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Kantarci K, Tosakulwong N, Lesnick TG, Zuk SM, Gunter JL, Gleason CE, Wharton W, Dowling NM, Vemuri P, Senjem ML, Shuster LT, Bailey KR, Rocca WA, Jack CR, Asthana S, Miller VM. Effects of hormone therapy on brain structure: A randomized controlled trial. Neurology 2016; 87:887-96. [PMID: 27473135 PMCID: PMC5035155 DOI: 10.1212/wnl.0000000000002970] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
Objective: To investigate the effects of hormone therapy on brain structure in a randomized, double-blinded, placebo-controlled trial in recently postmenopausal women. Methods: Participants (aged 42–56 years, within 5–36 months past menopause) in the Kronos Early Estrogen Prevention Study were randomized to (1) 0.45 mg/d oral conjugated equine estrogens (CEE), (2) 50 μg/d transdermal 17β-estradiol, or (3) placebo pills and patch for 48 months. Oral progesterone (200 mg/d) was given to active treatment groups for 12 days each month. MRI and cognitive testing were performed in a subset of participants at baseline, and at 18, 36, and 48 months of randomization (n = 95). Changes in whole brain, ventricular, and white matter hyperintensity volumes, and in global cognitive function, were measured. Results: Higher rates of ventricular expansion were observed in both the CEE and the 17β-estradiol groups compared to placebo; however, the difference was significant only in the CEE group (p = 0.01). Rates of ventricular expansion correlated with rates of decrease in brain volume (r = −0.58; p ≤ 0.001) and with rates of increase in white matter hyperintensity volume (r = 0.27; p = 0.01) after adjusting for age. The changes were not different between the CEE and 17β-estradiol groups for any of the MRI measures. The change in global cognitive function was not different across the groups. Conclusions: Ventricular volumes increased to a greater extent in recently menopausal women who received CEE compared to placebo but without changes in cognitive performance. Because the sample size was small and the follow-up limited to 4 years, the findings should be interpreted with caution and need confirmation. Classification of evidence: This study provides Class I evidence that brain ventricular volume increased to a greater extent in recently menopausal women who received oral CEE compared to placebo.
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Affiliation(s)
- Kejal Kantarci
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison.
| | - Nirubol Tosakulwong
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Timothy G Lesnick
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Samantha M Zuk
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Jeffrey L Gunter
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Carey E Gleason
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Whitney Wharton
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - N Maritza Dowling
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Prashanthi Vemuri
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Matthew L Senjem
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Lynne T Shuster
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Kent R Bailey
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Walter A Rocca
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Clifford R Jack
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Sanjay Asthana
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
| | - Virginia M Miller
- From the Departments of Radiology (K.K., S.M.Z., J.L.G., P.V., M.L.S., C.R.J.), Health Sciences Research (N.T., T.G.L., K.R.B., W.A.R.), Internal Medicine (L.T.S.), Neurology (W.A.R.), and Surgery and Physiology and Biomedical Engineering (V.M.M.), Mayo Clinic, Rochester, MN; Department of Medicine (C.E.G., S.A.), School of Medicine and Public Health, University of Wisconsin and Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans' Hospital, Madison, WI; Department of Neurology (W.W.), Emory University, Atlanta, GA; and Department of Biostatistics and Medical Informatics (N.M.D.), University of Wisconsin, Madison
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Abdalrhim AD, Marroush TS, Austin EE, Gersh BJ, Solak N, Rizvi SA, Bailey KR, Kullo IJ. Plasma Osteopontin Levels and Adverse Cardiovascular Outcomes in the PEACE Trial. PLoS One 2016; 11:e0156965. [PMID: 27284698 PMCID: PMC4902195 DOI: 10.1371/journal.pone.0156965] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/22/2016] [Indexed: 11/29/2022] Open
Abstract
Osteopontin (OPN) is a secreted glycophosphoprotein that has a role in inflammation, immune response and calcification. We hypothesized that plasma OPN levels are associated with adverse cardiovascular outcomes in patients with stable coronary artery disease (CAD) and preserved ejection fraction (EF) enrolled in the PEACE trial. We measured plasma OPN levels at baseline in 3567 CAD patients (mean age 64.5 ± 8.1 years, 81% men) by a sandwich chemiluminescent assay (coefficient of variation = 4.1%). OPN levels were natural log (Ln) transformed prior to analyses. We assessed whether Ln OPN levels were associated with the composite primary endpoint of cardiovascular death, non-fatal myocardial infarction and hospitalization for heart failure using multiple event multivariable Cox proportional hazards regression. Adjustment was performed for: (a) age and sex; (b) additional potential confounders; and (c) a parsimonious set of statistically significant 10 variates. During a median follow-up of 4.8 years, 416 adverse cardiovascular outcomes occurred in 366 patients. Ln OPN was significantly associated with the primary endpoint; HR (95% CI) = 1.56 (1.27, 1.92); P <0.001, and remained significant after adjustment for age and sex [1.31 (1.06, 1.61); P = 0.01] and after adjustment for relevant covariates [1.24 (1.01, 1.52); P = 0.04]. In a secondary analysis of the individual event types, Ln OPN was significantly associated with incident hospitalization for heart failure: HR (95% CI) = 2.04 (1.44, 2.89); P <0.001, even after adjustment for age, sex and additional relevant covariates. In conclusion, in patients with stable CAD and preserved EF on optimal medical therapy, plasma OPN levels were independently associated with the composite incident endpoint of adverse cardiovascular outcomes as well as incident hospitalization for heart failure.
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Affiliation(s)
- Ahmed D. Abdalrhim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Tariq S. Marroush
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Erin E. Austin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bernard J. Gersh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nusret Solak
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Syed A. Rizvi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kent R. Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Iftikhar J. Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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103
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Widmer RJ, Allison TG, Keane B, Dallas A, Bailey KR, Lerman LO, Lerman A. Workplace Digital Health Is Associated with Improved Cardiovascular Risk Factors in a Frequency-Dependent Fashion: A Large Prospective Observational Cohort Study. PLoS One 2016; 11:e0152657. [PMID: 27092940 PMCID: PMC4836693 DOI: 10.1371/journal.pone.0152657] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 03/17/2016] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the US. Emerging employer-sponsored work health programs (WHP) and Digital Health Intervention (DHI) provide monitoring and guidance based on participants' health risk assessments, but with uncertain success. DHI--mobile technology including online and smartphone interventions--has previously been found to be beneficial in reducing CVD outcomes and risk factors, however its use and efficacy in a large, multisite, primary prevention cohort has not been described to date. We analyzed usage of DHI and change in intermediate markers of CVD over the course of one year in 30,974 participants of a WHP across 81 organizations in 42 states between 2011 and 2014, stratified by participation log-ins categorized as no (n = 14,173), very low (<12/yr, n = 12,260), monthly (n = 3,360), weekly (n = 651), or semi-weekly (at least twice per week). We assessed changes in weight, waist circumference, body mass index (BMI), blood pressure, lipids, and glucose at one year, as a function of participation level. We utilized a Poisson regression model to analyze variables associated with increased participation. Those with the highest level of participation were slightly, but significantly (p<0.0001), older (48.3±11.2 yrs) than non-participants (47.7±12.2 yr) and more likely to be females (63.7% vs 37.3% p<0.0001). Significant improvements in weight loss were demonstrated with every increasing level of DHI usage with the largest being in the semi-weekly group (-3.39±1.06 lbs; p = 0.0013 for difference from weekly). Regression analyses demonstrated that greater participation in the DHI (measured by log-ins) was significantly associated with older age (p<0.001), female sex (p<0.001), and Hispanic ethnicity (p<0.001). The current study demonstrates the success of DHI in a large, community cohort to modestly reduce CVD risk factors in individuals with high participation rate. Furthermore, participants previously underrepresented in WHPs (females and Hispanics) and those with an increased number of CVD risk factors including age and elevated BMI show increased adherence to DHI, supporting the use of this low-cost intervention to improve CVD health.
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Affiliation(s)
- R Jay Widmer
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, United States of America
| | - Thomas G Allison
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, United States of America
| | - Brendie Keane
- CareHere, Inc., Nashville, TN, United States of America
| | | | - Kent R Bailey
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, United States of America.,Division of Biomedical Statistics and Informatics, Mayo Clinic and College of Medicine, Rochester, MN, 55905, United States of America
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, United States of America
| | - Amir Lerman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, United States of America
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104
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Park MS, Perkins SE, Spears GM, Ashrani AA, Leibson CL, Boos CM, Harmsen WS, Jenkins DH, Bailey KR, Ballman KV, Heit JA. Risk factors for venous thromboembolism after acute trauma: A population-based case-cohort study. Thromb Res 2016; 144:40-5. [PMID: 27284980 DOI: 10.1016/j.thromres.2016.03.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 02/29/2016] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Predictors of venous thromboembolism (VTE) after trauma are uncertain. OBJECTIVE To identify independent predictors of VTE after acute trauma. METHODS Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92days after hospitalization for acute trauma over the 18-year period, 1988-2005. We also identified all Olmsted County residents hospitalized for acute trauma over this time period and chose one to two residents frequency-matched to VTE cases on sex, event year group and ICD-9-CM trauma code predictive of surgery. In a case-cohort study, demographic, baseline and time-dependent characteristics were tested as predictors of VTE after trauma using Cox proportional hazards modeling. RESULTS Among 200 incident VTE cases, the median (interquartile range) time from trauma to VTE was 18 (6, 41) days. Of these, 62% cases developed VTE after hospital discharge. In a multiple variable model including 370 cohort members, patient age at injury, male sex, increasing injury severity as reflected by the Trauma Mortality Prediction Model (TMPM) Mortality Score, immobility prior to trauma, soft tissue leg injury, and prior superficial vein thrombosis were independent predictors of VTE (C-statistic=0.78). CONCLUSIONS We have identified clinical characteristics which can identify patients at increased risk for VTE after acute trauma, independent of surgery. Almost two thirds of all incident VTE events occurred after initial hospital discharge (18day median time from trauma to VTE) which questions current practice of not extending VTE prophylaxis beyond hospital discharge.
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Affiliation(s)
- Myung S Park
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States.
| | - Sarah E Perkins
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Grant M Spears
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Aneel A Ashrani
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Cynthia L Leibson
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Christine M Boos
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - William S Harmsen
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Donald H Jenkins
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Kent R Bailey
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - Karla V Ballman
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
| | - John A Heit
- Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, United States
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105
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Nemetz PN, Smith CY, Bailey KR, Roger VL, Edwards WD, Leibson CL. Trends in Coronary Atherosclerosis: A Tale of Two Population Subgroups. Am J Med 2016; 129:307-14. [PMID: 26551982 PMCID: PMC4755914 DOI: 10.1016/j.amjmed.2015.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously investigated trends in subclinical coronary artery disease and associated risk factors among autopsied non-elderly adults who died from nonnatural causes. Although grade of atherosclerosis declined from 1981 through 2009, the trend was nonlinear, ending in 1995, concurrent with increasing obesity/diabetes in this population. The previous study used linear regression and examined trends for all 4 major epicardial coronary arteries combined. The present investigation of coronary artery disease trends for the period 1995 through 2012 was prompted by a desire for more detailed examination of more recent coronary artery disease trends in light of reports that the epidemics of obesity and diabetes have slowed and are perhaps ending. METHODS This population-based series of cross-sectional investigations identified all Olmsted County, Minnesota residents aged 16-64 years who died 1995 through 2012 (N = 2931). For decedents with nonnatural manner of death, pathology reports were reviewed for grade of atherosclerosis assigned each major epicardial coronary artery. Using logistic regression, we estimated calendar-year trends in grade (unadjusted and age- and sex-adjusted) for each artery, initially as an ordinal measure (range, 0-4); then, based on evidence of nonproportional odds, as a dichotomous variable (any atherosclerosis, yes/no) and as an ordinal measure for persons with atherosclerosis (range, 1-4). RESULTS Of 474 nonnatural deaths, 453 (96%) were autopsied; 426 (90%) had coronary stenosis graded. In the ordinal-logistic model for trends in coronary artery disease grade (range, 0-4), the proportional odds assumption did not hold. In subsequent analysis as a dichotomous outcome (grades 0 vs 1-4), each artery exhibited a significant temporal decline in the proportion with any atherosclerosis. Conversely, for subjects with coronary artery disease grade 1-4, age- and sex-adjusted ordinal regression revealed no change over time in 2 arteries and statistically significant temporal increases in severity in 2 arteries. CONCLUSIONS Findings suggest that efforts to prevent coronary artery disease onset have been relatively successful. However, statistically significant increases in the grade of atherosclerosis in 2 arteries among persons with coronary artery disease may be indicative of a major public health challenge.
