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Rivier CA, Szejko N, Renedo D, Noche RB, Acosta JN, Both CP, Sharma R, Torres-Lopez VM, Payabvash S, de Havenon A, Sheth KN, Gill TM, Falcone GJ. Polygenic Susceptibility to Hypertension and Cognitive Performance in Middle-aged Persons Without Stroke or Dementia. Neurology 2023; 101:e512-e521. [PMID: 37295956 PMCID: PMC10401683 DOI: 10.1212/wnl.0000000000207427] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/04/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mounting evidence indicates that hypertension leads to a higher risk of dementia. Hypertension is a highly heritable trait, and a higher polygenic susceptibility to hypertension (PSH) is known to associate with a higher risk of dementia. We tested the hypothesis that a higher PSH leads to worse cognitive performance in middle-aged persons without dementia. Confirming this hypothesis would support follow-up research focused on using hypertension-related genomic information to risk-stratify middle-aged adults before hypertension develops. METHODS We conducted a nested cross-sectional genetic study within the UK Biobank (UKB). Study participants with a history of dementia or stroke were excluded. We categorized participants as having low (≤20th percentile), intermediate, or high (≥80th percentile) PSH according to results of 2 polygenic risk scores for systolic and diastolic blood pressure (BP) generated with data on 732 genetic risk variants. A general cognitive ability score was calculated as the first component of an analysis that included the results of 5 cognitive tests. Primary analyses focused on Europeans, and secondary analyses included all race/ethnic groups. RESULTS Of the 502,422 participants enrolled in the UKB, 48,118 (9.6%) completed the cognitive evaluation, including 42,011 (8.4%) of European ancestry. Multivariable regression models using systolic BP-related genetic variants indicated that compared with study participants with a low PSH, those with intermediate and high PSH had reductions of 3.9% (β -0.039, SE 0.012) and 6.6% (β -0.066, SE 0.014), respectively, in their general cognitive ability score (p < 0.001). Secondary analyses including all race/ethnic groups and using diastolic BP-related genetic variants yielded similar results (p < 0.05 for all tests). Analyses evaluating each cognitive test separately indicated that reaction time, numeric memory, and fluid intelligence drove the association between PSH and general cognitive ability score (all individual tests, p < 0.05). DISCUSSION Among nondemented, community-dwelling, middle-aged Britons, a higher PSH is associated with worse cognitive performance. These findings suggest that genetic predisposition to hypertension influences brain health in persons who have not yet developed dementia. Because information on genetic risk variants for elevated BP is available long before the development of hypertension, these results lay the foundation for further research focused on using genomic data for the early identification of high-risk middle-aged adults.
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Affiliation(s)
- Cyprien A Rivier
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
| | - Natalia Szejko
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Daniela Renedo
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Rommell B Noche
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Julian N Acosta
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Cameron P Both
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Richa Sharma
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Victor M Torres-Lopez
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Sam Payabvash
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Guido J Falcone
- From the Department of Neurology (C.A.R., N.S., D.R., J.N.A., R.S., V.M.T.-L., A.d.H., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.S.), and Department of Bioethics (N.S.), Medical University of Warsaw, Poland; Department of Neurosurgery (D.R.), Yale School of Medicine, New Haven; Frank H. Netter MD School of Medicine (R.B.N.), Quinnipiac University, North Haven, CT; UMass Chan Medical School (C.P.B.), University of Massachusetts, Worcester; and Department of Radiology (S.P.), and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
