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Spalding WM, Bertoia ML, Bulik CM, Seeger JD. Treatment characteristics among patients with binge-eating disorder: an electronic health records analysis. Postgrad Med 2023; 135:254-264. [PMID: 35037815 DOI: 10.1080/00325481.2021.2018255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Treatment for adults diagnosed with binge-eating disorder (BED) includes psychotherapy and/or pharmacotherapy and aims to reduce the frequency of binge-eating episodes and disordered eating, improve metabolic-related issues and reduce weight, and address mood symptoms. Data describing real-world treatment patterns are lacking; therefore, this study aims to characterize real-world treatment patterns among patients with BED. METHODS This retrospective study identified adult patients with BED using natural language processing of clinical notes from the Optum electronic health record database from 2009 to 2015. Treatment patterns were examined during the 12 months preceding the BED recognition date and during a follow-up period after BED recognition (1-3 years for most patients). RESULTS Among 1042 patients, 384 were categorized as the BED cohort and 658, who met less stringent criteria, were categorized as probable BED. In the BED cohort, mean ± SD age was 45.2 ± 13.4 years and 81.8% were women (probable BED, 45.9 ± 12.8 years, 80.2%). A greater percentage of patients in the BED cohort were prescribed pharmacotherapy (70.6% [probable BED, 66.9%]) than received/discussed psychotherapy (53.1% [probable BED, 39.2%]) at baseline. In the BED cohort, 54.4% of patients were prescribed antidepressants (probable BED, 52.4%), 25.3% stimulants (probable BED, 20.1%), and 34.4% nonspecific psychotherapy (probable BED, 24.6%) at baseline, with no substantive differences observed during follow-up. Low percentages of patients in the BED cohort received/discussed cognitive behavioral therapy at baseline (12.5% [probable BED, 9.0%) or during follow-up (13.0% [probable BED, 8.8%). Among patients with ≥1 psychotherapy visit, the mean ± SD number of visits in the BED cohort was 1.2 ± 5.9 at baseline (probable BED, 1.7 ± 7.3) and 2.2 ± 7.7 during follow-up (probable BED, 2.6 ± 7.7). CONCLUSION This cohort of patients with BED was treated more frequently with pharmacotherapy than psychotherapy. These data may help inform strategies for reducing differences between real-world treatment patterns and evidence-based recommendations.
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Affiliation(s)
| | | | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Kaplan S, Bertoia ML, Lass A, Wang FT, Evans A, Dhanda S, Roy D, Seeger JD. Delayed pregnancy detection and return to fertility with extended levonorgestrel-containing oral contraceptives: A real world setting cohort study. Pharmacoepidemiol Drug Saf 2023; 32:78-83. [PMID: 35713281 DOI: 10.1002/pds.5497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE As part of the European risk management plan of a 91-day extended levonorgestrel-containing combined oral contraceptive (COCLNG ), a study was performed to assess its safety. This analysis was conducted to examine delayed pregnancy detection and return to fertility with extended combined oral contraceptives (COC). METHODS We conducted a retrospective cohort study in new users of 91-day COCLNG or 28-day COCLNG within a US-based healthcare claims database from 2006 to 2017. Delayed pregnancy detection during current COCLNG exposure was defined as the time between estimated pregnancy start and first prenatal care encounter. Additionally, the time between estimated pregnancy start and COCLNG discontinuation was measured. To measure return to fertility, pregnancy rates were estimated among females who discontinued treatment. 91-day COCLNG users were propensity score-matched to 28-day COCLNG users. Hazard ratio for pregnancy was calculated using Cox proportional hazards models. RESULTS The 91-day and 28-day COCLNG users had 25 593 and 76 586 treatment episodes, respectively. The median time to pregnancy detection was 64.5 and 61.0 days (p = 0.24) in users of 91-day COCLNG and 28-day COCLNG . The median exposure time to treatment after estimated pregnancy start was 54.0 and 38.0 days (p < 0.01). In the fertility analysis, pregnancy rates were 54.82 (95% CI, 50.05-59.93) and 69.30 (95% CI, 64.98-73.82) per 1000 person-years in extended COCLNG discontinuers and 28-day COCLNG discontinuers. The adjusted hazard ratio of pregnancy was 0.77 (95% CI, 0.69-0.85). CONCLUSIONS Small differences were observed for pregnancy rates and delayed pregnancy detection between 91-day extended COCLNG and 28-day COCLNG , which may be related to the longer days' supply of extended COCLNG . Differences in the fertility analysis may be related to unmeasured residual confounding.
