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Geurts S, Tilly MJ, Kors JA, Deckers JW, Stricker BHC, De Groot NMS, Ikram MA, Kavousi M. Electrocardiographic parameters and the risk of new-onset atrial fibrillation in the general population. Europace 2022. [DOI: 10.1093/europace/euac053.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This study is further supported by the Senior Scientist Grant from Dutch Heart Foundation (03-004-2021-T050).
Background
The (shape of the) association and sex-differences between electrocardiographic parameters and new-onset atrial fibrillation (AF) remain incompletely understood.
Purpose
To investigate the association between electrocardiographic parameters and new-onset atrial fibrillation among men and women in the general population.
Methods
12,212 participants free of AF from a large population-based cohort study were included. Up to five repeated measurements of electrocardiographic parameters including PR, QRS, QT, QT corrected for heart rate (QTc), JT, RR interval, and heart rate were assessed at baseline and follow-up examinations. Cox proportional hazards models and joint models, both adjusted for cardiovascular risk factors, were used to determine the (shape of) association between baseline and longitudinal electrocardiographic parameters with new-onset AF. Additionally, we evaluated potential sex-differences.
Results
During a median follow-up of 9.3 years, 1,282 incident AF cases occurred among 12,212 participants (mean age 64.9 years, 58.2% women). Penalized cubic splines revealed that associations between baseline electrocardiographic measures and risk of new-onset AF were generally U-shaped (Figure 1). Sex-differences in terms of the shape of the various associations were most apparent for baseline PR, QT, QTc, RR, and heart rate in relation to new-onset AF. Longitudinal measures of PR (hazard ratio (HR), 95% confidence interval (CI), 1.43, 1.02-2.04, p=0.0393), and QTc interval (HR, 95% CI, 5.23, 2.18-12.45, p=0.0002) were significantly associated with new-onset AF. Sex-stratified analyses showed that the longitudinal associations were more prominent among men.
Conclusions
Baseline electrocardiographic measures and risk of new-onset AF were generally U-shaped. Longitudinal electrocardiographic measures of PR, and QTc interval were significantly associated with new-onset AF, more pronounced in men. Our findings imply that different thresholds of electrocardiographic parameters might translate to a differential risk of AF among men and women, and that treatment options targeting specific electrocardiographic parameters might prevent AF in the general population, in particular in men.
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Affiliation(s)
- S Geurts
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - MJ Tilly
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - JA Kors
- Erasmus University Medical Centre, Medical Informatics, Rotterdam, Netherlands (The)
| | - JW Deckers
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - BHC Stricker
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - NMS De Groot
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - MA Ikram
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - M Kavousi
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
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Geurts S, Tilly MJ, Arshi B, Stricker BHC, Kors JA, Deckers JW, De Groot NMS, Ikram MA, Kavousi M. Heart rate variability and atrial fibrillation in the general population: a longitudinal and mendelian randomization study. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This study is further supported by the Gender and prevention grant (555003017) from ZonMw.
Background
Sex-differences and the causality of the association between heart rate variability (HRV) and atrial fibrillation (AF) remain unclear.
Purpose
To investigate the sex-differences and the causality of the association between heart rate variability and atrial fibrillation.
Methods
12,334 participants free of AF from a large population-based cohort study were included. Measures of HRV including the standard deviation of normal RR-intervals (SDNN), SDNN corrected for heart rate (SDNNc), RR-interval differences (RMSSD), RMSSD corrected for heart rate (RMSSDc), and heart rate were assessed at baseline and follow-up examinations. Joint models, adjusted for cardiovascular risk factors, were used to determine the association between longitudinal measures of HRV with new-onset AF. Additionally, we evaluated sex-differences. Genetic variants for HRV were used as instrumental variables in a Mendelian randomization (MR) analysis using GWAS summary-level data.
Results
During a median follow-up of 9.4 years, 1,302 incident AF cases occurred. In joint models, higher SDNN (hazard ratio (HR), 95% confidence interval (CI), 1.24, 1.04-1.47, p=0.0213), and higher RMSSD (HR, 95% CI, 1.33, 1.13-1.54, p=0.0010) were significantly associated with new-onset AF. Sex-stratified analyses showed that the associations were mostly prominent among women. In MR analyses, genetically determined decreases in SDNN (odds ratio (OR), 95% CI, 1.60, 1.27-2.02, p=8.36x10-05), and RMSSD (OR, 95% CI, 1.56, 1.31-1.86, p= 6.32x10-07) were significantly associated with increased AF risk.
Conclusions
Longitudinal measures of uncorrected HRV were significantly associated with new-onset AF, in particular among women. MR analyses supported the causal relationship between uncorrected measures of HRV with AF. Our findings indicate that measures to modulate HRV might prevent AF in the general population, especially among women.
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Affiliation(s)
- S Geurts
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - MJ Tilly
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - B Arshi
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - BHC Stricker
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - JA Kors
- Erasmus University Medical Centre, Medical Informatics, Rotterdam, Netherlands (The)
| | - JW Deckers
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - NMS De Groot
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - MA Ikram
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - M Kavousi
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
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Geurts S, Van Der Burgh AC, Ikram MA, Kors JA, Stricker BHC, Deckers JW, Hoorn EJ, Chaker L, Kavousi M. Disentangling the association between kidney function and atrial fibrillation: a bidirectional Mendelian randomization study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Observational studies suggest that kidney function and atrial fibrillation (AF) are bidirectionally associated. Whether this bidirectional association is causal remains unclear.
Purpose
To investigate the causality of the bidirectional association between kidney function and AF.
Methods
Genetic variants associated with different measures of kidney function including estimated glomerular filtration rate (eGFR) based on creatinine (eGFRcreat), blood urea nitrogen (BUN), chronic kidney disease (CKD, eGFR <60ml/min/1.73m2), eGFR based on cystatin (eGFRcys), urine albumin-to-creatinine ratio (UACR) and microalbuminuria (MA, UACR >30mg/g) were retrieved from multiple Genome-Wide Association Studies (GWAS). These GWAS were all part of the Chronic Kidney Disease Genetics (CKDGen) Consortium (n=24,063–1,040,070). Genetic variants associated with AF were retrieved from a GWAS on AF (n=1,030,836). We used two-sample MR analyses to assess the potential causality of the bidirectional association between kidney function and AF.
Results
MR analyses supported a causal effect of genetically predicted BUN, CKD and MA on AF risk (for BUN: n=18 SNPs, outlier corrected odds ratio (OR): 2.05, per 1 unit increase of BUN (mg/dL), 95% CI: 1.30–3.25, p-value = 2.13E-03. For CKD: n=9 SNPs, outlier corrected OR: 1.10, 95% CI: 1.04–1.17, p-value = 1.97E-03. For MA: n=5 SNPs, outlier corrected OR: 1.26, 95% CI: 1.10–1.46, p-value = 1.38E-03). MR analyses also supported a causal effect of genetically predicted AF on eGFRcreat (n=97 SNPs, outlier corrected OR: 0.998, per 1 unit increase of log transformed eGFRcreat (ml/min/1.73m2), 95% CI: 0.997–0.999, p-value = 6.78E-03), CKD risk (n=107 SNPs, outlier corrected OR: 1.06, 95% CI: 1.03–1.09, p-value = 2.97E-04) and MA risk (n=83 SNPs, outlier corrected OR: 1.07, 95% CI: 1.04–1.09, p-value = 2.49E-08). A suggestive causal effect of genetically predicted AF on eGFRcys was found (n=103 SNPs, outlier corrected OR: 0.993, per 1 unit increase of log transformed eGFRcys (ml/min/1.73m2), 95% CI: 0.986–0.999, p-value = 4.60E-02). MR analyses did not support a significant causal effect of the other kidney function measures on AF risk and vice versa. Moreover, sensitivity analyses, including weighted median estimator (WME), MR-Egger and the MR pleiotropy residual sum and outlier test (MR-PRESSO) indicated that these findings were robust. Furthermore, the associations did not change when genetic variants associated with coronary artery disease and heart failure were excluded.
Conclusions
MR analyses supported a bidirectional causal association between kidney function and AF. Our findings carry the potential for identification of important therapeutic targets for both conditions with implications for secondary prevention.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Erasmus Medical Center and Erasmus University, Rotterdam Forest plot with the MR effect estimatesBidirectional MR: Kidney function and AF
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Affiliation(s)
- S Geurts
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - A C Van Der Burgh
- Erasmus University Medical Centre, Internal Medicine, Rotterdam, Netherlands (The)
| | - M A Ikram
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - J A Kors
- Erasmus University Medical Centre, Medical Informatics, Rotterdam, Netherlands (The)
| | - B H C Stricker
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - J W Deckers
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - E J Hoorn
- Erasmus University Medical Centre, Internal Medicine, Rotterdam, Netherlands (The)
| | - L Chaker
- Erasmus University Medical Centre, Internal Medicine, Rotterdam, Netherlands (The)
| | - M Kavousi
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
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Ardesch FH, Ruiter R, Mulder M, Lahousse L, Stricker BHC, Kiefte-de Jong JC. The Obesity Paradox in Lung Cancer: Associations With Body Size Versus Body Shape. Front Oncol 2020; 10:591110. [PMID: 33244459 PMCID: PMC7683800 DOI: 10.3389/fonc.2020.591110] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022] Open
Abstract
Background The association between obesity and lung cancer (LC) remains poorly understood. However, other indices of obesity on the basis of body shape instead of body size have not been examined yet. The aim of this study was to evaluate the association between different indices of body size and body shape and the risk of LC. In particular, this study examined the association between A Body Shape Index, a more precise indicator of abdominal fat than traditional anthropometric measures, and the risk of LC. Methods In the prospective cohort the Rotterdam Study, we analysed data of 9,689 participants. LC diagnoses were based on medical records and anthropometric measurements were assessed at baseline. Cox-regression analyses with corresponding Hazard Ratios were used to examine the association between the anthropometric measurements and the risk of LC with adjustment for potential confounders. Potential non-linear associations were explored with cubic splines using the Likelihood ratio (LR) test. Results During follow-up, 319 participants developed LC. Body mass Index (BMI) was inversely associated with the risk of lung cancer (HR 0.94, 95% CI: 0.91–0.97) and persisted after excluding lung cancer cases during the first 10 years of follow-up. There was evidence for a non-linear association between BMI and the risk of lung cancer (0,04, df = 1), which indicated that the inverse association between BMI and lung cancer was mainly present in non-obese participants. Waist circumference (WC) (HR 1.03 95% CI: 1.01–1.05), Waist-to-Hip Ratio (WHR) (HR 1.23 95% CI: 1.09–1.38) and ABSI (A Body Shape Index) (HR 1.17 95% CI: 1.05–1.30) were positively and linearly associated with the risk of lung cancer. Conclusions Body shape rather than body size may be an important risk indicator of LC. Future research should focus on the role of visceral fat and the risk of LC as well as the underlying mechanisms.
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Affiliation(s)
- F H Ardesch
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Public Health and Primary Care/LUMC Campus The Hague, Leiden University Medical Center, The Hague, Netherlands
| | - R Ruiter
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - M Mulder
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - L Lahousse
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - B H C Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - J C Kiefte-de Jong
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Public Health and Primary Care/LUMC Campus The Hague, Leiden University Medical Center, The Hague, Netherlands
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van der Toorn JE, van der Willik KD, Ruiter R, Vernooij MW, Stricker BHC, Schagen SB, Ikram MA, Kavousi M, Bos D. Aortic Arch Calcification and the Risk of Cancer: A Population-Based Cohort Study. Front Oncol 2020; 10:1700. [PMID: 33042813 PMCID: PMC7518099 DOI: 10.3389/fonc.2020.01700] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Atherosclerosis and cancer share multiple disease pathways. Yet, it is unclear if atherosclerosis is associated with a subsequent higher cancer risk. We determined the association of atherosclerotic calcification in the aortic arch, as proxy for systemic atherosclerosis, with the risk of cancer. Methods: Between 2003 and 2006, 2,404 participants (mean age: 69.5 years, 52.5% women) from the prospective population-based Rotterdam Study underwent computed tomography to quantify calcification in the aortic arch. Participants were followed for the onset of cancer, death, loss to follow-up, or January 1st, 2015, whichever came first. We computed sex-specific tertiles of aortic arch calcification volumes. Next, we examined the association between the volume and severity (i.e., tertiles) of aortic arch calcification and the risk of cancer using Cox proportional hazard models. Results: During a median (interquartile range) follow-up of 9.6 years (8.9–10.5), 348 participants were diagnosed with cancer. Participants with the greatest severity of aortic arch calcification had a higher risk of cancer [hazard ratio for the third tertile compared to the first tertile of aortic arch calcification volume in the total population is 1.39 (95% CI = 1.04–1.86)]. Conclusions: Individuals with the most severe aortic arch calcification had a higher risk of cancer. While this could reflect the impact of long-term exposure to shared risk factors, it might also point toward the co-occurrence of both conditions.
