1
|
Chevli PA, Freedman BI, Hsu FC, Xu J, Rudock ME, Ma L, Parks JS, Palmer ND, Shapiro MD. Plasma metabolomic profiling in subclinical atherosclerosis: the Diabetes Heart Study. Cardiovasc Diabetol 2021; 20:231. [PMID: 34876126 PMCID: PMC8653597 DOI: 10.1186/s12933-021-01419-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Incidence rates of cardiovascular disease (CVD) are increasing, partly driven by the diabetes epidemic. Novel prediction tools and modifiable treatment targets are needed to enhance risk assessment and management. Plasma metabolite associations with subclinical atherosclerosis were investigated in the Diabetes Heart Study (DHS), a cohort enriched for type 2 diabetes (T2D). METHODS The analysis included 700 DHS participants, 438 African Americans (AAs), and 262 European Americans (EAs), in whom coronary artery calcium (CAC) was assessed using ECG-gated computed tomography. Plasma metabolomics using liquid chromatography-mass spectrometry identified 853 known metabolites. An ancestry-specific marginal model incorporating generalized estimating equations examined associations between metabolites and CAC (log-transformed (CAC + 1) as outcome measure). Models were adjusted for age, sex, BMI, diabetes duration, date of plasma collection, time between plasma collection and CT exam, low-density lipoprotein cholesterol (LDL-C), and statin use. RESULTS At an FDR-corrected p-value < 0.05, 33 metabolites were associated with CAC in AAs and 36 in EAs. The androgenic steroids, fatty acid, phosphatidylcholine, and bile acid metabolism subpathways were associated with CAC in AAs, whereas fatty acid, lysoplasmalogen, and branched-chain amino acid (BCAA) subpathways were associated with CAC in EAs. CONCLUSIONS Strikingly different metabolic signatures were associated with subclinical coronary atherosclerosis in AA and EA DHS participants.
Collapse
Affiliation(s)
- Parag Anilkumar Chevli
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Megan E Rudock
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Lijun Ma
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John S Parks
- Section on Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Michael D Shapiro
- Section of Cardiovascular Medicine, Center for Preventive Cardiology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
2
|
Huo Y, Tang Y, Chen Y, Gao D, Han S, Bao S, De S, Terry JG, Carr JJ, Abramson RG, Landman BA. Stochastic tissue window normalization of deep learning on computed tomography. J Med Imaging (Bellingham) 2019; 6:044005. [PMID: 31763353 PMCID: PMC6863984 DOI: 10.1117/1.jmi.6.4.044005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/04/2019] [Indexed: 11/14/2022] Open
Abstract
Tissue window filtering has been widely used in deep learning for computed tomography (CT) image analyses to improve training performance (e.g., soft tissue windows for abdominal CT). However, the effectiveness of tissue window normalization is questionable since the generalizability of the trained model might be further harmed, especially when such models are applied to new cohorts with different CT reconstruction kernels, contrast mechanisms, dynamic variations in the acquisition, and physiological changes. We evaluate the effectiveness of both with and without using soft tissue window normalization on multisite CT cohorts. Moreover, we propose a stochastic tissue window normalization (SWN) method to improve the generalizability of tissue window normalization. Different from the random sampling, the SWN method centers the randomization around the soft tissue window to maintain the specificity for abdominal organs. To evaluate the performance of different strategies, 80 training and 453 validation and testing scans from six datasets are employed to perform multiorgan segmentation using standard 2D U-Net. The six datasets cover the scenarios, where the training and testing scans are from (1) same scanner and same population, (2) same CT contrast but different pathology, and (3) different CT contrast and pathology. The traditional soft tissue window and nonwindowed approaches achieved better performance on (1). The proposed SWN achieved general superior performance on (2) and (3) with statistical analyses, which offers better generalizability for a trained model.
Collapse
Affiliation(s)
- Yuankai Huo
- Vanderbilt University, Department of Electrical Engineering and Computer Science, Nashville, Tennessee, United States
| | - Yucheng Tang
- Vanderbilt University, Department of Electrical Engineering and Computer Science, Nashville, Tennessee, United States
| | - Yunqiang Chen
- 12 Sigma Technologies, San Diego, California, United States
| | - Dashan Gao
- 12 Sigma Technologies, San Diego, California, United States
| | - Shizhong Han
- 12 Sigma Technologies, San Diego, California, United States
| | - Shunxing Bao
- Vanderbilt University, Department of Electrical Engineering and Computer Science, Nashville, Tennessee, United States
| | - Smita De
- Cleveland Clinic, Cleveland, Ohio, United States
| | - James G. Terry
- Vanderbilt University Medical Center, Department of Radiology, Nashville, Tennessee, United States
| | - Jeffrey J. Carr
- Vanderbilt University Medical Center, Department of Radiology, Nashville, Tennessee, United States
| | - Richard G. Abramson
- Vanderbilt University Medical Center, Department of Radiology, Nashville, Tennessee, United States
| | - Bennett A. Landman
- Vanderbilt University, Department of Electrical Engineering and Computer Science, Nashville, Tennessee, United States
- Vanderbilt University Medical Center, Department of Radiology, Nashville, Tennessee, United States
| |
Collapse
|
3
|
Huo Y, Terry JG, Wang J, Nair S, Lasko TA, Freedman BI, Carr JJ, Landman BA. Fully automatic liver attenuation estimation combing CNN segmentation and morphological operations. Med Phys 2019; 46:3508-3519. [PMID: 31228267 DOI: 10.1002/mp.13675] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/13/2019] [Accepted: 06/15/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Manually tracing regions of interest (ROIs) within the liver is the de facto standard method for measuring liver attenuation on computed tomography (CT) in diagnosing nonalcoholic fatty liver disease (NAFLD). However, manual tracing is resource intensive. To address these limitations and to expand the availability of a quantitative CT measure of hepatic steatosis, we propose the automatic liver attenuation ROI-based measurement (ALARM) method for automated liver attenuation estimation. METHODS The ALARM method consists of two major stages: (a) deep convolutional neural network (DCNN)-based liver segmentation and (b) automated ROI extraction. First, liver segmentation was achieved using our previously developed SS-Net. Then, a single central ROI (center-ROI) and three circles ROI (periphery-ROI) were computed based on liver segmentation and morphological operations. The ALARM method is available as an open source Docker container (https://github.com/MASILab/ALARM). RESULTS Two hundred and forty-six subjects with 738 abdomen CT scans from the African American-Diabetes Heart Study (AA-DHS) were used for external validation (testing), independent from the training and validation cohort (100 clinically acquired CT abdominal scans). From the correlation analyses, the proposed ALARM method achieved Pearson correlations = 0.94 with manual estimation on liver attenuation estimations. When evaluating the ALARM method for detection of nonalcoholic fatty liver disease (NAFLD) using the traditional cut point of < 40 HU, the center-ROI achieved substantial agreements (Kappa = 0.79) with manual estimation, while the periphery-ROI method achieved "excellent" agreement (Kappa = 0.88) with manual estimation. The automated ALARM method had reduced variability compared to manual measurements as indicated by a smaller standard deviation. CONCLUSIONS We propose a fully automated liver attenuation estimation method termed ALARM by combining DCNN and morphological operations, which achieved "excellent" agreement with manual estimation for fatty liver detection. The entire pipeline is implemented as a Docker container which enables users to achieve liver attenuation estimation in five minutes per CT exam.
Collapse
Affiliation(s)
- Yuankai Huo
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | - James G Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Jiachen Wang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | - Sangeeta Nair
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Thomas A Lasko
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Barry I Freedman
- Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - J Jeffery Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37235, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37235, USA.,Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, 37235, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.,Institute of Imaging Science, Vanderbilt University, Nashville, TN, 37235, USA
| |
Collapse
|
4
|
Vidrascu EM, Bashore AC, Howard TD, Moore JB. Effects of early- and mid-life stress on DNA methylation of genes associated with subclinical cardiovascular disease and cognitive impairment: a systematic review. BMC MEDICAL GENETICS 2019; 20:39. [PMID: 30866842 PMCID: PMC6417232 DOI: 10.1186/s12881-019-0764-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/04/2019] [Indexed: 12/18/2022]
Abstract
Background Traditional and novel risk factors cannot sufficiently explain the differential susceptibility to cardiovascular disease (CVD). Epigenetics may serve to partially explain this residual disparity, with life course stressors shown to modify methylation of genes implicated in various diseases. Subclinical CVD is often comorbid with cognitive impairment (CI), which warrants research into the identification of common genes for both conditions. Methods We conducted a systematic review of the existing literature to identify studies depicting the relationship between life course stressors, DNA methylation, subclinical CVD, and cognition. Results A total of 16 articles (8 human and 8 animal) were identified, with the earliest published in 2008. Four genes (COMT, NOS3, Igfl1, and Sod2) were analyzed by more than one study, but not in association with both CVD and CI. One gene (NR3C1) was associated with both outcomes, albeit not within the same study. There was some consistency among studies with markers used for subclinical CVD and cognition, but considerable variability in stress exposure (especially in human studies), cell type/tissue of interest, method for detection of DNA methylation, and risk factors. Racial and ethnic differences were not considered, but analysis of sex in one human study found statistically significant differentially methylated X-linked loci associated with attention and intelligence. Conclusions This review suggests the need for additional studies to implement more comprehensive and methodologically rigorous study designs that can better identify epigenetic biomarkers to differentiate individuals vulnerable to both subclinical CVD and associated CI. Electronic supplementary material The online version of this article (10.1186/s12881-019-0764-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elena M Vidrascu
- Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Alexander C Bashore
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy D Howard
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Justin B Moore
- Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
5
|
Krajnc M, Pečovnik Balon B, Krajnc I. Non-traditional risk factors for coronary calcification and its progression in patients with type 2 diabetes: The impact of postprandial glycemia and fetuin-A. J Int Med Res 2019; 47:846-858. [PMID: 30616461 PMCID: PMC6381483 DOI: 10.1177/0300060518814080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective This study was performed to assess the impact of risk factors on the presence and progression of coronary calcification in patients with type 2 diabetes. Methods We prospectively enrolled 45 patients without cardiovascular or kidney disease. Coronary calcification was measured with multidetector computed tomography at baseline and 18 months. We also measured blood pressure; body mass index; serum levels of calcium, phosphate, and 25-hydroxyvitamin D; mineral bone density; and levels of alkaline phosphatase, parathormone, fetuin-A, high-sensitivity C-reactive protein, fibrinogen, albumin, homocysteine, lipids, HbA1c, and average preprandial and postprandial blood glucose at 18 months. Information about severe hypoglycemia and smoking was recorded. Spearman’s correlation coefficients were calculated. Multiple linear regression was used for the multivariate analysis. Results The median baseline calcium score was 63, and that at 18 months was 100. In the univariate analysis, albumin was significantly correlated with the baseline calcium score. Fetuin-A and postprandial glycemia were correlated with calcium score progression. In the multivariate model, postprandial glycemia and fetuin-A were independently associated with calcium score progression. Conclusions Fetuin-A and postprandial glycemia influence coronary calcification progression in patients with type 2 diabetes. The absence of some correlations could be due to pharmacological treatments for cardiovascular risk reduction.
Collapse
Affiliation(s)
- Mitja Krajnc
- 1 Department of Endocrinology and Diabetology, Maribor University Medical Centre, Slovenia
| | | | - Ivan Krajnc
- 2 Faculty of Medicine, University of Maribor, Slovenia
| |
Collapse
|
6
|
Mahapatra G, Smith SC, Hughes TM, Wagner B, Maldjian JA, Freedman BI, Molina AJA. Blood-based bioenergetic profiling is related to differences in brain morphology in African Americans with Type 2 diabetes. Clin Sci (Lond) 2018; 132:2509-2518. [PMID: 30401689 PMCID: PMC6512318 DOI: 10.1042/cs20180690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
Blood-based bioenergetic profiling has promising applications as a minimally invasive biomarker of systemic bioenergetic capacity. In the present study, we examined peripheral blood mononuclear cell (PBMC) mitochondrial function and brain morphology in a cohort of African Americans with long-standing Type 2 diabetes. Key parameters of PBMC respiration were correlated with white matter, gray matter, and total intracranial volumes. Our analyses indicate that these relationships are primarily driven by the relationship of systemic bioenergetic capacity with total intracranial volume, suggesting that systemic differences in mitochondrial function may play a role in overall brain morphology.
Collapse
Affiliation(s)
- Gargi Mahapatra
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157, U.S.A
| | - S Carrie Smith
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
| | - Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157, U.S.A
| | - Benjamin Wagner
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - Joseph A Maldjian
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - Barry I Freedman
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
| | - Anthony J A Molina
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157, U.S.A.