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Ye Y, Noche RB, Szejko N, Both CP, Acosta JN, Leasure AC, Brown SC, Sheth KN, Gill TM, Zhao H, Falcone GJ. A genome-wide association study of frailty identifies significant genetic correlation with neuropsychiatric, cardiovascular, and inflammation pathways. GeroScience 2023; 45:2511-2523. [PMID: 36928559 PMCID: PMC10651618 DOI: 10.1007/s11357-023-00771-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Frailty is an aging-related clinical phenotype defined as a state in which there is an increase in a person's vulnerability for dependency and/or mortality when exposed to a stressor. While underlying mechanisms leading to the occurrence of frailty are complex, the importance of genetic factors has not been fully investigated. We conducted a large-scale genome-wide association study (GWAS) of frailty, as defined by the five criteria (weight loss, exhaustion, physical activity, walking speed, and grip strength) captured in the Fried Frailty Score (FFS), in 386,565 European descent participants enrolled in the UK Biobank (mean age 57 [SD 8] years, 208,481 [54%] females). We identified 37 independent, novel loci associated with the FFS (p < 5 × 10-8), including seven loci without prior described associations with other traits. The variants associated with FFS were significantly enriched in brain tissues as well as aging-related pathways. Our post-GWAS bioinformatic analyses revealed significant genetic correlations between FFS and cardiovascular-, neurological-, and inflammation-related diseases/traits, and subsequent Mendelian Randomization analyses identified causal associations with chronic pain, obesity, diabetes, education-related traits, joint disorders, and depressive/neurological, metabolic, and respiratory diseases. The GWAS signals were replicated in the Health and Retirement Study (HRS, n = 9,720, mean age 73 [SD 7], 5,582 [57%] females), where the polygenic risk score built from UKB GWAS was significantly associated with the FFS in HRS individuals (OR per SD of the score 1.27, 95% CI 1.22-1.31, p = 1.3 × 10-11). These results provide new insight into the biology of frailty by comprehensively evaluating its genetic architecture.
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Affiliation(s)
- Yixuan Ye
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Rommell B Noche
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA
| | - Natalia Szejko
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Cameron P Both
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA
| | - Julian N Acosta
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA
| | - Audrey C Leasure
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA
| | - Stacy C Brown
- University of Hawai'I, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hongyu Zhao
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.
- Department of Biostatistics, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA.
| | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1004D, P.O. Box 20801, New Haven, CT, 06510, USA.
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Acosta JN, Both CP, Demarais ZS, Conlon CJ, Leasure AC, Torres-Lopez VM, de Havenon A, Petersen NH, Gill TM, Sansing LH, Sheth KN, Falcone GJ. Polygenic Susceptibility to Hypertension and Blood Pressure Control in Stroke Survivors. Neurology 2023; 100:e1587-e1597. [PMID: 36690452 PMCID: PMC10103110 DOI: 10.1212/wnl.0000000000206763] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Blood pressure (BP) is often not at goal in stroke survivors, leaving individuals vulnerable to additional vascular events. Given that BP is a highly heritable trait, we hypothesize that a higher polygenic susceptibility to hypertension (PSH) leads to worse BP control in stroke survivors. METHODS We conducted a study within the UK Biobank evaluating persons of European ancestry who survived an ischemic or hemorrhagic stroke. To model the PSH, we created polygenic risk scores (PRSs) for systolic and diastolic BP using 732 genetic variants. We divided the PRSs into quintiles and used linear/logistic regression to test whether higher PSH led to higher observed BP, uncontrolled BP (systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg), and resistant BP (uncontrolled BP despite being on ≥3 antihypertensive drugs). We conducted an independent replication using data from the Vitamin Intervention for Stroke Prevention (VISP) trial. RESULTS We analyzed 5,940 stroke survivors. When comparing stroke survivors with very low vs very high PSH, the mean systolic BP was 137 (SD 18) vs 143 (SD 20, p < 0.001), the mean diastolic BP was 81 (SD 10) vs 84 (SD 11, p < 0.001), the prevalence of uncontrolled BP was 42.8% vs 57.2% (p < 0.001), and the prevalence of resistant hypertension was 3.9% vs 11% (p < 0.001). Results remained significant using multivariable models (p < 0.001) and were replicated in the VISP study (all tests with p < 0.05). DISCUSSION A higher PSH is associated with worse BP control in stroke survivors. These findings point to genetic predisposition as an important determinant of poorly controlled BP in this population.
