 1.02-1.19, P = 0.02).

CONCLUSIONS

Female nonsmokers had risk of late AMD associated with increasing measures of greater obesity and increased risk of early AMD associated with greater BMI.

Misclassification can explain most apparent regression of age-related macular degeneration: results from multistate models with misclassification

PURPOSE

To investigate the impact of misclassification of age-related macular degeneration (AMD) on the baseline intensity and estimated effects of age, sex, and the Y402H variant in the complement factor H (CFH) gene on incidence, progression, and regression of AMD.

METHODS

The Beaver Dam Eye Study, a longitudinal population-based study of age-related eye diseases conducted in the city and township of Beaver Dam, Wisconsin, performed examinations every 5 years during a 20-year period (1988-1990 through 2008-2010). Study participants (N = 4379) aged 43 to 86 years at the baseline examination had retinal photographs taken at baseline and up to four subsequent examinations. Multistate models with misclassification in continuous time were used to model the effects of age, sex, and CFH genotype on incidence, progression, and regression of AMD and mortality.

RESULTS

After accounting for AMD misclassification, the occurrence of any AMD regression was rare (1%-4%), while it was relatively common (14%-21%) in models that do not account for misclassification. Failure to account for misclassification attenuated estimated age effects on incidence and progression to moderately severe early AMD and attenuated estimated CFH effects on incidence and progressions to moderately severe and severe early AMD.

CONCLUSIONS

Apparent regression of AMD can largely, if not completely, be explained by misclassification. Estimated age effects on incidence and progression to moderately severe early AMD and estimated CFH effects on incidence and progressions to moderately severe and severe early AMD were attenuated in multistate models that did not account for misclassification.

Association of gene polymorphisms with the risk of warfarin bleeding complications at therapeutic INR in patients with mechanical cardiac valves

WHAT IS KNOWN AND OBJECTIVE

Pharmacogenetic studies of the genetic regulation of warfarin dose requirement have been reported, but few have been on the bleeding complications at therapeutic international normalized ratio (INR). This study aimed to evaluate the effect of gene polymorphisms of CYP2C9, VKORC1, thrombomodulin (THBD) and C-reactive protein (CRP) on the risk of bleeding complications of warfarin at therapeutic INR in Korean patients with mechanical cardiac valves.

METHODS

A retrospective warfarin pharmacogenetic association study was performed. One hundred and forty-two patients with mechanical cardiac valves who were on warfarin anticoagulation therapy and maintained INR levels of 2·0-3·0 for 3 consecutive time intervals were followed up. CYP2C9 rs1057910, VKORC1 rs9934438, CRP rs1205, THBD rs1042580 and THBD rs3176123 were genotyped. The association between genotypes and warfarin bleeding complications was evaluated using logistic regression analysis, adjusted for demographic and clinical factors.

RESULTS AND DISCUSSION

Of 142 eligible patients, 21 patients (14·8%) had bleeding complications at therapeutic INR. Patients with the G allele in THBD rs1042580 (AG or GG) had a lower risk of bleeding than patients with the AA genotype (adjusted OR: 0·210, 95% CI: 0·050-0·875, P = 0·032). The THBD rs3176123 polymorphism did not show any association with bleeding. For CRP rs1205, patients with the A allele (GA or AA genotype) had a higher risk of bleeding than patients with the GG genotype (adjusted OR: 5·575, 95% CI: 1·409-22·058, P = 0·014). Variant VKORC1 and CYP2C9 genotypes did not confer a significant increase in the risk for bleeding complications.

WHAT IS NEW AND CONCLUSIONS

As expected, no association could be found between bleeding complications and two dose-related genes (CYP2C9*3 and VKORC1 rs9934438). In contrast, our results suggest that two genetic markers (THBD rs1042580 and CRP rs1205) could be predictors of bleeding complications of warfarin at normal INR. Given the retrospective study design and the relatively small sample size, our hypothesis requires further independent validation using more robust prospective designs. However, additional retrospective studies similar to ours but in populations with different genetic backgrounds should also be useful.

Relation of smoking, drinking, and physical activity to changes in vision over a 20-year period: the Beaver Dam Eye Study

OBJECTIVE

To describe the relationships of lifestyle characteristics to changes in vision and incidence of visual impairment (VI) over a 20-year period in the Beaver Dam Eye Study (BDES).

DESIGN

Longitudinal, population-based cohort study.

PARTICIPANTS

A cohort of 4926 persons aged 43 to 86 years participated in the baseline examinations in 1988-1990, and 3721, 2962, 2375, and 1913 persons participated in follow-up examinations in 1993-1995, 1998-2000, 2003-2005, and 2008-2010, respectively.

METHODS

Best-corrected visual acuity (BCVA) measured by a modified Early Treatment Diabetic Retinopathy Study protocol.

MAIN OUTCOME MEASURES

Change in number of letters read correctly and incidence of VI based on BCVA in the better eye assessed at each examination over a 20-year period.

RESULTS

The 20-year cumulative incidence of VI was 5.4%. There was a mean loss of 1.6 letters between examinations, with a 20-year loss of 6.6 letters. While adjusting for age, income, and age-related macular degeneration (AMD) severity, being a current or past smoker was related to a greater change in the numbers of letters lost. Persons who had not consumed alcoholic beverages over the past year and sedentary persons had higher odds of incident VI than persons who drank occasionally or who were physically active. For example, in women with early AMD and annual household income less than $10,000, the estimated 20-year cumulative incidence of VI in those who drank occasionally and were physically active was 5.9% compared with 25.8% in women who had not consumed alcoholic beverages over the past year and were sedentary.

CONCLUSIONS

Three modifiable behaviors-smoking, drinking alcohol, and physical activity-were associated with changes in vision. Further evidence that changes in these behaviors will result in less loss of vision is needed because of the expected increase in the burden of VI due to the aging of the population.

Risk for end-stage renal disease over 25 years in the population-based WESDR cohort

OBJECTIVE

In the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) cohort, we sought to examine whether a decline in the prevalence and incidence of end-stage renal disease (ESRD) was evident with increasing calendar year of type 1 diabetes diagnosis among people followed for 25 years. Factors associated with the hazard of incident ESRD that may mediate a decline were also investigated.

RESEARCH DESIGN AND METHODS

Participants were examined at baseline in 1980 (n = 996) and at 4-25 years of follow-up. ESRD was defined by self-reported renal transplant or dialysis. Cumulative incidence with competing risk of death was determined. Incident ESRD was modeled by period of diagnosis, adjusting for other known risk factors using discrete time hazard models.

RESULTS

When diabetes was diagnosed during 1970-1980, the unadjusted cumulative incidence of ESRD at 25 years was 9.3%. The unadjusted hazard of ESRD was reduced by 70% (P < 0.001), compared with those diagnosed with diabetes in 1922-1969; however, the association was attenuated by glycosylated hemoglobin level (HbA1c), systolic blood pressure, and antihypertensive use (hazard ratio [HR] 0.89 [95% CI 0.55-1.45]). HbA1c, age, and male sex remained associated with ESRD hazard after adjustment for kidney function and proliferative retinopathy.

