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Lennon NJ, Kottyan LC, Kachulis C, Abul-Husn NS, Arias J, Belbin G, Below JE, Berndt SI, Chung WK, Cimino JJ, Clayton EW, Connolly JJ, Crosslin DR, Dikilitas O, Velez Edwards DR, Feng Q, Fisher M, Freimuth RR, Ge T, Glessner JT, Gordon AS, Patterson C, Hakonarson H, Harden M, Harr M, Hirschhorn JN, Hoggart C, Hsu L, Irvin MR, Jarvik GP, Karlson EW, Khan A, Khera A, Kiryluk K, Kullo I, Larkin K, Limdi N, Linder JE, Loos RJF, Luo Y, Malolepsza E, Manolio TA, Martin LJ, McCarthy L, McNally EM, Meigs JB, Mersha TB, Mosley JD, Musick A, Namjou B, Pai N, Pesce LL, Peters U, Peterson JF, Prows CA, Puckelwartz MJ, Rehm HL, Roden DM, Rosenthal EA, Rowley R, Sawicki KT, Schaid DJ, Smit RAJ, Smith JL, Smoller JW, Thomas M, Tiwari H, Toledo DM, Vaitinadin NS, Veenstra D, Walunas TL, Wang Z, Wei WQ, Weng C, Wiesner GL, Yin X, Kenny EE. Selection, optimization and validation of ten chronic disease polygenic risk scores for clinical implementation in diverse US populations. Nat Med 2024; 30:480-487. [PMID: 38374346 PMCID: PMC10878968 DOI: 10.1038/s41591-024-02796-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
Polygenic risk scores (PRSs) have improved in predictive performance, but several challenges remain to be addressed before PRSs can be implemented in the clinic, including reduced predictive performance of PRSs in diverse populations, and the interpretation and communication of genetic results to both providers and patients. To address these challenges, the National Human Genome Research Institute-funded Electronic Medical Records and Genomics (eMERGE) Network has developed a framework and pipeline for return of a PRS-based genome-informed risk assessment to 25,000 diverse adults and children as part of a clinical study. From an initial list of 23 conditions, ten were selected for implementation based on PRS performance, medical actionability and potential clinical utility, including cardiometabolic diseases and cancer. Standardized metrics were considered in the selection process, with additional consideration given to strength of evidence in African and Hispanic populations. We then developed a pipeline for clinical PRS implementation (score transfer to a clinical laboratory, validation and verification of score performance), and used genetic ancestry to calibrate PRS mean and variance, utilizing genetically diverse data from 13,475 participants of the All of Us Research Program cohort to train and test model parameters. Finally, we created a framework for regulatory compliance and developed a PRS clinical report for return to providers and for inclusion in an additional genome-informed risk assessment. The initial experience from eMERGE can inform the approach needed to implement PRS-based testing in diverse clinical settings.
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Affiliation(s)
| | - Leah C Kottyan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Josh Arias
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gillian Belbin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sonja I Berndt
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - James J Cimino
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - David R Crosslin
- Tulane University, New Orleans, LA, USA
- University of Washington, Seattle, WA, USA
| | | | | | - QiPing Feng
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Tian Ge
- Mass General Brigham, Boston, MA, USA
| | | | | | | | | | - Maegan Harden
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Margaret Harr
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joel N Hirschhorn
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Clive Hoggart
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Hsu
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | | | | | - Amit Khera
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Katie Larkin
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nita Limdi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Ruth J F Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuan Luo
- Northwestern University, Evanston, IL, USA
| | | | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa J Martin
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Li McCarthy
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Tesfaye B Mersha
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Bahram Namjou
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Nihal Pai
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | | | - Cynthia A Prows
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - Heidi L Rehm
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dan M Roden
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Robb Rowley
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | - Hemant Tiwari
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | - Zhe Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wei-Qi Wei
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Eimear E Kenny
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Ochoa Chaar CI, Kim T, Alameddine D, DeWan A, Guzman R, Dardik A, Grossetta Nardini HK, Wallach JD, Kullo I, Murray M. Systematic review and meta-analysis of the genetics of peripheral arterial disease. JVS Vasc Sci 2023; 5:100133. [PMID: 38314202 PMCID: PMC10832467 DOI: 10.1016/j.jvssci.2023.100133] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background Peripheral artery disease (PAD) impacts more than 200 million people worldwide. The understanding of the genetics of the disease and its clinical implications continue to evolve. This systematic review provides a comprehensive summary of all DNA variants that have been studied in association with the diagnosis and progression of PAD, with a meta-analysis of the ones replicated in the literature. Methods A systematic review of all studies examining DNA variants associated with the diagnosis and progression of PAD was performed. Candidate gene and genome-wide association studies (GWAS) were included. A meta-analysis of 13 variants derived from earlier smaller candidate gene studies of the diagnosis of PAD was performed. The literature on the progression of PAD was limited, and a meta-analysis was not feasible because of the heterogeneity in the criteria used to characterize it. Results A total of 231 DNA variants in 112 papers were studied for the association with the diagnosis of PAD. There were significant variations in the definition of PAD and the selection of controls in the various studies. GWAS have established 19 variants associated with the diagnosis of PAD that were replicated in several large patient cohorts. Only variants in intercellular adhesion molecule-1 (rs5498), IL-6 (rs1800795), and hepatic lipase (rs2070895) showed significant association with the diagnosis of PAD. However, these variants were not noted in the published GWAS. Conclusions Genetic research in the diagnosis of PAD has significant heterogeneity, but recent GWAS have demonstrated variants consistently associated with the disease. More research focusing on the progression of PAD is needed to identify patients at risk of adverse events and develop strategies that would improve their outcomes.