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Affiliation(s)
- Janine E van der Toorn
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Kimberly D van der Willik
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands.,Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC - University Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, Netherlands.,Department of Clinical Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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6
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van der Willik KD, Ghanbari M, Fani L, Compter A, Ruiter R, Stricker BHC, Schagen SB, Ikram MA. Higher Plasma Amyloid-β Levels Are Associated with a Higher Risk of Cancer: A Population-Based Prospective Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 29:1993-2001. [PMID: 32727725 DOI: 10.1158/1055-9965.epi-20-0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/02/2020] [Accepted: 07/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Various studies show an inverse relation between Alzheimer disease and cancer, but findings are likely to be biased by surveillance and survival bias. Plasma amyloid-β (Aβ) is defined as a preclinical feature of Alzheimer disease, with lower levels of Aβ42 being associated with a higher risk of Alzheimer disease. To get more insight into the biological link between Alzheimer disease and cancer, we investigated plasma Aβ levels in relation to the risk of cancer. METHODS Between 2002 and 2005, we measured plasma Aβ40 and Aβ42 levels in 3,949 participants from the population-based Rotterdam Study. These participants were followed until the onset of cancer, all-cause dementia, death, loss to follow-up, or January 1, 2014, whichever came first. We used Cox proportional hazards models to investigate the association between plasma Aβ40 and Aβ42 levels, and the risk of cancer. Analyses were stratified by cancer site. RESULTS During a median (interquartile range) follow-up of 9.0 years (6.9-10.1), 560 participants were diagnosed with cancer. Higher levels of log2 plasma Aβ40 and Aβ42 were associated with a higher risk of cancer [hazard ratio per standard deviation increase for Aβ40 = 1.12 (95% confidence interval, CI = 1.02-1.23) and Aβ42 = 1.12 (95% CI = 1.03-1.23)]. These effect estimates were most pronounced for hematologic cancers, urinary tract cancers, and cancers of unknown primary origin. CONCLUSIONS We found that higher levels of both plasma Aβ40 and Aβ42 were associated with a higher risk of cancer. IMPACT Our study suggests a potential biological link between Alzheimer disease and cancer. The pathophysiologic role of Aβ in cancer and its causality warrant further investigation.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lana Fani
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
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7
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van der Willik KD, Ruiter R, van Rooij FJA, Verkroost-van Heemst J, Hogewoning SJ, Timmermans KCAA, Visser O, Schagen SB, Ikram MA, Stricker BHC. Ascertainment of cancer in longitudinal research: The concordance between the Rotterdam Study and the Netherlands Cancer Registry. Int J Cancer 2019; 147:633-640. [PMID: 31642518 PMCID: PMC7317466 DOI: 10.1002/ijc.32750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 11/06/2022]
Abstract
Complete and accurate registration of cancer is needed to provide reliable data on cancer incidence and to investigate aetiology. Such data can be derived from national cancer registries, but also from large population‐based cohort studies. Yet, the concordance and discordance between these two data sources remain unknown. We evaluated completeness and accuracy of cancer registration by studying the concordance between the population‐based Rotterdam Study (RS) and the Netherlands Cancer Registry (NCR) between 1989 and 2012 using the independent case ascertainment method. We compared all incident cancers in participants of the RS (aged ≥45 years) to registered cancers in the NCR in the same persons based on the date of diagnosis and the International Classification of Diseases (ICD) code. In total, 2,977 unique incident cancers among 2,685 persons were registered. Two hundred eighty‐eight cancers (9.7%) were coded by the RS that were not present in the NCR. These were mostly nonpathology‐confirmed lung and haematological cancers. Furthermore, 116 cancers were coded by the NCR, but not by the RS (3.9%), of which 20.7% were breast cancers. Regarding pathology‐confirmed cancer diagnoses, completeness was >95% in both registries. Eighty per cent of the cancers registered in both registries were coded with the same date of diagnosis and ICD code. Of the remaining cancers, 344 (14.5%) were misclassified with regard to date of diagnosis and 72 (3.0%) with regard to ICD code. Our findings indicate that multiple sources on cancer are complementary and should be combined to ensure reliable data on cancer incidence. What's new? While national cancer registries and population‐based cohort studies are the primary sources of data on cancer risk and incidence, the degree to which these data sets are concordant remains unknown. In this investigation, the authors evaluated concordance between the population‐based Rotterdam Study and the Netherlands Cancer Registry. The two data sets were highly concordant for pathology‐confirmed cancers and cancer site. Non‐pathology‐confirmed cancers, however, were under‐registered in the Netherlands Cancer Registry, potentially resulting in underestimation of cancer incidence. The findings highlight the important role that different sources of cancer diagnosis registration serve in providing reliable estimates of cancer incidence.
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Affiliation(s)
- Kimberly D van der Willik
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Sander J Hogewoning
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Karin C A A Timmermans
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Otto Visser
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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de Roos EW, Lahousse L, Verhamme KMC, Braunstahl GJ, Ikram MA, In 't Veen JCCM, Stricker BHC, Brusselle GGO. Asthma and its comorbidities in middle-aged and older adults; the Rotterdam Study. Respir Med 2018; 139:6-12. [PMID: 29858003 DOI: 10.1016/j.rmed.2018.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Little is known on the prevalence and characteristics of asthma in middle-aged and older adults, since previous studies mainly focused on children and young adults. Therefore, the aim was to investigate the prevalence of physician-diagnosed asthma and its comorbidities, in a population-based cohort of adults 45 years of age and over. METHODS We identified participants with physician-diagnosed asthma in the Rotterdam Study; a prospective population-based cohort in the Netherlands. Pulmonary function measurements and comorbidities of the asthma cases were assessed at baseline and compared to those of the general population. RESULTS Out of 14,621 participants (mean age 65.5 years; 59% women), 524 subjects (31.5%males) had physician-diagnosed asthma at study entry, implicating an asthma prevalence of 3.6% [95% Confidence Interval (CI) 3.3%-3.9%] (2.8% in males and 4.2% in females). Asthmatic subjects had a significantly higher prevalence of obesity and depressive symptoms (Odds Ratio [OR]: 2,02 [95% CI 1,66-2,47] and [OR]: 2,01 [95% CI 1,52-2,66] respectively). Longer duration of asthma and current smoking were associated with lower lung function in asthmatic subjects. CONCLUSION Four percent of middle-aged and older adults have physician-diagnosed asthma. These adult asthmatics suffer more frequently from obesity and depression than subjects without obstructive lung disease.
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Affiliation(s)
- Emmely W de Roos
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Katia M C Verhamme
- Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Respiratory Medicine Franciscus Gasthuis & Vlietland, PO Box 10900, 3045 PM Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Johannes C C M In 't Veen
- Department of Respiratory Medicine Franciscus Gasthuis & Vlietland, PO Box 10900, 3045 PM Rotterdam, The Netherlands
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Guy G O Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Respiratory Medicine Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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9
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Billar RJ, Leening MJG, Merkus D, Brusselle GGO, Hofman A, Stricker BHC, Ghofrani HA, Franco OH, Gall H, Felix JF. Measures of subclinical cardiac dysfunction and increased filling pressures associate with pulmonary arterial pressure in the general population: results from the population-based Rotterdam Study. Eur J Epidemiol 2017; 33:403-413. [PMID: 29236195 PMCID: PMC5945799 DOI: 10.1007/s10654-017-0341-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/06/2017] [Indexed: 01/13/2023]
Abstract
Pulmonary hypertension is associated with increased mortality and morbidity in the elderly population. Heart failure is a common cause of pulmonary hypertension. Yet, the relation between left heart parameters reflective of subclinical cardiac dysfunction and increased filling pressures, and pulmonary arterial pressures in the elderly population remains elusive. Within the population-based Rotterdam Study, 2592 unselected participants with a mean age of 72.6 years (61.4% women) had complete echocardiography data available. We studied the cross-sectional associations of left heart structure and systolic and diastolic function with echocardiographically measured pulmonary artery systolic pressure. Mean pulmonary artery systolic pressure was 25.4 mmHg. After multivariable-adjustment measures of both structure and function were independently associated with pulmonary artery systolic pressure: E/A ratio [0.63 mmHg (95% CI 0.35–0.91) per 1-SD increase], left atrial diameter [0.79 mmHg (0.50–1.09) per 1-SD increase], E/E′ ratio [1.27 mmHg (0.92–1.61) per 1-SD increase], left ventricular volume [0.62 mmHg (0.25–0.98) per 1-SD increase], fractional shortening [0.45 mmHg (0.17–0.74) per 1-SD increase], aortic root diameter [− 0.43 mmHg (− 0.72 to − 0.14) per 1-SD increase], mitral valve deceleration time [− 0.31 mmHg (− 0.57 to − 0.05) per 1-SD increase], and E′ [1.04 mmHg (0.66–1.42) per 1-SD increase]. Results did not materially differ when restricting the analyses to participants free of symptoms of shortness of breath. Structural and functional echocardiographic parameters of subclinical cardiac dysfunction and increased filling pressures are associated with pulmonary arterial pressures in the unselected general ageing population.
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Affiliation(s)
- Ryan J Billar
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Daphne Merkus
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Inspectorate for Health Care, Utrecht, The Netherlands
| | - H Ardeschir Ghofrani
- Medizinische Klinik II, University of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Gall
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Medizinische Klinik II, University of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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10
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Visser LE, van Schaik RHN, van Vliet M, Trienekens PH, De Smet PAGM, Vulto AG, Hofman A, van Duijn CM, Stricker BHC. The risk of bleeding complications in patients with cytochrome P450 CYP2C9*2 or CYP2C9*3 alleles on acenocoumarol or phenprocoumon. Thromb Haemost 2017; 92:61-6. [PMID: 15213846 DOI: 10.1160/th03-12-0741] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [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: 11/05/2022]
Abstract
SummaryThe principal enzyme involved in coumarin metabolism is CYP2C9. Allelic variants of CYP2C9, CYP2C9*2 and CYP2C9*3, code for enzymes with reduced activity. Despite increasing evidence that patients with these genetic variants require lower maintenance doses of anticoagulant therapy, there is lack of agreement among studies on the risk of bleeding and CYP2C9 polymorphisms. It was, therefore, our objective to study the effect of the CYP2C9 polymorphisms on bleeding complications during initiation and maintenance phases of coumarin anticoagulant therapy. The design of the study was a population-based cohort in a sample of the Rotterdam Study, a study in 7,983 subjects. All patients who started treatment with acenocoumarol or phenprocoumon in the study period from January 1, 1991 through December 31, 1998 and for whom INR data were available were included. Patients were followed until a bleeding complication, the end of their treatment, death or end of the study period. Proportional hazards regression analysis was used to estimate the risk of a bleeding complication in relation to CYP2C9 genotype after adjustment for several potentially confounding factors such as age, gender, target INR level, INR, time between INR measurements, and aspirin use. The effect of variant genotype on bleeding risk was separately examined during the initiation phase of 90 days after starting therapy with coumarins. The 996 patients with analysable data had a mean follow-up time of 481 days (1.3 years); 311 (31.2%) had at least 1 variant CYP2C9 allele and 685 (68.8%) had the wild type genotype. For patients with the wild type genotype, the rate of minor bleeding, major bleeding and fatal bleeding was 15.9, 3.4 and 0.2 per 100 treatmentyears, respectively. For patients with a variant genotype, the rate of minor, major and fatal bleeding was 14.6, 5.4 and 0.5 per 100 treatment-years. Patients with a variant genotype on acenocoumarol had a significantly increased risk for a major bleeding event (HR 1.83, 95% CI: 1.01-3.32). During the initiation phase of therapy we found no effect of variant genotype on bleeding risk. In this study among outpatients of an anticoagulation clinic using acenocoumarol or phenprocoumon, having a variant allele of CYP2C9 was associated with an increased risk of major bleeding events in patients on acenocoumarol, but not in patients on phenprocoumon. Although one might consider the assessment of the CYP2C9 genotype of a patient for dose adjustment before starting treatment with acenocoumarol, a prospective randomised trial should demonstrate whether this reduces the increased risk of major bleeding events.
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Affiliation(s)
- Loes E Visser
- Department of Internal Medicine, Erasmus MC, 3000 DR Rotterdam, The Netherlands
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11
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de Vries LM, Leening MJG, Dijk WA, Hooijschuur CAM, Stricker BHC, van Hemel NM. Trends in service time of pacemakers in the Netherlands: a long-term nationwide follow-up study. Neth Heart J 2017; 25:581-591. [PMID: 28770398 PMCID: PMC5612868 DOI: 10.1007/s12471-017-1024-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 07/12/2017] [Indexed: 12/18/2022] Open
Abstract
AIMS After decades of experience and strongly improved technology, service time of pacemaker generators is expected to increase. To test this hypothesis, we conducted a retrospective review of a large cohort of patients with a pacemaker. METHODS We reviewed data collected between 1984 and 2006 in the first national Dutch pacemaker registry. This registry covered 96% of all generators implanted. We analysed the time of and reason for explantation of pacemaker generators. A 7-year follow-up interval after first implantation and following replacements was used to analyse changes over time. RESULTS During 22 years of data collection, nearly 97,000 first pacemaker generators were implanted. A total of 27,937 (22.4%) generators were explanted within a mean of 6.3 (standard deviation 3.3) years. Reasons for approximately 60% of these explantations were 'end of life' of the pacemaker generator or elective system change. Complications or failures such as infections and recalls accounted for approximately 20% of the explantations. For the remaining 20%, the reasons for explantation had not been registered. CONCLUSION Despite progress in technology, a substantial proportion of pacemaker generators is explanted before its expected service time, with one in five generators being replaced due to technical failures, infections or other complications. Furthermore, the time interval between pacemaker implantation and explantation due to normal 'end of life' (battery EOL) decreased. Infections continue to rank highly as a cause for pacing system replacement, despite all current preventive measures.