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Affiliation(s)
- Peter N Nemetz
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Carin Y Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Veronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Cynthia L Leibson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
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106
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Kullo IJ, Jouni H, Austin EE, Brown SA, Kruisselbrink TM, Isseh IN, Haddad RA, Marroush TS, Shameer K, Olson JE, Broeckel U, Green RC, Schaid DJ, Montori VM, Bailey KR. Incorporating a Genetic Risk Score Into Coronary Heart Disease Risk Estimates: Effect on Low-Density Lipoprotein Cholesterol Levels (the MI-GENES Clinical Trial). Circulation 2016; 133:1181-8. [PMID: 26915630 DOI: 10.1161/circulationaha.115.020109] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether knowledge of genetic risk for coronary heart disease (CHD) affects health-related outcomes is unknown. We investigated whether incorporating a genetic risk score (GRS) in CHD risk estimates lowers low-density lipoprotein cholesterol (LDL-C) levels. METHODS AND RESULTS Participants (n=203, 45-65 years of age, at intermediate risk for CHD, and not on statins) were randomly assigned to receive their 10-year probability of CHD based either on a conventional risk score (CRS) or CRS + GRS ((+)GRS). Participants in the (+)GRS group were stratified as having high or average/low GRS. Risk was disclosed by a genetic counselor followed by shared decision making regarding statin therapy with a physician. We compared the primary end point of LDL-C levels at 6 months and assessed whether any differences were attributable to changes in dietary fat intake, physical activity levels, or statin use. Participants (mean age, 59.4±5 years; 48% men; mean 10-year CHD risk, 8.5±4.1%) were allocated to receive either CRS (n=100) or (+)GRS (n=103). At the end of the study period, the (+)GRS group had a lower LDL-C than the CRS group (96.5±32.7 versus 105.9±33.3 mg/dL; P=0.04). Participants with high GRS had lower LDL-C levels (92.3±32.9 mg/dL) than CRS participants (P=0.02) but not participants with low GRS (100.9±32.2 mg/dL; P=0.18). Statins were initiated more often in the (+)GRS group than in the CRS group (39% versus 22%, P<0.01). No significant differences in dietary fat intake and physical activity levels were noted. CONCLUSIONS Disclosure of CHD risk estimates that incorporated genetic risk information led to lower LDL-C levels than disclosure of CHD risk based on conventional risk factors alone. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01936675.
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Affiliation(s)
- Iftikhar J Kullo
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.).
| | - Hayan Jouni
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Erin E Austin
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Sherry-Ann Brown
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Teresa M Kruisselbrink
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Iyad N Isseh
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Raad A Haddad
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Tariq S Marroush
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Khader Shameer
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Janet E Olson
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Ulrich Broeckel
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Robert C Green
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Daniel J Schaid
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Victor M Montori
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
| | - Kent R Bailey
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (I.J.K., H.J., E.E.A., S.-A.B., T.M.K., I.N.I., R.A.H., T.S.M., K.S.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (J.E.O., D.J.S., K.R.B.); Department of Pediatrics, Medicine and Physiology, Medical College of Wisconsin, Milwaukee (U.B.); Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (R.C.G.); and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN (V.M.M.)
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107
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Shah M, Varghese RT, Miles JM, Piccinini F, Dalla Man C, Cobelli C, Bailey KR, Rizza RA, Vella A. TCF7L2 Genotype and α-Cell Function in Humans Without Diabetes. Diabetes 2016; 65:371-80. [PMID: 26525881 PMCID: PMC4747457 DOI: 10.2337/db15-1233] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
The diabetes-associated allele in TCF7L2 increases the rate of conversion to diabetes; however, the mechanism by which this occurs remains elusive. We hypothesized that the diabetes-associated allele in this locus (rs7903146) impairs insulin secretion and that this defect would be exacerbated by acute free fatty acid (FFA)-induced insulin resistance. We studied 120 individuals of whom one-half were homozygous for the diabetes-associated allele TT at rs7903146 and one-half were homozygous for the protective allele CC. After a screening examination during which glucose tolerance status was determined, subjects were studied on two occasions in random order while undergoing an oral challenge. During one study day, FFA was elevated by infusion of Intralipid plus heparin. On the other study day, subjects received the same amount of glycerol as present in the Intralipid infusion. β-Cell responsivity indices were estimated with the oral C-peptide minimal model. We report that β-cell responsivity was slightly impaired in the TT genotype group. Moreover, the hyperbolic relationship between insulin secretion and β-cell responsivity differed significantly between genotypes. Subjects also exhibited impaired suppression of glucagon after an oral challenge. These data imply that a genetic variant harbored within the TCF7L2 locus impairs glucose tolerance through effects on glucagon as well as on insulin secretion.
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Affiliation(s)
- Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - Ron T Varghese
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - John M Miles
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - Francesca Piccinini
- Department of Information Engineering, Università degli Studi di Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, Università degli Studi di Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, Università degli Studi di Padova, Padova, Italy
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
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108
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Ashrani AA, Gullerud RE, Petterson TM, Marks RS, Bailey KR, Heit JA. Risk factors for incident venous thromboembolism in active cancer patients: A population based case-control study. Thromb Res 2016; 139:29-37. [PMID: 26916293 DOI: 10.1016/j.thromres.2016.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/09/2015] [Accepted: 01/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Independent risk factors for cancer-associated incident venous thromboembolism (VTE) and their magnitude of risk are not fully characterized. AIM To identify non-cancer and cancer-specific risk factors for cancer-associated incident VTE. METHODS In a population-based retrospective case-control study, we used Rochester Epidemiology Project and Mayo Clinic Cancer Registry resources to identify all Olmsted County, MN residents with active cancer-associated incident VTE, 1973-2000 (cases; n=570) and 1-3 residents with active cancer matched to each case on age, sex, date and duration of active cancer (controls; n=604). Using conditional logistic regression, we tested cancer and non-cancer characteristics for an association with VTE, including a cancer site VTE risk score. RESULTS In the multivariable model, higher cancer site VTE risk score (OR=1.4 per 2-fold increase), cancer stage≥2 (OR=2.2), liver metastasis (OR=2.7), chemotherapy (OR=1.8) and progesterone use (OR=2.1) were independently associated with VTE, as were BMI<18.5kg/m(2) (OR=1.9) or ≥35kg/m(2) (OR=4.0), hospitalization (OR=7.9), nursing home confinement (OR=4.7), central venous (CV) catheter (OR=8.5) and any recent infection (OR=1.7). In a subgroup analysis, platelet count≥350×10(9)/L at time of cancer diagnosis was marginally associated with VTE (OR=2.3, p=0.07). CONCLUSION Cancer site, cancer stage≥2, liver metastasis, chemotherapy, progesterone, being underweight or obese, hospitalization/nursing home confinement, CV catheter, and infection are independent risk factors for incident VTE in active cancer patients.
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Affiliation(s)
- Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Rachel E Gullerud
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Randolph S Marks
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, United States
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - John A Heit
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
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109
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Gong Y, Wang Z, Beitelshees AL, McDonough CW, Langaee TY, Hall K, Schmidt SOF, Curry RW, Gums JG, Bailey KR, Boerwinkle E, Chapman AB, Turner ST, Cooper-DeHoff RM, Johnson JA. Pharmacogenomic Genome-Wide Meta-Analysis of Blood Pressure Response to β-Blockers in Hypertensive African Americans. Hypertension 2016; 67:556-63. [PMID: 26729753 DOI: 10.1161/hypertensionaha.115.06345] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/11/2015] [Indexed: 12/19/2022]
Abstract
African Americans suffer a higher prevalence of hypertension compared with other racial/ethnic groups. In this study, we performed a pharmacogenomic genome-wide association study of blood pressure (BP) response to β-blockers in African Americans with uncomplicated hypertension. Genome-wide meta-analysis was performed in 318 African American hypertensive participants in the 2 Pharmacogenomic Evaluation of Antihypertensive Responses studies: 150 treated with atenolol monotherapy and 168 treated with metoprolol monotherapy. The analysis adjusted for age, sex, baseline BP and principal components for ancestry. Genome-wide significant variants with P<5×10(-8) and suggestive variants with P<5×10(-7) were evaluated in an additional cohort of 141 African Americans treated with the addition of atenolol to hydrochlorothiazide treatment. The validated variants were then meta-analyzed in these 3 groups of African Americans. Two variants discovered in the monotherapy meta-analysis were validated in the add-on therapy. African American participants heterozygous for SLC25A31 rs201279313 deletion versus wild-type genotype had better diastolic BP response to atenolol monotherapy, metoprolol monotherapy, and atenolol add-on therapy: -9.3 versus -4.6, -9.6 versus -4.8, and -9.7 versus -6.4 mm Hg, respectively (3-group meta-analysis P=2.5×10(-8), β=-4.42 mm Hg per variant allele). Similarly, LRRC15 rs11313667 was validated for systolic BP response to β-blocker therapy with 3-group meta-analysis P=7.2×10(-8) and β=-3.65 mm Hg per variant allele. In this first pharmacogenomic genome-wide meta-analysis of BP response to β-blockers in African Americans, we identified novel variants that may provide valuable information for personalized antihypertensive treatment in this group.
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Affiliation(s)
- Yan Gong
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.).
| | - Zhiying Wang
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Amber L Beitelshees
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Caitrin W McDonough
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Taimour Y Langaee
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Karen Hall
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Siegfried O F Schmidt
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Robert W Curry
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - John G Gums
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Kent R Bailey
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Eric Boerwinkle
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Arlene B Chapman
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Stephen T Turner
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Rhonda M Cooper-DeHoff
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
| | - Julie A Johnson
- From the Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., C.W.M., T.Y.L., J.G.G., R.M.C.-D., J.A.J.), Department of Community Health and Family Medicine, College of Medicine (K.H., S.O.F.S., R.W.C., J.G.G.), and Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J.), University of Florida, Gainesville; Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Human Genetics, University of Texas Health Science Center at Houston (Z.W., E.B.); Department of Medicine and Program in Personalized & Genomic Medicine, University of Maryland, Baltimore (A.L.B.); Division of Biomedical Statistics and Informatics, Department of Health Sciences Research (K.R.B.) and Division of Nephrology and Hypertension (S.T.T.), Mayo Clinic, Rochester, MN; and Department of Medicine, University of Chicago, IL. (A.B.C.)
