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Kokkorakis M, Folkertsma P, van Dam S, Sirotin N, Taheri S, Chagoury O, Idaghdour Y, Henning RH, Forte JC, Mantzoros CS, de Vries DH, Wolffenbuttel BH. Effective questionnaire-based prediction models for type 2 diabetes across several ethnicities: a model development and validation study. EClinicalMedicine 2023; 64:102235. [PMID: 37936659 PMCID: PMC10626169 DOI: 10.1016/j.eclinm.2023.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 11/09/2023] Open
Abstract
Background Type 2 diabetes disproportionately affects individuals of non-White ethnicity through a complex interaction of multiple factors. Therefore, early disease detection and prediction are essential and require tools that can be deployed on a large scale. We aimed to tackle this problem by developing questionnaire-based prediction models for type 2 diabetes prevalence and incidence for multiple ethnicities. Methods In this proof of principle analysis, logistic regression models to predict type 2 diabetes prevalence and incidence, using questionnaire-only variables reflecting health state and lifestyle, were trained on the White population of the UK Biobank (n = 472,696 total, aged 37-73 years, data collected 2006-2010) and validated in five other ethnicities (n = 29,811 total) and externally in Lifelines (n = 168,205 total, aged 0-93 years, collected between 2006 and 2013). In total, 631,748 individuals were included for prevalence prediction and 67,083 individuals for the eight-year incidence prediction. Type 2 diabetes prevalence in the UK Biobank ranged between 6% in the White population to 23.3% in the South Asian population, while in Lifelines, the prevalence was 1.9%. Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC), and a detailed sensitivity analysis was conducted to assess potential clinical utility. We compared the questionnaire-only models to models containing physical measurements and biomarkers as well as to clinical non-laboratory type 2 diabetes risk tools and conducted a reclassification analysis. Findings Our algorithms accurately predicted type 2 diabetes prevalence (AUC = 0.901) and eight-year incidence (AUC = 0.873) in the White UK Biobank population. Both models replicated well in the Lifelines external validation, with AUCs of 0.917 and 0.817 for prevalence and incidence, respectively. Both models performed consistently well across different ethnicities, with AUCs of 0.855-0.894 for prevalence and 0.819-0.883 for incidence. These models generally outperformed two clinically validated non-laboratory tools and correctly reclassified >3,000 additional cases. Model performance improved with the addition of blood biomarkers but not with the addition of physical measurements. Interpretation Our findings suggest that easy-to-implement, questionnaire-based models could be used to predict prevalent and incident type 2 diabetes with high accuracy across several ethnicities, providing a highly scalable solution for population-wide risk stratification. Future work should determine the effectiveness of these models in identifying undiagnosed type 2 diabetes, validated in cohorts of different populations and ethnic representation. Funding University Medical Center Groningen.
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Affiliation(s)
- Michail Kokkorakis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Pytrik Folkertsma
- Ancora Health B.V., Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sipko van Dam
- Ancora Health B.V., Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nicole Sirotin
- Department of Preventive Medicine, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Shahrad Taheri
- National Obesity Treatment Centre, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Odette Chagoury
- National Obesity Treatment Centre, Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Youssef Idaghdour
- Program in Biology, Division of Science and Mathematics, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Robert H. Henning
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Ancora Health B.V., Groningen, Netherlands
| | - Christos S. Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston VA Healthcare System, Boston, MA, USA
| | - Dylan H. de Vries
- Ancora Health B.V., Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Wouters HJ, van der Klauw MM, Wolffenbuttel BH, Huls G, van Zeventer IA. The Association Between Anemia and Skin Autofluorescence, a Marker for Advanced Glycation End Product Accumulation. Hemasphere 2020; 4:e470. [PMID: 33134864 PMCID: PMC7593064 DOI: 10.1097/hs9.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
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Abstract
Although cobalamin (vitamin B12) deficiency was described over a century ago, it is still difficult to establish the correct diagnosis and prescribe the right treatment. Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric. A number of individuals with vitamin B12 deficiency may present with the classic megaloblastic anemia. In clinical practice, many cases of vitamin B12 deficiency are overlooked or sometimes even misdiagnosed. In this review, we describe the heterogeneous disease spectrum of patients with vitamin B12 deficiency in whom the diagnosis was either based on low serum B12 levels, elevated biomarkers like methylmalonic acid and/or homocysteine, or the improvement of clinical symptoms after the institution of parenteral vitamin B12 therapy. We discuss the possible clinical signs and symptoms of patients with B12 deficiency and the various pitfalls of diagnosis and treatment.
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Affiliation(s)
- Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Correspondence: Address to Bruce H. R. Wolffenbuttel, MD, PhD, Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31 9700 RB Groningen, The Netherlands
| | - Hanneke J.C.M. Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - M. Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
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Emous M, Wolffenbuttel BH, van Dijk G, Totté E, van Beek AP. Long-term self-reported symptom prevalence of early and late dumping in a patient population after sleeve gastrectomy, primary, and revisional gastric bypass surgery. Surg Obes Relat Dis 2018; 14:1173-1181. [DOI: 10.1016/j.soard.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/08/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
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van Waateringe RP, Muller Kobold AC, van Vliet-Ostaptchouk JV, van der Klauw MM, Koerts J, Anton G, Peters A, Trischler G, Kvaløy K, Naess M, Videm V, Hveem K, Waldenberger M, Koenig W, Wolffenbuttel BH. Influence of Storage and Inter- and Intra-Assay Variability on the Measurement of Inflammatory Biomarkers in Population-Based Biobanking. Biopreserv Biobank 2017; 15:512-518. [DOI: 10.1089/bio.2017.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Anneke C. Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Jan Koerts
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gabriele Anton
- Research Unit of Molecular Epidemiology and Institute of Epidemiology II, Helmholtz Zentrum München, Munich, Germany
| | - Annette Peters
- Research Unit of Molecular Epidemiology and Institute of Epidemiology II, Helmholtz Zentrum München, Munich, Germany
| | - Gerlinde Trischler
- Department of Internal Medicine II–Cardiology, University of Ulm Medical Centre, Ulm, Germany
| | - Kirsti Kvaløy
- Department of Public Health and General Practice, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Naess
- Department of Public Health and General Practice, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Vibeke Videm
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Immunology and Transfusion Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Kristian Hveem
- Department of Public Health and General Practice, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology and Institute of Epidemiology II, Helmholtz Zentrum München, Munich, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II–Cardiology, University of Ulm Medical Centre, Ulm, Germany
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Koning SH, Hoogenberg K, Scheuneman KA, Baas MG, Korteweg FJ, Sollie KM, Schering BJ, van Loon AJ, Wolffenbuttel BH, van den Berg PP, Lutgers HL. Neonatal and obstetric outcomes in diet- and insulin-treated women with gestational diabetes mellitus: a retrospective study. BMC Endocr Disord 2016; 16:52. [PMID: 27680327 PMCID: PMC5041294 DOI: 10.1186/s12902-016-0136-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To evaluate the neonatal and obstetric outcomes of pregnancies complicated by gestational diabetes mellitus (GDM). Screening and treatment - diet-only versus additional insulin therapy - were based on the 2010 national Dutch guidelines. METHODS Retrospective study of the electronic medical files of 820 singleton GDM pregnancies treated between January 2011 and September 2014 in a university and non-university hospital. Pregnancy outcomes were compared between regular care treatment regimens -diet-only versus additional insulin therapy- and pregnancy outcomes of the Northern region of the Netherlands served as a reference population. RESULTS A total of 460 women (56 %) met glycaemic control on diet-only and 360 women (44 %) required additional insulin therapy. Between the groups, there were no differences in perinatal complications (mortality, birth trauma, hyperbilirubinaemia, hypoglycaemia), small for gestational age, large for gestational age (LGA), neonate weighing >4200 g, neonate weighing ≥4500 g, Apgar score <7 at 5 min, respiratory support, preterm delivery, and admission to the neonatology department. Neonates born in the insulin-group had a lower birth weight compared with the diet-group (3364 vs. 3467 g, p = 0.005) and a lower gestational age at birth (p = 0.001). However, birth weight was not different between the groups when expressed in percentiles, adjusted for gestational age, gender, parity, and ethnicity. The occurrence of preeclampsia and gestational hypertension was comparable between the groups. In the insulin-group, labour was more often induced and more planned caesarean sections were performed (p = 0.001). Compared with the general obstetric population, the percentage of LGA neonates was higher in the GDM population (11.0 % vs.19.9 %, p = <0.001). CONCLUSIONS Neonatal and obstetric outcomes were comparable either with diet-only or additional insulin therapy. However, compared with the general obstetric population, the incidence of LGA neonates was significantly increased in this GDM cohort.
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Affiliation(s)
- Sarah H. Koning
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Kirsten A. Scheuneman
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Mick G. Baas
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Fleurisca J. Korteweg
- Department of Gynaecology and Obstetrics, Martini Hospital, Groningen, The Netherlands
| | - Krystyna M. Sollie
- Department of Gynaecology and Obstetrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bertine J. Schering
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Aren J. van Loon
- Department of Gynaecology and Obstetrics, Martini Hospital, Groningen, The Netherlands
| | - Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Paul P. van den Berg
- Department of Gynaecology and Obstetrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helen L. Lutgers
- Department of Endocrinology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Schutte E, de Vos LC, Lutgers HL, Lambers Heerspink HJ, Wolffenbuttel BH, Vart P, Zeebregts CJ, Gansevoort RT, Lefrandt JD. Association of Skin Autofluorescence Levels With Kidney Function Decline in Patients With Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2016; 36:1709-14. [DOI: 10.1161/atvbaha.116.307771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022]
Abstract
Objective—
Skin autofluorescence (SAF), a measure of advanced glycation end product accumulation, is associated with kidney function. We investigated the association of SAF with rate of kidney function decline in a cohort of patients with peripheral artery disease.
Approach and Results—
We performed a post hoc analysis of an observational longitudinal cohort study. We included 471 patients with peripheral artery disease, and SAF was measured at baseline. Primary end point was rate of estimated glomerular filtration rate (eGFR) decline. Secondary end points were incidence of eGFR <60 and <45 mL/min/1.73 m
2
and rapid eGFR decline, defined as a decrease in eGFR of >5 mL/min/1.73 m
2
/y. During a median follow-up of 3 years, the mean change in eGFR per year was −1.8±4.4 mL/min/1.73 m
2
/y. No significant difference in rate of eGFR decline was observed per 1 arbitrary unit increase in SAF (−0.1 mL/min/1.73 m
2
/y; 95% confidence interval, −0.7 to 0.5;
P
=0.8). Analyses of the secondary end points showed that there was an association of SAF with incidence of eGFR <60 and <45 mL/min/1.73 m
2
(hazard ratio, 1.54; 95% confidence interval, 1.13–2.10;
P
=0.006 and hazard ratio, 1.76; 95% confidence interval, 1.20–2.59;
P
=0.004, respectively), but after adjustment for age and sex, significance was lost. There was no association of SAF with rapid eGFR decline.
Conclusions—
In conclusion, in this cohort of patients with peripheral artery disease, elevated SAF was associated with lower baseline eGFR. Although SAF has previously been established as a predictor for cardiovascular disease and mortality, it did not predict the rate of kidney function decline during follow-up in this study.
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Affiliation(s)
- Elise Schutte
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisanne C. de Vos
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Helen L. Lutgers
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hiddo J. Lambers Heerspink
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bruce H.R. Wolffenbuttel
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Priya Vart
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T. Gansevoort
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joop D. Lefrandt
- From the Department of Nephrology (E.S., R.T.G.), Department of Vascular Medicine (L.C.d.V., J.D.L.), Department of Endocrinology (H.L.L., B.H.R.W.), Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), Department of Health Sciences (P.V.) and Division of Vascular Surgery, Department of Surgery (C.J.Z.), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Schutte E, Lambers Heerspink HJ, Lutgers HL, Bakker SJ, Vart P, Wolffenbuttel BH, Umanath K, Lewis JB, de Zeeuw D, Gansevoort RT. Serum Bicarbonate and Kidney Disease Progression and Cardiovascular Outcome in Patients With Diabetic Nephropathy: A Post Hoc Analysis of the RENAAL (Reduction of End Points in Non–Insulin-Dependent Diabetes With the Angiotensin II Antagonist Losartan) Study and IDNT (Irbesartan Diabetic Nephropathy Trial). Am J Kidney Dis 2015; 66:450-8. [DOI: 10.1053/j.ajkd.2015.03.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 03/20/2015] [Indexed: 11/11/2022]
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Brummelman P, Sattler MG, Meiners LC, van den Berg G, van der Klauw MM, Elderson MF, Dullaart RP, Koerts J, Werumeus Buning J, Tucha O, Wolffenbuttel BH, van den Bergh AC, van Beek AP. Cognition and brain abnormalities on MRI in pituitary patients. Eur J Radiol 2015; 84:295-300. [DOI: 10.1016/j.ejrad.2014.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Dullaart RP, Boersema J, Lefrandt JD, Wolffenbuttel BH, Bakker SJ. The inverse association of incident cardiovascular disease with plasma bilirubin is unaffected by adiponectin. Atherosclerosis 2014; 235:380-3. [DOI: 10.1016/j.atherosclerosis.2014.05.938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/13/2014] [Accepted: 05/19/2014] [Indexed: 12/27/2022]
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Slagter SN, van Vliet-Ostaptchouk JV, Vonk JM, Boezen HM, Dullaart RPF, Kobold ACM, Feskens EJM, van Beek AP, van der Klauw MM, Wolffenbuttel BH. Combined effects of smoking and alcohol on metabolic syndrome: the LifeLines cohort study. PLoS One 2014; 9:e96406. [PMID: 24781037 PMCID: PMC4004580 DOI: 10.1371/journal.pone.0096406] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/07/2014] [Indexed: 01/03/2023] Open
Abstract
Introduction The development of metabolic syndrome (MetS) is influenced by environmental factors such as smoking and alcohol consumption. We determined the combined effects of smoking and alcohol on MetS and its individual components. Methods 64,046 participants aged 18–80 years from the LifeLines Cohort study were categorized into three body mass index (BMI) classes (BMI<25, normal weight; BMI 25–30, overweight; BMI≥30 kg/m2, obese). MetS was defined according to the revised criteria of the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III). Within each BMI class and smoking subgroup (non-smoker, former smoker, <20 and ≥20 g tobacco/day), the cross-sectional association between alcohol and individual MetS components was tested using regression analysis. Results Prevalence of MetS varied greatly between the different smoking-alcohol subgroups (1.7–71.1%). HDL cholesterol levels in all alcohol drinkers were higher than in non-drinkers (0.02 to 0.29 mmol/L, P values<0.001). HDL cholesterol levels were lower when they were also a former or current smoker (<20 and ≥20 g tobacco/day). Consumption of ≤1 drink/day indicated a trend towards lower triglyceride levels (non-significant). Concurrent use alcohol (>1 drink/day) and tobacco showed higher triglycerides levels. Up to 2 drinks/day was associated with a smaller waist circumference in overweight and obese individuals. Consumption of >2 drinks/day increased blood pressure, with the strongest associations found for heavy smokers. The overall metabolic profile of wine drinkers was better than that of non-drinkers or drinkers of beer or spirits/mixed drinks. Conclusion Light alcohol consumption may moderate the negative associations of smoking with MetS. Our results suggest that the lifestyle advice that emphasizes smoking cessation and the restriction of alcohol consumption to a maximum of 1 drink/day, is a good approach to reduce the prevalence of MetS.