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Affiliation(s)
- Julián N Acosta
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Cameron P Both
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Zachariah S Demarais
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Carolyn J Conlon
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Audrey C Leasure
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Victor M Torres-Lopez
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Nils H Petersen
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Lauren H Sansing
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Guido J Falcone
- From the Division of Neurocritical Care & Emergency Neurology (J.N.A., C.P.B., A.C.L., V.M.T.-L., A.H., N.H.P., K.N.S., G.J.F.), Department of Neurology, Yale School of Medicine; Frank H. Netter MD School of Medicine (Z.S.D., C.J.C.); Division of Vascular Neurology (N.H.P., L.H.S.), Department of Neurology, Yale School of Medicine; and Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT.
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Abstract
Background The evidence linking vitamin D (VitD) levels and spontaneous intracerebral hemorrhage (ICH) remains inconclusive. We tested the hypothesis that lower genetically determined VitD levels are associated with higher risk of ICH. Methods and Results We conducted a 2 sample Mendelian Randomization (MR) study using publicly available summary statistics from published genome-wide association studies of VitD levels (417 580 study participants) and ICH (1545 ICH cases and 1481 matched controls). We used the inverse-variance weighted approach to generate causal estimates and the MR Pleiotropy Residual Sum and Outlier and MR-Egger approaches to assess for horizontal pleiotropy. To account for known differences in their underlying mechanism, we implemented stratified analysis based on the location of the hemorrhage within the brain (lobar or nonlobar). Our primary analysis indicated that each SD decrease in genetically instrumented VitD levels was associated with a 60% increased risk of ICH (odds ratio [OR], 1.60; [95% CI, 1.05-2.43]; P=0.029). We found no evidence of horizontal pleiotropy (MR-Egger intercept and MR Pleiotropy Residual Sum and Outlier global test with P>0.05). Stratified analyses indicated that the association was stronger for nonlobar ICH (OR, 1.87; [95% CI, 1.18-2.97]; P=0.007) compared with lobar ICH (OR, 1.43; [95% CI, 0.86-2.38]; P=0.17). Conclusions Lower levels of genetically proxied VitD levels are associated with higher ICH risk. These results provide evidence for a causal role of VitD metabolism in ICH.
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Affiliation(s)
- Natalia Szejko
- Department of NeurologyYale School of MedicineNew HavenCT
- Department of BioethicsMedical University of WarsawPoland
- Department of NeurologyMedical University of WarsawPoland
| | | | | | - Audrey Leasure
- Department of NeurologyYale School of MedicineNew HavenCT
| | - Charles Matouk
- Department of NeurosurgeryYale School of MedicineNew HavenCT
| | - Lauren Sansing
- Department of NeurologyYale School of MedicineNew HavenCT
| | - Thomas M. Gill
- Department of Internal Medicine, Geriatric MedicineYale School of MedicineNew HavenCT
| | - Zhao Hongyu
- Department of BiostatisticsYale School of Public HealthNew HavenCT
| | - Kevin Sheth
- Department of NeurologyYale School of MedicineNew HavenCT
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Acosta JN, Both CP, Rivier C, Szejko N, Leasure AC, Gill TM, Payabvash S, Sheth KN, Falcone GJ. Analysis of Clinical Traits Associated With Cardiovascular Health, Genomic Profiles, and Neuroimaging Markers of Brain Health in Adults Without Stroke or Dementia. JAMA Netw Open 2022; 5:e2215328. [PMID: 35622359 PMCID: PMC9142873 DOI: 10.1001/jamanetworkopen.2022.15328] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The American Heart Association (AHA) Life's Simple 7 (LS7) score captures 7 biological and lifestyle factors associated with promoting cardiovascular health. OBJECTIVES To test whether healthier LS7 profiles are associated with significant brain health benefits in persons without stroke or dementia, and to evaluate whether genomic information can recapitulate the observed