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White WM, Mielke MM, Lahr BD, Miller VD, Jayachandran M, Rocca WA, Bailey KR, Garovic VD. 35: A history of preeclampsia predicts coronary artery calcification three decades later. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Coutinho T, Pellikka PA, Bailey KR, Turner ST, Kullo IJ. Sex Differences in the Associations of Hemodynamic Load With Left Ventricular Hypertrophy and Concentric Remodeling. Am J Hypertens 2016; 29:73-80. [PMID: 26031305 DOI: 10.1093/ajh/hpv071] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/16/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) and concentric remodeling are associated with adverse cardiovascular outcomes. We hypothesized that measures of arterial load are associated with LVH and concentric remodeling, and that associations differ by sex. METHODS We studied 600 non-Hispanic whites (59% women) belonging to hypertensive sibships. By integrating arterial tonometry with echocardiography, we obtained the following hemodynamic measures: aortic characteristic impedance (Z c), proximal aortic compliance (PAC), systemic vascular resistance, augmentation index, and carotid-femoral pulse wave velocity (cfPWV). LVH and concentric remodeling were assessed by left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT), respectively. LVMI was log-transformed to reduce skewness. Hemodynamic measures were indexed to body size. Sex-specific multivariable linear regression analyses adjusting for confounders were performed to assess the associations of measures of arterial load with log LVMI and RWT. RESULTS None of the hemodynamic measures were associated with LVMI in either sex, or with RWT in men. However, in women, measures of aortic stiffness and early, pulsatile hemodynamic load were independently associated with increased RWT: β ± SE = 0.008 ± 0.004 for Z c; 0.003 ± 0.001 for cfPWV, and -0.009 ± 0.003 for PAC (P ≤ 0.05 for each). Female sex was a significant effect modifier of the associations of Z c, cfPWV, and PAC with RWT (P ≤ 0.03 for each of the interaction terms). CONCLUSIONS Greater Z c and cfPWV and lower PAC are independently associated with increased RWT in women but not in men. Our findings suggest that aortic stiffness and greater early, pulsatile hemodynamic load affect left ventricular concentric remodeling in a sex-specific manner.
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Affiliation(s)
- Thais Coutinho
- Department of Internal Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;
| | - Patricia A Pellikka
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen T Turner
- Department of Medicine, Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Buglioni A, Cannone V, Sangaralingham SJ, Heublein DM, Scott CG, Bailey KR, Rodeheffer RJ, Sarzani R, Burnett JC. Aldosterone Predicts Cardiovascular, Renal, and Metabolic Disease in the General Community: A 4-Year Follow-Up. J Am Heart Assoc 2015; 4:JAHA.115.002505. [PMID: 26702078 PMCID: PMC4845260 DOI: 10.1161/jaha.115.002505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND We recently reported that normal aldosterone levels are associated with cardiovascular, renal, and metabolic disease in a sample of the US general community (Visit 1). For the current analyses we used the same cohort in a new 4-year follow-up study (Visit 2). METHODS AND RESULTS We measured aldosterone at Visit 1 and analyzed its predictive role for new diseases at Visit 2 (n=1140). We measured aldosterone at Visit 2 and investigated its associations with disease at Visit 2 (n=1368). We analyzed aldosterone continuously and we also dichotomized the variable as whether subjects were in the third tertile versus second and first tertiles. As continuous variable at Visit 1, aldosterone predicted new onset hypertension (HTN) (OR=1.36, CI=1.13-1.63, P=0.001), central obesity (OR=1.36, CI=1.07-1.73, P=0.011), and use of lipid-lowering drugs (OR=1.25, CI=1.05-1.48, P=0.012) at Visit 2, after adjustment for age, sex, and body mass index. When in the third tertile (8.5-88.6 ng/dL), aldosterone predicted type 2 diabetes (T2DM, OR=1.96, CI=1.03-3.70, P=0.039). At Visit 2, aldosterone remained associated with HTN, obesity, and chronic kidney disease (CKD), as reported for Visit 1. However, aldosterone was not associated with heart failure (HF) at Visit 1 and 2, nor was aldosterone a predictor of HF between visits. CONCLUSIONS Aldosterone predicts new HTN, central obesity, T2DM, and use of lipid-lowering drugs in the general community and remains associated with HTN, obesity, and CKD over 4 years. Aldosterone is not associated nor predicts HF. Further studies are warranted to evaluate aldosterone as therapeutic target in the general community.
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Affiliation(s)
- Alessia Buglioni
- Cardiorenal Research Laboratory, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., J.C.B.) Division of Cardiovascular Diseases, Department of Medicine, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., R.J.R., J.C.B.)
| | - Valentina Cannone
- Cardiorenal Research Laboratory, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., J.C.B.) Division of Cardiovascular Diseases, Department of Medicine, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., R.J.R., J.C.B.)
| | - S Jeson Sangaralingham
- Cardiorenal Research Laboratory, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., J.C.B.) Division of Cardiovascular Diseases, Department of Medicine, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., R.J.R., J.C.B.)
| | - Denise M Heublein
- Cardiorenal Research Laboratory, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., J.C.B.) Division of Cardiovascular Diseases, Department of Medicine, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., R.J.R., J.C.B.)
| | - Christopher G Scott
- Department of Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (C.G.S., K.R.B.)
| | - Kent R Bailey
- Department of Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (C.G.S., K.R.B.)
| | - Richard J Rodeheffer
- Division of Cardiovascular Diseases, Department of Medicine, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., R.J.R., J.C.B.)
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics and "Hypertension Excellence Centre" of the European Society of Hypertension, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancon, Italy (R.S.) Italian National Research Centre on Aging "U. Sestilli", IRCCS-INRCA, Ancon, Italy (R.S.)
| | - John C Burnett
- Cardiorenal Research Laboratory, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., J.C.B.) Division of Cardiovascular Diseases, Department of Medicine, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., J.S., D.M.H., R.J.R., J.C.B.)
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Ye Z, Bailey KR, Austin E, Kullo IJ. Family history of atherosclerotic vascular disease is associated with the presence of abdominal aortic aneurysm. Vasc Med 2015; 21:41-6. [PMID: 26566659 DOI: 10.1177/1358863x15611758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We investigated whether family history (FHx) of atherosclerotic cardiovascular disease (ASCVD) was associated with presence of abdominal aortic aneurysm (AAA). The study cohort comprised of 696 patients with AAA (70±8 years, 84% men) and 2686 controls (68±10 years, 61% men) recruited from noninvasive vascular and stress electrocardiogram (ECG) laboratories at Mayo Clinic. AAA was defined as a transverse diameter of abdominal aorta ⩾ 3 cm or history of AAA repair. Controls were not known to have AAA. FHx was defined as having at least one first-degree relative with aortic aneurysm or with onset of ASCVD (coronary, cerebral or peripheral artery disease) before age 65 years. FHx of aortic aneurysm or ASCVD were each associated with presence of AAA after adjustment for age, sex, conventional risk factors and ASCVD: adjusted odds ratios (OR; 95% confidence interval): 2.17 (1.66-2.83, p < 0.01) and 1.31 (1.08-1.59, p < 0.01), respectively. FHx of ASCVD remained associated with AAA after additional adjustment for FHx of aortic aneurysm: adjusted OR: 1.27 (1.05-1.55, p = 0.01). FHx of ASCVD in multiple arterial locations was associated with higher odds of having AAA: the adjusted odds were 1.23 times higher for each additionally affected arterial location reported in the FHx (1.08-1.40, p = 0.01). Our results suggest both unique and shared environmental and genetic factors mediating susceptibility to AAA and ASCVD.
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Affiliation(s)
- Zi Ye
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Erin Austin
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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Melduni RM, Lee HC, Bailey KR, Miller FA, Hodge DO, Seward JB, Gersh BJ, Ammash NM. Real-time physiologic biomarker for prediction of atrial fibrillation recurrence, stroke, and mortality after electrical cardioversion: A prospective observational study. Am Heart J 2015; 170:914-22. [PMID: 26542499 DOI: 10.1016/j.ahj.2015.07.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial appendage emptying flow velocity (LAAEV) depends largely on left atrioventricular compliance and may play a role in mediating the perpetuation of atrial fibrillation (AF) and AF-related outcomes. METHODS We identified 3,251 consecutive patients with sustained AF undergoing first-time successful transesophageal echocardiography (TEE)-guided electrical cardioversion who were enrolled in a prospective registry between May 2000 and March 2012. Left atrial appendage emptying flow velocity was stratified into quartiles: ≤20.2, 20.3-33.9, 34-49.9, and ≥50 cm/s. Multivariate Cox regression models were used to identify independent predictors of AF recurrence, ischemic stroke, and all-cause mortality. RESULTS The mean (SD) age was 69 (12.6) years and 67% were men. Compared with the fourth quartile, patients in the first-third quartiles were significantly older, had higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack [TIA], vascular disease, age 65-74 years, sex category) scores, greater frequency of atrial spontaneous echo contrast, and AF of longer duration. Kaplan-Meier analysis showed a decreased probability of event-free survival with decreasing quartiles of LAAEV. Five-year cumulative event rates across first-fourth quartiles were 83%, 80%, 73%, and 73% (P < .001) for first AF recurrence; 7.5%, 7.0%, 4.1%, and 4.0%, for stroke (P = .01); and 31.3%, 26.1%, 24.1%, and 19.4%, for mortality (P < .001), respectively. Multivariate Cox regression analysis revealed an independent association of the first and second quartiles with AF recurrence (P < .001 and P < .001, respectively) and stroke (P = .03, and P = .04, respectively), and of the first quartile with mortality (P = .003). CONCLUSIONS Patients with decreased LAAEV have an increased risk of AF recurrence, stroke, and mortality after successful electrical cardioversion. Real-time measurement of LAAEV by TEE may be a useful physiologic biomarker for individualizing treatment decisions in patients with AF.
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Affiliation(s)
| | - Hon-Chi Lee
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, FL
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Rochester, FL
| | - James B Seward
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Cohoon KP, Leibson CL, Ransom JE, Ashrani AA, Park MS, Petterson TM, Long KH, Bailey KR, Heit JA. Corrigendum to ‘Direct medical costs attributable to venous thromboembolism among persons hospitalized for major operation: A population-based longitudinal study’. Surgery 2015. [DOI: 10.1016/j.surg.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Melduni RM, Schaff HV, Bailey KR, Cha SS, Ammash NM, Seward JB, Gersh BJ. Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study. Am Heart J 2015; 170:659-68. [PMID: 26386789 DOI: 10.1016/j.ahj.2015.06.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/20/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Data are lacking on the long-term prognostic implications of POAF. We hypothesized that POAF, which reflects underlying cardiovascular pathophysiologic substrate, is a predictive marker of late AF and long-term mortality. METHODS We identified 603 Olmsted County, Minnesota, residents without prior documented history of AF who underwent coronary artery bypass graft and/or valve surgery from 2000 to 2005. Patients were monitored for first documentation of late AF or death at >30 days postoperatively. Multivariate Cox regression models were used to assess the independent association of POAF with late AF and long-term mortality. RESULTS After a mean follow-up of 8.3 ± 4.2 years, freedom from late AF was less with POAF than no POAF (57.4% vs 88.9%, P < .001). The risk of late AF was highest within the first year at 18%. Univariate analysis demonstrated that POAF was associated with significantly increased risk of late AF [hazard ratio (HR), 5.09; 95% CI, 3.65-7.22] and long-term mortality (HR, 1.79; 95% CI, 1.38-2.22). After adjustment for age, sex, and clinical and surgical risk factors, POAF remained independently associated with development of late AF (HR, 3.52; 95% CI, 2.42-5.13) but not long-term mortality (HR, 1.16; 95% CI, 0.87-1.55). Conversely, late AF was independently predictive of long-term mortality (HR, 3.25; 95% CI, 2.42-4.35). Diastolic dysfunction independently influenced the risk of late AF and long-term mortality. CONCLUSIONS Postoperative atrial fibrillation was an independent predictive marker of late AF, whereas late AF, but not POAF, was independently associated with long-term mortality. Patients who develop new-onset POAF should be considered for continuous anticoagulation at least during the first year following cardiac surgery.