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Affiliation(s)
- L M de Vries
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - W A Dijk
- Thorax Center, University Medical Center Groningen, Groningen, The Netherlands
| | - C A M Hooijschuur
- Thorax Center, University Medical Center Groningen, Groningen, The Netherlands
| | - B H C Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - N M van Hemel
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Isaacs A, Sayed-Tabatabaei FA, Hofman A, Oostra BA, Klungel OH, Maitland-Vander Zee AH, Stricker BHC, Witteman JCM, van Duijn CM. The cholesteryl ester transfer protein I405V polymorphism is associated with increased high-density lipoprotein levels and decreased risk of myocardial infarction: the Rotterdam Study. ACTA ACUST UNITED AC 2016; 14:419-21. [PMID: 17568242 DOI: 10.1097/hjr.0b013e32801101aa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/26/2022]
Abstract
BACKGROUND AND DESIGN The effect of the cholesteryl ester transfer protein (CETP) I405V polymorphism on lipid levels, atherosclerosis and myocardial infarction (MI) was examined in 6421 participants from the Rotterdam Study. METHODS Quantitative outcomes were studied with linear models; Cox models were used to assess MI risk. RESULTS High-density lipoprotein cholesterol (HDL) increased by 0.06 [95% confidence interval (CI): 0.03, 0.09] mmol/l in VV carriers. The V allele was further associated with decreased MI risk in men [hazard ratio (95% confidence interval)=0.57 (0.45, 0.73), VV versus II] (Ptrend=0.02). CONCLUSION This study provides additional evidence for the association of CETP with HDL levels and suggests that CETP is an atherogenic protein increasing the risk of MI.
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Affiliation(s)
- Aaron Isaacs
- Genetic Epidemiology Unit, Erasmus Medical Center, Rotterdam, The Netherlands
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13
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Stricker BHC. [Risk factors for adverse effects of drugs: more research is necessary]. Ned Tijdschr Geneeskd 2015; 159:A9210. [PMID: 26374727] [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: 06/05/2023]
Abstract
When drugs are registered, relatively little is known about their adverse effects as clinical trials generally include only small numbers of patients and are of limited duration. New European legislation and the monitoring of adverse events are intended to enable the timely recognition of adverse effects of newly-registered drugs. However, many adverse effects of commonly-used older drugs are already well-known. Therefore, in order to improve the quality of health care, research should also be focused on the risk factors associated with developing such adverse effects.
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14
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Chain ASY, Dieleman JP, van Noord C, Hofman A, Stricker BHC, Danhof M, Sturkenboom MCJM, Della Pasqua O. Not-in-trial simulation I: Bridging cardiovascular risk from clinical trials to real-life conditions. Br J Clin Pharmacol 2014; 76:964-72. [PMID: 23617533 DOI: 10.1111/bcp.12151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 04/04/2013] [Indexed: 01/08/2023] Open
Abstract
AIMS The assessment of heart rate-corrected QT (QTc) interval prolongation relies on the evidence of drug effects in healthy subjects. This study demonstrates the relevance of pharmacokinetic-pharmacodynamic (PKPD) relationships to characterize drug-induced QTc interval prolongation and explore the discrepancies between clinical trials and real-life conditions. METHODS d,l-Sotalol data from healthy subjects and from the Rotterdam Study cohort were used to assess treatment response in a phase I setting and in a real-life conditions, respectively. Using modelling and simulation, drug effects at therapeutic doses were predicted in both populations. RESULTS Inclusion criteria were shown to restrict the representativeness of the trial population in comparison to real-life conditions. A significant part of the typical patient population was excluded from trials due to weight and baseline QTc interval criteria. Relative risk was significantly different between sotalol users with and without heart failure, hypertension, diabetes and myocardial infarction (P < 0.01). Although drug effects do cause an increase in the relative risk of QTc interval prolongation, the presence of diabetes represented an increase from 4.0 [95% confidence interval (CI) 2.7-5.8] to 6.5 (95% CI 1.6-27.1), whilst for myocardial infarction it increased from 3.4 (95% CI 2.3-5.13) to 15.5 (95% CI 4.9-49.3). CONCLUSIONS Our findings show that drug effects on QTc interval do not explain the observed QTc values in the population. The prevalence of high QTc values in the real-life population can be assigned to co-morbidities and concomitant medications. These findings substantiate the need to account for these factors when evaluating the cardiovascular risk of medicinal products.
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Affiliation(s)
- Anne S Y Chain
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden University, 2300 RA, Leiden, The Netherlands; Department of Medical Informatics, Erasmus Medical Centre, 3015 GE, Rotterdam, The Netherlands
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15
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Campos-Obando N, Castano-Betancourt MC, Oei L, Franco OH, Stricker BHC, Brusselle GG, Lahousse L, Hofman A, Tiemeier H, Rivadeneira F, Uitterlinden AG, Zillikens MC. Bone mineral density and chronic lung disease mortality: the rotterdam study. J Clin Endocrinol Metab 2014; 99:1834-42. [PMID: 24606086 DOI: 10.1210/jc.2013-3819] [Citation(s) in RCA: 22] [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: 02/13/2023]
Abstract
CONTEXT Low bone mineral density (BMD) has been associated with increased all-cause mortality. Cause-specific mortality studies have been controversial. OBJECTIVE The aim of the study was to investigate associations between BMD and all-cause mortality and in-depth cause-specific mortality. DESIGN AND SETTING We studied two cohorts from the prospective Rotterdam Study (RS), initiated in 1990 (RS-I) and 2000 (RS-II) with average follow-up of 17.1 (RS-I) and 10.2 (RS-II) years until January 2011. Baseline femoral neck BMD was analyzed in SD values. Deaths were classified according to International Classification of Diseases into seven groups: cardiovascular diseases, cancer, infections, external, dementia, chronic lung diseases, and other causes. Gender-stratified Cox and competing-risks models were adjusted for age, body mass index, and smoking. PARTICIPANTS The study included 5779 subjects from RS-I and 2055 from RS-II. MAIN OUTCOME MEASUREMENTS We measured all-cause and cause-specific mortality. RESULTS A significant inverse association between BMD and all-cause mortality was found in males [expressed as hazard ratio (95% confidence interval)]: RS-I, 1.07 (1.01-1.13), P = .020; RS-II, 1.31 (1.12-1.55), P = .001); but it was not found in females: RS-I, 1.05 (0.99-1.11), P = .098; RS-II, 0.91 (0.74-1.12), P = .362. An inverse association with chronic lung disease mortality was found in males [RS-I, 1.75 (1.34-2.29), P < .001; RS-II, 2.15 (1.05-4.42), P = .037] and in RS-I in females [1.72 (1.16-2.57); P = .008], persisting after multiple adjustments and excluding prevalent chronic obstructive pulmonary disease. A positive association between BMD and cancer mortality was detected in females in RS-I [0.89 (0.80-0.99); P = .043]. No association was found with cardiovascular mortality. CONCLUSIONS BMD is inversely associated with mortality. The strong association of BMD with chronic lung disease mortality is a novel finding that needs further analysis to clarify underlying mechanisms.
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Affiliation(s)
- Natalia Campos-Obando
- Departments of Internal Medicine (N.C.-O., M.C.C.-B., L.O., B.H.C.S., H.T., F.R., A.G.U., M.C.Z.) and Epidemiology (M.C.C.-B., O.H.F., B.H.C.S., G.G.B., L.L., A.H., F.R., A.G.U., M.C.Z.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Respiratory Medicine (G.G.B., L.L.), Ghent University Hospital, B-9000 Ghent, Belgium; Departments of Respiratory Medicine (G.G.B.) and Psychiatric Epidemiology (H.T.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; and Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (M.C.C.-B., L.O., O.H.F., A.H., F.R., A.G.U., M.C.Z.), 2300 RC Leiden, The Netherlands
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16
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Hofman A, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BHC, Tiemeier HW, Uitterlinden AG, Vernooij MW. The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 2013; 28:889-926. [PMID: 24258680 DOI: 10.1007/s10654-013-9866-z] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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17
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Tang W, Teichert M, Chasman DI, Heit JA, Morange PE, Li G, Pankratz N, Leebeek FW, Paré G, de Andrade M, Tzourio C, Psaty BM, Basu S, Ruiter R, Rose L, Armasu SM, Lumley T, Heckbert SR, Uitterlinden AG, Lathrop M, Rice KM, Cushman M, Hofman A, Lambert JC, Glazer NL, Pankow JS, Witteman JC, Amouyel P, Bis JC, Bovill EG, Kong X, Tracy RP, Boerwinkle E, Rotter JI, Trégouët DA, Loth DW, Stricker BHC, Ridker PM, Folsom AR, Smith NL. A genome-wide association study for venous thromboembolism: the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) consortium. Genet Epidemiol 2013; 37:512-521. [PMID: 23650146 DOI: 10.1002/gepi.21731] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/07/2013] [Accepted: 03/29/2013] [Indexed: 11/12/2022]
Abstract
Venous thromboembolism (VTE) is a common, heritable disease resulting in high rates of hospitalization and mortality. Yet few associations between VTE and genetic variants, all in the coagulation pathway, have been established. To identify additional genetic determinants of VTE, we conducted a two-stage genome-wide association study (GWAS) among individuals of European ancestry in the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) VTE consortium. The discovery GWAS comprised 1,618 incident VTE cases out of 44,499 participants from six community-based studies. Genotypes for genome-wide single-nucleotide polymorphisms (SNPs) were imputed to approximately 2.5 million SNPs in HapMap and association with VTE assessed using study-design appropriate regression methods. Meta-analysis of these results identified two known loci, in F5 and ABO. Top 1,047 tag SNPs (P ≤ 0.0016) from the discovery GWAS were tested for association in an additional 3,231 cases and 3,536 controls from three case-control studies. In the combined data from these two stages, additional genome-wide significant associations were observed on 4q35 at F11 (top SNP rs4253399, intronic to F11) and on 4q28 at FGG (rs6536024, 9.7 kb from FGG; P < 5.0 × 10(-13) for both). The associations at the FGG locus were not completely explained by previously reported variants. Loci at or near SUSD1 and OTUD7A showed borderline yet novel associations (P < 5.0 × 10(-6) ) and constitute new candidate genes. In conclusion, this large GWAS replicated key genetic associations in F5 and ABO, and confirmed the importance of F11 and FGG loci for VTE. Future studies are warranted to better characterize the associations with F11 and FGG and to replicate the new candidate associations.
