1
|
Chundru KJ, Korte JE, Wen CC, Neelon B, Wilson DA, Mateus J, Pearce JL, Alkis M, Finneran M, Simpson S, Florez H, Hunt KJ, Malek AM. Increasing Preterm Delivery and Small for Gestational Age Trends in South Carolina during the COVID-19 Pandemic. Int J Environ Res Public Health 2024; 21:465. [PMID: 38673376 PMCID: PMC11050409 DOI: 10.3390/ijerph21040465] [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] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
Preterm delivery (PTD) complications are a major cause of childhood morbidity and mortality. We aimed to assess trends in PTD and small for gestational age (SGA) and whether trends varied between race-ethnic groups in South Carolina (SC). We utilized 2015-2021 SC vital records linked to hospitalization and emergency department records. PTD was defined as clinically estimated gestation less than (<) 37 weeks (wks.) with subgroup analyses of PTD < 34 wks. and < 28 wks. SGA was defined as infants weighing below the 10th percentile for gestational age. This retrospective study included 338,532 (243,010 before the COVID-19 pandemic and 95,522 during the pandemic) live singleton births of gestational age ≥ 20 wks. born to 260,276 mothers in SC. Generalized estimating equations and a change-point during the first quarter of 2020 helped to assess trends. In unadjusted analyses, pre-pandemic PTD showed an increasing trend that continued during the pandemic (relative risk (RR) = 1.04, 95% CI: 1.02-1.06). PTD < 34 wks. rose during the pandemic (RR = 1.07, 95% CI: 1.02-1.12) with a significant change in the slope. Trends in SGA varied by race and ethnicity, increasing only in Hispanics (RR = 1.02, 95% CI: 1.00-1.04) before the pandemic. Our study reveals an increasing prevalence of PTD and a rise in PTD < 34 wks. during the pandemic, as well as an increasing prevalence of SGA in Hispanics during the study period.
Collapse
Affiliation(s)
- Kalyan J. Chundru
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jeffrey E. Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC 29401, USA
| | - Dulaney A. Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Julio Mateus
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, Atrium Health, Charlotte, NC 28204, USA
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Mallory Alkis
- Department of Obstetrics & Gynecology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Matthew Finneran
- Department of Obstetrics & Gynecology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Sarah Simpson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Hermes Florez
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC 29401, USA
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC 29401, USA
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| |
Collapse
|
2
|
Kirkman MS, Tripputi M, Krause-Steinrauf H, Bebu I, AbouAssi H, Burch H, Duran-Valdez E, Florez H, Garvey WT, Hsia DS, Salam M, Pop-Busui R. Comparative Effects of Randomized Second-line Therapy for Type 2 Diabetes on a Composite Outcome Incorporating Glycemic Control, Body Weight, and Hypoglycemia: An Analysis of the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:594-602. [PMID: 38194519 PMCID: PMC10973908 DOI: 10.2337/dc23-1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/03/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE In Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) (5,047 participants, mean follow-up 5.0 years), differences in glycemic control were demonstrated over time among four randomized therapies added to metformin. Weight gain and hypoglycemia are also important outcomes for people with type 2 diabetes. We compared the effects of the four randomized GRADE medications on a composite outcome incorporating glycemic deterioration, weight gain, and hypoglycemia. RESEARCH DESIGN AND METHODS The composite outcome was time to first occurrence of any of the following: HbA1c >7.5%, confirmed; ≥5% weight gain; or severe or recurrent nonsevere hypoglycemia. Secondary analyses included examination of individual components of the composite outcome, subgroup effects and potential mediators, and treatment satisfaction. Cumulative incidence was estimated with the Kaplan-Meier estimator. Cox proportional hazards models were used to assess pairwise group differences in risk of an outcome. RESULTS Risk of reaching the composite outcome (events per 100 participants per treatment year [PTYs]) was lowest with liraglutide (19 per 100 PTYs) followed by sitagliptin (26 per 100 PTYs), glargine (29 per 100 PTYs), and glimepiride (40 per 100 PTYs); all pairwise comparisons were statistically significant. The order was the same for risk of weight gain and hypoglycemia, but risk of glycemic deterioration was lowest with glargine, followed by liraglutide, glimepiride, and sitagliptin. No significant heterogeneity in risk of composite outcome was detected across prespecified covariates. Participants who reached the composite outcome had modestly but significantly lower treatment satisfaction. CONCLUSIONS Among participants treated with common second-line drug classes for type 2 diabetes, the liraglutide group had the lowest and glimepiride the highest risk of reaching a composite outcome encompassing glycemic deterioration, weight gain, and hypoglycemia. These findings may inform decision-making regarding type 2 diabetes therapy.
Collapse
Affiliation(s)
- M. Sue Kirkman
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark Tripputi
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | | | - Henry Burch
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Rockville, MD
| | | | - Hermes Florez
- Department of Medicine, University of Miami, Miami, FL
- Medical University of South Carolina, Charleston, SC
| | | | | | - Maamoun Salam
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
| |
Collapse
|
3
|
Florez H, Cobbs JR, Gregoski MJ. Importance of Optimizing Cardiorespiratory Fitness in Early Adulthood and Through Midlife. JAMA Netw Open 2023; 6:e233637. [PMID: 36853613 PMCID: PMC10547121 DOI: 10.1001/jamanetworkopen.2023.3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Hermes Florez
- Medical University of South Carolina, Charleston
- US Department of Veterans Affairs, Charleston, South Carolina
| | | | | |
Collapse
|
4
|
Kimbrel NA, Ashley-Koch AE, Qin XJ, Lindquist JH, Garrett ME, Dennis MF, Hair LP, Huffman JE, Jacobson DA, Madduri RK, Trafton JA, Coon H, Docherty AR, Mullins N, Ruderfer DM, Harvey PD, McMahon BH, Oslin DW, Beckham JC, Hauser ER, Hauser MA, Ashley-Koch AE, Aslan M, Beckham JC, Begoli E, Bhattacharya T, Brown B, Calhoun PS, Cheung KH, Choudhury S, Cliff AM, Cohn JD, Crivelli S, Cuellar-Hengartner L, Deangelis HE, Dennis MF, Dhaubhadel S, Finley PD, Ganguly K, Garvin MR, Gelernter JE, Hair LP, Harvey PD, Hauser ER, Hauser MA, Hengartner NW, Jacobson DA, Jones PC, Kainer D, Kaplan AD, Katz IR, Kember RL, Kimbrel NA, Kirby AC, Ko JC, Kolade B, Lagergren JH, Lane MJ, Levey DF, Levin D, Lindquist JH, Liu X, Madduri RK, Manore C, Martins SB, McCarthy JF, McDevitt-Cashman M, McMahon BH, Miller I, Morrow D, Oslin DW, Pavicic-Venegas M, Pestian J, Pyarajan S, Qin XJ, Rajeevan N, Ramsey CM, Ribeiro R, Rodriguez A, Romero J, Santel D, Schaefferkoetter N, Shi Y, Stein MB, Sullivan K, Sun N, Tamang SR, Townsend A, Trafton JA, Walker A, Wang X, Wangia-Anderson V, Yang R, Yoon HJ, Yoo S, Zamora-Resendiz R, Zhao H, Docherty AR, Mullins N, Coleman JRI, Shabalin A, Kang J, Murnyak B, Wendt F, Adams M, Campos AI, DiBlasi E, Fullerton JM, Kranzler HR, Bakian A, Monson ET, Rentería ME, Andreassen OA, Bulik CM, Edenberg HJ, Kessler RC, Mann JJ, Nurnberger JI, Pistis G, Streit F, Ursano RJ, Awasthi S, Bergen AW, Berrettini WH, Bohus M, Brandt H, Chang X, Chen HC, Chen WJ, Christensen ED, Crawford S, Crow S, Duriez P, Edwards AC, Fernández-Aranda F, Fichter MM, Galfalvy H, Gallinger S, Gandal M, Gorwood P, Guo Y, Hafferty JD, Hakonarson H, Halmi KA, Hishimoto A, Jain S, Jamain S, Jiménez-Murcia S, Johnson C, Kaplan AS, Kaye WH, Keel PK, Kennedy JL, Kim M, Klump KL, Levey DF, Li D, Liao SC, Lieb K, Lilenfeld L, Lori A, Magistretti PJ, Marshall CR, Mitchell JE, Myers RM, Okazaki S, Otsuka I, Pinto D, Powers A, Ramoz N, Ripke S, Roepke S, Rozanov V, Scherer SW, Schmahl C, Sokolowski M, Starnawska A, Strober M, Su MH, Thornton LM, Treasure J, Ware EB, Watson HJ, Witt SH, Woodside DB, Yilmaz Z, Zillich L, Agerbo E, Børglum AD, Breen G, Demontis D, Erlangsen A, Esko T, Gelernter J, Glatt SJ, Hougaard DM, Hwu HG, Kuo PH, Lewis CM, Li QS, Liu CM, Martin NG, McIntosh AM, Medland SE, Mors O, Nordentoft M, Nurnberger JI, Olsen C, Porteous D, Smith DJ, Stahl EA, Stein MB, Wasserman D, Werge T, Whiteman DC, Willour V, Coon H, Ruderfer DM, Dedert E, Elbogen EB, Fairbank JA, Hurley RA, Kilts JD, Martindale SL, Marx CE, McDonald SD, Moore SD, Morey RA, Naylor JC, Rowland J, Shura RD, Swinkels C, Tupler LA, Van Voorhees EE, Yoash-Gantz R, Gaziano JM, Muralidhar S, Ramoni R, Chang KM, O’Donnell CJ, Tsao PS, Breeling J, Hauser E, Sun Y, Huang G, Casas JP, Moser J, Whitbourne SB, Brewer JV, Conner T, Argyres DP, Stephens B, Brophy MT, Humphries DE, Selva LE, Do N, Shayan S(A, Cho K, Churby L, Wilson P, McArdle R, Dellitalia L, Mattocks K, Harley J, Whittle J, Jacono F, Wells J, Gutierrez S, Gibson G, Hammer K, Kaminsky L, Villareal G, Kinlay S, Xu J, Hamner M, Mathew R, Bhushan S, Iruvanti P, Godschalk M, Ballas Z, Ivins D, Mastorides S, Moorman J, Gappy S, Klein J, Ratcliffe N, Florez H, Okusaga O, Murdoch M, Sriram P, Yeh SS, Tandon N, Jhala D, Liangpunsakul S, Oursler KA, Whooley M, Ahuja S, Constans J, Meyer P, Greco J, Rauchman M, Servatius R, Gaddy M, Wallbom A, Morgan T, Stapley T, Sherman S, Ross G, Strollo P, Boyko E, Meyer L, Gupta S, Huq M, Fayad J, Hung A, Lichy J, Hurley R, Robey B, Striker R. Identification of Novel, Replicable Genetic Risk Loci for Suicidal Thoughts and Behaviors Among US Military Veterans. JAMA Psychiatry 2023; 80:135-145. [PMID: 36515925 PMCID: PMC9857322 DOI: 10.1001/jamapsychiatry.2022.3896] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Suicide is a leading cause of death; however, the molecular genetic basis of suicidal thoughts and behaviors (SITB) remains unknown. Objective To identify novel, replicable genomic risk loci for SITB. Design, Setting, and Participants This genome-wide association study included 633 778 US military veterans with and without SITB, as identified through electronic health records. GWAS was performed separately by ancestry, controlling for sex, age, and genetic substructure. Cross-ancestry risk loci were identified through meta-analysis. Study enrollment began in 2011 and is ongoing. Data were analyzed from November 2021 to August 2022. Main Outcome and Measures SITB. Results A total of 633 778 US military veterans were included in the analysis (57 152 [9%] female; 121 118 [19.1%] African ancestry, 8285 [1.3%] Asian ancestry, 452 767 [71.4%] European ancestry, and 51 608 [8.1%] Hispanic ancestry), including 121 211 individuals with SITB (19.1%). Meta-analysis identified more than 200 GWS (P < 5 × 10-8) cross-ancestry risk single-nucleotide variants for SITB concentrated in 7 regions on chromosomes 2, 6, 9, 11, 14, 16, and 18. Top single-nucleotide variants were largely intronic in nature; 5 were independently replicated in ISGC, including rs6557168 in ESR1, rs12808482 in DRD2, rs77641763 in EXD3, rs10671545 in DCC, and rs36006172 in TRAF3. Associations for FBXL19 and AC018880.2 were not replicated. Gene-based analyses implicated 24 additional GWS cross-ancestry risk genes, including FURIN, TSNARE1, and the NCAM1-TTC12-ANKK1-DRD2 gene cluster. Cross-ancestry enrichment analyses revealed significant enrichment for expression in brain and pituitary tissue, synapse and ubiquitination processes, amphetamine addiction, parathyroid hormone synthesis, axon guidance, and dopaminergic pathways. Seven other unique European ancestry-specific GWS loci were identified, 2 of which (POM121L2 and METTL15/LINC02758) were replicated. Two additional GWS ancestry-specific loci were identified within the African ancestry (PET112/GATB) and Hispanic ancestry (intergenic locus on chromosome 4) subsets, both of which were replicated. No GWS loci were identified within the Asian ancestry subset; however, significant enrichment was observed for axon guidance, cyclic adenosine monophosphate signaling, focal adhesion, glutamatergic synapse, and oxytocin signaling pathways across all ancestries. Within the European ancestry subset, genetic correlations (r > 0.75) were observed between the SITB phenotype and a suicide attempt-only phenotype, depression, and posttraumatic stress disorder. Additionally, polygenic risk score analyses revealed that the Million Veteran Program polygenic risk score had nominally significant main effects in 2 independent samples of veterans of European and African ancestry. Conclusions and Relevance The findings of this analysis may advance understanding of the molecular genetic basis of SITB and provide evidence for ESR1, DRD2, TRAF3, and DCC as cross-ancestry candidate risk genes. More work is needed to replicate these findings and to determine if and how these genes might impact clinical care.