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Affiliation(s)
- Sigal Kaplan
- Epidemiology, Teva Pharmaceutical Industries Ltd, Netanya, Israel
| | | | | | | | - Alison Evans
- Drug Safety Research Unit, Southampton, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Sandeep Dhanda
- Drug Safety Research Unit, Southampton, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Debabrata Roy
- Drug Safety Research Unit, Southampton, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Bertoia ML, Phiri K, Clifford CR, Doherty M, Zhou L, Wang LT, Bertoia NA, Wang FT, Seeger JD. Identification of pregnancies and infants within a United States commercial healthcare administrative claims database. Pharmacoepidemiol Drug Saf 2022; 31:863-874. [PMID: 35622900 PMCID: PMC9546262 DOI: 10.1002/pds.5483] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Health care insurance claims databases are becoming a more common data source for studies of medication safety during pregnancy. While pregnancies have historically been identified in such databases by pregnancy outcomes, International Classification of Diseases, 10th revision Clinical Modification (ICD-10-CM) Z3A codes denoting weeks of gestation provide more granular information on pregnancies and pregnancy periods (i.e. start and end dates). The purpose of this study was to develop a process that uses Z3A codes to identify pregnancies, pregnancy periods, and links infants within a commercial health insurance claims database. METHODS We identified pregnancies, gestation periods, pregnancy outcomes, and linked infants within the United States (US)-based Optum Research Database (ORD) between 2015 and 2020 via a series of algorithms utilizing diagnosis and procedure codes on claims. The diagnosis and procedure codes included ICD-10-CM codes, Current Procedural Terminology (CPT) codes, and Healthcare Common Procedure Coding System (HCPCS) codes. RESULTS We identified 1,030,874 pregnancies among 841,196 women of reproductive age. Of pregnancies with livebirth outcomes, 84% were successfully linked to infants. The prevalence of pregnancy outcomes (livebirth, stillbirth, ectopic, molar, abortion) was similar to national estimates. CONCLUSIONS This process provides an opportunity to study drug safety and care patterns during pregnancy and may be replicated in other claims databases containing ICD-10-CM, CPT, and HCPCS codes. Work is underway to validate and refine the various algorithms. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | - Li Zhou
- Optum Epidemiology, Boston, MA, USA
| | - Laura T Wang
- Department of Obstetrics and Gynecology, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
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Bulik CM, Bertoia ML, Lu M, Seeger JD, Spalding WM. Suicidality risk among adults with binge-eating disorder. Suicide Life Threat Behav 2021; 51:897-906. [PMID: 34080227 PMCID: PMC8597150 DOI: 10.1111/sltb.12768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate relative suicidality risk associated with binge-eating disorder (BED). METHODS Retrospective study of patients identified as having BED (N = 1042) and a matched general population cohort (N = 10,420) from the Optum electronic health record database between January 2009 and September 2015. Patients had ≥1 outpatient encounter with a provider who recognized BED during the 12-month baseline preceding entry date. Incidence and relative risk of suicidality were assessed. RESULTS Incidence per 1000 person-years (95% CI) of suicidal ideation and suicide attempts, respectively, was 31.1 (23.1, 41.0) and 12.7 (7.9, 19.4) in the BED cohort and 5.8 (4.7, 7.1) and 1.4 (0.9, 2.2) in the comparator cohort. Risk of suicidal ideation and suicide attempts was greater in the BED cohort (HR [95% CIs], 6.43 [4.42, 9.37]) than in the comparator cohort (HR [95% CI], 9.47 [4.99, 17.98]) during follow-up. After adjusting for psychiatric comorbidities, associations of suicidal ideation and suicide attempts with BED remained elevated in patients with BED having histories of suicidality. CONCLUSIONS Findings suggest that history of suicidality may result in an increased risk of suicidal ideation and suicide attempts in patients with BED relative to the general population. Psychiatric comorbidity burden may explain the elevated risk of these conditions in BED.
