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Zheng W, Zhang J, Jiang Y, Wang S, Yang Z. Overlapping Pattern of the Four Individual Components of Dyslipidemia in Adults: Analysis of Nationally Representative Data. J Clin Med 2024; 13:3624. [PMID: 38930152 PMCID: PMC11204754 DOI: 10.3390/jcm13123624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Dyslipidemia is a well-established risk factor for cardiovascular disease (CVD). However, among available drug treatments, only those targeted at lowering LDL-C and consequently TC have demonstrated efficacy in preventing CVD. This is to say that the benefit for those with isolated high TG or low HDL-C is limited. The objective of this study is to examine the overlapping pattern of the four dyslipidemia components in US adult populations, which is important for quantifying the proportion of those who are less likely to benefit from lipid-lowering drugs and for a more precise use of the drug. Methods: A total of 7822 participants aged over 20 with abnormalities in any of the four lipid parameters, excluding those on lipid-lowering medications, were included from the National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999-2000 through 2017-2018. The proportions of different combinations of them were calculated and presented using area-proportional Euler plots. Results: High TC, high LDL-C, high TG, and low HDL-C were seen in 32.8% (95% CI: 31.3%-34.2%), 28.1% (95% CI: 26.6%-29.6%), 26.7% (95% CI: 25.4%-28.0%), and 65.9% (95% CI: 64.0%-67.7%) of the people with dyslipidemia, respectively. The proportions of dyslipidemia cases attributable to "high LDL-C or high TC" (irrespective of HDL-C and TG levels), "normal LDL-C, normal TC, but high TG" (irrespective of HDL-C level), and "normal LDL-C, normal TC, normal TG, but low HDL-C" (i.e., isolated low HDL-C) accounted for 37.5% (95% CI: 35.9%-39.1%), 18.3% (95% CI: 17.2%-19.4%), and 44.2% (95% CI: 42.5%-46.0%), respectively. Conclusions: Some two-thirds of those with dyslipidemia had low HDL-C or high TG but normal LDL-C and normal TC. As these people are less likely to benefit from currently available drug treatments in terms of CVD prevention, it is important to identify other effective strategies or interventions targeted at them in order to achieve more precise and cost-effective management of dyslipidemia.
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Affiliation(s)
- Wenxiao Zheng
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China; (W.Z.); (S.W.)
| | - Jiayue Zhang
- Faculty of Medicine, Macau University of Science of Technology, Macau SAR, China;
| | - Ying Jiang
- Chronic Disease Research Institute, The Children’s Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310052, China;
| | - Shuting Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China; (W.Z.); (S.W.)
| | - Zuyao Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China; (W.Z.); (S.W.)
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Miao G, Fiehn O, Malloy KM, Zhang Y, Lee ET, Howard BV, Zhao J. Longitudinal lipidomic signatures of all-cause and CVD mortality in American Indians: findings from the Strong Heart Study. GeroScience 2023; 45:2669-2687. [PMID: 37055600 PMCID: PMC10651623 DOI: 10.1007/s11357-023-00793-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
Dyslipidemia is an independent and modifiable risk factor for aging and age-related disorders. Routine lipid panel cannot capture all individual lipid species in blood (i.e., blood lipidome). To date, a comprehensive assessment of the blood lipidome associated with mortality is lacking in large-scale community-dwelling individuals, especially in a longitudinal setting. Using liquid chromatograph-mass spectrometry, we repeatedly measured individual lipid species in 3,821 plasma samples collected at two visits (~ 5.5 years apart) from 1,930 unique American Indians in the Strong Heart Family Study. We first identified baseline lipids associated with risks for all-cause mortality and CVD mortality (mean follow-up period: 17.8 years) in American Indians, followed by replication of top hits in European Caucasians in the Malmö Diet and Cancer-Cardiovascular Cohort (n = 3,943, mean follow-up period: 23.7 years). The model adjusted age, sex, BMI, smoking, hypertension, diabetes, and LDL-c at baseline. We then examined the associations between changes in lipid species and risk of mortality. Multiple testing was controlled by false discovery rate (FDR). We found that baseline levels and longitudinal changes of multiple lipid species, e.g., cholesterol esters, glycerophospholipids, sphingomyelins, and triacylglycerols, were significantly associated with risks of all-cause or CVD mortality. Many lipids identified in American Indians could be replicated in European Caucasians. Network analysis identified differential lipid networks associated with risk of mortality. Our findings provide novel insight into the role of dyslipidemia in disease mortality and offer potential biomarkers for early prediction and risk reduction in American Indians and other ethnic groups.