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Affiliation(s)
| | | | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Stephen S Cha
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - James B Seward
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Kullo IJ, Jouni H, Olson JE, Montori VM, Bailey KR. Design of a randomized controlled trial of disclosing genomic risk of coronary heart disease: the Myocardial Infarction Genes (MI-GENES) study. BMC Med Genomics 2015; 8:51. [PMID: 26271327 PMCID: PMC4536729 DOI: 10.1186/s12920-015-0122-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 07/15/2015] [Indexed: 01/07/2023] Open
Abstract
Background Whether disclosure of a genetic risk score (GRS) for a common disease influences relevant clinical outcomes is unknown. We describe design of the Myocardial Infarction Genes (MI-GENES) Study, a randomized clinical trial to assess whether disclosing a GRS for coronary heart disease (CHD) leads to lowering of low-density lipoprotein cholesterol (LDL-C) levels. Methods and design We performed an initial screening genotyping of 28 CHD susceptibility single-nucleotide polymorphisms (SNPs) that are not associated with blood pressure or lipid levels, in 1000 individuals from Olmsted County, Minnesota who were participants in the Mayo Clinic BioBank and met eligibility criteria. We calculated GRS based on 28 SNPs and will enroll 110 patients each in two CHD genomic risk categories: high (GRS ≥1.1), and average/low (GRS <1.1). The study coordinator will obtain informed consent for the study that includes placing genetic testing results in the electronic health record. Participants will undergo a blood draw and return 6-10 weeks later (Visit 2) once genotyping is completed and a GRS calculated. At this visit, patients will be randomized (1:1) to receive CHD risk estimates from a genetic counselor based on a conventional risk score (CRS) vs. GRS, followed by shared decision making with a physician regarding statin use. Three and six months following the disclosure of CHD risk, participants will return for measurement of fasting lipid levels and assessment of changes in dietary fat intake and physical activity levels. Psychosocial measures will be assessed at baseline and after disclosure of CHD risk. Discussion The proposed trial will provide insights into the clinical utility of genetic testing for CHD risk assessment. Clinical trial registration ClinicalTrials.gov registration number: NCT01936675. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0122-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iftikhar J Kullo
- From the Division of Cardiovascular Diseases, Department of Medicine (IJK, HJ), Department of Health Sciences Research (JEO, KRB), Knowledge and Evaluation Research Unit (VMM), Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Hayan Jouni
- From the Division of Cardiovascular Diseases, Department of Medicine (IJK, HJ), Department of Health Sciences Research (JEO, KRB), Knowledge and Evaluation Research Unit (VMM), Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Janet E Olson
- From the Division of Cardiovascular Diseases, Department of Medicine (IJK, HJ), Department of Health Sciences Research (JEO, KRB), Knowledge and Evaluation Research Unit (VMM), Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- From the Division of Cardiovascular Diseases, Department of Medicine (IJK, HJ), Department of Health Sciences Research (JEO, KRB), Knowledge and Evaluation Research Unit (VMM), Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kent R Bailey
- From the Division of Cardiovascular Diseases, Department of Medicine (IJK, HJ), Department of Health Sciences Research (JEO, KRB), Knowledge and Evaluation Research Unit (VMM), Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Scantlebury DC, Kane GC, Wiste HJ, Bailey KR, Turner ST, Arnett DK, Devereux RB, Mosley TH, Hunt SC, Weder AB, Rodriguez B, Boerwinkle E, Weissgerber TL, Garovic VD. Left ventricular hypertrophy after hypertensive pregnancy disorders. Heart 2015; 101:1584-90. [PMID: 26243788 DOI: 10.1136/heartjnl-2015-308098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/09/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Cardiac changes of hypertensive pregnancy include left ventricular hypertrophy (LVH) and diastolic dysfunction. These are thought to regress postpartum. We hypothesised that women with a history of hypertensive pregnancy would have altered LV geometry and function when compared with women with only normotensive pregnancies. METHODS In this cohort study, we analysed echocardiograms of 2637 women who participated in the Family Blood Pressure Program. We compared LV mass and function in women with hypertensive pregnancies with those with normotensive pregnancies. RESULTS Women were evaluated at a mean age of 56 years: 427 (16%) had at least one hypertensive pregnancy; 2210 (84%) had normotensive pregnancies. Compared with women with normotensive pregnancies, women with hypertensive pregnancy had a greater risk of LVH (OR: 1.42; 95% CI 1.01 to 1.99, p=0.05), after adjusting for age, race, research network of the Family Blood Pressure Program, education, parity, BMI, hypertension and diabetes. When duration of hypertension was taken into account, this relationship was no longer significant (OR: 1.19; CI 0.08 to 1.78, p=0.38). Women with hypertensive pregnancies also had greater left atrial size and lower mitral E/A ratio after adjusting for demographic variables. The prevalence of systolic dysfunction was similar between the groups. CONCLUSIONS A history of hypertensive pregnancy is associated with LVH after adjusting for risk factors; this might be explained by longer duration of hypertension. This finding supports current guidelines recommending surveillance of women following a hypertensive pregnancy, and sets the stage for longitudinal echocardiographic studies to further elucidate progression of LV geometry and function after pregnancy. CLINICAL TRIAL REGISTRATIONS GENOA- NCT00005269; HyperGEN- NCT00005267; Sapphire- NCT00005270; GenNet- NCT00005268.
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Affiliation(s)
- Dawn C Scantlebury
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather J Wiste
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Donna K Arnett
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Thomas H Mosley
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Alan B Weder
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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Heit JA, Lahr BD, Ashrani AA, Petterson TM, Bailey KR. Predictors of venous thromboembolism recurrence, adjusted for treatments and interim exposures: a population-based case-cohort study. Thromb Res 2015; 136:298-307. [PMID: 26143712 PMCID: PMC4526375 DOI: 10.1016/j.thromres.2015.06.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predictors of venous thromboembolism (VTE) recurrence are uncertain. OBJECTIVE To identify predictors of VTE recurrence, adjusted for treatments and interim exposures. MATERIALS AND METHODS Using Rochester Epidemiology Project resources, all Olmsted County, MN residents with objectively-diagnosed incident VTE over the 13-year period, 1988-2000, who survived ≥1day were followed for first objectively-diagnosed VTE recurrence. For all patients with recurrence, and a random sample of all surviving incident VTE patients (n=415), we collected demographic and baseline characteristics, treatments and interim exposures. In a case-cohort study design, demographic, baseline, treatment and interim exposure characteristics were tested as potential predictors of VTE recurrence using time-dependent Cox proportional hazards modeling. RESULTS Among 1262 incident VTE patients, 306 developed recurrence over 6,440 person-years. Five-year recurrence rates, overall and for cancer-associated, idiopathic and non-cancer secondary VTE, were 24.5%, 43.4%, 27.3% and 18.1%, respectively. In multivariable analysis, interim hospitalization, active cancer, pregnancy, central venous catheter and respiratory infection were associated with increased hazards of recurrence, and warfarin and aspirin were associated with reduced hazards. Adjusting for treatments and these interim risk factors, male sex, baseline active cancer and failure to achieve a therapeutic aPTT in the first 24hours were independently associated with increased hazards of VTE recurrence over the entire follow-up period, while the hazards of recurrence for patient age, chronic lung disease, leg paresis, prior superficial vein thrombosis and idiopathic VTE varied over the follow-up period. CONCLUSIONS Baseline and interim exposures can stratify VTE recurrence risk and may be useful for directing secondary prophylaxis.
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Affiliation(s)
- John A Heit
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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120
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Lowe VJ, Tosakulwong N, Lesnick TG, Gunter JL, Senjem ML, Shuster LT, Mielke MM, Bailey KR, Jack CR, Rocca W, Miller VM, Kantarci K. IC‐P‐033: Treatment with 17β‐estradiol in postmenopausal women is associated with lower PiB‐PET retention. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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121
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Lowe VJ, Tosakulwong N, Lesnick TG, Gunter JL, Senjem ML, Shuster LT, Mielke MM, Bailey KR, Jack CR, Rocca W, Miller VM, Kantarci K. O3‐01‐02: Treatment with 17β‐estradiol in postmenopausal women is associated with lower PiB‐PET retention. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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122
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Cohoon KP, Andrews KL, Ashrani AA, Petterson TM, Bailey KR, Heit JA. Abstract 303: Risk Factors for Venous Thromboembolism (VTE) among Patients with Neurologic Disease and Leg Paresis: A Population-based Case-control Study. Arterioscler Thromb Vasc Biol 2015. [DOI: 10.1161/atvb.35.suppl_1.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Whether VTE risk can be further stratified among patients with neurologic disease and leg paresis is unknown.
Objective:
To identify independent risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) among patients with neurologic disease and leg paresis.
Methods:
Using the population-based resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN residents with incident DVT or PE over the 45-year period, 1966 to 2010. We performed a case-control study nested within the Olmsted County population with incident VTE associated with neurologic disease and leg paresis over the 18-year period, 1988-2010 (n=192). For each VTE case, we identified 1 Olmsted County resident with neurologic disease, leg paresis and no VTE (control) matched to each case on sex, date of birth (+/- 5 years), calendar year (+/- 1 year) and duration of medical records. Using conditional logistic regression, we tested duration of paresis (index-3 months, 3-12 months, and > 12 months), paresis etiology, and degree of immobility as potential risk factors for VTE after adjusting for other known VTE risk factors, including hospitalization for major surgery or acute medical illness, trauma/fracture, and active cancer.
Results:
In univariate analyses of the 192 pairs, trauma/fracture, hospitalization for major surgery or for acute medical illness, active cancer, duration of paresis, and degree of immobility were associated with VTE. In the multivariable analysis, hospitalization for acute medical illness, active cancer, degree of immobility (ambulatory without/with assistance, function from a wheelchair base, bed bound; OR: 2.60; 95%Cl: 1.65-4.11); p=<0.0001) were independent predictors of VTE.
Conclusion:
Among patients with neurologic disease and leg paresis, VTE risk can be further stratified by hospitalization for acute medical illness, active cancer and degree of immobility; these patients should be considered for VTE prophylaxis.
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Affiliation(s)
- Kevin P Cohoon
- Div of Cardiovascular Medicine, Dept of Internal Medicine, Univ of Wisconsin Hosp and Clinics, Madison, WI
| | - Karen L Andrews
- Dept of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Aneel A Ashrani
- Div of Hematology; Dept of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Tanya M Petterson
- Div of Biomedical Statistics and Informatics, Dept of Health Sciences Rsch, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Div of Biomedical Statistics and Informatics, Dept of Health Sciences Rsch, Mayo Clinic, Rochester, MN
| | - John A Heit
- Divs of Cardiovascular Diseases and Hematology, Dept of Internal Me, Mayo Clinic, Rochester, MN
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123
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Smith CY, Bailey KR, Emerson JA, Nemetz PN, Roger VL, Palumbo PJ, Edwards WD, Leibson CL. Contributions of increasing obesity and diabetes to slowing decline in subclinical coronary artery disease. J Am Heart Assoc 2015; 4:jah3915. [PMID: 25904589 PMCID: PMC4579948 DOI: 10.1161/jaha.114.001524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Our previous study of nonelderly adult decedents with nonnatural (accident, suicide, or homicide) cause of death (96% autopsy rate) between 1981 and 2004 revealed that the decline in subclinical coronary artery disease (CAD) ended in the mid‐1990s. The present study investigated the contributions of trends in obesity and diabetes mellitus to patterns of subclinical CAD and explored whether the end of the decline in CAD persisted. Methods and Results We reviewed provider‐linked medical records for all residents of Olmsted County, Minnesota, who died from nonnatural causes within the age range of 16 to 64 years between 1981 and 2009 and who had CAD graded at autopsy. We estimated trends in CAD risk factors including age, sex, systolic blood pressure, diabetes (qualifying fasting glucose or medication), body mass index, smoking, and diagnosed hyperlipidemia. Using multiple regression, we tested for significant associations between trends in CAD risk factors and CAD grade and assessed the contribution of trends in diabetes and obesity to CAD trends. The 545 autopsied decedents with recorded CAD grade exhibited significant declines between 1981 and 2009 in systolic blood pressure and smoking and significant increases in blood pressure medication, diabetes, and body mass index ≥30 kg/m2. An overall decline in CAD grade between 1981 and 2009 was nonlinear and ended in 1994. Trends in obesity and diabetes contributed to the end of CAD decline. Conclusions Despite continued reductions in smoking and blood pressure values, the previously observed end to the decline in subclinical CAD among nonelderly adult decedents was apparent through 2009, corresponding with increasing obesity and diabetes in that population.
