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Klopp AH, Enserro D, Powell M, Randall M, Schink JC, Mannel RS, Holman L, Bender D, Kushnir CL, Backes F, Zweizig SL, Waggoner S, Bradley KA, Lawrence LD, Hanjani P, Darus CJ, Small W, Cardenes HR, Feddock JM, Miller DS. Radiation Therapy With or Without Cisplatin for Local Recurrences of Endometrial Cancer: Results From an NRG Oncology/GOG Prospective Randomized Multicenter Clinical Trial. J Clin Oncol 2024:JCO2301279. [PMID: 38662968 DOI: 10.1200/jco.23.01279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/30/2023] [Accepted: 02/20/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE Pelvic recurrence is a frequent pattern of relapse for women with endometrial cancer. A randomized trial compared progression-free survival (PFS) after treatment with radiation therapy alone as compared with concurrent chemotherapy. MATERIALS AND METHODS Between February 2008 and August 2020, 165 patients were randomly assigned 1:1 to receive either radiation treatment alone or a combination of chemotherapy and radiation treatment. The primary objective of this study was to determine whether chemoradiation therapy was more effective than radiation therapy alone at improving PFS. RESULTS The majority of patients had low-grade (1 or 2) endometrioid histology (82%) and recurrences confined to the vagina (86%). External beam with either the three-dimensional or intensity modulated radiation treatment technique was followed by a boost delivered with brachytherapy or external beam. Patients randomly assigned to receive chemotherapy were treated with once weekly cisplatin (40 mg/m2). Rates of acute toxicity were higher in patients treated with chemoradiation as compared with radiation treatment alone. Median PFS was longer for patients treated with radiation therapy alone as compared with chemotherapy and radiation (median PFS was not reached for RT v 73 months for chemoradiation, hazard ratio of 1.25 (95% CI, 0.75 to 2.07). At 3 years, 73% of patients treated definitively with radiation and 62% of patients treated with chemoradiation were alive and free of disease progression. CONCLUSION Excellent outcomes can be achieved for women with localized recurrences of endometrial cancer when treated with radiation therapy. The addition of chemotherapy does not improve PFS for patients treated with definitive radiation therapy for recurrent endometrial cancer and increases acute toxicity. Patients with low-grade and vaginal recurrences who constituted the majority of those enrolled are best treated with radiation therapy alone.
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Affiliation(s)
- Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Danielle Enserro
- Clinical Trials Development Division, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Matthew Powell
- Washington University School of Medicine, Obstetrics & Gynecology, St Louis, MO
| | - Marcus Randall
- University of Kentucky, Radiation Oncology, Lexington, KY
| | - Julian C Schink
- Cancer Treatment Centers of America, City of Hope, Gynecologic Oncology, Chicago, IL
| | | | - Laura Holman
- University of Oklahoma Health Sciences, Oklahoma City, OK
| | - David Bender
- University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Floor Backes
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | - Susan L Zweizig
- University of Massachusetts Memorial Health Care, Gynecologic Oncology, Worcester, MA
| | - Steven Waggoner
- Cleveland Clinic Foundation, Medical Oncology, Cleveland, OH
| | - Kristin A Bradley
- University of Wisconsin Hospital and Clinics, Radiation Oncology, Madison, WI
| | | | - Parviz Hanjani
- Abington Memorial Hospital, Gynecologic Oncology, Abington, PA
| | - Christopher J Darus
- Maine Medical Center, Gynecologic Oncology, Scarborough, ME
- Providence Gynecologic Oncology Program and Earle A Chiles Research Institute, Portland, OR
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Cardinal Bernardin Cancer Center, Chicago, IL
| | - Higinia R Cardenes
- New York-Presbyterian Hospital, Weill Cornell Medicine, Clinical Radiation Oncology, New York, NY
| | | | - David S Miller
- University of Texas Southwestern Medical Center, Gynecologic Oncology, Dallas, TX
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Rimel BJ, Enserro D, Bender DP, Jackson CG, Tan A, Alluri N, Borowsky M, Moroney J, Hendrickson AW, Backes F, Swisher E, Powell M, MacKay H. NRG-GY012: Randomized phase 2 study comparing olaparib, cediranib, and the combination of cediranib/olaparib in women with recurrent, persistent, or metastatic endometrial cancer. Cancer 2024; 130:1234-1245. [PMID: 38127487 DOI: 10.1002/cncr.35151] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This paper reports the efficacy of the poly (ADP-ribose) polymerase inhibitor olaparib alone and in combination with the antiangiogenesis agent cediranib compared with cediranib alone in patients with advanced endometrial cancer. METHODS This was open-label, randomized, phase 2 trial (NCT03660826). Eligible patients had recurrent endometrial cancer, received at least one (<3) prior lines of chemotherapy, and were Eastern Cooperative Oncology Group performance status 0 to 2. Patients were randomly assigned (1:1:1), stratified by histology (serous vs. other) to receive cediranib alone (reference arm), olaparib, or olaparib and cediranib for 28-day cycles until progression or unacceptable toxicity. The primary end point was progression-free survival in the intention-to-treat population. Homologous repair deficiency was explored using the BROCA-GO sequencing panel. RESULTS A total of 120 patients were enrolled and all were included in the intention-to-treat analysis. Median age was 66 (range, 41-86) years and 47 (39.2%) had serous histology. Median progression-free survival for cediranib was 3.8 months compared with 2.0 months for olaparib (hazard ratio, 1.45 [95% CI, 0.91-2.3] p = .935) and 5.5 months for olaparib/cediranib (hazard ratio, 0.7 [95% CI, 0.43-1.14] p = .064). Four patients receiving the combination had a durable response lasting more than 20 months. The most common grade 3/4 toxicities were hypertension in the cediranib (36%) and olaparib/cediranib (33%) arms, fatigue (20.5% olaparib/cediranib), and diarrhea (17.9% cediranib). The BROCA-GO panel results were not associated with response. CONCLUSION The combination of cediranib and olaparib demonstrated modest clinical efficacy; however, the primary end point of the study was not met. The combination was safe without unexpected toxicity.
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Affiliation(s)
- Bobbie J Rimel
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Danielle Enserro
- Clinical Trials Development Division, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - David P Bender
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Camille Gunderson Jackson
- University of Oklahoma Health Sciences Center, Mercy Hospital Gynecologic Oncology, Oklahoma City, Oklahoma, USA
| | - Annie Tan
- Minnesota Oncology, Coon Rapids, Minnesota, USA
| | | | - Mark Borowsky
- Hackensack Meridian Health, Neptune, New Jersey, USA
| | - John Moroney
- University of Chicago Medicine, Schererville, Indiana, USA
| | | | - Floor Backes
- The Ohio State University Comprehensive Cancer Center, Ohio State Internal Medicine, Hilliard, Ohio, USA
| | | | - Matthew Powell
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Helen MacKay
- Division of Medical Oncology & Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
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3
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duPont NC, Enserro D, Brady MF, Moxley K, Walker JL, Cosgrove C, Bixel K, Tewari KS, Thaker P, Wahner Hendrickson AE, Rubin S, Fujiwara K, Casey AC, Soper J, Burger RA, Monk BJ. Prognostic significance of ethnicity and age in advanced stage epithelial ovarian cancer: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2022; 164:398-405. [PMID: 34857397 PMCID: PMC9400113 DOI: 10.1016/j.ygyno.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/03/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Age and ethnicity are among several factors that influence overall survival (OS) in ovarian cancer. The study objective was to determine whether ethnicity and age were of prognostic significance in women enrolled in a clinical trial evaluating the addition of bevacizumab to front-line therapy. METHODS Women with advanced stage ovarian, primary peritoneal, or fallopian tube cancer were enrolled in a phase III clinical trial. All women had surgical staging and received adjuvant chemotherapy with one of three regimens. Cox proportional hazards models were used to evaluate the relationship between OS with age and race/ethnicity among the study participants. RESULTS One-thousand-eight-hundred-seventy-three women were enrolled in the study. There were 280 minority women and 328 women over the age of 70. Women age 70 and older had a 34% increase risk for death when compared to women under 60 (HR = 1.34; 95% CI 1.16-1.54). Non-Hispanic Black women had a 54% decreased risk of death with the addition of maintenance bevacizumab (HR = 0.46, 95% CI:0.26-0.83). Women of Asian descent had more hematologic grade 3 or greater adverse events and a 27% decrease risk of death when compared to non-Hispanic Whites (HR = 0.73; 95% CI: 0.59-0.90). CONCLUSIONS Non-Hispanic Black women showed a decreased risk of death with the addition of bevacizumab and patients of Asian ancestry had a lower death rate than all other minority groups, but despite these clinically meaningful improvements there was no statistically significant difference in OS among the groups.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Black or African American/statistics & numerical data
- Age Factors
- Aged
- Aged, 80 and over
- Angiogenesis Inhibitors/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asian/statistics & numerical data
- Bevacizumab/therapeutic use
- Carboplatin/administration & dosage
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/pathology
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/pathology
- Chemotherapy, Adjuvant/methods
- Ethnicity/statistics & numerical data
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/pathology
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Middle Aged
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/pathology
- Prognosis
- Proportional Hazards Models
- Survival Rate
- White People/statistics & numerical data
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Affiliation(s)
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Mark F Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | - Katherine Moxley
- University of Oklahoma, Oklahoma University Hospital Science Center, Oklahoma City, OK 73104, USA.
| | - Joan L Walker
- University of Oklahoma, Oklahoma University Hospital Science Center, Oklahoma City, OK 73104, USA.
| | | | | | | | | | | | - Stephen Rubin
- Abramson Cancer Center at University of Pennsylvania, Philadelphia, PA 19111, USA.
| | - Keiichi Fujiwara
- Saitama Medical University/International Medical Center, Saitama, JP 350-1298, Japan.
| | | | - John Soper
- University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Robert A Burger
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), Phoenix, AZ, USA.
| | - Bradley J Monk
- University of Arizona College of Medicine, Phoenix Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ, USA.