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Affiliation(s)
- Guanhong Miao
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
- Center for Genetic Epidemiology and Bioinformatics, University of Florida, Gainesville, FL, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California-Davis, Davis, CA, USA
| | - Kimberly M Malloy
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Jinying Zhao
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA.
- Center for Genetic Epidemiology and Bioinformatics, University of Florida, Gainesville, FL, USA.
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Texis T, Rivera-Mancía S, Colín-Ramírez E, Cartas-Rosado R, Koepsell D, Rubio-Carrasco K, Rodríguez-Dorantes M, Gonzalez-Covarrubias V. Genetic Determinants of Atherogenic Indexes. Genes (Basel) 2023; 14:1214. [PMID: 37372394 DOI: 10.3390/genes14061214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Atherogenesis and dyslipidemia increase the risk of cardiovascular disease, which is the leading cause of death in developed countries. While blood lipid levels have been studied as disease predictors, their accuracy in predicting cardiovascular risk is limited due to their high interindividual and interpopulation variability. The lipid ratios, atherogenic index of plasma (AIP = log TG/HDL-C) and the Castelli risk index 2 (CI2 = LDL-C/HDL-C), have been proposed as better predictors of cardiovascular risk, but the genetic variability associated with these ratios has not been investigated. This study aimed to identify genetic associations with these indexes. The study population (n = 426) included males (40%) and females (60%) aged 18-52 years (mean 39 years); the Infinium GSA array was used for genotyping. Regression models were developed using R and PLINK. AIP was associated with variation on APOC3, KCND3, CYBA, CCDC141/TTN, and ARRB1 (p-value < 2.1 × 10-6). The three former were previously associated with blood lipids, while CI2 was associated with variants on DIPK2B, LIPC, and 10q21.3 rs11251177 (p-value 1.1 × 10-7). The latter was previously linked to coronary atherosclerosis and hypertension. KCND3 rs6703437 was associated with both indexes. This study is the first to characterize the potential link between genetic variation and atherogenic indexes, AIP, and CI2, highlighting the relationship between genetic variation and dyslipidemia predictors. These results also contribute to consolidating the genetics of blood lipid and lipid indexes.
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Affiliation(s)
- Tomas Texis
- National Institute of Genomic Medicine (INMEGEN), Mexico City 14610, Mexico
| | | | - Eloisa Colín-Ramírez
- School of Sports Sciences, Anahuac University of North Mexico, Huixquilucan 52786, Mexico
| | - Raul Cartas-Rosado
- National Institute of Cardiology Ignacio Chavez, Mexico City 14080, Mexico
| | - David Koepsell
- Conduct Research Committee, Texas A&M University, College Station, TX 77843, USA
| | - Kenneth Rubio-Carrasco
- National Institute of Genomic Medicine (INMEGEN), Mexico City 14610, Mexico
- School of Sports Sciences, Anahuac University of North Mexico, Huixquilucan 52786, Mexico
- Faculty of Chemistry UNAM, Mexico City 04510, Mexico
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Alrajeh K, AlAzzeh O, Roman Y. The frequency of major ABCG2, SLCO1B1 and CYP2C9 variants in Asian, Native Hawaiian and Pacific Islander women subgroups: implications for personalized statins dosing. Pharmacogenomics 2023; 24:381-398. [PMID: 37222158 PMCID: PMC10242434 DOI: 10.2217/pgs-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Aim: The frequencies of SLCO1B1*5 and CYP2C9*2 and *3 in specific Asian, Native Hawaiian and Pacific Islander (NHPI) subgroups are unknown. Patients & methods: Repository DNA samples from 1064 women self-identifying as Filipino, Korean, Japanese, Native Hawaiian, Marshallese or Samoan and aged 18 years or older were used for targeted sequencing of three genetic variants (rs4149056, rs1799853 and rs1057910). Results: SLCO1B1*5 was significantly less frequent in NHPI women (0.5-6%) than in Europeans (16%). Except for Koreans, CYP2C9*2 (0-1.4%) and *3 (0.5-3%) were significantly less frequent in all subgroups than in Europeans (8 and 12.7%, respectively). Prior reports showed that Asian and NHPI individuals have significantly higher ABCG2 Q141K allele frequency (13-46%) than Europeans (9.4%). Combined phenotype rates for rosuvastatin and fluvastatin revealed that Filipinos and Koreans had the highest frequencies of statin-associated myopathy symptoms risk alleles. Conclusion: Differences in ABCG2, SLCO1B1 and CYP2C9 allele frequencies among different racial and ethnic subgroups highlight the need for increased diversity in pharmacogenetic research. Risk alleles for statin-associated myopathy symptoms are more prevalent in Filipinos, underscoring the importance of genotype-based statin dosing.