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Affiliation(s)
- Sandra N. Slagter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jana V. van Vliet-Ostaptchouk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M. Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. Marieke Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P. F. Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke C. Muller. Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - André P. van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Willer CJ, Schmidt EM, Sengupta S, Peloso GM, Gustafsson S, Kanoni S, Ganna A, Chen J, Buchkovich ML, Mora S, Beckmann JS, Bragg-Gresham JL, Chang HY, Demirkan A, Den Hertog HM, Do R, Donnelly LA, Ehret GB, Esko T, Feitosa MF, Ferreira T, Fischer K, Fontanillas P, Fraser RM, Freitag DF, Gurdasani D, Heikkilä K, Hyppönen E, Isaacs A, Jackson AU, Johansson Å, Johnson T, Kaakinen M, Kettunen J, Kleber ME, Li X, Luan J, Lyytikäinen LP, Magnusson PK, Mangino M, Mihailov E, Montasser ME, Müller-Nurasyid M, Nolte IM, O’Connell JR, Palmer CD, Perola M, Petersen AK, Sanna S, Saxena R, Service SK, Shah S, Shungin D, Sidore C, Song C, Strawbridge RJ, Surakka I, Tanaka T, Teslovich TM, Thorleifsson G, Van den Herik EG, Voight BF, Volcik KA, Waite LL, Wong A, Wu Y, Zhang W, Absher D, Asiki G, Barroso I, Been LF, Bolton JL, Bonnycastle LL, Brambilla P, Burnett MS, Cesana G, Dimitriou M, Doney AS, Döring A, Elliott P, Epstein SE, Ingi Eyjolfsson G, Gigante B, Goodarzi MO, Grallert H, Gravito ML, Groves CJ, Hallmans G, Hartikainen AL, Hayward C, Hernandez D, Hicks AA, Holm H, Hung YJ, Illig T, Jones MR, Kaleebu P, Kastelein JJ, Khaw KT, Kim E, Klopp N, Komulainen P, Kumari M, Langenberg C, Lehtimäki T, Lin SY, Lindström J, Loos RJ, Mach F, McArdle WL, Meisinger C, Mitchell BD, Müller G, Nagaraja R, Narisu N, Nieminen TV, Nsubuga RN, Olafsson I, Ong KK, Palotie A, Papamarkou T, Pomilla C, Pouta A, Rader DJ, Reilly MP, Ridker PM, Rivadeneira F, Rudan I, Ruokonen A, Samani N, Scharnagl H, Seeley J, Silander K, Stančáková A, Stirrups K, Swift AJ, Tiret L, Uitterlinden AG, van Pelt LJ, Vedantam S, Wainwright N, Wijmenga C, Wild SH, Willemsen G, Wilsgaard T, Wilson JF, Young EH, Zhao JH, Adair LS, Arveiler D, Assimes TL, Bandinelli S, Bennett F, Bochud M, Boehm BO, Boomsma DI, Borecki IB, Bornstein SR, Bovet P, Burnier M, Campbell H, Chakravarti A, Chambers JC, Chen YDI, Collins FS, Cooper RS, Danesh J, Dedoussis G, de Faire U, Feranil AB, Ferrières J, Ferrucci L, Freimer NB, Gieger C, Groop LC, Gudnason V, Gyllensten U, Hamsten A, Harris TB, Hingorani A, Hirschhorn JN, Hofman A, Hovingh GK, Hsiung CA, Humphries SE, Hunt SC, Hveem K, Iribarren C, Järvelin MR, Jula A, Kähönen M, Kaprio J, Kesäniemi A, Kivimaki M, Kooner JS, Koudstaal PJ, Krauss RM, Kuh D, Kuusisto J, Kyvik KO, Laakso M, Lakka TA, Lind L, Lindgren CM, Martin NG, März W, McCarthy MI, McKenzie CA, Meneton P, Metspalu A, Moilanen L, Morris AD, Munroe PB, Njølstad I, Pedersen NL, Power C, Pramstaller PP, Price JF, Psaty BM, Quertermous T, Rauramaa R, Saleheen D, Salomaa V, Sanghera DK, Saramies J, Schwarz PE, Sheu WHH, Shuldiner AR, Siegbahn A, Spector TD, Stefansson K, Strachan DP, Tayo BO, Tremoli E, Tuomilehto J, Uusitupa M, van Duijn CM, Vollenweider P, Wallentin L, Wareham NJ, Whitfield JB, Wolffenbuttel BH, Ordovas JM, Boerwinkle E, Palmer CN, Thorsteinsdottir U, Chasman DI, Rotter JI, Franks PW, Ripatti S, Cupples LA, Sandhu MS, Rich SS, Boehnke M, Deloukas P, Kathiresan S, Mohlke KL, Ingelsson E, Abecasis GR. Discovery and refinement of loci associated with lipid levels. Nat Genet 2013; 45:1274-1283. [PMID: 24097068 PMCID: PMC3838666 DOI: 10.1038/ng.2797] [Citation(s) in RCA: 2104] [Impact Index Per Article: 191.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 09/13/2013] [Indexed: 11/16/2022]
Abstract
Levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and total cholesterol are heritable, modifiable risk factors for coronary artery disease. To identify new loci and refine known loci influencing these lipids, we examined 188,577 individuals using genome-wide and custom genotyping arrays. We identify and annotate 157 loci associated with lipid levels at P < 5 × 10(-8), including 62 loci not previously associated with lipid levels in humans. Using dense genotyping in individuals of European, East Asian, South Asian and African ancestry, we narrow association signals in 12 loci. We find that loci associated with blood lipid levels are often associated with cardiovascular and metabolic traits, including coronary artery disease, type 2 diabetes, blood pressure, waist-hip ratio and body mass index. Our results demonstrate the value of using genetic data from individuals of diverse ancestry and provide insights into the biological mechanisms regulating blood lipids to guide future genetic, biological and therapeutic research.
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Affiliation(s)
- Cristen J. Willer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan 48109, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Ellen M. Schmidt
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Sebanti Sengupta
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Stavroula Kanoni
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
| | - Andrea Ganna
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jin Chen
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | - Samia Mora
- Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave., Boston MA 02215, USA
- Harvard Medical School, Boston MA 02115, USA
| | - Jacques S. Beckmann
- Service of Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
| | - Jennifer L. Bragg-Gresham
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Hsing-Yi Chang
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ayşe Demirkan
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Ron Do
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Louise A. Donnelly
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School. Dundee, DD1 9SY, United Kingdom
| | - Georg B. Ehret
- Cardiology, Department of Specialities of Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
- Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Tõnu Esko
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
- Estonian Genome Center of the University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Mary F. Feitosa
- Department of Genetics, Washington University School of Medicine, USA
| | - Teresa Ferreira
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom
| | - Krista Fischer
- Estonian Genome Center of the University of Tartu, Tartu, Estonia
| | - Pierre Fontanillas
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
| | - Ross M. Fraser
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Daniel F. Freitag
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Deepti Gurdasani
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Kauko Heikkilä
- Hjelt Institute, Department of Public Health, University of Helsinki, Finland
| | - Elina Hyppönen
- Centre For Paediatric Epidemiology and Biostatistics/MRC Centre of Epidemiology for Child Health, University College of London Institute of Child Health, London, United Kingdom
| | - Aaron Isaacs
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Medical Systems Biology, Leiden, the Netherlands
| | - Anne U. Jackson
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Toby Johnson
- Genome Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UK
| | - Marika Kaakinen
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Finland
| | - Johannes Kettunen
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Marcus E. Kleber
- Department of Internal Medicine II – Cardiology, University of Ulm Medical Centre, Ulm, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Mannheim, University of Heidelberg, Ludolf-Krehl-Strasse 7-11, 68167 Mannheim, Germany
| | - Xiaohui Li
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jian’an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland
- Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Patrik K.E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Evelin Mihailov
- Estonian Genome Center of the University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - May E. Montasser
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, Neuherberg 85764, Germany
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians University, Munich, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jeffrey R. O’Connell
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Cameron D. Palmer
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
- Division of Endocrinology, Children’s Hospital Boston, Massachusetts 02115, USA
- Division of Genetics, Program in Genomics, Children’s Hospital, Boston, Massachusetts 02115, USA
| | - Markus Perola
- Estonian Genome Center of the University of Tartu, Tartu, Estonia
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Ann-Kristin Petersen
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Serena Sanna
- Istituto di Ricerca Genetica e Biomedica, CNR, Monserrato, 09042, Italy
| | - Richa Saxena
- Massachusetts General Hospital/Broad Institute, Harvard University, Cambridge, MA, USA
| | - Susan K. Service
- Center for Neurobehavioral Genetics, The Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Sonia Shah
- Genetic Epidemiology Group, Deparment of Epidemiology and Public Health, UCL, London WC1E 6BT, United Kingdom
| | - Dmitry Shungin
- Department of Clinical Sciences, Genetic & Molecular Epidemiology Unit, Lund University Diabetes Center, Scania University Hosptial, Malmö, Sweden
- Department of Odontology, Umeå University, Umeå, Sweden
- Department of Public Health and Primary Care, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Carlo Sidore
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
- Istituto di Ricerca Genetica e Biomedica, CNR, Monserrato, 09042, Italy
- Dipartimento di Scienze Biomediche, Universita di Sassari, 07100 SS, Italy
| | - Ci Song
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rona J. Strawbridge
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ida Surakka
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Toshiko Tanaka
- Clinical Research Branch, National Institute Health, Baltimore, MD, USA
| | - Tanya M. Teslovich
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | | | - Benjamin F. Voight
- Department of Genetics, University of Pennsylvania - School of Medicine, Philadelphia PA, 19104, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania - School of Medicine, Philadelphia PA, 19104, USA
| | - Kelly A. Volcik
- Human Genetics Center, University of Texas Health Science Center - School of Public Health, Houston, TX 77030, USA
| | | | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London, WC1B 5JU, United Kingdom
| | - Ying Wu
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Weihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Ealing Hospital, Southall, Middlesex UB1 3HW, United Kingdom
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Gershim Asiki
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Level 4, Institute of Metabolic Science Box 289 Addenbrooke’s Hospital Cambridge CB2 OQQ, UK
| | - Latonya F. Been
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jennifer L. Bolton
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Lori L Bonnycastle
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Paolo Brambilla
- Department of Experimental Medicine, University of Milano Bicocca, Italy
| | - Mary S. Burnett
- MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, USA
| | - Giancarlo Cesana
- Research Centre on Public Health, University of Milano Bicocca, Italy
| | - Maria Dimitriou
- Department of Dietetics-Nutrition, Harokopio University, 70 El. Venizelou Str, Athens, Greece
| | - Alex S.F. Doney
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School. Dundee, DD1 9SY, United Kingdom
| | - Angela Döring
- Institute of Epidemiology I, Helmholtz Zentrum München, Neuherberg 85764, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Paul Elliott
- Institute of Health Sciences, University of Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, UK
| | - Stephen E. Epstein
- MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, USA
| | | | - Bruna Gigante
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Harald Grallert
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Martha L. Gravito
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christopher J. Groves
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX3 7LJ, United Kingdom
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional research, Umeå University, Umeå, Sweden
| | - Anna-Liisa Hartikainen
- Department of Clinical Sciences/Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - Dena Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD 20892, USA
| | - Andrew A. Hicks
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy - Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Hilma Holm
- deCODE Genetics/Amgen, 101 Reykjavik, Iceland
| | - Yi-Jen Hung
- Division of Endocrinology & Metabolism, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg 85764, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover 30625, Germany
| | - Michelle R. Jones
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - John J.P. Kastelein
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Eric Kim
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Norman Klopp
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg 85764, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover 30625, Germany
| | | | - Meena Kumari
- Genetic Epidemiology Group, Deparment of Epidemiology and Public Health, UCL, London WC1E 6BT, United Kingdom
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland
- Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Shih-Yi Lin
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jaana Lindström
- Diabetes Prevention Unit, National Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Ruth J.F. Loos
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, USA
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at ount Sinai, New York, USA
- The Mindich Child Health and Development Institute, The Icahn School of Medicine at Mount Sinai, New York
| | - François Mach
- Cardiology, Department of Specialities of Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Wendy L McArdle
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom
| | - Christa Meisinger
- Institute of Epidemiology I, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Braxton D. Mitchell
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Gabrielle Müller
- Institute for Medical Informatics and Biometrics, University of Dresden, Medical Faculty Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Ramaiah Nagaraja
- Laboratory of Genetics, National Institute on Aging, Baltimore, MD21224, USA
| | - Narisu Narisu
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Tuomo V.M. Nieminen
- Department of Clinical Pharmacology, University of Tampere School of Medicine, Tamperew 33014, Finland
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali University Hospital, 101 Reykjavik, Iceland
| | - Ken K. Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
- MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London, WC1B 5JU, United Kingdom
| | - Aarno Palotie
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Department of Medical Genetics, Haartman Institute, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, United ingdom
| | - Theodore Papamarkou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Statistical Sciences, University College of London, London, United Kingdom
| | - Cristina Pomilla
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Anneli Pouta