Collapse
Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina,Veterans Affairs Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Allison E. Ashley-Koch
- Duke Molecular Physiology Institute, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Xue J. Qin
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Duke Molecular Physiology Institute, Durham, North Carolina
| | - Jennifer H. Lindquist
- Veterans Affairs Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | | | - Michelle F. Dennis
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren P. Hair
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer E. Huffman
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Daniel A. Jacobson
- Biosciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee,Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville,Department of Psychology, NeuroNet Research Center, University of Tennessee Knoxville
| | - Ravi K. Madduri
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois,Data Science and Learning Division, Argonne National Laboratory, Lemont, Illinois
| | - Jodie A. Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City,Biomedical Informatics, University of Utah School of Medicine, Salt Lake City
| | - Anna R. Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City,Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Niamh Mullins
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida,Research Service, Bruce W. Carter VA Medical Center, Miami, Florida
| | - Benjamin H. McMahon
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - David W. Oslin
- Veterans Integrated Service Networks 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth R. Hauser
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Duke Molecular Physiology Institute, Durham, North Carolina,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Allison E. Ashley-Koch
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mihaela Aslan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jean C. Beckham
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Edmond Begoli
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Tanmoy Bhattacharya
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ben Brown
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Patrick S. Calhoun
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kei-Hoi Cheung
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sutanay Choudhury
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ashley M. Cliff
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Judith D. Cohn
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Silvia Crivelli
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Leticia Cuellar-Hengartner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Haedi E. Deangelis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michelle F. Dennis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sayera Dhaubhadel
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Patrick D. Finley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kumkum Ganguly
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael R. Garvin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joel E. Gelernter
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lauren P. Hair
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Phillip D. Harvey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth R. Hauser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael A. Hauser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nick W. Hengartner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel A. Jacobson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Piet C. Jones
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David Kainer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Alan D. Kaplan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ira R. Katz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel L. Kember
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nathan A. Kimbrel
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Angela C. Kirby
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John C. Ko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Beauty Kolade
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John H. Lagergren
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Matthew J. Lane
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel F. Levey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Drew Levin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer H. Lindquist
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Xianlian Liu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ravi K. Madduri
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Carrie Manore
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Susana B. Martins
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John F. McCarthy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mikaela McDevitt-Cashman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Benjamin H. McMahon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Izaak Miller
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Destinee Morrow
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David W. Oslin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mirko Pavicic-Venegas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Pestian
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Saiju Pyarajan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Xue J. Qin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nallakkandi Rajeevan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christine M. Ramsey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ruy Ribeiro
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Alex Rodriguez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jonathan Romero
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel Santel
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Noah Schaefferkoetter
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Yunling Shi
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Murray B. Stein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kyle Sullivan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ning Sun
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Suzanne R. Tamang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Alice Townsend
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jodie A. Trafton
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Angelica Walker
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Xiange Wang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Victoria Wangia-Anderson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Renji Yang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hong-Jun Yoon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shinjae Yoo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rafael Zamora-Resendiz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hongyu Zhao
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anna R Docherty
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Niamh Mullins
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jonathan R I Coleman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Andrey Shabalin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - JooEun Kang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Balasz Murnyak
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Frank Wendt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mark Adams
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Adrian I Campos
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Emily DiBlasi
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Janice M Fullerton
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Henry R Kranzler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Amanda Bakian
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric T Monson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Miguel E Rentería
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ole A Andreassen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cynthia M Bulik
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Howard J Edenberg
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ronald C Kessler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - J John Mann
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John I. Nurnberger
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Giorgio Pistis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Fabian Streit
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert J Ursano
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Swapnil Awasthi
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Andrew W Bergen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Wade H Berrettini
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Martin Bohus
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Harry Brandt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Xiao Chang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hsi-Chung Chen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Wei J Chen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Erik D Christensen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Steven Crawford
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Crow
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Philibert Duriez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Alexis C Edwards
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Fernando Fernández-Aranda
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Manfred M Fichter
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hanga Galfalvy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Steven Gallinger
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Gandal
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Philip Gorwood
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Yiran Guo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jonathan D Hafferty
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hakon Hakonarson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Katherine A Halmi
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Akitoyo Hishimoto
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sonia Jain
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stéphane Jamain
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Susana Jiménez-Murcia
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Craig Johnson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Allan S Kaplan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Walter H Kaye
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Pamela K Keel
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James L Kennedy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Minsoo Kim
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kelly L Klump
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel F Levey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dong Li
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shih-Cheng Liao
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Klaus Lieb
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lisa Lilenfeld
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Adriana Lori
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Pierre J Magistretti
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christian R Marshall
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James E Mitchell
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Richard M Myers
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Satoshi Okazaki
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ikuo Otsuka
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dalila Pinto
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Abigail Powers
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nicolas Ramoz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephan Ripke
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stefan Roepke
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Vsevolod Rozanov
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen W Scherer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christian Schmahl
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Marcus Sokolowski
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anna Starnawska
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Strober
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mei-Hsin Su
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laura M Thornton
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Janet Treasure
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Erin B Ware
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hunna J Watson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephanie H Witt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - D Blake Woodside
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Zeynep Yilmaz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lea Zillich
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Esben Agerbo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anders D Børglum
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gerome Breen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ditte Demontis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Annette Erlangsen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Tõnu Esko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joel Gelernter
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen J Glatt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David M Hougaard
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hai-Gwo Hwu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Po-Hsiu Kuo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cathryn M Lewis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Qingqin S Li
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Chih-Min Liu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nicholas G Martin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Andrew M McIntosh
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sarah E Medland
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ole Mors
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Merete Nordentoft
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John I Nurnberger
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Catherine Olsen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David Porteous
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel J Smith
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eli A Stahl
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Murray B Stein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Danuta Wasserman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Thomas Werge
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David C Whiteman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Virginia Willour
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hilary Coon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Douglas M Ruderfer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric Dedert
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric B. Elbogen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John A. Fairbank
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robin A. Hurley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jason D. Kilts
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sarah L. Martindale
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christine E. Marx
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott D. McDonald
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott D. Moore
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rajendra A. Morey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer C. Naylor
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jared Rowland
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert D. Shura
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cindy Swinkels
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Larry A. Tupler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth E. Van Voorhees
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ruth Yoash-Gantz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - J. Michael Gaziano
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sumitra Muralidhar
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel Ramoni
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kyong-Mi Chang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christopher J. O’Donnell
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Philip S. Tsao
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James Breeling
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth Hauser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Yan Sun
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Grant Huang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Juan P. Casas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer Moser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stacey B. Whitbourne
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jessica V. Brewer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Todd Conner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dean P. Argyres
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Brady Stephens
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mary T. Brophy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Donald E. Humphries
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Luis E. Selva
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nhan Do
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shahpoor (Alex) Shayan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kelly Cho
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lori Churby
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Peter Wilson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel McArdle
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Louis Dellitalia
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kristin Mattocks
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Harley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jeffrey Whittle
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Frank Jacono
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Wells
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Salvador Gutierrez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gretchen Gibson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kimberly Hammer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laurence Kaminsky
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gerardo Villareal
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Kinlay
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Junzhe Xu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mark Hamner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Roy Mathew
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sujata Bhushan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Pran Iruvanti
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Godschalk
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Zuhair Ballas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Douglas Ivins
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen Mastorides
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jonathan Moorman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Saib Gappy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jon Klein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nora Ratcliffe
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hermes Florez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Olaoluwa Okusaga
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Maureen Murdoch
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Peruvemba Sriram
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shing Shing Yeh
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Neeraj Tandon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Darshana Jhala