LS7. DESIGN, SETTING, AND PARTICIPANTS This genetic association study was a nested neuroimaging study within the UK Biobank, a large population-based cohort study in the United Kingdom. Between March 2006 and October 2010, the UK Biobank enrolled 502 480 community-dwelling persons aged 40 to 69 years at recruitment. This study focused on a subset of 35 914 participants without stroke or dementia who completed research brain magnetic resonance imaging (MRI) and had available genome-wide data. All analyses were conducted between March 2021 and March 2022. EXPOSURES The LS7 (blood pressure, low-density lipoprotein cholesterol, hemoglobin A1c, smoking, exercise, diet, and body mass index) profiles were ascertained clinically and genomically. Independent genetic variants known to influence each of the traits included in the LS7 were assessed. The total LS7 score ranges from 0 (worst) to 14 (best) and was categorized as poor (≤4), average (>4 to 9) and optimal (>9). MAIN OUTCOMES AND MEASURES The outcomes of interest were 2 neuroimaging markers of brain health: white matter hyperintensity (WMH) volume and brain volume (BV). RESULTS The final analytical sample included 35 914 participants (mean [SD] age 64.1 [7.6] years; 18 830 [52.4%] women). For WMH, compared with persons with poor observed LS7 profiles, those with average profiles had 16% (β = -0.18; SE, 0.03; P < .001) lower mean volume and those with optimal profiles had 39% (β = -0.39; SE, 0.03; P < .001) lower mean volume. Similar results were obtained using the genomic LS7 for WMH (average LS7 profile: β = -0.06; SE, 0.014; P < .001; optimal LS7 profile: β = -0.08; SE, 0.018; P < .001). For BV, compared with persons with poor observed LS7 profiles, those with average LS7 profiles had 0.55% (β = 0.09; SE, 0.02; P < .001) higher volume, and those with optimal LS7 profiles had 1.9% (β = 0.14; SE, 0.02; P < .001) higher volume. The genomic LS7 profiles were not associated with BV. CONCLUSIONS AND RELEVANCE These findings suggest that healthier LS7 profiles were associated with better profiles of 2 neuroimaging markers of brain health in persons without stroke or dementia, indicating that cardiovascular health optimization was associated with improved brain health in asymptomatic persons. Genomic information appropriately recapitulated 1 of these associations, confirming the feasibility of modeling the LS7 genomically and pointing to an important role of genetic predisposition in the observed association among cardiometabolic and lifestyle factors and brain health.
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Affiliation(s)
- Julián N. Acosta
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Cameron P. Both
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Cyprien Rivier
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Natalia Szejko
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Audrey C. Leasure
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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Acosta JN, Both CP, Szejko N, Leasure AC, Abdelhakim S, Torres-Lopez VM, Brown SC, Matouk CC, Gunel M, Sheth KN, Falcone GJ. Genetically Determined Low-Density Lipoprotein Cholesterol and Risk of Subarachnoid Hemorrhage. Ann Neurol 2021; 91:145-149. [PMID: 34709661 DOI: 10.1002/ana.26250] [Citation(s) in RCA: 1] [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] [Received: 04/17/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
We evaluated whether genetically elevated low-density lipoprotein cholesterol (LDL-C) levels are associated with lower risk of intracranial aneurysms and subarachnoid hemorrhage (IA/SAH). We conducted a 2-sample Mendelian randomization (MR) study. Our primary analysis used the inverse-variance weighted method. In secondary analyses, we implemented the MR-PRESSO method, restricted our analysis to LDL-C-specific instruments, and performed multivariate MR. A 1-mmol/l increase in genetically instrumented LDL-C levels was associated with a 17% lower risk of IA/SAH (odds ratio = 0.83, 95% confidence interval = 0.73-0.94, p = 0.004). Results remained consistent in secondary and multivariate analyses (all p < 0.05). Our results provide evidence for an inverse causal relationship between LDL-C levels and risk of IA/SAH. ANN NEUROL 2021.