- Department of Clinical Sciences/Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- National Institute for Health and Welfare, Oulu, Finland
| | - Daniel J. Rader
- Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Translational Research Center, Philadelphia, PA 19104-5158, USA
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Translational Research Center, Philadelphia, PA 19104-5158, USA
| | - Muredach P. Reilly
- Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Translational Research Center, Philadelphia, PA 19104-5158, USA
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Building 421, Translational Research Center, Philadelphia, PA 19104-5158, USA
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave., Boston MA 02215, USA
- Harvard Medical School, Boston MA 02115, USA
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging NCHA), Leiden, The Netherlands
| | - Igor Rudan
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Aimo Ruokonen
- Department of Clinical Sciences/Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Nilesh Samani
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- School of International Development, University of East Anglia, Norwich NR4 7TJ, United Kingdom
| | - Kaisa Silander
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Alena Stančáková
- University of Eastern Finland and Kuopio University Hospital, 70210 Kuopio, Finland
| | - Kathleen Stirrups
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
| | - Amy J. Swift
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Laurence Tiret
- INSERM UMRS 937, Pierre and Marie Curie University, Paris, France
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging NCHA), Leiden, The Netherlands
| | - L. Joost van Pelt
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
- LifeLines Cohort Study, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sailaja Vedantam
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
- Division of Endocrinology, Children’s Hospital Boston, Massachusetts 02115, USA
- Division of Genetics, Program in Genomics, Children’s Hospital, Boston, Massachusetts 02115, USA
| | - Nicholas Wainwright
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Cisca Wijmenga
- LifeLines Cohort Study, University of Groningen, University Medical Center Groningen, The Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sarah H. Wild
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Gonneke Willemsen
- Department of Biological Psychology, VU Univ, Amsterdam, The Netherlands
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - James F. Wilson
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Elizabeth H. Young
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jing Hua Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Linda S. Adair
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Dominique Arveiler
- Department of Epidemiology and Public Health, EA 3430, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| | | | | | - Franklyn Bennett
- Chemical Pathology, Department of Pathology, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Bernhard O. Boehm
- Division of Endocrinology and Diabetes, Department of Internal Medicine, Ulm University Medical Centre, Ulm, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dorret I. Boomsma
- Department of Biological Psychology, VU Univ, Amsterdam, The Netherlands
| | - Ingrid B. Borecki
- Department of Genetics, Washington University School of Medicine, USA
| | - Stefan R. Bornstein
- Department of Medicine III, University of Dresden, Medical Faculty Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
| | - Michel Burnier
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Aravinda Chakravarti
- Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - John C. Chambers
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Ealing Hospital, Southall, Middlesex UB1 3HW, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yii-Der Ida Chen
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Francis S. Collins
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Richard S. Cooper
- Department of Preventive Medicine and Epidemiology, Loyola University Medical School, Maywood, Illinois 60153, USA
| | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - George Dedoussis
- Department of Dietetics-Nutrition, Harokopio University, 70 El. Venizelou Str, Athens, Greece
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alan B. Feranil
- Office of Population Studies Foundation, University of San Carlos, Talamban, Cebu City, Philippines
| | - Jean Ferrières
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France
| | - Luigi Ferrucci
- Clinical Research Branch, National Institute Health, Baltimore, MD, USA
| | - Nelson B. Freimer
- Center for Neurobehavioral Genetics, The Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
- Department of Psychiatry, University of California, Los Angeles, USA
| | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Leif C. Groop
- Department of Clinical Sciences, Lund University, SE-20502, Malmö, Sweden
- Department of Medicine, Helsinki University Hospital, FI-00029 Helsinki, Finland
| | | | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Ageing, Bethesda, MD, USA
| | - Aroon Hingorani
- Genetic Epidemiology Group, Deparment of Epidemiology and Public Health, UCL, London WC1E 6BT, United Kingdom
| | - Joel N. Hirschhorn
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
- Division of Endocrinology, Children’s Hospital Boston, Massachusetts 02115, USA
- Division of Genetics, Program in Genomics, Children’s Hospital, Boston, Massachusetts 02115, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging NCHA), Leiden, The Netherlands
| | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Steve E. Humphries
- Cardiovascular Genetics, BHF Laboratories, Institute Cardiovascular Science, University College London, London, United Kingdom
| | - Steven C. Hunt
- Cardiovascular Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | | | - Marjo-Riitta Järvelin
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, UK
- National Institute for Health and Welfare, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere School of Medicine, Tampere 33014, Finland
| | - Jaakko Kaprio
- Hjelt Institute, Department of Public Health, University of Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Antero Kesäniemi
- Institute of Clinical Medicine, Department of Medicine, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland
| | - Mika Kivimaki
- Genetic Epidemiology Group, Deparment of Epidemiology and Public Health, UCL, London WC1E 6BT, United Kingdom
| | - Jaspal S. Kooner
- Ealing Hospital, Southall, Middlesex UB1 3HW, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Heart & Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Peter J. Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ronald M. Krauss
- Children’s Hospital Oakland Research Institute, 5700 Martin Luther King Junior Way, Oakland, CA 94609, USA
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London, WC1B 5JU, United Kingdom
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, 70210 Kuopio, Finland
| | - Kirsten O. Kyvik
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, 70210 Kuopio, Finland
| | - Timo A. Lakka
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Cecilia M. Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom
| | - Nicholas G. Martin
- Queensland Institute of Medical Research, Locked Bag 2000, Royal Brisbane Hospital, Queensland 4029, Australia
| | - Winfried März
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Mannheim, University of Heidelberg, Ludolf-Krehl-Strasse 7-11, 68167 Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
- Synlab Academy, Synlab Services GmbH,Gottlieb-Daimler-Straße 25, 68165 Mannheim, Germany
| | - Mark I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX3 7LJ, United Kingdom
| | - Colin A. McKenzie
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Pierre Meneton
- U872 Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, 75006 Paris, France
| | - Andres Metspalu
- Estonian Genome Center of the University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Andrew D. Morris
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School. Dundee, DD1 9SY, United Kingdom
| | - Patricia B. Munroe
- Genome Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Pharmacology, NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UK
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Chris Power
- Centre For Paediatric Epidemiology and Biostatistics/MRC Centre of Epidemiology for Child Health, University College of London Institute of Child Health, London, United Kingdom
| | - Peter P. Pramstaller
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy - Affiliated Institute of the University of Lübeck, Lübeck, Germany
- Department of Neurology, General Central Hospital, Bolzano, Italy
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Jackie F. Price
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, United Kingdom
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Thomas Quertermous
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Danish Saleheen
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Center for Non-Communicable Diseases, Karachi, Pakistan
- Department of Medicine, University of Pennsylvania, USA
| | - Veikko Salomaa
- Unit of Chronic Disease Epidemiology and Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Dharambir K. Sanghera
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Peter E.H. Schwarz
- Department of Medicine III, University of Dresden, Medical Faculty Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden, German Center for Diabetes Research (DZD), Dresden, Germany
| | - Wayne H-H Sheu
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Alan R. Shuldiner
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland
| | - Agneta Siegbahn
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Kari Stefansson
- deCODE Genetics/Amgen, 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavík, Iceland
| | - David P. Strachan
- Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Bamidele O. Tayo
- Department of Preventive Medicine and Epidemiology, Loyola University Medical School, Maywood, Illinois 60153, USA
| | - Elena Tremoli
- Department of Pharmacological Sciences, University of Milan, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Jaakko Tuomilehto
- Diabetes Prevention Unit, National Institute for Health and Welfare, 00271 Helsinki, Finland
- Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria
- King Abdulaziz University, Faculty of Medicine, Jeddah 21589, Saudi Arabia
- Red RECAVA Grupo RD06/0014/0015, Hospital Universitario La Paz, 28046
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
- Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Cornelia M. van Duijn
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Medical Systems Biology, Leiden, the Netherlands
| | | | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - John B. Whitfield
- Queensland Institute of Medical Research, Locked Bag 2000, Royal Brisbane Hospital, Queensland 4029, Australia
| | - Bruce H.R. Wolffenbuttel
- LifeLines Cohort Study, University of Groningen, University Medical Center Groningen, The Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jose M. Ordovas
- Department of Cardiovascular Epidemiology and Population Genetics, National Center for rdiovascular Investigation, Madrid, Spain
- IMDEA-Alimentacion, Madrid, Spain
- Nutrition and Genomics Laboratory, Jean Mayer-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center - School of Public Health, Houston, TX 77030, USA
| | - Colin N.A. Palmer
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School. Dundee, DD1 9SY, United Kingdom
| | - Unnur Thorsteinsdottir
- deCODE Genetics/Amgen, 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavík, Iceland
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave., Boston MA 02215, USA
- Harvard Medical School, Boston MA 02115, USA
| | - Jerome I. Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Paul W. Franks
- Department of Clinical Sciences, Genetic & Molecular Epidemiology Unit, Lund University Diabetes Center, Scania University Hosptial, Malmö, Sweden
- Department of Public Health and Primary Care, Unit of Medicine, Umeå University, Umeå, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Samuli Ripatti
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Manjinder S. Sandhu
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA
| | - Michael Boehnke
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Panos Deloukas
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, CB10 1SA, Hinxton, United Kingdom
| | - Sekar Kathiresan
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Broad Institute, Program in Medical and Population Genetics, Cambridge, Massachusetts 02142, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Karen L. Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom
| | - Gonçalo R. Abecasis
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA
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13
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Klaver EI, van Loon HC, Stienstra R, Links TP, Keers JC, Kema IP, Kobold ACM, van der Klauw MM, Wolffenbuttel BH. Thyroid hormone status and health-related quality of life in the LifeLines Cohort Study. Thyroid 2013; 23:1066-73. [PMID: 23530992 PMCID: PMC3770241 DOI: 10.1089/thy.2013.0017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyroid disorders are prevalent in Western society, yet many subjects experience limited symptoms at diagnosis, especially in hypothyroidism. We hypothesize that health-related quality of life (HR-QOL) is more severely impaired in subjects with more abnormal thyroid hormone function tests. METHODS This is a cross-sectional study of Dutch adults participating in the LifeLines Cohort Study between December 2009 and August 2010. In 9491 Western European participants (median age 45 years; 3993 men and 5498 women), without current or former use of thyroid medication, we compared HR-QOL using the RAND 36-Item Health Survey between subjects with normal thyrotropin (TSH) values and subjects with disturbed thyroid hormone status (serum TSH, free thyroxine, and free triiodothyronine). The influence of possible confounders (age, smoking, co-morbidity) on HR-QOL was evaluated as well. RESULTS Suppressed TSH values (TSH < 0.5 mU/L) were found in 114 (1.2%), while 8334 (88.8%) had TSH within the normal range, 973 participants (10.3%) had TSH between 4 and 10 mU/L, and 70 (0.7%) had TSH > 10 mU/L. Men had a higher HR-QOL than women (70-92 vs. 65-89; p < 0.001), except for the domain "general health" (72 vs. 72; p = 0.692). Men with suppressed or elevated TSH values did not score significantly lower than euthyroid men for any of nine domains of the RAND 36-Item Health Survey. Compared with euthyroid women, women with suppressed TSH scored significantly lower in the domains "physical functioning" (84 vs. 89, p = 0.013) and "general health" (67 vs. 72, p = 0.036). Women with markedly elevated TSH (> 10 mU/L) had a score in all HR-QOL domains that was similar to that of women with normal TSH values. There were no differences in the physical component score and the mental component score between any of the TSH groups. Physical component score and mental component score were mainly determined by smoking status, co-morbidity, and body mass index or waist circumference. CONCLUSIONS In this population-based study, HR-QOL scores of subjects with suppressed TSH values or markedly elevated TSH values were generally not significantly lower than those of subjects with normal or mildly elevated TSH values.