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Affiliation(s)
- Cynthia M. Bulik
- Department of PsychiatryUniversity of North Carolina School of MedicineChapel HillNCUSA,Department of NutritionGillings School of Global Public HealthUniversity of North CarolinaChapel HillNCUSA,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Mei Lu
- Takeda Pharmaceuticals USALexingtonMAUSA
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Kaplan S, Bertoia ML, Wang FT, Zhou L, Lass A, Evans A, Dhanda S, Roy D, Seeger JD. Long-term safety of extended levonorgestrel-containing oral contraceptives in the United States. Contraception 2021; 105:26-32. [PMID: 34599911 DOI: 10.1016/j.contraception.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To compare the safety profile of Seasonique, a 91-day levonorgestrel-containing combined oral contraceptive (COCLNG), to 28-day COCLNG regarding the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE). STUDY DESIGN A new user cohort study was conducted in a US health care database from 2006 to 2017. Each 91-day COCLNG treatment episode in females was matched to up to four 28-day COCLNG treatment episodes by propensity score. We identified VTE cases in either (1) an inpatient setting with ICD-9 and ICD-10 diagnosis codes of PE and/or DVT in the primary position, or (2) an outpatient setting with ICD-9 or ICD-10 diagnosis codes of DVT in conjunction with an anticoagulant medication dispensing or alteplase (thrombolytic) during the 30-day period following the date of DVT diagnosis. VTE was validated using medical records. We assessed the study endpoints in the two cohorts using incidence rates and Cox proportional hazards models adjusted for potential confounders. RESULTS Of the 25,593 treatment episodes in 91-day COCLNG and 76,586 treatment episodes in 28-day COCLNG, 35 and 68 patients had VTEs, respectively, corresponding to a hazard ratio (HR) of 1.40 (95% confidence interval [CI], 0.90-2.19). The VTE algorithm had a positive predictive value of 76.4% (95% CI, 66.2%-84.8%). ATEs were recorded in 13 and 28 episodes, respectively, with a corresponding HR of 1.21 (95% CI, 0.58-2.53). CONCLUSIONS These results do not indicate a significant difference between 91-day COCLNG and 28-day COCLNG in terms of VTE or ATE risk. IMPLICATIONS Compared to use of 28-day COCLNG, use of 91-day extended COCLNG was not associated with a significant difference in risk of venous and arterial thromboembolism.
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Affiliation(s)
- Sigal Kaplan
- Global Pharmacovigilance, Teva Pharmaceutical Industries Ltd, Netanya, Israel.