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4
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Pugh SL, Brown PD, Enserro D. Missing repeated measures data in clinical trials. Neurooncol Pract 2021; 9:35-42. [DOI: 10.1093/nop/npab043] [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: 11/14/2022] Open
Abstract
Abstract
Clinical trials typically collect longitudinal data, data that are collected repeated over time, such as laboratories, scans, or patient-reported outcomes. Due to a variety of reasons, this data can be missing, whether a patient stops attending clinical visits (ie, dropout) or misses assessments intermittently. Understanding the reasons for missing data as well as predictors of missing data can aid in determination of the missing data mechanism. The analysis methods used are dependent on the missing data mechanism and may make certain assumptions about the missing data itself. Methods for nonignorable missing data, which assumes that the missing data depend on the missing data itself, make stronger assumptions and include pattern-mixture models and shared parameter models. Missing data that are ignorable after adjusting for other covariates can be analyzed using methods that adjust for covariates, such as mixed-effects models or multiple imputation. Missing data that are ignorable can be analyzed using standard approaches that require complete case data, such as change from baseline or proportion of patients who declined at a specified time point. In clinical trials, truly ignorable data are rare, resulting in additional analysis methods required for proper interpretation of the results. Conducting several analyses under different assumptions, called sensitivity analyses, can determine the extent of the impact of the missing data.
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Affiliation(s)
- Stephanie L Pugh
- Department of Statistics, American College of Radiology, NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Danielle Enserro
- Roswell Park Comprehensive Cancer Center, NRG Oncology Statistics and Data Management Center, Buffalo, New York, USA
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5
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Buechel ME, Enserro D, Burger RA, Brady MF, Wade K, Secord AA, Nixon AB, Mirniaharikandehei S, Liu H, Zheng B, O'Malley DM, Gray H, Tewari KS, Mannel RS, Birrer MJ, Moore KN. Correlation of imaging and plasma based biomarkers to predict response to bevacizumab in epithelial ovarian cancer (EOC). Gynecol Oncol 2021; 161:382-388. [PMID: 33712274 DOI: 10.1016/j.ygyno.2021.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 10/14/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Increasing measures of adiposity have been correlated with poor oncologic outcomes and a lack of response to anti-angiogenic therapies. Limited data exists on the impact of subcutaneous fat density (SFD) and visceral fat density (VFD) on oncologic outcomes. This ancillary analysis of GOG-218, evaluates whether imaging markers of adiposity were predictive biomarkers for bevacizumab (bev) use in epithelial ovarian cancer (EOC). PATIENTS AND METHODS There were 1249 patients (67%) from GOG-218 with imaging measurements. SFD and VFD were calculated utilizing Hounsfield units (HU). Proportional hazards models were used to assess the association between SFD and VFD with overall survival (OS). RESULTS Increased SFD and VFD showed an increased HR for death (HR per 1-SD increase 1.12, 95% CI:1.05-1.19 p = 0.0009 and 1.13, 95% CI: 1.05-1.20 p = 0.0006 respectively). In the predictive analysis for response to bev, high VFD showed an increased hazard for death in the placebo group (HR per 1-SD increase 1.22, 95% CI: 1.09-1.37; p = 0.025). However, in the bev group there was no effect seen (HR per 1-SD increase: 1.01, 95% CI: 0.90-1.14) Median OS was 45 vs 47 months in the VFD low groups and 36 vs 42 months in the VFD high groups on placebo versus bev, respectively. CONCLUSION High VFD and SFD have a negative prognostic impact on patients with EOC. High VFD appears to be a predictive marker of bev response and patients with high VFD may be more likely to benefit from initial treatment with bev.
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Affiliation(s)
- Megan E Buechel
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OK, United States of America.
| | - Danielle Enserro
- NRG Oncology SDMC, CTD Division, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Robert A Burger
- University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Mark F Brady
- NRG Oncology SDMC, CTD Division, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Katrina Wade
- Oschner Medical Center, New Orleans, LA, United States of America.
| | - Angeles Alvarez Secord
- Duke University, Division of Gynecologic Oncology, Durham, NC, United States of America.
| | - Andrew B Nixon
- Duke University, Division of Medical Oncology, Durham, NC, United States of America.
| | | | - Hong Liu
- University of Oklahoma, Department of Electrical and Computer Engineering, Norman, OK, United States of America.
| | - Bin Zheng
- University of Oklahoma, Department of Electrical and Computer Engineering, Norman, OK, United States of America.
| | - David M O'Malley
- James Cancer Center at the Ohio State University, Columbus, OH, United States of America.
| | - Heidi Gray
- University of Washington, Seattle, WA, United States of America.
| | | | - Robert S Mannel
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OK, United States of America.
| | - Michael J Birrer
- University of Alabama, Birmingham, AL, United States of America.
| | - Kathleen N Moore
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Section of Gynecologic Oncology, Oklahoma City, OK, United States of America.
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Russo S, Walker JL, Carlson JW, Carter J, Ward LC, Covens A, Tanner EJ, Armer JM, Ridner S, Hayes S, Taghian AG, Brunelle C, Lopez-Acevedo M, Davidson BA, Schaverien MV, Ghamande SA, Bernas M, Cheville AL, Yost KJ, Schmitz K, Coyle B, Zucker J, Enserro D, Pugh S, Paskett ED, Ford L, McCaskill-Stevens W. Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers. Gynecol Oncol 2020; 160:625-632. [PMID: 33158510 DOI: 10.1016/j.ygyno.2020.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023]
Abstract
Practice changing standardization of lower extremity lymphedema quantitative measurements with integrated patient reported outcomes will likely refine and redefine the optimal risk-reduction strategies to diminish the devastating limb-related dysfunction and morbidity associated with treatment of gynecologic cancers. The National Cancer Institute (NCI), Division of Cancer Prevention brought together a diverse group of cancer treatment, therapy and patient reported outcomes experts to discuss the current state-of-the-science in lymphedema evaluation with the potential goal of incorporating new strategies for optimal evaluation of lymphedema in future developing gynecologic clinical trials.
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Affiliation(s)
- Sandra Russo
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Joan L Walker
- Stephen Cancer Center, OUHSC, Oklahoma City, OK 73104, USA.
| | - Jay W Carlson
- Cancer Research for Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA.
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
| | - Leigh C Ward
- University of Queensland, St Lucia, Brisbane, QLD 4072, Australia.
| | - Allan Covens
- University of Toronto and Sunnybrook Health Science Centre, Toronto, ON M4N 3M5, Canada.
| | - Edward J Tanner
- Northwestern Medicine, Feinberg School of Medicine, Prentice Women's Hospital, 250 E Superior, Chicago, IL 60611, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri Health, DC 116.05, Ellis Fischel Cancer Center, 115 Business Loop 70 West, Columbia, MO 65203, USA.
| | - Sheila Ridner
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, USA.
| | - Sandi Hayes
- Queensland University of Technology, School of Public Health and Biomedical Innovation, Queensland, Australia.
| | - Alphonse G Taghian
- Harvard Medical School/Massachusetts General Hospital, Radiation Oncology, Boston, MA 02114, USA.
| | - Cheryl Brunelle
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA.
| | - Micael Lopez-Acevedo
- The George Washington University Hospital, School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA.
| | - Brittany A Davidson
- Duke University School of Medicine, Duke Cancer Center, 20 Duke Medical Center, Durham, NC 27710, USA.
| | - Mark V Schaverien
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Sharad A Ghamande
- Augusta University, Augusta Oncology, 3696 Wheeler Road, Augusta, GA 30909, USA.
| | - Michael Bernas
- TCU and UNTHSC School of Medicine, Forth Worth, TX 76207, USA.
| | | | | | - Kathryn Schmitz
- Penn State Cancer Institute, 400 University Drive, Hershey, PA 17033, USA.
| | - Barbara Coyle
- Patient Advocate, Lymphedema Advocacy Group, Minneapolis, MN, USA
| | - Jeannette Zucker
- National Lymphedema Network, 411 Lafayette Street, 6th Floor, New York, NY 10003, USA.
| | - Danielle Enserro
- NRG Oncology Statistics and Data Management Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, 1600 JFK Blvd, Suite 1020, Philadelphia, PA 1903, USA.
| | - Electra D Paskett
- The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43210, USA.
| | - Leslie Ford
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
| | - Worta McCaskill-Stevens
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Rockville, MD 20892-9785, USA.