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Affiliation(s)
- Khalifa Alrajeh
- Department of Pharmacotherapy & Outcome Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, Richmond, VA 23298, USA
- Department of Pharmacy Practice, King Faisal University College of Clinical Pharmacy, PO Box 400, Hofuf, Eastern Province, 31982, Saudi Arabia
| | - Ola AlAzzeh
- Department of Pharmacotherapy & Outcome Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, Richmond, VA 23298, USA
| | - Youssef Roman
- Department of Pharmacotherapy & Outcome Science, Virginia Commonwealth University School of Pharmacy, 410 N 12th Street, Richmond, VA 23298, USA
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Lin YW, Wang CC, Wu CC, Hsu YT, Lin FJ. Effectiveness of statins for the primary prevention of cardiovascular disease in the Asian elderly population. Int J Cardiol 2023; 373:25-32. [PMID: 36435332 DOI: 10.1016/j.ijcard.2022.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Population aging is a global trend, and the elderly have a higher risk of atherosclerotic cardiovascular disease (ASCVD) and related mortality. Statins have been observed to reduce cardiovascular events in patients with ASCVD. However, compared with secondary prevention, the benefits of statins for primary prevention are undetermined among the elderly. AIMS This study aimed to evaluate the effectiveness of statins in an elderly population without a history of cardiovascular disease (CVD). METHODS The study was carried out using the National Taiwan University Hospital Integrated Medical Database and the National Health Insurance Research Database in Taiwan. Patients aged 65 years and older without a history of CVD were identified between 1 February 2008 and 31 December 2015. New statin users were 1:4 matched to nonusers based on certain variables. The risks of major adverse cardiovascular events (MACEs) and all-cause mortality were estimated using Cox proportional hazards models. Further, we applied marginal structural models to account for time-varying low-density lipoprotein cholesterol (LDL-C) levels. RESULTS A total of 2761 new statin users and 9503 nonusers were selected after matching; the mean age was 71.8 years, and 63% were women. At a median follow-up of 4.8 years, statin use was associated with reduced risk of MACEs (hazard ratio [HR]: 0.75; 95% confidence interval [CI], 0.52-0.98) and mortality (HR: 0.72, 95% CI: 0.55-0.93) when accounting for time-varying LDL-C. No significant differences in effect were detected between subgroups. CONCLUSION Statin use could be beneficial for the primary prevention of CVD in elderly Asians.
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Affiliation(s)
- Yu-Wen Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Chuan Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Medical Education & Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yih-Ting Hsu
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Nguyen BT, Nguyen TV, Le TAD, Le NT. Gender Differences in Risk Factors for Dyslipidemia in the Khmer Ethnic People, Vietnam. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2484-2493. [PMID: 36561254 PMCID: PMC9745404 DOI: 10.18502/ijph.v51i11.11165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022]
Abstract
Background The majority of the Khmer ethnic people living in the Mekong Delta had a difficult socioeconomic life and limited access to information and health services. The study was conducted to determine the prevalence of dyslipidemia and risk factors in men and women of the Khmer ethnic people, in Vietnam. Methods A cross-sectional study was conducted on 1.800 Khmer people aged 25 - 64 yr living in Tra Vinh Province in the Mekong Delta region of Vietnam. Data were analyzed using descriptive statistics and multivariate logistic regression. Results The prevalence of dyslipidemia was high in men (47.3%) and in women (51.4%). Men had a higher prevalence of high TG (28.9% vs. 23.9%), whereas the prevalence of high TC (34.1% vs. 42.4%), and high LDL-C (28.2% vs. 37.9%) were lower in women, (all P<0.05). In men, dyslipidemia was significantly associated with central obesity (OR=2.58, 95% CI=1.32-5.06), overweight/obesity (OR=2.50, 95% CI=1.75-3.56), and diabetes (OR=2.15, 95% CI=1.22-3.78). In women, dyslipidemia was significantly associated with diabetes (OR=2.14, 95% CI=1.08-4.24), central obesity (OR=1.69, 95% CI=1.18-2.42), overweight/obesity (OR=1.50, 95% CI=1.06-2.10), and hypertension (OR=1.43, 95% CI=1.03-1.99). Age was significantly associated with increased risk of dyslipidemia in both genders. Conclusion Overall, the prevalence of dyslipidemia among Khmer men and women adults aged 25 - 64 years in Vietnam was high. Our findings indicated an urgent need to have dyslipidemia prevention intervention programs for the Khmer ethnic people in the Mekong Delta, especially training about obesity and increasing healthy lifestyles.