CONCLUSIONS

A lower incidence of ESRD among those more recently diagnosed with type 1 diabetes was explained by improvements in glycemic and blood pressure control over the last several decades. Intensive diabetes management, especially for glycemic control, remains important even in long-standing diabetes as it may delay the development of ESRD.

Oligodontia and curly hair occur with ectodysplasin-a mutations

Oligodontia is the developmental absence of more than 5 permanent teeth except for the third molar. Familial oligodontia can occur as an isolated form or as part of a genetic syndrome. Mutations in the MSX1, PAX9, AXIN2, EDA, and WNT10A genes have been identified in familial non-syndromic oligodontia. Ectodermal dysplasia is a group of syndromes involving abnormalities of the ectodermal structures and is comprised of more than 150 different forms. Mutations in the ectodysplasin-A (EDA) gene have been associated with X-linked hypohidrotic ectodermal dysplasia, and partial disruption of the EDA signaling pathway has been shown to cause an isolated form of oligodontia. We identified 2 X-linked oligodontia families and performed mutational analysis of the EDA gene. The mutational analysis revealed 2 novel EDA mutations: c.866G>T, p.Arg289Leu and c.1135T>G, p.Phe379Val (reference sequence NM_001399.4). These mutations were perfectly segregated with oligodontia and curly hair within each family and were not found in the 150 control X-chromosomes with the same ethnic background and in the exome variant server. This study broadens the mutational spectrum of the EDA gene and the understanding of X-linked oligodontia with curly hair.

Place-based exposure and cataract risk in the Beaver Dam cohort

According to the Centers for Disease Control and Prevention, with an aging U.S. population an estimated 30 million people will be diagnosed with cataract by 2020. Several modifiable risk factors have been identified for nuclear cataract, cortical cataract, and posterior subcapsular cataract (PSC), including smoking, diabetes, and steroid medications. In the study described here, the authors evaluated residential location as a potential proxy of risk factors for cataracts in the Beaver Dam Eye Study cohort established in 1987. Cataract risk was calculated using general estimating equation modeling to account for correlation between eyes. Fifteen-year cumulative incidence rates were calculated for each type of cataract by eye. Of the 4926 study participants, 3253 seen at the baseline examination were included in the analyses. Compared to urban residents, the odds ratio (95% confidence interval) for rural participants' risk of cortical, nuclear, and PSC was 0.92 (0.73, 1.16), 0.85 (0.69, 1.06), and 0.71 (0.48, 1.05), respectively, adjusting for age, sex, educational status, and smoking status. The lowest cumulative incidences were for those living in rural areas, compared to edge or urban areas for all three types of cataracts.

Germline mutations and genotype-phenotype correlations in patients with apparently sporadic pheochromocytoma/paraganglioma in Korea

The aim of our study was to assess the frequency of germline mutations and develop the genetic testing strategy in patients with apparently sporadic pheochromocytoma/paraganglioma (PPGL) in Korea. We included 53 patients diagnosed with non-syndromic PPGL without a family history of PPGLs in three referral centers from 2004 to 2011. Succinate dehydrogenase complex B (SDHB), SDHD, Von Hippel-Lindau (VHL), and rearranged during transfection (RET) genes were examined by direct sequencing and multiple ligation-dependent probe amplification. The study patients were composed of 26 men and 27 women, and mean age was 50.1 ± 13.5 years. The frequency of germline mutations was 13.2% (7/53): RET (n = 2), VHL (n = 1), SDHB (n = 2), and SDHD (n = 2). Six of seven mutation carriers were diagnosed before the age of 50. One of two patients harboring an SDHB mutation had malignant PPGLs. One patient with multifocal head and neck paraganglioma (PGL) and pheochromocytoma (PHEO) carried a SDHD mutation. The carriers of germline mutations in patients with apparently sporadic PPGL were 13.2% in our study. We recommend genetic testing in patients below 50 years and SDHD genetic testing in patients with multifocal PPGLs. In malignant PPGLs, SDHB genetic testing may be performed.

Prediction of age-related macular degeneration in the general population: the Three Continent AMD Consortium

PURPOSE

Prediction models for age-related macular degeneration (AMD) based on case-control studies have a tendency to overestimate risks. The aim of this study is to develop a prediction model for late AMD based on data from population-based studies.

DESIGN

Three population-based studies: the Rotterdam Study (RS), the Beaver Dam Eye Study (BDES), and the Blue Mountains Eye Study (BMES) from the Three Continent AMD Consortium (3CC).

PARTICIPANTS

People (n = 10,106) with gradable fundus photographs, genotype data, and follow-up data without late AMD at baseline.

METHODS

Features of AMD were graded on fundus photographs using the 3CC AMD severity scale. Associations with known genetic and environmental AMD risk factors were tested using Cox proportional hazard analysis. In the RS, the prediction of AMD was estimated for multivariate models by area under receiver operating characteristic curves (AUCs). The best model was validated in the BDES and BMES, and associations of variables were re-estimated in the pooled data set. Beta coefficients were used to construct a risk score, and risk of incident late AMD was calculated using Cox proportional hazard analysis. Cumulative incident risks were estimated using Kaplan-Meier product-limit analysis.

MAIN OUTCOME MEASURES

Incident late AMD determined per visit during a median follow-up period of 11.1 years with a total of 4 to 5 visits.

RESULTS

Overall, 363 participants developed incident late AMD, 3378 participants developed early AMD, and 6365 participants remained free of any AMD. The highest AUC was achieved with a model including age, sex, 26 single nucleotide polymorphisms in AMD risk genes, smoking, body mass index, and baseline AMD phenotype. The AUC of this model was 0.88 in the RS, 0.85 in the BDES and BMES at validation, and 0.87 in the pooled analysis. Individuals with low-risk scores had a hazard ratio (HR) of 0.02 (95% confidence interval [CI], 0.01-0.04) to develop late AMD, and individuals with high-risk scores had an HR of 22.0 (95% CI, 15.2-31.8). Cumulative risk of incident late AMD ranged from virtually 0 to more than 65% for those with the highest risk scores.

CONCLUSIONS

Our prediction model is robust and distinguishes well between those who will develop late AMD and those who will not. Estimated risks were lower in these population-based studies than in previous case-control studies.

Changing incidence of lens extraction over 20 years: the Beaver Dam eye study

OBJECTIVE

To investigate trends in the incidence of lens extraction over the past 20 years.

DESIGN

Longitudinal population-based cohort study.

PARTICIPANTS

Persons who participated in the Beaver Dam Eye Study.

METHODS

Eligible persons 43 to 84 years of age living in the city or township of Beaver Dam, Wisconsin, were recruited from 1987 through 1988. Participants were followed up every 5 years from 1993 through 1995, from 1998 through 2000, from 2003 through 2005, and from 2008 through 2010 after the baseline examination from 1988 through 1990. Examinations consisted of ocular examination with lens photography and grading; medical history; and measurements of blood pressure, height, and weight. Adjustments were made for age and gender. Values of risk variables were updated, and the incidence of lens extraction surgery was calculated in each 5-year interval.

MAIN OUTCOME MEASURES

Incidence of lens extraction with regard to presence of clinically significant lens opacity and visual function.