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Affiliation(s)
- Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Tanner Kim
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Andrew DeWan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Raul Guzman
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | | | - Joshua D. Wallach
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Michael Murray
- Department of Genetics, Yale University School of Medicine, New Haven, CT
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3
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Lennon NJ, Kottyan LC, Kachulis C, Abul-Husn N, Arias J, Belbin G, Below JE, Berndt S, Chung W, Cimino JJ, Clayton EW, Connolly JJ, Crosslin D, Dikilitas O, Velez Edwards DR, Feng Q, Fisher M, Freimuth R, Ge T, Glessner JT, Gordon A, Guiducci C, Hakonarson H, Harden M, Harr M, Hirschhorn J, Hoggart C, Hsu L, Irvin R, Jarvik GP, Karlson EW, Khan A, Khera A, Kiryluk K, Kullo I, Larkin K, Limdi N, Linder JE, Loos R, Luo Y, Malolepsza E, Manolio T, Martin LJ, McCarthy L, Meigs JB, Mersha TB, Mosley J, Namjou B, Pai N, Pesce LL, Peters U, Peterson J, Prows CA, Puckelwartz MJ, Rehm H, Roden D, Rosenthal EA, Rowley R, Sawicki KT, Schaid D, Schmidlen T, Smit R, Smith J, Smoller JW, Thomas M, Tiwari H, Toledo D, Vaitinadin NS, Veenstra D, Walunas T, Wang Z, Wei WQ, Weng C, Wiesner G, Xianyong Y, Kenny E. Selection, optimization, and validation of ten chronic disease polygenic risk scores for clinical implementation in diverse populations. medRxiv 2023:2023.05.25.23290535. [PMID: 37333246 PMCID: PMC10275001 DOI: 10.1101/2023.05.25.23290535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Polygenic risk scores (PRS) have improved in predictive performance supporting their use in clinical practice. Reduced predictive performance of PRS in diverse populations can exacerbate existing health disparities. The NHGRI-funded eMERGE Network is returning a PRS-based genome-informed risk assessment to 25,000 diverse adults and children. We assessed PRS performance, medical actionability, and potential clinical utility for 23 conditions. Standardized metrics were considered in the selection process with additional consideration given to strength of evidence in African and Hispanic populations. Ten conditions were selected with a range of high-risk thresholds: atrial fibrillation, breast cancer, chronic kidney disease, coronary heart disease, hypercholesterolemia, prostate cancer, asthma, type 1 diabetes, obesity, and type 2 diabetes. We developed a pipeline for clinical PRS implementation, used genetic ancestry to calibrate PRS mean and variance, created a framework for regulatory compliance, and developed a PRS clinical report. eMERGE's experience informs the infrastructure needed to implement PRS-based implementation in diverse clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li Hsu
- Fred Hutchinson Cancer Center and University of Washington
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ulrike Peters
- Fred Hutchinson Cancer Center and University of Washington
| | | | | | | | | | - Dan Roden
- Vanderbilt University Medical Center
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4
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Hui D, Xiao B, Dikilitas O, Freimuth RR, Irvin MR, Jarvik GP, Kottyan L, Kullo I, Limdi NA, Liu C, Luo Y, Namjou B, Puckelwartz MJ, Schaid D, Tiwari H, Wei WQ, Verma S, Kim D, Ritchie MD. Quantifying factors that affect polygenic risk score performance across diverse ancestries and age groups for body mass index. Pac Symp Biocomput 2023; 28:437-448. [PMID: 36540998 PMCID: PMC10018532] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Polygenic risk scores (PRS) have led to enthusiasm for precision medicine. However, it is well documented that PRS do not generalize across groups differing in ancestry or sample characteristics e.g., age. Quantifying performance of PRS across different groups of study participants, using genome-wide association study (GWAS) summary statistics from multiple ancestry groups and sample sizes, and using different linkage disequilibrium (LD) reference panels may clarify which factors are limiting PRS transferability. To evaluate these factors in the PRS generation process, we generated body mass index (BMI) PRS (PRSBMI) in the Electronic Medical Records and Genomics (eMERGE) network (N=75,661). Analyses were conducted in two ancestry groups (European and African) and three age ranges (adult, teenagers, and children). For PRSBMI calculations, we evaluated five LD reference panels and three sets of GWAS summary statistics of varying sample size and ancestry. PRSBMI performance increased for both African and European ancestry individuals using cross-ancestry GWAS summary statistics compared to European-only summary statistics (6.3% and 3.7% relative R2 increase, respectively, pAfrican=0.038, pEuropean=6.26x10-4). The effects of LD reference panels were more pronounced in African ancestry study datasets. PRSBMI performance degraded in children; R2 was less than half of teenagers or adults. The effect of GWAS summary statistics sample size was small when modeled with the other factors. Additionally, the potential of using a PRS generated for one trait to predict risk for comorbid diseases is not well understood especially in the context of cross-ancestry analyses - we explored clinical comorbidities from the electronic health record associated with PRSBMI and identified significant associations with type 2 diabetes and coronary atherosclerosis. In summary, this study quantifies the effects that ancestry, GWAS summary statistic sample size, and LD reference panel have on PRS performance, especially in cross-ancestry and age-specific analyses.
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Affiliation(s)
- Daniel Hui
- Graduate Program in Genomics and Computational Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Xiao
- Graduate Program in Genomics and Computational Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ozan Dikilitas
- Department of Internal Medicine, Department of Cardiovascular Medicine, Clinician-Investigator Training Program, Mayo Clinic, Rochester MN
| | - Robert R. Freimuth
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gail P. Jarvik
- Departments of Medicine and Genome Sciences, University of Washington, Seattle WA, USA
| | - Leah Kottyan
- Center for Autoimmune Genomics and Etiology, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Iftikhar Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Nita A. Limdi
- Department of Neurology & Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cong Liu
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Yuan Luo
- Department of Preventive Medicine (Health and Biomedical Informatics), Northwestern University, Chicago, IL USA
| | - Bahram Namjou
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | | | - Daniel Schaid
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Hemant Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shefali Verma
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dokyoon Kim
- Department of Biostatistics, Epidemiology and Informatics, Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marylyn D. Ritchie
- Department of Genetics, Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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5
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Levin MG, Tsao NL, Singhal P, Liu C, Vy HMT, Paranjpe I, Backman JD, Bellomo TR, Bone WP, Biddinger KJ, Hui Q, Dikilitas O, Satterfield BA, Yang Y, Morley MP, Bradford Y, Burke M, Reza N, Charest B, Judy RL, Puckelwartz MJ, Hakonarson H, Khan A, Kottyan LC, Kullo I, Luo Y, McNally EM, Rasmussen-Torvik LJ, Day SM, Do R, Phillips LS, Ellinor PT, Nadkarni GN, Ritchie MD, Arany Z, Cappola TP, Margulies KB, Aragam KG, Haggerty CM, Joseph J, Sun YV, Voight BF, Damrauer SM. Genome-wide association and multi-trait analyses characterize the common genetic architecture of heart failure. Nat Commun 2022; 13:6914. [PMID: 36376295 PMCID: PMC9663424 DOI: 10.1038/s41467-022-34216-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Heart failure is a leading cause of cardiovascular morbidity and mortality. However, the contribution of common genetic variation to heart failure risk has not been fully elucidated, particularly in comparison to other common cardiometabolic traits. We report a multi-ancestry genome-wide association study meta-analysis of all-cause heart failure including up to 115,150 cases and 1,550,331 controls of diverse genetic ancestry, identifying 47 risk loci. We also perform multivariate genome-wide association studies that integrate heart failure with related cardiac magnetic resonance imaging endophenotypes, identifying 61 risk loci. Gene-prioritization analyses including colocalization and transcriptome-wide association studies identify known and previously unreported candidate cardiomyopathy genes and cellular processes, which we validate in gene-expression profiling of failing and healthy human hearts. Colocalization, gene expression profiling, and Mendelian randomization provide convergent evidence for the roles of BCKDHA and circulating branch-chain amino acids in heart failure and cardiac structure. Finally, proteome-wide Mendelian randomization identifies 9 circulating proteins associated with heart failure or quantitative imaging traits. These analyses highlight similarities and differences among heart failure and associated cardiovascular imaging endophenotypes, implicate common genetic variation in the pathogenesis of heart failure, and identify circulating proteins that may represent cardiomyopathy treatment targets.