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Affiliation(s)
- Elise I. Klaver
- Department of Endocrinology, University of Groningen, Groningen, The Netherlands
| | - Hannah C.M. van Loon
- Department of Endocrinology, University of Groningen, Groningen, The Netherlands
| | - Riejanne Stienstra
- Department of Endocrinology, University of Groningen, Groningen, The Netherlands
| | - Thera P. Links
- Department of Endocrinology, University of Groningen, Groningen, The Netherlands
| | - Joost C. Keers
- LifeLines Cohort Study & Biobank, Groningen, The Netherlands
| | - Ido P. Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anneke C. Muller Kobold
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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14
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Berndt SI, Gustafsson S, Mägi R, Ganna A, Wheeler E, Feitosa MF, Justice AE, Monda KL, Croteau-Chonka DC, Day FR, Esko T, Fall T, Ferreira T, Gentilini D, Jackson AU, Luan J, Randall JC, Vedantam S, Willer CJ, Winkler TW, Wood AR, Workalemahu T, Hu YJ, Lee SH, Liang L, Lin DY, Min JL, Neale BM, Thorleifsson G, Yang J, Albrecht E, Amin N, Bragg-Gresham JL, Cadby G, den Heijer M, Eklund N, Fischer K, Goel A, Hottenga JJ, Huffman JE, Jarick I, Johansson Å, Johnson T, Kanoni S, Kleber ME, König IR, Kristiansson K, Kutalik Z, Lamina C, Lecoeur C, Li G, Mangino M, McArdle WL, Medina-Gomez C, Müller-Nurasyid M, Ngwa JS, Nolte IM, Paternoster L, Pechlivanis S, Perola M, Peters MJ, Preuss M, Rose LM, Shi J, Shungin D, Smith AV, Strawbridge RJ, Surakka I, Teumer A, Trip MD, Tyrer J, Van Vliet-Ostaptchouk JV, Vandenput L, Waite LL, Zhao JH, Absher D, Asselbergs FW, Atalay M, Attwood AP, Balmforth AJ, Basart H, Beilby J, Bonnycastle LL, Brambilla P, Bruinenberg M, Campbell H, Chasman DI, Chines PS, Collins FS, Connell JM, Cookson W, de Faire U, de Vegt F, Dei M, Dimitriou M, Edkins S, Estrada K, Evans DM, Farrall M, Ferrario MM, Ferrières J, Franke L, Frau F, Gejman PV, Grallert H, Grönberg H, Gudnason V, Hall AS, Hall P, Hartikainen AL, Hayward C, Heard-Costa NL, Heath AC, Hebebrand J, Homuth G, Hu FB, Hunt SE, Hyppönen E, Iribarren C, Jacobs KB, Jansson JO, Jula A, Kähönen M, Kathiresan S, Kee F, Khaw KT, Kivimaki M, Koenig W, Kraja AT, Kumari M, Kuulasmaa K, Kuusisto J, Laitinen JH, Lakka TA, Langenberg C, Launer LJ, Lind L, Lindström J, Liu J, Liuzzi A, Lokki ML, Lorentzon M, Madden PA, Magnusson PK, Manunta P, Marek D, März W, Mateo Leach I, McKnight B, Medland SE, Mihailov E, Milani L, Montgomery GW, Mooser V, Mühleisen TW, Munroe PB, Musk AW, Narisu N, Navis G, Nicholson G, Nohr EA, Ong KK, Oostra BA, Palmer CN, Palotie A, Peden JF, Pedersen N, Peters A, Polasek O, Pouta A, Pramstaller PP, Prokopenko I, Pütter C, Radhakrishnan A, Raitakari O, Rendon A, Rivadeneira F, Rudan I, Saaristo TE, Sambrook JG, Sanders AR, Sanna S, Saramies J, Schipf S, Schreiber S, Schunkert H, Shin SY, Signorini S, Sinisalo J, Skrobek B, Soranzo N, Stančáková A, Stark K, Stephens JC, Stirrups K, Stolk RP, Stumvoll M, Swift AJ, Theodoraki EV, Thorand B, Tregouet DA, Tremoli E, Van der Klauw MM, van Meurs JB, Vermeulen SH, Viikari J, Virtamo J, Vitart V, Waeber G, Wang Z, Widén E, Wild SH, Willemsen G, Winkelmann BR, Witteman JC, Wolffenbuttel BH, Wong A, Wright AF, Zillikens MC, Amouyel P, Boehm BO, Boerwinkle E, Boomsma DI, Caulfield MJ, Chanock SJ, Cupples LA, Cusi D, Dedoussis GV, Erdmann J, Eriksson JG, Franks PW, Froguel P, Gieger C, Gyllensten U, Hamsten A, Harris TB, Hengstenberg C, Hicks AA, Hingorani A, Hinney A, Hofman A, Hovingh KG, Hveem K, Illig T, Jarvelin MR, Jöckel KH, Keinanen-Kiukaanniemi SM, Kiemeney LA, Kuh D, Laakso M, Lehtimäki T, Levinson DF, Martin NG, Metspalu A, Morris AD, Nieminen MS, Njølstad I, Ohlsson C, Oldehinkel AJ, Ouwehand WH, Palmer LJ, Penninx B, Power C, Province MA, Psaty BM, Qi L, Rauramaa R, Ridker PM, Ripatti S, Salomaa V, Samani NJ, Snieder H, Sørensen TI, Spector TD, Stefansson K, Tönjes A, Tuomilehto J, Uitterlinden AG, Uusitupa M, van der Harst P, Vollenweider P, Wallaschofski H, Wareham NJ, Watkins H, Wichmann HE, Wilson JF, Abecasis GR, Assimes TL, Barroso I, Boehnke M, Borecki IB, Deloukas P, Fox CS, Frayling T, Groop LC, Haritunian T, Heid IM, Hunter D, Kaplan RC, Karpe F, Moffatt M, Mohlke KL, O’Connell JR, Pawitan Y, Schadt EE, Schlessinger D, Steinthorsdottir V, Strachan DP, Thorsteinsdottir U, van Duijn CM, Visscher PM, Di Blasio AM, Hirschhorn JN, Lindgren CM, Morris AP, Meyre D, Scherag A, McCarthy MI, Speliotes EK, North KE, Loos RJ, Ingelsson E. Genome-wide meta-analysis identifies 11 new loci for anthropometric traits and provides insights into genetic architecture. Nat Genet 2013; 45:501-12. [PMID: 23563607 PMCID: PMC3973018 DOI: 10.1038/ng.2606] [Citation(s) in RCA: 436] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 03/14/2013] [Indexed: 12/25/2022]
Abstract
Approaches exploiting trait distribution extremes may be used to identify loci associated with common traits, but it is unknown whether these loci are generalizable to the broader population. In a genome-wide search for loci associated with the upper versus the lower 5th percentiles of body mass index, height and waist-to-hip ratio, as well as clinical classes of obesity, including up to 263,407 individuals of European ancestry, we identified 4 new loci (IGFBP4, H6PD, RSRC1 and PPP2R2A) influencing height detected in the distribution tails and 7 new loci (HNF4G, RPTOR, GNAT2, MRPS33P4, ADCY9, HS6ST3 and ZZZ3) for clinical classes of obesity. Further, we find a large overlap in genetic structure and the distribution of variants between traits based on extremes and the general population and little etiological heterogeneity between obesity subgroups.
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Affiliation(s)
- Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Reedik Mägi
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
| | - Andrea Ganna
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Eleanor Wheeler
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Mary F. Feitosa
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Anne E. Justice
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA
| | - Keri L. Monda
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA
- Center for Observational Research, Amgen, Thousands Oaks, CA, 91320
| | | | - Felix R. Day
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - Tõnu Esko
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu 51010, Estonia
| | - Tove Fall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Teresa Ferreira
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Davide Gentilini
- Molecular Biology Department, Istituto Auxologico Italiano, Milano, Italy
| | - Anne U. Jackson
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Jian’an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - Joshua C. Randall
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Sailaja Vedantam
- Divisions of Genetics and Endocrinology and Center for Basic and Translational Obesity Research, Children’s Hospital, Boston, Massachusetts 02115, USA
- Metabolism Initiative and Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts 02142, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Cristen J. Willer
- Department of Internal Medicine (Cardiovascular), University of Michigan, Ann Arbor, MI 48109, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, MI 48109, USA
| | - Thomas W. Winkler
- Public Health and Gender Studies, Institute of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
| | - Andrew R. Wood
- Genetics of Complex Traits, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, EX1 2LU, UK
| | - Tsegaselassie Workalemahu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Yi-Juan Hu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia 30322, USA
| | - Sang Hong Lee
- The Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Liming Liang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Dan-Yu Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Josine L. Min
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Benjamin M. Neale
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114
| | | | - Jian Yang
- University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
- Queensland Institute of Medical Research, Brisbane 4029, Australia
| | - Eva Albrecht
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
| | - Jennifer L. Bragg-Gresham
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Gemma Cadby
- Genetic Epidemiology and Biostatistics Platform, Ontario Institute for Cancer Research. Toronto, Canada, M5G 1L7
- Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Toronto, Canada, M5G 1X5
- Centre for Genetic Epidemiology and Biostatistics, University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Martin den Heijer
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Niina Eklund
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Unit of Public Health Genomics, 00014, Helsinki, Finland
| | - Krista Fischer
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
| | - Anuj Goel
- Cardiovascular Medicine, University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford, OX3 7BN, UK
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, VU University Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Jennifer E. Huffman
- MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Ivonne Jarick
- Institute of Medical Biometry and Epidemiology, University of Marburg, 35037 Marburg, Germany
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
- Uppsala Clinical Research Center, Uppsala university hospital, Sweden
| | - Toby Johnson
- Genome Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Stavroula Kanoni
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Marcus E. Kleber
- LURIC Study nonprofit LLC, Freiburg, Germany
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Inke R. König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Kati Kristiansson
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Unit of Public Health Genomics, 00014, Helsinki, Finland
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, 1005 Lausanne, Switzerland
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Claudia Lamina
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Cecile Lecoeur
- University Lille Nord de France, 59000 Lille, France
- CNRS UMR8199-IBL-Institut Pasteur de Lille, F-59000 Lille, France
| | - Guo Li
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, SE1 7EH, UK
| | - Wendy L. McArdle
- School of Social and Community Medicine, University of Bristol, UK
| | - Carolina Medina-Gomez
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology and Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Julius S. Ngwa
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Lavinia Paternoster
- MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2BN, UK
| | - Sonali Pechlivanis
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Perola
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Unit of Public Health Genomics, 00014, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014, Helsinki, Finland
| | - Marjolein J. Peters
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Michael Preuss
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Universität zu Lübeck, Medizinische Klinik II, 23538 Lübeck, Germany
| | - Lynda M. Rose
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02215, USA
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Dmitry Shungin
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Odontology, Umeå University, Sweden
| | - Albert Vernon Smith
- Icelandic Heart Association, Kopavogur, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Rona J. Strawbridge
- Atherosclerosis Research Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Ida Surakka
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Unit of Public Health Genomics, 00014, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014, Helsinki, Finland
| | - Alexander Teumer
- Interfaculty Institute for Genetics and Functional Genomics, Ernst-Moritz-Arndt-University Greifswald, 17487 Greifswald, Germany
| | - Mieke D. Trip
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Heart Failure Research Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Jonathan Tyrer
- Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Jana V. Van Vliet-Ostaptchouk
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Liesbeth Vandenput
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Lindsay L. Waite
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama 35806, USA
| | - Jing Hua Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - Devin Absher
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama 35806, USA
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, The Netherlands
| | - Mustafa Atalay
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland
| | | | - Anthony J. Balmforth
- Division of Epidemiology, Multidisciplinary Cardiovascular Research Centre (MCRC), Leeds Institute of Genetics, Health and Therapeutics (LIGHT), University of Leeds, Leeds LS2 9JT, UK
| | - Hanneke Basart
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - John Beilby
- PathWest Laboratory of Western Australia, Department of Molecular Genetics, J Block, QEII Medical Centre, Nedlands, Western Australia 6009, Australia
- Department of Surgery and Pathology, University of Western Australia, Nedlands, Australia, 6009
| | - Lori L. Bonnycastle
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Paolo Brambilla
- Dipartimento di Medicina Sperimentale. Università degli Studi Milano-Bicocca, Monza, Italy
| | - Marcel Bruinenberg
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02215, USA
- Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Peter S. Chines
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Francis S. Collins
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - John M. Connell
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
- University of Dundee, Ninewells Hospital &Medical School, Dundee, DD1 9SY, UK
| | - William Cookson
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Femmie de Vegt
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Mariano Dei
- Istituto di Ricerca Genetica e Biomedicadel del CNR, Monserrato, 09042, Cagliari, Italy
| | - Maria Dimitriou
- Department of Dietetics-Nutrition, Harokopio University, 70 El. Venizelou Str, Athens, Greece
| | - Sarah Edkins
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Karol Estrada
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - David M. Evans
- MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2BN, UK
| | - Martin Farrall
- Cardiovascular Medicine, University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford, OX3 7BN, UK
| | - Marco M. Ferrario
- Epidemiology and Preventive Medicine Research Center, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Jean Ferrières
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France
| | - Lude Franke
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Francesca Frau
- University of Milan, Department of Health Sciences, Ospedale San Paolo, 20139 Milano, Italy
| | - Pablo V. Gejman
- University of Chicago, Chicago, Illinois 60637, USA
- Northshore University HealthSystem, Evanston, Illinois 60201, USA
| | - Harald Grallert
- Research Unit for Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Alistair S. Hall
- Division of Cardiovascular and Neuronal Remodelling, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, UK
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anna-Liisa Hartikainen
- Department of Clinical Sciences/Obstetrics and Gynecology, University of Oulu, 90014 Oulu, Finland
| | - Caroline Hayward
- MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Nancy L. Heard-Costa
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63108, USA
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, 45147 Essen, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, Ernst-Moritz-Arndt-University Greifswald, 17487 Greifswald, Germany
| | - Frank B. Hu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Sarah E. Hunt
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Elina Hyppönen
- Centre For Paediatric Epidemiolgy and Biostatistics/MRC Centre of Epidemiology for Child Health, University College of London Institute of Child Health, London, UK
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, California 94612, USA
| | - Kevin B. Jacobs
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
- Core Genotyping Facility, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland 21702, USA
| | - John-Olov Jansson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Antti Jula
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Population Studies Unit, 20720 Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, 33520 Tampere, Finland
| | - Sekar Kathiresan
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI) Queens University, Belfast
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge CB2 2SR, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Wolfgang Koenig
- Department of Internal Medicine II – Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Aldi T. Kraja
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, 00271, Helsinki, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland, Kuopio Campus and Kuopio University Hospital, 70210 Kuopio, Finland
| | | | - Timo A. Lakka
- Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden
| | - Jaana Lindström
- National Institute for Health and Welfare, Diabetes Prevention Unit, 00271 Helsinki, Finland
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, Singapore 138672, Singapore
| | - Antonio Liuzzi
- Department of Internal Medicine, Istituto Auxologico Italiano, Verbania, Italy
| | - Marja-Liisa Lokki
- Transplantation Laboratory, Haartman Institute, University of Helsinki, 00014, Helsinki, Finland
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Pamela A. Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63108, USA
| | - Patrik K. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Paolo Manunta
- Università Vita-Salute San Raffaele, Chair of Nephrology San Raffaele Scientific Institute, OU Nephrology and Dialysis, 20132 Milan, Italy
| | - Diana Marek
- Department of Medical Genetics, University of Lausanne, 1005 Lausanne, Switzerland
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Winfried März
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
- Synlab Academy, Mannheim, Germany
| | - Irene Mateo Leach
- Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Barbara McKnight
- Departments of Biostatistics, University of Washington, Seattle, Washington 98195, USA
| | - Sarah E. Medland
- Queensland Institute of Medical Research, Brisbane 4029, Australia
| | - Evelin Mihailov
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu 51010, Estonia
| | - Lili Milani
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
| | | | - Vincent Mooser
- Genetics Division, GlaxoSmithKline, King of Prussia, Pennsylvania 19406, USA
| | - Thomas W. Mühleisen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Patricia B. Munroe
- Genome Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Arthur W. Musk
- School of Population Health, The University of Western Australia, Nedlands WA 6009, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia, 6009
- Busselton Population Medical Research Foundation Inc., Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia
| | - Narisu Narisu
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen
| | - George Nicholson
- MRC Harwell, Harwell, UK
- Department of Statistics, University of Oxford, Oxford OX1 3TG, UK
| | - Ellen A. Nohr
- Department of Public Health, Section of Epidemiology, Aarhus University, Denmark
| | - Ken K. Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- MRC Unit for Lifelong Health & Ageing, London, UK
| | - Ben A. Oostra
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
- Department of Clinical Genetics, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Centre for Medical Systems Biology & Netherlands Consortium on Healthy Aging, Leiden, the Netherlands
| | - Colin N.A. Palmer
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School. Dundee, DD1 9SY
