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Johnson L, Youssef E, O'Shea J, Thornley T, Gallagher J, Ledwidge M, Ryan C. Estimating the prevalence of potential and actionable drug-gene interactions in Irish primary care: A cross-sectional study. Br J Clin Pharmacol 2024. [PMID: 38864275 DOI: 10.1111/bcp.16122] [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: 01/02/2024] [Revised: 04/03/2024] [Accepted: 04/13/2024] [Indexed: 06/13/2024] Open
Abstract
AIMS Pharmacogenetics (PGx) is increasingly recognized as a strategy for medicines optimisation and prevention of adverse drug reactions. According to guidelines produced by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetic Working Group (DPWG), most medicines with drug-gene interactions (DGIs) are prescribed in primary care. This study aimed to estimate the prevalence of potential and actionable DGIs involving all medicines dispensed in Irish primary care. METHODS Dispensings of 46 drugs to General Medical Services (GMS) patients in the Health Service Executive Primary Care Reimbursement Service Irish pharmacy claims database from 01 January 2021 to 31 December 2021 were analysed to estimate the national prevalence of total dispensings and incidence of first-time dispensings of drugs with potential DGIs according to the CPIC and/or DPWG guidelines. Phenotype frequency data from the UK Biobank and the CPIC were used to estimate the incidence of actionable DGIs. RESULTS One in five dispensings (12 443 637 of 62 754 498, 19.8%) were medicines with potential DGIs, 1 878 255 of these dispensed for the first time. On application of phenotype frequencies and linked guideline based therapeutic recommendations, 2 349 055 potential DGIs (18.9%) required action, such as monitoring and guarding against maximum dose, drug or dose change. One in five (369 700, 19.7%) first-time dispensings required action, with 139 169 (7.4%) requiring a change in prescribing. Antidepressants, weak opioids and statins were most commonly identified as having actionable DGIs. CONCLUSIONS This study estimated a high prevalence of DGIs in primary care in Ireland, identifying the need and opportunity to optimize drug therapy through PGx testing.
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Affiliation(s)
- L Johnson
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - E Youssef
- Faculty of Health, Science, Social Care & Education, Kingston University, London, UK
| | - J O'Shea
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - T Thornley
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - J Gallagher
- School of Medicine, University College Dublin, Dublin, Ireland
| | - M Ledwidge
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - C Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Pasman JA, Bergstedt J, Harder A, Gong T, Xiong Y, Hägg S, Fang F, Treur JL, Choi KW, Sullivan PF, Lu Y. Causes and consequences of major depressive disorder: An encompassing Mendelian randomization study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.21.24307678. [PMID: 38826420 PMCID: PMC11142270 DOI: 10.1101/2024.05.21.24307678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Major depressive disorder (MDD) is a prevalent and debilitating disorder that has been associated with a range of risk factors and outcomes. Causal pathways between MDD and other traits can be studied using genetic variants as instrumental variables. Methods A literature review was conducted to identify 201 MDD-associated traits. For 115 traits, there were well-powered genome-wide association study (GWAS) results available that could be used to assess the genetic correlation with MDD. Of these, there were 89 meeting criteria for investigating causal associations in both directions using two-sample Mendelian randomization (TSMR). Of the traits that were not captured by GWAS, 43 could be included as outcomes of MDD using one-sample MR (OSMR). A range of methods and sensitivity tests was applied to gauge robustness of results, together with statistical power analyses to aid interpretation. Outcomes Moderate to strong genetic overlap was found between MDD and most traits. Support for causal effects of MDD liability were found for circadian, cognitive, diet, medical disease, endocrine, functional, inflammatory, metabolic, mortality, physical activity, reproduction, risk behavior, social, socioeconomic, and suicide outcomes. Most associations were bidirectional, although there was less evidence for diet, disease, and endocrine traits causing MDD risk. Results were robust across sensitivity analyses. Interpretation This study provides a systematic overview of traits putatively causally related to MDD, confirming previous findings as well as identifying new associations. Our results highlight the importance of MDD as a risk factor cross-cutting across medical, functional, and psychosocial domains and emphasize the need for concerted efforts at reducing this highly prevalent disorder.