- Department of Medicine, Division of Geriatrics and Gerontology, University of California San Diego School of Medicine, La Jolla, CA 92093, U.S.A
| |
Collapse
|
7
|
Lenchik L, Register TC, Hsu FC, Xu J, Smith SC, Carr JJ, Freedman BI, Bowden DW. Bone Mineral Density of the Radius Predicts All-Cause Mortality in Patients With Type 2 Diabetes: Diabetes Heart Study. J Clin Densitom 2018; 21:347-354. [PMID: 29284565 PMCID: PMC5984132 DOI: 10.1016/j.jocd.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
This study aimed to determine the association between areal and volumetric bone mineral density (BMD) with all-cause mortality in patients with type 2 diabetes (T2D). Associations between BMD and all-cause mortality were examined in 576 women and 517 men with T2D in the Diabetes Heart Study. Volumetric BMD in the thoracic and lumbar spine was measured with quantitative computed tomography. Areal BMD (aBMD) in the lumbar spine, total hip, femoral neck, ultradistal radius, mid radius, and whole body was measured using dual X-ray absorptiometry. Association of BMD with all-cause mortality was determined using sequential models, stratified by sex: (1) unadjusted; (2) adjusted for age, race, smoking, alcohol, estrogen use; (3) model 2 plus history of cardiovascular disease, hypertension, and coronary artery calcification; (4) model 3 plus lean mass; and (5) model 3 plus fat mass. At baseline, mean age was 61.2 years for women and 62.7 years for men. At mean 11.0 ± 3.7 years' follow-up, 221 (36.4%) women and 238 (43.6%) men were deceased. In women, BMD at all skeletal sites (except spine aBMD and whole body aBMD) was inversely associated with all-cause mortality in the unadjusted model. These associations remained significant in the mid radius (hazard ratio per standard deviation = 0.79; p = 0.0057) and distal radius (hazard ratio per standard deviation = 0.76; p = 0.0056) after adjusting for all covariates, including lean mass. In men, volumetric BMD measurements but not aBMD were inversely associated with mortality and only in the unadjusted model. In this longitudinal study, lower baseline aBMD in the radius was associated with increased all-cause mortality in women with T2D, but not men, independent of other risk factors for death.
Collapse
Affiliation(s)
- Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Thomas C Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
8
|
Raffield LM, Cox AJ, Criqui MH, Hsu FC, Terry JG, Xu J, Freedman BI, Carr JJ, Bowden DW. Associations of coronary artery calcified plaque density with mortality in type 2 diabetes: the Diabetes Heart Study. Cardiovasc Diabetol 2018; 17:67. [PMID: 29751802 PMCID: PMC5946410 DOI: 10.1186/s12933-018-0714-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/08/2018] [Indexed: 02/27/2023] Open
Abstract
Background Coronary artery calcified plaque (CAC) is strongly predictive of cardiovascular disease (CVD) events and mortality, both in general populations and individuals with type 2 diabetes at high risk for CVD. CAC is typically reported as an Agatston score, which is weighted for increased plaque density. However, the role of CAC density in CVD risk prediction, independently and with CAC volume, remains unclear. Methods We examined the role of CAC density in individuals with type 2 diabetes from the family-based Diabetes Heart Study and the African American-Diabetes Heart Study. CAC density was calculated as mass divided by volume, and associations with incident all-cause and CVD mortality [median follow-up 10.2 years European Americans (n = 902, n = 286 deceased), 5.2 years African Americans (n = 552, n = 93 deceased)] were examined using Cox proportional hazards models, independently and in models adjusted for CAC volume. Results In European Americans, CAC density, like Agatston score and volume, was consistently associated with increased risk of all-cause and CVD mortality (p ≤ 0.002) in models adjusted for age, sex, statin use, total cholesterol, HDL, systolic blood pressure, high blood pressure medication use, and current smoking. However, these associations were no longer significant when models were additionally adjusted for CAC volume. CAC density was not significantly associated with mortality, either alone or adjusted for CAC volume, in African Americans. Conclusions CAC density is not associated with mortality independent from CAC volume in European Americans and African Americans with type 2 diabetes. Electronic supplementary material The online version of this article (10.1186/s12933-018-0714-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura M Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, 5100 Genetic Medicine Building, 120 Mason Farm Road, Chapel Hill, NC, 27599, USA. .,Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Amanda J Cox
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Molecular Basis of Disease, Griffith University, Southport, Brisbane, QLD, Australia
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
| | - Fang-Chi Hsu
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James G Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Jianzhao Xu
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Donald W Bowden
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
9
|
Prasada S, Oswalt C, Yeboah P, Saylor G, Bowden D, Yeboah J. Heart rate is an independent predictor of all-cause mortality in individuals with type 2 diabetes: The diabetes heart study. World J Diabetes 2018; 9:33-39. [PMID: 29359027 PMCID: PMC5763038 DOI: 10.4239/wjd.v9.i1.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/25/2017] [Accepted: 11/27/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To assess the association of resting heart rate with all-cause and cardiovascular disease (CVD) mortality in the Diabetes Heart Study (DHS).
METHODS Out of a total of 1443 participants recruited into the DHS, 1315 participants with type 2 diabetes who were free of atrial fibrillation and supraventricular tachycardia during the baseline exam were included in this analysis. Heart rate was collected from baseline resting electrocardiogram and mortality (all-cause and CVD) was obtained from state and national death registry. Kaplan-Meier (K-M) and Cox proportional hazard analyses were used to assess the association.
RESULTS The mean age, body mass index (BMI) and systolic blood pressure (SBP) of the cohort were 61.4 ± 9.2 years, 32.0 ± 6.6 kg/m2, and 139.4 ± 19.4 mmHg respectively. Fifty-six percent were females, 85% were whites, 15% were blacks, 18% were smokers. The mean ± SD heart rate was 69.8 (11.9) beats per minute (bpm). After a median follow-up time of 8.5 years (maximum follow-up time is 14.0 years), 258 participants were deceased. In K-M analysis, participants with heart rate above the median had a significantly higher event rate compared with those below the median (log-rank P = 0.0223). A one standard deviation increase in heart rate was associated with all-cause mortality in unadjusted (hazard ratio 1.16, 95%CI: 1.03-1.31) and adjusted (hazard ratio 1.20, 95%CI: 1.05-1.37) models. Similar results were obtained with CVD mortality as the outcome of interest.
CONCLUSION Heart rate is an independent predictor of all-cause mortality in this population with type 2 diabetes. In this study, a 1-SD increase in heart rate was associated with a 20% increase in risk suggesting that additional prognostic information may be gleaned from this ubiquitously collected vital sign.
Collapse
Affiliation(s)
- Sameer Prasada
- Department of Medical School (Medical students), Wake Forest University, Winston Salem, NC 27157, United States
| | - Cameron Oswalt
- Department of Medical School (Medical students), Wake Forest University, Winston Salem, NC 27157, United States
| | - Phyllis Yeboah
- Department of Internal Medicine, Wake Forest Baptist Health, Winston Salem, NC 27157, United States
| | - Georgia Saylor
- Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, NC 27157, United States
| | - Donald Bowden
- Department of Biochemistry, Genomics and Personalized Medicine Research, Wake Forest University, Winston Salem, NC 27157, United States
| | - Joseph Yeboah
- Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, NC 27157, United States
| |
Collapse
|
10
|
Rathinavelu S, Guidry-Elizondo C, Banu J. Molecular Modulation of Osteoblasts and Osteoclasts in Type 2 Diabetes. J Diabetes Res 2018; 2018:6354787. [PMID: 30525054 PMCID: PMC6247387 DOI: 10.1155/2018/6354787] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 02/08/2023] Open
Abstract
Diabetes is a common disease affecting majority of populations worldwide. Since 1980, there has been an increase in the number of people diagnosed as prediabetic and diabetic. Diabetes is characterized by high levels of circulating glucose and leads to most microvascular and macrovascular complications such as retinopathy, nephropathy, neuropathy, stroke, and myocardial infarction. Bone marrow vascular disruption and increased adiposity are also linked to various complications in type II diabetes mellitus. In addition to these complications, type 2 diabetic patients also have fragile bones caused by faulty mineralization mainly due to increased adiposity among diabetic patients that affects both osteoblast and osteoclast functions. Other factors that increase fracture risk in diabetic patients are increased oxidative stress, inflammation, and drugs administered to diabetic patients. This review reports the modulation of different pathways that affect bone metabolism in diabetic conditions.
Collapse
Affiliation(s)
- Selvalakshmi Rathinavelu
- Department of Health and Biomedical Sciences, College of Health Affairs, University of Texas Rio Grande Valley, 1201, W University Dr, Edinburg, TX 78539, USA
| | - Crissy Guidry-Elizondo
- Department of Health and Biomedical Sciences, College of Health Affairs, University of Texas Rio Grande Valley, 1201, W University Dr, Edinburg, TX 78539, USA
| | - Jameela Banu
- Department of Health and Biomedical Sciences, College of Health Affairs, University of Texas Rio Grande Valley, 1201, W University Dr, Edinburg, TX 78539, USA
- Department of Biology, College of Sciences, University of Texas Rio Grande Valley, 1201, W University Dr, Edinburg, TX 78539, USA
| |
Collapse
|
11
|
Wagenknecht LE, Divers J, Register TC, Russell GB, Bowden DW, Xu J, Langefeld CD, Lenchik L, Hruska KA, Carr JJ, Freedman BI. Bone Mineral Density and Progression of Subclinical Atherosclerosis in African-Americans With Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:4135-4141. [PMID: 27552541 PMCID: PMC5095232 DOI: 10.1210/jc.2016-1934] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Relative to European Americans, calcified atherosclerotic plaque (CP) is less prevalent and severe in African-Americans (AAs). OBJECTIVE Predictors of progression of CP in the aorta, carotid, and coronary arteries were examined in AAs over a mean 5.3 ± 1.4-year interval. DESIGN This is the African American-Diabetes Heart Study. SETTING A type 2 diabetes (T2D)-affected cohort was included. PARTICIPANTS A total of 300 unrelated AAs with T2D; 50% female, mean age 55 ± 9 years, baseline hemoglobin A1c 8.1 ± 1.8% was included. MAIN OUTCOME MEASURES Glycemic control, renal parameters, vitamin D, and computed tomography-derived measures of adiposity, vascular CP, and volumetric bone mineral density (vBMD) in lumbar and thoracic vertebrae were obtained at baseline and follow-up. RESULTS CP increased in incidence and quantity/mass in all three vascular beds over the 5-year study (P < .0001). Lower baseline lumbar and thoracic vBMD were associated with progression of abdominal aorta CP (P < .008), but not progression of carotid or coronary artery CP. Lower baseline estimated glomerular filtration rate was associated with progression of carotid artery CP (P = .0004), and higher baseline pericardial adipose volume was associated with progression of coronary artery (P = .001) and aorta (P = .0006) CP independent of body mass index. There was a trend for an inverse relationship between change in thoracic vBMD and change in aortic CP (P = .05). CONCLUSIONS In this longitudinal study, lower baseline thoracic and lumbar vBMD and estimated glomerular filtration rate and higher pericardial adipose volumes were associated with increases in CP in AAs with T2D. Changes in these variables and baseline levels and/or changes in glycemic control, albuminuria, and vitamin D were not significantly associated with progression of CP.
Collapse
Affiliation(s)
- Lynne E Wagenknecht
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jasmin Divers
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas C Register
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gregory B Russell
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald W Bowden
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jianzhao Xu
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carl D Langefeld
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Leon Lenchik
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Keith A Hruska
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - J Jeffrey Carr
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barry I Freedman
- Division of Public Health Sciences (L.E.W., J.D., G.B.R., C.D.L.), Department of Pathology (T.C.R.), Department of Biochemistry (D.W.B., J.X.), and Department of Radiology (L.L.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Division of Pediatric Nephrology (K.A.H.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.J.C.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Internal Medicine (B.I.F.), Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
12
|
Yuan M, Hsu FC, Bowden DW, Xu J, Smith SC, Wagenknecht LE, Comeau ME, Divers J, Register TC, Carr JJ, Langefeld CD, Freedman BI. Relationships between measures of adiposity with subclinical atherosclerosis in patients with type 2 diabetes. Obesity (Silver Spring) 2016; 24:1810-8. [PMID: 27356020 PMCID: PMC4963287 DOI: 10.1002/oby.21540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Assess cross-sectional relationships between body mass index (BMI), waist circumference (WC), pericardial (PAT), visceral (VAT), and subcutaneous adipose tissue (SAT) volumes with calcified plaque (CP) in African Americans (AAs) and European Americans (EAs) with type 2 diabetes. METHODS Computed tomography measured PAT, VAT, SAT, and CP in coronary arteries (CAC), carotid arteries, and aorta. Generalized estimating equations models were fitted to test for associations between adiposity and CP, stratified by ethnicity while accounting for familial correlations. RESULTS AAs (N = 753) vs. EAs (N = 562) had significantly lower PAT and VAT, despite equal or higher BMI. In multivariable models adjusting for age, gender, education, HbA1c, statins, smoking, cardiovascular disease, hypertension, nephropathy, and C-reactive protein, PAT positively associated with presence of CAC in AAs (P < 0.001), not EAs (P = 0.68; ethnicity interaction P < 0.01). Inverse associations were detected between SAT and severity of aorta CP (P < 0.01) in AAs and between BMI, WC, and SAT with severity of aorta CP in all participants. CONCLUSIONS Ethnic- and gender-specific differences in BMI, WC, PAT, SAT, and VAT were present in AAs and EAs with diabetes. Only PAT was positively associated with CAC in AAs; paradoxical inverse associations were seen between several other adiposity measures and subclinical cardiovascular disease.