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Affiliation(s)
- Michael G Levin
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Noah L Tsao
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Pankhuri Singhal
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ha My T Vy
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ishan Paranjpe
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Tiffany R Bellomo
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William P Bone
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiran J Biddinger
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Qin Hui
- Emory University School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
| | - Ozan Dikilitas
- Departments of Internal Medicine and Cardiovascular Medicine, and Mayo Clinician-Investigator Training Program, Mayo Clinic, Rochester, MN, USA
| | | | - Yifan Yang
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael P Morley
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuki Bradford
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Megan Burke
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Renae L Judy
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Megan J Puckelwartz
- Department of Pharmacology, Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Atlas Khan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Leah C Kottyan
- Department of Pediatrics, Division of Human Genetics and Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth M McNally
- Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharlene M Day
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, BioMe Phenomics Center, and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lawrence S Phillips
- Atlanta VA Health Care System, Decatur, GA, USA
- Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick T Ellinor
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Zoltan Arany
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas P Cappola
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth B Margulies
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Krishna G Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics and Heart Institute, Geisinger, Danville, PA, USA
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan V Sun
- Emory University School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
| | - Benjamin F Voight
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Scott M Damrauer
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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6
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Budoff MJ, Alpert B, Chirinos JA, Fernhall B, Hamburg N, Kario K, Kullo I, Matsushita K, Miyoshi T, Tanaka H, Townsend R, Valensi P. Clinical Applications Measuring Arterial Stiffness: An Expert Consensus for the Application of Cardio-Ankle Vascular Index. Am J Hypertens 2022; 35:441-453. [PMID: 34791038 PMCID: PMC9088840 DOI: 10.1093/ajh/hpab178] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this document is to provide clinicians with guidance, using expert consensus, to help summarize evidence and offer practical recommendations. METHODS Expert Consensus Documents are intended to provide guidance for clinicians in areas in which there are no clinical practice guidelines, especially for new and evolving tests such as arterial stiffness measurements, until any formal guidelines are released. RESULTS This expert consensus document is intended as a source of information for decision-making and to guide clinician-patient discussions in various clinical scenarios. CONCLUSIONS The goal is to help clinicians and patients make a more informed decision together.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA
| | - Bruce Alpert
- Department of Medicine, University of Tennessee Medical Group, Memphis, Tennessee, USA
| | - Julio A Chirinos
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bo Fernhall
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Naomi Hamburg
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kazuomi Kario
- Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Iftikhar Kullo
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kunihiro Matsushita
- Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Toru Miyoshi
- Department of Medicine, Okayama University, Okayama, Japan
| | - Hirofumi Tanaka
- Department of Medicine, The University of Texas at Austin, Austin, Texas, USA
| | - Ray Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, Department of Medicine, Jean Verdier Hospital, AP-HP, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
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7
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Bangash H, Elsekaily O, Gundelach J, Sutton J, Johnsen P, Freimuth R, Caraballo P, Kullo I. Provider Feedback on Implementation of a Genomic Clinical Decision Support for Familial Hypercholesterolemia. J Clin Lipidol 2022. [DOI: 10.1016/j.jacl.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Veturi Y, Lucas A, Bradford Y, Hui D, Dudek S, Theusch E, Verma A, Miller JE, Kullo I, Hakonarson H, Sleiman P, Schaid D, Stein CM, Edwards DRV, Feng Q, Wei WQ, Medina MW, Krauss R, Hoffmann TJ, Risch N, Voight BF, Rader DJ, Ritchie MD. A unified framework identifies new links between plasma lipids and diseases from electronic medical records across large-scale cohorts. Nat Genet 2021; 53:972-981. [PMID: 34140684 PMCID: PMC8555954 DOI: 10.1038/s41588-021-00879-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/05/2021] [Indexed: 02/05/2023]
Abstract
Plasma lipids are known heritable risk factors for cardiovascular disease, but increasing evidence also supports shared genetics with diseases of other organ systems. We devised a comprehensive three-phase framework to identify new lipid-associated genes and study the relationships among lipids, genotypes, gene expression and hundreds of complex human diseases from the Electronic Medical Records and Genomics (347 traits) and the UK Biobank (549 traits). Aside from 67 new lipid-associated genes with strong replication, we found evidence for pleiotropic SNPs/genes between lipids and diseases across the phenome. These include discordant pleiotropy in the HLA region between lipids and multiple sclerosis and putative causal paths between triglycerides and gout, among several others. Our findings give insights into the genetic basis of the relationship between plasma lipids and diseases on a phenome-wide scale and can provide context for future prevention and treatment strategies.
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Affiliation(s)
- Yogasudha Veturi
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anastasia Lucas
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuki Bradford
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Hui
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott Dudek
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Theusch
- Department of Pediatrics, University of California San Francisco, Oakland, CA, USA
| | - Anurag Verma
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason E. Miller
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Iftikhar Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, Children’s Hospital of Philadelphia, PA, USA
| | - Patrick Sleiman
- Center for Applied Genomics, Children’s Hospital of Philadelphia, PA, USA
| | - Daniel Schaid
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Charles M. Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R. Velez Edwards
- Department of Biomedical Informatics in School of Medicine, Vanderbilt University, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.,Division of Quantitative Science, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - QiPing Feng
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics in School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Marisa W. Medina
- Department of Pediatrics, University of California San Francisco, Oakland, CA, USA
| | - Ronald Krauss
- Department of Pediatrics, University of California San Francisco, Oakland, CA, USA
| | - Thomas J. Hoffmann
- Institute for Human Genetics, and Department of Epidemiology & Biostatistics, University of California and San Francisco, San Francisco, CA, USA
| | - Neil Risch
- Institute for Human Genetics, and Department of Epidemiology & Biostatistics, University of California and San Francisco, San Francisco, CA, USA
| | - Benjamin F. Voight
- Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute of Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J. Rader
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marylyn D. Ritchie
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,
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9
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Khan SS, Hoell C, Castillo LM, Connolly JJ, Crosslin DR, Chung WK, Gordon AS, Harr M, Jarvik GP, Kullo I, Larson EB, Leppig KA, Manolio T, Pacheco JA, Ralston JD, Puckelwartz MJ, Smith ME, Wells Q, McNally EM, Rasmussen-Torvik LJ. Practice Patterns After Return of Rare Variants Associated With Cardiomyopathy in the Electronic Medical Records and Genomics Network. Circ Heart Fail 2021; 14:e008155. [PMID: 33951936 DOI: 10.1161/circheartfailure.120.008155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine (S.S.K., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Preventive Medicine (S.S.K., L.J.R.-T.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christin Hoell
- Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lisa M Castillo
- Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John J Connolly
- Center for Applied Genomics, The Children's Hospital of Philadelphia, PA (J.J.C., M.H.)
| | - David R Crosslin
- Department of Biomedical Informatics and Medical Education (D.R.C.), University of Washington Medical Center, Seattle
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University School of Medicine, New York, NY (W.K.C.)
| | - Adam S Gordon
- Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Margaret Harr
- Center for Applied Genomics, The Children's Hospital of Philadelphia, PA (J.J.C., M.H.)
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.), University of Washington Medical Center, Seattle
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine and the Gonda Vascular Center, Mayo Clinic, Rochester, MN (I.K.)