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Suthat Liangpunsakul
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kris Ann Oursler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mary Whooley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sunil Ahuja
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joseph Constans
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Paul Meyer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer Greco
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Rauchman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Richard Servatius
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Melinda Gaddy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Agnes Wallbom
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Timothy Morgan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Todd Stapley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Sherman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - George Ross
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Patrick Strollo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Edward Boyko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laurence Meyer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Samir Gupta
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mostaqul Huq
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joseph Fayad
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Adriana Hung
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jack Lichy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robin Hurley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Brooks Robey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert Striker
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | | |
Collapse
|
5
|
Florez H, Muxi A, González E, Monegal A, Guañabens N, Peris P. Utilidad del trabecular bone score en sujetos adultos con osteogénesis imperfecta. Rev Osteoporos Metab Miner 2022. [DOI: 10.4321/s1889-836x2022000400005] [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: 03/29/2023] Open
|
6
|
Florez H, Hunt KJ, Valencia WM. Reducing Disparities in Cholesterol Control. JAMA 2022; 328:714-716. [PMID: 35997750 DOI: 10.1001/jama.2022.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hermes Florez
- Medical University of South Carolina, Charleston
- US Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Kelly J Hunt
- Medical University of South Carolina, Charleston
- US Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | | |
Collapse
|
7
|
Barzilay JI, Younes N, Pop-Busui R, Florez H, Seaquist E, Falck-Ytter C, Luchsinger JA. Corrigendum to "The cross-sectional association of renal dysfunction with tests of cognition in middle-aged adults with early type 2 diabetes The GRADE Study" [J. Diabetes Complicat., 35 (3) (2021) 107805]. J Diabetes Complications 2022; 36:108254. [PMID: 35803841 DOI: 10.1016/j.jdiacomp.2022.108254] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joshua I Barzilay
- Kaiser Permanente of Georgia, Division of Endocrinology, Atlanta, GA, United States of America; Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, MD, United States of America
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Hermes Florez
- GRECC Miami VA Healthcare System, University of Miami, Miami, FL, United States of America
| | - Elizabeth Seaquist
- Division of Diabetes and Endocrinology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Corinna Falck-Ytter
- Department of Medicine, VA North East Ohio Healthcare System, Case Western Reserve University, Cleveland, OH, United States of America
| | - Jose A Luchsinger
- Columbia University Irving Medical Center, Department of Medicine, New York, NY, United States of America; Columbia University Irving Medical Center, Department of Epidemiology, New York, NY, United States of America
| |
Collapse
|
8
|
Cajiao K, Florez H, Monegal A, Guañabens N, Peris P. AB1061 THE ROLE OF PROSTAGLANDIN E2 IN HYPERTROPHIC OSTEOARTHROPATHY AND/OR CLUBBING OF DIFFERENT CAUSES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHypertrophic osteoarthropathy (HOA) is characterized by several clinical findings, including arthralgia/arthritis, periostosis, and digital clubbing. It can occur as a congenital condition called pachydermoperiostosis, and more commonly, as a secondary manifestation of pulmonary or extrapulmonary diseases or malignancy. Genomic studies support the role of prostaglandin E2 (PGE2) in the pathogenesis of primary HOA, with mutations in the 15-hydroxyprostaglandin dehydrogenase encoding gene resulting in increased PGE2 levels.ObjectivesTo analyse the clinical characteristics, comorbidities, and the potential role of PGE2 in primary and secondary forms of HOA and/or clubbing and also evaluate the clinical evolution of these patients.MethodsEighteen patients (10 men/8 women) aged 15 to 78 years (49,9 ± 15,6) diagnosed with clubbing and/or HOA were attended in our Rheumatology Department over an 11-year period. We reviewed the clinical characteristics of the patients, including associated comorbidities, image findings, bone turnover markers (BTM), and serum and urinary levels of PGE2, among others. Additionally, we evaluated the treatment and the clinical evolution of these subjects.ResultsMost patients presented associated clinical conditions for HOA and/or clubbing, with only one, the youngest (15 years old), having primary HOA (pachydermoperiostosis). Pulmonary disorders were the most frequent associated conditions, with interstitial lung disease (4 cases), COPD (3 cases), and lung cancer (4 cases) being the most frequent, followed by liver diseases including primary biliary cirrhosis (1 patient), liver cirrhosis (2 patients) and chronic hepatitis C virus (2 patients). All the subjects evaluated (15/18) presented increased urinary PGE2 levels (the highest being observed in primary HOA), with most also presenting increased serum PGE2 values. BTM were evaluated in most subjects (17/18) showing increased values in most (11/17), particularly in PINP and CTx. 4 patients were treated with selective inhibitors of cyclooxygenase-2 (COX-2) presenting, when evaluated, a small decrease in urinary PGE2 titers and partly improving their symptoms, which clearly improved after treating the associated cause when possible.ConclusionIn the present series, all subjects with primary or secondary HOA and/or clubbing presented markedly increased PGE2values, particularly in urine, supporting the role of this agent in the etiopathogenesis of this disorder. Pulmonary disorders, including malignancy and liver diseases, constituted the most frequent associated conditions. The use of COX-2 seems to be an effective symptomatic therapeutic approach in this entity.Disclosure of InterestsNone declared
Collapse
|
9
|
Florez H, Carrasco JL, Barberá M, Hernández-Rodríguez J, Muxi A, Prieto-González S, Cid MC, Monegal A, Guañabens N, Peris P. AB1011 FACTORS RELATED TO GLUCOCORTICOID-INDUCED OSTEOPOROSIS AND FRAGILITY FRACTURES IN YOUNG SUBJECTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGlucocorticoid (GC) treatment is the most frequent cause of osteoporosis (OP) in young subjects. However, the factors related to the development of glucocorticoid-induced osteoporosis (GIOP) and fragility fractures (FF), and consequently, the therapeutic approach to GIOP in young populations is not well established.ObjectivesAnalyze the prevalence of GIOP and FF in GC-treated patients and compare the risk factors related to their development according to age (< and ≥50 years).Methods127 patients (62±18 years) receiving chronic GC treatment were included (≥5 mg/day of prednisone, >3 months). The clinical data collected included: dose and duration of GC treatment, disease activity, previous FF, anthropometric data, bone metabolism parameters (including bone turnover markers and the presence of hypogonadism), bone mineral density (by DXA; defining densitometric OP: T-score ≤-2.5 or Z-score ≤-2, depending on the age of the patient), trabecular bone score (by DXA), and vertebral fractures (X-ray). GIOP was defined as densitometric OP and/or FF. Results were compared between subjects < and ≥50 years old.ResultsThe prevalence of GIOP was similar in both age groups: <50 (n=36) 44.4% vs. 46.1% ≥50 years (n=91). Five subjects <50 (13.8%) and 30 ≥50 years (33%) presented FF (p=0.05). Young subjects with FF tended to be >40 years, have a higher body mass index (BMI) (25.4 vs. 23.3, p=n.s.), and inflammatory disease activity (CRP 0.90 vs. 0.06mg/dL, p=0.06). When analyzing the differential risk factors related to FF depending on age, a higher body mass index (BMI) (29.63 vs. 26.95, p=0.048) and inflammatory disease activity (PCR -0.87 vs. -2.51 [log scale], p=0.03) were observed in young subjects, while low lumbar T-scores (-1.08 vs.-0.06 DE, p=0.003) and higher cumulative GC-doses (9.11 vs. 8.56 g, p=0.03) were differential factors in subjects over 50. Hypogonadism was a risk factor independent of age (OR 4.89; 95%CI 1.36-17.59), being associated with the presence of FF in both age groups.ConclusionMore than 40% of the patients receiving GC developed GIOP, with a similar prevalence in both age groups (< and ≥50 years); however, FF are less common in young subjects. Hypogonadism is a determining risk factor for FF independent of age. In addition, young subjects with FF tend to be older, with a higher BMI and disease activity, and, thus, evaluation of these risk factors can improve the identification of subjects at increased risk of fracture.Disclosure of InterestsNone declared
Collapse
|
10
|
Ferri-Guerra J, Aparicio-Ugarriza R, Mohammed YN, Ysea O, Florez H, Ruiz JG. Propensity Score Matching to Determine the Impact of Metformin on All-Cause Mortality in Older Veterans with Diabetes Mellitus. South Med J 2022; 115:208-213. [PMID: 35237840 DOI: 10.14423/smj.0000000000001363] [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: 11/23/2022]
Abstract
OBJECTIVES To determine whether metformin is associated with reduced all-cause mortality in older adults with diabetes mellitus as compared with insulin or sulfonylureas, and to evaluate whether the metformin cumulative exposure followed a dose-response relation. METHODS Retrospective cohort study with propensity score matching in veterans 65 years old and older with diabetes mellitus. Patients who had new prescriptions for metformin were matched for demographic and clinical factors with patients receiving new prescriptions for insulin or sulfonylureas using propensity score matching. All-cause mortality risks were compared between metformin and insulin/sulfonylureas using multivariate Cox regression models. A similar approach was used for tertiles of cumulative metformin doses. RESULTS A sample of 174 veterans taking metformin was matched with 174 who took insulin/sulfonylureas. Most patients were men (97.4%), White (80.45%), and their mean ± standard deviation age was 69.15 ± 7.65 years. Metformin exposure was associated with reduced risk of all-cause mortality (hazard ratio 0.57, 95% confidence interval 0.39-0.84, P = 0.005). The upper tertile of cumulative metformin exposure was associated with lower all-cause mortality in the fully adjusted model (hazard ratio 0.28, 95% confidence interval 0.10-0.77, P = 0.013). CONCLUSIONS This propensity matching study shows that metformin exposure is associated with a lower risk of all-cause mortality. Higher metformin cumulative exposure seems to reduce the risk of all-cause mortality in older veterans with diabetes mellitus.
Collapse
Affiliation(s)
- Juliana Ferri-Guerra
- From the Miami VA Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Miami, Florida
| | - Raquel Aparicio-Ugarriza
- From the Miami VA Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Miami, Florida
| | - Y Nadeem Mohammed
- From the Miami VA Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Miami, Florida
| | - Otoniel Ysea
- From the Miami VA Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Miami, Florida
| | - Hermes Florez
- From the Miami VA Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Miami, Florida
| | - Jorge G Ruiz
- From the Miami VA Healthcare System Geriatric Research, Education, and Clinical Center (GRECC), Miami, Florida
| |
Collapse
|
11
|
Florez H, Hernández-Rodríguez J, Carrasco JL, Filella X, Prieto-González S, Monegal A, Guañabens N, Peris P. Low serum osteocalcin levels are associated with diabetes mellitus in glucocorticoid treated patients. Osteoporos Int 2022; 33:745-750. [PMID: 34557953 DOI: 10.1007/s00198-021-06167-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bone turnover markers are decreased in GC-treated subjects with DM. Decreased OC levels in GC-treated patients were associated with an increased risk of DM. These results suggest the involvement of OC in glucose homeostasis regulation in DM. INTRODUCTION Osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function, decreased OC levels, and the development and/or worsening of pre-existing diabetes mellitus (DM). Whether decreased OC levels in GC-treated subjects contribute to DM is not well known. The aim of this study was to analyse whether OC levels in GC-treated patients are associated with the presence of DM. METHODS One hundred twenty-seven patients (aged 61.5 ± 17.9 years) on GC treatment were included. GC dose, treatment duration, presence of DM and bone formation (OC, bone ALP, PINP) and resorption markers (urinary NTX, serum CTX) were analysed. The cut-offs of each bone turnover marker (BTM) for the presence of DM were evaluated and optimised with the Youden index and included in the logistic regression analysis. RESULTS Among the patients, 17.3% presented DM. No differences were observed in GC dose or duration or the presence of fractures. Diabetics showed lower levels of OC (7.57 ± 1.01 vs. 11.56 ± 1; p < 0.001), PINP (21.48 ± 1.01 vs. 28.39 ± 1; p = 0.0048), NTX (24.91 ± 1.01 vs. 31.7 ± 1; p = 0.036) and CTX (0.2 ± 1.01 vs. 0.3 ± 1; p = 0.0016). The discriminating BTM cut-offs for DM presence were < 9.25 ng/mL for OC, < 24 ng/mL for PINP, < 27.5 nMol/mM for NTX and < 0.25 ng/mL for CTX. In a multivariate logistic regression model adjusted for GC dose, BMI, age and the above four BTMs, only OC remained independently associated with DM presence. Thus, in a model adjusted for GC dose, BMI and age, OC was significantly associated with DM (OR: 6.1; 95%CI 1.87-19.89; p = 0.001). CONCLUSION Decreased OC levels in GC-treated patients are associated with increased odds of DM, and only OC was independently associated with DM in a model including four BTMs.
Collapse
Affiliation(s)
- H Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - J Hernández-Rodríguez
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J L Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - X Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - S Prieto-González
- Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - N Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| |
Collapse
|
12
|
Schwartz AV, Pan Q, Aroda VR, Crandall JP, Kriska A, Piromalli C, Wallia A, Temprosa M, Florez H. Long-term effects of lifestyle and metformin interventions in DPP on bone density. Osteoporos Int 2021; 32:2279-2287. [PMID: 34086101 PMCID: PMC10088864 DOI: 10.1007/s00198-021-05989-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/03/2021] [Indexed: 12/19/2022]
Abstract
UNLABELLED In the Diabetes Prevention Program Outcome Study (DPPOS), a cohort at high risk of diabetes, randomization to intensive lifestyle intervention or metformin, both associated with weight loss, did not have long-term negative effects on BMD compared with the placebo group. Potential positive effects of metformin on bone warrant further investigation. INTRODUCTION Randomization to lifestyle intervention (ILS) or metformin in the Diabetes Prevention Program (DPP) resulted in weight loss and reduced progression to diabetes. Weight loss is associated with reduced bone mineral density (BMD), but the long-term effects of these interventions on BMD are unknown. In the DPP Outcome Study (DPPOS), we determined if randomization to ILS or metformin, compared with placebo, was associated with differences in BMD approximately 16 years later. METHODS Of 3234 DPP participants, 2779 continued in DPPOS and were offered ILS in group format. Those randomized to metformin were offered unmasked metformin. At DPPOS year 12, 1367 participants had dual-energy X-ray absorptiometry scans. BMD in metformin and ILS groups was compared to placebo using sex-specific linear regression models, adjusted for age, race/ethnicity, and weight and weight-bearing activity at DPP baseline. RESULTS At DPPOS year 12, mean age was 66.5 (±9.5) years. Femoral neck BMD was similar in the ILS and placebo groups in men (difference = -0.021 g/cm2, 95%CI (-0.063, 0.021)) and in women (+0.014 g/cm2, 95%CI (-0.014, 0.042)). Femoral neck BMD was higher in the metformin compared to placebo group although not statistically different in men (+0.017 g/cm2, 95% CI (-0.023, 0.058)) and in women (+0.019 g/cm2, 95% CI (-0.009, 0.047)). Prevalence of osteoporosis was low and similar across treatment groups in men (0.9%; p=0.745) and women (2.4%; p=0.466). CONCLUSION In a cohort at high risk of diabetes, lifestyle intervention or metformin did not appear to have long-term negative effects on BMD. Potential positive effects of metformin on bone warrant further research.
Collapse
Affiliation(s)
- A V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| | - Q Pan
- Department of Statistics and The Biostatistics Center, George Washington University, Washington, D.C., USA
| | - V R Aroda
- MedStar Health Research Institute, Hyattsville, MD, USA
- Brigham Women's Hospital, Boston, MA, USA
| | - J P Crandall
- Albert Einstein College of Medicine, New York City, NY, USA
| | - A Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - A Wallia
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M Temprosa
- Department of Biostatistics and Bioinformatics and The Biostatistics Center, George Washington University, Washington, D.C., USA
| | - H Florez
- Department of Public Health Sciences and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | |
Collapse
|
13
|
Luchsinger JA, Younes N, Manly JJ, Barzilay J, Valencia W, Larkin ME, Falck-Ytter C, Krause-Steinrauf H, Pop-Busui R, Florez H, Seaquist E. Association of Glycemia, Lipids, and Blood Pressure With Cognitive Performance in People With Type 2 Diabetes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2021; 44:2286-2292. [PMID: 34285097 PMCID: PMC8740937 DOI: 10.2337/dc20-2858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/19/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is a risk factor for cognitive impairment. We examined the relation of glycemia, lipids, blood pressure (BP), hypertension history, and statin use with cognition in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS Cross-sectional analyses from GRADE at baseline examined the association of glycemia (hemoglobin A1c [HbA1c]), LDL, systolic BP (SBP) and diastolic BP (DBP), hypertension history, and statin use with cognition assessed by the Spanish English Verbal Learning Test, letter and animal fluency tests, and Digit Symbol Substitution Test (DSST). RESULTS Among 5,047 GRADE participants, 5,018 (99.4%) completed cognitive assessments. Their mean age was 56.7 ± 10.0 years, and 36.4% were women. Mean diabetes duration was 4.0 ± 2.7 years. HbA1c was not related to cognition. Higher LDL was related to modestly worse DSST scores, whereas statin use was related to modestly better DSST scores. SBP between 120 and 139 mmHg and DBP between 80 and 89 mmHg were related to modestly better DSST scores. Hypertension history was not related to cognition. CONCLUSIONS In people with type 2 diabetes of a mean duration of <5 years, lower LDL and statin use were related to modestly better executive cognitive function. SBP levels in the range of 120-139 mmHg and DBP levels in the range of 80-89 mmHg, but not lower levels, were related to modestly better executive function. These differences may not be clinically significant.