Collapse
Affiliation(s)
- Mingxia Yuan
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fang-Chi Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Donald W. Bowden
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jianzhao Xu
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - S. Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mary E. Comeau
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jasmin Divers
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas C. Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Carl D. Langefeld
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Centers for Genomics and Personalized Medicine Research & Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
13
|
Raffield LM, Cox AJ, Freedman BI, Hugenschmidt CE, Hsu FC, Wagner BC, Xu J, Maldjian JA, Bowden DW. Analysis of the relationships between type 2 diabetes status, glycemic control, and neuroimaging measures in the Diabetes Heart Study Mind. Acta Diabetol 2016; 53:439-47. [PMID: 26525870 PMCID: PMC4853281 DOI: 10.1007/s00592-015-0815-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/01/2015] [Indexed: 01/21/2023]
Abstract
AIMS To examine the relationships between type 2 diabetes (T2D) status, glycemic control, and T2D duration with magnetic resonance imaging (MRI)-derived neuroimaging measures in European Americans from the Diabetes Heart Study (DHS) Mind cohort. METHODS Relationships were examined using marginal models with generalized estimating equations in 784 participants from 514 DHS Mind families. Fasting plasma glucose, glycated hemoglobin, and diabetes duration were analyzed in 682 participants with T2D. Models were adjusted for potential confounders, including age, sex, history of cardiovascular disease, smoking, educational attainment, and use of statins or blood pressure medications. Association was tested with gray and white matter volume, white matter lesion volume, gray matter cerebral blood flow, and white and gray matter fractional anisotropy and mean diffusivity. RESULTS Adjusting for multiple comparisons, T2D status was associated with reduced white matter volume (p = 2.48 × 10(-6)) and reduced gray and white matter fractional anisotropy (p ≤ 0.001) in fully adjusted models, with a trend toward increased white matter lesion volume (p = 0.008) and increased gray and white matter mean diffusivity (p ≤ 0.031). Among T2D-affected participants, neither fasting glucose, glycated hemoglobin, nor diabetes duration were associated with the neuroimaging measures assessed (p > 0.05). CONCLUSIONS While T2D was significantly associated with MRI-derived neuroimaging measures, differences in glycemic control in T2D-affected individuals in the DHS Mind study do not appear to significantly contribute to variation in these measures. This supports the idea that the presence or absence of T2D, not fine gradations of glycemic control, may be more significantly associated with age-related changes in the brain.
Collapse
Affiliation(s)
- Laura M Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J Cox
- Molecular Basis of Disease, Griffith University, Southport, QLD, Australia
| | - Barry I Freedman
- Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Benjamin C Wagner
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
14
|
Martelle SE, Raffield LM, Palmer ND, Cox AJ, Freedman BI, Hugenschmidt CE, Williamson JD, Bowden DW. Dopamine pathway gene variants may modulate cognitive performance in the DHS - Mind Study. Brain Behav 2016; 6:e00446. [PMID: 27066308 PMCID: PMC4797918 DOI: 10.1002/brb3.446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is an established association between type 2 diabetes and accelerated cognitive decline. The exact mechanism linking type 2 diabetes and reduced cognitive function is less clear. The monoamine system, which is extensively involved in cognition, can be altered by type 2 diabetes status. Thus, this study hypothesized that sequence variants in genes linked to dopamine metabolism and associated pathways are associated with cognitive function as assessed by the Digit Symbol Substitution Task, the Modified Mini-Mental State Examination, the Stroop Task, the Rey Auditory-Verbal Learning Task, and the Controlled Oral Word Association Task for Phonemic and Semantic Fluency in the Diabetes Heart Study, a type 2 diabetes-enriched familial cohort (n = 893). METHODS To determine the effects of candidate variants on cognitive performance, genetic association analyses were performed on the well-documented variable number tandem repeat located in the 3' untranslated region of the dopamine transporter, as well as on single-nucleotide polymorphisms covering genes in the dopaminergic pathway, the insulin signaling pathway, and the convergence of both. Next, polymorphisms in loci of interest with strong evidence for involvement in dopamine processing were extracted from genetic datasets available in a subset of the cohort (n = 572) derived from Affymetrix(®) Genome-Wide Human SNP Array 5.0 and 1000 Genomes imputation from this array. RESULTS The candidate gene analysis revealed one variant from the DOPA decarboxylase gene, rs10499695, to be associated with poorer performance on a subset of Rey Auditory-Verbal Learning Task measuring retroactive interference (P = 0.001, β = -0.45). Secondary analysis of genome-wide and imputed data uncovered another DOPA decarboxylase variant, rs62445903, also associated with retroactive interference (P = 7.21 × 10(-7), β = 0.3). These data suggest a role for dopaminergic genes, specifically a gene involved in regulation of dopamine synthesis, in cognitive performance in type 2 diabetes.
Collapse
Affiliation(s)
- Susan E Martelle
- Department of Physiology and Pharmacology Wake Forest School of Medicine Winston - Salem North Carolina; Center for Genomics and Personalized Medicine Research Wake Forest School of Medicine Winston - Salem North Carolina
| | - Laura M Raffield
- Center for Genomics and Personalized Medicine Research Wake Forest School of Medicine Winston - Salem North Carolina
| | - Nichole D Palmer
- Center for Genomics and Personalized Medicine Research Wake Forest School of Medicine Winston - Salem North Carolina
| | - Amanda J Cox
- Molecular Basis of Disease Griffith University Southport Brisbane Queensland Australia
| | - Barry I Freedman
- Department of Internal Medicine, Nephrology Wake Forest School of Medicine Winston - Salem North Carolina
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Gerontology and Geriatric Medicine Wake Forest School of Medicine Winston - Salem North Carolina
| | - Jeff D Williamson
- Department of Internal Medicine, Gerontology and Geriatric Medicine Wake Forest School of Medicine Winston - Salem North Carolina
| | - Don W Bowden
- Center for Genomics and Personalized Medicine Research Wake Forest School of Medicine Winston - Salem North Carolina
| |
Collapse
|
15
|
Al-Safar H, Kamal W, Hassoun A, Almahmeed W, Rais N. Combined association analysis of interleukin 1-receptor antagonist (IL-1RN) variable number of tandem repeat (VNTR) and Haptoglobin 1/2 polymorphisms with type 2 diabetes mellitus risk. J Diabetes Metab Disord 2016; 15:10. [PMID: 27030821 PMCID: PMC4812649 DOI: 10.1186/s40200-016-0232-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/19/2016] [Indexed: 01/17/2023]
Abstract
Background The polymorphism of Interleukin 1 receptor antagonist gene (IL-1RN), which encodes a natural antagonist of pro-inflammatory cytokines belonging to IL-1 family and Haptoglobin (HP) have been studied in various ethnic groups in association with Type 2 Diabetes Mellitus (T2DM) risk and related complications. However, there was no study available among the Emirati population. Hence, we designed a combined study on IL-1RN and HP polymorphism to evaluate their association with prevalence of T2DM, related complication and hypertension and also its interaction with obesity status among Emirati population. Methods IL-1RN and HP genotypes were determined in total 487 Emiratis divided in two groups of T2DM case (n = 271) and healthy controls (n = 215) by polymerase chain reaction (PCR) followed by gel electrophoresis. Gene-gene interaction and polymorphism-obesity interaction were determined by multivariate logistic regression analysis. Results We found that the frequencies of IL-1RN*1/*1 and HP2-2 genotypes were significantly higher in cases than control and were associated with increased T2DM risk with an odds ratio (OR) of 1.60 (95 % CI 1.10–2.36) and 1.63 (95 % CI 1.11–2.64), respectively. The association lack any interaction with obesity status. Associations with occurrences of T2DM related complications and hypertension were not observed. Conclusions We report an association of IL-1RN and HP polymorphism with T2DM risk independent of each other and of obesity status but no association with related complications and hypertension. Electronic supplementary material The online version of this article (doi:10.1186/s40200-016-0232-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Habiba Al-Safar
- Khalifa University Center of Biotechnology, Khalifa University of Science, Technology & Research, P.O. Box 127788, Abu Dhabi, United Arab Emirates ; Khalifa University Center of Biotechnology, P.O. Box 127788, Abu Dhabi, United Arab Emirates
| | - Wala Kamal
- School of Life Sciences, Manipal University, P.O. Box-345050, Dubai, United Arab Emirates
| | - Ahmed Hassoun
- Dubai Diabetes Centre, Dubai Health Authority, Dubai, United Arab Emirates
| | - Wael Almahmeed
- Institute of cardiac science, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Naushad Rais
- School of Life Sciences, Manipal University, P.O. Box-345050, Dubai, United Arab Emirates
| |
Collapse
|
16
|
Adams JN, Martelle SE, Raffield LM, Freedman BI, Langefeld CD, Hsu FC, Maldjian JA, Williamson JD, Hugenschmidt CE, Carr JJ, Cox AJ, Bowden DW. Analysis of advanced glycation end products in the DHS Mind Study. J Diabetes Complications 2016; 30:262-8. [PMID: 26739237 PMCID: PMC4761276 DOI: 10.1016/j.jdiacomp.2015.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/16/2015] [Accepted: 11/29/2015] [Indexed: 12/11/2022]
Abstract
AIMS Human studies of links between advanced glycation end-products (AGEs) and disease phenotypes are less common than studies of animal and cell models. Here, we examined the association of total AGEs with diabetes risk factors in a predominately type 2 diabetes (T2D) affected cohort. METHODS AGEs were measured using an enzyme linked immunosorbant assay in 816 individuals from the DHS Mind Study (n=709 T2D affected), and association analyses were completed. RESULTS Total AGEs were associated with estimated glomerular filtration rate (p=0.0054; β=-0.1291) and coronary artery calcification (p=0.0352; β=1.1489) in the entire cohort. No significant associations were observed when individuals with T2D were analyzed separately. In individuals without T2D, increased circulating AGEs were associated with increased BMI (p=0.02, β=0.138), low density lipoproteins (p=0.046, β=17.07) and triglycerides (p=0.0004, β=0.125), and decreased carotid artery calcification (p=0.0004, β=-1.2632) and estimated glomerular filtration rate (p=0.0018, β=-0.1405). Strong trends were also observed for an association between AGEs and poorer cognitive performance on the digit symbol substitution test (p=0.046, β=-6.64) and decreased grey matter volume (p=0.037, β=-14.87). CONCLUSIONS AGEs may play an important role in a number of phenotypes and diseases, although not necessarily in interindividual variation in people with T2D. Further evaluation of specific AGE molecules may shed more light on these relationships.
Collapse
Affiliation(s)
- Jeremy N Adams
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - Susan E Martelle
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - Laura M Raffield
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine, Nephrology, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston Salem, North Carolina
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston Salem, North Carolina
| | - Joseph A Maldjian
- Radiologic Sciences and Advanced NeuroScience Imaging (ANSIR) Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - J Jeffery Carr
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston - Salem, NC, USA
| | - Amanda J Cox
- Molecular Basis of Disease, Griffith University, Southport, QLD, Australia
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston - Salem, NC, USA.
| |
Collapse
|
17
|
Adams JN, Raffield LM, Martelle SE, Freedman BI, Langefeld CD, Carr JJ, Cox AJ, Bowden DW. Genetic analysis of advanced glycation end products in the DHS MIND study. Gene 2016; 584:173-9. [PMID: 26915486 DOI: 10.1016/j.gene.2016.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/21/2016] [Accepted: 02/19/2016] [Indexed: 11/24/2022]
Abstract
Advanced glycation end-products (AGEs) are a diverse group of molecules produced by the non-enzymatic addition of glucose to proteins, lipids, and nucleic acids. AGE levels have been associated with hyperglycemia and diabetic complications, especially in animal models, but less clearly in human studies. We measured total serum AGEs using an enzyme linked immunosorbant assay (ELISA) in 506 subjects from 246 families in the Diabetes Heart Study (DHS)/DHS MIND Study (n=399 type 2 diabetes (T2D)-affected). Single nucleotide polymorphisms (SNPs) in several candidate genes, including known AGE receptors, were tested for their influence on circulating AGE levels. The genetic analysis was expanded to include an exploratory genome-wide association study (GWAS) and exome chip analysis of AGEs (≈440,000 SNPs). AGEs were found to be highly heritable (h(2)=0.628, p=8.96 × 10(-10)). While no SNPs from candidate genes were significantly associated after Bonferroni correction, rs1035798 in the gene AGER was the most significantly associated (p=0.007). Additionally, rs7198427, in MT1A, showed a nominally significant p-value (p=0.0099). No SNPs from the GWAS or exome studies were identified after correction for multiple comparisons; however, rs17054480 in the PALLD2 gene on chromosome 4 showed the strongest association (p=7.77 × 10(-7)). Five SNPs at two loci (ISCA2/NPC2 and FBXO33) had p-values of less than 2.0 × 10(-5) and three additional SNPs (rs716326 in MACROD2, and rs6795197 and rs6765857 in ZBTB38) showed a nominal association with p-values of less than 1.0 × 10(-5).These findings provide a foundation for further investigation into the genetic component of circulating AGEs.
Collapse
Affiliation(s)
- Jeremy N Adams
- Program in Molecular Genetics and Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Laura M Raffield
- Program in Molecular Genetics and Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Susan E Martelle
- Integrative Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Barry I Freedman
- Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Carl D Langefeld
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - J Jeffrey Carr
- Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Amanda J Cox
- Molecular Basis of Disease, Griffith University, Southport, QLD, Australia
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| |
Collapse
|
18
|
Raffield LM, Brenes GA, Cox AJ, Freedman BI, Hugenschmidt CE, Hsu FC, Xu J, Wagner BC, Williamson JD, Maldjian JA, Bowden DW. Associations between anxiety and depression symptoms and cognitive testing and neuroimaging in type 2 diabetes. J Diabetes Complications 2016; 30:143-9. [PMID: 26476474 PMCID: PMC4698057 DOI: 10.1016/j.jdiacomp.2015.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
AIMS Anxiety, depression, accelerated cognitive decline, and increased risk of dementia are observed in individuals with type 2 diabetes. Anxiety and depression may contribute to lower performance on cognitive tests and differences in neuroimaging observed in individuals with type 2 diabetes. METHODS These relationships were assessed in 655 European Americans with type 2 diabetes from 504 Diabetes Heart Study families. Participants completed cognitive testing, brain magnetic resonance imaging, the Brief Symptom Inventory Anxiety subscale, and the Center for Epidemiologic Studies Depression-10. RESULTS In analyses adjusted for age, sex, educational attainment, and use of psychotropic medications, individuals with comorbid anxiety and depression symptoms had lower performance on all cognitive testing measures assessed (p≤0.005). Those with both anxiety and depression also had increased white matter lesion volume (p=0.015), decreased gray matter cerebral blood flow (p=4.43×10(-6)), decreased gray matter volume (p=0.002), increased white and gray matter mean diffusivity (p≤0.001), and decreased white matter fractional anisotropy (p=7.79×10(-4)). These associations were somewhat attenuated upon further adjustment for health status related covariates. CONCLUSIONS Comorbid anxiety and depression symptoms were associated with cognitive performance and brain structure in a European American cohort with type 2 diabetes.