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Affiliation(s)
- Binh Thanh Nguyen
- Department of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Vietnam,Corresponding Author:
| | - Tap Van Nguyen
- Department of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Vietnam
| | - Thuong Anh Do Le
- Department of Medicine and Health, Ba Ria - Vung Tau University, Vung Tau, Vietnam
| | - Ngoc Thi Le
- Department of Public Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
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Thongtang N, Sukmawan R, Llanes EJB, Lee ZV. Dyslipidemia management for primary prevention of cardiovascular events: Best in-clinic practices. Prev Med Rep 2022; 27:101819. [PMID: 35656215 PMCID: PMC9152805 DOI: 10.1016/j.pmedr.2022.101819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Abstract
Dyslipidemia is a fundamental risk factor for cardiovascular diseases (CVDs) and can worsen the prognosis, if unaddressed. Lipid guidelines are still evolving as dyslipidemia is affecting newer patient subsets. However, these guidelines are governed by regional demographics and ethnic data. Primary care practitioners (PCPs) are the first to offer treatment, and hence placed early in the healthcare continuum. PCPs shoulder a huge responsibility in early detection of dyslipidemia for primary prevention of future cardiovascular (CV) events. Therefore, as members of Cardiovascular RISk Prevention (CRISP) in Asia network, the authors intend to align and shape-up the daily clinical practice workflow for PCPs and have a goal-directed strategy for managing dyslipidemia. This paper reviews the major international lipid guidelines, namely the American and European guidelines, and the regional guidelines from Indonesia, Malaysia, Philippines, Thailand, and Vietnam to identify their commonalities and heterogeneities. The authors, with a mutual consensus, have put forth, best in-clinic practices for screening, risk assessment, diagnosis, treatment, and management of dyslipidemia, particularly to reduce the overall risk of CV events, especially in the Asian context. The authors feel that PCPs should be encouraged to work in congruence with patients to decide on best possible therapy, which would be a holistic approach, rather than pursuing a "one-size-fits-all" approach. Since dyslipidemia is a dynamic field, accumulation of high-quality evidence and cross-validation studies in the future are warranted to develop best in-clinic practices at a global level.
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Affiliation(s)
- Nuntakorn Thongtang
- Division of Endocrinology and Metabolism, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Renan Sukmawan
- Department of Cardiology & Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Elmer Jasper B. Llanes
- Division of Cardiovascular Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Zhen-Vin Lee
- Cardiology Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Friedman MR, Liu Q, Meanley S, Haberlen SA, Brown AL, Turan B, Turan JM, Brennan-Ing M, Stosor V, Mimiaga MJ, Ware D, Egan JE, Plankey MW. Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019. Am J Public Health 2022; 112:S452-S462. [PMID: 35763737 PMCID: PMC9241468 DOI: 10.2105/ajph.2022.306735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).