| | - Aarno Palotie
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014, Helsinki, Finland
| | | | - Nancy Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Annette Peters
- Research Unit for Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Munich Heart Alliance, Munich, Germany
| | | | - Anneli Pouta
- Department of Clinical Sciences/Obstetrics and Gynecology, University of Oulu, 90014 Oulu, Finland
- National Institute for Health and Welfare, 90101 Oulu, Finland
| | - Peter P. Pramstaller
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano/Bozen, 39100, Italy - Affiliated Institute of the University of Lübeck, Lübeck, Germany
- Department of Neurology, General Central Hospital, Bolzano, Italy
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Inga Prokopenko
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LJ, UK
| | - Carolin Pütter
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Aparna Radhakrishnan
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
- NHS Blood and Transplant, Cambridge Centre, Cambridge, CB2 0PT, UK
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland
- The Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20520 Turku, Finland
| | - Augusto Rendon
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
- NHS Blood and Transplant, Cambridge Centre, Cambridge, CB2 0PT, UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Igor Rudan
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Timo E. Saaristo
- Finnish Diabetes Association, Kirjoniementie 15, 33680, Tampere, Finland
- Pirkanmaa Hospital District, Tampere, Finland
| | - Jennifer G. Sambrook
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
- NHS Blood and Transplant, Cambridge Centre, Cambridge, CB2 0PT, UK
| | - Alan R. Sanders
- University of Chicago, Chicago, Illinois 60637, USA
- Northshore University HealthSystem, Evanston, Illinois 60201, USA
| | - Serena Sanna
- Istituto di Ricerca Genetica e Biomedicadel del CNR, Monserrato, 09042, Cagliari, Italy
| | - Jouko Saramies
- South Karelia Central Hospital, 53130 Lappeenranta, Finland
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Schreiber
- Institute for Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany
| | - Heribert Schunkert
- Universität zu Lübeck, Medizinische Klinik II, 23538 Lübeck, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e. V. (DZHK), Universität zu Lübeck, 23538 Lübeck, Germany
| | - So-Youn Shin
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | | | - Juha Sinisalo
- Division of Cardiology, Cardiovascular Laboratory, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Boris Skrobek
- University Lille Nord de France, 59000 Lille, France
- CNRS UMR8199-IBL-Institut Pasteur de Lille, F-59000 Lille, France
| | - Nicole Soranzo
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, SE1 7EH, UK
| | - Alena Stančáková
- University of Eastern Finland and Kuopio University Hospital, 70210 Kuopio, Finland
| | - Klaus Stark
- Klinik und Poliklinik für Innere Medizin II, Universitätklinikum Regensburg, 93053 Regensburg, Germany
| | - Jonathan C. Stephens
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
- NHS Blood and Transplant, Cambridge Centre, Cambridge, CB2 0PT, UK
| | | | - Ronald P. Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Michael Stumvoll
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Amy J. Swift
- Genome Technology Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Eirini V. Theodoraki
- Department of Dietetics-Nutrition, Harokopio University, 70 El. Venizelou Str, Athens, Greece
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Elena Tremoli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Melanie M. Van der Klauw
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Joyce B.J. van Meurs
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Sita H. Vermeulen
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jorma Viikari
- Department of Medicine, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Jarmo Virtamo
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, 00271, Helsinki, Finland
| | - Veronique Vitart
- MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Gérard Waeber
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) University Hospital, 1011 Lausanne, Switzerland
| | - Zhaoming Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
- Core Genotyping Facility, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland 21702, USA
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014, Helsinki, Finland
| | - Sarah H. Wild
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Gonneke Willemsen
- Department of Biological Psychology, VU University Amsterdam, 1081 BT Amsterdam, The Netherlands
| | | | - Jacqueline C.M. Witteman
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Andrew Wong
- MRC Unit for Lifelong Health & Ageing, London, UK
| | - Alan F. Wright
- MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - M. Carola Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Philippe Amouyel
- Institut Pasteur de Lille, INSERM U744, Université Lille Nord de France, F-59000 Lille, France
| | - Bernhard O. Boehm
- Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, Ulm, Germany
| | - Eric Boerwinkle
- Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, Texas 77030, USA
| | - Dorret I. Boomsma
- Department of Biological Psychology, VU University Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Mark J. Caulfield
- Genome Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | - Daniele Cusi
- University of Milan, Department of Health Sciences, Ospedale San Paolo, 20139 Milano, Italy
- Fondazione Filarete, Milano, Italy
| | - George V. Dedoussis
- Department of Dietetics-Nutrition, Harokopio University, 70 El. Venizelou Str, Athens, Greece
| | - Jeanette Erdmann
- Universität zu Lübeck, Medizinische Klinik II, 23538 Lübeck, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e. V. (DZHK), Universität zu Lübeck, 23538 Lübeck, Germany
| | - Johan G. Eriksson
- Department of General Practice and Primary health Care, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, 00271 Helsinki, Finland
- Helsinki University Central Hospital, Unit of General Practice, 00280 Helsinki, Finland
| | - Paul W. Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Philippe Froguel
- University Lille Nord de France, 59000 Lille, France
- CNRS UMR8199-IBL-Institut Pasteur de Lille, F-59000 Lille, France
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, W12 0NN, London, UK
| | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Christian Hengstenberg
- Klinik und Poliklinik für Innere Medizin II, Universitätklinikum Regensburg, 93053 Regensburg, Germany
| | - Andrew A. Hicks
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano/Bozen, 39100, Italy - Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - Aroon Hingorani
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, 45147 Essen, Germany
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Kees G. Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Thomas Illig
- Research Unit for Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Hannover Unified Biobank, Hannover Medical School, 30625 Hannover, Germany
| | - Marjo-Riitta Jarvelin
- National Institute for Health and Welfare, 90101 Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
- Institute of Health Sciences, University of Oulu, 90014 Oulu, Finland
- Biocenter Oulu, University of Oulu, 90014 Oulu, Finland
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Sirkka M. Keinanen-Kiukaanniemi
- Institute of Health Sciences, University of Oulu, 90014 Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Lambertus A. Kiemeney
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
- Department of Urology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
- Comprehensive Cancer Center East, 6501 BG Nijmegen, The Netherlands
| | - Diana Kuh
- MRC Unit for Lifelong Health & Ageing, London, UK
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland, Kuopio Campus and Kuopio University Hospital, 70210 Kuopio, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, University of Tampere and Tampere University Hospital, 33520 Tampere, Finland
| | | | | | - Andres Metspalu
- Estonian Genome Center, University of Tartu, Tartu 50410, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu 51010, Estonia
| | - Andrew D. Morris
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School. Dundee, DD1 9SY
| | - Markku S. Nieminen
- Division of Cardiology, Cardiovascular Laboratory, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Inger Njølstad
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Albertine J. Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Willem H. Ouwehand
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
- NHS Blood and Transplant, Cambridge Centre, Cambridge, CB2 0PT, UK
| | - Lyle J. Palmer
- Genetic Epidemiology and Biostatistics Platform, Ontario Institute for Cancer Research. Toronto, Canada, M5G 1L7
- Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Toronto, Canada, M5G 1X5
| | - Brenda Penninx
- Department of Psychiatry, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
| | - Chris Power
- Centre For Paediatric Epidemiolgy and Biostatistics/MRC Centre of Epidemiology for Child Health, University College of London Institute of Child Health, London, UK
| | - Michael A. Province
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
- Departments of Epidemiology, Medicine and Health Services, University of Washington, Seattle, Washington 98195, USA
- Group Health Research Institute, Group Health, Seattle, Washington 98101, USA
| | - Lu Qi
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02215, USA
- Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Samuli Ripatti
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Unit of Public Health Genomics, 00014, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, 00271, Helsinki, Finland
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
- LifeLines Cohort Study, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Thorkild I.A. Sørensen
- Institute of Preventive Medicine, Bispebjerg University Hospital, Copenhagen, and Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Timothy D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, SE1 7EH, UK
| | - Kari Stefansson
- deCODE Genetics, 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavík, Iceland
| | - Anke Tönjes
- Department of Medicine, University of Leipzig, 04103 Leipzig, Germany
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Jaakko Tuomilehto
- National Institute for Health and Welfare, Diabetes Prevention Unit, 00271 Helsinki, Finland
- Red RECAVA Grupo RD06/0014/0015, Hospital Universitario La Paz, 28046 Madrid, Spain
- Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria
- South Ostrobothnia Central Hospital, 60220 Seinajoki, Finland
| | - André G. Uitterlinden
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
- Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Pim van der Harst
- Department of Genetics, University Medical Center Groningen, University of Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Peter Vollenweider
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) University Hospital, 1011 Lausanne, Switzerland
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - Hugh Watkins
- Cardiovascular Medicine, University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford, OX3 7BN, UK
| | - H.-Erich Wichmann
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Klinikum Grosshadern, Munich, Germany
| | - James F. Wilson
- Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Goncalo R. Abecasis
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Themistocles L. Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- University of Cambridge Metabolic Research Labs, Institute of Metabolic Science Addenbrooke’s Hospital, CB2 OQQ, Cambridge, UK
| | - Michael Boehnke
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Ingrid B. Borecki
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Panos Deloukas
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Caroline S. Fox
- Division of Intramural Research, National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, Massachusetts 01702, USA
| | - Timothy Frayling
- Genetics of Complex Traits, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, EX1 2LU, UK
| | - Leif C. Groop
- Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden
| | - Talin Haritunian
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
| | - Iris M. Heid
- Public Health and Gender Studies, Institute of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - David Hunter
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LJ, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Old Road Headington, Oxford, OX3 7LJ, UK
| | - Miriam Moffatt
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Karen L. Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Jeffrey R. O’Connell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Eric E. Schadt
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1498, New York, NY 10029-6574 USA
- Institute of Genomics and Multiscale Biology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1498, New York, NY 10029-6574 USA
| | - David Schlessinger
- Laboratory of Genetics, National Institute on Aging, Baltimore, Maryland 21224, USA
| | | | - David P. Strachan
- Division of Population Health Sciences and Education, St George’s, University of London, London, SW17 0RE, UK
| | - Unnur Thorsteinsdottir
- deCODE Genetics, 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavík, Iceland
| | - Cornelia M. van Duijn
- Department of Epidemiology, Erasmus MC, Rotterdam, 3015GE, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA)
- Center of Medical Systems Biology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Peter M. Visscher
- The Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
| | | | - Joel N. Hirschhorn
- Divisions of Genetics and Endocrinology and Center for Basic and Translational Obesity Research, Children’s Hospital, Boston, Massachusetts 02115, USA
- Metabolism Initiative and Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts 02142, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Cecilia M. Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Andrew P. Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - David Meyre
- University Lille Nord de France, 59000 Lille, France
- CNRS UMR8199-IBL-Institut Pasteur de Lille, F-59000 Lille, France
- Department of Clinical Epidemiology and Biostatistics, McMasterUniversity, Hamilton, Ontario L8S 4L8, Canada
| | - André Scherag
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LJ, UK
- Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Old Road Headington, Oxford, OX3 7LJ, UK
| | - Elizabeth K. Speliotes
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kari E. North
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA
| | - Ruth J.F. Loos
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- The Charles Bronfman Institute of Personalized Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
- The Mindich Child Health and Development Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
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Sattler MG, van Beek AP, Wolffenbuttel BH, van den Berg G, Sluiter WJ, Langendijk JA, van den Bergh AC. The incidence of second tumours and mortality in pituitary adenoma patients treated with postoperative radiotherapy versus surgery alone. Radiother Oncol 2012; 104:125-30. [DOI: 10.1016/j.radonc.2012.04.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 11/30/2022]
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Dolfing JG, Stassen CM, van Haard PM, Wolffenbuttel BH, Schweitzer DH. Comparison of MRI-assessed body fat content between lean women with polycystic ovary syndrome (PCOS) and matched controls: less visceral fat with PCOS. Hum Reprod 2011; 26:1495-500. [DOI: 10.1093/humrep/der070] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Voorham J, Haaijer-Ruskamp FM, Wolffenbuttel BH, Stolk RP, Denig P. Medication Adherence Affects Treatment Modifications in Patients With Type 2 Diabetes. Clin Ther 2011; 33:121-34. [DOI: 10.1016/j.clinthera.2011.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2010] [Indexed: 11/30/2022]
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de Jong WH, de Vries EG, Wolffenbuttel BH, Kema I. Automated mass spectrometric analysis of urinary free catecholamines using on-line solid phase extraction. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:1506-12. [DOI: 10.1016/j.jchromb.2010.03.050] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 03/19/2010] [Accepted: 03/31/2010] [Indexed: 11/27/2022]
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Schokker MC, Links TP, Bouma J, Keers JC, Sanderman R, Wolffenbuttel BH, Hagedoorn M. The role of overprotection by the partner in coping with diabetes: A moderated mediation model. Psychol Health 2010; 26:95-111. [DOI: 10.1080/08870440903342325] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marike C. Schokker
- a Health Psychology Section, Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - Thera P. Links
- b Department of Endocrinology , University Medical Center Groningen, Groningen, University of Groningen , The Netherlands
| | - Jelte Bouma
- a Health Psychology Section, Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - Joost C. Keers
- b Department of Endocrinology , University Medical Center Groningen, Groningen, University of Groningen , The Netherlands
| | - Robbert Sanderman
- a Health Psychology Section, Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - Bruce H.R. Wolffenbuttel
- b Department of Endocrinology , University Medical Center Groningen, Groningen, University of Groningen , The Netherlands
| | - Mariët Hagedoorn
- a Health Psychology Section, Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
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van Beek AP, van den Bergh AC, van den Berg LM, van den Berg G, Keers JC, Langendijk JA, Wolffenbuttel BH. In Response to Dr. Klein et al. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2007.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Persoon AC, Jager PL, Sluiter WJ, Plukker JT, Wolffenbuttel BH, P. Links T. A sensitive Tg assay or rhTSH stimulated Tg: what's the best in the long-term follow-up of patients with differentiated thyroid carcinoma? PLoS One 2007; 2:e816. [PMID: 17726546 PMCID: PMC1950687 DOI: 10.1371/journal.pone.0000816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 07/18/2007] [Indexed: 11/18/2022] Open
Abstract
Sensitivity of thyroglobulin (Tg) measurement in the follow-up of differentiated thyroid carcinoma (DTC) can be optimized by using a sensitive Tg assay and rhTSH stimulation. We evaluated the diagnostic yield of a sensitive Tg assay and rhTSH stimulated Tg in the detection of recurrences in the follow-up of DTC. Additionally the value of imaging techniques for the localization of recurrences was evaluated. We included 121 disease free patients in long-term follow-up for DTC (median 10 years, range 1-34). Tg during thyroid hormone suppression therapy (Tg-on) and rhTSH stimulated Tg were measured with a sensitive Tg assay. Patients with rhTSH stimulated Tg > or =1.0 ng/ml underwent imaging with neck ultrasound, FDG-PET and post therapy 131I WBS. Sensitive Tg measurement resulted in 3 patients with Tg-on > or =1.0 ng/ml, recurrence could be localized in 2 of them. RhTSH stimulation resulted in Tg > or =1.0 ng/ml in another 17 of 118 patients. Recurrence could be localized in only 1 additional patient (1 out of 118 patients). Recurrence was localized by neck ultrasound in 1 of 3, by FDG-PET in 2 of 3 and by post therapy 131I WBS in 2 of 3 patients. In the detection of recurrences in DTC, rhTSH stimulation had very limited additional value in comparison to Tg-on measurement with a sensitive Tg assay. We consider this too low to justify rhTSH stimulation in all patients during long-term follow up. Neck ultrasound, FDG-PET and post therapy 131I WBS showed complementary value in localization of disease, but were only positive in a small fracture of all procedures.