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Affiliation(s)
- Weihong Tang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Martina Teichert
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Scientific Institute Dutch Pharmacists, The Hague, The Netherlands
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - John A Heit
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Guo Li
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nathan Pankratz
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Frank W Leebeek
- Department of Haematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Guillaume Paré
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S4K1, Canada
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - 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
| | - Saonli Basu
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lynda Rose
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sebastian M Armasu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Thomas Lumley
- Department of Statistics, University of Aukland, Aukland, NZ
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.,Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Netherlands Consortium for Healthy Aging, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mark Lathrop
- Commissariat à l'Energie Atomique, Institut de Génomique, Centre National de Génotypage, F-91057, Evry, France
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington, Vermont, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jean-Charles Lambert
- INSERM, UMR_S 744, Institut Pasteur de Lille; Université de Lille Nord de France, F-59019, Lille, France
| | | | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Philippe Amouyel
- INSERM, UMR_S 744, Institut Pasteur de Lille; Université de Lille Nord de France, F-59019, Lille, France.,Centre Hospitalier Régional Universitaire de Lille, F-59037, Lille, France
| | - Joshua C Bis
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Edwin G Bovill
- Department of Pathology, University of Vermont, Burlington, VT, USA
| | - Xiaoxiao Kong
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Russell P Tracy
- Departments of Biochemistry and Pathology, University of Vermont, Burlington, VT, USA
| | - Eric Boerwinkle
- Human Genetics Center and Human Genome Sequencing Center, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jerome I Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David-Alexandre Trégouët
- INSERM, UMR_S 937, ICAN Institute for Cardiometabolism and Nutrition, University Pierre & Marie Curie, Paris 06, F-75013, Paris, France
| | - Daan W Loth
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Drug Safety Unit, Inspectorate for Health Care, The Hague, the Netherlands
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,Drug Safety Unit, Inspectorate for Health Care, The Hague, the Netherlands
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
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den Hoed M, Eijgelsheim M, Esko T, Brundel BJJM, Peal DS, Evans DM, Nolte IM, Segrè AV, Holm H, Handsaker RE, Westra HJ, Johnson T, Isaacs A, Yang J, Lundby A, Zhao JH, Kim YJ, Go MJ, Almgren P, Bochud M, Boucher G, Cornelis MC, Gudbjartsson D, Hadley D, van der Harst P, Hayward C, den Heijer M, Igl W, Jackson AU, Kutalik Z, Luan J, Kemp JP, Kristiansson K, Ladenvall C, Lorentzon M, Montasser ME, Njajou OT, O'Reilly PF, Padmanabhan S, St Pourcain B, Rankinen T, Salo P, Tanaka T, Timpson NJ, Vitart V, Waite L, Wheeler W, Zhang W, Draisma HHM, Feitosa MF, Kerr KF, Lind PA, Mihailov E, Onland-Moret NC, Song C, Weedon MN, Xie W, Yengo L, Absher D, Albert CM, Alonso A, Arking DE, de Bakker PIW, Balkau B, Barlassina C, Benaglio P, Bis JC, Bouatia-Naji N, Brage S, Chanock SJ, Chines PS, Chung M, Darbar D, Dina C, Dörr M, Elliott P, Felix SB, Fischer K, Fuchsberger C, de Geus EJC, Goyette P, Gudnason V, Harris TB, Hartikainen AL, Havulinna AS, Heckbert SR, Hicks AA, Hofman A, Holewijn S, Hoogstra-Berends F, Hottenga JJ, Jensen MK, Johansson A, Junttila J, Kääb S, Kanon B, Ketkar S, Khaw KT, Knowles JW, Kooner AS, Kors JA, Kumari M, Milani L, Laiho P, Lakatta EG, Langenberg C, Leusink M, Liu Y, Luben RN, Lunetta KL, Lynch SN, Markus MRP, Marques-Vidal P, Mateo Leach I, McArdle WL, McCarroll SA, Medland SE, Miller KA, Montgomery GW, Morrison AC, Müller-Nurasyid M, Navarro P, Nelis M, O'Connell JR, O'Donnell CJ, Ong KK, Newman AB, Peters A, Polasek O, Pouta A, Pramstaller PP, Psaty BM, Rao DC, Ring SM, Rossin EJ, Rudan D, Sanna S, Scott RA, Sehmi JS, Sharp S, Shin JT, Singleton AB, Smith AV, Soranzo N, Spector TD, Stewart C, Stringham HM, Tarasov KV, Uitterlinden AG, Vandenput L, Hwang SJ, Whitfield JB, Wijmenga C, Wild SH, Willemsen G, Wilson JF, Witteman JCM, Wong A, Wong Q, Jamshidi Y, Zitting P, Boer JMA, Boomsma DI, Borecki IB, van Duijn CM, Ekelund U, Forouhi NG, Froguel P, Hingorani A, Ingelsson E, Kivimaki M, Kronmal RA, Kuh D, Lind L, Martin NG, Oostra BA, Pedersen NL, Quertermous T, Rotter JI, van der Schouw YT, Verschuren WMM, Walker M, Albanes D, Arnar DO, Assimes TL, Bandinelli S, Boehnke M, de Boer RA, Bouchard C, Caulfield WLM, Chambers JC, Curhan G, Cusi D, Eriksson J, Ferrucci L, van Gilst WH, Glorioso N, de Graaf J, Groop L, Gyllensten U, Hsueh WC, Hu FB, Huikuri HV, Hunter DJ, Iribarren C, Isomaa B, Jarvelin MR, Jula A, Kähönen M, Kiemeney LA, van der Klauw MM, Kooner JS, Kraft P, Iacoviello L, Lehtimäki T, Lokki MLL, Mitchell BD, Navis G, Nieminen MS, Ohlsson C, Poulter NR, Qi L, Raitakari OT, Rimm EB, Rioux JD, Rizzi F, Rudan I, Salomaa V, Sever PS, Shields DC, Shuldiner AR, Sinisalo J, Stanton AV, Stolk RP, Strachan DP, Tardif JC, Thorsteinsdottir U, Tuomilehto J, van Veldhuisen DJ, Virtamo J, Viikari J, Vollenweider P, Waeber G, Widen E, Cho YS, Olsen JV, Visscher PM, Willer C, Franke L, Erdmann J, Thompson JR, Pfeufer A, Sotoodehnia N, Newton-Cheh C, Ellinor PT, Stricker BHC, Metspalu A, Perola M, Beckmann JS, Smith GD, Stefansson K, Wareham NJ, Munroe PB, Sibon OCM, Milan DJ, Snieder H, Samani NJ, Loos RJF. Identification of heart rate-associated loci and their effects on cardiac conduction and rhythm disorders. Nat Genet 2013; 45:621-31. [PMID: 23583979 DOI: 10.1038/ng.2610] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/21/2013] [Indexed: 12/16/2022]
Abstract
Elevated resting heart rate is associated with greater risk of cardiovascular disease and mortality. In a 2-stage meta-analysis of genome-wide association studies in up to 181,171 individuals, we identified 14 new loci associated with heart rate and confirmed associations with all 7 previously established loci. Experimental downregulation of gene expression in Drosophila melanogaster and Danio rerio identified 20 genes at 11 loci that are relevant for heart rate regulation and highlight a role for genes involved in signal transmission, embryonic cardiac development and the pathophysiology of dilated cardiomyopathy, congenital heart failure and/or sudden cardiac death. In addition, genetic susceptibility to increased heart rate is associated with altered cardiac conduction and reduced risk of sick sinus syndrome, and both heart rate-increasing and heart rate-decreasing variants associate with risk of atrial fibrillation. Our findings provide fresh insights into the mechanisms regulating heart rate and identify new therapeutic targets.
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Affiliation(s)
- Marcel den Hoed
- Medical Research Council MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
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Siiskonen SJ, Koomen ER, Visser LE, Herings RMC, Guchelaar HJ, Stricker BHC, Nijsten TEC. Exposure to phototoxic NSAIDs and quinolones is associated with an increased risk of melanoma. Eur J Clin Pharmacol 2013; 69:1437-44. [PMID: 23471440 DOI: 10.1007/s00228-013-1476-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Ultraviolet radiation exposure is the most important exogenous risk factor for cutaneous malignancies. It is possible that phototoxic drugs promote the development of cutaneous melanoma (CM) by intensifying the effect of ultraviolet light on the skin. We investigated the association between the use of common systemic phototoxic drugs and development of CM. METHODS This study was a case-control study in a Dutch population-based cohort. The drug dispensing data was obtained from PHARMO, a Dutch drug dispensing and hospital admissions registry, and linked to PALGA, the nationwide pathology network of the Netherlands. The cases were patients diagnosed with pathologically confirmed primary CM between 1991 and 2004. Controls were sampled from the PHARMO population. Exposure to systemic phototoxic drugs was measured and included antimicrobial agents, diuretics, antipsychotic drugs, antidiabetic drugs, cardiac drugs, antimalarials and nonsteroidal anti-inflammatory drugs (NSAIDs). A multivariate conditional logistic regression analysis was performed to study the association between exposure to phototoxic drugs and CM. RESULTS The study population included 1,318 cases and 6,786 controls. Any phototoxic drug during the study period was dispensed for 46 % of the cases and 43 % of the controls (p = 0.012). The use of quinolones [odds ratio (OR) 1.33, 95 % confidence interval (CI) 1.01-1.76] and propionic acid derivative NSAIDs (OR 1.33, 95 % CI 1.14-1.54) had a positive association with CM. CONCLUSIONS Our study shows that the use of phototoxic drugs is associated with an increased risk of developing CM. Even a short-term use of phototoxic quinolones and propionic acid derivative NSAIDs may increase the risk for CM. Patient education to promote sun-protective behaviour is essential to avoid immediate adverse effects and possible long-term effects of phototoxic drugs.
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Affiliation(s)
- Satu J Siiskonen
- Department of Dermatology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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20
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Leening MJG, Deckers JW, Stricker BHC. Screening for heart failure in the elderly and the competition of co-morbidity. What if we could prevent heart failure from reaching the finish line first? Eur J Heart Fail 2013; 15:477. [PMID: 23429974 DOI: 10.1093/eurjhf/hft030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/14/2022] Open
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21
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Ruiter R, Visser LE, van Herk-Sukel MPP, Geelhoed-Duijvestijn PH, de Bie S, Straus SMJM, Mol PGM, Romio SA, Herings RMC, Stricker BHC. Prescribing of rosiglitazone and pioglitazone following safety signals: analysis of trends in dispensing patterns in the Netherlands from 1998 to 2008. Drug Saf 2012; 35:471-80. [PMID: 22540371 DOI: 10.2165/11596950-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Relevant safety signals in the EU are regularly communicated in so-called 'Direct Healthcare Professional Communications' (DHPCs) or European Medicines Agency (EMA) press releases. Trends of a decrease in the use of rosiglitazone following regulatory safety warnings have been described in the US. In the EU, however, relatively little is known about dispensing patterns following DHPCs or other safety signals such as EMA press releases. OBJECTIVE The objective of this study was to analyse trends in dispensing patterns of rosiglitazone and pioglitazone following DHPCs and EMA press releases in the EU member state, the Netherlands. METHODS Data for this study were obtained from the PHARMO Record Linking System, which includes drug dispensing records from community pharmacies of approximately 2.5 million individuals in the Netherlands. Over the period 1998-2008 an auto-regressive, integrated, moving average model (ARIMA) was fitted. The DHPC letters or EMA press releases were used as determinants. Adjustments were made for publication of certain literature. Stratification was performed for dispensings prescribed by general practitioners (GPs) and those prescribed by specialists. RESULTS For rosiglitazone, four EMA press releases and two DHPCs were issued; for pioglitazone, one DHPC was issued. The number of rosiglitazone dispensings prescribed by GPs decreased significantly after publication of DHPCs and EMA press releases concerning the risk of macular oedema and risk of fractures (both p-values 0.001). The number of rosiglitazone dispensings decreased statistically significantly after publication of EMA press releases 2 and 3 concerning cardiovascular risks but not for EMA press release 4. Adjustment for certain publications in the literature reduced the effect of communicated safety issues on the proportion of dispensings. CONCLUSIONS Although it is difficult to disentangle the effect of DHPCs and EMA press releases from the effect of reports published in the literature, our results suggest that prescribers may react to such safety communications.
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Affiliation(s)
- Rikje Ruiter
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
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22
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Ellinor PT, Lunetta KL, Albert CM, Glazer NL, Ritchie MD, Smith AV, Arking DE, Müller-Nurasyid M, Krijthe BP, Lubitz SA, Bis JC, Chung MK, Dörr M, Ozaki K, Roberts JD, Smith JG, Pfeufer A, Sinner MF, Lohman K, Ding J, Smith NL, Smith JD, Rienstra M, Rice KM, Van Wagoner DR, Magnani JW, Wakili R, Clauss S, Rotter JI, Steinbeck G, Launer LJ, Davies RW, Borkovich M, Harris TB, Lin H, Völker U, Völzke H, Milan DJ, Hofman A, Boerwinkle E, Chen LY, Soliman EZ, Voight BF, Li G, Chakravarti A, Kubo M, Tedrow UB, Rose LM, Ridker PM, Conen D, Tsunoda T, Furukawa T, Sotoodehnia N, Xu S, Kamatani N, Levy D, Nakamura Y, Parvez B, Mahida S, Furie KL, Rosand J, Muhammad R, Psaty BM, Meitinger T, Perz S, Wichmann HE, Witteman JCM, Kao WHL, Kathiresan S, Roden DM, Uitterlinden AG, Rivadeneira F, McKnight B, Sjögren M, Newman AB, Liu Y, Gollob MH, Melander O, Tanaka T, Stricker BHC, Felix SB, Alonso A, Darbar D, Barnard J, Chasman DI, Heckbert SR, Benjamin EJ, Gudnason V, Kääb S. Meta-analysis identifies six new susceptibility loci for atrial fibrillation. Nat Genet 2012; 44:670-5. [PMID: 22544366 DOI: 10.1038/ng.2261] [Citation(s) in RCA: 452] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 04/05/2012] [Indexed: 11/09/2022]
Abstract
Atrial fibrillation is a highly prevalent arrhythmia and a major risk factor for stroke, heart failure and death. We conducted a genome-wide association study (GWAS) in individuals of European ancestry, including 6,707 with and 52,426 without atrial fibrillation. Six new atrial fibrillation susceptibility loci were identified and replicated in an additional sample of individuals of European ancestry, including 5,381 subjects with and 10,030 subjects without atrial fibrillation (P < 5 × 10(-8)). Four of the loci identified in Europeans were further replicated in silico in a GWAS of Japanese individuals, including 843 individuals with and 3,350 individuals without atrial fibrillation. The identified loci implicate candidate genes that encode transcription factors related to cardiopulmonary development, cardiac-expressed ion channels and cell signaling molecules.
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Affiliation(s)
- Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA.
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Ruiter R, Teichert M, Straus SMJM, Stricker BHC, Visser LE. Concomitant use of contraceptives and potentially teratogenic medicinal products--results from a study using pharmacy dispensing data in the Netherlands. Reprod Sci 2012; 19:987-94. [PMID: 22527986 DOI: 10.1177/1933719112440050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to analyze to what extent potentially teratogenic medicinal products are dispensed concomitantly with contraceptives. Data on dispensed medicinal products in this population-based study were obtained from the Dutch Foundation for Pharmaceutical Statistics. For over 178 potentially teratogenic medicinal products, concomitant use of contraceptives was assessed. The proportion of potentially teratogenic medicinal products dispensed concomitantly with a contraceptive varied significantly from 40.9% (95% CI 40.7-41.2) in 2005 to 43.4% in 2009 (95% CI 44.2-43.7). Significant differences existed as well between age categories with the lowest proportions of concomitant use of contraceptives for any potentially teratogenic drug in women aged 36 through 45 years (35.0%, 95% CI 34.9-35.1) in comparison to those aged 26 through 35 years (47.1%, 95% CI 46.9-47.3) and 15 through 25 years (53.6%, 95% CI 53.4-53.8). Although our data retrieval did not cover the use of nonpharmacological forms of contraception such as condoms and sterilization and as situations may occur during which the use of drugs with (low) teratogenic potential is a balanced decision, our results raise doubts about the safe use of medicinal products with teratogenic potential.