RESULTS

Age- and gender-adjusted incidence of lens extraction increased over the 4 intervals from 1.8% (95% confidence interval [CI], 1.3%-2.5%) in the interval between the first and second study examinations to 11.7% (95% CI, 9.9%-13.8%) in the most recent study interval. The increase in incidence of surgery was significantly higher at successive intervals in persons without clinically significant lens opacity at each preceding examination (interval 1, 0.8% [95% CI, 0.6%-1.1%]; interval 4, 9.4% [95% CI, 7.8%-11.2%]) compared with persons with at least 1 detectable type of opacity (interval 1, 9.2% [95% CI, 6.4%-13.2%]; interval 4, 16.5% [95% CI, 13.4%-20.0%]). Recency of examination was not attenuated by adjusting for additional risk factors. There was no evidence that the increased incidence in surgery was preceded by poorer visual acuity, near vision, or contrast sensitivity at the beginning of each interval.

CONCLUSIONS

The incidence of lens extraction has increased over the past 20 years in persons older than 65 years. The relative increase of surgery is higher in those without any clinically significant lens opacity and in persons with visual acuity better than 20/40 at an examination as measured 5 years before observed incidence of lens extraction.

Risk alleles in CFH and ARMS2 and the long-term natural history of age-related macular degeneration: the Beaver Dam Eye Study

OBJECTIVE

To describe the relationships of risk alleles in complement factor H (CFH, rs1061170) and age-related maculopathy susceptibility 2 (ARMS2, rs10490924) to the incidence and progression of age-related macular degeneration (AMD) during a 20-year period.

METHODS

There were 4282 persons aged 43 to 86 years at the baseline examination in 1988-1990 enrolled in a population-based cohort study who participated in at least 1 examination spaced 5 years apart during a 20-year period and had gradable fundus photographs for AMD and genotype information on CFH and ARMS2. Low, intermediate, and high genetic risk for AMD was defined by the presence of 0 to 1, 2, or 3 to 4 risk alleles for CFH and ARMS2, respectively. Multistate models were used to estimate the progression of AMD throughout the entire age range.

RESULTS

There were 2820 (66%), 1129 (26%), and 333 persons (8%) with low, intermediate, and high genetic risk for AMD, respectively. The 5-year incidences of early and late AMD were 9.1% and 1.6%, respectively, and increased with age but did not differ significantly by sex. Using the multistate model, of persons aged 45 years with no AMD in the low, intermediate, and high AMD genetic risk groups, 33.0%, 39.9%, and 46.5%, respectively, were estimated to develop early AMD, and 1.4%, 5.2%, and 15.3% were estimated to develop late AMD by age 80 years.

CONCLUSIONS

These population-based data provide estimates of the long-term risk of the incidence and progression of AMD and its lesions by age and genetic risk alleles for CFH and ARMS2. They also show that when early AMD is present, knowing the phenotype contributes more to risk assessment than knowing the genetic risk based on these 2 AMD genes.

Seven new loci associated with age-related macular degeneration

Age-related macular degeneration (AMD) is a common cause of blindness in older individuals. To accelerate the understanding of AMD biology and help design new therapies, we executed a collaborative genome-wide association study, including >17,100 advanced AMD cases and >60,000 controls of European and Asian ancestry. We identified 19 loci associated at P < 5 × 10(-8). These loci show enrichment for genes involved in the regulation of complement activity, lipid metabolism, extracellular matrix remodeling and angiogenesis. Our results include seven loci with associations reaching P < 5 × 10(-8) for the first time, near the genes COL8A1-FILIP1L, IER3-DDR1, SLC16A8, TGFBR1, RAD51B, ADAMTS9 and B3GALTL. A genetic risk score combining SNP genotypes from all loci showed similar ability to distinguish cases and controls in all samples examined. Our findings provide new directions for biological, genetic and therapeutic studies of AMD.

Nitrate-nitrogen levels in rural drinking water: Is there an association with age-related macular degeneration?

We examined the association of nitrate-nitrogen exposure from rural private drinking water and incidence of age-related macular degeneration (AMD). All participants in the Beaver Dam Eye Study (53916 improvement plan code) completed a questionnaire and had an ocular examination including standardized, graded fundus photographs at five examinations. Only information from rural residents in that study are included in this report. Data from an environmental monitoring study with probabilistic-based agro-chemical sampling, including nitrate-nitrogen, of rural private drinking water were available. Incidence of early AMD was associated with elevated nitrate-nitrogen levels in rural private drinking water supply (10.0% for low, 19.2% for medium, and 26.1% for high nitrate-nitrogen level in the right eye). The odds ratios (ORs) were 1.77 (95% confidence interval [CI]: 1.12-2.78) for medium and 2.88 (95% CI: 1.59-5.23) for high nitrate-nitrogen level. Incidence of late AMD was increased for those with medium or high levels of nitrate-nitrogen compared to low levels (2.3% for low and 5.1% for the medium or high nitrate-nitrogen level, for the right eye). The OR for medium or high nitrate-nitrogen groups was 2.80 (95% CI: 1.07-7.31) compared to the low nitrate-nitrogen group.

Association of oxidative stress with mortality: the Beaver Dam Eye Study

Epidemiological studies have shown that oxidative stress is associated with cardiovascular disease (CVD) and diabetes. However, the association of oxidative stress marker with non-CVD and CVD mortality has not been extensively evaluated. The association of baseline serum 8-isoprostane (8-ISO) with all-cause, non-CVD, and CVD mortality was examined in a random subset (n = 1,753) of a population-based study of 4,926 adults (99% non-Hispanic whites; 56% women) aged 43-86 years from the Beaver Dam Eye Study. Cause of death was ascertained by death certificate between 1987 and 2002. 8-ISO was measured by immunoassay. Cox proportional hazards regression analysis was used to estimate mortality hazard ratios (HRs) and 95% confidence intervals (CIs) by one 8-ISO standard deviation. During a median follow-up of 13.1 years, 590 (33.7%) participants died (290 CVD deaths). After adjusting for socio-demographics and CVD risk factors, 8-ISO was significantly associated with all-cause (HR = 1.1, 95% CI 1.01-1.2) and non-CVD (HR = 1.14, 95% CI 1.01-1.28) mortality but not with CVD mortality (HR = 1.06, 95% CI 0.93-1.2). When limited to participants with BMI < 25 kg/m², individuals in the highest 8-ISO quartile had approximately 34 to 36% increased risk of all-cause, non-CVD, and CVD death compared to those at the lowest quartile. In contrast, 8-ISO was not significantly associated with mortality among those with BMI ≥ 25 kg/m². These findings suggest that baseline serum 8-ISO, a marker of oxidative stress, is an independent risk factor of all-cause, non-CVD, and CVD mortality among a cohort of middle-aged adults with normal BMI.

Long-term use of aspirin and age-related macular degeneration

CONTEXT

Aspirin is widely used for relief of pain and for cardioprotective effects. Its use is of concern to ophthalmologists when ocular surgery is being considered and also in the presence of age-related macular degeneration (AMD).

OBJECTIVE

To examine the association of regular aspirin use with incidence of AMD.