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Affiliation(s)
- Carin Y. Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.)
| | - Kent R. Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.)
| | - Jane A. Emerson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.)
| | - Peter N. Nemetz
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.)
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada (P.N.N.)
| | - Véronique L. Roger
- Department of Internal Medicine, Mayo Clinic, Rochester, MN (R.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.)
| | | | - William D. Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (W.D.E.)
| | - Cynthia L. Leibson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (C.Y.S., K.R.B., J.A.E., P.N.N., R., C.L.L.)
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Sangaralingham SJ, McKie PM, Ichiki T, Scott CG, Heublein DM, Chen HH, Bailey KR, Redfield MM, Rodeheffer RJ, Burnett JC. Circulating C-type natriuretic peptide and its relationship to cardiovascular disease in the general population. Hypertension 2015; 65:1187-94. [PMID: 25895587 DOI: 10.1161/hypertensionaha.115.05366] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
C-type natriuretic peptide (CNP) is an endothelium-derived peptide that is released as a protective mechanism in response cardiovascular injury or disease. However, no studies have investigated circulating CNP, identifying clinical factors that may influence CNP and its relationship to cardiovascular disease in the general population. We studied 1841 randomly selected subjects from Olmsted County, MN (mean age, 63±11 years; 48% men). Plasma CNP was measured by a well-established radioimmunoassay and echocardiography, clinical characterization, and detailed medical record review were performed. We report that CNP circulates at various concentrations (median, 13 pg/mL), was unaffected by sex, was weakly associated by age, and that highest quartile of CNP identified a high-risk phenotype. Subjects with CNP in the highest quartile were associated with increased risk of myocardial infarction (multivariable-adjusted hazard ratio, 1.51; 95% confidence interval, 1.09-2.09; P=0.01) but not heart failure, cerebrovascular accidents, or death during a follow-up of 12 years. Addition of the highest quartile of CNP to clinical variables led to a modest increase in the integrated discrimination improvement for risk of myocardial infarction. In a large community-based cohort, elevated circulating CNP identified a high-risk phenotype that included cardiovascular comorbidities and left ventricular dysfunction, and provided evidence that highest concentrations of CNP potentially has prognostic value in predicting future risk of myocardial infarction. Together, these data from the general population highlight the potential value of CNP and support the need for additional studies to evaluate whether mechanisms regulating CNP could improve outcomes.
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Affiliation(s)
- S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN.
| | - Paul M McKie
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Tomoko Ichiki
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Christopher G Scott
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Horng H Chen
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Margaret M Redfield
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Richard J Rodeheffer
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - John C Burnett
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
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Ashrani AA, Barsoum MK, Crusan DJ, Petterson TM, Bailey KR, Heit JA. Is lipid lowering therapy an independent risk factor for venous thromboembolism? A population-based case-control study. Thromb Res 2015; 135:1110-6. [PMID: 25891841 DOI: 10.1016/j.thromres.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The independent effect of lipid lowering therapy (LLT) on venous thromboembolism (VTE) risk is uncertain. OBJECTIVE To test statin and non-statin LLT as potential VTE risk factors. METHODS Using Rochester Epidemiology Project resources, we identified all Olmsted County, MN residents with objectively diagnosed incident VTE (cases) over the 13-year period, 1988-2000 (n=1340), and one to two matched controls (n=1538). We reviewed their complete medical records for baseline characteristics previously identified as independent VTE risk factors, and for statin and non-statin LLT. Using conditional logistic regression, we tested the overall effect of LLT on VTE risk and also separately explored the role of statin versus that of non-statin LLT, adjusting for other baseline characteristics. RESULTS Among cases and controls, 74 and 111 received statin LLT, and 32 and 50 received non-statin LLT, respectively. Univariately, and after individually controlling for other potential VTE risk factors (i.e., BMI, trauma/fracture, leg paresis, hospitalization for surgery or medical illness, nursing home residence, active cancer, central venous catheter, varicose veins, prior superficial vein thrombosis, diabetes, congestive heart failure, angina/myocardial infarction, stroke, peripheral vascular disease, smoking, anticoagulation), LLT was associated with decreased odds of VTE (unadjusted OR=0.73; p=0.03). When considered separately, statin and non-statin LLT were each associated with moderate, non-significant lower odds of VTE. After adjusting for angina/myocardial infarction, each was significantly associated with decreased odds of VTE (OR=0.63, p<0.01 and OR=0.61, p=0.04, respectively). CONCLUSIONS LLT is associated with decreased VTE risk after adjusting for known risk factors.
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Affiliation(s)
- Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Michel K Barsoum
- Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Crusan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - John A Heit
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
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Miller VM, Lahr BD, Bailey KR, Heit JA, Harman SM, Jayachandran M. Longitudinal effects of menopausal hormone treatments on platelet characteristics and cell-derived microvesicles. Platelets 2015; 27:32-42. [PMID: 25856160 PMCID: PMC4732432 DOI: 10.3109/09537104.2015.1023273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Activated platelets serve as a catalyst for thrombin generation and a source of vasoactive and mitogenic factors affecting vascular remodeling. Oral menopausal hormone treatments (MHT) may carry greater thrombotic risk than transdermal products. This study compared effects of oral and transdermal MHT on platelet characteristics, platelet proteins, and platelet-derived microvesicles (MV) in recently menopausal women. Platelets and MV were prepared from blood of a subset of women (n = 117) enrolled in the Kronos Early Estrogen Prevention Study prior to and after 48 months of treatment with either oral conjugated equine estrogen (0.45 mg/day), transdermal 17β-estradiol (50 µg/day), each with intermittent progesterone (200 mg/day for 12 days a month), or placebo pills and patch. Platelet count and expression of platelet P-selectin and fibrinogen receptors were similar across groups. An aggregate measure of 4-year change in vasoactive and mitogenic factors in platelet lysate, by principle component analysis, indicated significantly lower values in both MHT groups compared to placebo. Increases in numbers of tissue factor positive and platelet-derived MV were significantly greater in the transdermal compared to placebo group. MHT was associated with significantly reduced platelet content of vasoactive and mitogenic factors representing a potential mechanism by which MHT may affect vascular remodeling. Various hormonal compositions and doses of MHT could differentially regulate nuclear transcription in bone marrow megakaryocytes and non-genomic pathways in circulating platelets thus determining numbers and characteristics of circulating MV. Thrombotic risk associated with oral MHT most likely involves liver-derived inflammatory/coagulation proteins rather than circulating platelets per se.
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Affiliation(s)
- Virginia M Miller
- a Department of Surgery , College of Medicine, Mayo Clinic , Rochester , MN , USA .,b Department of Physiology & Biomedical Engineering , Mayo Clinic , Rochester , MN , USA
| | - Brian D Lahr
- c Division of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , MN , USA
| | - Kent R Bailey
- c Division of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , MN , USA .,d Division of Epidemiology , Mayo Clinic , Rochester , MN , USA
| | - John A Heit
- e Division of Cardiovascular Diseases , Internal Medicine, Mayo Clinic , Rochester , MN , USA , and
| | - S Mitchell Harman
- f Kronos Longevity Research Institute and Phoenix VA Health Care System , Phoenix , AZ , USA
| | - Muthuvel Jayachandran
- b Department of Physiology & Biomedical Engineering , Mayo Clinic , Rochester , MN , USA
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Cohoon KP, Leibson CL, Ransom JE, Ashrani AA, Petterson TM, Long KH, Bailey KR, Heit JA. Costs of venous thromboembolism associated with hospitalization for medical illness. Am J Manag Care 2015; 21:e255-e263. [PMID: 26244788 PMCID: PMC4586032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. STUDY DESIGN Population-based cohort study conducted in Olmsted County, Minnesota. METHODS Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County residents with objectively diagnosed incident VTE during or within 92 days of hospitalization for acute medical illness over the 18-year period of 1988 to 2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case for event date (±1 year), duration of prior medical history, and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or December 31, 2011 (study end date). We censored follow-up such that each case and matched control had similar periods of observation. We used generalized linear modeling (controlling for age, sex, preexisting conditions, and costs 1 year before index) to predict costs for cases and controls. RESULTS Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P<.001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared with controls for up to 3 years. CONCLUSIONS VTE during or after recent hospitalization for medical illness contributes a substantial economic burden.
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Affiliation(s)
| | | | | | | | | | | | | | - Johm A Heit
- Stabile 6-Hematology Research, Mayo Clinic, 200 First St, SW, Rochester, MN 55905. E-mail:
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Cohoon KP, Leibson CL, Ransom JE, Ashrani AA, Park MS, Petterson TM, Long KH, Bailey KR, Heit JA. Direct medical costs attributable to venous thromboembolism among persons hospitalized for major operation: a population-based longitudinal study. Surgery 2015; 157:423-31. [PMID: 25633736 DOI: 10.1016/j.surg.2014.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/29/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND We estimated medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for major operation. METHODS Using Rochester Epidemiology Project resources, we identified all Olmsted County, MN, residents with objectively diagnosed incident VTE within 92 days of hospitalization for major operation during an 18-year period, 1988-2005 (n = 355). One Olmsted County resident hospitalized for major operation without VTE was matched to each case on event date (±1 year), type of operation, duration of previous medical history, and active cancer status. Subjects were followed in Rochester Epidemiology Project provider-linked billing data for standardized, inflation-adjusted direct medical costs from 1 year before index (case's VTE event date and control's matched date) to earliest of death, emigration, or December 31, 2011. We used generalized linear modeling to predict costs for cases and controls and used bootstrapping methods to assess uncertainty and significance of mean adjusted cost differences. RESULTS Adjusted mean predicted costs were more than 1.5-fold greater for cases ($55,956) than for controls ($32,718) (P ≤ .001) from index to up to 5 years postindex. Cost differences between cases and controls were greatest within the first 3 months after index (mean difference = $12,381). Costs were greater for cases than controls (mean difference = $10,797) from 3 months to up to 5 years postindex and together accounted for about half of the overall cost difference. CONCLUSION VTE during or after recent hospitalization for major operation contributes a substantial economic burden; VTE-attributable costs are greatest in the initial 3 months but persist for up to 5 years.
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Affiliation(s)
- Kevin P Cohoon
- Division of Cardiovascular Diseases and Gonda Vascular Center, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Cynthia L Leibson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jeanine E Ransom
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Myung S Park
- Division of Trauma, Critical Care and General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John A Heit
- Division of Cardiovascular Diseases and Gonda Vascular Center, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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Petterson TM, Marks RS, Ashrani AA, Bailey KR, Heit JA. Risk of site-specific cancer in incident venous thromboembolism: a population-based study. Thromb Res 2014; 135:472-8. [PMID: 25547213 DOI: 10.1016/j.thromres.2014.12.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The risk of venous thromboembolism (VTE) by cancer site is uncertain. OBJECTIVE To estimate VTE risk by tumor site. METHODS We enumerated observed active cancers by cancer site for Olmsted County, MN residents with incident VTE over the 13-year period, 1988-2000 (n = 345 of 1417). We used 1988-2000 Iowa State Surveillance, Epidemiology, and End Results (SEER) data to estimate the expected age-specific prevalence of cancer by cancer site for all VTE cases; standardized Morbidity Ratios (SMR) for each cancer site were estimated by dividing the observed number of cancers in the VTE incident cohort by the expected number. Relative risk regression was used to model the observed number of cancers of each site, adjusting for the expected value based on SEER prevalence data, using generalized linear regression with a Poisson error and the natural log of the age- and sex-group expected count as an offset. RESULTS For men and women with VTE, all cancer sites had an increased SMR, ranging from 4.1 for head neck cancer to 47.3 for brain cancer. Among women, the SMR for breast, ovarian and other gynecologic cancers were 8.4, 13.0 and 8.4, respectively; for men, prostate cancer SMR was 7.9. Adjusting for age and sex, the relative risk (RR) of cancer in VTE cases was associated with cancer site in a multivariable model (p < 0.001). Adjusting for age and sex, pancreatic, brain, other digestive cancers, and lymphoma had significantly higher RRs than the grouped comparison cancers. CONCLUSIONS Incident VTE risk can be stratified by cancer site.