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Velagaleti RS, Larson MG, Enserro D, Song RJ, Vasan RS. Clinical course after a first episode of heart failure: insights from the Framingham Heart Study. Eur J Heart Fail 2020; 22:1768-1776. [DOI: 10.1002/ejhf.1918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/21/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Raghava S. Velagaleti
- Framingham Heart Study Framingham MA USA
- Cardiology Section, Department of Medicine Boston VA Healthcare System West Roxbury MA USA
| | - Martin G. Larson
- Framingham Heart Study Framingham MA USA
- Department of Mathematics and Statistics Boston University Boston MA USA
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics Roswell Park Comprehensive Cancer Center Buffalo NY USA
| | - Rebecca J. Song
- Department of Epidemiology Boston University School of Public Health Boston MA USA
| | - Ramachandran S. Vasan
- Framingham Heart Study Framingham MA USA
- Preventive Medicine and Cardiology Sections, Department of Medicine, School of Medicine, and Department of Epidemiology, School of Public Health Boston University Boston MA USA
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8
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Mayadev JS, Enserro D, Lin YG, Da Silva DM, Lankes HA, Aghajanian C, Ghamande S, Moore KN, Kennedy VA, Fracasso PM, Schilder RJ. Sequential Ipilimumab After Chemoradiotherapy in Curative-Intent Treatment of Patients With Node-Positive Cervical Cancer. JAMA Oncol 2020; 6:92-99. [PMID: 31774464 DOI: 10.1001/jamaoncol.2019.3857] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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
Importance Despite standard chemoradiotherapy (CRT), most women with lymph node (LN)-positive cervical cancer experience disease recurrence. Immunotherapy is being investigated in the up-front treatment setting. Objectives To assess the safety of sequential immunotherapy after CRT and to investigate human papillomavirus (HPV) genotype and HLA allele status on survival and programmed cell death 1 (PD-1) expression before and after CRT and sequential immunotherapy. Design, Setting, and Participants This prospective phase 1 trial conducted in 29 Gynecology Oncology Cooperative Group member institutions enrolled participants from December 18, 2012, to August 31, 2016, with a 14.8-month median follow-up and translational end points. Thirty-four women with International Federation of Gynecology and Obstetrics stage IB2 to IVA cervical cancer with positive pelvic LNs, para-aortic LNs, or both were enrolled; 13 did not receive ipilimumab and were excluded from the analysis. Data were analyzed from January 21 to April 4, 2018. Interventions Treatment consisted of 6 weekly doses of cisplatin, 40 mg/m2, concurrent with radiotherapy. After completion of chemotherapy, sequential ipilimumab was given every 21 days for 4 doses. Two dosage levels of ipilimumab, 3 mg/kg and 10 mg/kg, were studied to identify the maximum tolerated dose. Main Outcomes and Measures The primary end point was safety, and the secondary end points were overall survival and progression-free survival. Exploratory end points included HPV genotype, HLA allele status, and PD-1 expression measured in peripheral blood. Results The median age of the 32 participants included in the intent-to-treat analysis was 50 (range, 26-61) years, and 22 patients (69%) were white. Of the 21 patients who received ipilimumab, all had positive pelvic LN, and 6 (29%) had positive para-aortic LNs. All patients completed CRT, and of the 21 patients who received at least 2 cycles of ipilimumab, 18 (86%) completed 4 cycles of ipilimumab, and 3 (14%) completed 2 cycles. The maximum tolerated dose was 10 mg/kg. Two of the 21 patients (9.5%) who received ipilimumab had self-limiting grade 3 toxic effects (lipase increase; dermatitis). The 12-month overall survival was 90%, and progression-free survival was 81%. Human papillomavirus genotype and HLA subtype were not associated with progression-free survival or overall survival. T cells expressing PD-1 increased after CRT, and levels were sustained with ipilimumab. Conclusions and Relevance This study's findings suggest that the use of immunotherapy after CRT for curative-intent treatment of patients with cervical cancer is tolerable and effective. The results indicated that PD-1 was upregulated after CRT and sustained with sequential ipilimumab therapy. These immune findings may help guide future therapies to harness the activated T-cell phenotype in patients with node-positive cervical cancer.
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Affiliation(s)
- Jyoti S Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, Medical Center, La Jolla
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Yvonne G Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles
| | - Diane M Da Silva
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles
| | - Heather A Lankes
- Biopathology Center, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Carol Aghajanian
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sharad Ghamande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Augusta University Medical Center, Augusta, Georgia
| | - Kathleen N Moore
- Department of Obstetrics and Gynecology, Oklahoma University Health Science Center, Oklahoma City
| | - Vanessa A Kennedy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Davis Comprehensive Cancer Center, Sacramento
| | - Paula M Fracasso
- Department of Medicine, UVA Cancer Center, University of Virginia, Charlottesville
| | - Russell J Schilder
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Coleman RL, Spirtos NM, Enserro D, Herzog TJ, Sabbatini P, Armstrong DK, Kim JW, Park SY, Kim BG, Nam JH, Fujiwara K, Walker JL, Casey AC, Alvarez Secord A, Rubin S, Chan JK, DiSilvestro P, Davidson SA, Cohn DE, Tewari KS, Basen-Engquist K, Huang HQ, Brady MF, Mannel RS. Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer. N Engl J Med 2019; 381:1929-1939. [PMID: 31722153 PMCID: PMC6941470 DOI: 10.1056/nejmoa1902626] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [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: 01/03/2023]
Abstract
BACKGROUND Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation. METHODS We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator. The primary end point was overall survival. RESULTS A total of 485 patients underwent randomization, 240 to secondary cytoreduction before chemotherapy and 245 to chemotherapy alone. The median follow-up was 48.1 months. Complete gross resection was achieved in 67% of the patients assigned to surgery who underwent the procedure. Platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance was administered to 84% of the patients overall and was equally distributed between the two groups. The hazard ratio for death (surgery vs. no surgery) was 1.29 (95% confidence interval [CI], 0.97 to 1.72; P = 0.08), which corresponded to a median overall survival of 50.6 months and 64.7 months, respectively. Adjustment for platinum-free interval and chemotherapy choice did not alter the effect. The hazard ratio for disease progression or death (surgery vs. no surgery) was 0.82 (95% CI, 0.66 to 1.01; median progression-free survival, 18.9 months and 16.2 months, respectively). Surgical morbidity at 30 days was 9%; 1 patient (0.4%) died from postoperative complications. Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery. CONCLUSIONS In this trial involving patients with platinum-sensitive, recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy did not result in longer overall survival than chemotherapy alone. (Funded by the National Cancer Institute and others; GOG-0213 ClinicalTrials.gov number, NCT00565851.).
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Affiliation(s)
- Robert L Coleman
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Nick M Spirtos
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Danielle Enserro
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Thomas J Herzog
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Paul Sabbatini
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Deborah K Armstrong
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Jae-Weon Kim
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Sang-Yoon Park
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Byoung-Gie Kim
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Joo-Hyun Nam
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Keiichi Fujiwara
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Joan L Walker
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Ann C Casey
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Angeles Alvarez Secord
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Steve Rubin
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - John K Chan
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Paul DiSilvestro
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Susan A Davidson
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - David E Cohn
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Krishnansu S Tewari
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Karen Basen-Engquist
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Helen Q Huang
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Mark F Brady
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
| | - Robert S Mannel
- From the University of Texas M.D. Anderson Cancer Center, Houston (R.L.C., K.B.-E.); Women's Cancer Center of Nevada, Las Vegas (N.M.S.); NRG Oncology Statistical and Data Management Center, Roswell Park Cancer Institute, Buffalo (D.E., H.Q.H., M.F.B.), and Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (P.S.) - both in New York; the University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati (T.J.H.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (D.K.A.); Seoul National University College of Medicine (J.-W.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.), and Asan Medical Center, University of Ulsan College of Medicine (J.-H.N.), Seoul, and the Research Institute and Hospital, National Cancer Center, Goyang (S.-Y.P.) - all in South Korea; Saitama Medical University International Medical Center, Hidaka, Japan (K.F.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.L.W., R.S.M.); National Surgical Adjuvant Breast and Bowel Project/NRG Oncology, U.S. Oncology Research, and Metro-Minnesota Community Oncology Research Consortium, Minneapolis (A.C.C.); Duke Cancer Institute, Duke University Medical Center, Durham, NC (A.A.S.); Abramson Cancer Center, University of Pennsylvania, Philadelphia (S.R.); Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco (J.K.C.); Women and Infants Hospital, Providence, RI (P.D.); the University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver (S.A.D.); Ohio State University, Columbus (D.E.C.); and the University of California, Irvine, Orange (K.S.T.)