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Affiliation(s)
- Adrienne C.M. Persoon
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Pieter L. Jager
- Department of Nuclear Medicine, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Wim J. Sluiter
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - John T.M. Plukker
- Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Thera P. Links
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, The Netherlands
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Abstract
Background In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Objective Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? Theory The theoretical framework is based on the concept of the learning organisation. Design Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. Results In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. Conclusion Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.
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Affiliation(s)
- I M Eijkelberg
- Faculty of Health Sciences, Department of Health Organisation, Policy and Economics, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Rennenberg RJ, Bravenboer B, Wolffenbuttel BH. [Empty sella syndrome as the cause of panhypopituitarism]. Ned Tijdschr Geneeskd 2004; 148:33-6. [PMID: 14750453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
In two patients, men aged 78 and 42 years respectively, an empty-sella syndrome was found. The first patient presented with chronic fatigue, in the second the empty sella was the late result of prior neurosurgery followed by external irradiation. Both suffered from panhypopituitarism. In both cases the diagnosis was confirmed following laboratory tests and MRI. Hormone-replacement therapy was found to provide adequate treatment. The course of the empty-sella syndrome is usually benign and with adequate hormone-replacement therapy a good quality of life is maintained.
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Affiliation(s)
- R J Rennenberg
- Academisch Ziekenhuis, afd. Interne Geneeskunde, Postbus 5800, 6202 AZ Maastricht.
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de Clercq PA, Hasman A, Wolffenbuttel BH. Design of a consumer health record for supporting the patient-centered management of chronic diseases. Stud Health Technol Inform 2002; 84:1445-9. [PMID: 11604965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This paper describes and discusses the design and usage of a shareable consumer health record system to investigate whether these systems can assist in the management of chronic diseases. This web-based system that can be used both by care providers and patients contains medical and patient information, provides access to websites that contain quality information, provides guideline-based advice, allows discussion between patients and allows us to interrogate both patients and care providers on a regular basis in order to get a good impression of the utility of such a consumer record for both chronic patients and the physicians and nurses. A health record system that was developed for the area of Diabetes is presented as an example.
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Affiliation(s)
- P A de Clercq
- Department of Medical Informatics, University of Maastricht, Maastricht, The Netherlands.
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25
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Abstract
Patients with acromegaly, who are not cured after transsphenoidal adenomectomy, may be treated with external irradiation and/or octreotide injections. Recently, a long-acting formulation of octreotide (Sandostatin LAR has become available in clinical practice. We assessed the effects of treatment with this long-acting octreotide in 18 consecutive patients with acromegaly treated in our center, who had persistent signs and symptoms of acromegaly despite transsphenoidal surgery with (n=7) or without irradiation (n=11). Twelve had already been treated with regular Sandostatin for a period of 0.5-8 years in dosages of 3 x 50 to 3 x 300 mcg s.c. (median daily dose 300 mcg). All patients started with i.m. injections of 20 mg Sandostatin LAR every 4 weeks. In the patients who started treatment with octreotide for the first time, mean serum IGF-1 levels (measured by IRMA, Nichols Diagnostics) decreased from 634+/-229 to 255+/-88 ng/ml after 3 months, 271+/-81 ng/ml after 1 year and 263+/-97 ng/ml after 2 years (all P<0.05), while random GH levels (DELFIA, Wallac) decreased from 6.6 (range 3.1-67.0) to 2.1 (0.5-3.1) mU/l after 2 years (P<0.05). In the 12 patients who had already been treated with octreotide, mean IGF-1 also fell, from 367+/-193 to 331+/-195 ng/ml (P=0.023) after 3 months, to 342+/-191 ng/ml after 1 year and 277+/-169 ng/ml (P=0.002) after 2 years, while random GH levels decreased from 4.5 (1.1-46) mU/l at baseline to 2.1 (0.4-23.0) after 2 years (P=0.003). Therefore, the average decrease of IGF-1 was 10% after 3 months and 25% after 2 years. One patient had a decrease of less than 5% (but her IGF-1 was normal, 193 ng/ml), and one patient showed no response to both regular and long-acting Sandostatin (ave. IGF-1, 755 ng/ml). No specific side-effects occurred. One patient chose to return to t.i.d. injection of regular octreotide because of slight worsening of her complaints of headache despite normal IGF-1 levels. All other patients favoured continuation of the monthly injections. In six patients, the dose had to be increased to 30-40 mg monthly because the IGF-1 levels still remained elevated. Sandostatin LAR may be considered a great improvement for the treatment of patients with (symptomatic) acromegaly.
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Affiliation(s)
- C A Heijckmann
- Department of Endocrinology, University Hospital Maastricht, P.O. Box 5800, NL-6202 AZ Maastricht, The Netherlands
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Vrijhoef HJ, Diederiks JP, Spreeuwenberg C, Wolffenbuttel BH. Substitution model with central role for nurse specialist is justified in the care for stable type 2 diabetic outpatients. J Adv Nurs 2001; 36:546-55. [PMID: 11703549 DOI: 10.1046/j.1365-2648.2001.02007.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM OF THE STUDY Assessment of effects on quality of care, in terms of patient outcomes, when tasks in the care for outpatients with stable type 2 diabetes are transferred from internist to nurse specialist and from outpatient clinic to general practice. BACKGROUND For the management of chronic diseases with a high prevalence and requiring current monitoring, it is suggested that substitution of care may be an appropriate solution to safeguard high quality care. DESIGN AND METHODS A 12-month nonequivalent control group design was used. General practitioners (GPs) referring diabetes patients to the University Hospital Maastricht were asked to choose for the traditional model or the nurse specialist model. Informed consent was obtained from patients with stable diabetes type 2 attending these practices. All patients received care according to the model chosen by their GP. Identified outcomes were: clinical status, health status, self-care behaviour, knowledge of diabetes, patient satisfaction, and consultation with care-providers. RESULTS In the control group (n=47) no patients were treated with oral hypoglycaemic agents (OHA) only. The control group was compared with an intervention subgroup (n=52) also without patients receiving OHA only. Clinical data were available for all patients. Patients without complete data from questionnaires had better mean concentration of HbA1c than patients with complete data (P=0.004). The traditional care model and the nurse specialist model achieved equal outcomes, while glycaemic control of patients in the nurse specialist model improved (from 8.6% to 8.3%) but deteriorated in the traditional model (from 8.6% to 8.8%; P-value between groups=0.001). CONCLUSIONS The model with nurse specialists taking on roles and tasks beyond those traditionally regarded as their remit as well as new ones, is effective for the care of stable diabetic outpatients.
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Affiliation(s)
- H J Vrijhoef
- Health Care Studies, Faculty of Health Science, University Maastricht, Maastricht, The Netherlands.
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Vrijhoef HJ, Spreeuwenberg C, Eijkelberg IM, Wolffenbuttel BH, van Merode GG. Adoption of disease management model for diabetes in region of Maastricht. BMJ 2001; 323:983-5. [PMID: 11679390 PMCID: PMC1121511 DOI: 10.1136/bmj.323.7319.983] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- H J Vrijhoef
- Department of Health Care Studies, Faculty of Health Sciences, University of Maastricht, The Netherlands.
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Abstract
CONTEXT Type 2 diabetes is a growing clinical and public health problem. Preventive efforts related to lifestyle modification are not always successful; therefore, alternative prevention strategies need to be studied. OBJECTIVE To investigate the effectiveness of ramipril, an angiotensin-converting enzyme inhibitor, in preventing diabetes among high-risk persons. DESIGN, SETTING, AND PARTICIPANTS The randomized, controlled Heart Outcomes Prevention Evaluation trial of 5720 patients older than 55 years without known diabetes but with vascular disease who were followed up for a mean of 4.5 years. The study included 267 hospitals in 19 countries and was conducted between 1994 and 1999. INTERVENTION Patients were randomly assigned to receive ramipril, up to 10 mg/d (n = 2837), or placebo (n = 2883). MAIN OUTCOME MEASURE Diagnosis of diabetes determined from self-report at follow-up visits every 6 months, compared between the 2 groups. RESULTS One hundred and two individuals (3.6%) in the ramipril group developed diabetes compared with 155 (5.4%) in the placebo group (relative risk [RR], 0.66; 95% confidence interval [CI], 0.51-0.85, P<.001). Similar results were noted when different diagnostic criteria were used; in the ramipril group, the RR for diagnosis of diabetes and hemoglobin A(1c) greater than 110% was 0.60 (95% CI, 0.43-0.85), for initiation of glucose-lowering therapy, 0.56 (95% CI, 0.41-0.77), and for both, 0.51 (95% CI, 0.34-0.76). These effects were also consistently seen in several subgroups examined. CONCLUSIONS Ramipril is associated with lower rates of new diagnosis of diabetes in high-risk individuals. Because these results have important clinical and public health implications, this hypothesis requires prospective confirmation.
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Affiliation(s)
- S Yusuf
- Canadian Cardiovascular Collaboration Project Office, Hamilton General Hospital, 237 Barton St East, Hamilton, Ontario, Canada L8L 2X2.
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Oranje WA, Sels JP, Rondas-Colbers GJ, Lemmens PJ, Wolffenbuttel BH. Effect of atorvastatin on LDL oxidation and antioxidants in normocholesterolemic type 2 diabetic patients. Clin Chim Acta 2001; 311:91-4. [PMID: 11566168 DOI: 10.1016/s0009-8981(01)00549-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Oxidative stress in diabetes increases lipid peroxidation, which stimulates the development of atherosclerosis. METHODS We investigated in a 3-month placebo-controlled study with 19 normocholesterolemic type 2 diabetic patients whether treatment with 10-mg atorvastatin influenced antioxidants and reduced LDL oxidizability, assessed by in vitro production of conjugated dienes after copper-induced LDL oxidation. RESULTS The lag phase, as a measure of the resistance of LDL to oxidation, did not change (62.8+/-8.2 respectively 59.6+/-9.7 min, p=n.s.), while conjugated dienes decreased (512+/-74 respectively 487+/-50 nmol, p=0.012). Plasma alpha-tocopherol and ubiquinol levels decreased, while their ratios to LDL cholesterol remained stable. CONCLUSIONS Atorvastatin favourably influences some parameters of LDL oxidation. Whether this effect is clinically relevant remains to be determined.
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Affiliation(s)
- W A Oranje
- Department of Endocrinology and Metabolism, University Hospital Maastricht, Maastricht, The Netherlands.
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30
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Wolffenbuttel BH, Elving LD, Maassen JA, Bravenboer B, Hoekstra JB. -to: Waldhäusl W (2001) Editorial: Finally we have arrived in a new millennium. Diabetologia 44: 1-2. Diabetologia 2001; 44:923. [PMID: 11508280 DOI: 10.1007/pl00002963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wolffenbuttel BH, Huijberts MS. [Disorders of lipid metabolism in 3 patients with diabetes mellitus type 2]. Ned Tijdschr Geneeskd 2001; 145:761-5. [PMID: 11346911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Three patients with diabetes mellitus (type 2) and cardiovascular disease had disturbed lipid concentrations: two women aged 60 and 73 years and one man aged 47 years. The lipid levels were normalised during the 9-18 years of treatment with medication and in this period the patients experienced no cardiovascular events. Disturbances in plasma lipid levels play a major role in the increased risk of cardiovascular disease in patients with diabetes mellitus (type 2). Cholesterol-lowering treatment should be aggressive and based on the lipid profile. Statins reduce cardiovascular events by lowering the concentration of both the total cholesterol and low-density lipoprotein cholesterol whereas fibrates reduce cardiovascular events by increasing high-density lipoprotein cholesterol concentrations and lowering triglyceride concentrations.
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Affiliation(s)
- B H Wolffenbuttel
- Academisch Ziekenhuis, afd. Endocrinologie, Postbus 5800, 6202 AZ Maastrict.
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Blaak EE, Wolffenbuttel BH, Saris WH, Pelsers MM, Wagenmakers AJ. Weight reduction and the impaired plasma-derived free fatty acid oxidation in type 2 diabetic subjects. J Clin Endocrinol Metab 2001; 86:1638-44. [PMID: 11297597 DOI: 10.1210/jcem.86.4.7397] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In a previous study the oxidation of plasma free fatty acids (FFA) under baseline conditions and during exercise was lower in type 2 diabetic subjects compared with weight-matched controls. The present study intended to investigate the effect of weight reduction (very low calorie diet) on plasma FFA oxidation in seven type 2 diabetic male subjects (body fat, 37.4 +/- 1.2%; age, 51.3 +/- 3.4 yr; plasma glucose, 7.45 +/- 0.48 mmol/L). Subjects underwent a 10-week diet period. Body composition and substrate utilization during rest and during bicycle exercise (50% of maximum aerobic capacity) were determined before and after the diet (during weight-stable conditions). FFA metabolism was studied by means of the tracer [U-(13)C]palmitate. Rates of oxidation of plasma FFA were corrected with an acetate recovery factor. Additionally, activities of mitochondrial enzymes and cytosolic fatty acid-binding protein were determined in biopsies from the vastus lateralis muscle before and after the diet. The very low calorie diet resulted in a weight loss of 15.3 kg (110.8 +/- 7.4 vs. 95.5 +/- 5.8 kg; P < 0.01). The basal rates of appearance and disappearance of FFA decreased as a result of diet. The rates of appearance and disappearance of FFA during exercise were not different before and after diet. The oxidation of plasma-derived fatty acids tended to decrease after diet during baseline conditions (P = 0.10), whereas the plasma FFA oxidation during exercise was not different before and after the diet (14.1 +/- 1.9 vs. 14.8 +/- 1.8 micromol/kg fat-free mass.min). Skeletal muscle cytosolic fatty acid-binding protein and the activities of muscle oxidative enzymes did not significantly change as a result of weight loss. In conclusion, considerable weight reduction did not significantly improve plasma-derived FFA oxidation under baseline conditions and during exercise, suggesting that this impairment reflects a primary defect leading to the development of type 2 diabetes mellitus rather than resulting from the type 2 diabetic state.