| | | | | | - Li Zhou
- Epidemiology, Optum, Boston, MA, USA
| | | | - Alison Evans
- Drug Safety Research Unit, Southampton, UK; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Sandeep Dhanda
- Drug Safety Research Unit, Southampton, UK; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Debabrata Roy
- Drug Safety Research Unit, Southampton, UK; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Würtz AML, Jakobsen MU, Bertoia ML, Hou T, Schmidt EB, Willett WC, Overvad K, Sun Q, Manson JE, Hu FB, Rimm EB. Replacing the consumption of red meat with other major dietary protein sources and risk of type 2 diabetes mellitus: a prospective cohort study. Am J Clin Nutr 2021; 113:612-621. [PMID: 33094800 PMCID: PMC7948828 DOI: 10.1093/ajcn/nqaa284] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Greater consumption of red meat has been associated with a higher risk of type 2 diabetes mellitus (T2DM). A decreased intake of red meat and simultaneous increased intake of other high-protein foods may be associated with a lower risk of T2DM. These analyses of specific food replacements for red meat may provide more accurate dietary advice. OBJECTIVE We examined the association between a decrease in intake of red meat accompanied by an increase in other major dietary protein sources and risk of T2DM. METHODS We prospectively followed 27,634 males in the Health Professionals Follow-up Study, 46,023 females in the Nurses' Health Study, and 75,196 females in the Nurses' Health Study II. Diet was assessed by a validated FFQ and updated every 4 y. Cox proportional hazards models adjusted for T2DM risk factors were used to model the food replacements. We calculated HRs and 95% CIs for the T2DM risk associated with replacements of 1 daily serving of red meat with another protein source. RESULTS During 2,113,245 person-years of follow-up, we identified 8763 incident T2DM cases from 1990 to 2013. In the pooled analyses, a decrease in total red meat intake during a 4-y period replaced with another common protein food was associated with a lower risk of T2DM in the subsequent 4-y period. The HR (95% CI) per 1 serving/d was 0.82 (0.75, 0.90) for poultry, 0.87 (0.77, 0.98) for seafood, 0.82 (0.78, 0.86) for low-fat dairy, 0.82 (0.77, 0.86) for high-fat dairy, 0.90 (0.81, 0.99) for eggs, 0.89 (0.82, 0.98) for legumes, and 0.83 (0.78, 0.89) for nuts. The associations were present for both unprocessed and processed red meat, although stronger for the replacement of processed red meat. CONCLUSIONS Replacing red meat consumption with other protein sources was associated with a lower risk of T2DM.
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Affiliation(s)
- Anne Mette L Würtz
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marianne U Jakobsen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark.,Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Monica L Bertoia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tao Hou
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kim Overvad
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Liang C, Bertoia ML, Ding Y, Clifford CR, Qiao Q, Gagne JJ, Dore DD. Exenatide use and incidence of pancreatic and thyroid cancer: A retrospective cohort study. Diabetes Obes Metab 2019; 21:1037-1042. [PMID: 30474347 DOI: 10.1111/dom.13597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 01/10/2023]
Abstract
A retrospective cohort study, supplemented with a nested case-control study, was performed using two administrative databases from commercial health plans in the United States to compare the incidence of pancreatic and thyroid cancer among users of exenatide versus other antidiabetic drugs (OADs). Patients with type 2 diabetes who initiated exenatide or OADs between 1 June 2005 and 30 June 2015 were included. Pancreatic and thyroid cancers were identified using chart-validated algorithms in the cohort study. Cases in the nested case-control study were chart-confirmed pancreatic or thyroid cancers, and controls were sampled using risk-set sampling. The time-fixed analyses comparing 33 629 exenatide initiators with 49 317 propensity-score-matched OAD initiators yielded hazard ratios of 0.76 (95% confidence interval [CI] 0.47-1.21) for pancreatic cancer and 1.46 (95% CI 0.98-2.19) for thyroid cancer. Results in the time-dependent analyses by cumulative duration or dose were similar. Nested case-control analyses yielded rate ratios of 0.61 (95%CI, 0.37-1.00) for pancreatic cancer and 0.89 (95% CI, 0.64-1.24) for thyroid cancer. This observational study suggested exenatide use was not associated with an increased risk of pancreatic or thyroid cancer.