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de Boer RA, Nayor M, deFilippi CR, Enserro D, Bhambhani V, Kizer JR, Blaha MJ, Brouwers FP, Cushman M, Lima JAC, Bahrami H, van der Harst P, Wang TJ, Gansevoort RT, Fox CS, Gaggin HK, Kop WJ, Liu K, Vasan RS, Psaty BM, Lee DS, Hillege HL, Bartz TM, Benjamin EJ, Chan C, Allison M, Gardin JM, Januzzi JL, Shah SJ, Levy D, Herrington DM, Larson MG, van Gilst WH, Gottdiener JS, Bertoni AG, Ho JE. Association of Cardiovascular Biomarkers With Incident Heart Failure With Preserved and Reduced Ejection Fraction. JAMA Cardiol 2019; 3:215-224. [PMID: 29322198 DOI: 10.1001/jamacardio.2017.4987] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [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: 01/09/2023]
Abstract
Importance Nearly half of all patients with heart failure have preserved ejection fraction (HFpEF) as opposed to reduced ejection fraction (HFrEF), yet associations of biomarkers with future heart failure subtype are incompletely understood. Objective To evaluate the associations of 12 cardiovascular biomarkers with incident HFpEF vs HFrEF among adults from the general population. Design, Setting, and Participants This study included 4 longitudinal community-based cohorts: the Cardiovascular Health Study (1989-1990; 1992-1993 for supplemental African-American cohort), the Framingham Heart Study (1995-1998), the Multi-Ethnic Study of Atherosclerosis (2000-2002), and the Prevention of Renal and Vascular End-stage Disease study (1997-1998). Each cohort had prospective ascertainment of incident HFpEF and HFrEF. Data analysis was performed from June 25, 2015, to November 9, 2017. Exposures The following biomarkers were examined: N-terminal pro B-type natriuretic peptide or brain natriuretic peptide, high-sensitivity troponin T or I, C-reactive protein (CRP), urinary albumin to creatinine ratio (UACR), renin to aldosterone ratio, D-dimer, fibrinogen, soluble suppressor of tumorigenicity, galectin-3, cystatin C, plasminogen activator inhibitor 1, and interleukin 6. Main Outcomes and Measures Development of incident HFpEF and incident HFrEF. Results Among the 22 756 participants in these 4 cohorts (12 087 women and 10 669 men; mean [SD] age, 60 [13] years) in the study, during a median follow-up of 12 years, 633 participants developed incident HFpEF, and 841 developed HFrEF. In models adjusted for clinical risk factors of heart failure, 2 biomarkers were significantly associated with incident HFpEF: UACR (hazard ratio [HR], 1.33; 95% CI, 1.20-1.48; P < .001) and natriuretic peptides (HR, 1.27; 95% CI, 1.16-1.40; P < .001), with suggestive associations for high-sensitivity troponin (HR, 1.11; 95% CI, 1.03-1.19; P = .008), plasminogen activator inhibitor 1 (HR, 1.22; 95% CI, 1.03-1.45; P = .02), and fibrinogen (HR, 1.12; 95% CI, 1.03-1.22; P = .01). By contrast, 6 biomarkers were associated with incident HFrEF: natriuretic peptides (HR, 1.54; 95% CI, 1.41-1.68; P < .001), UACR (HR, 1.21; 95% CI, 1.11-1.32; P < .001), high-sensitivity troponin (HR, 1.37; 95% CI, 1.29-1.46; P < .001), cystatin C (HR, 1.19; 95% CI, 1.11-1.27; P < .001), D-dimer (HR, 1.22; 95% CI, 1.11-1.35; P < .001), and CRP (HR, 1.19; 95% CI, 1.11-1.28; P < .001). When directly compared, natriuretic peptides, high-sensitivity troponin, and CRP were more strongly associated with HFrEF compared with HFpEF. Conclusions and Relevance Biomarkers of renal dysfunction, endothelial dysfunction, and inflammation were associated with incident HFrEF. By contrast, only natriuretic peptides and UACR were associated with HFpEF. These findings highlight the need for future studies focused on identifying novel biomarkers of the risk of HFpEF.
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Affiliation(s)
- Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | | | - Danielle Enserro
- Department of Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Vijeta Bhambhani
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins University, Baltimore, Maryland
| | - Frank P Brouwers
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Mary Cushman
- Division of Hematology/Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland.,Department of Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Maryland
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ron T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Caroline S Fox
- Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Hanna K Gaggin
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Willem J Kop
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, Massachusetts.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hans L Hillege
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle
| | - Emelia J Benjamin
- Framingham Heart Study, Framingham, Massachusetts.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Cheeling Chan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Levy
- Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland.,Framingham Heart Study, Framingham, Massachusetts
| | - David M Herrington
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Martin G Larson
- Department of Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Wiek H van Gilst
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - Alain G Bertoni
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jennifer E Ho
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
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Mayadev J, Enserro D, Brady W, Ghamande S, Moore K, Lin Y, DaSilva D, Aghajanian C, Schilder R. Positron emission tomography as an imaging biomarker after chemoradiation and immunotherapy for cervical cancer patients treated on GOG 9929. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tewari KS, Burger RA, Enserro D, Norquist BM, Swisher EM, Brady MF, Bookman MA, Fleming GF, Huang H, Homesley HD, Fowler JM, Greer BE, Boente M, Liang SX, Ye C, Bais C, Randall LM, Chan JK, Ferriss JS, Coleman RL, Aghajanian C, Herzog TJ, DiSaia PJ, Copeland LJ, Mannel RS, Birrer MJ, Monk BJ. Final Overall Survival of a Randomized Trial of Bevacizumab for Primary Treatment of Ovarian Cancer. J Clin Oncol 2019; 37:2317-2328. [PMID: 31216226 DOI: 10.1200/jco.19.01009] [Citation(s) in RCA: 246] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE We report the final, protocol-specified analysis of overall survival (OS) in GOG-0218, a phase III, randomized trial of bevacizumab in women with newly diagnosed ovarian, fallopian tube, or primary peritoneal carcinoma. METHODS A total of 1,873 women with incompletely resected stage III to IV disease were randomly assigned 1:1:1 to six 21-day cycles of intravenous carboplatin (area under the concentration v time curve 6) and paclitaxel (175 mg/m2) versus chemotherapy plus concurrent bevacizumab (15 mg/kg, cycles 2 to 6) versus chemotherapy plus concurrent and maintenance bevacizumab (cycles 2 to 22). Inclusion criteria included a Gynecologic Oncology Group performance status of 0 to 2 and no history of clinically significant vascular events or evidence of intestinal obstruction. OS was analyzed in the intention-to-treat population. A total of 1,195 serum and/or tumor specimens were sequenced for BRCA1/2 and damaging mutations in homologous recombination repair (HRR) genes. Intratumoral microvessel density was studied using CD31 immunohistochemistry. RESULTS Median follow-up was 102.9 months. Relative to control (n = 625), for patients receiving bevacizumab-concurrent (n = 625), the hazard ratio (HR) of death was 1.06 (95% CI, 0.94 to 1.20); for bevacizumab-concurrent plus maintenance (n = 623), the HR was 0.96 (95% CI, 0.85 to 1.09). Disease-specific survival was not improved in any arm. No survival advantage was observed after censoring patients who received bevacizumab at crossover or as second line. Median OS for stage IV bevacizumab-concurrent plus maintenance was 42.8 v 32.6 months for stage IV control (HR, 0.75; 95% CI, 0.59 to 0.95). Relative to wild type, the HR for death for BRCA1/2 mutated carcinomas was 0.62 (95% CI, 0.52 to 0.73), and for non-BRCA1/2 HRR, the HR was 0.65 (95% CI, 0.51 to 0.85). BRCA1/2, HRR, and CD31 were not predictive of bevacizumab activity. CONCLUSION No survival differences were observed for patients who received bevacizumab compared with chemotherapy alone. Testing for BRCA1/2 mutations and homologous recombination deficiency is essential.
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Affiliation(s)
| | - Robert A Burger
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - John K Chan
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - J Stuart Ferriss
- Dell Seton Medical Center at The University of Texas, Austin, TX
| | | | | | | | - Philip J DiSaia
- University of California, Irvine, Medical Center, Orange, CA
| | | | - Robert S Mannel
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Bradley J Monk
- University of Arizona and Creighton University, Phoenix, AZ
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13
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Mueller A, Dalton E, Enserro D, Wang C, Flynn M. Recontact practices of cancer genetic counselors and an exploration of professional, legal, and ethical duty. J Genet Couns 2019; 28:836-846. [PMID: 31058402 DOI: 10.1002/jgc4.1126] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 01/07/2023]
Abstract
The duty to recontact continues to be revisited in the field of clinical genetics and is currently relevant for cancer genetic counseling given the transition from single-gene to multi-gene panel testing. We recruited cancer genetic counselors through the National Society of Genetic Counselors list-serv to complete an online survey assessing current practices and perspectives regarding recontacting patients about diagnostic genetic tests. Forty-one percent of respondents reported that they have recontacted patients to offer updated (new) diagnostic genetic testing (40/97). A majority (61%, 17/28), of genetic counselors who reported recontact specifically for panel testing indicated that the availability of management recommendations for genes not previously tested routinely was an important factor in the decision to recontact. All respondents who recontacted patients reported "improved patient care" as a perceived benefit. Respondents indicated that recontact is mostly a patient responsibility (49%), followed by a shared responsibility between the provider and patient (43%). Few respondents (2%) reported a uniform ethical duty to recontact patients regarding new and updated testing, while the majority (89%) felt that there was some degree of ethical duty. A greater percentage of those who reported past recontact practices reported intention to recontact in the future (p = 0.001). There is little consensus among the genetic counselor respondents about how to approach the recontacting of patients to offer updated genetic testing.