DESIGN, SETTING, AND PARTICIPANTS

The Beaver Dam Eye Study, a longitudinal population-based study of age-related eye diseases conducted in Wisconsin. Examinations were performed every 5 years over a 20-year period (1988-1990 through 2008-2010). Study participants (N = 4926) were aged 43 to 86 years at the baseline examination. At subsequent examinations, participants were asked if they had regularly used aspirin at least twice a week for more than 3 months.

MAIN OUTCOME MEASURE

Incidence of early AMD, late AMD, and 2 subtypes of late AMD (neovascular AMD and pure geographic atrophy), assessed in retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System.

RESULTS

The mean duration of follow-up was 14.8 years. There were 512 incident cases of early AMD (of 6243 person-visits at risk) and 117 incident cases of late AMD (of 8621 person-visits at risk) over the course of the study. Regular aspirin use 10 years prior to retinal examination was associated with late AMD (hazard ratio [HR], 1.63 [95% CI, 1.01-2.63]; P = .05), with estimated incidence of 1.76% (95% CI, 1.17%-2.64%) in regular users and 1.03% (95% CI, 0.70%-1.51%) in nonusers. For subtypes of late AMD, regular aspirin use 10 years prior to retinal examination was significantly associated with neovascular AMD (HR, 2.20 [95% CI, 1.20-4.15]; P = .01) but not pure geographic atrophy (HR, 0.66 [95% CI, 0.25-1.95]; P = .45). Aspirin use 5 years (HR, 0.86 [95% CI, 0.71-1.05]; P = .13) or 10 years (HR, 0.86 [95% CI, 0.65-1.13]; P = .28) prior to retinal examination was not associated with incident early AMD.

CONCLUSIONS

Among an adult cohort, aspirin use 5 years prior to observed incidence was not associated with incident early or late AMD. However, regular aspirin use 10 years prior was associated with a small but statistically significant increase in the risk of incident late and neovascular AMD.

Abstract PD09-05: Single nucleotide polymorphism of XRCC1 which participates in DNA repair mechanism predicts clinical outcome in relapsed or metastatic breast cancer patients treated with S1 and oxaliplatin chemotherapy: Results from multicenter prospective study (TORCH_KCSG BR07-03)

Background: S1 and oxaliplatin (SOX) combination chemotherapy is an effective regimen in anthracycline and taxane pretreated metastatic breast cancer (MBC) patients with manageable toxicities (KCSG BR07-03, SABCS 2011 #Abst P3-16-06). The aim of this study was to investigate the association of the single nucleotide polymorphisms (SNPs) and clinical outcome in MBC treated with SOX chemotherapy.

Patients and Methods: A total of 87 MBC patients previously treated with or resistant to anthracycline and taxane chemotherapy were enrolled in this prospective multicenter trial. The patients received S-1 80mg/m2/day (day 1–14) and oxaliplatin 130 mg/m2 (day 1) every 3 weeks till progression. Among the 87 patients, 77 patients were available for SNP analysis. Germline DNA from peripheral blood (PB) mononuclear cells was extracted. SNPs in 4 genes from pathways that may influence cellular sensitivity to S1 and oxaliplatin (TS, ERCC, XPD, and XRCC) were genotyped from PB sample using PCR-restriction fragment length polymorphism.

Results: Overall response rate (RR) was 38.5% (95% CI: 27.7–49.3) and disease control rate was 67.9% (95% CI:57.5–78.3) to SOX. Median time-to-progression (TTP) and overall survival (OS) were 6.0 mo (95% CI: 5.1–6.9 mo) and 19.4 mo (95% CI: not estimated), respectively. XRCC1 Arg194Trp SNP which participates in DNA repair mechanism showed correlation with the clinical outcome. RR was tend to higher in XRCC1 Arg194Trp CC genotype compared with CT or TT genotype (50.0 % vs 35.1% or 12.5%, P = 0.121). TTP of patients with CC genotype in XRCC1 Arg194Trp was significantly longer than the TTP of patients with CT or TT genotype (median TTP: 6.4 mo in CC, 5.9 mo in CT, 3.0 mo in TT, P = 0.007) as well as overall survival (OS) (median OS: not reached in CC, 13.9 mo in CT, 7.1 mo in TT, P = 0.006). After adjusting for hormone receptor status, performance status, and visceral involvement, prognostic value of XRCC1 Arg194Trp SNP remained significant (Hazard Ratio=1.322 and 4.484, P = 0.016). Other SNPs were not significantly associated with survival or toxicities.

Conclusion: XRCC1 Arg194Trp SNP is associated with clinical outcome of MBC patients treated with SOX chemotherapy. Further studies of the relationship between germline polymorphisms in XRCC1 and functional mechanism researches are warranted.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD09-05.

Using distance correlation and SS-ANOVA to assess associations of familial relationships, lifestyle factors, diseases, and mortality

We present a method for examining mortality as it is seen to run in families, and lifestyle factors that are also seen to run in families, in a subpopulation of the Beaver Dam Eye Study. We observe that pairwise distance between death age in related persons is on average less than pairwise distance in death age between random pairs of unrelated persons. Our goal is to examine the hypothesis that pairwise differences in lifestyle factors correlate with the observed pairwise differences in death age that run in families. Szekely and Rizzo [Szekely GJ, Rizzo ML (2009) Ann Appl Stat 3(4): 1236-1265] have recently developed a method called distance correlation, which is suitable for this task with some enhancements. We build a Smoothing Spline ANOVA (SS-ANOVA) model for predicting death age based on four major lifestyle factors generally known to be related to mortality and four major diseases contributing to mortality, to develop a lifestyle mortality risk vector and a disease mortality risk vector. We then examine to what extent pairwise differences in these scores correlate with pairwise differences in mortality as they occur between family members and between unrelated persons. We find significant distance correlations between death ages, lifestyle factors, and family relationships. Considering only sib pairs compared with unrelated persons, distance correlation between siblings and mortality is, not surprisingly, stronger than that between more distantly related family members and mortality. The methodological approach here adapts to exploring relationships between multiple clusters of variables with observable (real-valued) attributes, and other factors for which only possibly nonmetric pairwise dissimilarities are observed.

Effect of the Y402H variant in the complement factor H gene on the incidence and progression of age-related macular degeneration: results from multistate models applied to the Beaver Dam Eye Study

OBJECTIVES

To investigate the effect of age, sex, and the Y402H variant in the complement factor H (CFH) gene on the incidence, progression, and regression of age-related macular degeneration (AMD) as well as the effect of these factors and AMD on mortality, using multistate models.

METHODS

Analyses included 4379 persons aged 43 to 84 years at the time of the census. The status of AMD on a 5-level severity scale was graded from retinal photographs taken at up to 5 study visits between 1988 and 2010. Multistate models in continuous time were used to model the effects of age, sex, and CFH genotype on the incidence, progression, and regression of AMD and mortality.

RESULTS

The CFH Y402H genotype CC was associated, relative to genotype TT (reported as hazard ratio; 95% CI), with increased incidence of AMD (no to minimally severe early AMD, 1.98; 1.57-2.49), progression of AMD (minimally severe early to moderately severe early AMD, 1.73; 1.29-2.33; moderately severe early to severe early AMD, 1.30; 0.86-1.94; and severe early to late AMD, 1.72; 1.01-2.91) but not with regression of AMD or mortality. Late AMD was associated with increased mortality (1.37; 1.15-1.62) relative to no AMD, but earlier stages of AMD were not.