Collapse
Affiliation(s)
- José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY
| | - Naji Younes
- The Biostatistics Center, Department of Bios-tatistics and Bioinformatics, Milken Institute of Public Health, The George Washington University, Rockville, MD
| | - Jennifer J Manly
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | | | - Willy Valencia
- Department of Medicine, University of Miami, Miami, FL.,Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
| | - Mary E Larkin
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA
| | - Corinna Falck-Ytter
- Department of Medicine, VA North East Ohio Healthcare System, Case Western Reserve University, Cleveland, OH
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Bios-tatistics and Bioinformatics, Milken Institute of Public Health, The George Washington University, Rockville, MD
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Hermes Florez
- Department of Medicine, University of Miami, Miami, FL.,Geriatric Research Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, FL
| | | | | | | |
Collapse
|
14
|
Hazuda HP, Pan Q, Florez H, Luchsinger JA, Crandall JP, Venditti EM, Golden SH, Kriska AM, Bray GA. Association of Intensive Lifestyle and Metformin Interventions With Frailty in the Diabetes Prevention Program Outcomes Study. J Gerontol A Biol Sci Med Sci 2021; 76:929-936. [PMID: 33428709 DOI: 10.1093/gerona/glaa295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors that results in increased vulnerability to adverse health outcomes with aging. Diabetes and hyperglycemia are established risk factors for frailty. We sought to examine whether the odds of frailty among individuals at high risk of diabetes randomized to treatment with intensive lifestyle (ILS), metformin, or placebo differed after long-term follow-up. METHOD The sample comprised participants in the Diabetes Prevention Program (DPP) clinical trial, who continued follow-up in the DPP Outcomes Study (DPPOS) and completed frailty assessments in DPPOS Years 8 (n = 2385) and 10 (n = 2289), approximately 12 and 14 years after DPP randomization. Frailty was classified using Fried Frailty Phenotype criteria. GEE models adjusting for visit year with repeated measures pooled for Years 8 and 10 were used to estimate pairwise odds ratios (ORs) between ILS, metformin, and placebo for the outcomes of frail and prefrail versus nonfrail. RESULTS Frailty prevalence by treatment group was ILS = 3.0%, metformin = 5.4%, placebo = 5.7% at Year 8, and ILS = 3.6%, metformin = 5.3%, placebo = 5.4% at Year 10. Odds ratios (95% CI) estimated with GEE models were ILS versus placebo, 0.62 (0.42-0.93), p = .022; metformin versus placebo, 0.99 (0.69-1.42), p = .976; and ILS versus metformin, 0.63 (0.42-0.94), p = .022. Odds of being frail versus nonfrail were 37% lower for ILS compared to metformin and placebo. CONCLUSIONS Early ILS intervention, at an average age of about 50 years, in persons at high risk of diabetes may reduce frailty prevalence in later life. Metformin may be ineffective in reducing frailty prevalence. CLINICAL TRIALS REGISTRATION NUMBERS NCT00004992 (DPP) and NCT00038727 (DPPOS).
Collapse
Affiliation(s)
- Helen P Hazuda
- University of Texas Health Science Center at San Antonio
| | - Qing Pan
- Biostatistics Center, The George Washington University
| | | | | | | | | | | | | | - George A Bray
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| |
Collapse
|
15
|
Guañabens N, Olmos JM, Hernández JL, Cerdà D, Hidalgo Calleja C, Martinez López JA, Arboleya L, Aguilar Del Rey FJ, Martinez Pardo S, Ros Vilamajó I, Suris Armangué X, Grados D, Beltrán Audera C, Suero-Rosario E, Gómez Gracia I, Salmoral Chamizo A, Martín-Esteve I, Florez H, Naranjo A, Castañeda S, Ojeda Bruno S, García Carazo S, García Vadillo A, López Vives L, Martínez-Ferrer À, Borrell Paños H, Aguado Acín P, Castellanos-Moreira R, Tebé C, Gómez-Vaquero C. Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study. Osteoporos Int 2021; 32:1333-1342. [PMID: 33459805 DOI: 10.1007/s00198-021-05824-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
UNLABELLED Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.
Collapse
Affiliation(s)
- N Guañabens
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - J M Olmos
- Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - J L Hernández
- Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - D Cerdà
- Department of Rheumatology, Hospital Moisès Broggi, Sant Joan Despí, University of Barcelona, Barcelona, Spain
| | - C Hidalgo Calleja
- Department of Rheumatology, University Hospital de Salamanca, Salamanca, Spain
| | - J A Martinez López
- Department of Rheumatology, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - L Arboleya
- Department of Rheumatology, University Hospital Central de Asturias, Oviedo, Spain
| | - F J Aguilar Del Rey
- Department of Rheumatology, University Hospital Virgen de la Victoria, Malaga, Spain
| | - S Martinez Pardo
- Department of Rheumatology, University Hospital Mutua Terrassa, Barcelona, Spain
| | - I Ros Vilamajó
- Department of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - X Suris Armangué
- Department of Rheumatology, Hospital General de Granollers, Granollers, International University of Catalunya, Barcelona, Spain
| | - D Grados
- Department of Rheumatology, Hospital d'Igualada, Igualada, Barcelona, Spain
| | - C Beltrán Audera
- Department of Rheumatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - E Suero-Rosario
- Department of Rheumatology, Hospital General Mateu Orfila, Maó, Spain
| | - I Gómez Gracia
- Department of Rheumatology, University Hospital Reina Sofía, Cordoba, Spain
| | - A Salmoral Chamizo
- Department of Rheumatology, University Hospital Reina Sofía, Cordoba, Spain
| | - I Martín-Esteve
- Department of Rheumatology, Hospital General Mateu Orfila, Maó, Spain
| | - H Florez
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Naranjo
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S Castañeda
- Department of Rheumatology, University Hospital La Princesa IIS-IP, Madrid, Spain
| | - S Ojeda Bruno
- Department of Rheumatology, University Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - S García Carazo
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - A García Vadillo
- Department of Rheumatology, University Hospital La Princesa IIS-IP, Madrid, Spain
| | - L López Vives
- Department of Rheumatology, Hospital Sant Rafael, Barcelona, Spain
| | - À Martínez-Ferrer
- Department of Rheumatology, University Hospital Doctor Peset, Valencia, Spain
| | - H Borrell Paños
- Department of Rheumatology, Hospital Sant Rafael, Barcelona, Spain
| | - P Aguado Acín
- Department of Rheumatology, University Hospital La Paz, Madrid, Spain
| | - R Castellanos-Moreira
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Tebé
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Gómez-Vaquero
- Department of Rheumatology, University Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | |
Collapse
|
16
|
Barzilay JI, Younes N, Pop-Busui R, Florez H, Seaquist E, Falck-Ytter C, Luchsinger JA. The cross-sectional association of renal dysfunction with tests of cognition in middle-aged adults with early type 2 diabetes: The GRADE Study. J Diabetes Complications 2021; 35:107805. [PMID: 33288412 PMCID: PMC7870547 DOI: 10.1016/j.jdiacomp.2020.107805] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The association of renal dysfunction with tests of cognition in type 2 diabetes has been examined in individuals with moderate and advanced renal disease. Here we examine the association of renal dysfunction with tests of cognition in a cohort of middle-aged adults with short duration diabetes (mean 4.0 ± 2.8 years). METHODS Baseline data were examined from the Glycemia Reduction Approaches in Diabetes (GRADE) study (n = 4998). Renal dysfunction was defined by the presence of albumin in the urine or by estimated glomerular filtration rate (eGFR). Cognition was assessed with the Spanish English Verbal Learning Test, Letter and Animal fluency tests, and the Digit Symbol Substitution Test. RESULTS Participants with albuminuria or eGFR <60 ml/min/1.73 m2 had significantly lower test scores of information processing speed and perception, executive function and ability to categorize information, and of verbal learning and memory compared to participants without renal disease. Adjustment for hypertension, dyslipidemia, and waist circumference attenuated many of these findings but markers of impaired learning and executive function continued to remain lower in association with higher urine albumin levels. CONCLUSION In type 2 diabetes of short duration, there are already subtle deficiencies in markers of cognition in association with renal disease in middle aged adults.
Collapse
Affiliation(s)
- Joshua I Barzilay
- Kaiser Permanente of Georgia, Division of Endocrinology, Atlanta, GA, United States of America; Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Rockville, MD, United States of America
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Hermes Florez
- GRECC Miami VA Healthcare System, University of Miami, Miami, FL, United States of America
| | - Elizabeth Seaquist
- Division of Diabetes and Endocrinology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Corinna Falck-Ytter
- Department of Medicine, VA North East Ohio Healthcare System, Case Western Reserve University, Cleveland, OH, United States of America
| | - Jose A Luchsinger
- Columbia University Irving Medical Center, Department of Medicine, New York, NY, United States of America; Columbia University Irving Medical Center, Department of Epidemiology, New York, NY, United States of America
| |
Collapse
|
17
|
Swift SL, Elfassy T, Bailey Z, Florez H, Feaster DJ, Calonico S, Sidney S, Kiefe CI, Zeki Al Hazzouri A. Association of negative financial shocks during the Great Recession with depressive symptoms and substance use in the USA: the CARDIA study. J Epidemiol Community Health 2020; 74:995-1001. [PMID: 32788306 DOI: 10.1136/jech-2020-213917] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Great Recession of 2008 was marked by large increases in unemployment and decreases in the household wealth of many Americans. In the 21st century, there have also been increases in depressive symptoms, alcohol use and drug use among some groups in the USA. The objective of this analysis is to evaluate the influence of negative financial shocks incurred during the Great Recession on depressive symptoms, alcohol and drug use. METHODS We employed a quasi-experimental fixed-effects design, using data from adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Our financial shock predictors were within-person change in employment status, income and debt to asset ratio between 2005 and 2010. Our outcomes were within-person change in depressive symptoms score, alcohol use and past 30-day drug use. RESULTS In adjusted models, we found that becoming unemployed and experiencing a drop in income and were associated with an increase in depressive symptoms. Incurring more debts than assets was also associated with an increase in depressive symptoms and a slight decrease in daily alcohol consumption (mL). CONCLUSION Our findings suggest that multiple types of financial shocks incurred during an economic recession negatively influence depressive symptoms among black and white adults in the USA, and highlight the need for future research on how economic recessions are associated with health.
Collapse
Affiliation(s)
- Samuel Longworth Swift
- Center for Healthcare Equity in Kidney Disease, University of New Mexico, New Mexico, Albuquerque, USA
| | - Tali Elfassy
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Zinzi Bailey
- Sylvester Cancer Center, University of Miami, Miami, Florida, USA
| | - Hermes Florez
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Daniel J Feaster
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | | | - Steve Sidney
- Kaiser Permanente Norther California Division of Research, Oakland, California, USA
| | - Catarina I Kiefe
- Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, USA
| | | |
Collapse
|
18
|
Kalyani RR, Metter EJ, Xue QL, Egan JM, Chia CW, Studenski S, Shaffer NC, Golden S, Al-Sofiani M, Florez H, Ferrucci L. The Relationship of Lean Body Mass With Aging to the Development of Diabetes. J Endocr Soc 2020; 4:bvaa043. [PMID: 32666006 PMCID: PMC7334003 DOI: 10.1210/jendso/bvaa043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/16/2020] [Indexed: 12/22/2022] Open
Abstract
CONTEXT Older adults have the greatest burden of diabetes; however, the contribution of age-related muscle loss to its development remains unclear. OBJECTIVE We assessed the relationship of lean body mass with aging to incident diabetes in community-dwelling adults. DESIGN AND SETTING We studied participants in the Baltimore Longitudinal Study of Aging with median follow-up of 7 years (range 1-16). Cox proportional hazard models with age as the time scale were used. Time-dependent lean body mass measures were updated at each follow-up visit available. PARTICIPANTS Participants included 871 men and 984 women without diabetes who had ≥ 1 assessment of body composition using dual x-ray absorptiometry. MAIN OUTCOMES Incident diabetes, defined as self-reported history and use of glucose-lowering medications; or fasting plasma glucose ≥ 126 mg/dL and 2-hour oral glucose tolerance test glucose ≥ 200 mg/dL either at the same visit or 2 consecutive visits. RESULTS The baseline mean [standard deviation] age was 58.9 [17.3] years. Men and women with a higher percentage of total lean body mass had lower fasting and 2-hour glucose levels, and less prediabetes (all P < 0.01). Among men, comparing highest versus lowest quartiles, percentage of total lean body mass (hazard ratio [HR], 0.46; 95% confidence interval, 0.22-0.97), percentage leg lean mass (HR, 0.38; 0.15-0.96), and lean-to-fat mass ratio (HR, 0.39; 0.17-0.89) were inversely associated with incident diabetes after accounting for race and attenuated after adjustment for height and weight. Conversely, absolute total lean body mass was positively associated with incident diabetes among women, with similar trends in men. No associations were observed with muscle strength or quality. CONCLUSIONS Relatively lower lean body mass with aging is associated with incident diabetes in men and partially related to anthropometrics, but not so in women.
Collapse
Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, The Johns Hopkins University, Baltimore, Maryland
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Qian-Li Xue
- Center on Aging and Health, The Johns Hopkins University, Baltimore, Maryland
- Division of Geriatrics, The Johns Hopkins University, Baltimore, Maryland
| | | | - Chee W Chia
- National Institute on Aging, Baltimore, Maryland
| | | | | | - Sherita Golden
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, Maryland
| | - Mohammed Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland
- Division of Endocrinology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hermes Florez
- Division of Geriatrics & Endocrinology, University of Miami Miller School of Medicine, Miami, Florida
| | | |
Collapse
|
19
|
Baskaran D, Aparicio-Ugarriza R, Ferri-Guerra J, Milyani R, Florez H, Ruiz JG. Is There an Association Between Metformin Exposure and Frailty? Gerontol Geriatr Med 2020; 6:2333721420924956. [PMID: 32596419 PMCID: PMC7297486 DOI: 10.1177/2333721420924956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Frailty and type 2 diabetes mellitus share similar pathophysiological mechanisms which metformin may target. The purpose of this study was to determine whether exposure to metformin is associated with frailty in veterans. This is a cross-sectional study of veterans 65 years and older with type 2 diabetes who were screened for frailty between January 2016 and August 2017. We constructed a 44-item Frailty Index including multiple variables using a deficit accumulation framework. After adjustment for covariates, the association was calculated using binomial logistic regression models with frailty status as the outcome variable, and metformin exposure as the independent variable. Patients were 98.3% male and 56.7% White with a mean age of 72.9 (SD = 6.8) years. The proportion of robust, prefrail and frail patients was 2.9% (n = 22), 46.7 % (n = 356) and 50.5% (n = 385), respectively. In binomial logistic regression, exposure to metformin was associated with lower risk for frailty, adjusted odds ratio (OR) = .55 (95% confidence interval [CI] = .39–.77), p ≤ .001. This study shows that exposure to metformin was associated with lower risk for frailty in community-dwelling veterans.