Collapse
Affiliation(s)
- Laura M Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Benjamin C Wagner
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
19
|
Bonomo JA, Palmer ND, He JC, Fan Y, Hicks PJ, Lea JP, Okusa MD, Bowden DW, Freedman BI. Association Analysis of the Reticulon 1 Gene in End-Stage Kidney Disease. Am J Nephrol 2015; 42:259-64. [PMID: 26496126 DOI: 10.1159/000441199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The reticulon 1 gene (RTN1) encodes reticulons, endoplasmic reticulum stress proteins recently implicated in kidney disease progression. METHODS RTN1 single nucleotide polymorphisms (SNPs) were tested for association with type 2 diabetes (T2D)-associated end-stage kidney disease (ESKD) in African Americans (AAs) and European Americans (EAs), and AAs with non-diabetic ESKD. RTN1 SNPs that were associated with T2D-ESKD in AA cases compared to non-nephropathy controls were identified from a discovery genome-wide association study (n=1,797), then tested for replication in 1,847 additional AA T2D-ESKD cases and controls. RESULTS Three intronic RTN1 variants were nominally associated with T2D-ESKD in both discovery and replication analyses: rs1952034, rs12431381 and rs12434215 (additive models); combined T2D-ESKD (discovery+replication) p values were 0.015-3.0×10(-4) (ORs 0.67-0.77; minor alleles protective). In addition, rs12434215 was weakly associated with T2D-ESKD in 557 EA T2D-ESKD cases contrasted with 753 EA non-nephropathy controls (p=0.019; OR 0.69, dominant model). Nominal association extended to non-diabetic causes of ESKD in 1,459 additional AA cases (rs12431381 and rs12434215 p values 0.014-0.015; OR 0.77). An all-cause ESKD association analysis contrasted the 3,594 AA ESKD cases with 1,489 AA non-nephropathy controls and detected association with rs12434215 (p=6.7×10(-4), OR 0.73) and rs12431381 (p=7.5×10(-4), OR 0.75) in dominant models. Of the 3 SNPs, only rs12434215 was weakly associated with T2D per se when contrasting T2D non-nephropathy cases with non-diabetic controls (additive model p=0.032 AAs; p=0.048 EAs). CONCLUSIONS These results suggest evidence of genetic association between common variants in RTN1 and ESKD in AAs and EAs.
Collapse
Affiliation(s)
- Jason A Bonomo
- Center for Genomics and Personalized Medicine Research, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, N.C., USA
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Raffield LM, Cox AJ, Carr JJ, Freedman BI, Hicks PJ, Langefeld CD, Hsu FC, Bowden DW. Analysis of a cardiovascular disease genetic risk score in the Diabetes Heart Study. Acta Diabetol 2015; 52:743-51. [PMID: 25700702 PMCID: PMC4506855 DOI: 10.1007/s00592-015-0720-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/02/2015] [Indexed: 01/20/2023]
Abstract
AIMS It remains unclear whether the high cardiovascular disease (CVD) burden in people with type 2 diabetes (T2D) is associated with genetic variants that contribute to CVD in general populations. Recent studies have examined genetic risk scores of single-nucleotide polymorphisms (SNPs) identified by genome-wide association studies for their cumulative contribution to CVD-related traits. Most analyses combined SNPs associated with a single phenotypic class, e.g., lipids. In the present analysis, we examined a more comprehensive risk score comprised of SNPs associated with a broad range of CVD risk phenotypes. METHODS The composite risk score was analyzed for potential associations with subclinical CVD, self-reported CVD events, and mortality in 983 T2D-affected individuals of European descent from 466 Diabetes Heart Study (DHS) families. Genetic association was examined using marginal models with generalized estimating equations for subclinical CVD and prior CVD events and Cox proportional hazards models with sandwich-based variance estimation for mortality; analyses were adjusted for age and sex. RESULTS An increase in genetic risk score was significantly associated with higher levels of coronary artery calcified plaque (p = 1.23 × 10(-4)); however, no significant associations with self-reported myocardial infarction and CVD events and all-cause and CVD mortality were observed. CONCLUSIONS These results suggest that a genetic risk score of SNPs associated with CVD events and risk factors does not significantly account for CVD risk in the DHS, highlighting the limitations of applying current genetic markers for CVD in individuals with diabetes.
Collapse
Affiliation(s)
- Laura M. Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J. Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Barry I. Freedman
- Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Pamela J. Hicks
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl D. Langefeld
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W. Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Corresponding Author: Dr Donald W Bowden Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine Medical Center Boulevard, Winston Salem, NC, USA, 27157 Tel: +1 336-713-7507, Fax: +1 336-713-7544
| |
Collapse
|
21
|
Hsu FC, Raffield LM, Hugenschmidt CE, Cox A, Xu J, Carr JJ, Freedman BI, Maldjian JA, Williamson JD, Bowden DW. Relationships between Cognitive Performance, Neuroimaging and Vascular Disease: The DHS-MIND Study. Neuroepidemiology 2015; 45:1-11. [PMID: 26185004 DOI: 10.1159/000435775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/04/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus increases the risk of cognitive decline and dementia, and elevated burdens of vascular disease are hypothesized to contribute to this risk. These relationships were examined in the Diabetes Heart Study-MIND using a battery of cognitive tests, neuroimaging measures and subclinical cardiovascular disease (CVD) burden assessed by coronary artery calcified (CAC) plaque. We hypothesized that CAC would attenuate the association between neuroimaging measures and cognition performance. METHODS Associations were examined using marginal models in this family-based cohort of 572 European Americans from 263 families. All models were adjusted for age, gender, education, type 2 diabetes and hypertension, with some neuroimaging measures additionally adjusted for intracranial volume. RESULTS Higher total brain volume was associated with better performance on the Digit Symbol Substitution Task and Semantic Fluency (both p ≤ 7.0 × 10(-4)). Higher gray matter volume was associated with better performance on the Modified Mini-Mental State Examination and Semantic Fluency (both p ≤ 9.0 × 10(-4)). Adjusting for CAC caused minimal changes to the results. CONCLUSIONS Relationships exist between neuroimaging measures and cognitive performance in a type 2 diabetes-enriched European American cohort. Associations were minimally attenuated after adjusting for subclinical CVD. Additional work is needed to understand how subclinical CVD burden interacts with other factors and impacts relationships between neuroimaging and cognitive testing measures.
Collapse
Affiliation(s)
- Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, N.C., USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Murea M, Hsu FC, Cox AJ, Hugenschmidt CE, Xu J, Adams JN, Raffield LM, Whitlow CT, Maldjian JA, Bowden DW, Freedman BI. Structural and functional assessment of the brain in European Americans with mild-to-moderate kidney disease: Diabetes Heart Study-MIND. Nephrol Dial Transplant 2015; 30:1322-9. [PMID: 25722384 DOI: 10.1093/ndt/gfv030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Advanced chronic kidney disease (CKD) is associated with altered cerebral structure and function. Relationships between mild-to-moderate CKD and brain morphology and cognitive performance were evaluated in European Americans (EAs). METHODS A total of 478 EAs with estimated glomerular filtration rate (eGFR) >45 mL/min/1.73 m(2) and urine albumin:creatinine ratio (UACR) < 300 mg/g, most with type 2 diabetes (T2D), were included. Measures of total intracranial volume (TICV), cerebrospinal fluid volume, total white matter volume (TWMV), total gray matter volume (TGMV), total white matter lesion volume (TWMLV), hippocampal white matter volume (HWMV) and hippocampal gray matter volume (HGMV) were obtained with magnetic resonance imaging. Cognitive testing included memory (Rey Auditory Visual Learning Test), global cognition (Modified Mini-Mental State Examination) and executive function (Stroop Task, Semantic Fluency, Digit Symbol Substitution Test). Associations with CKD were assessed using log-transformed eGFR and UACR, adjusted for age, sex, body mass index, smoking, hemoglobin A1c, blood pressure, diabetes duration, cardiovascular disease and education. RESULTS Participants were 55.2% female, 78.2% had T2D; mean ± SD age 67.6 ± 9.0 years, T2D duration 16.4 ± 6.5 years, eGFR 92.0 ± 22.3 mL/min/1.73 m(2) and UACR 23.8 ± 39.6 mg/g. In adjusted models, eGFR was negatively associated with TICV only in participants with T2D [parameter estimate (β): -72.2, P = 0.002]. In non-diabetic participants, inverse relationships were observed between eGFR and HGMV (β: -1.0, P = 0.03) and UACR and normalized TWMLV (β: -0.2, P = 0.03). Kidney function and albuminuria did not correlate with cognitive testing. CONCLUSIONS In EAs with mild CKD enriched for T2D, brain structure and cognitive performance were generally not impacted. Longitudinal studies are necessary to determine when cerebral structural changes and cognitive dysfunction develop with progressive CKD in EAs.
Collapse
Affiliation(s)
- Mariana Murea
- Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J Cox
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Internal Medicine-Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeremy N Adams
- Molecular Genetics and Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura M Raffield
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher T Whitlow
- Radiologic Sciences and Advanced NeuroScience Imaging (ANSIR) Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- Radiologic Sciences and Advanced NeuroScience Imaging (ANSIR) Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
23
|
Freedman BI, Langefeld CD, Lu L, Palmer ND, Smith SC, Bagwell BM, Hicks PJ, Xu J, Wagenknecht LE, Raffield LM, Register TC, Carr JJ, Bowden DW, Divers J. APOL1 associations with nephropathy, atherosclerosis, and all-cause mortality in African Americans with type 2 diabetes. Kidney Int 2015; 87:176-81. [PMID: 25054777 PMCID: PMC4281283 DOI: 10.1038/ki.2014.255] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/30/2014] [Accepted: 06/05/2014] [Indexed: 12/30/2022]
Abstract
Albuminuria and reduced estimated glomerular filtration rate (eGFR) associate with two apolipoprotein L1 gene (APOL1) variants in nondiabetic African Americans (AAs). Whether APOL1 associates with subclinical atherosclerosis and survival remains unclear. To determine this, 717 African American-Diabetes Heart Study participants underwent computed tomography to determine coronary artery-, carotid artery-, and aorta-calcified atherosclerotic plaque mass scores in addition to the urine albumin:creatinine ratio (UACR), eGFR, and C-reactive protein (CRP). Associations between mass scores and APOL1 were assessed adjusting for age, gender, African ancestry, body mass index (BMI), hemoglobin A1c, smoking, hypertension, use of statins and angiotensin-converting enzyme inhibitors, albuminuria, and eGFR. Participants were 58.9% female with mean age 56.5 years, eGFR 89.5 ml/min per 1.73 m(2), UACR 169.6 mg/g, and coronary artery-, carotid artery-, and aorta-calcified plaque mass scores of 610, 171, and 5378, respectively. In fully adjusted models, APOL1 risk variants were significantly associated with lower levels of carotid artery-calcified plaque (β=-0.42, s.e. 0.18; dominant model) and marginally lower coronary artery plaque (β=-0.36, s.e. 0.21; dominant model), but not with aorta-calcified plaque, CRP, UACR, or eGFR. By the end of a mean follow-up of 5.0 years, 89 participants had died. APOL1 nephropathy risk variants were significantly associated with improved survival (hazard ratio 0.67 for one copy; 0.44 for two copies). Thus, APOL1 nephropathy variants associate with lower levels of subclinical atherosclerosis and reduced risk of death in AAs with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine–Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carl D. Langefeld
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences-Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lingyi Lu
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences-Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicholette D. Palmer
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences-Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - S. Carrie Smith
- Department of Internal Medicine–Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Benjamin M. Bagwell
- Department of Internal Medicine–Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Pamela J. Hicks
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jianzhao Xu
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences-Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laura M. Raffield
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas C. Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - J. Jeffrey Carr
- Department of Radiology; Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Donald W. Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jasmin Divers
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Division of Public Health Sciences-Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
24
|
Raffield LM, Hsu FC, Cox AJ, Carr JJ, Freedman BI, Bowden DW. Predictors of all-cause and cardiovascular disease mortality in type 2 diabetes: Diabetes Heart Study. Diabetol Metab Syndr 2015; 7:58. [PMID: 26146522 PMCID: PMC4490739 DOI: 10.1186/s13098-015-0055-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/18/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Many studies evaluated the best predictors for cardiovascular disease (CVD) events in individuals with type 2 diabetes (T2D), but few studies examined the factors most strongly associated with mortality in T2D. The Diabetes Heart Study (DHS), an intensively phenotyped family-based cohort enriched for T2D, provided an opportunity to address this question. METHODS Associations with mortality were examined in 1022 European Americans affected by T2D from 476 DHS families. All-cause mortality was 31.2 % over an average 9.6 years of follow-up. Cox proportional hazards models with sandwich-based variance estimation were used to evaluate associations between all-cause and CVD mortality and 24 demographic and clinical factors, including coronary artery calcified plaque (CAC), carotid artery intima-media thickness, medications, body mass index, waist hip ratio, lipids, blood pressure, kidney function, QT interval, educational attainment, and glycemic control. Nominally significant factors (p < 0.25) from univariate analyses were included in model selection (backward elimination, forward selection, and stepwise selection). Age and sex were included in all models. RESULTS The all-cause mortality model selected from the full DHS sample included age, sex, CAC, urine albumin: creatinine ratio (UACR), insulin use, current smoking, and educational attainment. The CVD mortality model selected from the full sample included age, sex, CAC, UACR, triglycerides, and history of CVD events. Beyond age, the most significant associations for both mortality models were CAC (2.03 × 10(-4) ≤ p ≤ 0.001) and UACR (1.99 × 10(-8) ≤ p ≤ 2.23 × 10(-8)). To confirm the validity of the main predictors identified with model selection using the full sample, a two-fold cross-validation approach was used, and similar results were observed. CONCLUSIONS This analysis highlights important demographic and clinical factors, notably CAC and albuminuria, which predict mortality in the general population of patients with T2D.