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Affiliation(s)
- Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic Rochester, MN, United States
| | - Randolph S Marks
- Division of Medical Oncology, Department of Oncology, Mayo Clinic Rochester, MN, United States
| | - Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, MN, United States
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic Rochester, MN, United States
| | - John A Heit
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic Rochester, MN, United States; Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic Rochester, MN, United States.
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Buglioni A, Cannone V, Cataliotti A, Sangaralingham SJ, Heublein DM, Scott CG, Bailey KR, Rodeheffer RJ, Dessì-Fulgheri P, Sarzani R, Burnett JC. Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease. Hypertension 2014; 65:45-53. [PMID: 25368032 DOI: 10.1161/hypertensionaha.114.03936] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to investigate the role of aldosterone as a mediator of disease and its relationship with the counter-regulatory natriuretic peptide (NP) system. We measured plasma aldosterone (n=1674; aged≥45 years old) in a random sample of the general population from Olmsted County, MN. In a multivariate logistic regression model, aldosterone analyzed as a continuous variable was associated with hypertension (odds ratio [OR]=1.75; 95% confidence interval [CI]=1.57-1.96; P<0.0001), obesity (OR=1.34; 95% CI=1.21-1.48; P<0.0001), chronic kidney disease (OR=1.39; 95% CI=1.22-1.60; P<0.0001), central obesity (OR=1.47; 95% CI=1.32-1.63; P<0.0001), metabolic syndrome (OR=1.41; 95% CI=1.26-1.58; P<0.0001), high triglycerides (OR=1.23; 95% CI=1.11-1.36; P<0.0001), concentric left ventricular hypertrophy (OR=1.22; 95% CI=1.09-1.38; P=0.0007), and atrial fibrillation (OR=1.24; 95% CI=1.01-1.53; P=0.04), after adjusting for age and sex. The associations with hypertension, central obesity, metabolic syndrome, triglycerides, and concentric left ventricular hypertrophy remained significant after further adjustment for body mass index, NPs, and renal function. Furthermore, aldosterone in the highest tertile correlated with lower NP levels and increased mortality. Importantly, most of these associations remained significant even after excluding subjects with aldosterone levels above the normal range. In conclusion, we report that aldosterone is associated with hypertension, chronic kidney disease, obesity, metabolic syndrome, concentric left ventricular hypertrophy, and lower NPs in the general community. Our data suggest that aldosterone, even within the normal range, may be a biomarker of cardiorenal and metabolic disease. Further studies are warranted to evaluate a therapeutic and preventive strategy to delay the onset and progression of disease, using mineralocorticoid antagonists or chronic NP administration in high-risk subjects identified by plasma aldosterone.
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Affiliation(s)
- Alessia Buglioni
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.).
| | - Valentina Cannone
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Alessandro Cataliotti
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Christopher G Scott
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Kent R Bailey
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Richard J Rodeheffer
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Paolo Dessì-Fulgheri
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Riccardo Sarzani
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - John C Burnett
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
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Vandell AG, McDonough CW, Gong Y, Langaee TY, Lucas AM, Chapman AB, Gums JG, Beitelshees AL, Bailey KR, Johnson RJ, Boerwinkle E, Turner ST, Cooper-DeHoff RM, Johnson JA. Hydrochlorothiazide-induced hyperuricaemia in the pharmacogenomic evaluation of antihypertensive responses study. J Intern Med 2014; 276:486-97. [PMID: 24612202 PMCID: PMC4130802 DOI: 10.1111/joim.12215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Elevations in uric acid (UA) and the associated hyperuricaemia are commonly observed secondary to treatment with thiazide diuretics. We sought to identify novel single nucleotide polymorphisms (SNPs) associated with hydrochlorothiazide (HCTZ)-induced elevations in UA and hyperuricaemia. METHODS A genome-wide association study of HCTZ-induced changes in UA was performed in Caucasian and African American participants from the pharmacogenomic evaluation of antihypertensive responses (PEAR) study who were treated with HCTZ monotherapy. Suggestive SNPs were replicated in Caucasians and African Americans from the PEAR study who were treated with HCTZ add-on therapy. Replicated regions were followed up through expression and pathway analysis. RESULTS Five unique gene regions were identified in African Americans (LUC7L2, ANKRD17/COX18, FTO, PADI4 and PARD3B), and one region was identified in Caucasians (GRIN3A). Increases in UA of up to 1.8 mg dL(-1) were observed following HCTZ therapy in individuals homozygous for risk alleles, with heterozygotes displaying an intermediate phenotype. Several risk alleles were also associated with an increased risk of HCTZ-induced clinical hyperuricaemia. A composite risk score, constructed in African Americans using the 'top' SNP from each gene region, was strongly associated with HCTZ-induced UA elevations (P = 1.79 × 10(-7) ) and explained 11% of the variability in UA response. Expression studies in RNA from whole blood revealed significant differences in expression of FTO by rs4784333 genotype. Pathway analysis showed putative connections between many of the genes identified through common microRNAs. CONCLUSION Several novel gene regions were associated with HCTZ-induced UA elevations in African Americans (LUC7L2, COX18/ANKRD17, FTO, PADI4 and PARD3B), and one region was associated with these elevations in Caucasians (GRIN3A).
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Affiliation(s)
- A G Vandell
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida College of Pharmacy, Gainesville, FL, USA
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Kermott CA, Bailey KR, Olson JE. Validation of a population coronary disease predictive system: the CASSANDRA model. Br J Soc Med 2014; 68:1009. [DOI: 10.1136/jech-2014-204165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Leibson CL, Petterson TM, Smith CY, Bailey KR, Emerson JA, Ashrani AA, Takahashi PY, Heit JA. Rethinking guidelines for VTE risk among nursing home residents: a population-based study merging medical record detail with standardized nursing home assessments. Chest 2014; 146:412-421. [PMID: 24626961 DOI: 10.1378/chest.13-2652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments. METHODS This population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression. RESULTS The multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2). CONCLUSIONS Contrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.
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Affiliation(s)
- Cynthia L Leibson
- Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jane A Emerson
- Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Aneel A Ashrani
- Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Primary Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John A Heit
- Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Khaleghi M, Isseh IN, Bailey KR, Kullo IJ. Family history as a risk factor for peripheral arterial disease. Am J Cardiol 2014; 114:928-32. [PMID: 25107577 DOI: 10.1016/j.amjcard.2014.06.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
The association of a family history of peripheral arterial disease (PAD) with the presence of PAD is largely unknown. We conducted a case-control study of 2,296 patients with PAD (69 ± 10 years, 64% men) and 4,390 controls (66 ± 11 years, 62% men) identified from noninvasive vascular and stress testing laboratories at Mayo Clinic, Rochester, Minnesota, from October 2006 through June 2012. PAD was defined as an ankle brachial index of ≤ 0.9 at rest and/or after exercise, a history of lower extremity revascularization, or having poorly compressible leg arteries. Controls were patients with normal ankle brachial index or without a history of PAD. Family history of PAD was defined as having at least 1 first-degree relative who had undergone revascularization or stent placement for PAD before the age of 65 years. Logistic regression analyses were used to evaluate whether a family history of PAD was associated with the presence of PAD, independent of conventional risk factors. A family history of PAD was present more often in patients with PAD than in controls, with a resulting odds ratio (OR) of 2.20 (95% confidence interval [CI] 1.82 to 2.67). The association remained significant after adjustment for conventional risk factors (OR 1.97, 95% CI 1.60 to 2.42). The association was stronger in younger subjects (age <68 years; adjusted OR 2.46, 95% CI 1.79 to 3.38) than in older subjects (adjusted OR 1.61, 95% CI 1.22 to 2.12). A greater number of affected relatives with PAD was also associated with greater odds of presence of PAD (adjusted OR 1.86, 95% CI 1.48 to 2.33 and adjusted OR 2.56, 95% CI 1.60 to 4.11 for patients with 1 and ≥ 2 affected relatives with PAD, respectively). In conclusion, individuals with a family history of PAD have nearly double the odds of having PAD relative to those without such a history.
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Cannone V, Scott CG, Bailey KR, Olson TM, Theis JL, Redfield MM, Rodeheffer RJ, Burnett JC. The Soluble Guanylate Cyclase Genetic Variant rs13139571 Is Associated with an “Unfavorable” Metabolic Phenotype in an US General Community. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Mahyar Khaleghi
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Iyad N. Isseh
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Hayan Jouni
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Sunghwan Sohn
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Kent R. Bailey
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Iftikhar J. Kullo
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
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Rea S, Bailey KR, Pathak J, Haug PJ. Variation in Cohorts Derived from EHR Data in Four Care Delivery Settings. AMIA Jt Summits Transl Sci Proc 2014; 2014:97-101. [PMID: 25954584 PMCID: PMC4419770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Susan Rea
- Intermountain Healthcare, Salt Lake City, UT
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Chapman AB, Cotsonis G, Parekh V, Schwartz GL, Gong Y, Bailey KR, Turner ST, Gums JG, Beitelshees AL, Cooper-DeHoff R, Boerwinkle E, Johnson JA. Night blood pressure responses to atenolol and hydrochlorothiazide in black and white patients with essential hypertension. Am J Hypertens 2014; 27:546-54. [PMID: 23886594 DOI: 10.1093/ajh/hpt124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Night blood pressure (BP) predicts patient outcomes. Variables associated with night BP response to antihypertensive agents have not been fully evaluated in essential hypertension. METHODS We sought to measure night BP responses to hydrochlorothiazide (HCTZ), atenolol (ATEN), and combined therapy using ambulatory blood pressure (ABP) monitoring in 204 black and 281 white essential hypertensive patients. Initial therapy was randomized; HCTZ and ATEN once daily doses were doubled after 3 weeks and continued for 6 more weeks with the alternate medication added for combined therapy arms. ABP was measured at baseline and after completion of each drug. Night, day, and night/day BP ratio responses (treatment - baseline) were compared in race/sex subgroups. RESULTS Baseline night systolic BP and diastolic BP, and night/day ratios were greater in blacks than whites (P < 0.01, all comparisons). Night BP responses to ATEN were absent and night/day ratios increased significantly in blacks (P < 0.05). At the end of combined therapy, women, blacks, and those starting with HCTZ as opposed to ATEN had significantly greater night BP responses (P < 0.01). Variables that significantly associated with ATEN response differed from those that associated with HCTZ response and those that associated with night BP response differed from those that associated with day BP response. CONCLUSIONS In summary, after completion of HCTZ and ATEN therapy, women, blacks, and those who started with HCTZ had greater night BP responses. Reduced night BP response and increased night/day BP ratios occured with ATEN in blacks. Given the prognostic significance of night BP, strategies for optimizing night BP antihypertensive therapy should be considered. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier NCT00246519.