Collapse
Affiliation(s)
- Dhanya Baskaran
- Miami VAHS Geriatric Research Education and Clinical Center (GRECC), FL, USA
| | - Raquel Aparicio-Ugarriza
- Miami VAHS Geriatric Research Education and Clinical Center (GRECC), FL, USA.,Miller School of Medicine, University of Miami, FL, USA
| | - Juliana Ferri-Guerra
- Miami VAHS Geriatric Research Education and Clinical Center (GRECC), FL, USA.,Miller School of Medicine, University of Miami, FL, USA
| | | | - Hermes Florez
- Miami VAHS Geriatric Research Education and Clinical Center (GRECC), FL, USA.,Miller School of Medicine, University of Miami, FL, USA
| | - Jorge G Ruiz
- Miami VAHS Geriatric Research Education and Clinical Center (GRECC), FL, USA.,Miller School of Medicine, University of Miami, FL, USA
| |
Collapse
|
20
|
Florez H, Hernández-Rodríguez J, Carrasco JL, Prieto-González S, Filella X, Monegal A, Guañabens N, Peris P. SAT0467 LOW SERUM OSTEOCALCIN LEVELS ARE ASSOCIATED WITH THE PRESENCE OF DIABETES MELLITUS IN GLUCOCORTICOID TREATED PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Increasing evidence indicates that osteocalcin (OC) is involved in the regulation of glucose homeostasis. Glucocorticoid (GC) treatment is associated with impaired osteoblast function and decreased OC levels and also with the development of CG-induced diabetes mellitus (GIDM). However, whether decreased OC levels in GC-treated subjects contribute to GIDM is not well known.Objectives:To analyse whether OC levels in GC-treated patients are associated with the presence of GIDM.Methods:127 patients (aged 62±18years, 63% women) on GC treatment for autoimmune diseases (≥5mg/day, >3 months) were included. Clinical and anthropometric data were analysed, including the GC dose and treatment duration, presence of GIDM, fragility fractures, densitometric osteoporosis and bone formation (OC, bone alkaline phosphatase [BAP], PINP) and resorption markers (urinary NTX, serum CTX). The cut-offs of each bone marker for the presence of GIDM were estimated and optimized with the Youden index and included in the logistic regression analysis (adjusted for BMI, age and GC doses).Results:17.3% of patients presented GIDM. Diabetic subjects were older (70.5±12.2 vs. 59.6±18.4, p=0.001) and had a higher BMI than non-diabetics (30±5.2 vs. 26±4.2, p=0.002). No differences were observed in GC dose or duration or in the presence of vertebral fractures. Diabetics showed lower levels of OC (7.57±1.01 vs. 11.56±1; p<0.001), PINP (21.48±1.01 vs. 28.39±1; p=0.0048), NTx (24.91±1.01 vs. 31.7±1; p=0.036) and CTX (0.2±1.01 vs. 0.3±1; p=0.0016) with similar BAP values. The best discriminating cut-offs for GIDM presence were: <9.25ng/mL for OC, <24ng/mL for PINP, <27.5nMol/mM for NTX and <0.25ng/mL for CTX. On multivariate analysis OC (<9.25) was the only marker related to the presence of GIDM (OR 6.1; CI95% 1.87-19.89; p=0.001).Conclusion:Decreased OC levels in GC-treated patients are associated with an increased risk of GIDM, a finding that was not observed with other bone turnover markers, further confirming the involvement of OC in the glucose homeostasis regulation in this entity.Disclosure of Interests:None declared
Collapse
|
21
|
Gómez Vaquero C, Olmos JM, Hernández JL, Cerda D, Hidalgo C, Martínez López J, Arboleya Rodríguez LM, Aguilar del Rey J, Martinez Pardo S, Ros I, Surís X, Grados Canovas D, Beltrán Audera C, Suero-Rosario E, Gómez Gracia I, Salmoral A, Martín-Esteve I, Florez H, Naranjo A, Castañeda S, Ojeda S, García Carazo S, García-Vadillo A, López Vives L, Martínez-Ferrer À, Borrell Paños H, Aguado P, Castellanos-Moreira R, Tebé C, Guañabens N. OP0323 INCIDENCE OF CLINICAL FRAGILITY FRACTURES IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS. A MULTICENTRIC CASE-CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Incidence of clinical fractures in rheumatoid arthritis (RA) is not as well-known as hip or vertebral fracture incidence.Objectives:1. To estimate the incidence of clinical fragility fractures in a population of postmenopausal women diagnosed with RA and compare it with that of the general population; 2. To analyze the risk factors for fracture.Methods:330 postmenopausal women with RA from 19 Spanish Rheumatology Departments, randomly selected from the registry of RA patients in each center. The control group consisted of 660 Spanish postmenopausal women from the Camargo Cohort. Clinical fractures during the previous 5 years were recorded. Assessed risk factors for fracture were: sociodemographic characteristics, BMD and variables related to RA.Results:Median age of RA patients was 64 yrs. vs. 63 yrs. in controls (ns). Evolution of the disease was 8 yrs. 78% and 76% had RF and ACPA+, respectively. 69% of patients were in remission or low activity. 85% had received glucocorticoids and methotrexate and 40% at least one biological DMARD. We identified 105 fractures (87 fragility and 18 traumatic) in 75 patients. Fifty-four patients and 47 controls had at least one major fracture (MF) (p< 0.001). Incidence of MF was 3.55 per 100 patient-year in patients and 0.72 in controls. Risk factors for MF in RA patients were age, previous fracture, parental hip fracture, postmenopausal period, hip BMD and cumulative dose of glucocorticoids. In controls, risk factors were age, age at menopause and lumbar BMD.Among RA-associated factors, MFs were associated with erosions, disease activity and disability. Previous fracture in RA patients was a strong risk for MF (HR: 10.37 [95% CI: 2.95-36.41]).Conclusion:Between 3 and 4 of every 100 postmenopausal women with RA have a major fracture per year, four times more than the general population. Disease activity and disability associated with RA, the cumulative dose of glucocorticoids and mainly previous fracture are associated with the development of fragility fractures.References:NoneAcknowledgments:Funded in part by ISCIII (PI18/00762) that included FEDER funds from the EU.Disclosure of Interests:Carmen Gómez Vaquero: None declared, Jose Manuel Olmos: None declared, J. Luis Hernández: None declared, Dacia Cerda: None declared, Cristina Hidalgo: None declared, JA Martínez López: None declared, Luis Marcelino Arboleya Rodríguez: None declared, Javier Aguilar del Rey: None declared, Silvia Martinez Pardo: None declared, Inmaculada Ros: None declared, Xavier Surís: None declared, Dolors Grados Canovas: None declared, Chesús Beltrán Audera: None declared, Evelyn Suero-Rosario: None declared, Inmaculada Gómez Gracia: None declared, Asunción Salmoral: None declared, Irene Martín-Esteve: None declared, Helena Florez: None declared, Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Santos Castañeda: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, S García Carazo: None declared, Alberto García-Vadillo: None declared, Laura López Vives: None declared, À Martínez-Ferrer: None declared, Helena Borrell Paños: None declared, Pilar Aguado: None declared, Raul Castellanos-Moreira: None declared, Cristian Tebé: None declared, Núria Guañabens: None declared
Collapse
|
22
|
Ferri-Guerra J, Aparicio-Ugarriza R, Salguero D, Baskaran D, Mohammed YN, Florez H, Ruiz JG. The Association of Frailty with Hospitalizations and Mortality among Community Dwelling Older Adults with Diabetes. J Frailty Aging 2020; 9:94-100. [PMID: 32259183 DOI: 10.14283/jfa.2019.31] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. OBJECTIVES Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. DESIGN Retrospective cohort. SETTING Outpatient. PARTICIPANTS Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. MEASUREMENTS The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. RESULTS We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. CONCLUSIONS Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.
Collapse
Affiliation(s)
- J Ferri-Guerra
- Jorge G. Ruiz, MD, VA GRECC Associate Director for Clinical Affairs, Bruce W. Carter Miami VAMC, GRECC (11GRC), 1201 NW 16th Street, Miami, Florida 33125, Telephone: (305) 575-3388 /Fax: (305) 575-3365, Mail: , ORCID: 0000-0003-3069-8502
| | | | | | | | | | | | | |
Collapse
|
23
|
Fang H, Hui Q, Lynch J, Honerlaw J, Assimes TL, Huang J, Vujkovic M, Damrauer SM, Pyarajan S, Gaziano JM, DuVall SL, O’Donnell CJ, Cho K, Chang KM, Wilson PW, Tsao PS, Sun YV, Tang H, Gaziano JM, Ramoni R, Breeling J, Chang KM, Huang G, Muralidhar S, O’Donnell CJ, Tsao PS, Muralidhar S, Moser J, Whitbourne SB, Brewer JV, Concato J, Warren S, Argyres DP, Stephens B, Brophy MT, Humphries DE, Do N, Shayan S, Nguyen XMT, Pyarajan S, Cho K, Hauser E, Sun Y, Zhao H, Wilson P, McArdle R, Dellitalia L, Harley J, Whittle J, Beckham J, Wells J, Gutierrez S, Gibson G, Kaminsky L, Villareal G, Kinlay S, Xu J, Hamner M, Haddock KS, Bhushan S, Iruvanti P, Godschalk M, Ballas Z, Buford M, Mastorides S, Klein J, Ratcliffe N, Florez H, Swann A, Murdoch M, Sriram P, Yeh SS, Washburn R, Jhala D, Aguayo S, Cohen D, Sharma S, Callaghan J, Oursler KA, Whooley M, Ahuja S, Gutierrez A, Schifman R, Greco J, Rauchman M, Servatius R, Oehlert M, Wallbom A, Fernando R, Morgan T, Stapley T, Sherman S, Anderson G, Sonel E, Boyko E, Meyer L, Gupta S, Fayad J, Hung A, Lichy J, Hurley R, Robey B, Striker R. Harmonizing Genetic Ancestry and Self-identified Race/Ethnicity in Genome-wide Association Studies. Am J Hum Genet 2019; 105:763-772. [PMID: 31564439 DOI: 10.1016/j.ajhg.2019.08.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/28/2019] [Indexed: 02/08/2023] Open
Abstract
Large-scale multi-ethnic cohorts offer unprecedented opportunities to elucidate the genetic factors influencing complex traits related to health and disease among minority populations. At the same time, the genetic diversity in these cohorts presents new challenges for analysis and interpretation. We consider the utility of race and/or ethnicity categories in genome-wide association studies (GWASs) of multi-ethnic cohorts. We demonstrate that race/ethnicity information enhances the ability to understand population-specific genetic architecture. To address the practical issue that self-identified racial/ethnic information may be incomplete, we propose a machine learning algorithm that produces a surrogate variable, termed HARE. We use height as a model trait to demonstrate the utility of HARE and ethnicity-specific GWASs.
Collapse
|
24
|
Ritzel R, Harris SB, Baron H, Florez H, Roussel R, Espinasse M, Muehlen-Bartmer I, Zhang N, Bertolini M, Brulle-Wohlhueter C, Munshi M, Bolli GB. Erratum. A Randomized Controlled Trial Comparing Efficacy and Safety of Insulin Glargine 300 Units/mL Versus 100 Units/mL in Older People With Type 2 Diabetes: Results From the SENIOR Study. Diabetes Care 2018;41:1672-1680. Diabetes Care 2019; 42:1604. [PMID: 31227584 PMCID: PMC6647046 DOI: 10.2337/dc19-er08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
25
|
Sultana T, Milyani R, Florez H. MON-LB066 Older Self Neglect as an Unusual Presentation in Panhypopituitarism. J Endocr Soc 2019. [PMCID: PMC6550582 DOI: 10.1210/js.2019-mon-lb066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Panhypopituitarism can emerge from pituitary adenoma, infection, infiltration, or congenital causes.1 Clinical presentation vary with symptoms associated with thyroid, adrenal and gonadal insufficiency.2 Headache or visual impairments can occur secondary to pituitary mass. A 74-year-old white veteran male was brought to the emergency department exhibiting a delirium. His neighbor reported a year of progressive decline, weight loss, social withdrawal, memory dysfunction, changes in behavior and personality. The patient denies visual disturbance or headaches. Screening with 3D-CAM (Confusion Assessment Method) indicative of delirium. On admission, he was afebrile, pulse at 55/min and BP of 105/66 mmHg. The mini nutritional assessment was 7 (i.e., malnourished) and 17/30 points on Montreal Cognitive Assessment (MoCA<26 for cognitive impairment). His neurological examination showed no focal deficit. A laboratory profile revealed hyponatremia (130 mEq/L; NR 136 - 145 mEq/L) and hyperkalemia (5.4 mEq/L; NR 3.5 - 5.1 mEq/L). Leucocytes were documented in urine indicating urinary tract infection. He was hospitalized and prescribed antimicrobial therapy and fluids. On day three, agitation and behavioral disturbance emerged and prompted the primary team to order CT scan of the head that showed a suprasellar mass, suggestive of pituitary adenoma. Further studies detected a low morning cortisol (3.8 ug/dl; NR 6-30 ug/dl ) with normal ACTH (17.33 pg/mL NR 7.2 - 63.3), low free T4 (0.6 ng/dl; NR 0.71 - 1.85 ng/dl) with normal TSH (2.00 uIU/mL, NR 0.45 - 4.70 uIU/mL), but no evidence of diabetes insipidus. Endocrinology team was consulted and treatment was initiated with glucocorticoid and levothyroxine replacement. On day 12, the patient was reevaluated and was found alert and oriented to person, time and place. He scored 25/30 on MOCA. A recommendation for brain biopsy was refused by the patient. The relationship between personality changes and panhypopituitarism is yet to be understood. This case illustrates the need to keep a high index of suspicion for endocrine and metabolic disorders in older adults with atypical presentation of delirium and self-neglect.References1. Fernandez-Rodriguez E, Bernabeu I, Andujar-Plata P, Casanueva FF (2012) Subclinical hypopituitarism. Best Pract Res Clin Endocrinol Metab 26: 461-469.2. Toogood AA, Stewart PM (2008) Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am 37: 235-261. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.