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Affiliation(s)
- E E Blaak
- Department of Human Biology, Nutrition Research Center, Maastricht University, 6200 MD Maastricht, The Netherlands.
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Abstract
Type 2 diabetes mellitus is characterised by impaired insulin secretion, diminished peripheral insulin action and increased hepatic glucose production. Clinical trials have indicated that near-normal glucose control may reduce the risk for microvascular and - to a lesser extent - macrovascular complications in Type 2 diabetic patients. Thiazolidinediones improve insulin action by activating a nuclear receptor, PPARgamma. Therefore, these drugs are often referred to as 'insulin sensitisers'. Rosiglitazone is the second compound of this group. Clinical studies with rosiglitazone have shown that it is effective in lowering blood glucose levels in Type 2 diabetic patients treated with either diet alone, sulphonylurea or metformin. Preliminary studies suggest that rosiglitazone also improves glycaemic control in insulin-treated patients while even slightly decreasing insulin dose. The magnitude of the effects is, however, moderate. In diet-treated patients, the reduction of HbA1c levels amounted on average 0.5 - 1.5% and addition to existing sulphonylurea therapy decreased HbA1c by 1.0 - 1.2%. The clinical relevance of additional beneficial effects, i.e., on blood pressure and microalbuminuria, needs to be determined further. Rosiglitazone does not cause hypoglycaemia or gastrointestinal side effects. There is however some concern related to fluid retention, which seems to be an effect of all PPARgamma agonists. In patients treated with rosiglitazone, no severe hepatotoxic side effects have been noticed until now. In the treatment of our patients with Type 2 diabetes, drugs like rosiglitazone which directly reduce insulin resistance are very welcome but more data on its combined use with insulin are needed. Additional studies will also explore its long-term effects in sparing beta-cell function and reducing diabetes-related complications and atherosclerosis.
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Affiliation(s)
- B H Wolffenbuttel
- Dept. of Endocrinology & Metabolism, University Hospital Maastricht, P.O. Box 5800, NL-6202 AZ Maastricht, The Netherlands.
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Kopff B, Mucha S, Wolffenbuttel BH, Drzewoski J. Diabetic ketoacidosis in a patient with acromegaly. Med Sci Monit 2001; 7:142-7. [PMID: 11208511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Abnormalities of glucose metabolism are a common feature of acromegaly. Overt diabetes mellitus develops in about 10-15% of patients. We present an unusual complication of acromegaly: a 37-year old man with a 2-year history of acromegaly developed diabetic ketoacidosis 3 weeks after transsphenoidal adenomectomy. No specific cause for this sudden metabolic derangement could be demonstrated. Insulin need was very high in the first days after the onset of ketoacidosis, but was considerably reduced after initiation of treatment with octreotide and after successful re-operation.
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Affiliation(s)
- B Kopff
- Department of Metabolic Diseases and Gastroenterology, Medical University of Łódź, ul. Kopcinskiego 22, 90-153 Łódź, Poland
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Lauritzen T, Griffin S, Borch-Johnsen K, Wareham NJ, Wolffenbuttel BH, Rutten G. The ADDITION study: proposed trial of the cost-effectiveness of an intensive multifactorial intervention on morbidity and mortality among people with Type 2 diabetes detected by screening. Int J Obes (Lond) 2000; 24 Suppl 3:S6-11. [PMID: 11063279 DOI: 10.1038/sj.ijo.0801420] [Citation(s) in RCA: 197] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The overall aims of the ADDITION study are to evaluate whether screening for prevalent undiagnosed Type 2 diabetes is feasible, and whether subsequent optimised intensive treatment of diabetes, and associated risk factors, is feasible and beneficial. DESIGN Population-based screening in three European countries followed by an open, randomised controlled trial. SUBJECTS AND METHODS People aged 40-69 y in the community, without known diabetes, will be offered a random capillary blood glucose screening test by their primary care physicians, followed, if equal to or greater than 5.5 mmol/l, by fasting and 2-h post-glucose-challenge blood glucose measurements. Three thousand newly diagnosed patients will subsequently receive conventional treatment (according to current national guidelines) or intensive multifactorial treatment (lifestyle advice, prescription of aspirin and ACE-inhibitors, in addition to protocol-driven tight control of blood glucose, blood pressure and cholesterol). Patients allocated to intensive treatment will be further randomised to centre-specific interventions to motivate adherence to lifestyle changes and medication. Duration of follow-up is planned for 5 y. Endpoints will include mortality, macrovascular and microvascular complications, patient health status and satisfaction, process-of-care indicators and costs.
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Affiliation(s)
- T Lauritzen
- Department of General Practice, University of Aarhus, Denmark
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Blaak EE, Wagenmakers AJ, Glatz JF, Wolffenbuttel BH, Kemerink GJ, Langenberg CJ, Heidendal GA, Saris WH. Plasma FFA utilization and fatty acid-binding protein content are diminished in type 2 diabetic muscle. Am J Physiol Endocrinol Metab 2000; 279:E146-54. [PMID: 10893334 DOI: 10.1152/ajpendo.2000.279.1.e146] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, we investigated the hypothesis that impairments in forearm skeletal muscle free fatty acid (FFA) metabolism are present in patients with type 2 diabetes both in the overnight fasted state and during beta-adrenergic stimulation. Eight obese subjects with type 2 diabetes and eight nonobese controls (Con) were studied using the forearm balance technique and indirect calorimetry during infusion of the stable isotope tracer [U-(13)C]palmitate after an overnight fast and during infusion of the nonselective beta-agonist isoprenaline (Iso, 20 ng. kg lean body mass(-1) x min(-1)). Additionally, activities of mitochondrial enzymes and of cytoplasmatic fatty acid-binding protein (FABP) were determined in biopsies from the vastus lateralis muscle. Both during fasting and Iso infusion, the tracer balance data showed that forearm muscle FFA uptake (Con vs. type 2: fast 449+/-69 vs. 258 +/-42 and Iso 715+/-129 vs. 398+/-70 nmol. 100 ml tissue(-1) x min(-1), P<0.05) and FFA release were lower in type 2 diabetes compared with Con. Also, the oxidation of plasma FFA by skeletal muscle was blunted during Iso infusion in type 2 diabetes (Con vs. type 2: Iso 446 +/- 274 vs. 16+/-70 nmol. 100 ml tissue(-1) x min(-1), P<0.05). The net forearm glycerol release was increased in type 2 diabetic subjects (P< 0.05), which points to an increased forearm lipolysis. Additionally, skeletal muscle cytoplasmatic FABP content and the activity of muscle oxidative enzymes were lowered in type 2 diabetes. We conclude that the uptake and oxidation of plasma FFA are impaired in the forearm muscles of type 2 diabetic subjects in the overnight fasted state with and without Iso stimulation.
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Affiliation(s)
- E E Blaak
- Department of Human Biology, Maastricht University and Academic Hospital, 6200 MD Maastricht, The Netherlands
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van Maanen JM, Albering HJ, de Kok TM, van Breda SG, Curfs DM, Vermeer IT, Ambergen AW, Wolffenbuttel BH, Kleinjans JC, Reeser HM. Does the risk of childhood diabetes mellitus require revision of the guideline values for nitrate in drinking water? Environ Health Perspect 2000; 108:457-61. [PMID: 10811574 PMCID: PMC1638059 DOI: 10.1289/ehp.00108457] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In recent years, several studies have addressed a possible relationship between nitrate exposure and childhood type 1 insulin-dependent diabetes mellitus. The present ecologic study describes a possible relation between the incidence of type 1 diabetes and nitrate levels in drinking water in The Netherlands, and evaluates whether the World Health Organization and the European Commission standard for nitrate in drinking water (50 mg/L) is adequate to prevent risk of this disease. During 1993-1995 in The Netherlands, 1,104 cases of type 1 diabetes were diagnosed in children 0-14 years of age. We were able to use 1,064 of these cases in a total of 2,829,020 children in this analysis. We classified mean nitrate levels in drinking water in 3,932 postal code areas in The Netherlands in 1991-1995 into two exposure categories. One category was based on equal numbers of children exposed to different nitrate levels (0.25-2.08, 2.10-6.42, and 6.44-41.19 mg/L nitrate); the other was based on cut-off values of 10 and 25 mg/L nitrate. We determined standardized incidence ratios (SIRs) for type 1 diabetes in subgroups of the 2,829,020 children with respect to both nitrate exposure categories, sex, and age and as compared in univariate analysis using the chi-square test for trend. We compared the incidence rate ratios (IRRs) by multivariate analysis in a Poisson regression model. We found an effect of increasing age of the children on incidence of type 1 diabetes, but we did not find an effect of sex or of nitrate concentration in drinking water using the two exposure categories. For nitrate levels > 25 mg/L, an increased SIR and an increased IRR of 1.46 were observed; however, this increase was not statistically significant, probably because of the small number of cases (15 of 1,064). We concluded that there is no convincing evidence that nitrate in drinking water at current exposure levels is a risk factor for childhood type 1 diabetes mellitus in The Netherlands, although a threshold value > 25 mg/L for the occurrence of this disease can not be excluded.
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Affiliation(s)
- J M van Maanen
- Department of Health Risk Analysis and Toxicology, Faculty of Health Sciences, University of Maastricht, Maastricht, The Netherlands.
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38
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Abstract
Two patients, one with insulinoma and one with Cushing's syndrome, are presented. Biochemical evaluation readily suggested the correct diagnosis. During radiologic imaging, the anatomic abnormality giving rise to these diseases, i.e. a pancreatic islet cell tumor, and an adrenal adenoma, at first were mistakenly interpreted as an accessory spleen on the basis of specific computed tomography and magnetic resonance imaging appearances. The insulinoma was identified as such during laparotomy, whereas additional jodo-cholesterol scintigraphy revealed the real nature of the lesion in the patient with Cushing's syndrome. Both patients were operated successfully.
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Affiliation(s)
- J P Sels
- Department of Endocrinology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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39
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Wolffenbuttel BH, Gomis R, Squatrito S, Jones NP, Patwardhan RN. Addition of low-dose rosiglitazone to sulphonylurea therapy improves glycaemic control in Type 2 diabetic patients. Diabet Med 2000; 17:40-7. [PMID: 10691158 DOI: 10.1046/j.1464-5491.2000.00224.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS This study was designed to test the efficacy and safety of low-dose rosiglitazone, a potent, insulin-sensitizing thiazolidinedione, in combination with sulphonylurea in Type 2 diabetic patients. METHODS For the intention-to-treat analysis, 574 patients (59% male, mean age 61 years) were available, randomized to receive 26 weeks of twice-daily placebo (n = 192), rosiglitazone 1 mg (n = 199) or rosiglitazone 2 mg (n = 183) in addition to existing sulphonylurea treatment with gliclazide (47.6% of patients), glibenclamide (41.8%) or glipizide (9.4%) (two patients were taking carbutamide or glimepiride). Change in haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), fructosamine, insulin, C-peptide, albumin, and lipids were measured, and safety was evaluated. RESULTS Mean baseline HbA1c was 9.2% and FPG was 11.4 mmol/l. Rosiglitazone at doses of 1 and 2 mg b.d. plus sulphonylurea produced significant decreases, compared with sulphonylurea plus placebo, in HbA1c (-0.59% and -1.03%, respectively; both P<0.0001) and FPG (1.35 mmol/l and 2.44 mmol/l, respectively; both P<0.0001). Both HDL-cholesterol and LDL-cholesterol increased and potentially beneficial decreases in non-esterified fatty acids and gamma glutamyl transpeptidase levels were seen in both rosiglitazone groups. The overall incidence of adverse experiences was similar in all three treatment groups, with no significant cardiac events, hypoglycaemia or hepatotoxicity. CONCLUSIONS Overall, the combination of rosiglitazone and a sulphonylurea was safe, well tolerated and effective in patients with Type 2 diabetes.
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40
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Oranje WA, Rondas-Colbers GJ, Swennen GN, Jansen H, Wolffenbuttel BH. Lack of effect on LDL oxidation and antioxidant status after improvement of metabolic control in type 2 diabetes. Diabetes Care 1999; 22:2083-4. [PMID: 10587847 DOI: 10.2337/diacare.22.12.2083] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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41
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Abstract
Type 2 diabetes mellitus is a heterogeneous disorder characterised by defects in insulin secretion as well as reduced insulin action. During aging, glucose intolerance will gradually develop, and this is manifested primarily by an increase in the postprandial blood glucose response while fasting blood glucose levels are often less elevated. Abnormal beta-cell secretion of insulin is a main feature of this. Treatment of elderly patients with type 2 diabetes mellitus focuses on reduction of (hyperglycaemic) complaints and prevention of the development or progression of secondary complications. Although regular physical activity and dietary measures, aiming at bodyweight normalisation, are the cornerstones of therapy, pharmacological treatment with oral blood glucose lowering-agents often proves necessary to control the hyperglycaemia. In the United Kingdom Prospective Diabetes Study (UKPDS) it was clearly shown that patients with type 2 diabetes mellitus who were intensively treated with oral blood glucose-lowering agents or insulin developed less microvascular complications. The question whether achievement of strict metabolic control is also of benefit in elderly patients, is still unanswered. Sulphonylureas are drugs which stimulate insulin secretion by enhancing the release of insulin from the pancreatic beta-cells without an effect on insulin synthesis. They are frequently used in the treatment of type 2 diabetes mellitus, and several preparations are available. In general, there are no major differences in effectiveness between the various sulphonylureas. Long term treatment with sulphonylureas will decrease fasting and postprandial plasma glucose levels by 3 to 5 mmol/L, and glycosylated haemoglobin by 20%. However, after its initial decline, plasma glucose level will often go up slightly during the following months to years. Sulphonylureas are usually well tolerated. Hypoglycaemia is the most frequently occurring adverse effect, which may be very serious and damaging in the elderly. It has been associated primarily with long-acting sulphonylureas, like chlorpropamide and glibenclamide (glyburide). Hypoglycaemic episodes may trigger serious events like myocardial infarction or stroke. Therefore, shorter-acting compounds like tolbutamide and gliclazide have been relatively well tolerated and appear to be the best choice to treat elderly patients. It is advisable to start with a low dose and increase the dose, when needed, in small steps. The efficacy of sulphonylureas is much greater when they are taken before a meal. Because of the fact that type 2 diabetes mellitus is a progressive disease, and residual beta-cell function decreases with time, insulin therapy may ultimately be warranted in a significant number of patients.