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Affiliation(s)
- Arlene B Chapman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Pereira NL, Redfield MM, Scott C, Tosakulwong N, Olson TM, Bailey KR, Rodeheffer RJ, Burnett JC. A functional genetic variant (N521D) in natriuretic peptide receptor 3 is associated with diastolic dysfunction: the prevalence of asymptomatic ventricular dysfunction study. PLoS One 2014; 9:e85708. [PMID: 24465655 PMCID: PMC3899045 DOI: 10.1371/journal.pone.0085708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/29/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the impact of a functional genetic variant in the natriuretic peptide clearance receptor, NPR3, on circulating natriuretic peptides (NPs) and myocardial structure and function in the general community. Background NPR3 plays an important role in the clearance of NPs and through direct signaling mechanisms modulates smooth muscle cell function and cardiac fibroblast proliferation. A NPR3 nonsynonymous single nucleotide polymorphism (SNP) rs2270915, resulting in a N521D substitution in the intracellular catalytic domain that interacts with Gi could affect receptor function. Whether this SNP is associated with alterations in NPs levels and altered cardiac structure and function is unknown. Methods DNA samples of 1931 randomly selected residents of Olmsted County, Minnesota were genotyped. Plasma NT-proANP1-98, ANP1-28, proBNP1-108, NT-proBNP1-76, BNP1-32 and BNP3-32 levels were measured. All subjects underwent comprehensive echocardiography. Results Genotype frequencies for rs2270915 were as follows: (A/A 60%, A/G 36%, G/G 4%). All analyses performed were for homozygotes G/G versus wild type A/A plus the heterozygotes A/G. Diastolic dysfunction was significantly more common (p = 0.007) in the homozygotes G/G (43%) than the A/A+A/G (28%) group. Multivariate regression adjusted for age, sex, body mass index and hypertension demonstrated rs2270915 to be independently associated with diastolic dysfunction (odds ratio 1.94, p = 0.03). There was no significant difference in NPs levels between the 2 groups suggesting that the clearance function of the receptor was not affected. Conclusions A nonsynonymous NPR3 SNP is independently associated with diastolic dysfunction and this association does not appear to be related to alterations in circulating levels of natriuretic peptides.
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Affiliation(s)
- Naveen L. Pereira
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| | - Margaret M. Redfield
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christopher Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nirubol Tosakulwong
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Timothy M. Olson
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kent R. Bailey
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Richard J. Rodeheffer
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - John C. Burnett
- Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
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Pathak J, Bailey KR, Beebe CE, Bethard S, Carrell DS, Chen PJ, Dligach D, Endle CM, Hart LA, Haug PJ, Huff SM, Kaggal VC, Li D, Liu H, Marchant K, Masanz J, Miller T, Oniki TA, Palmer M, Peterson KJ, Rea S, Savova GK, Stancl CR, Sohn S, Solbrig HR, Suesse DB, Tao C, Taylor DP, Westberg L, Wu S, Zhuo N, Chute CG. Normalization and standardization of electronic health records for high-throughput phenotyping: the SHARPn consortium. J Am Med Inform Assoc 2013; 20:e341-8. [PMID: 24190931 PMCID: PMC3861933 DOI: 10.1136/amiajnl-2013-001939] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/07/2013] [Accepted: 10/11/2013] [Indexed: 11/03/2022] Open
Abstract
RESEARCH OBJECTIVE To develop scalable informatics infrastructure for normalization of both structured and unstructured electronic health record (EHR) data into a unified, concept-based model for high-throughput phenotype extraction. MATERIALS AND METHODS Software tools and applications were developed to extract information from EHRs. Representative and convenience samples of both structured and unstructured data from two EHR systems-Mayo Clinic and Intermountain Healthcare-were used for development and validation. Extracted information was standardized and normalized to meaningful use (MU) conformant terminology and value set standards using Clinical Element Models (CEMs). These resources were used to demonstrate semi-automatic execution of MU clinical-quality measures modeled using the Quality Data Model (QDM) and an open-source rules engine. RESULTS Using CEMs and open-source natural language processing and terminology services engines-namely, Apache clinical Text Analysis and Knowledge Extraction System (cTAKES) and Common Terminology Services (CTS2)-we developed a data-normalization platform that ensures data security, end-to-end connectivity, and reliable data flow within and across institutions. We demonstrated the applicability of this platform by executing a QDM-based MU quality measure that determines the percentage of patients between 18 and 75 years with diabetes whose most recent low-density lipoprotein cholesterol test result during the measurement year was <100 mg/dL on a randomly selected cohort of 273 Mayo Clinic patients. The platform identified 21 and 18 patients for the denominator and numerator of the quality measure, respectively. Validation results indicate that all identified patients meet the QDM-based criteria. CONCLUSIONS End-to-end automated systems for extracting clinical information from diverse EHR systems require extensive use of standardized vocabularies and terminologies, as well as robust information models for storing, discovering, and processing that information. This study demonstrates the application of modular and open-source resources for enabling secondary use of EHR data through normalization into standards-based, comparable, and consistent format for high-throughput phenotyping to identify patient cohorts.
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Affiliation(s)
- Jyotishman Pathak
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Calvin E Beebe
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven Bethard
- Department of Linguistics, University of Colorado, Boulder, Colorado, USA
| | | | - Pei J Chen
- Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Dmitriy Dligach
- Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Cory M Endle
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Lacey A Hart
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter J Haug
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Stanley M Huff
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Vinod C Kaggal
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Dingcheng Li
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - James Masanz
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy Miller
- Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Thomas A Oniki
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Martha Palmer
- Department of Linguistics, University of Colorado, Boulder, Colorado, USA
| | - Kevin J Peterson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan Rea
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Guergana K Savova
- Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Craig R Stancl
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Harold R Solbrig
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale B Suesse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cui Tao
- School of Biomedical Informatics, University of Texas Health Sciences Center, Houston, Texas, USA
| | - David P Taylor
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Stephen Wu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Ning Zhuo
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Christopher G Chute
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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White WM, Turner ST, Bailey KR, Mosley TH, Kardia SL, Wiste HJ, Kullo IJ, Garovic VD. Hypertension in pregnancy is associated with elevated homocysteine levels later in life. Am J Obstet Gynecol 2013; 209:454.e1-7. [PMID: 23791689 DOI: 10.1016/j.ajog.2013.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/22/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hyperhomocysteinemia is associated with an elevated cardiovascular disease risk. We examined whether women with a history of hypertension in pregnancy are more likely to have a high level of serum homocysteine decades after pregnancy. STUDY DESIGN Serum homocysteine was measured at a mean age of 60 years in nulliparous women (n = 216), and women with a history of normotensive (n = 1825) or hypertensive (n = 401) pregnancies who participated in the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Relationships between homocysteine and pregnancy history were examined by linear and logistic regression, controlling for multiple covariates including personal and family history of hypertension, diabetes, obesity, tobacco use, and demographics. RESULTS A history of hypertension in pregnancy, when compared with normotensive pregnancy, was associated with a 4.5% higher serum homocysteine level (P = .015) and 1.60-fold increased odds of having an elevated homocysteine (95% confidence interval, 1.15-2.21; P = .005) after adjusting for potentially confounding covariates. In contrast, a history of normotensive pregnancy, as compared with nulliparity, was associated with a 6.1% lower serum homocysteine level (P = .005) and a 0.49-fold reduced odds of elevated homocysteine levels (95% confidence interval, 0.32-0.74; P < .001). CONCLUSION Homocysteine levels decades after pregnancy are higher in women with a history of pregnancy hypertension, even after controlling for potential confounders. Thus, pregnancy history may prompt homocysteine assessment and risk modification in an attempt at primary prevention of cardiovascular disease.
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Fan J, Arruda-Olson AM, Leibson CL, Smith C, Liu G, Bailey KR, Kullo IJ. Billing code algorithms to identify cases of peripheral artery disease from administrative data. J Am Med Inform Assoc 2013; 20:e349-54. [PMID: 24166724 PMCID: PMC3861931 DOI: 10.1136/amiajnl-2013-001827] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To construct and validate billing code algorithms for identifying patients with peripheral arterial disease (PAD). Methods We extracted all encounters and line item details including PAD-related billing codes at Mayo Clinic Rochester, Minnesota, between July 1, 1997 and June 30, 2008; 22 712 patients evaluated in the vascular laboratory were divided into training and validation sets. Multiple logistic regression analysis was used to create an integer code score from the training dataset, and this was tested in the validation set. We applied a model-based code algorithm to patients evaluated in the vascular laboratory and compared this with a simpler algorithm (presence of at least one of the ICD-9 PAD codes 440.20–440.29). We also applied both algorithms to a community-based sample (n=4420), followed by a manual review. Results The logistic regression model performed well in both training and validation datasets (c statistic=0.91). In patients evaluated in the vascular laboratory, the model-based code algorithm provided better negative predictive value. The simpler algorithm was reasonably accurate for identification of PAD status, with lesser sensitivity and greater specificity. In the community-based sample, the sensitivity (38.7% vs 68.0%) of the simpler algorithm was much lower, whereas the specificity (92.0% vs 87.6%) was higher than the model-based algorithm. Conclusions A model-based billing code algorithm had reasonable accuracy in identifying PAD cases from the community, and in patients referred to the non-invasive vascular laboratory. The simpler algorithm had reasonable accuracy for identification of PAD in patients referred to the vascular laboratory but was significantly less sensitive in a community-based sample.
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Affiliation(s)
- Jin Fan
- Geriatric Cardiovascular Department, Chinese PLA General Hospital, Beijing, China
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143
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Abstract
BACKGROUND We investigated whether disease location influences survival in patients with peripheral arterial disease. METHODS AND RESULTS Patients (n = 12,731; mean age, 67.5 ± 12.7 years; 57.4% male) who underwent outpatient noninvasive lower extremity arterial evaluation were followed up for 5.9 ± 3.1 years for all-cause mortality. Peripheral arterial disease (n = 8930) was defined as a resting or postexercise ankle-brachial index (ABI) ≤ 0.90, and normal ABI (n = 3,801) was defined as a resting and postexercise ABI of 1.00 to 1.30. Presence or absence of disease at the proximal location or distal location was determined on the basis of Doppler signals in leg arteries; 42% had no PD or DD, 45% had proximal (14% postexercise PD only), 30% had distal disease, 17% had both proximal and distal disease, 28% had proximal only and 14% had distal only. We performed multivariable logistic regression to identify factors associated with disease location, and Cox proportional hazard regression to assess the respective effects of proximal or distal disease on survival. Older age, male sex, diabetes, heart failure, and critical limb ischemia were associated with distal disease, whereas female sex, smoking, hypertension, dyslipidemia, coronary heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and critical limb ischemia were associated with proximal disease. Over a mean follow-up of 5.9 ± 3.1 years, 3039 patients (23.9%) died. After adjustment for potential confounders, the hazard ratios (HRs) of death associated with PD only and DD only were 1.3 (1.3 to 1.4) and 1.5 (1.4 to 1.6), respectively. After additional adjustment for resting ABI, there was no significant association between proximal disease and death, whereas the association of distal disease with death remained significant (HR, 1.2; 95% CI, 1.1 to 1.3). CONCLUSIONS In patients with peripheral arterial disease, proximal and distal disease locations were associated with distinctive risk factor and comorbidity profiles. Distal disease was associated with worse survival even after adjustment for risk factors, comorbidities, and resting ABI.
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Affiliation(s)
- Qian Chen
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN
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144
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Gong Y, McDonough CW, Beitelshees AL, Karnes JH, O'Connell JR, Turner ST, Chapman AB, Gums JG, Bailey KR, Boerwinkle E, Johnson JA, Cooper-DeHoff RM. PROX1 gene variant is associated with fasting glucose change after antihypertensive treatment. Pharmacotherapy 2013; 34:123-30. [PMID: 24122840 DOI: 10.1002/phar.1355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To assess the relationship of the 33 single nucleotide polymorphisms (SNPs) previously associated with fasting glucose in Caucasians in genome-wide association studies (GWAS) with glucose response to antihypertensive drugs shown to increase risk for hyperglycemia and diabetes. DESIGN Randomized, multicenter clinical trial. PATIENTS A total of 456 Caucasian men and women with uncomplicated hypertension. MEASUREMENTS AND MAIN RESULTS The Pharmacogenomic Evaluation of Antihypertensives Responses study evaluated blood pressure and glucose response in uncomplicated hypertensive patients randomized to either atenolol or hydrochlorothiazide (HCTZ) monotherapy, followed by combination therapy with both agents. Association of these SNPs with atenolol- or HCTZ-induced glucose response was evaluated in 456 Caucasian patients using linear regression adjusting for age, sex, body mass index, baseline glucose, baseline insulin, and principal component for ancestry. The SNP rs340874 in the 5' region of PROX1 gene was significantly associated with atenolol-induced glucose change (p=0.0013). Participants harboring the C allele of this SNP had greater glucose elevation after approximately 9 weeks of atenolol monotherapy (β = +2.39 mg/dl per C allele), consistent with the direction of effect in fasting glucose GWAS, that showed the C allele is associated with higher fasting glucose. CONCLUSION These data suggest that PROX1 SNP rs340874, discovered in fasting glucose GWAS, may also be a pharmacogenetic risk factor for antihypertensive-induced hyperglycemia. β-blockers and thiazides may interact with genetic risk factors to increase risk for dysglycemia and diabetes.