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle (E.B.L., K.A.L., J.D.R.)
| | - Kathleen A Leppig
- Kaiser Permanente Washington Health Research Institute, Seattle (E.B.L., K.A.L., J.D.R.)
| | - Teri Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD (T.M.)
| | - Jennifer A Pacheco
- Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle (E.B.L., K.A.L., J.D.R.)
| | - Megan J Puckelwartz
- Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maureen E Smith
- Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Quinn Wells
- Department of Medicine, Vanderbilt University Medical Center. Nashville, TN (Q.W.)
| | - Elizabeth M McNally
- Division of Cardiology, Department of Medicine (S.S.K., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.,Center for Genetic Medicine (C.H., L.M.C., A.D.G., J.A.P., M.J.P., M.E.S., E.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine (S.S.K., L.J.R.-T.), Feinberg School of Medicine, Northwestern University, Chicago, IL
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10
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Kunji K, El-Menyar A, Ullah E, Kullo I, Saad M, Al Suwaidi J. WHOLE GENOME SEQUENCING OF A MIDDLE EASTERN COHORT REPLICATES KNOWN LOCI FOR CORONARY HEART DISEASE AND IDENTIFIES POTENTIAL NOVEL ONES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01372-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Finn KS, Lynch J, Aufox S, Bland S, Chung W, Halverson C, Hebbring S, Hoell C, Holm I, Jarvik G, Kullo I, Leppig K, Myers M, Prows C, Rasouly HM, Singh R, Weisner G, Williams J, Wynn J, Smith M, Sharp R. Returning negative results from
large‐scale
genomic screening: Experiences from the
eMERGE III
network. Am J Med Genet A 2020; 185:508-516. [DOI: 10.1002/ajmg.a.62002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kelsey Stuttgen Finn
- Biomedical Ethics Research Program Mayo Clinic Rochester Minnesota USA
- Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA
| | - John Lynch
- Department of Communication University of Cincinnati Cincinnati Ohio USA
| | - Sharon Aufox
- Center for Genomic Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois USA
| | - Sarah Bland
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville Tennessee USA
| | - Wendy Chung
- Department of Pediatrics Columbia University New York New York USA
| | - Colin Halverson
- School of Medicine Indiana University‐Purdue University Indianapolis Indiana USA
| | - Scott Hebbring
- Center for Human Genetics Marshfield Clinic Research Institute Marshfield Wisconsin USA
| | - Christin Hoell
- Center for Genomic Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois USA
| | - Ingrid Holm
- Department of Pediatrics Harvard Medical School Boston Massachusetts USA
- Division of Genetics and Genomics Boston Children's Hospital Boston Massachusetts USA
| | - Gail Jarvik
- Division of Medical Genetics School of Medicine, University of Washington Seattle Washington USA
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Kathleen Leppig
- Genetic Services Kaiser Permanente of Washington Seattle Washington USA
- Biomedical and Health Informatics University of Washington Seattle Washington USA
| | - Melanie Myers
- College of Medicine University of Cincinnati Cincinnati Ohio USA
- Department of Pediatrics Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati Ohio USA
| | - Cynthia Prows
- Department of Pediatrics Cincinnati Children's Hospital Medical Center, University of Cincinnati Cincinnati Ohio USA
| | - Hila Milo Rasouly
- Department of Medicine, Division of Nephrology Columbia University Irving Medical Center New York New York USA
| | - Rajbir Singh
- Department of Microbiology and Immunology Meharry Medical College Nashville Tennessee USA
- Department of Obstetrics and Gynecology Meharry Medical College Nashville Tennessee USA
| | - Georgia Weisner
- Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA
- Vanderbilt Clinical and Translational Hereditary Cancer Program Vanderbilt‐Ingram Cancer Center, Vanderbilt University Medical Center Nashville Tennessee USA
| | - Janet Williams
- Geisinger Genomic Medicine Institute Danville Pennsylvania USA
| | - Julia Wynn
- Department of Pediatrics Columbia University New York New York USA
| | - Maureen Smith
- Department of Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois USA
| | - Richard Sharp
- Biomedical Ethics Research Program Mayo Clinic Rochester Minnesota USA
- Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA
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12
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Stuttgen K, Pacyna J, Kullo I, Sharp R. Neutral, Negative, or Negligible? Changes in Patient Perceptions of Disease Risk Following Receipt of a Negative Genomic Screening Result. J Pers Med 2020; 10:E24. [PMID: 32316380 PMCID: PMC7354612 DOI: 10.3390/jpm10020024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 01/12/2023] Open
Abstract
Most individuals who undergo genomic screening will receive negative results or results not sufficient to warrant a clinical response. Even though a majority of individuals receive negative results, little is known about how negative results may impact individuals' perception of disease risk. Changes in risk perception (specifically reductions in perceived risk) may affect both probands and their family members if inaccurate information is communicated to family members. We surveyed patients who received negative results as part of their participation in a genomic screening study and assessed their perceptions of disease risk following receipt of results. Participants had either hyperlipidemia or colon polyps (or both) and received their negative genomic screening results by mail. Of 1712 total individuals recruited, 1442 completed the survey (84.2% completion rate). Approximately one quarter of individuals believed their risk for heart disease to be lower and approximately one third of individuals believed their risk for colon cancer to be lower after receiving and evaluating their negative genomic screening result. 78% of those who believed their risk for one or both diseases had declined had already shared or intended to share their result with family members. Our study suggests patients may interpret a negative genomic screening result as implying a reduction in their overall disease risk.
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Affiliation(s)
- Kelsey Stuttgen
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (K.S.); (J.P.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55901, USA
| | - Joel Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (K.S.); (J.P.)
| | - Iftikhar Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA;
| | - Richard Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55901, USA; (K.S.); (J.P.)
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55901, USA
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13
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Henrikson NB, Wagner JK, Hampel H, DeVore C, Shridhar N, Williams JL, Donohue KE, Kullo I, Prince AER. What guidance does HIPAA offer to providers considering familial risk notification and cascade genetic testing? J Law Biosci 2020; 7:lsaa071. [PMID: 34221429 PMCID: PMC8249115 DOI: 10.1093/jlb/lsaa071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND It is unclear how the Health Insurance Portability and Accountability Act (HIPAA) should be interpreted in the context of sharing of genomic information between family members. METHODS The authors analyzed the HIPAA Privacy Rule, reviewed the literature and constructed a clinical scenario to inform how HIPAA can be interpreted for multiple forms of patient- and provider-mediated genetic risk notification. RESULTS Under HIPAA, healthcare providers can lawfully notify relatives to recommend genetic risk assessment using multiple approaches, including supporting the patient telling their own relatives, contacting relatives directly with the patient's authorization, or contacting a relative's provider directly. CONCLUSIONS Multiple forms of patient- or provider-mediated contact of relatives are already legally permissible under HIPAA, are consistent with ethical obligations of care to patients and their families, and could result in improved population health through identification of clinically actionable disease risk. Unanswered questions remain about implementation and impacts of provider-mediated programs.
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Affiliation(s)
| | | | | | - Christopher DeVore
- Asian Pacific American Institute for Congressional Studies, Washington DC, USA
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14
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Klarin D, Dikilitas O, Wolford B, Levin M, Paranjpe I, Judy R, Lynch J, Assimes TL, Sun Y, Rader D, Wilson PW, Scali S, Berceli S, Kathiresan S, Natarajan P, Nadkarni G, Willer C, Kullo I, Damrauer SM, Tsao P. Polygenic Risk Score Identifies Patients at Increased Risk for Abdominal Aortic Aneurysm and May Benefit from Ultrasound Screening. JVS Vasc Sci 2020. [DOI: 10.1016/j.jvssci.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Taylor CO, Lemke KW, Richards TM, Roe KD, He T, Arruda-Olson A, Carrell D, Denny JC, Hripcsak G, Kiryluk K, Kullo I, Larson EB, Peissig P, Walton NA, Wei-Qi W, Ye Z, Chute CG, Weiner JP. Comorbidity Characterization Among eMERGE Institutions: A Pilot Evaluation with the Johns Hopkins Adjusted Clinical Groups® System. AMIA Jt Summits Transl Sci Proc 2019; 2019:145-152. [PMID: 31258966 PMCID: PMC6568092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Electronic health records (EHR) are valuable to define phenotype selection algorithms used to identify cohorts ofpatients for sequencing or genome wide association studies (GWAS). To date, the electronic medical records and genomics (eMERGE) network institutions have developed and applied such algorithms to identify cohorts with associated DNA samples used to discover new genetic associations. For complex diseases, there are benefits to stratifying cohorts using comorbidities in order to identify their genetic determinants. The objective of this study was to: (a) characterize comorbidities in a range of phenotype-selected cohorts using the Johns Hopkins Adjusted Clinical Groups® (ACG®) System, (b) assess the frequency of important comorbidities in three commonly studied GWAS phenotypes, and (c) compare the comorbidity characterization of cases and controls. Our analysis demonstrates a framework to characterize comorbidities using the ACG system and identified differences in mean chronic condition count among GWAS cases and controls. Thus, we believe there is great potential to use the ACG system to characterize comorbidities among genetic cohorts selected based on EHR phenotypes.