Collapse
Affiliation(s)
- Laura M. Raffield
- />Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Fang-Chi Hsu
- />Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Amanda J. Cox
- />Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - J. Jeffrey Carr
- />Department of Radiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Barry I. Freedman
- />Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Donald W. Bowden
- />Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC USA
- />Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 USA
| |
Collapse
|
25
|
Prediction of mortality using a multi-bed vascular calcification score in the Diabetes Heart Study. Cardiovasc Diabetol 2014; 13:160. [PMID: 25496604 PMCID: PMC4266952 DOI: 10.1186/s12933-014-0160-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
Background Vascular calcified plaque, a measure of subclinical cardiovascular disease (CVD), is unlikely to be limited to a single vascular bed in patients with multiple risk factors. Consideration of vascular calcified plaque as a global phenomenon may allow for a more accurate assessment of the CVD burden. The aim of this study was to examine the utility of a combined vascular calcified plaque score in the prediction of mortality. Methods Vascular calcified plaque scores from the coronary, carotid, and abdominal aortic vascular beds and a derived multi-bed score were examined for associations with all-cause and CVD-mortality in 699 European-American type 2 diabetes (T2D) affected individuals from the Diabetes Heart Study. The ability of calcified plaque to improve prediction beyond Framingham risk factors was assessed. Results Over 8.4 ± 2.3 years (mean ± standard deviation) of follow-up, 156 (22.3%) participants were deceased, 74 (10.6%) from CVD causes. All calcified plaque scores were significantly associated with all-cause (HR: 1.4-1.8; p < 1x10−5) and CVD-mortality (HR: 1.5-1.9; p < 1×10−4) following adjustment for Framingham risk factors. Associations were strongest for coronary calcified plaque. Improvement in prediction of outcome beyond Framingham risk factors was greatest using coronary calcified plaque for all-cause mortality (AUC: 0.720 to 0.757, p = 0.004) and the multi-bed score for CVD mortality (AUC: 0.731 to 0.767, p = 0.008). Conclusions Although coronary calcified plaque and the multi-bed score were the strongest predictors of all-cause mortality and CVD-mortality respectively in this T2D-affected sample, carotid and abdominal aortic calcified plaque scores also significantly improved prediction of outcome beyond traditional risk factors and should not be discounted as risk stratification tools. Electronic supplementary material The online version of this article (doi:10.1186/s12933-014-0160-5) contains supplementary material, which is available to authorized users.
Collapse
|
26
|
Raffield LM, Cox AJ, Hugenschmidt CE, Freedman BI, Langefeld CD, Williamson JD, Hsu FC, Maldjian JA, Bowden DW. Heritability and genetic association analysis of neuroimaging measures in the Diabetes Heart Study. Neurobiol Aging 2014; 36:1602.e7-15. [PMID: 25523635 DOI: 10.1016/j.neurobiolaging.2014.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/15/2014] [Indexed: 12/24/2022]
Abstract
Patients with type 2 diabetes are at increased risk of age-related cognitive decline and dementia. Neuroimaging measures such as white matter lesion volume, brain volume, and fractional anisotropy may reflect the pathogenesis of these cognitive declines, and genetic factors may contribute to variability in these measures. This study examined multiple neuroimaging measures in 465 participants from 238 families with extensive genotype data in the type 2 diabetes enriched Diabetes Heart Study-Mind cohort. Heritability of these phenotypes and their association with candidate single-nucleotide polymorphisms (SNPs), and SNP data from genome- and exome-wide arrays were explored. All neuroimaging measures analyzed were significantly heritable (ĥ(2) = 0.55-0.99 in unadjusted models). Seventeen candidate SNPs (from 16 genes/regions) associated with neuroimaging phenotypes in prior studies showed no significant evidence of association. A missense variant (rs150706952, A432V) in PLEKHG4B from the exome-wide array was significantly associated with white matter mean diffusivity (p = 3.66 × 10(-7)) and gray matter mean diffusivity (p = 2.14 × 10(-7)). This analysis suggests genetic factors contribute to variation in neuroimaging measures in a population enriched for metabolic disease and other associated comorbidities.
Collapse
Affiliation(s)
- Laura M Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J Cox
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
27
|
Raffield LM, Agarwal S, Cox AJ, Hsu FC, Carr JJ, Freedman BI, Xu J, Bowden DW, Vitolins MZ. Cross-sectional analysis of calcium intake for associations with vascular calcification and mortality in individuals with type 2 diabetes from the Diabetes Heart Study. Am J Clin Nutr 2014; 100:1029-35. [PMID: 25099552 PMCID: PMC4163793 DOI: 10.3945/ajcn.114.090365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The use of calcium supplements to prevent declines in bone mineral density and fractures is widespread in the United States, and thus reports of elevated cardiovascular disease (CVD) risk in users of calcium supplements are a major public health concern. Any elevation in CVD risk with calcium supplement use would be of particular concern in individuals with type 2 diabetes (T2D) because of increased risks of CVD and fractures observed in this population. OBJECTIVE In this study, we examined associations between calcium intake from diet and supplements and measures of subclinical CVD (calcified plaque in the coronary artery, carotid artery, and abdominal aorta) and mortality in individuals affected by T2D. DESIGN We performed a cross-sectional analysis in individuals affected by T2D from the family-based Diabetes Heart Study (n = 720). RESULTS We observed no significant associations of calcium from diet or supplements with any of our measures of calcified plaque, and no greater mortality risk was observed with increased calcium intake. Instead, calcium supplement use was modestly associated with reduced all-cause mortality in women (HR: 0.62; 95% CI: 0.42, 0.92; P = 0.017). CONCLUSION Our results do not support a substantial association between calcium intake from diet or supplements and CVD risk in individuals with T2D.
Collapse
Affiliation(s)
- Laura M Raffield
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Subhashish Agarwal
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Amanda J Cox
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Fang-Chi Hsu
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - J Jeffrey Carr
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Barry I Freedman
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Jianzhao Xu
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Donald W Bowden
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| | - Mara Z Vitolins
- From the Molecular Genetics and Genomics Program (LMR), the Centers for Human Genomics (LMR, AJC, JX, and DWB) and Diabetes Research (LMR, AJC, JX, and DWB), and the Departments of Biochemistry (AJC and DWB), Biostatistical Sciences (F-CH), Internal Medicine-Nephrology (BIF), and Epidemiology & Prevention (MZV), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (SA); and the Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (JJC)
| |
Collapse
|
28
|
Cox AJ, Hsu FC, Freedman BI, Herrington DM, Criqui MH, Carr JJ, Bowden DW. Contributors to mortality in high-risk diabetic patients in the Diabetes Heart Study. Diabetes Care 2014; 37:2798-803. [PMID: 24989706 PMCID: PMC4392938 DOI: 10.2337/dc14-0081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Not all individuals with type 2 diabetes and high coronary artery calcified plaque (CAC) experience the same risk for adverse outcomes. This study examined a subset of high-risk individuals based on CAC >1,000 mg (using a total mass score) and evaluated whether differences in a range of modifiable cardiovascular disease (CVD) risk factors provided further insights into risk for mortality. RESEARCH DESIGN AND METHODS We assessed contributors to all-cause mortality among 371 European American individuals with type 2 diabetes and CAC >1,000 from the Diabetes Heart Study (DHS) after 8.2 ± 3.0 years (mean ± SD) of follow-up. Differences in known CVD risk factors, including modifiable CVD risk factors, were compared between living (n = 218) and deceased (n = 153) participants. Cox proportional hazards regression models were used to quantify risk for all-cause mortality. RESULTS Deceased participants had a longer duration of type 2 diabetes (P = 0.02) and reduced use of cholesterol-lowering medications (P = 0.004). Adjusted analyses revealed that vascular calcified plaque scores were associated with increased risk for mortality (hazard ratio 1.31-1.63; 3.89 × 10(-5) < P < 0.03). Higher HbA1c, lipids, and C-reactive protein and reduced kidney function also were associated with a 1.1- to 1.5-fold increased risk for mortality (3.45 × 10(-6) < P < 0.03) after adjusting for confounding factors. CONCLUSIONS Even in this high-risk group, vascular calcification and known CVD risk factors provide useful information for ongoing assessment. The use of cholesterol-lowering medication seemed to be protective for mortality.
Collapse
Affiliation(s)
- Amanda J Cox
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Barry I Freedman
- Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
| | - David M Herrington
- Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - J Jeffrey Carr
- Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donald W Bowden
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
29
|
Cox AJ, Azeem A, Yeboah J, Soliman EZ, Aggarwal SR, Bertoni AG, Carr JJ, Freedman BI, Herrington DM, Bowden DW. Heart rate-corrected QT interval is an independent predictor of all-cause and cardiovascular mortality in individuals with type 2 diabetes: the Diabetes Heart Study. Diabetes Care 2014; 37:1454-61. [PMID: 24574343 PMCID: PMC4182905 DOI: 10.2337/dc13-1257] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Heart rate-corrected QT (QTc) interval is associated with mortality in the general population, but this association is less clear in individuals with type 2 diabetes. We assessed the association of QTc interval with all-cause and cardiovascular disease (CVD) mortality in the Diabetes Heart Study. RESEARCH DESIGN AND METHODS We studied 1,020 participants with type 2 diabetes (83% European Americans; 55% women; mean age 61.4 years) who were free of atrial fibrillation, major ventricular conduction defects, and antiarrhythmic therapy at baseline. QT duration was automatically calculated from a standard 12-lead electrocardiogram (ECG). Following American Heart Association/American College of Cardiology Foundation recommendations, a linear scale was used to correct the QT for heart rate. Using Cox regression, risk was estimated per 1-SD increase in QTc interval as well as prolonged QTc interval (>450 ms) vs. normal QTc interval for mortality. RESULTS At baseline, the mean (SD) QTc duration was 414.9 ms (18.1), and 3.0% of participants had prolonged QTc. After a median follow-up time of 8.5 years (maximum follow-up time 13.9 years), 204 participants were deceased. In adjusted multivariate models, a 1-SD increase in QTc interval was associated with an 18% higher risk for all-cause mortality (hazard ratio 1.18 [95% CI 1.03-1.36]) and 29% increased risk for CVD mortality (1.29 [1.05-1.59]). Similar results were obtained when QTc interval was used as a categorical variable (prolonged vs. normal) (all-cause mortality 1.73 [0.95-3.15]; CVD mortality 2.86 [1.35-6.08]). CONCLUSIONS Heart rate QTc interval is an independent predictor of all-cause and CVD mortality in this population with type 2 diabetes, suggesting that additional prognostic information may be available from this simple ECG measure.