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Affiliation(s)
| | | | - Yan Ding
- Optum Epidemiology, Boston, Massachusetts
| | | | - Qing Qiao
- Medical Evidence and Observational Research, AstraZeneca, Gothenburg, Sweden
| | - Joshua J Gagne
- Optum Epidemiology, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David D Dore
- Optum Epidemiology, Boston, Massachusetts
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
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Downer MK, Bertoia ML, Mukamal KJ, Rimm EB, Stampfer MJ. Change in Alcohol Intake in Relation to Weight Change in a Cohort of US Men with 24 Years of Follow-Up. Obesity (Silver Spring) 2017; 25:1988-1996. [PMID: 28940996 PMCID: PMC5679228 DOI: 10.1002/oby.21979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to prospectively investigate the potential effects of alcohol by subtype on reported long-term weight change. METHODS This study examined changes in alcohol intake (total, wine, light beer, regular beer, and liquor) and simultaneous changes in reported body weight within 4-year periods from 1986 to 2010 from US men in the Health Professionals Follow-Up Study. The study adjusted for age, changes in lifestyle and dietary covariates, and cardiovascular risk factors. RESULTS The study included observations of 44,603 four-year periods from 14,971 men. Total alcohol, total beer, regular beer, and liquor intakes, modeled as the increase in weight per increase in drinks per day, were each directly associated with moderate weight gain over the 4-year periods, in pounds: total alcohol: 0.23 (0.10 to 0.35); total beer: 0.29 (0.08 to 0.51); regular beer: 0.61 (0.22 to 1.00); and liquor: 0.28 (0.09 to 0.48). Results for wine and light beer were as follows: wine: 0.16 (-0.04 to 0.36) and light beer: -0.38 (-1.07 to 0.08). Results were strongest for men < 55 years old. CONCLUSIONS Increased alcohol consumption was associated with minor reported weight gain at levels unlikely to be clinically meaningful. Beverage-specific differences were not substantial enough to make dietary recommendations for weight loss or maintenance by beverage type. The greatest risk of weight gain was among men who increased consumption to levels well above moderation.
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Affiliation(s)
- Mary Kathryn Downer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Monica L Bertoia
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Ken J Mukamal
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Daraghmeh AH, Bertoia ML, Al-Qadi MO, Abdulbaki AM, Roberts MB, Eaton CB. Evidence for the vitamin D hypothesis: The NHANES III extended mortality follow-up. Atherosclerosis 2016; 255:96-101. [DOI: 10.1016/j.atherosclerosis.2016.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/12/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
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Bao Y, Bertoia ML, Lenart EB, Stampfer MJ, Willett WC, Speizer FE, Chavarro JE. Origin, Methods, and Evolution of the Three Nurses' Health Studies. Am J Public Health 2016; 106:1573-81. [PMID: 27459450 DOI: 10.2105/ajph.2016.303338] [Citation(s) in RCA: 323] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We have summarized the evolution of the Nurses' Health Study (NHS), a prospective cohort study of 121 700 married registered nurses launched in 1976; NHS II, which began in 1989 and enrolled 116 430 nurses; and NHS3, which began in 2010 and has ongoing enrollment. Over 40 years, these studies have generated long-term, multidimensional data, including lifestyle- and health-related information across the life course and an extensive repository of various biological specimens. We have described the questionnaire data collection, disease follow-up methods, biorepository resources, and data management and statistical procedures. Through integrative analyses, these studies have sustained a high level of scientific productivity and substantially influenced public health recommendations. We have highlighted recent interdisciplinary research projects and discussed future directions for collaboration and innovation.
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Affiliation(s)
- Ying Bao
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Monica L Bertoia
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Elizabeth B Lenart
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meir J Stampfer
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Frank E Speizer
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jorge E Chavarro
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
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Bertoia ML, Rimm EB, Mukamal KJ, Hu FB, Willett WC, Cassidy A. Dietary flavonoid intake and weight maintenance: three prospective cohorts of 124,086 US men and women followed for up to 24 years. BMJ 2016; 352:i17. [PMID: 26823518 PMCID: PMC4730111 DOI: 10.1136/bmj.i17] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine whether dietary intake of specific flavonoid subclasses (including flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, and flavonoid polymers) is associated with weight change over time. DESIGN Three prospective cohort studies. SETTING Health professionals in the United States. PARTICIPANTS 124,086 men and women participating in the Health Professionals Follow-up Study (HPFS), Nurses' Health Study (NHS), and Nurses' Health Study II (NHS II). MAIN OUTCOME MEASURE Self reported change in weight over multiple four year time intervals between 1986 and 2011. RESULTS Increased consumption of most flavonoid subclasses, including flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers, was inversely associated with weight change over four year time intervals, after adjustment for simultaneous changes in other lifestyle factors including other aspects of diet, smoking status, and physical activity. In the pooled results, the greatest magnitude of association was observed for anthocyanins (-0.23 (95% confidence interval -0.30 to -0.15) lbs per additional standard deviation/day, 10 mg), flavonoid polymers (-0.18 (-0.28 to -0.08) lbs per additional SD/day, 138 mg), and flavonols (-0.16 (-0.26 to -0.06) lbs per additional SD/day, 7 mg). After additional adjustment for fiber intake, associations remained significant for anthocyanins, proanthocyanidins, and total flavonoid polymers but were attenuated and no longer statistically significant for other subclasses. CONCLUSIONS Higher intake of foods rich in flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers may contribute to weight maintenance in adulthood and may help to refine dietary recommendations for the prevention of obesity and its potential consequences.