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Affiliation(s)
- Rikje Ruiter
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
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Leening MJG, Kavousi M, Heeringa J, van Rooij FJA, Verkroost-van Heemst J, Deckers JW, Mattace-Raso FUS, Ziere G, Hofman A, Stricker BHC, Witteman JCM. Methods of data collection and definitions of cardiac outcomes in the Rotterdam Study. Eur J Epidemiol 2012; 27:173-85. [PMID: 22388767 PMCID: PMC3319884 DOI: 10.1007/s10654-012-9668-8] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/17/2012] [Indexed: 02/07/2023]
Abstract
The prevalence of cardiovascular diseases is rising. Therefore, adequate risk prediction and identification of its determinants is increasingly important. The Rotterdam Study is a prospective population-based cohort study ongoing since 1990 in the city of Rotterdam, The Netherlands. One of the main targets of the Rotterdam Study is to identify the determinants and prognosis of cardiovascular diseases. Case finding in epidemiological studies is strongly depending on various sources of follow-up and clear outcome definitions. The sources used for collection of data in the Rotterdam Study are diverse and the definitions of outcomes in the Rotterdam Study have changed due to the introduction of novel diagnostics and therapeutic interventions. This article gives the methods for data collection and the up-to-date definitions of the cardiac outcomes based on international guidelines, including the recently adopted cardiovascular disease mortality definitions. In all, detailed description of cardiac outcome definitions enhances the possibility to make comparisons with other studies in the field of cardiovascular research and may increase the strength of collaborations.
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Affiliation(s)
- Maarten J G Leening
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ruiter R, Visser LE, van Herk-Sukel MPP, Coebergh JWW, Haak HR, Geelhoed-Duijvestijn PH, Straus SMJM, Herings RMC, Stricker BHC. Lower risk of cancer in patients on metformin in comparison with those on sulfonylurea derivatives: results from a large population-based follow-up study. Diabetes Care 2012; 35:119-24. [PMID: 22100960 PMCID: PMC3241334 DOI: 10.2337/dc11-0857] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Numerous studies have suggested a decreased risk of cancer in patients with diabetes on metformin. Because different comparison groups were used, the effect magnitude is difficult to estimate. Therefore, the objective of this study was to further analyze whether, and to what extent, use of metformin is associated with a decreased risk of cancer in a cohort of incident users of metformin compared with users of sulfonylurea derivatives. RESEARCH DESIGN AND METHODS Data for this study were obtained from dispensing records from community pharmacies individually linked to hospital discharge records from 2.5 million individuals in the Netherlands. The association between the risk of cancer in those using metformin compared with those using sulfonylurea derivatives was analyzed using Cox proportional hazard models with cumulative duration of drug use as a time-varying determinant. RESULTS Use of metformin was associated with a lower risk of cancer in general (hazard ratio 0.90 [95% CI 0.88-0.91]) compared with use of sulfonylurea derivatives. When specific cancers were used as end points, similar estimates were found. Dosage-response relations were identified for users of metformin but not for users of sulfonylurea derivatives. CONCLUSIONS In our study, cumulative exposure to metformin was associated with a lower risk of specific cancers and cancer in general, compared with cumulative exposure to sulfonylurea derivatives. However, whether this should indeed be seen as a decreased risk of cancer for the use of metformin or as an increased risk of cancer for the use sulfonylurea derivatives remains to be elucidated.
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Affiliation(s)
- Rikje Ruiter
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
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Ruiter R, Bijl MJ, van Schaik RHN, Berns EMJJ, Hofman A, Coebergh JWW, van Noord C, Visser LE, Stricker BHC. CYP2C19*2 polymorphism is associated with increased survival in breast cancer patients using tamoxifen. Pharmacogenomics 2011; 11:1367-75. [PMID: 21047200 DOI: 10.2217/pgs.10.112] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Variant alleles of the CYP2C19 gene were recently associated with survival in breast cancer patients on tamoxifen therapy. CYP2C19 is one of the enzymes involved in the metabolism of tamoxifen into active metabolites. We investigated the hypothesis that CYP2C19*2 and *3 variants, known for their lack of enzyme activity, are associated with an increased breast cancer mortality rate in patients using tamoxifen. MATERIALS & METHODS In the prospective population based Rotterdam study, the association between CYP2C19*2 carriers and breast cancer mortality was studied among 80 incident users of tamoxifen. Survival was analyzed with life tables and Cox regression analysis, with drug exposure as a time-dependent variable. Adjustments were made for calendar time, average tamoxifen dose, age, the indication for tamoxifen, CYP2D6 genotype and concomitant use of CYP2C19 inhibitors or inducers. RESULTS In patients on tamoxifen, CYP2C19*2 carriers were associated with a significantly longer breast cancer survival rate than patients with the wild-type (hazard ratio 0.26, 95%CI: 0.08-0.87). CONCLUSION This study suggests that CYP2C19 genotype may possibly be a predictive factor for survival in breast cancer patients using tamoxifen.
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Affiliation(s)
- Rikje Ruiter
- Department of Epidemiology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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27
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Hofman A, van Duijn CM, Franco OH, Ikram MA, Janssen HLA, Klaver CCW, Kuipers EJ, Nijsten TEC, Stricker BHC, Tiemeier H, Uitterlinden AG, Vernooij MW, Witteman JCM. The Rotterdam Study: 2012 objectives and design update. Eur J Epidemiol 2011; 26:657-86. [PMID: 21877163 PMCID: PMC3168750 DOI: 10.1007/s10654-011-9610-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 01/09/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Hoorn EJ, Rivadeneira F, van Meurs JBJ, Ziere G, Stricker BHC, Hofman A, Pols HAP, Zietse R, Uitterlinden AG, Zillikens MC. Mild hyponatremia as a risk factor for fractures: the Rotterdam Study. J Bone Miner Res 2011; 26:1822-8. [PMID: 21381111 DOI: 10.1002/jbmr.380] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies suggest that mild hyponatremia is associated with fractures, but prospective studies are lacking. We studied whether hyponatremia is associated with fractures, falls, and/or bone mineral density (BMD). A total of 5208 elderly subjects with serum sodium assessed at baseline were included from the prospective population-based Rotterdam Study. The following data were analyzed: BMD, vertebral fractures (mean follow-up 6.4 years), nonvertebral fractures (7.4 years), recent falls, comorbidity, medication, and mortality. Hyponatremia was detected in 399 subjects (7.7%, 133.4 ± 2.0 mmol/L). Subjects with hyponatremia were older (73.5 ± 10.3 years versus 70.0 ± 9.0 years, p < .001), had more recent falls (23.8% versus 16.4%, p < .01), higher type 2 diabetes mellitus prevalence (22.2% versus 10.3%, p < .001), and more often used diuretics (31.1% versus 15.0%, p < .001). Hyponatremia was not associated with lower BMD but was associated with increased risk of incident nonvertebral fractures [hazard ratio (HR) =1.39, 95% confidence interval (CI) 1.11-1.73, p = .004] after adjustment for age, sex, and body mass index. Further adjustments for disability index, use of diuretics, use of psycholeptics, recent falls, and diabetes did not modify results. In the fully adjusted model, subjects with hyponatremia also had increased risk of vertebral fractures at baseline [odds ratio (OR) = 1.78, 95% CI 1.04-3.06, p = .037] but not at follow-up. Finally, all-cause mortality was higher in subjects with hyponatremia (HR = 1.21, 95% CI 1.03-1.43, p = .022). It is concluded that mild hyponatremia in the elderly is associated with an increased risk of vertebral fractures and incident nonvertebral fractures but not with BMD. Increased fracture risk in hyponatremia also was independent of recent falls, pointing toward a possible effect on bone quality.
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Affiliation(s)
- Ewout J Hoorn
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract
BACKGROUND AND PURPOSE Depression after stroke is common. Like stroke, transient ischemic attack (TIA) is a manifestation of long-term atherosclerotic damage to the brain. However, the risk of depression developing after a TIA is uncertain. We studied whether TIA increases the risk of incident late-life depression. METHODS A cohort study of 5095 inhabitants of Rotterdam, the Netherlands, was performed between 1993 and 2005. Participants were aged 56 years or older and free of depression at baseline. TIA and depression were identified through regular standardized examinations and continuous monitoring of medical records. We estimated hazard ratios (HR) with time-varying Cox regression analyses, adjusting for sociodemographic and health-related factors. RESULTS During follow-up, 407 depressive syndromes occurred, of which 103 met criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM) for depressive disorders. TIA was significantly associated with the risk of incident depressive syndromes (HR, 1.68; 95% CI, 1.12-2.51) and DSM-defined depressive disorders (HR, 2.42; 95% CI, 1.26-4.67). The risk of depressive syndromes increased with the number of TIA a person had experienced (HR, 1.45; 95% CI, 1.17-1.81), as did the risk of depressive disorders (HR, 1.63; 95% CI, 1.18-2.24). In persons without a history of depression at baseline, we found an almost 3-fold increased risk of DSM-defined depressive disorders (HR, 2.91; 95% CI, 0.96-8.81). CONCLUSIONS TIA was independently associated with an increased risk of incident depression. Our finding suggests that symptomatic cerebrovascular disease increases the vulnerability to late-life depression.
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Affiliation(s)
- Hendrika J Luijendijk
- Erasmus Medical Center, Department of Epidemiology, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Abstract
Sudden cardiac death is among the most common causes of cardiovascular death in developed countries. The majority of sudden cardiac deaths are caused by acute ventricular arrhythmia following repolarization disturbances. An important risk factor for repolarization disturbances is use of QT prolonging drugs, probably partly explained by gene-drug interactions. In this review, we will summarize QT interval physiology, known risk factors for QT prolongation, including drugs and the contribution of pharmacogenetics. The long QT syndrome can be congenital or acquired. The congenital long QT syndrome is caused by mutations in ion channel subunits or regulatory protein coding genes and is a rare monogenic disorder with a mendelian pattern of inheritance. Apart from that, several common genetic variants that are associated with QT interval duration have been identified. Acquired QT prolongation is more prevalent than the congenital form. Several risk factors have been identified with use of QT prolonging drugs as the most frequent cause. Most drugs that prolong the QT interval act by blocking hERG-encoded potassium channels, although some drugs mainly modify sodium channels. Both pharmacodynamic as well as pharmacokinetic mechanisms may be responsible for QT prolongation. Pharmacokinetic interactions often involve drugs that are metabolized by cytochrome P450 enzymes. Pharmacodynamic gene-drug interactions are due to genetic variants that potentiate the QT prolonging effect of drugs. QT prolongation, often due to use of QT prolonging drugs, is a major public health issue. Recently, common genetic variants associated with QT prolongation have been identified. Few pharmacogenetic studies have been performed to establish the genetic background of acquired QT prolongation but additional studies in this newly developing field are warranted.
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Affiliation(s)
- Charlotte van Noord
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Rodenburg EM, Stricker BHC, Visser LE. Sex-related differences in hospital admissions attributed to adverse drug reactions in the Netherlands. Br J Clin Pharmacol 2011; 71:95-104. [PMID: 21143505 DOI: 10.1111/j.1365-2125.2010.03811.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Women are more at risk for developing adverse drug reactions (ADRs) due to differences in pharmacokinetics, pharmacodynamics and drug use. ADRs regularly lead to hospital admissions. WHAT THIS STUDY ADDS There are differences between the sexes in hospital admissions attributed to ADRs. The risk of being hospitalized with an ADR varies between the sexes in the type of reaction and the causative drug. AIM Adverse drug reactions (ADRs) are a major burden in health care, regularly leading to hospital admission, morbidity or death. Women tend to have a higher risk of adverse drug reactions with a 1.5 to 1.7-fold greater risk than men. Our primary aim was to study differences in ADR-related hospitalizations between the sexes. METHODS We conducted a nationwide study of all ADR-related hospitalizations in the period between 2000 and 2005 in the Netherlands, which were selected from all 9,287,162 hospital admissions in this period. ADR-drug group combinations with at least 50 admissions in one of the sexes were selected. Relative risks and confidence intervals were calculated with respect to total admissions and total prescriptions with men as reference. RESULTS In total, 0.41% of the 4,236,368 admissions in men (95% CI 0.40, 0.42%) and 0.47% of the 5,050,794 admissions in women (95% CI 0.46, 0.48%) were attributed to an ADR by medical specialists (57% of all ADR-related admissions were in women). Differences between the sexes in risk for ADR-related hospitalization were found for antineoplastic and immunosuppressive drugs, antirheumatics, anticoagulants and salicylates, cardiovascular and neurological drugs, steroids and antibiotics. In certain drug categories, risks for hospitalization changed after taking into account total drug prescriptions. CONCLUSION In all different drug classes, significant differences exist between the sexes in ADR-related hospital admissions. Cardiovascular drugs account for the most pronounced differences between men and women. More research is needed to explain the clear sex differences in ADR-related hospital admissions.