CONCLUSIONS

Using the multistate models, we show that the Y402H risk variant is associated with lifetime incidence of early AMD and progression of early to late AMD and that late AMD is associated with mortality risk.

Relationship of blood pressure and other factors to serial retinal arteriolar diameter measurements over time: the beaver dam eye study

OBJECTIVE

To describe the relationship of blood pressure (BP), antihypertensive medication use, and other factors to serial measurements of retinal arteriolar diameters over time in the Beaver Dam Eye Study.

METHODS

Retinal arteriolar diameter was measured by computer-assisted methods and summarized as central retinal arteriolar equivalent (CRAE) in 4573 persons aged 43 to 99 years at 4 examinations (each separated by 5 years) during a 15-year period. Associations of CRAE with risk factors measured concurrently and 5 years previously were determined using multivariate analyses.

RESULTS

While adjusting for image quality, refraction, and lens status, age (per 10 years: β estimate, -0.73; P < .001), systolic BP (per 10 mm Hg: concurrent examination, -2.74; P < .001; previous examination, -1.75; P < .001), smoking status (smoker vs nonsmoker: concurrent examination, 4.29; P < .001; previous examination, 1.63; P = .004), body mass index (per category: concurrent examination, -0.51; P = .05; previous examination, -0.22; P = .44), and heavy alcohol consumption (drinking) (current vs past/never heavy drinker: concurrent examination, -2.54; P = .03; previous examination, -2.42; P = .02) were associated with CRAE. In the same model, there were significant interactions between concurrent and previous systolic BP (0.11; P = .003) and between concurrent and previous body mass index (0.12; P = .04). Use of calcium channel blockers at both the concurrent and past examination (vs neither examination, 1.59; P = .01), but not other classes of antihypertensive drugs, was associated with CRAE.

CONCLUSIONS

Retinal arteriolar diameter is independently associated with past and current systolic BP, calcium channel blocker use, smoking status, body mass index, and heavy drinking during 5-year intervals. The relationships with CRAE are stronger for concurrent than for past measures of these variables.

Changes in retinal vessel diameter and incidence and progression of diabetic retinopathy

OBJECTIVE

To describe the relationship of change in retinal vessel diameters to the subsequent 6-year incidence and progression of diabetic retinopathy (DR) and incidence of proliferative diabetic retinopathy (PDR) and macular edema (ME) in persons with diabetes mellitus.

DESIGN

A total of 1098 persons with diabetes who had DR graded from fundus photographs and had computer-assisted measurements of the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent(CRVE) participated in examinations in 1980-1982, 1984-1986, and 1990-1992.

RESULTS

During the first 4-year period, the mean change in CRAE and CRVE was −0.37 and 2.54 μm, respectively.The 6-year incidence and progression of DR and the incidence of PDR and ME from 1984-1986 to 1990-1992 were 56%, 39%, 15%, and 11%, respectively. In multivariate analyses, while controlling for duration, diabetes type, and other factors, an increase of 10 μm in CRVE from 1980-1982 to 1984-1986 was associated with increases in the 6-year incidence of DR (odds ratio [OR],1.26; 95% CI, 1.10-1.43), progression of DR (OR, 1.21;95% CI, 1.12-1.30), incidence of PDR (OR, 1.19; 95%CI, 1.07-1.32), and incidence of ME (OR, 1.16; 95% CI,1.03-1.31). No interactions of these associations by diabetes type were found (data not shown). Change in CRAE was unrelated to the incidence or progression of DR (data not shown).

CONCLUSIONS

Independent of DR severity level, glycemic control, and other factors, widening of the retinal venular but not arteriolar diameter was associated with subsequent incidence and progression of DR. The CRVE may provide additional information regarding the risk of incidence and progression of DR beyond traditional risk factors.

Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients

BACKGROUND

Cancer patients are at high risk for skin problems because rapidly proliferating skin cells are susceptible to anticancer therapies. However, the effects of daily skin care habits on development of skin problems in cancer patients have rarely been studied.

PATIENTS AND METHODS

We conducted a survey of daily skin care habits and the presence of skin problems in 866 cancer patients.

RESULTS

Hot water bath>1 h significantly increased the risk of definite eruptions [odds ratio (OR) 4.09] and the risk of itching or pain on the skin (OR 1.73). Diligent use of moisturizers did not decrease the risk of definite eruptions and symptoms, and daily bathing, scrubbing off the skin while bathing, and sun protection did not influence the risk of definite eruptions and symptoms. Subgroup analysis of 183 breast cancer patients showed results similar to the total results, including that hot water bath>1 h significantly increased the risk of definite eruptions (OR 3.41).

CONCLUSIONS

Being a cross-sectional study, our study could not prove causality. However, at the present stage of knowledge, avoidance of hot water baths of protracted duration should be first emphasized in patient education to prevent skin problems in cancer patients.

The relationship of cataract and cataract extraction to age-related macular degeneration: the Beaver Dam Eye Study

OBJECTIVE

To examine the associations of cataract and cataract surgery with early and late age-related macular degeneration (AMD) over a 20-year interval.

DESIGN

Longitudinal population-based study of age-related eye diseases.

PARTICIPANTS

Beaver Dam Eye Study participants.

METHODS

Persons aged 43 to 86 years participated in the baseline examination in 1988-1990. Participants were followed up at 5-year intervals after the baseline examination. Examinations consisted of ocular examination with lens and fundus photography, medical history, measurements of blood pressure, height, and weight. Values of risk variables were updated, and incidences of early and late AMD were calculated for each 5-year interval. Odds ratios were computed using discrete linear logistic regression modeling with generalized estimating equation methods to account for correlation between the eyes and multiple intervals.

MAIN OUTCOME MEASURES

Age-related macular degeneration.

RESULTS

After adjusting for age and sex, neither cataract nor cataract surgery was associated with increased odds for developing early AMD. Further adjusting for high-risk gene alleles (CFH and ARMS2) and other possible risk factors did not materially affect the odds ratio (OR). However, cataract surgery was associated with incidence of late AMD (OR 1.93; 95% confidence interval [CI], 1.28-2.90). This OR was not materially altered by further adjusting for high-risk alleles (CFH Y402H, ARMS2) or other risk factors. The OR for late AMD was higher for cataract surgery performed 5 or more years prior compared with less than 5 years prior.

CONCLUSIONS

These data strongly support the past findings of an association of cataract surgery with late AMD independent of other risk factors, including high-risk genetic status, and suggest the importance of considering these findings when counseling patients regarding cataract surgery. These findings should provide further impetus for the search for measures to prevent or delay the development of age-related cataract.

Cross-sectional associations of blood elements, clotting factors, nephropathy, and retinal outcomes in long duration type 1 diabetes

PURPOSE

To determine the association of blood elements, selected clotting factors, and nephropathy with proliferative diabetic retinopathy (PDR) and macular edema (ME) in those with long duration type 1 diabetes.