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Affiliation(s)
- Joëlle A. Pasman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Genetic Epidemiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jacob Bergstedt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Arvid Harder
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Ying Xiong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
| | - Jorien L. Treur
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Genetic Epidemiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karmel W. Choi
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
- Departments of Genetics and Psychiatry, UNC Chapel Hill, NC, USA
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels Väg 12, Stockholm, Sweden
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Shakt G, Tsao NL, Levin MG, Walker V, Kember RL, Klarin D, Tsao P, Voight BF, Scali ST, Damrauer SM. Major Depressive Disorder Impacts Peripheral Artery Disease Risk Through Intermediary Risk Factors. J Am Heart Assoc 2024; 13:e030233. [PMID: 38362853 PMCID: PMC11010076 DOI: 10.1161/jaha.123.030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/28/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) has been identified as a causal risk factor for multiple forms of cardiovascular disease. Although observational evidence has linked MDD to peripheral artery disease (PAD), causal evidence of this relationship is lacking. METHODS AND RESULTS Inverse variance weighted 2-sample Mendelian randomization was used to test the association the between genetic liability for MDD and genetic liability for PAD. Genetic liability for MDD was associated with increased genetic liability for PAD (odds ratio [OR], 1.17 [95% CI, 1.06-1.29]; P=2.6×10-3). Genetic liability for MDD was also associated with increased genetically determined lifetime smoking (β=0.11 [95% CI, 0.078-0.14]; P=1.2×10-12), decreased alcohol intake (β=-0.078 [95% CI, -0.15 to 0]; P=0.043), and increased body mass index (β=0.10 [95% CI, 0.02-0.19]; P=1.8×10-2), which in turn were associated with genetic liability for PAD (smoking: OR, 2.81 [95% CI, 2.28-3.47], P=9.8×10-22; alcohol: OR, 0.77 [95% CI, 0.66-0.88]; P=1.8×10-4; body mass index: OR, 1.61 [95% CI, 1.52-1.7]; P=1.3×10-57). Controlling for lifetime smoking index, alcohol intake, and body mass index with multivariable Mendelian randomization completely attenuated the association between genetic liability for MDD with genetic liability for PAD. CONCLUSIONS This work provides evidence for a possible causal association between MDD and PAD that is dependent on intermediate risk factors, adding to the growing body of evidence suggesting that effective management and treatment of cardiovascular diseases may require a composite of physical and mental health interventions.
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Affiliation(s)
- Gabrielle Shakt
- Corporal Michael Crescenz VA Medical CenterPhiladelphiaPAUSA
- Department of Surgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Noah L. Tsao
- Corporal Michael Crescenz VA Medical CenterPhiladelphiaPAUSA
- Department of Surgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Michael G. Levin
- Corporal Michael Crescenz VA Medical CenterPhiladelphiaPAUSA
- Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Venexia Walker
- Department of Surgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUnited Kingdom
| | - Rachel L. Kember
- Corporal Michael Crescenz VA Medical CenterPhiladelphiaPAUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Derek Klarin
- VA Palo Alto Health Care SystemPalo AltoCAUSA
- Division of Vascular SurgeryStanford UniversityPalo AltoCAUSA
| | - Phil Tsao
- VA Palo Alto Health Care SystemPalo AltoCAUSA
- Department of MedicineStanford University School of MedicineStanfordCAUSA
| | - Benjamin F. Voight
- Corporal Michael Crescenz VA Medical CenterPhiladelphiaPAUSA
- Department of Systems Pharmacology and Translational TherapeuticsUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of Genetics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Scott M. Damrauer
- Corporal Michael Crescenz VA Medical CenterPhiladelphiaPAUSA
- Department of Surgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of Genetics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
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Lee SM, Baek JC. Serum Vitamin Levels, Cardiovascular Disease Risk Factors, and Their Association with Depression in Korean Women: A Cross-Sectional Study of a Nationally Representative Sample. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2183. [PMID: 38138286 PMCID: PMC10744936 DOI: 10.3390/medicina59122183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Serum vitamin levels, cardiovascular disease risk factors, and their association with depression is a complex issue that has been the subject of much research. Therefore, we investigated the relationship between vitamin A, B9, and E levels, cardiovascular risk factors, and depression in premenopausal and menopausal South Korean women. Materials and Methods: This cross-sectional study used the 2016-2018 Korea National Health and Nutrition Examination Survey data. Depression was assessed using a questionnaire to check for symptoms of depression or the Patient Health Questionnaire-9. Blood samples were collected from the antecubital vein in the morning after an overnight fast. Covariates were defined as self-reported physician diagnoses. Well-trained medical staff performed the standard procedures. Statistical analysis was performed using the complex sample analysis method of SPSS, using two separate logistic regression models (model 1: adjusted for age; model 2: adjusted for age, marital status, smoking, and alcohol consumption). Results: A total of 3313 women aged over 20 years were enrolled. The association between vitamin A levels and depression was as follows: lower levels of vitamin A were associated with an increased risk of depression in premenopausal women in model 1 and model 2. The levels of serum vitamins E and B9 were not correlated with depression in premenopausal and postmenopausal women. In the premenopausal group, depression increased in the obesity (model 1: p = 0.037; model 2: p = 0.047) and diabetes mellitus (model 1: p = 0.010; model 2: p = 0.009) groups. The menopausal group with depression had higher rates of stroke (model 1: p = 0.017; model 2: p = 0.039) and myocardial infarction (model 1: p = 0.004; model 2: p = 0.008) than the group without depression. Conclusions: Depression is correlated with lower blood levels of vitamin A in premenopausal women. Vitamin B9 and E levels were not associated with depression independent of menopausal status. Depression is associated with obesity and diabetes mellitus in premenopausal women and with stroke and myocardial infarction in postmenopausal women.
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Affiliation(s)
- Seon Mi Lee
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea;
| | - Jong Chul Baek
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Republic of Korea
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
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