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Affiliation(s)
- Casey Overby Taylor
- Johns Hopkins University School of Medicine
- Johns Hopkins University School of Public Health
| | | | | | | | - Ting He
- Johns Hopkins University School of Medicine
| | | | - David Carrell
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | | | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | | | - Christopher G Chute
- Johns Hopkins University School of Medicine
- Johns Hopkins University School of Public Health
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16
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Zhang X, Veturi Y, Verma S, Bone W, Verma A, Lucas A, Hebbring S, Denny JC, Stanaway IB, Jarvik GP, Crosslin D, Larson EB, Rasmussen-Torvik L, Pendergrass SA, Smoller JW, Hakonarson H, Sleiman P, Weng C, Fasel D, Wei WQ, Kullo I, Schaid D, Chung WK, Ritchie MD. Detecting potential pleiotropy across cardiovascular and neurological diseases using univariate, bivariate, and multivariate methods on 43,870 individuals from the eMERGE network. Pac Symp Biocomput 2019; 24:272-283. [PMID: 30864329 PMCID: PMC6457436] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The link between cardiovascular diseases and neurological disorders has been widely observed in the aging population. Disease prevention and treatment rely on understanding the potential genetic nexus of multiple diseases in these categories. In this study, we were interested in detecting pleiotropy, or the phenomenon in which a genetic variant influences more than one phenotype. Marker-phenotype association approaches can be grouped into univariate, bivariate, and multivariate categories based on the number of phenotypes considered at one time. Here we applied one statistical method per category followed by an eQTL colocalization analysis to identify potential pleiotropic variants that contribute to the link between cardiovascular and neurological diseases. We performed our analyses on ~530,000 common SNPs coupled with 65 electronic health record (EHR)-based phenotypes in 43,870 unrelated European adults from the Electronic Medical Records and Genomics (eMERGE) network. There were 31 variants identified by all three methods that showed significant associations across late onset cardiac- and neurologic- diseases. We further investigated functional implications of gene expression on the detected "lead SNPs" via colocalization analysis, providing a deeper understanding of the discovered associations. In summary, we present the framework and landscape for detecting potential pleiotropy using univariate, bivariate, multivariate, and colocalization methods. Further exploration of these potentially pleiotropic genetic variants will work toward understanding disease causing mechanisms across cardiovascular and neurological diseases and may assist in considering disease prevention as well as drug repositioning in future research.
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Affiliation(s)
- Xinyuan Zhang
- Genomics and Computational Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA*Authors contributed equally to this work
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17
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Kumar S, Hossain J, Javed A, Kullo I, Balagopal PB. Relationship of circulating spexin with markers of cardiovascular disease: a pilot study in adolescents with obesity. Pediatr Obes 2018; 13:374-380. [PMID: 29045048 PMCID: PMC5906205 DOI: 10.1111/ijpo.12249] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/18/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Spexin, a novel peptide, has potential implications in obesity, satiety and energy homeostasis. The current study examined the relationship of spexin with various biomarkers of cardiovascular disease and endothelial function in adolescents with obesity. METHODS Nineteen adolescents with obesity (age, 15.8 ± 1.7 years) were studied. Spexin, leptin and various cardiovascular disease biomarkers were measured. Endothelial function was assessed by high-resolution Doppler ultrasonography of the right brachial artery. RESULTS Spexin concentration (median [interquartile range] 0.38 ng/mL [0.29-0.59 ng/mL]) was inversely correlated (r = -0.50, P = 0.03) with leptin. When participants were clustered into two groups ('high spexin and low leptin' vs. 'low spexin and high leptin'), the odds of having 'low spexin and high leptin' in participants with higher hs-CRP (≥ 3 mg/L) were 12.25 times (95 per cent CI -1 to139, P = 0.026) higher than those of participants with lower hs-CRP (<3 mg/L). Spexin levels, however, were not associated with measures of endothelial function. CONCLUSIONS The inverse association between spexin and leptin and the presence of higher concentrations of hs-CRP in adolescents with obesity in the setting of 'low spexin and high leptin' suggest a potential role for spexin in the regulation of satiety and certain cardiovascular risk factors in children with obesity.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, Wilmington, DE, USA
| | - Asma Javed
- Division of Pediatric and Adolescent Gynecology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - P. Babu Balagopal
- Nemours Children's Specialty Care, Division of Biomedical Research, Jacksonville, FL, USA and Mayo Clinic College of Medicine, Jacksonville, FL,USA
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18
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Davies D, Kullo I. SITOSTEROLEMIA: A RARE CAUSE OF PREMATURE CORONARY HEART DISEASE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32735-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Farwati M, Kumbamu A, Kochan D, Kullo I. A PATIENT DECISION AID FOR FAMILIAL HYPERCHOLESTEROLEMIA BASED ON PATIENT AND PROVIDER FEEDBACK. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33194-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Jose M, Fan X, Kullo I. DIFFERENCES IN PREVALENCE OF PHENOTYPICALLY AND GENOTYPICALLY ASCERTAINED FAMILIAL HYPERCHOLESTEROLEMIA IN A COHORT WITH HYPERCHOLESTEROLEMIA. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32270-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Arruda-Olson AM, Afzal N, Mallipeddi VP, Said A, Pacha HM, Chaudhry A, Scott C, Bailey K, Rooke T, Wennberg P, Kaggal V, Kullo I, Chaudhry R, Liu H. AUTOMATED DATA EXTRACTION FROM ELECTRONIC HEALTH RECORDS TO CREATE NOVEL PROGNOSTIC MODELS FOR PERIPHERAL ARTERY DISEASE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32572-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ye Z, Kullo I. ASSOCIATION OF POTENTIALLY FUNCTIONAL VARIANTS IN GENES IMPLICATED IN MENDELIAN AORTOPATHY WITH ASCENDING AORTIC DILATATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32604-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ye Z, Austin E, Kullo I. Abstract 489: A Data Driven Approach to Identify Subtypes of Abdominal Aortic Aneurysm With Distinct Clinical and Genetic Characteristics. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.489] [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: 11/16/2022]
Abstract
Background:
Abdominal aortic aneurysm (AAA) is a complex and heterogeneous disorder. We hypothesized that dense phenomapping using electronic health records (EHR) can identify subtypes of AAA with distinct clinical and genetic characteristics.