METHODS

Participants (N = 442) were seen in 2005-2007 at the 25-year follow-up of a population-based study of diabetic retinopathy, and were eligible for this analysis. Fundus photographs were graded using a standard retinopathy severity scheme. Laboratory measures included hematocrit, white blood cell and platelet counts, serum fibrinogen, interleukin-6, and von Willebrand factor.

RESULTS

In models including duration of diabetes, hypertension, and diabetic nephropathy, only hematocrit was marginally associated with decreased odds of PDR (odds ratio 0.87; 95% confidence interval 0.74-1.01; P for trend per quintile = 0.06). Stratifying by nephropathy status, in those with and without nephropathy, there were no significant associations of any laboratory measures with PDR or ME. None of the variables we examined were associated with ME in individuals with or without nephropathy.

CONCLUSION

In persons with long duration type 1 diabetes, none of the blood elements or clotting factors were associated with increased odds of PDR or ME. Investigation of common pathways that lead to diabetic nephropathy and diabetic retinal outcomes should be a research priority in efforts to prevent vision-threatening complications of diabetes and nephropathy.

Replication analysis for severe diabetic retinopathy

PURPOSE

The purpose of this study is to attempt to replicate the top single nucleotide polymorphism (SNP) associations from a previous genome-wide association study (GWAS) for the sight-threatening complications of diabetic retinopathy in an independent cohort of diabetic subjects from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR).

METHODS

This study included 469 type 1 diabetic, Caucasian subjects from WESDR. Cases (n = 208) were defined by prior laser treatment for either proliferative diabetic retinopathy or diabetic macular edema. Controls (n = 261) were all other subjects in the cohort. Three hundred eighty-nine SNPs were tested for association using the Illumina GoldenGate custom array. A retinopathy-only subanalysis was conducted in 437 subjects by removing those with end-stage renal disease. Evaluation for association between cases and controls was conducted by using chi-square tests. A combined analysis incorporated the results from WESDR with the prior GWAS.

RESULTS

No associations were significant at a genome-wide level. The analysis did identify SNPs that can be pursued in future replication studies. The top association was at rs4865047, an intronic SNP, in the gene CEP135 (P value 2.06 × 10(-5)). The top association from the subanalysis was at rs1902491 (P value 2.81 × 10(-5)), a SNP that sits upstream of the gene NPY2R.

CONCLUSIONS

This study nominates several novel genetic loci that may be associated with severe diabetic retinopathy. In order to confirm these findings, replication and extension in additional cohorts will be necessary as susceptibility alleles for diabetic retinopathy appear to be of modest effect.

Signal quality assessment of retinal optical coherence tomography images

PURPOSE

The purpose of this article was to assess signal quality of retinal optical coherence tomography (OCT) images from multiple devices using subjective and quantitative measurements.

METHODS

A total of 120 multiframe OCT images from 4 spectral domain OCT devices (Cirrus, RTVue, Spectralis, and 3D OCT-1000) were evaluated subjectively by trained graders, and measured quantitatively using a derived parameter, maximum tissue contrast index (mTCI). An intensity histogram decomposition model was proposed to separate the foreground and background information of OCT images and to calculate the mTCI. The mTCI results were compared with the manufacturer signal index (MSI) provided by the respective devices, and to the subjective grading scores (SGS).

RESULTS

Statistically significant correlations were observed between the paired methods (i.e., SGS and MSI, SGS and mTCI, and mTCI and MSI). Fisher's Z transformation indicated the Pearson correlation coefficient ρ ≥ 0.8 for all devices. Using the Deming regression, correlation parameters between the paired methods were established. This allowed conversion from the proprietary MSI values to SGS and mTCI that are universally applied to each device.

CONCLUSIONS

The study suggests signal quality of retinal OCT images can be evaluated subjectively and objectively, independent of the devices. Together with the proposed histogram decomposition model, mTCI may be used as a standardization metric for OCT signal quality that would affect measurements.

P3-16-06: Phase II Trial of TS-1 in Combination with Oxaliplatin (SOX) in Patients with Metastatic Breast Cancer (MBC) Previously Treated with Anthracycline and Taxane Chemotherapy [TORCH] [Korean Cancer Study Group (KCSG) BR07-03]

Background

Oxaliplatin, a platinum analogue, is an active drug in advanced anthracycline and taxane-pretreated breast cancer patients as a single agent and with 5-fluorouracil (5-FU) combination. TS-1 was developed by the scientific theory of both potentiating antitumor activity of 5-FU and reducing gastrointestinal toxicity. This trial was performed to evaluate the efficacy and safety of TS-1 in combination with oxaliplatin in metastatic breast cancer (MBC) patients previously treated with anthracycline and taxane chemotherapy.

Methods: Between October 2007 and October 2009, MBC patients were enrolled in this prospective multicenter trial. Eligible criteria included age ≥18 years, at least one measurable lesion, prior treatment with anthracycline and taxane chemotherapy, and ECOG Performance Status 0–2. TS-1 40 mg/m2 b.i.d. on days 1–14 with oxaliplatin 130 mg/m2 on day 1 were administered every 3 weeks till disease progression. Primary end-point was response rate, and secondary end-points were time-to-progression (TTP), overall survival (OS), duration of response (DOR) and toxicities. Response was evaluated every 6 weeks according to the RECIST criteria v. 1.0 and toxicity was assessed with NCICTCAE v.3.0.(ClinicalTrials.gov identifier NCT00527930).

Results: A total of 87 patients were enrolled. Median age was 48 years (range 30–71 years). Nineteen patients (21.8%) had de novo stage IV and 68 patients (78.2%) had recurrent disease. Thirty-five patients (40.2%) received two-lines of prior chemotherapy in palliative setting. Forty-eight patients (55.2%) had ≥ 3 disease sites. Fifty-four patients (62.1%) were hormone receptor positive, and 25 patients (28.7%) were triple negative. Five patients received prior anti-HER2 therapy. A total of 525 cycles were administered (median 6 cycles, range: 1 ∼ 22+ cycle). In per-protocol analysis, overall response rate was 38.5% (95% CI: 27.7−49.3) (CR 0%, PR 38.5%) and disease control rate (CR, PR, and SD) was 67.9% (95% CI: 57.5−78.3). Median TTP, OS, and DOR were 6.0 months (95% CI: 5.1−6.9 months), 19.4 months (95% CI: not estimated), 6.6 months (95% CI: 3.7−9.6 months), respectively. RR was not different by triple negativity (39.1% in TNBC vs. 38.2% in non-TNBC, P=0.361). TTP was not different according to the number of prior chemotherapy regimens. Reported grade 3 or 4 toxicities (per cycle) were neutropenia (10.3%), thrombocytopenia (5.5%), diarrhea (1.9%), vomiting (1.9%), and stomatitis (0.2%). There was no treatment-related death.

Conclusions: SOX is an effective regimen in anthracycline and taxane pretreated MBC patients with manageable toxicities.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-16-06.