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Affiliation(s)
- Julián N Acosta
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Cameron P Both
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Natalia Szejko
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Audrey C Leasure
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Safa Abdelhakim
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Victor M Torres-Lopez
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Stacy C Brown
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Charles C Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Murat Gunel
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Guido J Falcone
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
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Acosta JN, Leasure AC, Both CP, Szejko N, Brown S, Torres-Lopez V, Abdelhakim S, Schindler J, Petersen N, Sansing L, Gill TM, Sheth KN, Falcone GJ. Cardiovascular Health Disparities in Racial and Other Underrepresented Groups: Initial Results From the All of Us Research Program. J Am Heart Assoc 2021; 10:e021724. [PMID: 34431358 PMCID: PMC8649271 DOI: 10.1161/jaha.121.021724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background All of Us is a novel research program that aims to accelerate research in populations traditionally underrepresented in biomedical research. Our objective was to evaluate the burden of cardiovascular disease (CVD) in broadly defined underrepresented groups. Methods and Results We evaluated the latest data release of All of Us. We conducted a cross‐sectional analysis combining survey and electronic health record data to estimate the prevalence of CVD upon enrollment in underrepresented groups defined by race, ethnicity, age (>75 years), disability (not able to carry out everyday physical activities), sexual orientation and gender identity lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+), income (annual household income <$35 000 US dollars) and education (less than a high school degree). We used multivariate logistic regression to estimate the adjusted odds ratio (OR) and product terms to test for interaction. The latest All of Us data release includes 315 297 participants. Of these, 230 577 (73%) had information on CVD and 17 958 had CVD (overall prevalence, 7.8%; 95% CI, 7.7–7.9). Multivariate analyses adjusted by hypertension, hyperlipidemia, type 2 diabetes mellitus, body mass index, and smoking indicated that, compared with White participants, Black participants had a higher adjusted odds of CVD (OR, 1.21; 95% CI, 1.16–1.27). Higher adjusted odds of CVD were also observed in underrepresented groups defined by other factors, including age >75 years (OR, 1.90; 95% CI, 1.81–1.99), disability (OR, 1.60; 95% CI, 1.53–1.68), and income <$35 000 US dollars (OR, 1.22; 95% CI, 1.17–1.27). Sex significantly modified the odds of CVD in several of the evaluated groups. Conclusions Among participants enrolled in All of Us, underrepresented groups defined based on race, ethnicity and other factors have a disproportionately high burden of CVD. The All of Us research program constitutes a powerful platform to accelerate research focused on individuals in underrepresented groups.
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Affiliation(s)
- Julián N Acosta
- Department of Neurology Yale School of Medicine New Haven CT
| | | | - Cameron P Both
- Department of Neurology Yale School of Medicine New Haven CT
| | - Natalia Szejko
- Department of Neurology Yale School of Medicine New Haven CT
| | - Stacy Brown
- John A. Burns School of Medicine University of Hawaii Honolulu HI
| | | | - Safa Abdelhakim
- Department of Neurology Yale School of Medicine New Haven CT
| | | | - Nils Petersen
- Department of Neurology Yale School of Medicine New Haven CT
| | - Lauren Sansing
- Department of Neurology Yale School of Medicine New Haven CT
| | - Thomas M Gill
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kevin N Sheth
- Department of Neurology Yale School of Medicine New Haven CT
| | - Guido J Falcone
- Department of Neurology Yale School of Medicine New Haven CT
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Acosta JN, Leasure AC, Kuohn LR, Both CP, Petersen NH, Sansing LH, Matouk CC, Testai F, Langefeld CD, Woo D, Kamel H, Murthy SB, Qureshi A, Mayer SA, Sheth KN, Falcone GJ. Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage. Crit Care Med 2021; 49:828-837. [PMID: 33591003 PMCID: PMC8611893 DOI: 10.1097/ccm.0000000000004891] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage. DESIGN Individual patient data meta-analysis of three studies of intracerebral hemorrhage. SETTING Two randomized clinical trials and one multiethnic observational study. PATIENTS Patients with spontaneous, nontraumatic intracerebral hemorrhage. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Our exposure of interest was admission hemoglobin levels and the primary outcome was 3-month postintracerebral hemorrhage-dichotomized modified Rankin Scale (0-3 vs 4-6). Intermediate outcomes were admission hematoma volume and hematoma expansion defined as 6 mL or 33% increase in hemorrhage size on repeat CT. A total of 4,172 intracerebral hemorrhage patients were included in the study (mean age 63 [sd = 14]; female sex 1,668 [40%]). Each additional g/dL of admission hemoglobin was associated with 14% (odds ratio, 0.86; 95% CI, 0.82-0.91) and 7% (odds ratio, 0.93; 95% CI, 0.88-0.98) reductions in the risk of poor outcome in unadjusted and adjusted analyses, respectively. Dose-response analyses indicated a linear relationship between admission hemoglobin levels and poor outcome across the entire evaluated range (test-for-trend p < 0.001). No consistent associations were found between the admission hemoglobin levels and hematoma volume or hematoma expansion. CONCLUSIONS Higher hemoglobin levels are associated with better outcome in intracerebral hemorrhage. Further research is needed to evaluate admission hemoglobin levels as both a therapeutic target and predictor of outcome.