Collapse
|
30
|
Adams JN, Raffield LM, Freedman BI, Langefeld CD, Ng MCY, Carr JJ, Cox AJ, Bowden DW. Analysis of common and coding variants with cardiovascular disease in the Diabetes Heart Study. Cardiovasc Diabetol 2014; 13:77. [PMID: 24725463 PMCID: PMC4021556 DOI: 10.1186/1475-2840-13-77] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/26/2014] [Indexed: 11/24/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a major cardiovascular disease (CVD) risk factor. Identification of genetic risk factors for CVD is important to understand disease risk. Two recent genome-wide association study (GWAS) meta-analyses in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium detected CVD-associated loci. Methods Variants identified in CHARGE were tested for association with CVD phenotypes, including vascular calcification, and conventional CVD risk factors, in the Diabetes Heart Study (DHS) (n = 1208; >80% T2DM affected). This included 36 genotyped or imputed single nucleotide polymorphisms (SNPs) from DHS GWAS data. 28 coding SNPs from 14 top CHARGE genes were also identified from exome sequencing resources and genotyped, along with 209 coding variants from the Illumina HumanExome BeadChip genotype data in the DHS were also tested. Genetic risk scores (GRS) were calculated to evaluate the association of combinations of variants with CVD measures. Results After correction for multiple comparisons, none of the CHARGE SNPs were associated with vascular calcification (p < 0.0014). Multiple SNPs showed nominal significance with calcification, including rs599839 (PSRC1, p = 0.008), rs646776 (CELSR2, p = 0.01), and rs17398575 (PIK3CG, p = 0.009). Additional COL4A2 and CXCL12 SNPs were nominally associated with all-cause or CVD-cause mortality. Three SNPs were significantly or nominally associated with serum lipids: rs3135506 (Ser19Trp, APOA5) with triglycerides (TG) (p = 5×10−5), LDL (p = 0.00070), and nominally with high density lipoprotein (HDL) (p = 0.0054); rs651821 (5′UTR, APOA5) with increased TGs (p = 0.0008); rs13832449 (splice donor, APOC3) associated with decreased TGs (p = 0.0015). Rs45456595 (CDKN2A, Gly63Arg), rs5128 (APOC3, 3′UTR), and rs72650673 (SH2B3, Glu400Lys) were nominally associated with history of CVD, subclinical CVD, or CVD risk factors (p < 0.010). From the exome chip, rs3750103 (CHN2, His204Arg/His68Arg) with carotid intima-medial thickness (IMT) (p = 3.9×10−5), and rs61937878 (HAL, Val549Met) with infra-renal abdominal aorta CP (AACP) (p = 7.1×10−5). The unweighted GRS containing coronary artery calcified plaque (CAC) SNPs was nominally associated with history of prior CVD (p = 0.033; OR = 1.09). The weighted GRS containing SNPs was associated with CAC and myocardial infarction (MI) was associated with history of MI (p = 0.026; OR = 1.15). Conclusions Genetic risk factors for subclinical CVD in the general population (CHARGE) were modestly associated with T2DM-related risk factors and CVD outcomes in the DHS.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| |
Collapse
|
31
|
Cox AJ, Hsu FC, Ng MCY, Langefeld CD, Freedman BI, Carr JJ, Bowden DW. Genetic risk score associations with cardiovascular disease and mortality in the Diabetes Heart Study. Diabetes Care 2014; 37:1157-64. [PMID: 24574349 PMCID: PMC4178326 DOI: 10.2337/dc13-1514] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Given the high rates of cardiovascular disease (CVD) and associated mortality in individuals with type 2 diabetes, identifying and understanding predictors of CVD events and mortality could help inform clinical management in this high-risk group. Recent large-scale genetic studies may provide additional tools in this regard. RESEARCH DESIGN AND METHODS Genetic risk scores (GRSs) were constructed in 1,175 self-identified European American (EA) individuals comprising the family-based Diabetes Heart Study based on 1) 13 single nucleotide polymorphisms (SNPs) and 2) 30 SNPs with previously documented associations with CVD in genome-wide association studies. Associations between each GRS and a self-reported history of CVD, coronary artery calcified plaque (CAC) determined by noncontrast computed tomography scan, all-cause mortality, and CVD mortality were examined using marginal models with generalized estimating equations and Cox proportional hazards models. RESULTS The weighted 13-SNP GRS was associated with prior CVD (odds ratio [OR] 1.51 [95% CI 1.22-1.86]; P = 0.0002), CAC (β-coefficient [β] 0.22 [0.02-0.43]; P = 0.04) and CVD mortality (hazard ratio [HR] 1.35 [1.10-1.81]; P = 0.04) when adjusting for the other known CVD risk factors: age, sex, type 2 diabetes affection status, BMI, current smoking status, hypertension, and dyslipidemia. The weighted 30-SNP GRS was also associated with prior CVD (OR 1.33 [1.08-1.65]; P = 0.008), CAC (β 0.29 [0.08-0.50]; P = 0.006), all-cause mortality (HR 1.28 [1.05-1.56]; P = 0.01), and CVD mortality (HR 1.46 [1.08-1.96]; P = 0.01). CONCLUSIONS These findings support the utility of two simple GRSs in examining genetic associations for adverse outcomes in EAs with type 2 diabetes.
Collapse
|
32
|
Cox AJ, Hugenschmidt CE, Raffield LM, Langefeld CD, Freedman BI, Williamson JD, Hsu FC, Bowden DW. Heritability and genetic association analysis of cognition in the Diabetes Heart Study. Neurobiol Aging 2014; 35:1958.e3-1958.e12. [PMID: 24684796 DOI: 10.1016/j.neurobiolaging.2014.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/15/2014] [Accepted: 03/03/2014] [Indexed: 11/16/2022]
Abstract
Cognitive performance is an important component of healthy aging. Type 2 diabetes (T2D) is associated with negative outcomes for the brain and cognition, although causal mechanisms have not been definitely determined. Genetic risk factors warrant further consideration in this context. This study examined the heritability of cognitive function as assessed by (1) the Digit Symbol Substitution Task; (2) the Modified Mini-Mental State Examination; (3) the Stroop Task; (4) the Rey Auditory-Verbal Learning Task; and (5) the Controlled Oral Word Association Task for Phonemic and Semantic Fluency, in the family-based, T2D-enriched, Diabetes Heart Study sample (n = 550 participants from 257 families). The genetic basis of these cognitive measures was further evaluated by association analysis with candidate single-nucleotide polymorphisms (SNPs) and genome-wide SNP data. Measures of cognitive function were significantly heritable (hˆ(2) = 0.28-0.62) following adjustment for age, gender, and education. A total of 31 SNPs (from 26 genes/regions) selected to form an a priori set of candidate SNPs showed limited evidence of association with cognitive function when applying conservative metrics of significance. Genome-wide assessment of both noncoding and coding variants revealed suggestive evidence of association for several coding variants including rs139509083 in CNST (p = 4.9 × 10(-9)), rs199968569 in PLAA (p = 4.9 × 10(-9)) and rs138487371 in PCDH8 (p = 3.7 × 10(-8)). The identification of a heritable component to cognitive performance in T2D suggests a role for genetic contributors to cognitive performance even in the presence of metabolic disease and other associated comorbidities and is supported by the identification of genetic association signals in functionally plausible candidates.
Collapse
Affiliation(s)
- Amanda J Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura M Raffield
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
33
|
Modifiable cardiovascular disease risk factors among indigenous populations. Adv Prev Med 2014; 2014:547018. [PMID: 24649368 PMCID: PMC3933231 DOI: 10.1155/2014/547018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/07/2013] [Accepted: 10/09/2013] [Indexed: 01/29/2023] Open
Abstract
Objective. To identify modifiable cardio-metabolic and lifestyle risk factors among indigenous populations from Australia (Aboriginal Australians/Torres Strait Islanders), New Zealand (Māori), and the United States (American Indians and Alaska Natives) that contribute to cardiovascular disease (CVD). Methods. National health surveys were identified where available. Electronic databases identified sources for filling missing data. The most relevant data were identified, organized, and synthesized. Results. Compared to their non-indigenous counterparts, indigenous populations exhibit lower life expectancies and a greater prevalence of CVD. All indigenous populations have higher rates of obesity and diabetes, hypertension is greater for Māori and Aboriginal Australians, and high cholesterol is greater only among American Indians/Alaska Natives. In turn, all indigenous groups exhibit higher rates of smoking and dangerous alcohol behaviour as well as consuming less fruits and vegetables. Aboriginal Australians and American Indians/Alaska Natives also exhibit greater rates of sedentary behaviour. Conclusion. Indigenous groups from Australia, New Zealand, and the United States have a lower life expectancy then their respective non-indigenous counterparts. A higher prevalence of CVD is a major driving force behind this discrepancy. A cluster of modifiable cardio-metabolic risk factors precede CVD, which, in turn, is linked to modifiable lifestyle risk factors.
Collapse
|
34
|
Freedman BI, Bowden DW, Smith SC, Xu J, Divers J. Relationships between electrochemical skin conductance and kidney disease in Type 2 diabetes. J Diabetes Complications 2014; 28:56-60. [PMID: 24140119 PMCID: PMC3877197 DOI: 10.1016/j.jdiacomp.2013.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND SUDOSCAN® non-invasively measures peripheral small fiber and autonomic nerve activity using electrochemical skin conductance. Since neuropathy and nephropathy are microvascular Type 2 diabetes (T2D) complications, relationships between skin conductance, estimated glomerular filtration rate (eGFR), and urine albumin:creatinine ratio (UACR) were assessed. METHODS Two hundred five African Americans (AA) with T2D, 93 AA non-diabetic controls, 185 European Americans (EA) with T2D, and 73 EA non-diabetic controls were evaluated. Linear models were fitted stratified by population ancestry and T2D, adjusted for covariates. RESULTS Relative to EA, AA had lower skin conductance (T2D cases p<0.0001; controls p<0.0001). Skin conductance was also lower in T2D cases vs. controls in each population (p<0.0001, AA and EA). Global skin conductance was significantly associated with eGFR in AA and EA with T2D; adjusting for age, gender, BMI, and HbA1c, positive association was detected between skin conductance and eGFR in AA T2D cases (parameter estimate 3.38, standard error 1.2; p=5.2E(-3)), without association in EA T2D cases (p=0.22). CONCLUSIONS Noninvasive measurement of skin conductance strongly associated with eGFR in AA with T2D, replicating results in Hong Kong Chinese. SUDOSCAN® may prove useful as a low cost, non-invasive screening tool to detect undiagnosed diabetic kidney disease in populations of African ancestry.
Collapse
Affiliation(s)
- Barry I Freedman
- Department of Internal Medicine - Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Susan Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jasmin Divers
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Division of Public Health Sciences - Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
35
|
Abdullah N, Attia J, Oldmeadow C, Scott RJ, Holliday EG. The architecture of risk for type 2 diabetes: understanding Asia in the context of global findings. Int J Endocrinol 2014; 2014:593982. [PMID: 24744783 PMCID: PMC3976842 DOI: 10.1155/2014/593982] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/30/2014] [Indexed: 02/07/2023] Open
Abstract
The prevalence of Type 2 diabetes is rising rapidly in both developed and developing countries. Asia is developing as the epicentre of the escalating pandemic, reflecting rapid transitions in demography, migration, diet, and lifestyle patterns. The effective management of Type 2 diabetes in Asia may be complicated by differences in prevalence, risk factor profiles, genetic risk allele frequencies, and gene-environment interactions between different Asian countries, and between Asian and other continental populations. To reduce the worldwide burden of T2D, it will be important to understand the architecture of T2D susceptibility both within and between populations. This review will provide an overview of known genetic and nongenetic risk factors for T2D, placing the results from Asian studies in the context of broader global research. Given recent evidence from large-scale genetic studies of T2D, we place special emphasis on emerging knowledge about the genetic architecture of T2D and the potential contribution of genetic effects to population differences in risk.
Collapse
Affiliation(s)
- Noraidatulakma Abdullah
- School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, NSW 2308, Australia
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - John Attia
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW 2305, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW 2305, Australia
| | - Rodney J. Scott
- School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Area Pathology Service, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Elizabeth G. Holliday
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW 2305, Australia
- *Elizabeth G. Holliday:
| |
Collapse
|
36
|
Hugenschmidt CE, Hsu FC, Hayasaka S, Carr JJ, Freedman BI, Nyenhuis DL, Williamson JD, Bowden DW. The influence of subclinical cardiovascular disease and related risk factors on cognition in type 2 diabetes mellitus: The DHS-Mind study. J Diabetes Complications 2013; 27:422-8. [PMID: 23659774 PMCID: PMC3770734 DOI: 10.1016/j.jdiacomp.2013.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 01/21/2023]
Abstract
We hypothesized that measures of coronary artery calcified plaque (CAC) collected at baseline from the Diabetes Heart Study (DHS) would explain associations between cognition and diabetes collected at follow-up approximately 7 years later. The DHS is a sibling study of cardiovascular disease (CVD) in a cohort with a high prevalence of type 2 diabetes (~80%). Associations between baseline CAC and cognitive performance were tested using generalized estimating equations and mixed effects models to adjust for familial relationships. Diabetes status was associated (p<0.05) with poorer performance on tests of verbal memory, processing speed, and semantic fluency adjusting for age, sex, education, and hypertension status. As hypothesized, including CAC in the statistical model attenuated this association. Additionally, CAC and fasting glucose predicted performance in tasks not associated with diabetes status in this study (Stroop Task, Phonemic Fluency). These results confirm work attributing the heterogeneity of cognitive outcomes in type 2 diabetes to subclinical risk factors that combine to affect different aspects of brain function. Importantly, these results imply that risk factor intervention should begin before comorbidities, particularly CVD, become clinically apparent.
Collapse
Affiliation(s)
- Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Maldjian JA, Whitlow CT, Saha BN, Kota G, Vandergriff C, Davenport EM, Divers J, Freedman BI, Bowden DW. Automated white matter total lesion volume segmentation in diabetes. AJNR Am J Neuroradiol 2013; 34:2265-70. [PMID: 23868156 DOI: 10.3174/ajnr.a3590] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE WM lesion segmentation is often performed with the use of subjective rating scales because manual methods are laborious and tedious; however, automated methods are now available. We compared the performance of total lesion volume grading computed by use of an automated WM lesion segmentation algorithm with that of subjective rating scales and expert manual segmentation in a cohort of subjects with type 2 diabetes. MATERIALS AND METHODS Structural T1 and FLAIR MR imaging data from 50 subjects with diabetes (age, 67.7 ± 7.2 years) and 50 nondiabetic sibling pairs (age, 67.5 ± 9.4 years) were evaluated in an institutional review board-approved study. WM lesion segmentation maps and total lesion volume were generated for each subject by means of the Statistical Parametric Mapping (SPM8) Lesion Segmentation Toolbox. Subjective WM lesion grade was determined by means of a 0-9 rating scale by 2 readers. Ground-truth total lesion volume was determined by means of manual segmentation by experienced readers. Correlation analyses compared manual segmentation total lesion volume with automated and subjective evaluation methods. RESULTS Correlation between average lesion segmentation and ground-truth total lesion volume was 0.84. Maximum correlation between the Lesion Segmentation Toolbox and ground-truth total lesion volume (ρ = 0.87) occurred at the segmentation threshold of k = 0.25, whereas maximum correlation between subjective lesion segmentation and the Lesion Segmentation Toolbox (ρ = 0.73) occurred at k = 0.15. The difference between the 2 correlation estimates with ground-truth was not statistically significant. The lower segmentation threshold (0.15 versus 0.25) suggests that subjective raters overestimate WM lesion burden. CONCLUSIONS We validate the Lesion Segmentation Toolbox for determining total lesion volume in diabetes-enriched populations and compare it with a common subjective WM lesion rating scale. The Lesion Segmentation Toolbox is a readily available substitute for subjective WM lesion scoring in studies of diabetes and other populations with changes of leukoaraiosis.