A 32 kb critical region excluding Y402H in CFH mediates risk for age-related macular degeneration

Complement factor H shows very strong association with Age-related Macular Degeneration (AMD), and recent data suggest that multiple causal variants are associated with disease. To refine the location of the disease associated variants, we characterized in detail the structural variation at CFH and its paralogs, including two copy number polymorphisms (CNP), CNP147 and CNP148, and several rare deletions and duplications. Examination of 34 AMD-enriched extended families (N = 293) and AMD cases (White N = 4210 Indian = 134; Malay = 140) and controls (White N = 3229; Indian = 117; Malay = 2390) demonstrated that deletion CNP148 was protective against AMD, independent of SNPs at CFH. Regression analysis of seven common haplotypes showed three haplotypes, H1, H6 and H7, as conferring risk for AMD development. Being the most common haplotype H1 confers the greatest risk by increasing the odds of AMD by 2.75-fold (95% CI = [2.51, 3.01]; p = 8.31×10(-109)); Caucasian (H6) and Indian-specific (H7) recombinant haplotypes increase the odds of AMD by 1.85-fold (p = 3.52×10(-9)) and by 15.57-fold (P = 0.007), respectively. We identified a 32-kb region downstream of Y402H (rs1061170), shared by all three risk haplotypes, suggesting that this region may be critical for AMD development. Further analysis showed that two SNPs within the 32 kb block, rs1329428 and rs203687, optimally explain disease association. rs1329428 resides in 20 kb unique sequence block, but rs203687 resides in a 12 kb block that is 89% similar to a noncoding region contained in ΔCNP148. We conclude that causal variation in this region potentially encompasses both regulatory effects at single markers and copy number.

Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study

In animal models, inflammatory processes have been shown to have an important role in the development of kidney disease. In humans, however, the independent relation between markers of inflammation and the risk of chronic kidney disease (CKD) is not known. To clarify this, we examined the relationship of several inflammatory biomarker levels (high-sensitivity C-reactive protein, tumor necrosis factor-α receptor 2, white blood cell count, and interleukin-6) with the risk of developing CKD in a population-based cohort of up to 4926 patients with 15 years of follow-up. In cross-sectional analyses, we found that all these inflammation markers were positively associated with the outcome of interest, prevalent CKD. However, in longitudinal analyses examining the risk of developing incident CKD among those who were CKD-free at baseline, only tumor necrosis factor-α receptor 2, white blood cell count, and interleukin-6 levels (hazard ratios comparing highest with the lowest tertile of 2.10, 1.90, and 1.45, respectively), and not C-reactive protein (hazard ratio 1.09), were positively associated with incident CKD. Thus, elevations of most markers of inflammation predict the risk of developing CKD. Each marker should be independently verified.

Linkage analysis of quantitative refraction and refractive errors in the Beaver Dam Eye Study

PURPOSE

Refraction, as measured by spherical equivalent, is the need for an external lens to focus images on the retina. While genetic factors play an important role in the development of refractive errors, few susceptibility genes have been identified. However, several regions of linkage have been reported for myopia (2q, 4q, 7q, 12q, 17q, 18p, 22q, and Xq) and for quantitative refraction (1p, 3q, 4q, 7p, 8p, and 11p). To replicate previously identified linkage peaks and to identify novel loci that influence quantitative refraction and refractive errors, linkage analysis of spherical equivalent, myopia, and hyperopia in the Beaver Dam Eye Study was performed.

METHODS

Nonparametric, sibling-pair, genome-wide linkage analyses of refraction (spherical equivalent adjusted for age, education, and nuclear sclerosis), myopia and hyperopia in 834 sibling pairs within 486 extended pedigrees were performed.

RESULTS

Suggestive evidence of linkage was found for hyperopia on chromosome 3, region q26 (empiric P = 5.34 × 10(-4)), a region that had shown significant genome-wide evidence of linkage to refraction and some evidence of linkage to hyperopia. In addition, the analysis replicated previously reported genome-wide significant linkages to 22q11 of adjusted refraction and myopia (empiric P = 4.43 × 10(-3) and 1.48 × 10(-3), respectively) and to 7p15 of refraction (empiric P = 9.43 × 10(-4)). Evidence was also found of linkage to refraction on 7q36 (empiric P = 2.32 × 10(-3)), a region previously linked to high myopia.

CONCLUSIONS

The findings provide further evidence that genes controlling refractive errors are located on 3q26, 7p15, 7p36, and 22q11.

Bidirectional association of retinal vessel diameters and estimated GFR decline: the Beaver Dam CKD Study

BACKGROUND

Recent cross-sectional studies have reported an association between retinal vessel caliber and chronic kidney disease (CKD), but the direction of the association between these 2 processes is not clear. In a prospective study with multiple measurements of retinal vessel diameters and serum creatinine, we examined whether baseline retinal vessel diameter is associated with future risk of decreased kidney function, or vice versa.

STUDY DESIGN

Population-based cohort study.

SETTING & PARTICIPANTS

3,199 Wisconsin adults aged 43-84 years who were followed up prospectively for 15 years.

PREDICTOR

Baseline retinal arteriolar and venular diameters for analysis 1 and baseline estimated glomerular filtration rate (eGFR) categories for analysis 2.

OUTCOMES & MEASUREMENTS

For analysis 1, incident CKD, defined as eGFR <60 mL/min/1.73 m(2) accompanied by a 25% decrease in eGFR, during follow-up. For analysis 2, incident retinal arteriolar narrowing, defined as a central retinal arteriolar equivalent measurement <144.0 μm, and incident retinal venular dilation, defined as a central retinal venular equivalent measurement >243.8 μm.

RESULTS

Baseline retinal arteriolar and venular diameters were not associated with 15-year risk of incident CKD. After adjustment for age, sex, diabetes, hypertension, and other confounders, the multivariable HR of incident CKD comparing the narrowest with the widest quartile was 1.15 (95% CI, 0.74-1.80) for retinal arteriolar diameter and 1.05 (95% CI, 0.67-1.67) for retinal venular diameter. Similarly, there was no significant association between eGFR and 15-year risk of incident retinal arteriolar narrowing or retinal venular widening. Compared with eGFR >90 mL/min/1.73 m(2) (referent), the multivariable HR for those with eGFR <45 mL/min/1.73 m(2) was 1.66 (95% CI, 0.93-2.96) for incident retinal arteriolar narrowing and 0.60 (95% CI, 0.17-1.85) for retinal venular widening.

LIMITATIONS

Lack of data for albuminuria and loss to follow-up.

CONCLUSIONS

Retinal vessel diameters and CKD may run together through shared mechanisms, but are not causally related.

Complete blood cell count and retinal vessel diameters

OBJECTIVE

To examine the cross-sectional associations of components of the complete blood cell count with retinal vessel diameters.

METHODS

The data are from the baseline examination of the Beaver Dam Eye Study cohort (n = 4730) from March 1, 1988, to September 14, 1990. Blood pressure was measured, a medical history including questions on cigarette smoking was obtained, and fundus photographs centered on the optic disc were taken and digitized. Retinal arteriole and venule diameters were measured using computer-assisted software. The central retinal arteriole equivalent and central retinal venule equivalent were computed. A complete blood cell count was done.