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Affiliation(s)
- M B Graal
- Department of Endocrinology and Metabolism, University Hospital Maastricht, The Netherlands
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42
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Abstract
Repaglinide is a new oral blood glucose lowering agent, a member of the carbamoylmethyl benzoic acid (CMBA) family. Its mechanism of action is partly similar to that of the sulphonylurea: the release of insulin from the pancreatic beta cells is stimulated by closure of ATP-dependent potassium channels. However, repaglinide regulates these channels via a different binding site on the beta cell than glibenclamide, and the drug does not cause insulin release in the absence of glucose, or during voltage-clamping. After oral administration the drug is rapidly absorbed and eliminated. It is therefore used in a meal-related dosing regimen; repaglinide is taken with each main meal. This meal-related use may give a more physiological mimick of daytime insulin requirement than once-daily or twice-daily use of sulphonylurea. Patients using repaglinide are less likely to develop hypoglycaemic symptoms when they miss or postpone a meal in comparison with patients on glibenclamide treatment. In long-term comparative phase 3 clinical studies it was found that repaglinide is equally effective in maintaining glycaemic control as existing sulphonylurea, but it gives significantly better control of postprandial blood glucose levels. Repaglinide can be used as monotherapy both in obese and non-obese type 2 diabetic patients, and is also very effective in combination with drugs like metformin or thiazolidines. Because of its excretion through liver and bile it is also an attractive drug for diabetic patients with diminished kidney function, especially the elderly diabetic. Although the overall incidence of hypoglycaemia was similar during use of repaglinide and of sulphonylurea, fewer serious hypoglycaemic episodes were observed in repaglinide-treated patients.
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Affiliation(s)
- B H Wolffenbuttel
- Dept. of Endocrinology and Metabolism, University Hospital Maastricht, The Netherlands.
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43
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Abstract
Miglitol (Bay m 1099, Bayer) is a second generation alpha-glucosidase inhibitor. It is a derivative of 1-desoxynojirimycin, and binds reversibly to the brushborder alpha-glucosidase enzymes. In contrast to its parent drug (acarbose, Bay g 5421, Bayer), miglitol is almost completely absorbed in the small intestine. It has to be taken with each main meal, and through its effect on carbohydrate digestion it blunts the postprandial blood glucose increase. Miglitol has no or a very small effect on fasting blood glucose levels. The blood-glucose lowering effects of miglitol in patients with Type 2 diabetes are lower than those of the frequently-used sulphonylurea compounds. Long-term studies show that a moderate average reduction of HbA1c of 0.3-0.7% point from baseline can be achieved. An advantage over sulphonylurea is the effect on serum insulin levels: miglitol therapy leads to slightly lower postprandial levels of serum insulin, whereas chronic sulphonylurea treatment usually increases serum insulin levels. This insulin-sparing effect may, in theory, lead to a lesser weight gain or even no weight gain and reduced risk of hypoglycaemia during chronic treatment. Long-term experience in Type 1 diabetic patients is limited. Similarly, miglitol may lead to reduced postprandial glucose excursions, slightly reduced insulin requirements and perhaps, as a consequence, a lower risk of hypoglycaemia. More long-term data are needed to fully assess to the clinical use of miglitol in these patients.
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Affiliation(s)
- J P Sels
- Department of Endocrinology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Van Maanen JM, Albering HJ, Van Breda SG, Curfs DM, Ambergen AW, Wolffenbuttel BH, Kleinjans JC, Reeser HM. Nitrate in drinking water and risk of childhood diabetes in The Netherlands. Diabetes Care 1999; 22:1750. [PMID: 10526751 DOI: 10.2337/diacare.22.10.1750b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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45
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Blaak EE, Kemerink GJ, Pakbiers MT, Wolffenbuttel BH, Heidendal GA, Saris WH. Microdialysis assessment of local adipose tissue lipolysis during beta-adrenergic stimulation in upper-body-obese subjects with type II diabetes. Clin Sci (Lond) 1999; 97:421-8. [PMID: 10491342 DOI: 10.1042/cs0970421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study was designed to investigate indicators of abdominal adipose tissue lipolysis (microdialysis), and subcutaneous adipose tissue blood flow and whole-body lipolysis, in obesity-associated type II diabetes during overnight-fasted conditions (baseline) and during intravenous infusion of the non-selective beta-agonist isoprenaline. Basal subcutaneous adipose tissue blood flow and isoprenaline-induced increases in adipose tissue blood flow were not significantly different between subjects with type II diabetes and non-obese, non-diabetic controls. Adipose tissue interstitial glycerol concentrations were significantly higher in subjects with type II diabetes compared with controls (P<0. 01), and during isoprenaline infusion there was a decrease in interstitial glycerol in both groups (P<0.001). Arterial glycerol concentrations were higher in subjects with type II diabetes compared with controls (P<0.05), whereas the increases in arterial glycerol concentration in response to isoprenaline infusion were of a similar magnitude in the two groups. Estimated subcutaneous adipose tissue glycerol release was not significantly different between the groups (controls and subjects with type II diabetes: baseline, -129+/-32 and -97+/-72 micromol.min(-1).100 g(-1) adipose tissue respectively; isoprenaline, -231+/-76 and -286+/-98 micromol. min(-1).100 g(-1) respectively). Values for fat oxidation were not significantly different between groups, whereas the isoprenaline-induced increase in fat oxidation tended to be less pronounced in subjects with type II diabetes compared with controls (0.022+/-0.008 and 0.038+/-0.003 g/min respectively; P=0.058). Thus estimated basal subcutaneous adipose tissue glycerol release, expressed per unit of fat mass, is not different in controls and in subjects with type II diabetes. Additionally, the isoprenaline-induced increases in indicators of local abdominal subcutaneous adipose tissue, systemic lipolysis and abdominal adipose tissue blood flow responses were comparable in obese subjects with type II diabetes and in controls. The last two findings contrast with previous data from obese subjects, indicating that the regulation of lipolysis may differ in obesity and obesity-associated type II diabetes.
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Affiliation(s)
- E E Blaak
- Department of Human Biology, Maastricht University and University Hospital, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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46
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Affiliation(s)
- W A Oranje
- Department of Endocrinology and Metabolism, University Hospital Maastricht, and Cardiovascular Research Institute Maastricht, The Netherlands
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47
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Wolffenbuttel BH, Heine RJ. [Glycemic regulation and management of essential hypertension in diabetics with type 2 diabetes mellitus; the 'United Kingdom prospective diabetes study' of diabetic complications]. Ned Tijdschr Geneeskd 1999; 143:1197-201. [PMID: 10389533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Patients with type 2 diabetes mellitus often develop micro- and macrovascular complications. In 25% of them, complications are already present at the time of diagnosis. The principal objective of the United Kingdom prospective diabetes study was to determine if good blood glucose control and adequate treatment of hypertension in patients with type 2 diabetes mellitus can prevent development of diabetes-related complications. The question was also studied if they way in which this blood glucose control was achieved and the way of treating the blood pressure affected the prognosis. Blood glucose control was found to reduce the incidence of--especially--microvascular complications. Oral hypoglycaemic agents and insulin both play an important part in achieving good control. Treatment with metformin reduced mortality due to cardiovascular disease in obese patients. Strict control of the blood pressure reduced development of micro- and macrovascular complications; the mortality from diabetes-related disorders and the numbers of patients suffering a stroke or heart failure. Non of the antihypertensive drugs used (an ACE inhibitor and a beta-blocking agent) offered any advantages over the other.
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48
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Huvers FC, De Leeuw PW, Houben AJ, De Haan CH, Hamulyak K, Schouten H, Wolffenbuttel BH, Schaper NC. Endothelium-dependent vasodilatation, plasma markers of endothelial function, and adrenergic vasoconstrictor responses in type 1 diabetes under near-normoglycemic conditions. Diabetes 1999; 48:1300-7. [PMID: 10342820 DOI: 10.2337/diabetes.48.6.1300] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is unknown whether and to what extent changes in various endothelial functions and adrenergic responsiveness are related to the development of microvascular complications in type 1 diabetes. Therefore, endothelium-dependent and endothelium-independent vasodilatation, endothelium-dependent hemostatic factors, and one and two adrenergic vasoconstrictor responses were determined in type 1 patients with and without microvascular complications. A total of 34 patients with type 1 diabetes were studied under euglycemic conditions on two occasions (11 without microangiopathy, 10 with proliferative and preproliferative retinopathy previously treated by laser coagulation, 13 with microalbuminuria, and 12 healthy volunteers also were studied). Forearm vascular responses to brachial artery infusions of N(G)-monomethyl-L-arginine (L-NMMA), sodium nitroprusside, acetylcholine (ACh), clonidine, and phenylephrine were determined. The ACh infusions were repeated during coinfusion of L-arginine. Furthermore, plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator antigen levels, von Willebrand factor antigen levels, tissue factor pathway inhibitor (TFPI) activity, and endothelin-1 levels were measured. No differences in endothelium-dependent or endothelium-independent vasodilatation or adrenergic constriction were observed between the diabetic patients and the healthy volunteers. In comparison to the first ACh infusion, the maximal response to repeated ACh during L-arginine administration was reduced in the diabetic patients, except in the patients with proliferative and preproliferative retinopathy previously treated by laser coagulation. In these patients, the combined infusion of L-arginine and ACh resulted in an enhanced response. TFPI activity was elevated, and PAI-1 activity was reduced in the type 1 diabetic patients. Furthermore, PAI-1 activity was positively correlated with urinary albumin excretion (r = 0.48, P < 0.01) and inversely correlated with the vasodilatory response to the highest ACh dose (r = -0.37, P < 0.05). The response to the highest ACh and L-NMMA dose were positively correlated with mean arterial blood pressure (r = 0.32, P < 0.01; r = 0.41, P < 0.01, respectively). Forearm endothelium-dependent and endothelium-independent vasodilatation and adrenergic responsiveness were unaltered in type 1 diabetic patients with and without microvascular complications. Relative to healthy control subjects, endothelium-dependent vasodilatation was depressed during a repeated ACh challenge (with L-arginine coinfusion) in the diabetic patients without complications or with microalbuminuria. In contrast, this vasodilatation was enhanced in the patients with retinopathy. Elevation of TFPI was the most consistent marker of endothelial damage of all the endothelial markers measured.
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Affiliation(s)
- F C Huvers
- Department of General Internal Medicine, University Hospital Nijmegen, The Netherlands
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49
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Crijns FR, Wolffenbuttel BH, De Mey JG, Struijker Boudier HA. Mechanical properties of mesenteric arteries in diabetic rats: consequences of outward remodeling. Am J Physiol 1999; 276:H1672-7. [PMID: 10330253 DOI: 10.1152/ajpheart.1999.276.5.h1672] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diabetes induces hemodynamic and biochemical changes that can influence mechanical properties of arteries. Structure and mechanics of mesenteric small arteries were investigated in rats with streptozotocin-induced diabetes (duration 7-9 wk). The external diameter of mesenteric artery branches was measured in control (n = 9) and diabetic (n = 7) Wistar Rp rats at baseline and during pressurization in situ (0-150 mmHg) under normal and passive smooth muscle conditions. Mean arterial pressure and mesenteric artery pressure were not significantly different. Baseline mesenteric artery diameter was larger in the diabetes-induced group (439 +/- 12 vs. 388 +/- 18 micrometers, P < 0.05). Media cross-sectional area of arteries from diabetic rats was not significantly increased (0.0149 +/- 0.0015 vs. 0.0122 +/- 0.0007 mm2). Cross-sectional compliance was significantly increased in diabetic rats at intraluminal pressures ranging from 25 to 75 mmHg (P < 0.005), whereas cross-sectional distensibility was not modified. Wall tension and circumferential wall stress were increased in diabetes. These results indicate that mesenteric small arteries of diabetic rats display eutrophic outward remodeling associated with increased wall tension and circumferential wall stress.
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Affiliation(s)
- F R Crijns
- Department of Endocrinology and Metabolism, Cardiovascular Research Institute Maastricht, University Hospital Maastricht, 6202 AZ Maastricht, The Netherlands.
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50
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Abstract
OBJECTIVE This study intended to investigate disturbances in beta-adrenergically-mediated substrate utilization and thermogenesis in obese subjects with mild non insulin-dependent diabetes mellitus (NIDDM). DESIGN Following a baseline period of 30 min, the beta-agonist isoproterenol (ISO) was administered in increasing doses of 6, 12, and 24 ng/kgFFM x min, each dose for 30 min. SUBJECTS Nine healthy lean males (CON, 50.6+/-2.4 y, % body fat: 16.0+/-1.8) and 10 obese subjects with NIDDM (51.8+/-2.4 y, % body fat 34.1+/-1.9). RESULTS Basal non esterified fatty acid concentrations (NEFA) and basal fat oxidation (absolute or expressed per unit fat free mass, FFM) were significantly higher in NIDDM as compared to CON, whereas basal carbohydrate (CHO) oxidation was significantly lower. The ISO-induced increase in NEFA-concentrations was blunted in NIDDM (delta at 24 ng/kgFFM x min: CON: 717+/-59 micromol/l vs NIDDM: 358+/-97 micromol/l, P< 0.01). The non-protein respiratory exchange ratio (RER) did not change in NIDDM and significantly decreased in CON during ISO-infusion (P < 0.05), reflecting the tendency towards a blunted increase in fat oxidation in NIDDM (delta fat ox at 24 ng; CON: 0.025+/-0.005 g/min vs NIDDM 0.016+/-0.007 g/min). The ISO-induced thermogenic response was comparable in NIDDM and CON (at 24 ng %increase above baseline: CON: 16.8+/-2.2% vs NIDDM: 14.7+/-0.9%). At all time points, there were no significant differences in circulating ISO and noradrenaline concentrations. Basal adrenaline (A) concentrations and A concentrations during ISO-infusion were significantly lower in NIDDM (basal A; CON: 64+/-15 pg/ml vs NIDDM: 25+/-2 pg/ml, P < 0.001). CONCLUSION There appear to be deviations in beta-adrenoceptor mediated fat utilization and adrenal medulla function in obesity-associated NIDDM. The impairments in sympathetically mediated fat utilization have previously been observed in 'simple' obese subjects, indicating that these disturbances are confined to the obese state per se.
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Affiliation(s)
- E E Blaak
- Department of Human Biology, Maastricht University, The Netherlands
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