Collapse
Affiliation(s)
- J A Maldjian
- From Advanced Neuroscience Imaging Research Laboratory
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Cox AJ, Ng MCY, Xu J, Langefeld CD, Koch KL, Dawson PA, Carr JJ, Freedman BI, Hsu FC, Bowden DW. Association of SNPs in the UGT1A gene cluster with total bilirubin and mortality in the Diabetes Heart Study. Atherosclerosis 2013; 229:155-60. [PMID: 23642732 PMCID: PMC3691283 DOI: 10.1016/j.atherosclerosis.2013.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/19/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A negative relationship between total bilirubin concentration (TBili) and CVD risk has been documented in a series of epidemiological studies. In addition, TBili is thought to be under strong genetic regulation via the UGT1A gene family, suggesting it may be a heritable CVD risk factor. However, few studies directly relate TBili-associated UGT1A variants to CVD severity or outcome. This study replicated the genetic association for TBili in the Diabetes Heart Study (DHS), and examined the relationships of TBili-associated SNPs with measures of subclinical CVD and mortality. METHODS This investigation included 1220 self-described European American (EA) individuals from the DHS, a family-based study examining risk for macrovascular complications in type 2 diabetes (T2D). Genetic associations with TBili were examined using the Affymetrix Genome-wide Human SNP Array 5.0 and the Illumina Infinium Human Exome beadchip v1.0. Subsequent analyses assessed the relationships of the top TBili-associated SNPs with measures of vascular calcified plaque and mortality. RESULTS A genome-wide association study detected 18 SNPs within the UGT1A gene family associated with TBili at p < 5 × 10(-8). The top hit was rs887829 (p = 8.67 × 10(-20)). There was no compelling evidence of association between the top TBili-associated SNPs and vascular calcified plaque (p = 0.05-0.88). There was, however, evidence of association with all-cause mortality (p = 0.0004-0.06), the top hit being rs2741034. CONCLUSION These findings support a potential role for UGT1A genetic variants in risk for mortality in T2D. Further quantification of the extent of CVD risk conferred by UGT1A gene family variants in a high risk cohort with T2D is still required.
Collapse
Affiliation(s)
- Amanda J Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Maggie C-Y Ng
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kenneth L Koch
- Department of Internal Medicine - Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Paul A Dawson
- Department of Internal Medicine - Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Jeffrey Carr
- Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
39
|
Raffield LM, Cox AJ, Hsu FC, Ng MCY, Langefeld CD, Carr JJ, Freedman BI, Bowden DW. Impact of HDL genetic risk scores on coronary artery calcified plaque and mortality in individuals with type 2 diabetes from the Diabetes Heart Study. Cardiovasc Diabetol 2013; 12:95. [PMID: 23799899 PMCID: PMC3695806 DOI: 10.1186/1475-2840-12-95] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/14/2013] [Indexed: 01/21/2023] Open
Abstract
Background Patients with type 2 diabetes (T2D) are at elevated risk for cardiovascular disease (CVD) events and mortality. Recent studies have assessed the impact of genetic variants affecting high-density lipoprotein cholesterol (HDL) concentrations on CVD risk in the general population. This study examined the utility of HDL-associated single nucleotide polymorphisms (SNPs) for CVD risk prediction in European Americans with T2D enrolled in the Diabetes Heart Study (DHS). Methods Genetic risk scores (GRS) of HDL-associated SNPs were constructed and evaluated for potential associations with mortality and with coronary artery calcified atherosclerotic plaque (CAC), a measure of subclinical CVD strongly associated with CVD events and mortality. Two sets of SNPs were used to construct GRS; while all SNPs were selected primarily for their impacts on HDL, one set of SNPs had pleiotropic effects on other lipid parameters, while the other set lacked effects on low-density lipoprotein cholesterol (LDL) or triglyceride concentrations. Results The GRS were specifically associated with HDL concentrations (4.90 × 10-7 < p < 0.02) in models adjusted for age, sex, and body mass index (BMI), but were not associated with LDL or triglycerides. Cox proportional hazards regression analysis suggested the HDL-associated GRS had no impact on risk of CVD-mortality (0.48 < p < 0.99) in models adjusted for other known CVD risk factors. However, associations between several of the GRS and CAC were observed (3.85 × 10-4 < p < 0.03) in models adjusted for other known CVD risk factors. Conclusions The GRS analyzed in this study provide a tool for assessment of HDL-associated SNPs and their impact on CVD risk in T2D. The observed associations between several of the GRS and CAC suggest a potential role for HDL-associated SNPs on subclinical CVD risk in patients with T2D.
Collapse
Affiliation(s)
- Laura M Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Cox AJ, Lehtinen AB, Xu J, Langefeld CD, Freedman BI, Carr JJ, Bowden DW. Polymorphisms in the Selenoprotein S gene and subclinical cardiovascular disease in the Diabetes Heart Study. Acta Diabetol 2013; 50:391-9. [PMID: 23161441 PMCID: PMC3597768 DOI: 10.1007/s00592-012-0440-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/03/2012] [Indexed: 12/16/2022]
Abstract
Selenoprotein S (SelS) has previously been associated with a range of inflammatory markers, particularly in the context of cardiovascular disease (CVD). The aim of this study was to examine the role of SELS genetic variants in risk for subclinical CVD and mortality in individuals with type 2 diabetes mellitus (T2DM). The association between 10 polymorphisms tagging SELS and coronary (CAC), carotid (CarCP) and abdominal aortic calcified plaque, carotid intima media thickness and other known CVD risk factors was examined in 1220 European Americans from the family-based Diabetes Heart Study. The strongest evidence of association for SELS SNPs was observed for CarCP; rs28665122 (5' region; β = 0.329, p = 0.044), rs4965814 (intron 5; β = 0.329, p = 0.036), rs28628459 (3' region; β = 0.331, p = 0.039) and rs7178239 (downstream; β = 0.375, p = 0.016) were all associated. In addition, rs12917258 (intron 5) was associated with CAC (β = -0.230, p = 0.032), and rs4965814, rs28628459 and rs9806366 were all associated with self-reported history of prior CVD (p = 0.020-0.043). These results suggest a potential role for the SELS region in the development subclinical CVD in this sample enriched for T2DM. Further understanding the mechanisms underpinning these relationships may prove important in predicting and managing CVD complications in T2DM.
Collapse
Affiliation(s)
- Amanda J Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | | | |
Collapse
|
41
|
Register TC, Divers J, Bowden DW, Carr JJ, Lenchik L, Wagenknecht LE, Hightower RC, Xu J, Smith SC, Hruska KA, Langefeld CD, Freedman BI. Relationships between serum adiponectin and bone density, adiposity and calcified atherosclerotic plaque in the African American-Diabetes Heart Study. J Clin Endocrinol Metab 2013; 98:1916-22. [PMID: 23543659 PMCID: PMC3644610 DOI: 10.1210/jc.2012-4126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
CONTEXT Adiposity, bone mineral density (BMD), and calcified atherosclerotic plaque (CP) exhibit complex interrelationships that are not well understood. Adipokines vary in relation to changes in body composition and may play roles in regulation of BMD and risk of cardiovascular disease. OBJECTIVE Our objective was to examine the relationship between serum adiponectin and quantitative computed tomography-derived measures of volumetric BMD (vBMD) in thoracic and lumbar vertebrae, adipose tissue volumes, and CP in coronary, carotid, and infrarenal aortoiliac arteries. Generalized linear models were fitted to test for associations between adiponectin and measured phenotypes. PARTICIPANTS A total of 479 unrelated African Americans with type 2 diabetes, 57% female with a mean ± SD (median) age of 55.6 ± 9.5 (55.0) years and diabetes duration of 10.3 ± 8.2 (8.0) years. RESULTS Serum adiponectin was 8.26 ± 7.41 (6.10) μg/mL, coronary artery CP mass score was 280 ± 634 (14), carotid artery CP was 47 ± 133 (0), and aortoiliac CP was 1616 ± 2864 (319). Women had significantly higher body mass index and serum adiponectin and lower coronary and carotid artery calcium than males (all P < .05). Before and after adjusting for age, sex, body mass index, mean arterial pressure, smoking status, hemoglobin A1c, thiazolidinedione use, and low-density lipoprotein-cholesterol, adiponectin was inversely associated with thoracic and lumbar vertebral vBMD [parameter estimates (PEs) of -0.06 and -0.021, respectively; both P < .0005], visceral adipose tissue (PE -0.02; P < 0.0001), and C-reactive protein (PE -0.07; P < .0001) and positively associated with intermuscular adipose tissue (PE 0.01; P = .03). After covariate adjustment, significant associations were not observed between adiponectin and CP in any vascular bed (P > .1). CONCLUSION Serum adiponectin levels were inversely associated with cross-sectional measures of thoracic and lumbar vertebral vBMD, inflammation, and visceral adiposity in African Americans but not with vascular CP after adjustment for covariates. The data support a regulatory/signaling role for adiponectin in the modulation of bone density.
Collapse
Affiliation(s)
- Thomas C Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Cox AJ, Hsu FC, Carr JJ, Freedman BI, Bowden DW. Glomerular filtration rate and albuminuria predict mortality independently from coronary artery calcified plaque in the Diabetes Heart Study. Cardiovasc Diabetol 2013; 12:68. [PMID: 23594619 PMCID: PMC3637614 DOI: 10.1186/1475-2840-12-68] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/12/2013] [Indexed: 11/17/2022] Open
Abstract
Background Risk stratification in individuals with type 2 diabetes (T2D) remains an important priority in the management of associated morbidity and mortality, including from cardiovascular disease (CVD). The current investigation examined whether estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) were independent predictors of CVD-mortality in European Americans (EAs) with T2D after accounting for subclinical CVD. Methods The family-based Diabetes Heart Study (DHS) cohort (n=1,220) had baseline measures of serum creatinine, eGFR, UACR and coronary artery calcified plaque (CAC) assessed by non-contrast computed tomography scan. Cox proportional hazards regression was performed to determine risk for all-cause mortality and CVD-mortality associated with indices of kidney disease after accounting for traditional CVD risk factors and CAC as a measure of subclinical CVD. Results Participants were followed for 8.2±2.6 years (mean±SD) during which time 247 (20.9%) were deceased, 107 (9.1%) from CVD. Univariate analyses revealed positive associations between serum creatinine (HR:1.56; 95% CI:1.37–1.80; p<0.0001) and UACR (1.59; 1.43–1.77; p>0.0001) and negative associations between serum albumin (0.74; 0.65–0.84; p<0.0001) and eGFR (0.66; 0.58–0.76; p<0.0001) with all-cause mortality. Associations remained significant after adjustment for traditional CVD risk factors, as well as for CAC. Similar trends were noted when predicting risk for CVD-mortality. Conclusions The DHS reveals that kidney function and albuminuria are independent risk factors for all-cause mortality and CVD-mortality in EAs with T2D, even after accounting for CAC.
Collapse
Affiliation(s)
- Amanda J Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | |
Collapse
|
43
|
Cox AJ, Hugenschmidt CE, Wang PT, Hsu FC, Kenchaiah S, Daniel K, Langefeld CD, Freedman BI, Herrington DM, Carr JJ, Stacey B, Bowden DW. Usefulness of biventricular volume as a predictor of mortality in patients with diabetes mellitus (from the Diabetes Heart Study). Am J Cardiol 2013; 111:1152-8. [PMID: 23351459 DOI: 10.1016/j.amjcard.2012.12.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/23/2012] [Accepted: 12/23/2012] [Indexed: 01/12/2023]
Abstract
Patients with type 2 diabetes mellitus are at increased risk for cardiovascular disease (CVD) and mortality. Beyond traditional CVD risk factors, novel measures reflecting additional aspects of disease pathophysiology, such as biventricular volume (BiVV), may be useful for risk stratification. The aim of this study was to examine the relationship between BiVV and risk for mortality in European Americans with type 2 diabetes mellitus from the Diabetes Heart Study (DHS). BiVV was calculated from 771 noncontrast computed tomographic scans performed to image coronary artery calcified plaque. Relationships between BiVV and traditional CVD risk factors were examined. Cox proportional-hazards regression was performed to determine risk for mortality (all-cause and CVD mortality) associated with increasing BiVV. Area under the curve analysis was used to assess BiVV utility in risk prediction models. During 8.4 ± 2.4 years of follow-up, 23% of the patients died. In unadjusted analyses, BiVV was significantly associated with increasing body mass index, height, coronary artery calcified plaque, history of hypertension, and previous myocardial infarction (p <0.0001 to 0.012). BiVV was significantly associated with all-cause (hazard ratio 2.45, 95% confidence interval 1.06 to 5.67, p = 0.036) and CVD (hazard ratio 4.36, 95% confidence interval 1.36 to 14.03, p = 0.014) mortality in models adjusted for other known CVD risk factors. Area under the curve increased from 0.76 to 0.78 (p = 0.04) and from 0.74 to 0.77 (p = 0.02) for all-cause and CVD mortality with the inclusion of BiVV. In conclusion, in the absence of echocardiography or other noninvasive imaging modalities to assess ventricular volumes, or when such methods are contraindicated, BiVV from computed tomography may be considered a tool for the stratification of high-risk patients, such as those with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Amanda J Cox
- Center for Human Genomics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Agarwal S, Cox AJ, Herrington DM, Jorgensen NW, Xu J, Freedman BI, Carr JJ, Bowden DW. Coronary calcium score predicts cardiovascular mortality in diabetes: diabetes heart study. Diabetes Care 2013; 36:972-7. [PMID: 23230101 PMCID: PMC3609509 DOI: 10.2337/dc12-1548] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In type 2 diabetes mellitus (T2DM), it remains unclear whether coronary artery calcium (CAC) provides additional information about cardiovascular disease (CVD) mortality beyond the Framingham Risk Score (FRS) factors. RESEARCH DESIGN AND METHODS A total of 1,123 T2DM participants, ages 34-86 years, in the Diabetes Heart Study followed up for an average of 7.4 years were separated using baseline computed tomography scans of CAC (0-9, 10-99, 100-299, 300-999, and ≥1,000). Logistic regression was performed to examine the association between CAC and CVD mortality adjusting for FRS. Areas under the curve (AUC) with and without CAC were compared. Net reclassification improvement (NRI) compared FRS (model 1) versus FRS+CAC (model 2) using 7.4-year CVD mortality risk categories 0% to <7%, 7% to <20%, and ≥20%. RESULTS Overall, 8% of participants died of cardiovascular causes during follow-up. In multivariate analysis, the odds ratios (95% CI) for CVD mortality using CAC 0-9 as the reference group were, CAC 10-99: 2.93 (0.74-19.55); CAC 100-299: 3.17 (0.70-22.22); CAC 300-999: 4.41(1.15-29.00); and CAC ≥1,000: 11.23 (3.24-71.00). AUC (95% CI) without CAC was 0.70 (0.67-0.73), AUC with CAC was 0.75 (0.72-0.78), and NRI was 0.13 (0.07-0.19). CONCLUSIONS In T2DM, CAC predicts CVD mortality and meaningfully reclassifies participants, suggesting clinical utility as a risk stratification tool in a population already at increased CVD risk.