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Affiliation(s)
- Eline M Rodenburg
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
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Peters BJM, Rodin AS, Klungel OH, van Duijn CM, Stricker BHC, van't Slot R, de Boer A, Maitland-van der Zee AH. Pharmacogenetic interactions between ABCB1 and SLCO1B1 tagging SNPs and the effectiveness of statins in the prevention of myocardial infarction. Pharmacogenomics 2010; 11:1065-76. [PMID: 20712525 DOI: 10.2217/pgs.10.81] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Genetic variability within the SLCO1B1 and ABCB1 transporter genes has been associated with modification of statin effectiveness in cholesterol management. MATERIALS & METHODS We conducted a case-control study using a population-based registry of pharmacy records linked to the hospital discharge records. Within a hypercholesterolemic cohort, we included 668 myocardial infarction cases and 1217 controls. RESULTS We tested 24 tagging SNPs and found two SNPs within ABCB1 (rs3789244, p = 0.01; rs1922242, p = 0.01) to interact with statin treatment. In addition, we found a nonsignificant haplotype-treatment interaction (p = 0.054). The odds ratio for subjects homozygous for SLCO1B1*1A was 0.49 (95% CI: 0.34-0.71) compared with 0.31 (95% CI: 0.24-0.41) for heterozygous or noncarriers of the *1A allele. CONCLUSION This is the first study to demonstrate that common genetic variability within the SLCO1B1 and ABCB1 genes is associated with the modification of the effectiveness of statins in the prevention of the clinical outcome, myocardial infarction.
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Affiliation(s)
- Bas J M Peters
- Faculty of Science, Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht University, Utrecht, The Netherlands
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Siemes C, Visser LE, de Jong FH, Coebergh JWW, Uitterlinden AG, Hofman A, Stricker BHC, van Schaik RHN. Cytochrome P450 3A gene variation, steroid hormone serum levels and prostate cancer--The Rotterdam Study. Steroids 2010; 75:1024-32. [PMID: 20621111 DOI: 10.1016/j.steroids.2010.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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] [Received: 12/22/2009] [Revised: 07/01/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To study if polymorphisms in genes encoding for CYP3A enzymes, that play a role in steroid hormone metabolism, affect steroid hormone serum levels and prostate cancer incidence or mortality. METHODS 3048 male participants of The Rotterdam Study were included. Prostate cancer cases and non-cases were studied for differences in baseline hormone levels with Student's t-test. General linear models were performed on different random subsets of hormone levels to study associations with genotype. Cox' proportional hazard models were used to study prostate cancer incidence and mortality among genotypes. RESULTS Both DHEAS sulphate as free-testosterone were significantly increased at baseline in males who developed a prostate cancer within the study period. CYP3A4 G-allele carriage was associated with lower levels of estrone sulphate (p=0.005) and higher levels of estradiol (p=0.04) compared to non-carriers. CYP3A5 A-allele carriage was associated with increased levels of estrone sulphate (p=0.02). CYP3A7 G-allele carriage was associated with the highest number of significant differences in steroid hormone levels. Carriers of the allele resulting in continued enzyme expression during adulthood had decreased levels of dehydroepiandrosterone (DHEA) sulphate (p=0.05), androstenedione (p=0.006), estrone (p=0.0001) and estrone sulphate (p=0.003) compared to mean levels of these hormones in homozygous wild type carriers. CYP3A43 genotype was not associated with any of the studied hormone levels. However, carriers of the CYP3A43 G-allele showed a significant 5-fold increase in mortality among early onset diagnosed prostate cancers. CONCLUSION Increased levels of free testosterone and DHEA sulphate were associated with prostate cancer incidence along the study period. Primarily the amount of CYP3A7 expression seemed to affect steroid hormone levels. Nevertheless, testosterone, a precursor of the prostate growth and differentiation stimulating dehydrotestosterone, was not influenced by CYP3A genotype. In line with this, no significant associations were observed for CYP3A genotypes and prostate cancer incidence.
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Affiliation(s)
- Claire Siemes
- Department of Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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van den Hondel KE, Eijgelsheim M, Ruiter R, Witteman JCM, Hofman A, Stricker BHC. Effect of short-term NSAID use on echocardiographic parameters in elderly people: a population-based cohort study. Heart 2010; 97:540-3. [PMID: 21097821 DOI: 10.1136/hrt.2010.200717] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of heart failure. NSAIDs inhibit the synthesis of renal prostaglandin, which results in a higher total blood volume, cardiac output and preload. The association between recent start of NSAIDs in elderly people and echocardiographic parameters was investigated. METHODS In the Rotterdam Study, a population-based cohort study, the effect of NSAIDs on left ventricular end-systolic dimension, left ventricular end-diastolic dimension, fractional shortening and left ventricular systolic function was studied in all participants for whom an echocardiogram was available (n=5307). NSAID use was categorised as current NSAID use on the date of echocardiography, past use and never used before echocardiography during the study period. Current use was divided into short-term NSAID use (≤ 14 days) and long-term NSAID use (> 14 days). Associations between drug exposure and echocardiographic measurements were assessed using linear and logistic regression analyses. RESULTS Current NSAID use for < 14 days was associated with a significantly higher left ventricular end-systolic dimension (+1.74 mm, 95% CI 0.20 to 3.28), left ventricular end-diastolic dimension (+3.69 mm, 95% CI 1.08 to 6.31) and significantly lower fractional shortening (-6.03%, 95% CI -9.81% to -2.26%) compared with non-users. Current NSAID use for > 14 days was associated with a higher left end-diastolic dimension (+1.96 mm, 95% CI 0.82 to 3.11) but there was no change in the other echocardiographic parameters. CONCLUSION This study is the first to investigate the association between NSAIDs and echocardiographic parameters and suggests that there is a transient effect of short-term use of NSAIDs on the left ventricular dimension and function of the heart.
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Sotoodehnia N, Isaacs A, de Bakker PIW, Dörr M, Newton-Cheh C, Nolte IM, van der Harst P, Müller M, Eijgelsheim M, Alonso A, Hicks AA, Padmanabhan S, Hayward C, Smith AV, Polasek O, Giovannone S, Fu J, Magnani JW, Marciante KD, Pfeufer A, Gharib SA, Teumer A, Li M, Bis JC, Rivadeneira F, Aspelund T, Köttgen A, Johnson T, Rice K, Sie MPS, Wang YA, Klopp N, Fuchsberger C, Wild SH, Mateo Leach I, Estrada K, Völker U, Wright AF, Asselbergs FW, Qu J, Chakravarti A, Sinner MF, Kors JA, Petersmann A, Harris TB, Soliman EZ, Munroe PB, Psaty BM, Oostra BA, Cupples LA, Perz S, de Boer RA, Uitterlinden AG, Völzke H, Spector TD, Liu FY, Boerwinkle E, Dominiczak AF, Rotter JI, van Herpen G, Levy D, Wichmann HE, van Gilst WH, Witteman JCM, Kroemer HK, Kao WHL, Heckbert SR, Meitinger T, Hofman A, Campbell H, Folsom AR, van Veldhuisen DJ, Schwienbacher C, O'Donnell CJ, Volpato CB, Caulfield MJ, Connell JM, Launer L, Lu X, Franke L, Fehrmann RSN, te Meerman G, Groen HJM, Weersma RK, van den Berg LH, Wijmenga C, Ophoff RA, Navis G, Rudan I, Snieder H, Wilson JF, Pramstaller PP, Siscovick DS, Wang TJ, Gudnason V, van Duijn CM, Felix SB, Fishman GI, Jamshidi Y, Stricker BHC, Samani NJ, Kääb S, Arking DE. Common variants in 22 loci are associated with QRS duration and cardiac ventricular conduction. Nat Genet 2010; 42:1068-76. [PMID: 21076409 PMCID: PMC3338195 DOI: 10.1038/ng.716] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 10/19/2010] [Indexed: 12/16/2022]
Abstract
QRS interval on the electrocardiogram reflects ventricular depolarization and conduction time, and is a risk factor for mortality, sudden death, and heart failure. We performed a genome-wide association meta-analysis in 40,407 European-descent individuals from 14 studies, with further genotyping in 7170 additional Europeans, and identified 22 loci associated with QRS duration (P < 5 × 10−8). These loci map in or near genes in pathways with established roles in ventricular conduction such as sodium channels, transcription factors, and calcium-handling proteins, but also point to novel biologic processes, such as kinase inhibitors and genes related to tumorigenesis. We demonstrate that SCN10A, a gene at our most significant locus, is expressed in the mouse ventricular conduction system, and treatment with a selective SCN10A blocker prolongs QRS duration. These findings extend our current knowledge of ventricular depolarization and conduction.
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Affiliation(s)
- Nona Sotoodehnia
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA.
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Kaur G, Verhamme KMC, Dieleman JP, Vanrolleghem A, van Soest EM, Stricker BHC, Sturkenboom MCJM. Association between calcium channel blockers and gingival hyperplasia. J Clin Periodontol 2010; 37:625-30. [PMID: 20642630 DOI: 10.1111/j.1600-051x.2010.01574.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To study the effect of the dose and type of calcium channel blockers (CCBs) on the risk of gingival hyperplasia and to quantify this association. METHODS The study was conducted within the Integrated Primary Care Information Project in The Netherlands. A nested case-control study was designed within a cohort of all patients who were new users of either CCBs or drugs interacting with the renin-angiotensin system (RAS). Cases were all individuals with a validated diagnosis of gingival hyperplasia. Controls were matched on age, gender and index date. RESULTS Within the study population, 103 cases of gingival hyperplasia were identified and matched to 7677 controls. The risk of gingival hyperplasia was higher in current users of CCBs [adjusted odds ratio (OR(adj)) 2.2, 95% confidence intervals (95% CI): 1.4-3.4], especially in dihydropyridines (OR(adj) 2.1, 95% CI: 1.3-3.5) and benzothiazepine derivatives (OR(adj) 2.9, 95% CI: 1.3-6.5) than in RAS drug users. The risk increased in patients using more than the recommended daily dose (OR(adj) 3.0, 95% CI: 1.6-5.5) and when the duration of current use was <1 month (OR(adj) 5.2, 95% CI: 2.1-12.6). CONCLUSION This study shows that the risk of gingival hyperplasia is twofold higher in current users of CCBs than in users of RAS drugs. The association was dose dependent and the highest for dihydropyridines or benzothiazepine derivates.
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Affiliation(s)
- Gaganpreet Kaur
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Flohil SC, de Vries E, van Meurs JBJ, Fang Y, Stricker BHC, Uitterlinden AG, Nijsten T. Vitamin D-binding protein polymorphisms are not associated with development of (multiple) basal cell carcinomas. Exp Dermatol 2010; 19:1103-5. [PMID: 20812960 DOI: 10.1111/j.1600-0625.2010.01139.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Vitamin D-binding protein (VDBP) single nucleotide polymorphisms (SNP) may affect skin carcinogenesis. The objective was to test the association between two functional VDBP SNPs and the susceptibility to (multiple) basal cell carcinomas (BCCs). Of the 7983 participants, 5790 (72.5%) and 5823 (72.9%) participants were genotyped for rs7041 and rs4588, respectively, and three haplotypes (Gc1s, Gc2 and Gc1f) were analysed. Two hundred and thirty-three persons developed a BCC of whom 122 (52.4%) developed multiple BCCs during a mean follow-up of 11.6 years. The VDBP genotype was not associated with (multiple) BCC development using Cox proportional hazards and Andersen-Gill analyses, respectively. Stratifying age groups demonstrated that in the youngest age-group, the A/T variant of rs7041 was associated with BCC development [adjusted hazard ratio (HR) = 1.88 (95%CI 1.10-3.20)], while homozygote Gc1s carriers had a significantly lower BCC risk [adjusted HR = 0.53 (95%CI 0.31-0.91)]. In conclusion, the VDBP polymorphisms were not associated with susceptibility to (multiple) BCCs, but age-gene interactions were observed.
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Becker ML, Visser LE, van Schaik RHN, Hofman A, Uitterlinden AG, Stricker BHC. OCT1 polymorphism is associated with response and survival time in anti-Parkinsonian drug users. Neurogenetics 2010; 12:79-82. [PMID: 20680652 PMCID: PMC3029819 DOI: 10.1007/s10048-010-0254-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 07/19/2010] [Indexed: 01/11/2023]
Abstract
Substrates for the Organic Cation Transporter 1, encoded by the SLC22A1 gene, are metformin, amantadine, pramipexole, and, possibly, levodopa. Recently, we identified that the rs622342 A > C polymorphism is associated with the HbA1c lowering effect in metformin users. In the Rotterdam Study, we associated this polymorphism with higher prescribed doses of all anti-Parkinsonian drugs. Between the first and fifth prescriptions for levodopa, for each minor rs622342 C allele, the prescribed doses were 0.34 defined daily dose higher (95% CI 0.064, 0.62; p=0.017). The mortality ratio after start of levodopa therapy was 1.47 times higher (95% CI 1.01, 2.13; p=0.045).