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Affiliation(s)
- Amy Mueller
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, Massachusetts.,MS Genetic Counseling Program, Boston University School of Medicine, Boston, Massachusetts
| | | | - Danielle Enserro
- Boston University School of Public Health, Boston, Massachusetts
| | - Catharine Wang
- Boston University School of Public Health, Boston, Massachusetts
| | - Maureen Flynn
- MGH Institute of Health Professions, Boston, Massachusetts
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Spirtos NM, Enserro D, Homesley HD, Gibbons SK, Cella D, Morris RT, DeGeest K, Lee RB, Miller DS. The addition of paclitaxel to doxorubicin and cisplatin and volume-directed radiation does not improve overall survival (OS) or long-term recurrence-free survival (RFS) in advanced endometrial cancer (EC): A randomized phase III NRG/Gynecologic Oncology Group (GOG) study. Gynecol Oncol 2019; 154:13-21. [PMID: 31053405 DOI: 10.1016/j.ygyno.2019.03.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/16/2018] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine if the addition of paclitaxel (P) to cisplatin and doxorubicin (CD) following surgical debulking and volume-directed radiation therapy improved long-term, recurrence-free survival (RFS) and overall survival (OS) in patients with advanced-stage endometrial cancer (EC). METHODS Prospective, randomized GOG trial comparing (CD) (50 mg/m2)/(45 mg/m2) +/- (P) (160 mg/m2) following volume-directed radiation and surgery in advanced EC. A Kaplan-Meier (KM) analysis characterized the relationship between treatment arms and the OS outcome, a log-rank test assessed the independence of treatment with the OS outcome, and the treatment effect on estimated OS was determined using a Cox proportional hazards (PH) model stratified by stage. The PH assumption was assessed using a test of interaction between treatment variable and the natural logarithm of survival time. Adverse events, regardless of attribution, were graded. RESULTS Since initial publication, 60 deaths occurred, leaving 311 patients alive with 290 (93.8%) recurrence- free. There was no significant decrease in the risk of recurrence or death associated with the CDP treatment regimen stratified for stage (p = 0.14, one-tail). The exploratory analysis for OS and the corresponding homogeneity tests for different effects across subgroups revealed only EFRT and EFRT & GRD status to have significantly different treatment effects (p = 0.027 and p = 0.017, respectively). Second primary malignancies were identified in 17/253 (6.4%) and 19/263 (7.0%) of patients treated with CD and CDP respectively. Breast (2.4%) followed by colon (1%) were the two cancers most frequently diagnosed in this setting. CONCLUSION No significant difference between treatment arms was identified. Subgroup analysis both in the initial and current reports demonstrated a trend towards improved RFS and OS in patients treated with CDP and EFRT. This long-term analysis of outcomes also identified the necessity of providing on-going cancer screening to patients enrolled in trials.
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Affiliation(s)
- Nick M Spirtos
- Women's Cancer Center, Las Vegas, NV 89169, United States of America.
| | - Danielle Enserro
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States of America.
| | - Howard D Homesley
- Gynecologic Oncology Network/Brody School of Medicine, Division of Gynecologic Oncology, Leo Jenkins Cancer Center, Greenville, NC 28734, United States of America
| | - Susan K Gibbons
- Albany Medical Center, Dept. of Radiation Oncology, Albany, NY 12208, United States of America.
| | - David Cella
- Northwestern University, Dept. of Medical Social Sciences, Feinberg School of Medicine, Chicago, IL 60201, United States of America.
| | - Robert T Morris
- Wayne State University, Dept. of Gynecologic Oncology, Detroit, MI 48201, United States of America.
| | - Koen DeGeest
- University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America.
| | - Roger B Lee
- Obstetrics & Gynecology, Tacoma General Hospital, Tacoma, WA, United States of America
| | - David S Miller
- Division of Gynecologic Oncology, UT Southwestern Medical Center at Dallas, Dallas, TX 75390-9032, United States of America.
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Hensley ML, Enserro D, Miller DS. Reply to F. Tomao et al. J Clin Oncol 2019; 37:936. [PMID: 30811298 DOI: 10.1200/jco.18.02063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Martee L Hensley
- Martee L. Hensley, MD, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Danielle Enserro, PhD, Roswell Park Comprehensive Cancer Center, Buffalo, NY; and David S. Miller, MD, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Danielle Enserro
- Martee L. Hensley, MD, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Danielle Enserro, PhD, Roswell Park Comprehensive Cancer Center, Buffalo, NY; and David S. Miller, MD, The University of Texas Southwestern Medical Center, Dallas, TX
| | - David S Miller
- Martee L. Hensley, MD, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Danielle Enserro, PhD, Roswell Park Comprehensive Cancer Center, Buffalo, NY; and David S. Miller, MD, The University of Texas Southwestern Medical Center, Dallas, TX
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Hensley ML, Enserro D, Hatcher H, Ottevanger PB, Krarup-Hansen A, Blay JY, Fisher C, Moxley KM, Lele SB, Lea JS, Tewari KS, Thaker PH, Zivanovic O, O’Malley DM, Robison K, Miller DS. Adjuvant Gemcitabine Plus Docetaxel Followed by Doxorubicin Versus Observation for High-Grade Uterine Leiomyosarcoma: A Phase III NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol 2018; 36:JCO1800454. [PMID: 30289732 PMCID: PMC6241678 DOI: 10.1200/jco.18.00454] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE We conducted a randomized phase III trial to determine whether adjuvant chemotherapy improves survival in women with uterine leiomyosarcoma. METHODS Women with uterus-confined, high-grade leiomyosarcoma who were confirmed disease free by imaging were randomly assigned to four cycles of gemcitabine plus docetaxel, followed by four cycles of doxorubicin, or to observation. All were followed for evidence of recurrence. The primary end point was overall survival (OS). RESULTS With international collaboration, 38 of the targeted accrual of 216 patients were enrolled, after which the study was closed by the National Cancer Institute for accrual futility. Twenty patients were assigned to chemotherapy, 18 to observation. Among the 17 patients treated with at least one cycle of chemotherapy, grade 3 or 4 toxicities were observed in 47%; among the 18 patients assigned to observation, one had grade 3 hypertension. There were six deaths (chemotherapy, n = 5; observation, n = 1), all due to disease. The restricted mean survival time for OS was estimated as 34.3 months (95% CI, 25.3 to 43.3 months) in the chemotherapy arm and as 46.4 months (95% CI, 43.6 to 49.1 months) in the observation arm. There were eight recurrences in each arm. The restricted mean survival time for recurrence-free survival was estimated as 18.1 (95% CI, 14.2 to 22.0) months in the chemotherapy arm and as 14.6 months (95% CI, 10.3 to 19.0 months) in the observation arm. Neither survival outcome comparison was considered statistically robust, due to the small sample size. CONCLUSION Despite international collaboration to test the role of adjuvant chemotherapy in uterine-confined leiomyosarcoma, this study was closed for accrual futility. Although the sample size precludes robust statistical comparison, observed OS and recurrence-free survival data do not show superior outcomes with adjuvant chemotherapy.
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Affiliation(s)
- Martee L. Hensley
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Danielle Enserro
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Helen Hatcher
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Petronella B. Ottevanger
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Anders Krarup-Hansen
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Jean-Yves Blay
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Cyril Fisher
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Katherine M. Moxley
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Shashikant B. Lele
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Jayanthi S. Lea
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Krishnansu S. Tewari
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Premal H. Thaker
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Oliver Zivanovic
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - David M. O’Malley
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - Katina Robison
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
| | - David S. Miller
- Martee L. Hensley, Memorial Sloan Kettering Cancer Center; Martee L. Hensley and Oliver Zivanovic, Weill Cornell Medical College, New York City; Danielle Enserro and Shashikant B. Lele, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Helen Hatcher, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge; Cyril Fisher, University of Birmingham, Birmingham, United Kingdom; Petronella B. Ottevanger, Radboud University Medical Center, Nijmegen, the Netherlands; Anders Krarup-Hansen, University Hospital Copenhagen, Copenhagen, Denmark; Jean-Yves Blay, Centre Leon Berard, Lyon, France; Katherine M. Moxley, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Jayanthi S. Lea, and David S. Miller, The University of Texas Southwestern Medical Center, Dallas, TX; Krishnansu S. Tewari, University of California at Irvine, Orange, CA; Premal H. Thaker, Washington University School of Medicine, and Siteman Cancer Center, St Louis, MO; David M. O’Malley, The Ohio State University College of Medicine, Columbus, OH; Katina Robison, Women and Infants Hospital in Rhode Island, Providence, RI
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Tsao CW, Lyass A, Enserro D, Larson MG, Ho JE, Kizer JR, Gottdiener JS, Psaty BM, Vasan RS. Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction. JACC Heart Fail 2018; 6:678-685. [PMID: 30007560 DOI: 10.1016/j.jchf.2018.03.006] [Citation(s) in RCA: 241] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community. BACKGROUND Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality. METHODS In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were ≥60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades. RESULTS Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade. CONCLUSIONS In several U.S. community-based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations.