Methods & Results:
AAA cases (n=1108) and controls (n=4694) were identified from the Mayo vascular disease biorepository and had available high-density genotyping data. 132 Candidate genetic variants (p < 10E-5) associated with atherosclerotic cardiovascular disease (ASCVD) or AAA were selected from GWAS catalog. Using model-based Gaussian-mixture cluster analysis of 46 clinical features from 6 data domains, 24 data elements, 204 variables (including age, sex, vital signs, laboratory data, medication use, family history), spanning over 20 years of observational time in the EHR, we identified two subtypes of AAA: subtype 1(S1, n=421) with faster AAA growth rate (baseline size adjusted mean difference, 95% CI: 0.013, 0.001 to 0.020 cm / year faster, p = 0.03), higher all-cause mortality (age & sex adjusted hazard ratio, 95% CI: 1.36, 1.09 - 1.70, p < 0.01) than subtype 2 (S2, n=687). As compared with the controls, thyroid disorder / rheumatoid or osteoarthritis / infectious conditions were uniquely associated with increased odds ratio for S1; ASCVD / hyperlipidemia / hypertension were uniquely associated with increased odds ratio for S2. After adjustment for all group-specific diseases, genetic variants in
CDKN2B-AS1, NOA1-REST, ERG, ZNF335-MMP9
and
SMAD3
were associated with S1 and variants in
MMP12, DAB2IP, LHFPL2, LPA, FSTL5
and
SORT1
were associated with S2 (all FDR p < 0.05). After adjustment for disease comorbidities and genetic variants differently associated with S1 and S2, the increased risk for all-cause death of S1 than S2 and the difference in AAA expansion rate in subgroups attenuated (Both p-values > 0.09)
Conclusions:
We identified two subtypes of AAA with different rates of aneurysm expansion and all-cause mortality, which were associated with subtype-specific disease comorbidities and genetic markers, suggesting the potential of leveraging EHR to facilitate individualized medicine in patients with AAA.
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Affiliation(s)
- Zi Ye
- Mayo Clinic, Rochester, MN
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Mallipeddi VP, Kullo I, Afzal N, Kalra M, Lewis B, Scott C, Liu H, Rooke T, Arruda-Olson A. ASSOCIATION OF ANKLE BRACHIAL INDEX WITH LIMB OUTCOMES IN PERIPHERAL ARTERY DISEASE: A COMMUNITY-BASED STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35472-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Safarova M, Austin E, de Andrade M, Bastarache L, Ye Z, Zheng N, Schaid D, Williams M, Ritchie M, Borthwick K, Larson E, Scrol A, Jarvik G, Manolio T, Hebbring S, Denny J, Kullo I. SCANNING THE PHENOME TO UNCOVER PLEIOTROPIC EFFECTS OF PCSK9. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35950-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hasnie A, Safarova M, Balachandran P, Kullo I. PHYSICIAN PERSPECTIVES ON CLINICAL DECISION SUPPORT FOR FAMILIAL HYPERCHOLESTEROLEMIA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35096-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ye Z, Fan X, Kullo I. RISK FACTORS ASSOCIATED WITH EARLY- VERSUS LATE-ACCELERATED GROWTH PATTERNS IN PATIENTS WITH ABDOMINAL AORTIC ANEURYSM. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35413-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bhat A, Balachandran P, Smith C, Safarova M, Kullo I. FAMILIAL HYPERCHOLESTEROLEMIA: AWARENESS, DETECTION AND CONTROL IN THE COMMUNITY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35071-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Balachandran P, Cheng Y, Mojarad MR, Safarova M, Liu H, Kullo I. MINING ELECTRONIC HEALTH RECORDS FOR FAMILIAL HYPERCHOLESTEROLEMIA IN EMERGE NETWORK. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35882-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pacha HM, Kullo I, Kalra M, Lewis B, Scott C, Arruda-Olson A. RATE AND PREDICTORS FOR LIMB REVASCULARIZATION AND AMPUTATION AFTER DIAGNOSIS OF PERIPHERAL ARTERIAL DISEASE: A COMMUNITY-BASED STUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32313-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Ye Z, Austin E, Schaid D, Kullo I. SEX DIFFERENCES IN ABDOMINAL AORTIC ANEURYSM EXPANSION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32360-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Safarova M, Jouni H, Olson J, Bailey K, Kullo I. THE IMPACT OF FAMILY HISTORY ON STATIN INITIATION IN THE MYOCARDIAL INFARCTION GENES (MI-GENES) CLINICAL TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31995-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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33
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Brown SA, Kullo I. RECLASSIFICATION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK BY A GENETIC RISK SCORE FOR CORONARY HEART DISEASE: THE MI-GENES STUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31969-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arruda-Olson AM, Abram S, Lewis B, Isseh I, Haddad R, Scott C, Kullo I. HOSPITALIZATION AFTER DIAGNOSIS OF PERIPHERAL ARTERIAL DISEASE IN THE COMMUNITY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62065-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Wohlfahrt P, Somers VK, Sochor O, Kullo I, Jean N, Lopez-Jimenez F. Influence of body fatness distribution and total lean mass on aortic stiffness in nonobese individuals. Am J Hypertens 2015; 28:401-8. [PMID: 25189869 DOI: 10.1093/ajh/hpu153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/14/2022] Open
Abstract
BACKGROUND Subjects with normal body mass index but high body fat percentage have higher cardiovascular risk than subjects with normal weight and low fat mass. However, the association of fat distribution and lean mass with carotid-femoral pulse wave velocity (cfPWV) among nonobese apparently healthy individuals has never been assessed. METHODS In 136 nonobese volunteers (mean age = 45±9 years; 57% women) without manifest cardiovascular disease, cfPWV was measured by applanation tonometry. Fat and lean mass were measured by dual-energy x-ray absorptiometry. RESULTS In univariate analysis, total fat (r = 0.17; P < 0.01), trunk fat (r = 0.27; P < 0.01), and trunk/total fat ratio (r = 0.32; P < 0.01) were correlated with cfPWV. After adjustment for age and mean arterial pressure, only central fat distribution (trunk/total fat ratio) was significantly associated with cfPWV. In the fully adjustment model, there was a significant interaction between fat distribution and lean mass. When the study sample was grouped by fat distribution and total lean mass medians, subjects with central fat distribution and low lean mass (group 4) had higher log-transformed cfPWV than the noncentral fat/low lean mass group (group 2) (0.89, 95% confidence interval (CI) = 0.86-0.92 vs. 0.85, 95% CI = 0.83-0.87; P < 0.01) or the noncentral fat/high lean mass group (group 1) (0.89, 95% CI = 0.86-0.92 vs. 0.84, 95% CI = 0.81-0.87; P < 0.01) after adjustments. Aortic stiffness increased from group 1 to group 4 (P for linear trend < 0.001). CONCLUSIONS Among normal weight individuals without manifest cardiovascular disease, the combination of central fat distribution and low lean mass is associated with higher cfPWV. These factors are more closely related to cfPWV than total fat mass.