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Affiliation(s)
- Matthijs L Becker
- Department of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Eijgelsheim M, Newton-Cheh C, Sotoodehnia N, de Bakker PIW, Müller M, Morrison AC, Smith AV, Isaacs A, Sanna S, Dörr M, Navarro P, Fuchsberger C, Nolte IM, de Geus EJC, Estrada K, Hwang SJ, Bis JC, Rückert IM, Alonso A, Launer LJ, Hottenga JJ, Rivadeneira F, Noseworthy PA, Rice KM, Perz S, Arking DE, Spector TD, Kors JA, Aulchenko YS, Tarasov KV, Homuth G, Wild SH, Marroni F, Gieger C, Licht CM, Prineas RJ, Hofman A, Rotter JI, Hicks AA, Ernst F, Najjar SS, Wright AF, Peters A, Fox ER, Oostra BA, Kroemer HK, Couper D, Völzke H, Campbell H, Meitinger T, Uda M, Witteman JCM, Psaty BM, Wichmann HE, Harris TB, Kääb S, Siscovick DS, Jamshidi Y, Uitterlinden AG, Folsom AR, Larson MG, Wilson JF, Penninx BW, Snieder H, Pramstaller PP, van Duijn CM, Lakatta EG, Felix SB, Gudnason V, Pfeufer A, Heckbert SR, Stricker BHC, Boerwinkle E, O'Donnell CJ. Genome-wide association analysis identifies multiple loci related to resting heart rate. Hum Mol Genet 2010; 19:3885-94. [PMID: 20639392 DOI: 10.1093/hmg/ddq303] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Higher resting heart rate is associated with increased cardiovascular disease and mortality risk. Though heritable factors play a substantial role in population variation, little is known about specific genetic determinants. This knowledge can impact clinical care by identifying novel factors that influence pathologic heart rate states, modulate heart rate through cardiac structure and function or by improving our understanding of the physiology of heart rate regulation. To identify common genetic variants associated with heart rate, we performed a meta-analysis of 15 genome-wide association studies (GWAS), including 38,991 subjects of European ancestry, estimating the association between age-, sex- and body mass-adjusted RR interval (inverse heart rate) and approximately 2.5 million markers. Results with P < 5 × 10(-8) were considered genome-wide significant. We constructed regression models with multiple markers to assess whether results at less stringent thresholds were likely to be truly associated with RR interval. We identified six novel associations with resting heart rate at six loci: 6q22 near GJA1; 14q12 near MYH7; 12p12 near SOX5, c12orf67, BCAT1, LRMP and CASC1; 6q22 near SLC35F1, PLN and c6orf204; 7q22 near SLC12A9 and UfSp1; and 11q12 near FADS1. Associations at 6q22 400 kb away from GJA1, at 14q12 MYH6 and at 1q32 near CD34 identified in previously published GWAS were confirmed. In aggregate, these variants explain approximately 0.7% of RR interval variance. A multivariant regression model including 20 variants with P < 10(-5) increased the explained variance to 1.6%, suggesting that some loci falling short of genome-wide significance are likely truly associated. Future research is warranted to elucidate underlying mechanisms that may impact clinical care.
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Affiliation(s)
- Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Teichert M, Visser LE, Dufour M, Rodenburg E, Straus SMJM, De Smet PAGM, Stricker BHC. Isotretinoin use and compliance with the Dutch Pregnancy Prevention Programme: a retrospective cohort study in females of reproductive age using pharmacy dispensing data. Drug Saf 2010; 33:315-26. [PMID: 20297863 DOI: 10.2165/11319190-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Isotretinoin is very effective in the treatment of severe acne. However, because of the teratogenic properties of this agent an isotretinoin Pregnancy Prevention Programme (PPP) was implemented in the Netherlands to guarantee that treatment is contraindicated in women of reproductive age unless at least one effective method of contraception is used. Furthermore, the PPP stipulates that isotretinoin treatment should be managed by physicians or specialists experienced in treatment with this drug and that only monthly prescriptions are issued. OBJECTIVE To assess compliance with the Dutch isotretinoin PPP in women of reproductive age during the study period of 1 January 2005 to 31 December 2008. METHODS Detailed information on dispensed medication and co-medication was available from the Dutch Foundation of Pharmaceutical Statistics. Four types of outcome were studied: concomitant dispensing of hormonal contraceptive with isotretinoin; the proportion of specialist prescribing of isotretinoin; prescribing of conventional acne therapy prior to isotretinoin initiation; and isotretinoin dispensing exceeding the maximum amount. The use of contraceptives in women aged between 15 and 45 years was defined as concomitant if the period of systemic contraceptive use overlapped the period of isotretinoin dispensing for at least 10 days, or if any dispensing of an intrauterine or intravaginal contraceptive was recorded since the year 2000. Dispensings were separated into those prescribed by either specialists or general practitioners (GPs). The use of antibacterials, antiandrogens or topical agents against acne was checked 4 months prior to an isotretinoin dispensing, and a possible excess of the maximum amount of isotretinoin was defined as prescriptions of more than 100 defined daily doses. RESULTS During the study period, data were available for 442 Dutch pharmacies encompassing 4881 women of reproductive age using isotretinoin at least once during study period. Among women of reproductive age, the use of isotretinoin increased during the study period. The proportion of isotretinoin initiation with concomitant oral hormonal or intrauterine contraceptives was low (59.3% [95% CI 57.6, 61.0]). Initiation of isotretinoin by a specialist increased the chance for concomitant contraception by 26% (95% CI 6.0, 49.0); in 78.2% (95% CI 76.8, 79.6) of women, isotretinoin was initiated by a specialist. Conventional acne therapy up to 16 months prior to isotretinoin initiation was found in 70% of the women (70.3% [95% CI 66.0, 74.6]). In 1.4% (95% CI 1.0, 1.8) of cases of treatment initiation, the amount of isotretinoin dispensed on one prescription seemed too high. CONCLUSION Attention should be paid to improving the implementation of the isotretinoin PPP. Despite clear guidelines and warnings in the product information, our study strongly suggests that concomitant use of isotretinoin and contraceptives is too low. Even though we will have missed non-pharmacological forms of contraception, these results raise doubts about the safe use of isotretinoin in women of reproductive age in the Netherlands. Furthermore, isotretinoin does not seem to be used in cases of severe acne only. Reserving isotretinoin prescribing to specialists may improve adherence to the PPP.
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Affiliation(s)
- Martina Teichert
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
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van Noord C, Sturkenboom MCJM, Straus SMJM, Witteman JCM, Stricker BHC. Non-cardiovascular drugs that inhibit hERG-encoded potassium channels and risk of sudden cardiac death. Heart 2010; 97:215-20. [PMID: 20406763 DOI: 10.1136/hrt.2009.188367] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Virtually all QTc-prolonging drugs act by blocking the human ether a go-go-related gene (hERG)-encoded potassium channels (hERG channels), whereas not all QTc-prolonging drugs are associated with an increased risk of serious cardiac arrhythmias. This study assessed whether non-cardiovascular hERG channel blockers are associated with an increased risk of sudden cardiac death (SCD) and whether hERG-channel-inhibiting capacity is an indicator of the risk of SCD. METHODS AND RESULTS The risk of SCD was studied in the Integrated Primary Care Information database, a longitudinal general practice research database. A case-control study was performed, matched for age, gender and calendar time. Odds ratios were calculated with conditional logistic regression, multivariably adjusted. In addition, the hERG-channel-inhibiting capacity of the different drugs was compared, defined as the effective free therapeutic plasma concentration (ETCP(unbound)) divided by the concentration that inhibits 50% of the potassium channels (IC50), with the risk of SCD. 1424 cases of SCD and 14 443 controls were identified. Current use of hERG channel blockers was associated with an increased risk of SCD. The risk of SCD was significantly increased in users of antipsychotic drugs. Patients using hERG channel blockers with a high ETCP(unbound)/IC50 ratio (≥ 0.033) had a higher risk of SCD than patients using drugs with a low ETCP(unbound)/IC50 ratio (<0.033). CONCLUSIONS The current use of hERG channel blockers was associated with an increased risk of SCD in the general population. In addition, drugs with a high hERG-channel-inhibiting capacity had a higher risk of SCD than drugs with a low hERG-channel-inhibiting capacity.
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Affiliation(s)
- Charlotte van Noord
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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van Noord C, Sturkenboom MCJM, Straus SMJM, Hofman A, Witteman JCM, Stricker BHC. Population-based studies of antithyroid drugs and sudden cardiac death. Br J Clin Pharmacol 2010; 68:447-54. [PMID: 19740403 DOI: 10.1111/j.1365-2125.2009.03474.x] [Citation(s) in RCA: 8] [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] [Indexed: 01/08/2023] Open
Abstract
AIM Thyroid free T4 is associated with QTc-interval prolongation, which is a risk factor for sudden cardiac death (SCD). Hyperthyroidism has been associated with SCD in case reports, but there are no population-based studies confirming this. The aim was to investigate whether use of antithyroid drugs (as a direct cause or as an indicator of poorly controlled hyperthyroidism) is associated with an increased risk of SCD. METHODS We studied the occurrence of SCD in a two-step procedure in two different Dutch populations. First, the prospective population-based Rotterdam Study including 7898 participants (> or =55 years old). Second, we used the Integrated Primary Care Information (IPCI) database, which is a longitudinal general practice research database to see whether we could replicate results from the first study. Drug use at the index date was assessed with prescription information from automated pharmacies (Rotterdam Study) or drug prescriptions from general practices (IPCI). We used a Cox proportional hazards model in a cohort analysis, adjusted for age, gender and use of QTc prolonging drugs (Rotterdam Study) and conditional logistic regression analysis in a case-control analysis, matched for age, gender, practice and calendar time and adjusted for arrhythmia and cerebrovascular ischaemia (IPCI). RESULTS In the Rotterdam Study, 375 participants developed SCD during follow-up. Current use of antithyroid drugs was associated with SCD [adjusted hazard ratio 3.9; 95% confidence interval (CI) 1.7, 8.7]. IPCI included 1424 cases with SCD and 14 443 controls. Also in IPCI, current use of antithyroid drugs was associated with SCD (adjusted odds ratio 2.9; 95% CI 1.1, 7.4). CONCLUSIONS Use of antithyroid drugs was associated with a threefold increased risk of SCD. Although this might be directly caused by antithyroid drug use, it might be more readily explained by underlying poorly controlled hyperthyroidism, since treated patients who developed SCD still had low thyroid-stimulating hormone levels shortly before death.
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Affiliation(s)
- Charlotte van Noord
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
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Kwadijk-de Gijsel S, Bijl MJ, Visser LE, van Schaik RHN, Hofman A, Vulto AG, van Gelder T, Ch Stricker BH. Variation in the CYP2D6 gene is associated with a lower serum sodium concentration in patients on antidepressants. Br J Clin Pharmacol 2010; 68:221-5. [PMID: 19694742 DOI: 10.1111/j.1365-2125.2009.03448.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To study the effect of the CYP2D6*4 polymorphism on serum sodium concentration in users of antidepressants [selective serotonin reuptake inhibitors and tricyclic antidepressants (TCAs)]. METHODS In this population-based cohort study, all subjects in the Rotterdam Study were included who used an antidepressant at baseline and from whom a blood sample was available in which CYP2D6 genotype and serum sodium concentration could be determined (n= 76). Multivariate linear regression was used to study the association between CYP2D6*4 and serum sodium concentration. RESULTS CYP2D6 poor metabolizers (PMs) (*4/*4) had a significantly lower mean serum sodium concentration in comparison with CYP2D6 extensive metabolizers (EMs) (*1/*1) [difference -3.9 mmol l(-1); 95% confidence interval (CI) -0.86, -7.03; P= 0.013]. In CYP2D6*4 heterozygotes (*1/*4) serum sodium concentration was 1.7 mmol l(-1) (95% CI -3.48, 0.18) lower compared with CYP2D6 EMs, but this difference was not statistically significant (P= 0.077). CONCLUSIONS The serum sodium concentration in PMs was lower in users of an antidepressant, especially in TCA users. Therefore CYP2D6 PMs might be at increased risk of developing symptoms of hyponatraemia.
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Becker ML, Visser LE, van Schaik RHN, Hofman A, Uitterlinden AG, Stricker BHC. Influence of genetic variation in CYP3A4 and ABCB1 on dose decrease or switching during simvastatin and atorvastatin therapy. Pharmacoepidemiol Drug Saf 2010; 19:75-81. [PMID: 19802823 DOI: 10.1002/pds.1866] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Simvastatin and atorvastatin are metabolized by the CYP3A4 enzyme and transported by the ABCB1 transporter. We studied whether the polymorphism CYP3A4*1B and the polymorphisms C1236T, G2677A/T and C3435T in the ABCB1 gene were associated with a decrease of the prescribed dose or a switch to another cholesterol lowering drug during simvastatin and atorvastatin therapy. These events may indicate that statin plasma levels were too high and resulted in an adverse drug reaction or a too strong reduction in cholesterol level. METHODS We identified 1239 incident simvastatin and atorvastatin users in the Rotterdam Study, a population-based cohort study. Associations between the polymorphisms in the CYP3A4 and ABCB1 gene and the time to a decrease in dose or a switch to another cholesterol lowering drug were studied using Cox proportional hazards. RESULTS Simvastatin and atorvastatin users with the CYP3A4*1B variant G allele had a lower risk (HR 0.46; 95%CI 0.24-0.90) for these events than users with the wild-type AA genotype. No significant associations were found for the ABCB1 polymorphisms. The association with the CYP3A4*1B polymorphism was found in women (HR 0.33; 95%CI 0.12-0.89) and was non-significant in men (HR 0.69 95%CI 0.28-1.70). This association was stronger in patients with the ABCB1 3435T variant allele versus the G allele. CONCLUSION In simvastatin and atorvastatin users, the CYP3A4*1B G allele is associated with a lower risk of elevated statin plasma levels, particularly in women and in users with the ABCB1 3435T variant allele.