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Affiliation(s)
- Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
| | - Asya Lyass
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Danielle Enserro
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts; Roswell Park Cancer Institute, Buffalo, New York
| | - Martin G Larson
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Jennifer E Ho
- Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - John S Gottdiener
- Division of Cardiology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Cardiology and Preventative Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Buechel M, Enserro D, Burger RA, Brady MF, Wade K, Secord AA, Nixon AB, Mirniaharikandehei S, Liu H, Zheng B, Gray H, Tewari KS, O'Malley DM, Mannel RS, Moore KN, Birrer MJ. Correlation of imaging and plasma-based biomarkers to predict response to bevacizumab in epithelial ovarian cancer (EOC): A GOG 218 ancillary data analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Megan Buechel
- University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | - Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | - Hong Liu
- University of Oklahom, Norman, OK
| | | | | | | | | | | | | | - Michael J. Birrer
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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19
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Coleman RL, Enserro D, Spirtos N, Herzog TJ, Sabbatini P, Armstrong DK, Kim B, Fujiwara K, Walker JL, Flynn PJ, Secord AA, Cohn DE, Brady MF, Mannel RS. A phase III randomized controlled trial of secondary surgical cytoreduction (SSC) followed by platinum-based combination chemotherapy (PBC), with or without bevacizumab (B) in platinum-sensitive, recurrent ovarian cancer (PSOC): A NRG Oncology/Gynecologic Oncology Group (GOG) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5501] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Thomas J. Herzog
- University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati, OH
| | - Paul Sabbatini
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Deborah Kay Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Byoung Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Patrick J. Flynn
- NSABP/NRG Oncology, and Metro-Minnesota Community Oncology Research Consotrium (MMCORC), Minneapolis, MN
| | | | | | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
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20
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Burger RA, Enserro D, Tewari KS, Brady MF, Bookman MA, Fleming GF, Huang HQ, Homesley HD, Fowler J, Boente M, Randall LM, Chan JK, Ferris JS, DiSaia PJ, Copeland LJ, Mannel RS, Birrer MJ, Monk BJ. Final overall survival (OS) analysis of an international randomized trial evaluating bevacizumab (BEV) in the primary treatment of advanced ovarian cancer: A NRG oncology/Gynecologic Oncology Group (GOG) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5517] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Mark F. Brady
- NRG Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | - Michael J. Birrer
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Bradley J. Monk
- University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ
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21
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Hensley ML, Enserro D, Hatcher H, Ottevanger PB, Krarup-Hansen A, Blay JY, Fisher C, Moxley KM, Lele SB, Lea JS, Tewari KS, Thaker PH, Zivanovic O, O'Malley DM, Robison K, Miller DS. Adjuvant gemcitabine plus docetaxel followed by doxorubicin versus observation for uterus-limited, high-grade leiomyosarcoma: A phase III GOG study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Martee Leigh Hensley
- Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, NY
| | | | - Helen Hatcher
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | | | - Cyril Fisher
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Premal H. Thaker
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | - Katina Robison
- Women and Infants Hospital in Rhode Island, Providence, RI
| | - David S. Miller
- The University of Texas Southwestern Medical Center, Dallas, TX
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22
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Bhambhani V, Kizer JR, Lima JAC, van der Harst P, Bahrami H, Nayor M, deFilippi CR, Enserro D, Blaha MJ, Cushman M, Wang TJ, Gansevoort RT, Fox CS, Gaggin HK, Kop WJ, Liu K, Vasan RS, Psaty BM, Lee DS, Brouwers FP, Hillege HL, Bartz TM, Benjamin EJ, Chan C, Allison M, Gardin JM, Januzzi JL, Levy D, Herrington DM, van Gilst WH, Bertoni AG, Larson MG, de Boer RA, Gottdiener JS, Shah SJ, Ho JE. Predictors and outcomes of heart failure with mid-range ejection fraction. Eur J Heart Fail 2018; 20:651-659. [PMID: 29226491 PMCID: PMC5899688 DOI: 10.1002/ejhf.1091] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/05/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
AIMS While heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) are well described, determinants and outcomes of heart failure with mid-range ejection fraction (HFmrEF) remain unclear. We sought to examine clinical and biochemical predictors of incident HFmrEF in the community. METHODS AND RESULTS We pooled data from four community-based longitudinal cohorts, with ascertainment of new heart failure (HF) classified into HFmrEF [ejection fraction (EF) 41-49%], HFpEF (EF ≥50%), and HFrEF (EF ≤40%). Predictors of incident HF subtypes were assessed using multivariable Cox models. Among 28 820 participants free of HF followed for a median of 12 years, there were 200 new HFmrEF cases, compared with 811 HFpEF and 1048 HFrEF. Clinical predictors of HFmrEF included age, male sex, systolic blood pressure, diabetes mellitus, and prior myocardial infarction (multivariable adjusted P ≤ 0.003 for all). Biomarkers that predicted HFmrEF included natriuretic peptides, cystatin-C, and high-sensitivity troponin (P ≤ 0.0004 for all). Natriuretic peptides were stronger predictors of HFrEF [hazard ratio (HR) 2.00 per 1 standard deviation increase, 95% confidence interval (CI) 1.81-2.20] than of HFmrEF (HR 1.51, 95% CI 1.20-1.90, P = 0.01 for difference), and did not differ in their association with incident HFmrEF and HFpEF (HR 1.56, 95% CI 1.41-1.73, P = 0.68 for difference). All-cause mortality following the onset of HFmrEF was worse than that of HFpEF (50 vs. 39 events per 1000 person-years, P = 0.02), but comparable to that of HFrEF (46 events per 1000 person-years, P = 0.78). CONCLUSIONS We found overlap in predictors of incident HFmrEF with other HF subtypes. In contrast, mortality risk after HFmrEF was worse than HFpEF, and similar to HFrEF.
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Affiliation(s)
- Vijeta Bhambhani
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R. Kizer
- Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Joao A. C. Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Hossein Bahrami
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland. Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Danielle Enserro
- Department of Preventive Medicine, Boston University School of Medicine, Massachusetts
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland. Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Thomas J. Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Hanna K Gaggin
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Willem J. Kop
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ramachandran S. Vasan
- Department of Preventive Medicine, Boston University School of Medicine, Massachusetts,Framingham Heart Study, Framingham, Massachusetts,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Douglas S. Lee
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Frank P. Brouwers
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Hans L. Hillege
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Traci M. Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Emelia J. Benjamin
- Framingham Heart Study, Framingham, Massachusetts,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Cheeling Chan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Allison
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, California
| | - Julius M. Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James L. Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel Levy
- Framingham Heart Study, Framingham, Massachusetts,Population Sciences Branch of the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David M. Herrington
- Section on Cardiovascular Medicine, Wake Forest School of Medicine Winston Salem, North Carolina
| | - Wiek H. van Gilst
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland. Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine Winston Salem, North Carolina
| | - Martin G. Larson
- Framingham Heart Study, Framingham, Massachusetts,Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - John S. Gottdiener
- Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, Maryland
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer E. Ho
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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23
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Zachariah JP, Quiroz R, Enserro D, Andersson C, Keaney JF, Sullivan LM, Vasan RS. Association of Parental Obesity and Diabetes Mellitus With Circulating Adipokines in Nonobese Nondiabetic Offspring. J Am Heart Assoc 2017; 6:JAHA.116.004973. [PMID: 28713075 PMCID: PMC5586263 DOI: 10.1161/jaha.116.004973] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Adipokines are implicated in the development of obesity‐related traits. We hypothesized that nonobese participants without diabetes mellitus (DM) whose parents were obese or had DM would have altered circulating adipokines compared with those without parental history of these conditions. Methods and Results Participants in the community‐based Framingham Third Generation cohort who were not obese (body mass index <30) and not diabetic with both parents in the Framingham Offspring cohort were included in this analysis (n=2034, mean age 40 years, 54% women). Circulating concentrations of fetuin A, RBP4 (retinol binding protein 4), FABP4 (fatty acid binding protein 4), leptin, LEP‐R (leptin receptor), and adiponectin were assayed. Parental DM was defined as occurring before age 60 years, and obesity was defined as body mass index ≥30 before age 60 years. General estimating equations were used to compare concentrations of adipokines among participants with 0, 1, or 2 parents affected by obesity or DM (separate analyses for each), adjusting for known correlates of adipokines. Overall, 44% had at least 1 parent who was obese and 15% had parents with DM. Parental obesity was associated with higher serum levels of FABP4 and LEP‐R in their offspring (P=0.02 for both). Parental DM was associated with lower adiponectin but higher RBP4 concentrations in offspring (P≤0.02 for both). Conclusions In our community‐based sample, a parental history of DM or obesity was associated with an altered adipokine profile in nonobese nondiabetic offspring. Additional studies are warranted to evaluate whether such preclinical biomarker alterations presage future risk of disease.
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Affiliation(s)
- Justin P Zachariah
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital Baylor College of Medicine, Houston, TX
| | - Rene Quiroz
- Cardiology Section, Boston University, Boston, MA
| | - Danielle Enserro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - John F Keaney
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Lisa M Sullivan
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Ramachandran S Vasan
- Cardiology Section, Boston University, Boston, MA.,Preventive Medicine Section, Boston University, Boston, MA.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
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24
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Ho JE, Enserro D, Brouwers FP, Kizer JR, Shah SJ, Psaty BM, Bartz TM, Santhanakrishnan R, Lee DS, Chan C, Liu K, Blaha MJ, Hillege HL, van der Harst P, van Gilst WH, Kop WJ, Gansevoort RT, Vasan RS, Gardin JM, Levy D, Gottdiener JS, de Boer RA, Larson MG. Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.003116. [PMID: 27266854 DOI: 10.1161/circheartfailure.115.003116] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [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: 10/06/2015] [Accepted: 05/12/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). METHODS AND RESULTS Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF subtype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95% CI, 0.77-0.82 and external: 0.76; 95% CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80-0.84) and validation samples (internal: 0.80; 95% CI, 0.78-0.83 and external: 0.76; 95% CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). CONCLUSIONS We describe and validate risk prediction models for HF subtypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF subtypes.