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Affiliation(s)
- Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida
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Cannone V, Huntley BK, Olson TM, Heublein DM, Scott CG, Bailey KR, Redfield MM, Rodeheffer RJ, Burnett JC. Atrial natriuretic peptide genetic variant rs5065 and risk for cardiovascular disease in the general community: a 9-year follow-up study. Hypertension 2013; 62:860-5. [PMID: 24041948 DOI: 10.1161/hypertensionaha.113.01344] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We analyzed the phenotype associated with the atrial natriuretic peptide (ANP) genetic variant rs5065 in a random community-based sample. We also assessed and compared the biological action of 2 concentrations (10(-10) mol/L, 10(-8) mol/L) of ANP and ANP-RR, the protein variant encoded by the minor allele of rs5065, on activation of the guanylyl cyclase (GC)-A and GC-B receptors, production of the second messenger 3',5'-cGMP in endothelial cells, and endothelial permeability. rs5065 genotypes were determined in a cross-sectional adult cohort from Olmsted County, MN (n=1623). Genotype frequencies for rs5065 were 75%, 24%, and 1% for TT, TC, and CC, respectively. Multivariate analysis showed that the C allele was associated with increased risk of cerebrovascular accident (hazard ratio, 1.43; 95% confidence interval, 1.09-1.86; P=0.009) and higher prevalence of myocardial infarction (odds ratio, 1.82; 95% confidence interval, 1.07-3.09; P=0.026). ANP-RR 10(-8) mol/L activated the GC-A receptor (83.07±8.31 versus no treatment 0.18±0.04 per 6 wells; P=0.006), whereas ANP-RR 10(-10) mol/L did not. Neither 10(-8) mol/L nor 10(-10) mol/L ANP-RR activated GC-B receptor (P=0.10, P=0.35). ANP 10(-8) mol/L and ANP-RR 10(-8) mol/L stimulated 3',5'-cGMP production in endothelial cells similarly (P=0.58). Both concentrations of ANP-RR significantly enhanced human aortic endothelial cell permeability (69 versus 29 relative fluorescence units [RFUs], P=0.012; 58 versus 39 RFUs, P=0.015) compared with ANP. The minor allele of rs5065 was associated with increased cardiovascular risk. ANP-RR activated the GC-A receptor, increased 3',5'-cGMP in endothelial cells, and when compared with ANP, augmented endothelial cell permeability.
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Affiliation(s)
- Valentina Cannone
- Cardiorenal Research Laboratory, Guggenheim 915, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905.
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Kattah AG, Asad R, Scantlebury DC, Bailey KR, Wiste HJ, Hunt SC, Mosley TH, Kardia SLR, Turner ST, Garovic VD. Hypertension in pregnancy is a risk factor for microalbuminuria later in life. J Clin Hypertens (Greenwich) 2013; 15:617-23. [PMID: 24034653 PMCID: PMC3775278 DOI: 10.1111/jch.12116] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 01/14/2023]
Abstract
The authors aimed to compare renal function by estimated glomerular filtration rate and albuminuria in 3 groups of women: nulliparous women, women with a history of normotensive pregnancies, and women with a history of at least one hypertensive pregnancy. Women who participated in the second Family Blood Pressure Program Study visit (2000-2004) and had serum creatinine and urine albumin measurements (n=3015) were categorized as having had no pregnancy lasting >6 months (n=341), having had only normotensive pregnancies (n=2199), or having had at least 1 pregnancy with hypertension (n=475) based on a standardized questionnaire. Women who reported having had at least one pregnancy with hypertension were significantly more likely to be hypertensive (75.6% vs 59.4%, P<.001), diabetic (34.2% vs 27.3%, P≤.001), and have higher body mass index (32.8 vs 30.5, P<.001) than those who reported normotensive pregnancies. There was a significantly greater risk of microalbuminuria (urine albumin-creatinine ratio >25 mg/g) in those who reported at least one pregnancy with hypertension (odds ratio, 1.37; confidence interval, 1.02-1.85; P=.04) than in those with normotensive pregnancies, after adjusting for risk factors for chronic kidney and cardiovascular disease. Hypertension in pregnancy is associated with an increased risk of future microalbuminuria.
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Affiliation(s)
| | - Reem Asad
- Division of Nephrology and HypertensionMayo ClinicRochesterMN
| | | | - Kent R. Bailey
- Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMN
| | - Heather J. Wiste
- Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMN
| | - Steven C. Hunt
- Department of Internal MedicineUniversity of UtahSalt Lake CityUT
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Cannone V, Cefalu' AB, Noto D, Scott CG, Bailey KR, Cavera G, Pagano M, Sapienza M, Averna MR, Burnett JC. The atrial natriuretic peptide genetic variant rs5068 is associated with a favorable cardiometabolic phenotype in a Mediterranean population. Diabetes Care 2013; 36:2850-6. [PMID: 23637347 PMCID: PMC3747944 DOI: 10.2337/dc12-2337] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We hypothesized that the minor allele of the atrial natriuretic peptide (ANP) genetic variant rs5068 is associated with a favorable cardiometabolic phenotype in a general Mediterranean population. RESEARCH DESIGN AND METHODS We genotyped a random sample of the residents of Ventimiglia di Sicilia, Sicily, for rs5068. RESULTS Genotype frequencies of rs5068 are AA, 93.5%; AG, 6.4%; and GG, 0.1%. All subsequent analyses are AA versus AG+GG. After adjusting for age and sex, the minor G allele is associated with lower BMI (estimate [SE]: -1.7 kg/m(2) [0.8], P = 0.04). In the AG+GG group, males with HDL cholesterol levels <40 mg/dL are less frequent (P = 0.05) and obesity tends to be less prevalent (P = 0.07). Importantly, the G allele is associated with a lower prevalence of metabolic syndrome (P = 0.02). After adjusting for BMI, the above associations were attenuated. Independently of age, sex, and BMI, the minor allele is also associated with lower systolic blood pressure (-6.0 mmHg [2.5], P = 0.02) and lower prevalence of hypertension (odds ratio 0.41 [95% CI 0.20-0.83], P = 0.01). CONCLUSIONS The association between the minor allele of rs5068 and a favorable cardiometabolic phenotype that we previously reported in a U.S. population is now replicated in a Mediterranean population in which the G allele of rs5068 is associated with lower blood pressure, BMI, and prevalence of hypertension and metabolic syndrome. These findings may lead to a diagnostic strategy to assess cardiometabolic risk and lay the foundation for the future development of an ANP or ANP-like therapy for metabolic syndrome.
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Affiliation(s)
- Valentina Cannone
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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148
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Cannone V, McKie PM, Cefalu AB, Noto D, Cavera G, Pagano M, Sapienza M, Olson TM, Heublein DM, Scott CG, Bailey KR, Averna M, Burnett JC. Genetic variants of ANP and cardiometabolic protection: from populations to novel therapeutics. BMC Pharmacol Toxicol 2013. [PMCID: PMC3765652 DOI: 10.1186/2050-6511-14-s1-o7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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149
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Mauck KF, Froehling DA, Daniels PR, Dahm DL, Ashrani AA, Crusan DJ, Petterson TM, Bailey KR, Heit JA. Incidence of venous thromboembolism after elective knee arthroscopic surgery: a historical cohort study. J Thromb Haemost 2013; 11:1279-86. [PMID: 23648016 PMCID: PMC3827585 DOI: 10.1111/jth.12283] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/22/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence of symptomatic venous thromboembolism (VTE) after knee arthroscopy is uncertain. OBJECTIVES To estimate the incidence of symptomatic VTE after arthroscopic knee surgery. METHODS In a population-based historical cohort study, all Olmsted County, MN, USA, residents undergoing a first arthroscopic knee surgery during the 18-year period of 1988-2005 were followed for incident deep venous thrombosis or pulmonary embolism. The cumulative incidence of VTE after knee arthroscopy was determined using the Kaplan-Meier product limit estimator. Patient age at surgery, sex, calendar year of surgery, body mass index, anesthesia characteristics, and hospitalization were tested as potential predictors of VTE using Cox proportional hazards modeling, both univariately and adjusted for age and sex. RESULTS Among 4833 Olmsted County residents with knee arthroscopy, 18 developed postoperative VTE, all within the first 6 weeks after surgery. The cumulative incidence rates of symptomatic VTE at 7, 14, and 35 days were 0.2%, 0.3%, and 0.4%, respectively. The hazard for postoperative VTE was significantly increased for older patient age (hazard ratio = 1.34 for each 10-year increase in patient age; P = 0.03) and hospitalization either before or after knee arthroscopy (hazard ratio = 14.1; P < 0.001). CONCLUSIONS The incidence of symptomatic VTE after arthroscopic knee surgery is very low. Older age and hospitalization are associated with increased risk. Routine prophylaxis to prevent symptomatic VTE is likely not needed in this patient population.
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Affiliation(s)
- K F Mauck
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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150
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Turner ST, Boerwinkle E, O'Connell JR, Bailey KR, Gong Y, Chapman AB, McDonough CW, Beitelshees AL, Schwartz GL, Gums JG, Padmanabhan S, Hiltunen TP, Citterio L, Donner KM, Hedner T, Lanzani C, Melander O, Saarela J, Ripatti S, Wahlstrand B, Manunta P, Kontula K, Dominiczak AF, Cooper-DeHoff RM, Johnson JA. Genomic association analysis of common variants influencing antihypertensive response to hydrochlorothiazide. Hypertension 2013; 62:391-7. [PMID: 23753411 DOI: 10.1161/hypertensionaha.111.00436] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To identify novel genes influencing blood pressure response to thiazide diuretic therapy for hypertension, we conducted genome-wide association meta-analyses of ≈1.1 million single-nucleotide polymorphisms in a combined sample of 424 European Americans with primary hypertension treated with hydrochlorothiazide from the Pharmacogenomic Evaluation of Antihypertensive Responses study (n=228) and the Genetic Epidemiology of Responses to Antihypertensive study (n=196). Polymorphisms associated with blood pressure response at P<10(-5) were tested for replication of the associations in independent samples of hydrochlorothiazide-treated European hypertensives. The rs16960228 polymorphism in protein kinase C, α replicated for same-direction association with diastolic blood pressure response in the Nordic Diltiazem study (n=420) and the Genetics of Drug Responsiveness in Essential Hypertension study (n=206), and the combined 4-study meta-analysis P value achieved genome-wide significance (P=3.3 × 10(-8)). Systolic or diastolic blood pressure responses were consistently greater in carriers of the rs16960228 A allele than in GG homozygotes (>4/4 mm Hg) across study samples. The rs2273359 polymorphism in the GNAS-EDN3 region also replicated for same-direction association with systolic blood pressure response in the Nordic Diltiazem study, and the combined 3-study meta-analysis P value approached genome-wide significance (P=5.5 × 10(-8)). The findings document clinically important effects of genetic variation at novel loci on blood pressure response to a thiazide diuretic, which may be a basis for individualization of antihypertensive drug therapy and identification of new drug targets.
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Affiliation(s)
- Stephen T Turner
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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