Collapse
Affiliation(s)
- Tallat Sultana
- Geriatric Research, Education and Clinical Center, Bruce W. Carter Miami VAMC Division of Geriatrics & Palliative Medicine , University of Miami Miller School of Medicine, Miami, FL, United States
| | | | | |
Collapse
|
26
|
Ritzel R, Harris SB, Baron H, Florez H, Roussel R, Espinasse M, Muehlen-Bartmer I, Zhang N, Bertolini M, Brulle-Wohlhueter C, Munshi M, Bolli GB. A Randomized Controlled Trial Comparing Efficacy and Safety of Insulin Glargine 300 Units/mL Versus 100 Units/mL in Older People With Type 2 Diabetes: Results From the SENIOR Study. Diabetes Care 2018; 41:1672-1680. [PMID: 29895556 DOI: 10.2337/dc18-0168] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE SENIOR compared the efficacy and safety of insulin glargine 300 units/mL (Gla-300) with glargine 100 units/mL (Gla-100) in older people (≥65 years old) with type 2 diabetes. RESEARCH DESIGN AND METHODS SENIOR was an open-label, two-arm, parallel-group, multicenter phase 3b trial designed to enroll ∼20% of participants aged ≥75 years. Participants were randomized 1:1 to Gla-300 or Gla-100, titrated to a fasting self-monitored plasma glucose of 5.0-7.2 mmol/L (90-130 mg/dL). RESULTS In total, 1,014 participants were randomized (mean age: 71 years). Comparable reductions in HbA1c were observed from baseline to week 26 for Gla-300 (-0.89%) and Gla-100 (-0.91%) in the overall population (least squares mean difference: 0.02% [95% CI -0.092 to 0.129]) and for participants aged ≥75 years (-0.11% [-0.330 to 0.106]). Incidence and rates of confirmed (≤3.9 mmol/L [≤70 mg/dL]) or severe hypoglycemia events were low and similar between both treatment groups, with lower rates of documented symptomatic hypoglycemia with Gla-300. The lower risk of hypoglycemia with Gla-300 versus Gla-100 was more apparent in the subgroup aged ≥75 years versus the overall population. Significantly lower annualized rates of documented symptomatic (≤3.9 mmol/L [≤70 mg/dL]) hypoglycemia were observed (Gla-300: 1.12; Gla-100: 2.71; rate ratio: 0.45 [95% CI 0.25-0.83]). CONCLUSIONS Efficacy and safety of Gla-300 was demonstrated in older people (≥65 years of age) with type 2 diabetes, with comparable reductions in HbA1c and similarly low or lower risk of documented symptomatic hypoglycemia versus Gla-100. A significant benefit in hypoglycemia reduction was seen in participants aged ≥75 years.
Collapse
Affiliation(s)
- Robert Ritzel
- Klinikum Schwabing and Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Munich, Germany
| | | | - Helen Baron
- University of Southern California, Los Angeles, CA
| | - Hermes Florez
- Miller School of Medicine, University of Miami, Coral Gables, FL
| | | | | | | | | | | | | | - Medha Munshi
- Joslin Diabetes Center, Harvard University, Boston, MA
| | - Geremia B Bolli
- Department of Medicine, Perugia University Medical School, Perugia, Italy
| |
Collapse
|
27
|
Guardiola M, Salvatierra K, Florez H. Computer analysis of resistance mutations to HCV NS5A antivirals. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
28
|
Nieto-Martínez R, Mechanick JI, Brajkovich I, Ugel E, Risques A, Florez H, González-Rivas JP. Prevalence of diabetes in three regions of Venezuela. The VEMSOLS study results. Prim Care Diabetes 2018; 12:126-132. [PMID: 29249672 DOI: 10.1016/j.pcd.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela. METHODS During 2006-2010, 1334 subjects ≥20years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software. FINDINGS Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%-10.0%), higher in men than women (11.2% and 7.0% respectively; p=0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%-9.9%). This figure increased with age, with the lowest prevalence in the 20-29year old group (1.8% [95% CI, 0.6%-4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%-40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%-2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%-16.7%), and only 48.2% were aware of their diabetes condition. CONCLUSION In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.
Collapse
Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" (UCLA), Barquisimeto, Venezuela; Cardio-Metabolic Unit 7, Barquisimeto, Venezuela; Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA; South Florida Veterans Affairs Foundation for Research & Education, Miami, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imperia Brajkovich
- Department of Internal Medicine B, School of Medicine "Luis Razetti", University Hospital of Caracas, University Central de Venezuela, Caracas, Venezuela
| | - Eunice Ugel
- Department of Preventive Medicine, School of Medicine, University Centre-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Alejandro Risques
- Department of Social and Preventive Medicine, School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Hermes Florez
- University of Miami Miller School of Medicine and Miami Veterans Affairs Medical Center, Miami, FL, USA
| | | |
Collapse
|
29
|
Elfassy T, Mossavar-Rahmani Y, Van Horn L, Gellman M, Sotres-Alvarez D, Schneiderman N, Daviglus M, Beasley JM, Llabre MM, Shaw PA, Prado G, Florez H, Zeki Al Hazzouri A. Associations of Sodium and Potassium with Obesity Measures Among Diverse US Hispanic/Latino Adults: Results from the Hispanic Community Health Study/Study of Latinos. Obesity (Silver Spring) 2018; 26:442-450. [PMID: 29318759 PMCID: PMC5783725 DOI: 10.1002/oby.22089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate cross-sectional associations of sodium and potassium with BMI, waist circumference (WC), and body fat and to determine whether the nativity and/or duration of United States (US) residence modified these associations. METHODS Sodium and potassium were derived from 24-hour diet recalls from 16,156 US participants of the 2008 to 2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and from 24-hour urine in 447 HCHS/SOL participants. BMI, WC, and body fat were measured. RESULTS Dietary sodium that was 500 mg/d higher was cross-sectionally associated with a 0.07-kg/m2 higher BMI (P < 0.05) and a 0.18-cm larger WC (P = 0.04). Dietary potassium that was 500 mg/d higher was only associated with lower BMI and smaller WC among those who were foreign-born with 10 + years in the US (-0.13 kg/m2 , P < 0.01 and -0.36 cm, P = 0.01, respectively) and among those who were US-born (-0.62 kg/m2 , P < 0.01 and -1.42 cm, P < 0.01, respectively). Urinary sodium that was 500 mg/d higher was associated with a 0.27-kg/m2 higher BMI (P < 0.01) and 0.54 kg more body fat (P < 0.01). CONCLUSIONS Sodium intake was associated with higher BMI, WC, and body fat. Potassium intake was associated with lower BMI and smaller WC among US-born participants and participants with a longer duration of US residence.
Collapse
Affiliation(s)
- Tali Elfassy
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Marc Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Martha Daviglus
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | | | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Pamela A Shaw
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Hermes Florez
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | | |
Collapse
|
30
|
Elfassy T, Yi SS, Llabre MM, Schneiderman N, Gellman M, Florez H, Prado G, Zeki Al Hazzouri A. Neighbourhood socioeconomic status and cross-sectional associations with obesity and urinary biomarkers of diet among New York City adults: the heart follow-up study. BMJ Open 2017; 7:e018566. [PMID: 29289939 PMCID: PMC5778292 DOI: 10.1136/bmjopen-2017-018566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine whether neighbourhood socioeconomic status (SES) is associated with body mass index (BMI), waist circumference (WC) and biomarkers of diet (urinary sodium and potassium excretion). DESIGN A cross-sectional study. SETTING The data reported were from the 2010 Heart Follow-up Study, a population-based representative survey of 1645 adults. PARTICIPANTS Community-dwelling diverse residents of New York City nested within 128 neighbourhoods (zip codes). PRIMARY AND SECONDARY OUTCOME MEASURES BMI (kg/m2) and WC (inches) were measured during in-home visits, and 24-hour urine sample was collected to measure biomarkers of diet: sodium (mg/day) and potassium (mg/day), with high sodium and low potassium indicative of worse diet quality. RESULTS After adjusting for individual-level characteristics using multilevel linear regressions, low versus high neighbourhood SES tertile was associated with 1.83 kg/m2 higher BMI (95% CI 0.41 to 3.98) and 251 mg/day lower potassium excretion (95% CI -409 to 93) among women only, with no associations among men (P values for neighbourhood SES by sex interactions <0.05). CONCLUSION Our results suggest that women may be particularly vulnerable to the effects of a socioeconomically disadvantaged neighbourhood. Future neighbourhood research should explore sex differences, as these can inform tailored interventions. TRIAL REGISTRATION NUMBER NCT01889589; Results.
Collapse
Affiliation(s)
- Tali Elfassy
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Stella S Yi
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Marc Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Hermes Florez
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | | |
Collapse
|
31
|
Labrada M, Mintzer MJ, Karanam C, Castellanos R, Cruz L, Hoang M, Wieger R, Aguilar E, Florez H, Ruiz JG. Dramatic Reduction in 30-Day Readmissions Through High-Risk Screening and Two-Phase Interdisciplinary Care. South Med J 2017; 110:757-760. [PMID: 29197308 DOI: 10.14423/smj.0000000000000745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Thirty-day readmissions are common, serious, and costly. Most important, often they are preventable. The purpose of this quality improvement study was to evaluate an interdisciplinary, two-phase intervention to reduce 30-day readmissions among high-risk medical patients. One or two high-risk patients were selected each weekday by a hospitalist using literature-based, locally tested criteria that included common medical illnesses, active psychiatric illness, and recent or recurrent hospital admissions. METHODS Patients admitted to 1 of 5 medical hospitalist teams were selected to receive the intervention; patients admitted to the 4 remaining teams were used for comparison. The two-phase care coordination intervention consisted of a daily interdisciplinary team meeting for the selected high-risk patients and postdischarge interventions that included outpatient care coordination until the patients' first follow-up appointment. The care plan addressed medical/geriatric assessment, social stability, medication reconciliation, nutritional needs, care coordination including future appointments/testing, and community services. Eighty-five patients in the intervention group were compared with 84 patients from the comparison group using propensity score matching. Patient characteristics were similar at baseline. RESULTS The intervention group demonstrated a reduction in 30-day readmissions by 52% (11 vs 23, P = 0.019). Length of stay was reduced: 5.5 days compared with 7.2 days (P = 0.258). CONCLUSIONS This intervention produced a significant reduction in 30-day readmissions for high-risk patients and a trend for shorter lengths of stay compared with similarly matched patients. Future research trials are needed to verify these results.
Collapse
Affiliation(s)
- Mabel Labrada
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Michael J Mintzer
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Chandana Karanam
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Raquel Castellanos
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Lorinda Cruz
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Minh Hoang
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Regina Wieger
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Enrique Aguilar
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Hermes Florez
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| | - Jorge G Ruiz
- From the Miami GRECC and MiamiVeterans Affairs Healthcare System, Miami, and the University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
32
|
Abstract
RECENT FINDINGS Eating disorders (ED) affect energy intake modifying body fat depots. Prior evidence suggests that binge eating disorder (BED) and bulimia nervosa (BN) could increase the risk for type 2 diabetes (T2D), while anorexia nervosa (AN) could reduce it. PURPOSE OF REVIEW A systematic review and meta-analysis were conducted to evaluate if ED are risk factors for T2D. Ten studies were selected out of 1057 screened. Meta-analysis of six studies with T2D as outcome is reported. Among cross-sectional studies, both BED (OR 3.69, 95% CI [1.12-12.12]) and BN (OR 3.45 [1.92-6.1]) increased the risk of T2D, while AN was not associated with lower risk (OR 0.87 [0.40-1.88]). Cohort studies showed increased risk of T2D with BN (RR 1.7 [1.2-2.5]), and decreased risk with AN (RR 0.71 [0.52-0.98]), but for BED the association was less clear (OR 3.34 [0.85-13.12]). Limitations of studies and recommendations for future research are presented.
Collapse
Affiliation(s)
- Ramfis Nieto-Martínez
- Geriatric Research, Education, and Clinical Center (GRECC) and South Florida Veterans Affairs Foundation for Research & Education, Miami VA Healthcare System, Miami, FL, USA.
- Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela.