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Affiliation(s)
- M Reuel Friedman
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Qimin Liu
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Steven Meanley
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Sabina A Haberlen
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Andre L Brown
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Bulent Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Janet M Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Mark Brennan-Ing
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Valentina Stosor
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Matthew J Mimiaga
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - James E Egan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Michael W Plankey
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
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9
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Saleh M, Kim JY, March C, Gebara N, Arslanian S. Youth prediabetes and type 2 diabetes: Risk factors and prevalence of dysglycaemia. Pediatr Obes 2022; 17:e12841. [PMID: 34382374 DOI: 10.1111/ijpo.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The American Diabetes Association recommends risk-based screening for dysglycaemia (prediabetes and type 2 diabetes) in youth with overweight/obesity plus ≥1 risk factor. However, evidence for these recommendations is lacking. OBJECTIVES Examine the association between the number of risk factors and the prevalence of dysglycaemia in youth with overweight/obesity at initial presentation. METHODS In a paediatric obesity registry, youth (>10 and <20 years old, body mass index ≥85th percentile) were categorized into four groups according to number of risk factors (1, 2, 3 and ≥4). Based on oral glucose tolerance test, participants were classified into normal glucose tolerance or dysglycaemia. RESULTS Of 635 youth, 31.5% had prediabetes and 6.1% had type 2 diabetes. The prevalence of dysglycaemia was 23.1% with 1 risk factor and increased to 44.9% with ≥4 risk factors (p = 0.025). Dyslipidaemia, family history of type 2 diabetes and maternal history of gestational diabetes were significantly associated with dysglycaemia. Fasting and 2-h insulin, 2-h glucose increased (all p < 0.0001) and ALT increased (p = 0.001) with increasing risk factors. Insulin sensitivity and β-cell function deteriorated significantly with increasing risk factors. CONCLUSION Screening for dysglycaemia in youth with obesity and any additional risk factor is warranted to target early management.
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Affiliation(s)
- Mohamed Saleh
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joon Young Kim
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - Christine March
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nour Gebara
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Pediatric Research in Obesity and Metabolism, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Pediatric Research in Obesity and Metabolism, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Iyer DG, Shah NS, Hastings KG, Hu J, Rodriguez F, Boothroyd DB, Krishnan AV, Falasinnu T, Palaniappan L. Years of Potential Life Lost Because of Cardiovascular Disease in Asian-American Subgroups, 2003-2012. J Am Heart Assoc 2020; 8:e010744. [PMID: 30890022 PMCID: PMC6509739 DOI: 10.1161/jaha.118.010744] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Asian‐American subgroups (Asian‐Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display varied cardiovascular disease mortality patterns, especially at younger ages. This study aims to examine the years of potential life lost because of ischemic heart disease and cerebrovascular disease among the 6 largest Asian‐American subgroups compared with non‐Hispanic whites. Methods and Results We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012 to calculate race‐specific life expectancy, mean years of potential life lost, and years of potential life lost per 100 000 population for each Asian subgroup and non‐Hispanic whites. Asian‐American subgroups display heterogeneity in cardiovascular disease burden. Asian‐Indians had a high burden of ischemic heart disease; Asian‐Indian men lost 724 years per 100 000 population in 2012 and a mean of 17 years to ischemic heart disease. Respectively, Vietnamese and Filipino men and women lost a mean of 17 and 16 years of life to cerebrovascular disease; Filipino men lost 352 years per 100 000 population in 2012. All Asian subgroups for both sexes had higher years of life lost to cerebrovascular disease compared with non‐Hispanic whites. Conclusions Cardiovascular disease burden varies among Asian subgroups, and contributes to greater premature mortality in certain subgroups. Asian‐Indian and Filipino populations have the highest years of life lost because of ischemic heart disease and Filipino and Vietnamese have the highest years of life lost because of cerebrovascular disease. Analysis of risk factors and development of subgroup‐specific interventions are required to address these health disparities.