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Affiliation(s)
- Jennifer E Ho
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.). jho
| | - Danielle Enserro
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Frank P Brouwers
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Jorge R Kizer
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Sanjiv J Shah
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Bruce M Psaty
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Traci M Bartz
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Rajalakshmi Santhanakrishnan
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Douglas S Lee
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Cheeling Chan
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Kiang Liu
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Michael J Blaha
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Hans L Hillege
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Pim van der Harst
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Wiek H van Gilst
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Willem J Kop
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Ron T Gansevoort
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Ramachandran S Vasan
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Julius M Gardin
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Daniel Levy
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - John S Gottdiener
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Rudolf A de Boer
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
| | - Martin G Larson
- From the Cardiovascular Research Center, Massachusetts General Hospital (J.E.H.); Cardiovascular Medicine Section, Department of Medicine (R.S.) and Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, MA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, MA (J.E.H., R.S.V., D.L., M.G.L.); Department of Mathematics and Statistics, Boston University, MA (D.E., M.G.L.); Department of Cardiology (F.P.B., H.L.H., P.v.d.H., W.H.v.G., R.A.d.B.) and Division of Nephrology, Department of Internal Medicine (R.T.G.), University Medical Center Groningen, The Netherlands; Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (J.R.K.); Division of Cardiology (S.J.S.), Department of Medicine (C.C., K.L.), and Department of Preventive Medicine (C.C., K.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services (B.M.P.) and Department of Biostatistics (T.M.B.), University of Washington; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.M.P.); Institute for Clinical Evaluative Sciences, Toronto, Canada (D.S.L.); University Health Network, University of Toronto, Canada (D.S.L.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD (M.J.B.); Department of Medicine, Hackensack University Medical Center and Rutgers New Jersey Medical School, Hackensack, NJ (J.M.G.); Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (W.J.K.); Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (J.S.G.)
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Puurunen MK, Enserro D, Xanthakis V, Larson MG, Benjamin EJ, Tofler GH, Wollert KC, O'Donnell CJ, Vasan RS. Biomarkers for the prediction of venous thromboembolism in the community. Thromb Res 2016; 145:34-9. [DOI: 10.1016/j.thromres.2016.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/24/2016] [Accepted: 07/12/2016] [Indexed: 12/22/2022]
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Andersson C, Quiroz R, Enserro D, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Mitchell GF, Vasan RS. Association of Parental Hypertension With Arterial Stiffness in Nonhypertensive Offspring: The Framingham Heart Study. Hypertension 2016; 68:584-9. [PMID: 27456526 DOI: 10.1161/hypertensionaha.116.07426] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023]
Abstract
High arterial stiffness seems to be causally involved in the pathogenesis of hypertension. We tested the hypothesis that offspring of parents with hypertension may display higher arterial stiffness before clinically manifest hypertension, given that hypertension is a heritable condition. We compared arterial tonometry measures in a sample of 1564 nonhypertensive Framingham Heart Study third-generation cohort participants (mean age: 38 years; 55% women) whose parents were enrolled in the Framingham Offspring Study. A total of 468, 715, and 381 participants had 0 (referent), 1, and 2 parents with hypertension. Parental hypertension was associated with greater offspring mean arterial pressure (multivariable-adjusted estimate=2.9 mm Hg; 95% confidence interval, 1.9-3.9, and 4.2 mm Hg; 95% confidence interval, 2.9-5.5, for 1 and 2 parents with hypertension, respectively; P<0.001 for both) and with greater forward pressure wave amplitude (1.6 mm Hg; 95% confidence interval, 0.6-2.7, and 1.9 mm Hg; 95% confidence interval, 0.6-3.2, for 1 and 2 parents with hypertension, respectively; P=0.003 for both). Carotid-femoral pulse wave velocity and augmentation index displayed similar dose-dependent relations with parental hypertension in sex-, age-, and height-adjusted models, but associations were attenuated on further adjustment. Offspring with at least 1 parent in the upper quartile of augmentation index and carotid-femoral pulse wave velocity had significantly higher values themselves (P≤0.02). In conclusion, in this community-based sample of young, nonhypertensive adults, we observed greater arterial stiffness in offspring of parents with hypertension. These observations are consistent with higher vascular stiffness at an early stage in the pathogenesis of hypertension.
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Affiliation(s)
- Charlotte Andersson
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.).
| | - Rene Quiroz
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Danielle Enserro
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Martin G Larson
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Naomi M Hamburg
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Joseph A Vita
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Daniel Levy
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Emelia J Benjamin
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Gary F Mitchell
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
| | - Ramachandran S Vasan
- From Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (C.A., M.G.L., D.L., E.J.B., R.S.V.); Section of Cardiology, Department of Internal Medicine, Glostrup Hospital, Denmark (C.A.); Cardiology Clinic of San Antonio, TX (R.Q.); Department of Epidemiology (D.E., E.J.B., R.S.V.) and Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA; Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Whitaker Cardiovascular Institute (N.M.H., J.A.V., E.J.B., R.S.V.) and Section of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine, MA; National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.)
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Haring R, Enserro D, Xanthakis V, Mitchell GF, Benjamin EJ, Hamburg NM, Sullivan L, Nauck M, Wallaschofski H, Vasan RS. Plasma Fibroblast Growth Factor 23: Clinical Correlates and Association With Cardiovascular Disease and Mortality in the Framingham Heart Study. J Am Heart Assoc 2016; 5:JAHA.116.003486. [PMID: 27385427 PMCID: PMC5015386 DOI: 10.1161/jaha.116.003486] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 11/30/2022]
Abstract
Background Fibroblast growth factor 23 (FGF23) is emerging as a novel biomarker of bone metabolism, chronic kidney disease, and cardiovascular disease (CVD). However, its clinical correlates and potential predictive role in a community‐based setting are incompletely understood. Methods and Results We evaluated participants of the Framingham Heart Study (seventh examination cycle of the Offspring cohort plus second examination cycle of the multiethnic Omni cohort) to identify clinical correlates of plasma FGF23 (N=3236) and examine its cross‐sectional association with vascular function (N=2209), and longitudinal association with 10‐year incidence of CVD (N=2823), and all‐cause mortality (N=3223). Circulating FGF23 concentrations were positively related to African‐American and Asian ethnicity, waist circumference, current smoking, serum glucose, history of CVD, and antihypertensive medication use; and negatively related to male sex, hormone replacement therapy, and estimated glomerular filtration rate. Multivariable‐adjusted cross‐sectional analyses showed no consistent association of FGF23 with vascular function measures. During a median follow‐up time of 10.8 years, 347 incident CVD events and 412 deaths occurred. Multivariable‐adjusted Cox regression models revealed a positive association of FGF23 with all‐cause mortality (hazard ratio [HR] per SD increase, 1.31; 95% CI, 1.20–1.42), but not with incident CVD (HR per SD increase, 1.05; 95% CI, 0.94–1.17). Conclusions In our large, community‐based sample, FGF23 was associated with mortality risk, but not with vascular function or incident CVD.
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Affiliation(s)
- Robin Haring
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
| | - Danielle Enserro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Vanessa Xanthakis
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
| | | | - Emelia J Benjamin
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
| | - Naomi M Hamburg
- Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Lisa Sullivan
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Greifswald, Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ramachandran S Vasan
- Preventive Medicine and Epidemiology Section, Boston University School of Medicine, Boston, MA Cardiology Section, Evans Department of Medicine, Boston University School of Medicine, Boston, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
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Pase MP, Beiser A, Enserro D, Xanthakis V, Aparicio H, Satizabal CL, Himali JJ, Kase CS, Vasan RS, DeCarli C, Seshadri S. Association of Ideal Cardiovascular Health With Vascular Brain Injury and Incident Dementia. Stroke 2016; 47:1201-6. [PMID: 27073239 DOI: 10.1161/strokeaha.115.012608] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [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: 12/30/2015] [Accepted: 02/26/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The American Heart Association developed the ideal cardiovascular health (CVH) index as a simple tool to promote CVH; yet, its association with brain atrophy and dementia remains unexamined. METHODS Our aim was to investigate the prospective association of ideal CVH with vascular brain injury, including the 10-year risks of incident stroke and dementia, as well as cognitive decline and brain atrophy on magnetic resonance imaging, measured for ≈7 years. We studied 2750 stroke- and dementia-free Framingham Heart Study Offspring cohort participants (mean age, 62±9 years; 45% men). Ideal CVH was quantified on a 7-point scale with 1 point awarded for each of the following: nonsmoking status, ideal body mass index, regular physical activity, healthy diet, as well as optimum blood pressure, cholesterol, and fasting blood glucose. Both recent (baseline) and remote (6.9 years earlier) ideal CVH scores were examined. RESULTS Recent ideal CVH was associated with stroke (hazard ratio, 0.80; 95% confidence interval, 0.67-0.95), vascular dementia (hazard ratio, 0.49; 95% confidence interval, 0.30-0.81), frontal brain atrophy (P=0.003), and cognitive decline on tasks measuring visual memory and reasoning (P<0.05). In addition to predicting stroke, vascular dementia, whole-brain atrophy, and cognitive decline, remote ideal CVH was associated with the incidence of all-cause dementia (hazard ratio, 0.80; 95% confidence interval, 0.67-0.97) and Alzheimer disease (hazard ratio, 0.79; 95% confidence interval, 0.64-0.98). CONCLUSIONS Adherence to the American Heart Association's ideal CVH factors and behaviors, particularly in midlife, may protect against cerebrovascular disease and dementia.