- Miami Veterans Affairs Medical Center, 1201 Northwest 16th Street, CLC 207, Miami, FL, 33125, USA.
| | | | - José R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine. Mayo Clinic, Rochester, MN, USA
| | - Hermes Florez
- Geriatric Research, Education, and Clinical Center (GRECC) and South Florida Veterans Affairs Foundation for Research & Education, Miami VA Healthcare System, Miami, FL, USA
- Departments of Public Health Sciences and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
33
|
Abstract
In a world where the population is ageing, there is growing interest and demand for research evaluating strategies that address the ageing process. After 60 years of successful use of metformin in our pharmaceutical armamentarium, we are learning that, beyond improving glycaemic control, metformin may have additional mechanisms and pathways of action that need further study. Although, metformin's effect on clinical ageing outcomes may still be considered speculative, the findings from studies into cellular and animal models and from observational and pilot human studies support the existence of beneficial effects on ageing. At present, progress for human research, using randomised clinical trials to evaluate metformin's clinical impact, has just started. Here, we present a review on the ageing process and the mechanisms involved, and the role that metformin may have to counter these. We go on to discuss the upcoming large randomised clinical trials that may provide insight on the use of metformin for ageing outcomes beyond glycaemic control.
Collapse
Affiliation(s)
- Willy Marcos Valencia
- Geriatric Research Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 N.W. 16th Street, (11 GRC) CLC 207 A2, Miami, FL, 33125, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ana Palacio
- Geriatric Research Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 N.W. 16th Street, (11 GRC) CLC 207 A2, Miami, FL, 33125, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leonardo Tamariz
- Geriatric Research Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 N.W. 16th Street, (11 GRC) CLC 207 A2, Miami, FL, 33125, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hermes Florez
- Geriatric Research Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 N.W. 16th Street, (11 GRC) CLC 207 A2, Miami, FL, 33125, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
34
|
Alexander A, Florez H, Ladera N. Hyperglycemia and dyslipidemia of Isabela, Galápagos, Ecuador: A pilot study of cardiovascular risk factors in an Isolated Island community. Diabetes Res Clin Pract 2017; 130:108-112. [PMID: 28601002 DOI: 10.1016/j.diabres.2017.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/03/2017] [Accepted: 05/16/2017] [Indexed: 01/01/2023]
Abstract
AIM To evaluate the prevalence of hyperglycemia and dyslipidemia in the population of Isabela, Galápagos, Ecuador, across gender and age (above or below 50). METHODS In this population-based retrospective cross-sectional study among individuals in Isabela, Galápagos, Ecuador, demographic and metabolic factors were evaluated based on World Health Organization (WHO) Global Guidelines. RESULTS The population overall exceeded the WHO guidelines for cardiovascular health. As to be expected, there was significance in the trend of increasing dyslipidemia and hyperglycemia with age except postprandial glucose. In those individuals below the age of 50, 8.0%, 49% and 26% had hyperglycemia, hypercholesterolemia and hypertriglyceridemia, respectively. However, in those above 50, they measured 24%, 68% and 36% respectively, showing a significant increase. CONCLUSIONS Hyperglycemia and dyslipidemia appear to be prevalent in Isabela, Galápagos, Ecuador and this pilot study supports further research into metabolic syndrome and diabetes. Such data may help in healthcare planning and screening to ensure not only timely diagnosis, but prevention. The limitations of this data illustrate modalities that data collection can be improved, such as having a linked clinical history to the data itself and better patient follow up for such entities as post prandial glucose, for example. However, this pilot study presents a starting point for future directions of research, such as ascertaining prevalence of diabetes type II, metabolic syndrome and cardiovascular disease.
Collapse
Affiliation(s)
- Abigail Alexander
- University of Miami Miller School of Medicine, USA; International Outreach Initiative, Galápagos, Ecuador.
| | | | - Nuria Ladera
- International Outreach Initiative, Galápagos, Ecuador
| |
Collapse
|
35
|
Luchsinger JA, Ma Y, Christophi CA, Florez H, Golden SH, Hazuda H, Crandall J, Venditti E, Watson K, Jeffries S, Manly JJ, Pi-Sunyer FX. Metformin, Lifestyle Intervention, and Cognition in the Diabetes Prevention Program Outcomes Study. Diabetes Care 2017; 40:958-965. [PMID: 28500216 PMCID: PMC5481986 DOI: 10.2337/dc16-2376] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/03/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the association of the Diabetes Prevention Program (DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. RESEARCH DESIGN AND METHODS The DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score. RESULTS A total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 ± 10.7 years underwent cognitive assessments; 67.7% women, 54.6% non-Hispanic white, 20.7% non-Hispanic black, 14.6% Hispanic, 5.5% American Indian, and 4.6% Asian; 26.6% were homozygous or heterozygous for APOE-ε4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9%; P < 0.001) compared with lifestyle (47.0%) and metformin (50.4%). Metformin exposure was higher in the metformin group (8.72 years; P < 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition. CONCLUSIONS Exposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.
Collapse
Affiliation(s)
| | - Yong Ma
- Biostatistics Center, The George Washington University, Washington, DC
| | | | | | | | - Helen Hazuda
- University of Texas Health Science Center, San Antonio, TX
| | | | | | - Karol Watson
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | |
Collapse
|
36
|
Valencia Rodrigo W, Botros D, Pendlebury D, Florez H, Lee C, Oursler K, Katzel L, Morey M. PROACTIVE REACH AND TELEHEALTH MONITORING (GEROFIT) ENHANCE RESISTANCE EXERCISE AT RURAL SETTINGS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.839] [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: 11/14/2022] Open
Affiliation(s)
- W. Valencia Rodrigo
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
- University of Miami School of Medicine Department of Public Health Sciences, Miami, Florida,
| | - D. Botros
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
- Jackson Memorial Hospital, Miami, Florida,
| | - D. Pendlebury
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
| | - H. Florez
- Miami VA Geriatrics Research, Education and Clinical Center (GRECC), Miami, Florida,
- University of Miami School of Medicine Department of Public Health Sciences, Miami, Florida,
| | - C. Lee
- Greater LA VA Geriatrics Research, Education and Clinical Center (GRECC), Los Angeles, California,
- UCLA David Geffen School of Medicine, Los Angeles, California,
| | - K. Oursler
- Salem VA Geriatrics Research and Education, Salem, New York,
- University of Maryland School of Medicine - Department of Medicine,
Baltimore, Maryland,
| | - L.I. Katzel
- Baltimore VA Geriatrics Research, Education and Clinical Center (GRECC), Baltimore, Maryland,
- University of Maryland School of Medicine - Department of Medicine,
Baltimore, Maryland,
| | - M.C. Morey
- Durham VA Geriatrics Research, Education and Clinical Center (GRECC), Durham, North Carolina,
- Duke University School of Medicine - Department of Medicine, Durham, North Carolina
| |
Collapse
|
37
|
Nieto-Martínez R, Inés Marulanda M, González-Rivas JP, Ugel E, Durán M, Barengo N, Aschner P, Patiño M, López Gómez L, Monsalve P, Marcano H, Florez H. Cardio-Metabolic Health Venezuelan Study (EVESCAM): Design and Implementation. Invest Clin 2017; 58:56-69. [PMID: 29939500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The EVESCAM (EstudioVenezolano de Salud Cardio-Metabólica) is the first national, population survey in Venezuela, designed to examine the prevalence of diabetes and cardio-metabolic risk factors and its relationship with lifestyle. It is a cross-sectional, cluster sampling study, which recruited 4454 participants aged ≥ 20 years. The data were collected in community health-care centers by trained health professionals and medical students. The data collected from each subject included, after informed consent, structured questionnaires (clinical, demographic, physical activity, nutritional and psychological), anthropometric measurements (weight, height and waist circumference), body fat by bioelectrical impedance, hand grip, blood pressure, electrocardiogram, and biochemical measurements (standard 75 g oral glucose tolerance test, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). The data will be used to estimate the prevalence of overweight, obesity, prediabetes, diabetes, hypertension, dyslipidemias, sarcopenia and metabolic syndrome; and to examine their relationships with lifestyle factors. The risk of coronary heart disease and impaired glucose regulation will be estimated using the Framingham Coronary Heart Disease Risk Score and the Latin America adaptation of the Finnish Diabetes Risk Score (LA-FINDRISC), respectively. These results will guide national cardiovascular and diabetes prevention strategies, and will be available for government agencies to help in the implementation of public health policies.
Collapse
|
38
|
Rockette-Wagner B, Storti KL, Dabelea D, Edelstein S, Florez H, Franks PW, Montez MG, Pomeroy J, Kriska AM. Activity and Sedentary Time 10 Years After a Successful Lifestyle Intervention: The Diabetes Prevention Program. Am J Prev Med 2017; 52:292-299. [PMID: 27887769 PMCID: PMC5318249 DOI: 10.1016/j.amepre.2016.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/31/2016] [Accepted: 10/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This study aims to determine if evidence exists for a lasting effect of the Diabetes Prevention Program (DPP) lifestyle intervention on activity levels by comparing objectively collected activity data between the DPP Outcome Study (DPPOS) cohort and adults from the National Health and Nutrition Examination Survey (NHANES; 2003-2006). METHODS Average minutes/day of light and moderate to vigorous physical activity (MVPA) and sedentary behavior from ActiGraph accelerometers (collected 2010-2012) were examined (2013-2014) for comparable DPPOS and NHANES subgroups by age, sex, and diabetes status. Longitudinal questionnaire data on leisure activity, collected yearly from DPP baseline to the time of accelerometer measurement (1996-2010; 11.9-year mean follow-up), were also examined to provide support for a long-term intervention effect. RESULTS Average minutes/day of accelerometer-derived MVPA was higher in all DPPOS subgroups versus NHANES subgroups of similar age/sex/diabetes status; with values as much as twice as high in some DPPOS subgroups. Longitudinal questionnaire data from DPP/DPPOS showed a maintained increase of 1.24 MET hours/week (p=0.026) of leisure activity in DPPOS participants from all original study arms between DPP baseline and accelerometer recording. There were no consistent differences between comparable DPPOS and NHANES subgroups for accelerometer-derived sedentary or light-intensity activity minutes/day. CONCLUSIONS More than 10 years after the start of DPP, DPPOS participants performed more accelerometer-measured MVPA than similar adults from NHANES. Longitudinal questionnaire data support the accelerometer-based findings by suggesting that leisure activity levels at the time of accelerometer recording remained higher than DPP baseline levels.
Collapse
Affiliation(s)
| | - Kristi L Storti
- Department of Kinesiology, Health, and Sport Science, Indiana University of Pennsylvania, Indiana, Pennsylvania
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado, Denver, Colorado
| | - Sharon Edelstein
- George Washington University Biostatistics Center, Rockville, Maryland
| | - Hermes Florez
- Department of Medicine, University of Miami, Miami, Florida
| | - Paul W Franks
- Department of Clinical Science, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maria G Montez
- University of Texas Health Science Center, San Antonio, Texas
| | - Jeremy Pomeroy
- Diabetes Epidemiology and Clinical Research Section, U.S. NIH, Phoenix, Arizona; Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
39
|
Abstract
Microvascular complications (retinopathy, nephropathy, and neuropathy) affect hundreds of millions of patients with type 2 diabetes. They usually affect people with longstanding or uncontrolled disease, but they can also be present at diagnosis or in those yet to have a diagnosis made. The presentation and progression of these complications can lead to loss of visual, renal, and neurologic functions, impaired mobility and cognition, poor quality of life, limitations for employment and productivity, and increased costs for the patient and society. If left uncontrolled or untreated, they lead to irreversible damage and even death. This review focuses on the primary and secondary prevention of diabetic microvascular complications in patients with type 2 diabetes, beyond glycemic control. Interventions discussed include standard of care interventions supported by guidelines from major organizations, as well as additional proposed interventions that are supported by research published in the past decade. High level evidence sources such as systematic reviews and large, multicenter randomized clinical trials have been prioritized. Smaller trials were included where high quality evidence was unavailable.
Collapse
Affiliation(s)
- Willy Marcos Valencia
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33125, USA
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA
| | - Hermes Florez
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA
- Departments of Public Health Sciences and Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
40
|
Sharit J, Idrees T, Andrade AD, Anam R, Karanam C, Valencia W, Florez H, Ruiz JG. Use of an online personal health record's Track Health function to promote positive lifestyle behaviors in Veterans with prediabetes. J Health Psychol 2016; 23:681-690. [PMID: 27920356 DOI: 10.1177/1359105316681065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This pilot 3-month clinical trial investigated the feasibility, effectiveness, and acceptability of using the Track Health function of the Veterans Health Administration's personal health record for eliciting a more positive physical activity and dietary intake lifestyle in a sample of 38 overweight and obese Veterans with prediabetes. Comparisons between baseline and 3 months post-intervention indicated significant improvements in weight, physical activity, abdominal circumference, and blood pressure. Use of a personal health record that users can identify with and find usable and useful coupled with instruction targeting critical functionalities could potentially promote healthy behavioral lifestyle changes.