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Affiliation(s)
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA
| | - Ondrej Sochor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Iftikhar Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA
| | - Nathalie Jean
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA
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Windham BG, Simpson BN, Lirette S, Bridges J, Bielak L, Peyser PA, Kullo I, Turner S, Griswold ME, Mosley TH. Associations between inflammation and cognitive function in African Americans and European Americans. J Am Geriatr Soc 2015; 62:2303-10. [PMID: 25516026 DOI: 10.1111/jgs.13165] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine associations between specific inflammatory biomarkers and cognitive function in African Americans (AAs) and European Americans (EAs) with prevalent vascular risk factors. DESIGN Cross-sectional analysis using generalized estimating equations to account for familial clustering; standardized β-coefficients, adjusted for age, sex, and education are reported. SETTING Community cohort study in Jackson, Mississippi, and Rochester, Minnesota. PARTICIPANTS Genetic Epidemiology Network of Arteriopathy (GENOA)-Genetics of Microangiopathic Brain Injury (GMBI) Study participants. MEASUREMENTS Associations between inflammation (high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, soluble tumor necrosis factor (TNF) receptor 1 and 2 (sTNFR1, sTNFR2)) and cognitive function (global, processing speed, language, memory, and executive function) were examined in AAs and EAs (N = 1,965; aged 26-95, 64% women, 52% AA, 75% with hypertension). RESULTS In AAs, higher sTNFR2 was associated with poorer cognition in all domains (global: -0.11, P = .009; processing speed: -0.11, P < .001; language: -0.08, P = .002; memory: -0.09, P = .008; executive function: -0.07, P = .03); sTNFR1 was associated with slower processing speed (-0.08, P < .001) and poorer executive function (-0.08, P = .008); higher CRP was associated with slower processing speed (-0.04, P = .024), and higher IL6 was associated with poorer executive function (-0.07, P = .02). In EA, only higher sTNFR1 was associated with slower processing speed (-0.05, P = .007). Associations were not found between cognition and sTNFR2, CRP, or IL6 in EA. CONCLUSION In a population with high vascular risk, adverse associations between inflammation and cognitive function were especially apparent in AAs, primarily involving markers of TNFα activity.
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Affiliation(s)
- B Gwen Windham
- Division of Geriatric Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Caraballo PJ, Parkulo M, Blair D, Elliott M, Schultz C, Sutton J, Rao P, Bruflat J, Bleimeyer R, Crooks J, Gabrielson D, Nicholson W, Rohrer Vitek C, Wix K, Bielinski SJ, Pathak J, Kullo I. Clinical Decision Support to Implement CYP2D6 Drug-Gene Interaction. Stud Health Technol Inform 2015; 216:946. [PMID: 26262248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The level of CYP2D6 metabolic activity can be predicted by pharmacogenomic testing, and concomitant use of clinical decision support has the potential to prevent adverse effects from those drugs metabolized by this enzyme. Our initial findings after implementation of clinical decision support alerts integrated in the electronic health records suggest high feasibility, but also identify important challenges.
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Affiliation(s)
| | | | | | | | | | | | - Padma Rao
- Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | - Kelly Wix
- Mayo Clinic, Rochester, Minnesota, USA
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Ye Z, Coutinho T, Pellikka P, Villarraga HR, Borlaug B, Kullo I. MEASURES OF PULSATILE ARTERIAL LOAD ARE ASSOCIATED WITH MYOCARDIAL WALL STRESS DURING SYSTOLE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)62039-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Asad R, Weissgerber TL, Turner S, Bailey K, Mosely T, Kardia S, Wiste H, Kullo I, Garovic V. Novel coronary heart disease markers many years after hypertensive pregnancy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Overby CL, Pathak J, Gottesman O, Haerian K, Perotte A, Murphy S, Bruce K, Johnson S, Talwalkar J, Shen Y, Ellis S, Kullo I, Chute C, Friedman C, Bottinger E, Hripcsak G, Weng C. A collaborative approach to developing an electronic health record phenotyping algorithm for drug-induced liver injury. J Am Med Inform Assoc 2013; 20:e243-52. [PMID: 23837993 DOI: 10.1136/amiajnl-2013-001930] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 01/09/2023] Open
Abstract
OBJECTIVE To describe a collaborative approach for developing an electronic health record (EHR) phenotyping algorithm for drug-induced liver injury (DILI). METHODS We analyzed types and causes of differences in DILI case definitions provided by two institutions-Columbia University and Mayo Clinic; harmonized two EHR phenotyping algorithms; and assessed the performance, measured by sensitivity, specificity, positive predictive value, and negative predictive value, of the resulting algorithm at three institutions except that sensitivity was measured only at Columbia University. RESULTS Although these sites had the same case definition, their phenotyping methods differed by selection of liver injury diagnoses, inclusion of drugs cited in DILI cases, laboratory tests assessed, laboratory thresholds for liver injury, exclusion criteria, and approaches to validating phenotypes. We reached consensus on a DILI phenotyping algorithm and implemented it at three institutions. The algorithm was adapted locally to account for differences in populations and data access. Implementations collectively yielded 117 algorithm-selected cases and 23 confirmed true positive cases. DISCUSSION Phenotyping for rare conditions benefits significantly from pooling data across institutions. Despite the heterogeneity of EHRs and varied algorithm implementations, we demonstrated the portability of this algorithm across three institutions. The performance of this algorithm for identifying DILI was comparable with other computerized approaches to identify adverse drug events. CONCLUSIONS Phenotyping algorithms developed for rare and complex conditions are likely to require adaptive implementation at multiple institutions. Better approaches are also needed to share algorithms. Early agreement on goals, data sources, and validation methods may improve the portability of the algorithms.
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McDavid A, Crane PK, Newton KM, Crosslin DR, McCormick W, Weston N, Ehrlich K, Hart E, Harrison R, Kukull WA, Rottscheit C, Peissig P, Stefanski E, McCarty CA, Zuvich RL, Ritchie MD, Haines JL, Denny JC, Schellenberg GD, de Andrade M, Kullo I, Li R, Mirel D, Crenshaw A, Bowen JD, Li G, Tsuang D, McCurry S, Teri L, Larson EB, Jarvik GP, Carlson CS. Enhancing the power of genetic association studies through the use of silver standard cases derived from electronic medical records. PLoS One 2013; 8:e63481. [PMID: 23762230 PMCID: PMC3677889 DOI: 10.1371/journal.pone.0063481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 04/06/2013] [Indexed: 01/26/2023] Open
Abstract
The feasibility of using imperfectly phenotyped "silver standard" samples identified from electronic medical record diagnoses is considered in genetic association studies when these samples might be combined with an existing set of samples phenotyped with a gold standard technique. An analytic expression is derived for the power of a chi-square test of independence using either research-quality case/control samples alone, or augmented with silver standard data. The subset of the parameter space where inclusion of silver standard samples increases statistical power is identified. A case study of dementia subjects identified from electronic medical records from the Electronic Medical Records and Genomics (eMERGE) network, combined with subjects from two studies specifically targeting dementia, verifies these results.