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Affiliation(s)
- Matthew P Pase
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Alexa Beiser
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Danielle Enserro
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Vanessa Xanthakis
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Hugo Aparicio
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Claudia L Satizabal
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Jayandra J Himali
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Carlos S Kase
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Ramachandran S Vasan
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Charles DeCarli
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.)
| | - Sudha Seshadri
- From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
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Andersson C, Enserro D, Sullivan L, Wang TJ, Januzzi JL, Benjamin EJ, Vita JA, Hamburg NM, Larson MG, Mitchell GF, Vasan RS. Relations of circulating GDF-15, soluble ST2, and troponin-I concentrations with vascular function in the community: The Framingham Heart Study. Atherosclerosis 2016; 248:245-51. [PMID: 26972631 DOI: 10.1016/j.atherosclerosis.2016.02.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/03/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Growth differentiation factor-15 (GDF-15), soluble (s)ST2, and high-sensitivity troponin-I (hs-TnI) are associated with incident cardiovascular disease (CVD) including heart failure, yet the underlying mechanisms are not fully understood. We investigated if GDF-15, sST2, and hs-TnI are related to subclinical vascular dysfunction in the community, which may explain the relations of these biomarkers with CVD. METHODS We evaluated 1823 Framingham Study participants (mean age 61 ± 10 years, 54% women) who underwent routine assessment of vascular function. We related circulating GDF-15, sST2, and hs-TnI concentrations to measures of arterial stiffness (carotid-femoral pulse wave velocity, CFPWV; augmentation index; and forward pressure wave amplitude, FW), endothelial-dependent vasodilation (flow-mediated dilation, FMD), and baseline and hyperemic brachial flow velocities using linear regression adjusting for standard risk factors. RESULTS After multivariable adjustment, GDF-15 levels were positively associated with CFPWV (0.044 [95% confidence interval 0.007-0.081] standard deviation [SD] change per SD increase in loge[GDF-15], p = 0.02) and FW (0.076 [0.026-0.126] SD change per SD increase in loge[GDF-15], p = 0.003) and inversely related to FMD (-0.051 [-0.101-0.0003] SD change per SD increase in loge[GDF-15], p = 0.048). sST2 was positively associated with CFPWV (0.032 [0.0005-0.063] SD change per SD increase in loge[sST2], p = 0.046), and hs-TnI inversely associated with hyperemic flow velocity (-0.041 [-0.082-0.0004] SD change per SD increase in loge[hs-TnI], p = 0.048). CONCLUSION In our community-based investigation, individual cardiac stress biomarkers were differentially related to select aspects of vascular function. These findings may contribute to the associations of circulating GDF-15, sST2, and hs-TnI with incident CVD and heart failure.
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Affiliation(s)
- Charlotte Andersson
- The Boston University's and National Heart, Lung, Blood Institute's Framingham Heart Study, Framingham, MA, USA.
| | | | - Lisa Sullivan
- Department of Biostatistics, Boston University, MA, USA
| | - Thomas J Wang
- The Boston University's and National Heart, Lung, Blood Institute's Framingham Heart Study, Framingham, MA, USA; Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emelia J Benjamin
- The Boston University's and National Heart, Lung, Blood Institute's Framingham Heart Study, Framingham, MA, USA; Sections of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Joseph A Vita
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Naomi M Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Martin G Larson
- The Boston University's and National Heart, Lung, Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | | | - Ramachandran S Vasan
- The Boston University's and National Heart, Lung, Blood Institute's Framingham Heart Study, Framingham, MA, USA; Sections of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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30
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Andersson C, Enserro D, Larson MG, Xanthakis V, Vasan RS. Implications of the US cholesterol guidelines on eligibility for statin therapy in the community: comparison of observed and predicted risks in the Framingham Heart Study Offspring Cohort. J Am Heart Assoc 2015; 4:jah3937. [PMID: 25888372 PMCID: PMC4579932 DOI: 10.1161/jaha.115.001888] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Concerns have been raised that the 2013 atherosclerotic cardiovascular disease (ASCVD) risk estimator overpredicts risk in contemporary cohorts. Whether suboptimal calibration will lead to overtreatment with statins is unknown. We investigated the numbers of people eligible for statin treatment in the Framingham Heart Study Offspring Cohort, based on the 2013 cholesterol guidelines, and estimated the proportion that may be overtreated as a result of potential miscalibration of the ASCVD estimator. Methods and Results During a median follow‐up of 10 years, we observed 285 ASCVD events (8.4%; comprising ischemic stroke, myocardial infarction, and coronary artery disease death) among 3396 men and 112 events (2.9%) among 3838 women. Hosmer–Lemeshow chi‐square statistics were 16.3 in men (340 predicted versus 285 observed events) and 29.1 in women (166 predicted versus 112 observed events). Overprediction predominantly occurred among women in the highest risk decile and among men in the ≥7th risk deciles, for which observed ASCVD event rates were ≥7.5%. In total, 2615 participants (36%; 867 women) were eligible for statins based on the new guidelines. Of these, 171 women (20%) and 154 men (9%) were reclassified downward (as not eligible for statin therapy) using a recalibrated ASCVD estimator. In the latter group, 18 women (10.5%; 95% CI 5.9% to 15.2%) and 11 men (7.1%; 95% CI 3.0% to 11.3%) experienced ASCVD. Conclusions The risk estimator overpredicted ASCVD risk but did so mainly among high‐risk participants who would be considered eligible for statin use anyway. Our findings may mitigate concerns regarding the potential impact of miscalibration of the ASCVD estimator in contemporary cohorts.
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Affiliation(s)
- Charlotte Andersson
- Framingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.)
| | - Danielle Enserro
- Framingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.)
| | - Martin G Larson
- Framingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Mathematics and Statistics, Boston University, Boston, MA (D.E., M.G.L.) Department of Biostatistics, Boston University School of Public Health, Boston, MA (M.G.L., R.S.V.)
| | - Vanessa Xanthakis
- Framingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Sections of Preventive Medicine and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA (V.X., R.S.V.) Department of Epidemiology, Boston University School of Public Health, Boston, MA (V.X.)
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, MA (C.A., D.E., M.G.L., V.X., R.S.V.) Department of Biostatistics, Boston University School of Public Health, Boston, MA (M.G.L., R.S.V.) Sections of Preventive Medicine and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA (V.X., R.S.V.)
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31
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Cheng S, Enserro D, Xanthakis V, Sullivan LM, Murabito JM, Benjamin EJ, Polak JF, O'Donnell CJ, Wolf PA, O'Connor GT, Keaney JF, Vasan RS. Association of exhaled carbon monoxide with subclinical cardiovascular disease and their conjoint impact on the incidence of cardiovascular outcomes. Eur Heart J 2014; 35:2980-7. [PMID: 24574370 DOI: 10.1093/eurheartj/ehu052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Whereas endogenous carbon monoxide (CO) is cytoprotective at physiologic levels, excess CO concentrations are associated with cardiometabolic risk and may represent an important marker of progression from subclinical to clinical cardiovascular disease (CVD). METHODS AND RESULTS In 1926 participants of the Framingham Offspring Study (aged 57 ± 10 years, 46% women), we investigated the relationship of exhaled CO, a surrogate of blood CO concentration, with both prevalent subclinical CVD and incident clinical CVD events. Presence of subclinical CVD was determined using a comprehensive panel of diagnostic tests used to assess cardiac and vascular structure and function. Individuals with the highest (>5 p.p.m.) compared with lowest (≤4 p.p.m.) CO exposure were more likely to have subclinical CVD [odds ratios (OR): 1.67, 95% CI: 1.32-2.12; P < 0.001]. During the follow-up period (mean 5 ± 3 years), 193 individuals developed overt CVD. Individuals with both high CO levels and any baseline subclinical CVD developed overt CVD at an almost four-fold higher rate compared with those with low CO levels and no subclinical disease (22.1 vs. 6.3%). Notably, elevated CO was associated with incident CVD in the presence [hazards ration (HR): 1.83, 95% CI: 1.08-3.11; P = 0.026] but not in the absence (HR: 0.80, 95% CI: 0.42-1.53; P = 0.51) of subclinical CVD (Pinteraction = 0.019). Similarly, subclinical CVD was associated with incident CVD in the presence of high but not low CO exposure. CONCLUSION Our findings in a community-based sample suggest that elevated CO is a marker of greater subclinical CVD burden and, furthermore, a potential key component in the progression from subclinical to clinical CVD.
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Affiliation(s)
- Susan Cheng
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Vanessa Xanthakis
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Department of Biostatistics, Boston University, Boston, MA, USA Sections of Preventive Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lisa M Sullivan
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Joanne M Murabito
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Department of Cardiology, Boston University School of Medicine, Boston, MA, USA
| | - Joseph F Polak
- Department of Radiology, New England Medical Center, Boston, MA, USA
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Philip A Wolf
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - George T O'Connor
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - John F Keaney
- Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA Sections of Preventive Medicine, Boston University School of Medicine, Boston, MA, USA Department of Cardiology, Boston University School of Medicine, Boston, MA, USA Department of Epidemiology, Boston University School of Medicine, Boston, MA, USA
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