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Affiliation(s)
- Divya G Iyer
- 1 University of Connecticut School of Medicine Farmington CT
| | - Nilay S Shah
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Katherine G Hastings
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Jiaqi Hu
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Fatima Rodriguez
- 3 Division of Cardiovascular Medicine Stanford University Stanford CA
| | - Derek B Boothroyd
- 4 Quantitative Sciences Unit Stanford University School of Medicine Stanford CA
| | - Aruna V Krishnan
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Titilola Falasinnu
- 5 Division of Epidemiology Department of Health Research & Policy Stanford University School of Medicine Stanford CA
| | - Latha Palaniappan
- 2 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
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11
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Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP. Atherosclerotic Cardiovascular Disease Risk Prediction in Disaggregated Asian and Hispanic Subgroups Using Electronic Health Records. J Am Heart Assoc 2019; 8:e011874. [PMID: 31291803 PMCID: PMC6662141 DOI: 10.1161/jaha.118.011874] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Risk assessment is the cornerstone for atherosclerotic cardiovascular disease ( ASCVD ) treatment decisions. The Pooled Cohort Equations ( PCE ) have not been validated in disaggregated Asian or Hispanic populations, who have heterogeneous cardiovascular risk and outcomes. Methods and Results We used electronic health record data from adults aged 40 to 79 years from a community-based, outpatient healthcare system in northern California between January 1, 2006 and December 31, 2015, without ASCVD and not on statins. We examined the calibration and discrimination of the PCE and recalibrated the equations for disaggregated race/ethnic subgroups. The cohort included 231 622 adults with a mean age of 53.1 (SD 9.7) years and 54.3% women. There were 56 130 Asian (Chinese, Asian Indian, Filipino, Japanese, Vietnamese, and other Asian) and 19 760 Hispanic (Mexican, Puerto Rican, and other Hispanic) patients. There were 2703 events (332 and 189 in Asian and Hispanic patients, respectively) during an average of 3.9 (SD 1.5) years of follow-up. The PCE overestimated risk for NHW s, African Americans, Asians, and Hispanics by 20% to 60%. The extent of overestimation of ASCVD risk varied by disaggregated racial/ethnic subgroups, with a predicted-to-observed ratio of ASCVD events ranging from 1.1 for Puerto Rican patients to 1.9 for Chinese patients. The PCE had adequate discrimination, although it varied significantly by race/ethnic subgroups (C-indices 0.66-0.83). Recalibration of the PCE did not significantly improve its performance. Conclusions Using electronic health record data from a large, real-world population, we found that the PCE generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups.
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Affiliation(s)
- Fatima Rodriguez
- 1 Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Sukyung Chung
- 2 Palo Alto Foundation Research Institute Palo Alto CA.,3 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Manuel R Blum
- 1 Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA.,4 Department of General Internal Medicine Inselspital Bern University Hospital University of Bern Switzerland
| | - Adrien Coulet
- 5 Université de Lorraine CNRS Inria LORIA Nancy France.,6 Stanford Center for Biomedical Informatics Research Stanford University Stanford CA
| | - Sanjay Basu
- 7 Departments of Medicine and of Health Research and Policy Centers for Primary Care and Outcomes Research and Center for Population Health Sciences Stanford University Stanford CA
| | - Latha P Palaniappan
- 3 Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
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12
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Poursafa P, Dadvand P, Amin MM, Hajizadeh Y, Ebrahimpour K, Mansourian M, Pourzamani H, Sunyer J, Kelishadi R. Association of polycyclic aromatic hydrocarbons with cardiometabolic risk factors and obesity in children. ENVIRONMENT INTERNATIONAL 2018; 118:203-210. [PMID: 29886236 DOI: 10.1016/j.envint.2018.05.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 05/23/2023]
Abstract
A limited body of evidence exists on the association of exposure to polycyclic aromatic hydrocarbons (PAHs) with cardiometabolic risk factors and obesity in children. No study has evaluated these associations in subgroups of children with and without excess weight, and those with and without cardiometabolic risk factors. We aimed to investigate the association between PAH exposure and cardiometabolic risk factors in children independent of their weight status. The secondary aim was to evaluate the obesogen properties of PAHs in children independent of their cardiometabolic risk factors. This study was based on a representative sample of 186 children (aged 6-18 years) living in Isfahan, Iran (2014-2016). We enrolled four groups of participants with and without excess weight and with and without cardiometabolic risk factor. Urinary levels of monohydroxy PAHs (OH-PAHs) were measured twice, six months apart. Logistic regression models were developed to estimate the associations of tertiles of urinary OH-PAH concentrations with cardiometabolic risk factors and excess weight, adjusted for the relevant covariates. The findings in all participants combined showed that increased risk of cardiometabolic risk factors and excess weight was associated with exposure to most of evaluated PAHs. Exposure to 1-hydroxypyrene was associated with higher risk of cardiometabolic risk factors in participants with excess weight. Exposure to 2-Naphtol was also associated with higher risk of cardiometabolic risk factors in both groups, but the associations were not significant (p < 0.1). For participants without cardiometabolic risk factors, exposure to 2-naphtol, 9-phenanthrol, and ∑ OH-PAH was associated with increased risk of obesity. For participants with cardiometabolic risk factors, we observed similar pattern of associations for 2-naphtol and ∑ OH-PAH, but the associations were not statistically significant (p < 0.1). We found that exposure to PAHs could possibly explain, in part, the cardiometabolic risk factors in children with excess weight as well as obesity in children with normal cardiometabolic profile.