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Affiliation(s)
- Matthijs L Becker
- Department of Epidemiology, Erasmus MC, 3000 CA Rotterdam, the Netherlands
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Ellinor PT, Lunetta KL, Glazer NL, Pfeufer A, Alonso A, Chung MK, Sinner MF, de Bakker PIW, Mueller M, Lubitz SA, Fox E, Darbar D, Smith NL, Smith JD, Schnabel RB, Soliman EZ, Rice KM, Van Wagoner DR, Beckmann BM, van Noord C, Wang K, Ehret GB, Rotter JI, Hazen SL, Steinbeck G, Smith AV, Launer LJ, Harris TB, Makino S, Nelis M, Milan DJ, Perz S, Esko T, Köttgen A, Moebus S, Newton-Cheh C, Li M, Möhlenkamp S, Wang TJ, Kao WHL, Vasan RS, Nöthen MM, MacRae CA, Stricker BHC, Hofman A, Uitterlinden AG, Levy D, Boerwinkle E, Metspalu A, Topol EJ, Chakravarti A, Gudnason V, Psaty BM, Roden DM, Meitinger T, Wichmann HE, Witteman JCM, Barnard J, Arking DE, Benjamin EJ, Heckbert SR, Kääb S. Common variants in KCNN3 are associated with lone atrial fibrillation. Nat Genet 2010; 42:240-4. [PMID: 20173747 PMCID: PMC2871387 DOI: 10.1038/ng.537] [Citation(s) in RCA: 363] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 01/22/2010] [Indexed: 11/09/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia. A subset of patients with lone AF have no overt heart disease and an increased heritability of AF. We sought to identify common genetic variants underlying lone AF. Cases were from the German AF Network, Heart and Vascular Health Study, Atherosclerosis Risk in Communities Study, Cleveland Clinic, and Massachusetts General Hospital. Subjects were genotyped, HapMap SNPs imputed, and age- sex- and hypertension-adjusted analyses performed. A meta-analysis was conducted using 1,335 cases of lone AF and 12,844 referents. A novel locus on chromosome 1q21 was identified, and the most significant SNP, rs13376333, had an adjusted odds ratio of 1.56 (P=6.3×10−12). This association was replicated in two cohorts with lone AF for an overall odds ratio of 1.52 (P=1.83×10−21). Rs13376333 is intronic to KCNN3, a potassium channel involved in atrial repolarization. KCNN3 represents a novel potential therapeutic target in the treatment of AF.
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Affiliation(s)
- Patrick T Ellinor
- [1] Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA. [2] Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA. [3] Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA. [4] These authors contributed equally to this work
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van Noord C, Sturkenboom MCJM, Straus SMJM, Hofman A, Kors JA, Witteman JCM, Stricker BHC. Serum glucose and insulin are associated with QTc and RR intervals in nondiabetic elderly. Eur J Endocrinol 2010; 162:241-8. [PMID: 19897609 DOI: 10.1530/eje-09-0878] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [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
AIMS To study whether nondiabetic persons with impaired fasting serum glucose and hyperinsulinemia have QTc/QT interval prolongation and RR interval shortening in the electrocardiogram (ECG), and whether these were associated with an increased risk of sudden cardiac death. METHODS This study consisted of two analyses. First, a cross-sectional analysis was used as part of the population-based Rotterdam Study including 1050 men and 1520 women (>or=55 years) without diabetes mellitus. Participants in round 3 of the Rotterdam Study for whom an ECG and fasting serum glucose and fasting insulin measurements were available were eligible for the study. Participants using digoxin or QTc-prolonging drugs and participants with left ventricular hypertrophy and left and right bundle branch block were excluded. The endpoints of the study were the lengths of the QTc, QT, and RR intervals. The associations were examined by means of linear regression analysis. Secondly, in all 6020 participants of the Rotterdam Study with an ECG, the associations between the QTc, QT, and RR intervals and sudden cardiac death were examined by means of Cox regression analysis. RESULTS Overall, there was a significant association between impaired fasting serum glucose and the QTc interval with an increase of 2.6 ms (95% confidence interval (CI): 0.3; 5.0) in those with fasting glucose >6 mmol/l. Hyperinsulinemia was also associated with QTc prolongation (3.0 ms (0.8; 5.3)) in those with fasting insulin >or=100 pmol/l. Impaired fasting glucose (IFG) and hyperinsulinemia were significantly associated with a decrease of the RR interval (-33.7 ms (-48.8; -18.6) and -44.4 ms (-58.7; -30.0) respectively). Participants in the fourth quartile of the QTc and QT intervals had a significantly increased risk of sudden cardiac death compared to participants in the first quartile (hazard ratio (HR) 2.87 (95% CI: 2.02-4.06); HR 3.05 (1.99-4.67) respectively). Furthermore, there was a significant inverse association between the fourth quartile of the RR interval compared to the first quartile and the risk of sudden cardiac death (HR 0.49 (0.34-0.80)). CONCLUSION In this population-based study, we demonstrated that IFG and hyperinsulinemia are associated with a significantly increased QTc interval and with significant shortening of the RR interval, the latter probably due to an increased sympathetic activity. In addition, we demonstrated that both a prolonged QTc interval and a shortened RR interval are associated with an increased risk of sudden cardiac death.
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Affiliation(s)
- Charlotte van Noord
- Department of Epidemiology, Internal Medicine Medical Informatics, Erasmus Medical Center, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
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Becker ML, Visser LE, van Schaik RHN, Hofman A, Uitterlinden AG, Stricker BHC. Common genetic variation in the ABCB1 gene is associated with the cholesterol-lowering effect of simvastatin in males. Pharmacogenomics 2010; 10:1743-51. [PMID: 19891551 DOI: 10.2217/pgs.09.105] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIMS The cholesterol-lowering drug simvastatin is a substrate for P-glycoprotein (P-gp). P-gp, encoded by ABCB1, is an efflux transporter and genetic variation in ABCB1 is associated with drug levels and response. We examined the Rotterdam Study, which is a population-based cohort study of people aged 55 years and older, to see whether the C1236T, G2677T/A and C3435T polymorphisms and haplotypes in the ABCB1 gene are associated with the total cholesterol and low-density lipoprotein cholesterol-lowering effect of simvastatin. MATERIALS & METHODS We identified 85 incident simvastatin users, for whom a cholesterol measurement both before and after the start of simvastatin therapy was available. Associations between the ABCB1 gene variants and reductions in cholesterol levels were analyzed. In our analysis we stratified for gender, because the level of P-gp expression in the liver is higher in men than in women. RESULTS The three ABCB1 polymorphisms were associated with total cholesterol reduction in the whole population. In men, both the 1236/2677/3435 TTT haplotype and the CGT haplotype were associated with larger reductions in total cholesterol (TTT: -0.40 mmol/l, 95% CI: -0.63 to -0.17; CGT: -0.44 mmol/l, 95% CI: -0.77 to -0.11) and low-density lipoprotein cholesterol levels (TTT: -0.51 mmol/l, 95% CI: -0.81 to -0.22; CGT: -0.53 mmol/l, 95% CI: -0.92 to -0.15) than the reference CGC haplotype. In women, genetic variation in the ABCB1 gene was not associated with total and low-density lipoprotein cholesterol levels. CONCLUSION Male simvastatin users with the ABCB1 1236/2677/3435 TTT and CGT haplotype have larger reductions in total cholesterol and low-density lipoprotein cholesterol compared with the wild-type CGC haplotype. For women, no associations were found.
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van Noord C, Dörr M, Sturkenboom MCJM, Straus SMJM, Reffelmann T, Felix SB, Hofman A, Kors JA, Haring R, de Jong FH, Nauck M, Uitterlinden AG, Wallaschofski H, Witteman JCM, Völzke H, Stricker BHC. The association of serum testosterone levels and ventricular repolarization. Eur J Epidemiol 2009; 25:21-8. [PMID: 19957021 PMCID: PMC2807939 DOI: 10.1007/s10654-009-9406-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 11/19/2009] [Indexed: 01/08/2023]
Abstract
It is assumed that testosterone is an important regulator of gender-related differences in ventricular repolarization. Therefore, our aim was to study whether serum levels of testosterone are associated with QTc, QT and RR interval variation. Setting: two independent population-based cohort studies. Participants: 445 male participants (≥55 years) from the Rotterdam study cohort and 1,428 male participants from the study of health in Pomerania (SHIP) with an electrocardiogram who were randomly sampled for assessment of serum testosterone at baseline, after exclusion of participants with testosterone altering drugs, QTc prolonging drugs or dig(it)oxin, left ventricular hypertrophy and left and right bundle branch block. Endpoints: length of the QTc, QT and RR intervals. Analysis: linear regression model, adjusted for the two individual studies and a pooled analysis of both studies. The pooled analysis of the Rotterdam study and SHIP showed that the QTc interval gradually decreased among the tertiles (P value for trend 0.024). The third tertile of serum testosterone was associated with a lower QTc interval compared to the first tertile [−3.4 ms (−6.5; −0.3)]. However, the third tertile of serum testosterone was not associated with a lower QT interval compared to the first tertile [−0.7 ms (−3.1; 1.8)]. The RR interval gradually increased among the tertiles (P value for trend 0.002) and the third tertile of serum testosterone showed an increased RR interval compared to the first tertile [33.5 ms (12.2; 54.8)]. In the pooled analysis of two population-based studies, serum testosterone levels were not associated with the QT interval, which could be due to a lack of power. Lower QTc intervals in men with higher serum testosterone levels could be due to the association of serum testosterone with prolongation of the RR interval.
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Affiliation(s)
- Charlotte van Noord
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Bijl MJ, Luijendijk HJ, van den Berg JF, Visser LE, van Schaik RHN, Hofman A, Vulto AG, van Gelder T, Tiemeier H, Stricker BHC. Association between the CYP2D6*4 polymorphism and depression or anxiety in the elderly. Pharmacogenomics 2009; 10:541-7. [PMID: 19374513 DOI: 10.2217/pgs.09.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION 5-methoxytryptamine (5-MT), a precursor of serotonin, is considered to be an endogenous substrate of cytochrome P450 2D6 (CYP2D6). Homozygous carriers of the variant allele CYP2D6*4 lack CYP2D6 enzyme activity. Relative to extensive metabolizers, these poor metabolizers may have lower baseline serotonin concentrations in various brain regions, and may be more prone to depression or anxiety. AIM To test whether the CYP2D6*4/*4 genotype is associated with a predisposition to depression or anxiety disorders in the elderly. MATERIALS & METHODS We conducted a cross-sectional study within the Rotterdam Study, a population-based cohort study, among persons aged 55 years or older, who were screened for depression and anxiety disorders at two consecutive examination rounds. Logistic regression was used to analyze the association between the CYP2D6*4 polymorphism and the risk of depression or anxiety disorders. RESULTS The risk of major depression in CYP2D6*4/*4 was not significantly different from extensive metabolizers (OR = 0.85; 95% CI: 0.36-2.00; p = 0.72). Neither did we find an association between CYP2D6 genotype and minor depression (OR = 1.56; 95% CI: 0.69-3.52; p = 0.28). No increased risk of anxiety disorders was found (OR = 1.19; 95% CI: 0.68-2.09; p = 0.55). CONCLUSION Variation in the CYP2D6 gene is not related to a predisposition to depression or anxiety disorders in the elderly.
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Affiliation(s)
- Monique J Bijl
- Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Benjamin EJ, Rice KM, Arking DE, Pfeufer A, van Noord C, Smith AV, Schnabel RB, Bis JC, Boerwinkle E, Sinner MF, Dehghan A, Lubitz SA, D'Agostino RB, Lumley T, Ehret GB, Heeringa J, Aspelund T, Newton-Cheh C, Larson MG, Marciante KD, Soliman EZ, Rivadeneira F, Wang TJ, Eiríksdottir G, Levy D, Psaty BM, Li M, Chamberlain AM, Hofman A, Vasan RS, Harris TB, Rotter JI, Kao WHL, Agarwal SK, Stricker BHC, Wang K, Launer LJ, Smith NL, Chakravarti A, Uitterlinden AG, Wolf PA, Sotoodehnia N, Köttgen A, van Duijn CM, Meitinger T, Mueller M, Perz S, Steinbeck G, Wichmann HE, Lunetta KL, Heckbert SR, Gudnason V, Alonso A, Kääb S, Ellinor PT, Witteman JCM. Variants in ZFHX3 are associated with atrial fibrillation in individuals of European ancestry. Nat Genet 2009; 41:879-81. [PMID: 19597492 PMCID: PMC2761746 DOI: 10.1038/ng.416] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 06/11/2009] [Indexed: 11/10/2022]
Abstract
We conducted meta-analyses of genome-wide association studies (GWAS) for atrial fibrillation (AF) in participants from five community-based cohorts. Meta-analyses of 896 prevalent (15,768 referents) and 2,517 incident (21,337 referents) AF cases identified a novel locus for AF (ZFHX3, rs2106261, risk ratio [RR]=1.19; P=2.3×10−7), an association that was replicated in the German AF Network (odds ratio=1.44; P=1.6×10−11). Combining the discovery and replication results, rs2106261 was significantly associated with AF (RR=1.25; P=1.8×10−15).
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Affiliation(s)
- Emelia J Benjamin
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.
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