Collapse
Affiliation(s)
- Subhashish Agarwal
- Department of Cardiology, Oakwood Hospital and Medical Center, Dearborn, Michigan, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Genetic analysis of haptoglobin polymorphisms with cardiovascular disease and type 2 diabetes in the Diabetes Heart Study. Cardiovasc Diabetol 2013; 12:31. [PMID: 23399657 PMCID: PMC3576297 DOI: 10.1186/1475-2840-12-31] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/01/2013] [Indexed: 12/29/2022] Open
Abstract
Background Haptoglobin (HP) is an acute phase protein that binds to freely circulating hemoglobin. HP exists as two distinct forms, HP1 and HP2. The longer HP2 form has been associated with cardiovascular (CVD) events and mortality in individuals with type 2 diabetes (T2DM). Methods This study examined the association of HP genotypes with subclinical CVD, T2DM risk, and associated risk factors in a T2DM-enriched sample. Haptoglobin genotypes were determined in 1208 European Americans (EA) from 473 Diabetes Heart Study (DHS) families via PCR. Three promoter SNPs (rs5467, rs5470, and rs5471) were also genotyped. Results Analyses revealed association between HP2-2 duplication and increased carotid intima-media thickness (IMT; p = 0.001). No association between HP and measures of calcified arterial plaque were observed, but the HP polymorphism was associated with triglyceride concentrations (p = 0.005) and CVD mortality (p = 0.04). We found that the HP2-2 genotype was associated with increased T2DM risk with an odds ratio (OR) of 1.49 (95% CI 1.18-1.86, p = 6.59x10-4). Promoter SNPs were not associated with any traits. Conclusions This study suggests association between the HP duplication and IMT, triglycerides, CVD mortality, and T2DM in an EA population enriched for T2DM. Lack of association with atherosclerotic calcified plaque likely reflect differences in the pathogenesis of these CVD phenotypes. HP variation may contribute to the heritable risk for CVD complications in T2DM.
Collapse
|
46
|
Divers J, Palmer ND, Lu L, Register TC, Carr JJ, Hicks PJ, Hightower RC, Smith SC, Xu J, Cox AJ, Hruska KA, Bowden DW, Lewis CE, Heiss G, Province MA, Borecki IB, Kerr KF, Chen YDI, Palmas W, Rotter JI, Wassel CL, Bertoni AG, Herrington DM, Wagenknecht LE, Langefeld CD, Freedman BI. Admixture mapping of coronary artery calcified plaque in African Americans with type 2 diabetes mellitus. ACTA ACUST UNITED AC 2012; 6:97-105. [PMID: 23233742 DOI: 10.1161/circgenetics.112.964114] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The presence and severity of coronary artery calcified plaque (CAC) differs markedly between individuals of African and European descent, suggesting that admixture mapping may be informative for identifying genetic variants associated with subclinical cardiovascular disease. METHODS AND RESULTS Admixture mapping of CAC was performed in 1040 unrelated African Americans with type 2 diabetes mellitus from the African American-Diabetes Heart Study, Multi-Ethnic Study of Atherosclerosis and Family Heart Study using the Illumina custom ancestry informative marker panel. All cohorts obtained computed tomography scanning of the coronary arteries using identical protocols. For each ancestry informative marker, the probability of inheriting 0, 1, and 2 copies of a European-derived allele was determined. Linkage analysis was performed by testing for association between each ancestry informative marker using these probabilities and CAC, accounting for global ancestry, age, sex, and study. Markers on 1p32.3 in the GLIS1 gene (rs6663966, logarithm of odds [LOD]=3.7), 1q32.1 near CHIT1 (rs7530895, LOD=3.1), 4q21.2 near PRKG2 (rs1212373, LOD=3.0), and 11q25 in the OPCML gene (rs6590705, LOD=3.4) had statistically significant LOD scores, whereas markers on 8q22.2 (rs6994682, LOD=2.7), 9p21.2 (rs439314, LOD=2.7), and 13p32.1 (rs7492028, LOD=2.8) manifested suggestive evidence of linkage. These regions were uniformly characterized by higher levels of European ancestry associating with higher levels or odds of CAC. Findings were replicated in 1350 African Americans without diabetes mellitus and 2497 diabetic European Americans from Multi-Ethnic Study of Atherosclerosis and the Diabetes Heart Study. CONCLUSIONS Fine mapping these regions will likely identify novel genetic variants that contribute to CAC and clarify racial differences in susceptibility to subclinical cardiovascular disease.
Collapse
Affiliation(s)
- Jasmin Divers
- Departments of Biostatistical Sciences,Wake Forest School of Medicine, Winston-Salem, NC 27157-1053, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Bobo WV, Cooper WO, Stein CM, Olfson M, Mounsey J, Daugherty J, Ray WA. Positive predictive value of a case definition for diabetes mellitus using automated administrative health data in children and youth exposed to antipsychotic drugs or control medications: a Tennessee Medicaid study. BMC Med Res Methodol 2012; 12:128. [PMID: 22920280 PMCID: PMC3500229 DOI: 10.1186/1471-2288-12-128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 08/20/2012] [Indexed: 11/30/2022] Open
Abstract
Background We developed and validated an automated database case definition for diabetes in children and youth to facilitate pharmacoepidemiologic investigations of medications and the risk of diabetes. Methods The present study was part of an in-progress retrospective cohort study of antipsychotics and diabetes in Tennessee Medicaid enrollees aged 6–24 years. Diabetes was identified from diabetes-related medical care encounters: hospitalizations, outpatient visits, and filled prescriptions. The definition required either a primary inpatient diagnosis or at least two other encounters of different types, most commonly an outpatient diagnosis with a prescription. Type 1 diabetes was defined by insulin prescriptions with at most one oral hypoglycemic prescription; other cases were considered type 2 diabetes. The definition was validated for cohort members in the 15 county region geographically proximate to the investigators. Medical records were reviewed and adjudicated for cases that met the automated database definition as well as for a sample of persons with other diabetes-related medical care encounters. Results The study included 64 cases that met the automated database definition. Records were adjudicated for 46 (71.9%), of which 41 (89.1%) met clinical criteria for newly diagnosed diabetes. The positive predictive value for type 1 diabetes was 80.0%. For type 2 and unspecified diabetes combined, the positive predictive value was 83.9%. The estimated sensitivity of the definition, based on adjudication for a sample of 30 cases not meeting the automated database definition, was 64.8%. Conclusion These results suggest that the automated database case definition for diabetes may be useful for pharmacoepidemiologic studies of medications and diabetes.
Collapse
Affiliation(s)
- William V Bobo
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Cox AJ, Agarwal S, Herrington DM, Carr JJ, Freedman BI, Bowden DW. C-reactive protein concentration predicts mortality in type 2 diabetes: the Diabetes Heart Study. Diabet Med 2012; 29:767-70. [PMID: 22211818 PMCID: PMC4386279 DOI: 10.1111/j.1464-5491.2011.03560.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Although current American Heart Association guidelines address C-reactive protein concentration and cardiovascular disease risk, it remains unclear whether this paradigm is consistent across populations with differing disease burdens. Individuals with Type 2 diabetes mellitus represent one group at increased risk of cardiovascular disease and subsequent mortality. This study aimed to examine the relationship between C-reactive protein concentrations and risk for all-cause mortality in European Americans with Type 2 diabetes from the Diabetes Heart Study. METHODS A total of 846 European Americans with Type 2 diabetes and baseline measures of C-reactive protein were evaluated. Vital status was determined after a follow-up period of 7.3 ± 2.1 years (mean ± SD). C-reactive protein concentrations were compared between living and deceased subgroups along with other known risk factors for cardiovascular disease, including blood lipids. Logistic regression was performed to determine risk for mortality associated with increasing C-reactive protein concentrations. RESULTS At follow-up 160 individuals (18.7%) were deceased. No significant differences in baseline serum glucose or lipid measures were observed between living and deceased subgroups. Baseline C-reactive protein concentrations were significantly higher in the deceased subgroup (9.37 ± 15.94) compared with the living subgroup (5.36 ± 7.91 mg/l; P < 0.0001). Participants with C-reactive protein concentrations of 3-10 mg/l were approximately two times more likely to be deceased at follow-up (OR 2.06; 95% CI 1.17-3.62); those with C-reactive protein >10 mg/l were more than five times more likely to be deceased (OR 5.24; CI 2.80-9.38). CONCLUSIONS This study documents the utility of C-reactive protein in predicting risk for all-cause mortality in European Americans with Type 2 diabetes and supports its use as a screening tool in risk prediction models.
Collapse
Affiliation(s)
- A. J. Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - S. Agarwal
- Division of Cardiology, Oakwood Hospital and Medical Center, Dearborn, MI
| | - D. M Herrington
- Department of Internal Medicine – Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J. J. Carr
- Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - B. I. Freedman
- Department of Internal Medicine – Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D. W. Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
49
|
Divers J, Hugenschmidt C, Sink KM, Williamson JD, Ge Y, Smith SC, Bowden DW, Whitlow CT, Lyders E, Maldjian JA, Freedman BI. Cerebral white matter hyperintensity in African Americans and European Americans with type 2 diabetes. J Stroke Cerebrovasc Dis 2012; 22:e46-52. [PMID: 22608346 DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/27/2012] [Accepted: 03/29/2012] [Indexed: 11/30/2022] Open
Abstract
Previous studies involving inner city populations detected higher cerebral white matter hyperintensity (WMH) scores in African Americans (AAs) compared with European Americans (EAs). This finding might be attributable to the higher prevalence of cardiovascular disease (CVD) risk factors and poorer access to healthcare in AAs. Despite racial differences in CVD risk factor profiles, AAs have paradoxically lower levels of subclinical CVD. We hypothesized that AAs with diabetes and good access to healthcare would have comparable or lower levels of WMH as EAs. Racial differences in the distribution of WMH were analyzed in 46 AAs and 156 EAs with type 2 diabetes enrolled in the Diabetes Heart Study (DHS)-Mind, and replicated in a sample of 113 AAs and 61 EAs patients who had clinically indicated cerebral magnetic resonance imaging. Wilcoxon 2-sample tests and linear models were used to compare the distribution of WMH in AAs and EAs and to test for association between WMH and race. The unadjusted mean WMH score from the Diabetes Heart Study-Mind was 1.9 in AAs and 2.3 in EAs (P = .3244). Among those with clinically indicated magnetic resonance imaging, the mean WMH score was 2.9 in AAs and 3.9 in EAs (P = .0503). Adjustment for age and sex produced no statistically significant differences in WMH score between AAs and EAs. These independent datasets reveal comparable WMH scores in AAs and EAs, suggesting that disparities in access to healthcare and environmental exposures likely underlie the previously reported excess burden of WMH in AAs.
Collapse
Affiliation(s)
- Jasmin Divers
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Pitocco D, Fuso L, Conte EG, Zaccardi F, Condoluci C, Scavone G, Incalzi RA, Ghirlanda G. The diabetic lung--a new target organ? Rev Diabet Stud 2012; 9:23-35. [PMID: 22972442 DOI: 10.1900/rds.2012.9.23] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Several abnormalities of the respiratory function have been reported in patients with type 1 and type 2 diabetes. These abnormalities concern lung volume, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. Many hypotheses have emerged, and characteristic histological changes have been described in the "diabetic lung", which could explain this abnormal respiratory function. Given the specific abnormalities in diabetic patients, the lung could thus be considered as a target organ in diabetes. Although the practical implications of these functional changes are mild, the presence of an associated acute or chronic pulmonary and/or cardiac disease could determine severe respiratory derangements in diabetic patients. Another clinical consequence of the pulmonary involvement in diabetes is the accelerated decline in respiratory function. The rate of decline in respiratory function in diabetics has been found to be two-to-three times faster than in normal non-smoking subjects, as reported in longitudinal studies. This finding, together with the presence of anatomical and biological changes similar to those described in the aging lung, indicates that the "diabetic lung" could even be considered a model of accelerated aging. This review describes and analyses the current insight into the relationship of diabetes and lung disease, and suggests intensifying research into the lung as a possible target organ in diabetes.
Collapse
Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, Catholic University of Rome, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|