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Affiliation(s)
- Parinaz Poursafa
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Mohammad Mehdi Amin
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yaghoub Hajizadeh
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Ebrahimpour
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Pourzamani
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Ciber on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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13
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Wang C, Zhu W, Wei Y, Su R, Feng H, Hadar E, Hod M, Yang H. The associations between early pregnancy lipid profiles and pregnancy outcomes. J Perinatol 2017; 37:127-133. [PMID: 27787507 DOI: 10.1038/jp.2016.191] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the association between early pregnancy lipid profiles and pregnancy outcomes. STUDY DESIGN Retrospective 6 months analysis of 5218 singleton pregnant women. Each participant's demographic and medical data were collected by questionnaires and medical records. Total cholesterol (TC), triglycerides (TG), high-density lipid cholesterol (HDL-C) and low-density lipid cholesterol (LDL-C) levels were divided into quartiles, and the women were categorized as having low (<25th percentile), referent (25 to <75th percentile) or high (>75th percentile) TC, TG, HDL-C and LDL-C values. Differences between groups were tested using t-test and Pearson's χ2-test. Binary logistic regression and multivariate analysis was conducted to evaluate the associations between lipid values and the risk of pregnancy outcomes. RESULTS (1) Women who subsequently developed adverse pregnancy outcomes had higher levels of TC, TG, LDL-C and lower levels of HDL-C during early pregnancy (<14 gestational weeks). (2) A trend toward an increasing incidence of adverse pregnancy outcomes was noted with increasing levels of TC, TG and LDL-C, and decreasing level of HDL-C. (3) The more numbers of TC, TG and LDL-C above 75th percentile and HDL-C inferior to 25th percentile women had, the higher their risk of developing adverse pregnancy outcomes. (4) Low TG level was a protective factor for gestational diabetes mellitus (GDM) (<1.44 mmol l-1, odds ratio (OR)=0.706, 95% confidence interval (CI), 0.586 to 0.852) and large for gestational age infants (LGA) (<1.44 mmol l-1, OR=0.769, 95% CI, 0.631 to 0.936), and low LDL-C (<1.89 mmol l-1) level was protective factor for preterm birth. High TG (>1.40 mmol l-1, OR=1.327, 95% CI, 1.130 to 1.558), TC (>4.29 mmol l-1, OR=1.250, 95% CI, 1.062 to 1.471), and LDL-C (>2.62 mmol l-1, OR=1.25, 95% CI, 1.069 to 1.480) levels and a low HDL-C (<1.89 mmol l-1, OR=1.190, 95% CI, 1.007 to 1.405) level were associated with increased risk of GDM. A high TG (>1.40 mmol l-1, OR=1.550, 95% CI, 1.025 to 2.343) level was related to high risk of pre-eclampsia (PE), while a high LDL-C (>2.62 mmol l-1, OR=1.400, 95% CI, 1.100 to 1.781) level was risk factor for macrosomia. (5) After adjusting for confounders, early pregnancy TC was an independent risk factor for GDM (ajusted odds ratio [aOR]=1.184, 95% CI, 1.085 to 1.291), TG level was independently associated with the prevalence of GDM (aOR=1.253, 95% CI, 1.141 to 1.375) and PE (aOR=1.245, 95% CI, 1.023 to 1.516), and LDL-C level was significantly associated with risk of GDM (aOR=1.162, 95% CI, 1.052 to 1.283) and preterm birth (aOR=1.264, 95% CI, 1.065, 1.501). CONCLUSIONS Early pregnancy high levels of TC, TG, LDL-C and low level of HDL-C may be predictive biomarkers for adverse pregnancy outcomes, while early pregnancy low TC, TG, LDL-C levels and high HDL-C levels could have some protective roles.
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Affiliation(s)
- C Wang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China
| | - W Zhu
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China.,Exchange and Cooperation Division, National Institute of Hospital Administration, Beijing, China
| | - Y Wei
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China
| | - R Su
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China
| | - H Feng
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China
| | - E Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Yang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China
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