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Affiliation(s)
- Julián N. Acosta
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Audrey C. Leasure
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Lindsey R. Kuohn
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Cameron P. Both
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Nils H. Petersen
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Division of Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Lauren H. Sansing
- Division of Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Charles C. Matouk
- Neurovascular Surgery, Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Fernando Testai
- Vascular Neurology, Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl D. Langefeld
- Departments of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Daniel Woo
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Hooman Kamel
- Division of Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Santosh B. Murthy
- Division of Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Adnan Qureshi
- Department of Neurology, University of Missouri, Columbia, MO, USA
- Zeenat Qureshi Stroke Institute, St. Cloud, MO, USA
| | | | - Kevin N. Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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Acosta JN, Szejko N, Both CP, Vanent K, Noche RB, Gill TM, Matouk CC, Sheth KN, Gunel M, Falcone GJ. Genetically Determined Smoking Behavior and Risk of Nontraumatic Subarachnoid Hemorrhage. Stroke 2021; 52:582-587. [PMID: 33440997 DOI: 10.1161/strokeaha.120.031622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Animal and observational studies indicate that smoking is a risk factor for aneurysm formation and rupture, leading to nontraumatic subarachnoid hemorrhage (SAH). However, a definitive causal relationship between smoking and the risk of SAH has not been established. Using Mendelian randomization (MR) analyses, we tested the hypothesis that smoking is causally linked to the risk of SAH. METHODS We conducted a 1-sample MR study using data from the UK Biobank, a large cohort study that enrolled over 500 000 Britons aged 40 to 69 from 2006 to 2010. Participants of European descent were included. SAH cases were ascertained using a combination of self-reported, electronic medical record, and death registry data. As the instrument, we built a polygenic risk score using independent genetic variants known to associate (P<5×10-8) with smoking behavior. This polygenic risk score represents the genetic susceptibility to smoking initiation. The primary MR analysis utilized the ratio method. Secondary MR analyses included the inverse variance weighted and weighted median methods. RESULTS A total of 408 609 study participants were evaluated (mean age, 57 [SD 8], female sex, 220 937 [54%]). Among these, 132 566 (32%) ever smoked regularly, and 904 (0.22%) had a SAH. Each additional SD of the smoking polygenic risk score was associated with 21% increased risk of smoking (odds ratio [OR], 1.21 [95% CI, 1.20-1.21]; P<0.001) and a 10% increased risk of SAH (OR, 1.10 [95% CI, 1.03-1.17]; P=0.006). In the primary MR analysis, genetic susceptibility to smoking was associated with a 63% increase in the risk of SAH (OR, 1.63 [95% CI, 1.15-2.31]; P=0.006). Secondary analyses using the inverse variance weighted method (OR, 1.57 [95% CI, 1.13-2.17]; P=0.007) and the weighted median method (OR, 1.74 [95% CI, 1.06-2.86]; P=0.03) yielded similar results. There was no significant pleiotropy (MR-Egger intercept P=0.39; MR Pleiotropy Residual Sum and Outlier global test P=0.69). CONCLUSIONS These findings provide evidence for a causal link between smoking and the risk of SAH.
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Affiliation(s)
- Julián N Acosta
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT
| | - Natalia Szejko
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT.,Department of Neurology (N.S.), Medical University of Warsaw, Poland.,Department of Bioethics (N.S.), Medical University of Warsaw, Poland
| | - Cameron P Both
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT
| | - Kevin Vanent
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT
| | - Rommell B Noche
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, CT
| | - Charles C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT
| | | | - Guido J Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.N.A., N.S., C.P.B., K.V., R.B.N., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT
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