RESULTS

In age- and sex-adjusted analyses, red blood cell count, hemoglobin level, hematocrit, and white blood cell count were all statistically significantly associated with central retinal venule equivalent and central retinal arteriole equivalent, while platelet count was associated only with central retinal venule equivalent. These relationships persisted in more fully adjusted models, except platelet count became statistically significantly associated with both central retinal arteriole equivalent and central retinal venule equivalent.

CONCLUSIONS

Blood components as measured in a complete blood cell count are significant correlates of retinal vessel diameters and should be considered in analyses where retinal blood vessel diameters are outcomes.

Serum cystatin C and the incidence of type 2 diabetes mellitus

AIMS/HYPOTHESIS

To examine the association of serum cystatin C with the incidence of type 2 diabetes mellitus over a 15 year follow-up period.

METHODS

The 15 year cumulative incidence of diabetes was measured in a cohort of Beaver Dam Eye Study participants (n = 3,472, 1988-2003). A person was defined as developing diabetes (a positive history of diabetes mellitus treated with insulin, oral hypoglycaemic agents and/or diet, or elevations in glycosylated haemoglobin levels) in the absence of diabetes at baseline. The relation of cystatin C and other risk factors to incident type 2 diabetes was determined using discrete time extension of the proportional hazards model.

RESULTS

The 15 year cumulative incidence of diabetes was estimated to be 9.6%. After controlling for age, sex, body mass index, smoking status, glycosylated haemoglobin, proteinuria, chronic kidney disease status and hypertension status, serum cystatin C at baseline was associated with the 15 year cumulative incidence of type 2 diabetes (OR per log of cystatin C unit 2.19, 95% CI 1.02-4.68).

CONCLUSIONS/INTERPRETATION

These findings show a positive relationship of serum cystatin C levels with the incidence of type 2 diabetes mellitus independently of confounding risk factors. The findings strongly suggest the need for further evaluation of the potential importance of cystatin C in the pathogenesis of type 2 diabetes mellitus.

Characterization of nalidixic acid-resistant and fluoroquinolone-reduced susceptible Salmonella Typhimurium in swine

From 2001 to 2008, a total of 27 isolates of Salmonella enterica serovar Typhimurium were obtained from 930 swine. All 27 isolates were resistant to streptomycin and tetracycline. Seventeen isolates were multidrug resistant to more than three antimicrobial agents. Seven of these multidrug-resistant isolates were pentaresistant to ampicillin, chloramphenicol, streptomycin, tetracycline, and nalidixic acid. Among 27 isolates, 14 isolates (51.8 %) were nalidixic acid resistant (MIC, ≥128 μg/ml) and had reduced susceptibility to various quinolones (MIC, 0.125 to 2 μg/ml). When quinolone resistance-determining regions in the gyrA and gyrB genes of these isolates were sequenced, 13 isolates had Asp87→Tyr mutations and 1 isolate had Asp87→Gly mutation in the quinolone resistance-determining region of gyrA, whereas no mutation was found in gyrB. Genes for qnrA, qnrB, and qnrS were not detected by PCR with specific primers. Pulsed-field gel electrophoresis of genomic DNA digested with Xba I showed two patterns suggesting a clonal spread of Salmonella Typhimurium in swine in Korea.

The 25-year cumulative incidence of lower extremity amputations in people with type 1 diabetes

OBJECTIVE

To examine the 25-year cumulative incidence of lower-extremity amputation (LEA) in people with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Cumulative incidence of LEA was ascertained in Wisconsin Epidemiologic Study of Diabetic Retinopathy participants (n = 943) using the Kaplan-Meier approach accounting for competing risk of death. Relationships of baseline characteristics with incidence of LEA were explored using a proportional hazards approach with discrete linear regression modeling.

RESULTS

The overall 25-year incidence of LEA was 10.1%. In multivariate analyses (results reported as odds ratio; 95% CI), being male (3.90; 2.29-6.65), heavy smoking (2.07; 1.11-3.85), having hypertension (3.36; 1.91-5.93), diabetic retinopathy (2.62; 1.13-6.09), neuropathy (1.68; 1.02-2.76), and higher HbA(1c) (per 1% 1.40; 1.24-1.58) were independently associated with the incidence of LEA.

CONCLUSIONS

Our results show a high 25-year incidence of LEA and suggest that glycemic control and blood pressure control and preventing heavy smoking may result in reduction in its incidence.

Refraction in adults with diabetes

OBJECTIVES

To examine refraction, change in refraction, and risk factors for change in refraction in adults with type 1 and type 2 diabetes mellitus.

METHODS

Population-based study. Modified Early Treatment of Diabetic Retinopathy Study refractions and a standard history were obtained for all participants. Baseline and 10-year follow-up data were available.

RESULTS

Age and education were significantly associated with refraction in persons with younger-onset diabetes (T1D) and in those with older-onset diabetes (T2D); refractions were similar for both groups. Persons of similar age with T1D were likely to be more myopic than were those with T2D (P < .01). In those with T1D, on average, there was a -0.28-diopter (D) change in refraction in 10 years. Those with longer duration of diabetes and proliferative retinopathy were more likely to have hyperopic shifts in refraction. In persons with T2D, there was, on average, a +0.48-D change in refraction during the 10 years, but there was little consistency in the amount of change by age at baseline.

CONCLUSIONS

In persons of similar age, those with T1D were likely to be slightly more myopic than were those with T2D. Overall, mean refraction and the important risk factors of age and education were similar to those reported in nondiabetic populations.

15-year cumulative incidence and associated risk factors for retinopathy in nondiabetic persons

OBJECTIVE

To investigate the relationship of systemic factors to the 15-year cumulative incidence of retinopathy in nondiabetic persons in the Beaver Dam Eye Study.

METHODS

Included were 4699 persons, 43 to 86 years of age at baseline examination in 1988-1990 and with follow-up in 1993-1995 and/or 1998-2000 and/or 2003-2005. Stereoscopic color fundus photographs were graded to determine the presence of retinopathy. The main outcome measure was cumulative incidence of retinopathy accounting for competing risk of death or diabetes mellitus.

RESULTS

The 15-year cumulative incidence of retinopathy in the nondiabetic cohort was 14.2%. In multivariate analyses, older age (hazard ratio [HR] per age group, 1.13; 95% confidence interval [CI], 1.01-1.27), higher systolic blood pressure (HR per 10 mm Hg, 1.15; 95% CI, 1.07-1.20), presence of chronic kidney disease (HR, 1.51; 95% CI, 1.12-2.00), and wider retinal arteriolar diameter (HR per 10 μm, 1.17; 95% CI, 1.10-1.26) at baseline were associated with the incidence of retinopathy. In a separate model, the 15-year incidence of retinopathy was higher in those with uncontrolled hypertension compared with those who did not have hypertension (HR, 2.07; 95% CI, 1.51-2.83). There were no associations of body mass index, lipid levels, glycosylated hemoglobin level, smoking status, markers of inflammation, endothelial dysfunction and oxidative stress, and hematologic factors with retinopathy incidence.

CONCLUSIONS

These data show 2 modifiable factors, uncontrolled hypertension and chronic kidney disease, are related to an increased incidence of retinopathy in nondiabetic persons and show that control of blood pressure is associated with a lower risk of incident retinopathy compared with uncontrolled blood pressure.