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Affiliation(s)
- Andrew McDavid
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
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42
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Coutinho T, Kullo I. ARTERIAL STIFFNESS IS ASSOCIATED WITH INCREASE IN BLOOD PRESSURE AND HYPERTENSION SEVERITY OVER TIME IN TREATED HYPERTENSIVES. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61445-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dhoble A, Lahr B, Allison TG, Kullo I, Lopez-Jimenez F, Squires RW, Gau G, Thomas RJ, Kopecky SL. CARDIOPULMONARY FITNESS IS ASSOCIATED WITH LOWER CARDIOVASCULAR MORTALITY IN A COMMUNITY-BASED COHORT. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60568-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vasan RS, Glazer NL, Felix JF, Lieb W, Wild PS, Felix SB, Watzinger N, Larson MG, Smith NL, Dehghan A, Grosshennig A, Schillert A, Teumer A, Schmidt R, Kathiresan S, Lumley T, Aulchenko YS, König IR, Zeller T, Homuth G, Struchalin M, Aragam J, Bis JC, Rivadeneira F, Erdmann J, Schnabel RB, Dörr M, Zweiker R, Lind L, Rodeheffer RJ, Greiser KH, Levy D, Haritunians T, Deckers JW, Stritzke J, Lackner KJ, Völker U, Ingelsson E, Kullo I, Haerting J, O'Donnell CJ, Heckbert SR, Stricker BH, Ziegler A, Reffelmann T, Redfield MM, Werdan K, Mitchell GF, Rice K, Arnett DK, Hofman A, Gottdiener JS, Uitterlinden AG, Meitinger T, Blettner M, Friedrich N, Wang TJ, Psaty BM, van Duijn CM, Wichmann HE, Munzel TF, Kroemer HK, Benjamin EJ, Rotter JI, Witteman JC, Schunkert H, Schmidt H, Völzke H, Blankenberg S. Genetic variants associated with cardiac structure and function: a meta-analysis and replication of genome-wide association data. JAMA 2009; 302:168-78. [PMID: 19584346 PMCID: PMC2975567 DOI: 10.1001/jama.2009.978-a] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Echocardiographic measures of left ventricular (LV) structure and function are heritable phenotypes of cardiovascular disease. OBJECTIVE To identify common genetic variants associated with cardiac structure and function by conducting a meta-analysis of genome-wide association data in 5 population-based cohort studies (stage 1) with replication (stage 2) in 2 other community-based samples. DESIGN, SETTING, AND PARTICIPANTS Within each of 5 community-based cohorts comprising the EchoGen consortium (stage 1; n = 12 612 individuals of European ancestry; 55% women, aged 26-95 years; examinations between 1978-2008), we estimated the association between approximately 2.5 million single-nucleotide polymorphisms (SNPs; imputed to the HapMap CEU panel) and echocardiographic traits. In stage 2, SNPs significantly associated with traits in stage 1 were tested for association in 2 other cohorts (n = 4094 people of European ancestry). Using a prespecified P value threshold of 5 x 10(-7) to indicate genome-wide significance, we performed an inverse variance-weighted fixed-effects meta-analysis of genome-wide association data from each cohort. MAIN OUTCOME MEASURES Echocardiographic traits: LV mass, internal dimensions, wall thickness, systolic dysfunction, aortic root, and left atrial size. RESULTS In stage 1, 16 genetic loci were associated with 5 echocardiographic traits: 1 each with LV internal dimensions and systolic dysfunction, 3 each with LV mass and wall thickness, and 8 with aortic root size. In stage 2, 5 loci replicated (6q22 locus associated with LV diastolic dimensions, explaining <1% of trait variance; 5q23, 12p12, 12q14, and 17p13 associated with aortic root size, explaining 1%-3% of trait variance). CONCLUSIONS We identified 5 genetic loci harboring common variants that were associated with variation in LV diastolic dimensions and aortic root size, but such findings explained a very small proportion of variance. Further studies are required to replicate these findings, identify the causal variants at or near these loci, characterize their functional significance, and determine whether they are related to overt cardiovascular disease.
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Gerszten RE, Accurso F, Bernard GR, Caprioli RM, Klee EW, Klee GG, Kullo I, Laguna TA, Roth FP, Sabatine M, Srinivas P, Wang TJ, Ware LB. Challenges in translating plasma proteomics from bench to bedside: update from the NHLBI Clinical Proteomics Programs. Am J Physiol Lung Cell Mol Physiol 2008; 295:L16-22. [PMID: 18456800 DOI: 10.1152/ajplung.00044.2008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The emerging scientific field of proteomics encompasses the identification, characterization, and quantification of the protein content or proteome of whole cells, tissues, or body fluids. The potential for proteomic technologies to identify and quantify novel proteins in the plasma that can function as biomarkers of the presence or severity of clinical disease states holds great promise for clinical use. However, there are many challenges in translating plasma proteomics from bench to bedside, and relatively few plasma biomarkers have successfully transitioned from proteomic discovery to routine clinical use. Key barriers to this translation include the need for "orthogonal" biomarkers (i.e., uncorrelated with existing markers), the complexity of the proteome in biological samples, the presence of high abundance proteins such as albumin in biological samples that hinder detection of low abundance proteins, false positive associations that occur with analysis of high dimensional datasets, and the limited understanding of the effects of growth, development, and age on the normal plasma proteome. Strategies to overcome these challenges are discussed.
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Affiliation(s)
- Robert E Gerszten
- Cardiology Division and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kullo I, Khaleghi M, Bielak L, Turner S, Peyser P. SIBLING HISTORY OF HYPERTENSION IS ASSOCIATED WITH HIGHER SYSTOLIC AND DIASTOLIC BLOOD PRESSURE AND INCREASED ARTERIAL WAVE REFLECTION. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mozes G, Mohacsi T, Gloviczki P, Menawat S, Kullo I, Spector D, Taylor J, Crotty TB, O'Brien T. Adenovirus-mediated gene transfer of macrophage colony stimulating factor to the arterial wall in vivo. Arterioscler Thromb Vasc Biol 1998; 18:1157-63. [PMID: 9672077 DOI: 10.1161/01.atv.18.7.1157] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Macrophage colony stimulating factor (MCSF) is believed to play a key role in one of the earliest events in atherosclerosis, ie, monocyte to macrophage differentiation in the arterial intima. The aim of this study was to examine the biological effects of vascular wall expression of MCSF. A recombinant adenovirus vector encoding human MCSF (AdMCSF) was generated by standard techniques of homologous recombination in 293 cells. The rabbit carotid artery was transduced with AdMCSF. As negative controls, carotid arteries were transduced with either an adenoviral vector encoding beta-galactosidase, an adenoviral vector encoding apolipoprotein E, or diluent alone. Intima-media thickness ratio was calculated 5 and 21 days after transduction. The cell type present in intimal infiltrates was analyzed by immunohistochemistry. MCSF expression was demonstrated in the vessel wall of AdMCSF-transduced vessels by reverse transcription-polymerase chain reaction and immunofluorescence. In contrast to control vessels, adenovirus-mediated MCSF expression was associated with an intimal cellular infiltrate consisting of smooth muscle cells and small numbers of macrophages. Whereas the intima-media thickness ratio was greater in AdMCSF-transduced vessels at 5 days, this difference was no longer statistically significant at 21 days. These results suggest that MCSF may play a role in recruitment of monocytes and macrophages to the vessel wall and may contribute to smooth muscle cell proliferation and migration.
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Affiliation(s)
- G Mozes
- Division of Vascular Surgery, The Mayo Clinic, Rochester, Minn 55905, USA
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O'Brien T, Mozes G, Kullo I, Cable D, Crotty T, Gloviczki P, Katusic Z. 1.P.119 Nitric oxide synthase gene transfer improves cholesterol-induced vasomotor dysfunction in the rabbit aorta. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88298-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kullo I, Mozes G, Schwartz R, Gloviczki P, Crotty T, Katusic Z, O'Brien T. 146 Adenoviral-mediated gene transfer of endothelial nitric oxide synthase to the rabbit carotid artery alters vascular reactivity. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)87568-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mozes G, Gloviczki P, Kullo I, Crotty T, O'Brien T. 134 Adenoviral-mediated gene transfer of macrophage colony stimulating factor to the vessel wall results in an intimal infiltrate. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)87557-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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