Collapse
Affiliation(s)
- Joseph Sharit
- 1 University of Miami, USA.,2 Geriatric Research Education and Clinical Center, Miami Veterans Administration Healthcare System, USA
| | | | - Allen D Andrade
- 4 James J. Peters Veterans Administration Medical Center, USA
| | - Ramanakumar Anam
- 2 Geriatric Research Education and Clinical Center, Miami Veterans Administration Healthcare System, USA
| | - Chandana Karanam
- 2 Geriatric Research Education and Clinical Center, Miami Veterans Administration Healthcare System, USA
| | | | - Hermes Florez
- 2 Geriatric Research Education and Clinical Center, Miami Veterans Administration Healthcare System, USA.,5 University of Miami Miller School of Medicine, USA
| | - Jorge G Ruiz
- 2 Geriatric Research Education and Clinical Center, Miami Veterans Administration Healthcare System, USA.,5 University of Miami Miller School of Medicine, USA
| |
Collapse
|
41
|
Nieto-Martínez R, González-Rivas JP, Florez H, Mechanick JI. Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale. Endocrinol Metab Clin North Am 2016; 45:967-1009. [PMID: 27823615 DOI: 10.1016/j.ecl.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided.
Collapse
Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Av. Andrés Bello con Av. Libertador, Apartado 516, Barquisimeto, Venezuela; Department of Physiology, School of Medicine, University of Panamá, Vía Transísmica, Apartado 0824, Estafeta Universitaria, Panamá, República de Panamá.
| | - Juan P González-Rivas
- The Andes Clinic of Cardio-Metabolic Studies, Av. Miranda entre calles Bermúdez y Arismendi, Apartado 3112, Timotes, Venezuela
| | - Hermes Florez
- Miami Veterans Affairs Medical Center, University of Miami Miller School of Medicine, 1201 Northwest 16th Street, CLC 207, Miami, FL 33125, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, 1192 Park Avenue, New York, NY 10128, USA
| |
Collapse
|
42
|
Munshi MN, Florez H, Huang ES, Kalyani RR, Mupanomunda M, Pandya N, Swift CS, Taveira TH, Haas LB. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39:308-18. [PMID: 26798150 PMCID: PMC5317234 DOI: 10.2337/dc15-2512] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.
Collapse
Affiliation(s)
- Medha N Munshi
- Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Hermes Florez
- Geriatric Research Education and Clinical Centers, Miami Veterans Affairs Healthcare System and University of Miami, Miami, FL
| | - Elbert S Huang
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
| | - Rita R Kalyani
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Naushira Pandya
- Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL
| | | | | | | |
Collapse
|
43
|
Florez H, Reaven PD, Bahn G, Moritz T, Warren S, Marks J, Reda D, Duckworth W, Abraira C, Hayward R, Emanuele N. Rosiglitazone treatment and cardiovascular disease in the Veterans Affairs Diabetes Trial. Diabetes Obes Metab 2015; 17:949-55. [PMID: 25964070 PMCID: PMC4676911 DOI: 10.1111/dom.12487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/31/2015] [Accepted: 05/02/2015] [Indexed: 01/17/2023]
Abstract
AIMS To evaluate the relationship between patterns of rosiglitazone use and cardiovascular (CV) outcomes in the Veterans Affairs Diabetes Trial (VADT). METHODS Time-dependent survival analyses, case-control and 1 : 1 propensity matching approaches were used to examine the relationship between patterns of rosiglitazone use and CV outcomes in the VADT, a randomized controlled study that assessed the effect of intensive glycaemic control on CV outcomes in 1791 patients with type 2 diabetes (T2D) whose mean age was 60.4 ± 9 years. Participants were recruited between 1 December 2000 and 31 May 2003, and were followed for 5-7.5 years (median 5.6) with a final visit by 31 May 2008. Rosiglitazone (4 mg and 8 mg daily) was initiated per protocol in both the intensive-therapy and standard-therapy groups. Main outcomes included a composite CV outcome, CV death and myocardial infarction (MI). RESULTS Both daily doses of rosiglitazone were associated with lower risk for the primary composite CV outcome [4 mg: hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.49-0.81 and 8 mg: HR 0.60, 95% CI 0.49-0.75] after adjusting for demographic and clinical covariates. A reduction in CV death was also observed (HR 0.25, p < 0.001, for both 4 and 8 mg/day rosiglitazone); however, the effect on MI was less evident for 8 mg/day and not significant for 4 mg/day. CONCLUSIONS In older patients with T2D the use of rosiglitazone was associated with decreased risk of the primary CV composite outcome and CV death. Rosiglitazone use did not lead to a higher risk of MI.
Collapse
Affiliation(s)
- H Florez
- Miami VA Healthcare System, GRECC, University of Miami, Miami, FL, USA
| | - P D Reaven
- Phoenix VA Health Care Center, Department of Medicine, Phoenix, AZ, USA
| | - G Bahn
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| | - T Moritz
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| | - S Warren
- VA Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, University of New Mexico, Albuquerque, NM, USA
| | - J Marks
- Miami VA Healthcare System, GRECC, University of Miami, Miami, FL, USA
| | - D Reda
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| | - W Duckworth
- Phoenix VA Health Care Center, Department of Medicine, Phoenix, AZ, USA
| | - C Abraira
- Miami VA Healthcare System, GRECC, University of Miami, Miami, FL, USA
| | - R Hayward
- VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - N Emanuele
- Hines VA Cooperative Studies Program, Coordinating Center, Hines VA Hospital, Hines, IL, USA
| |
Collapse
|
44
|
Rockette-Wagner B, Edelstein S, Venditti EM, Reddy D, Bray GA, Carrion-Petersen ML, Dabelea D, Delahanty LM, Florez H, Franks PW, Montez MG, Rubin R, Kriska AM. The impact of lifestyle intervention on sedentary time in individuals at high risk of diabetes. Diabetologia 2015; 58:1198-202. [PMID: 25851102 PMCID: PMC4417075 DOI: 10.1007/s00125-015-3565-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
AIMS/HYPOTHESIS The Diabetes Prevention Program (DPP) lifestyle intervention successfully achieved its goal of increasing leisure physical activity levels. This current study examines whether the lifestyle intervention also changed time spent being sedentary and the impact of sedentary time on diabetes development in this cohort. METHODS 3,232 DPP participants provided baseline data. Sedentary behaviour was assessed via an interviewer-administered questionnaire and reported as time spent watching television specifically (or combined with sitting at work). Mean change in sedentary time was examined using repeated measures ANCOVA. The relationship between sedentary time and diabetes incidence was determined using Cox proportional hazards models. RESULTS During the DPP follow-up (mean: 3.2 years), sedentary time declined more in the lifestyle than the metformin or placebo participants (p < 0.05). For the lifestyle group, the decrease in reported mean television watching time (22 [95% CI 26, 17] min/day) was greater than in the metformin or placebo groups (p < 0.001). Combining all participants together, there was a significantly increased risk of developing diabetes with increased television watching (3.4% per hour spent watching television), after controlling for age, sex, treatment arm and leisure physical activity (p < 0.01), which was attenuated when time-dependent weight was added to the model. CONCLUSIONS/INTERPRETATION In the DPP, the lifestyle intervention was effective at reducing sedentary time, which was not a primary goal. In addition, in all treatment arms, individuals with lower levels of sedentary time had a lower risk of developing diabetes. Future lifestyle intervention programmes should emphasise reducing television watching and other sedentary behaviours in addition to increasing physical activity. TRIAL REGISTRATION ClinicalTrials.gov NCT00004992.
Collapse
|
45
|
Florez H, Luo J, Castillo-Florez S, Mitsi G, Hanna J, Tamariz L, Palacio A, Nagendran S, Hagan M. Impact of Metformin-Induced Gastrointestinal Symptoms on Quality of Life and Adherence in Patients with Type 2 Diabetes. Postgrad Med 2015; 122:112-20. [DOI: 10.3810/pgm.2010.03.2128] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
46
|
Abstract
The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes-related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.
Collapse
Affiliation(s)
- W M Valencia
- Geriatrics Research, Education and Clinical Center, Miami Bruce W. Carter VA Medical Center, Miami, FL, USA; Department of Public Health Sciences, Division of Epidemiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | |
Collapse
|
47
|
Abstract
Weight loss in older adults has been a controversial topic for more than a decade. An obesity paradox has been previously described and the issue of weight status on health outcomes remains a highly debated topic. However, there is little doubt that physical activity (PA) has a myriad of benefits in older adults, especially in obese individuals who are inactive and have a poor cardiometabolic profile. In this review, we offer a critical view to clarify misunderstandings regarding the obesity paradox, particularly as it relates to obese older adults. We also review the evidence on PA and lifestyle interventions for the improvement of cardiorespiratory fitness, which can prevent disease and provide benefits to obese older adults, independent of weight changes.
Collapse
Affiliation(s)
- Willy Marcos Valencia
- Geriatrics Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA,
| | | | | |
Collapse
|
48
|
Florez H, Temprosa MG, Orchard TJ, Mather KJ, Marcovina SM, Barrett-Connor E, Horton E, Saudek C, Pi-Sunyer XF, Ratner RE, Goldberg RB. Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance. Diabetes Obes Metab 2014; 16:326-33. [PMID: 24118860 PMCID: PMC3943638 DOI: 10.1111/dom.12220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 12/28/2022]
Abstract
AIMS To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence. METHODS We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years. RESULTS In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk. CONCLUSIONS MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.
Collapse
Affiliation(s)
- Hermes Florez
- Geriatric Research, Education, and Clinical Center, Miami Veterans Affairs Healthcare System and Divisions of Epidemiology, Geriatric Medicine & Endocrinology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kieren J Mather
- Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana
| | - Santica M Marcovina
- Northwest Lipid Research Labs, University of Washington, Seattle, Washington
| | - Elizabeth Barrett-Connor
- Department of Family and Preventive Medicine, University of California, San Digeo, La Jolla, California
| | | | | | - Xavier F Pi-Sunyer
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, St. Luke’s Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Ronald B Goldberg
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
49
|
Modi YS, Qurban Q, Zlotcavitch L, Echeverri RJ, Feuer W, Florez H, Galor A. Ocular surface symptoms in veterans returning from operation Iraqi freedom and operation enduring freedom. Invest Ophthalmol Vis Sci 2014; 55:650-3. [PMID: 24408975 DOI: 10.1167/iovs.13-13330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To correlate situational exposures and psychiatric disease with self-reported ocular surface symptoms in a younger veteran population involved in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF). METHODS Cross-sectional study of all veterans evaluated in the OIF/OEF clinic between December 2012 and April 2013 who completed the dry eye questionnaire and screening evaluations for environmental exposures, posttraumatic stress disorder (PTSD), and depression. The main outcome measures were the influence of environmental exposure and psychiatric disease on ocular surface symptoms. RESULTS Of 115 participants, the average age was 33 years. While overseas, exposure to incinerated waste (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.23-5.81, P = 0.02) and PTSD (OR 2.68, 95% CI 1.23-5.85, P = 0.02) were associated with self-reported ocular surface symptoms. On return to the United States, older age (OR per decade 2.66, 95% CI 1.65-4.31, P = 0.04) was associated with persistent symptoms and incinerated waste was associated with resolution of symptoms (OR 0.25, 95% CI 0.07-0.90, P = 0.04). When evaluating symptom severity, 26% of the responders complained of severe ocular surface symptoms, with PTSD (OR 3.10, 95% CI 1.22-7.88, P = 0.02) and depression (OR 4.28, 95% CI 1.71-10.68, P = 0.002) being significant risk factors for their presence. CONCLUSIONS PTSD was significantly associated with ocular surface symptoms both abroad and on return to the United States, whereas air pollution in the form of incinerated waste, was correlated with reversible symptoms.
Collapse
Affiliation(s)
- Yasha S Modi
- Miami Veterans Administration Medical Center, Miami, Florida
| | | | | | | | | | | | | |
Collapse
|
50
|
Marrero D, Pan Q, Barrett-Connor E, de Groot M, Zhang P, Percy C, Florez H, Ackermann R, Montez M, Rubin RR. Impact of diagnosis of diabetes on health-related quality of life among high risk individuals: the Diabetes Prevention Program outcomes study. Qual Life Res 2013; 23:75-88. [PMID: 23709097 DOI: 10.1007/s11136-013-0436-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 01/24/2023]
Abstract
PURPOSE The purpose of this study is to assess if diagnosis of type 2 diabetes affected health-related quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration. METHODS 3,210 participants with pre-diabetes were randomized to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB). HRQoL was assessed using the SF-36 including: (1) 8 SF-36 subscales; (2) the physical component (PCS) and mental component summary (MCS) scores; and (3) the SF-6D. The sample was categorized by diabetes free versus diagnosed. For diagnosed subgroup, mean scores in the diabetes-free period, at 6 months, 2, 4 and 6 years post-diagnosis, were compared. RESULTS PCS and SF-6D scores declined in all participants in all treatment arms (P < .001). MCS scores did not change significantly in any treatment arm regardless of diagnosis. ILS participants reported a greater decrease in PCS scores at 6 months post-diagnosis (P < .001) and a more rapid decline immediately post-diagnosis in SF-6D scores (P = .003) than the MET or PLB arms. ILS participants reported a significant decrease in the social functioning subscale at 6 months (P < .001) and two years (P < .001) post-diagnosis. CONCLUSIONS Participants reported a decline in measures of overall health state (SF-6D) and overall physical HRQoL, whether or not they were diagnosed with diabetes during the study. There was no change in overall mental HRQoL. Participants in the ILS arm with diabetes reported a more significant decline in some HRQoL measures than those in the MET and PLB arms that developed diabetes.
Collapse
Affiliation(s)
- D Marrero
- Indiana University School of Medicine, Indianapolis, IN, USA,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|