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Affiliation(s)
- Monica L Bertoia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
| | - Kenneth J Mukamal
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA Department of Medicine, Beth Israel Deaconess Medical Center, Boston
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
| | - Aedín Cassidy
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
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Bertoia ML, Mukamal KJ, Cahill LE, Hou T, Ludwig DS, Mozaffarian D, Willett WC, Hu FB, Rimm EB. Correction: Changes in Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for Up to 24 Years: Analysis from Three Prospective Cohort Studies. PLoS Med 2016; 13:e1001956. [PMID: 26789645 PMCID: PMC4720400 DOI: 10.1371/journal.pmed.1001956] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Cardiovascular disease (CVD) is the most common cause of death and disability worldwide. Therefore, great importance has been placed on the discovery of novel risk factors and metabolic pathways relevant in the prevention and management of CVD. Such research is ongoing and may continue to lead to better risk stratification of individuals and/or the development of new intervention targets and treatment options. This review highlights emerging biomarkers related to lipid metabolism, glycemia, inflammation, and cardiac damage, some of which show promising associations with CVD risk and provide further understanding of the underlying pathophysiology. However, their measurement methodology and assays will require validation and standardization, and it will take time to accumulate evidence of their role in CVD in various population settings in order to fully assess their clinical utility. Several of the novel biomarkers represent intriguing, potentially game-changing targets for therapy.
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Affiliation(s)
- Leah E Cahill
- Department of Medicine, Dalhousie University, 5790 University Ave, Halifax, NS, B3H 1V7, Canada.
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Monica L Bertoia
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sarah A Aroner
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, Boston, MA, USA.
| | - Majken K Jensen
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
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Bertoia ML, Mukamal KJ, Cahill LE, Hou T, Ludwig DS, Mozaffarian D, Willett WC, Hu FB, Rimm EB. Changes in Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for Up to 24 Years: Analysis from Three Prospective Cohort Studies. PLoS Med 2015; 12:e1001878. [PMID: 26394033 PMCID: PMC4578962 DOI: 10.1371/journal.pmed.1001878] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current dietary guidelines recommend eating a variety of fruits and vegetables. However, based on nutrient composition, some particular fruits and vegetables may be more or less beneficial for maintaining or achieving a healthy weight. We hypothesized that greater consumption of fruits and vegetables with a higher fiber content or lower glycemic load would be more strongly associated with a healthy weight. METHODS AND FINDINGS We examined the association between change in intake of specific fruits and vegetables and change in weight in three large, prospective cohorts of 133,468 United States men and women. From 1986 to 2010, these associations were examined within multiple 4-y time intervals, adjusting for simultaneous changes in other lifestyle factors, including other aspects of diet, smoking status, and physical activity. Results were combined using a random effects meta-analysis. Increased intake of fruits was inversely associated with 4-y weight change: total fruits -0.53 lb per daily serving (95% CI -0.61, -0.44), berries -1.11 lb (95% CI -1.45, -0.78), and apples/pears -1.24 lb (95% CI -1.62, -0.86). Increased intake of several vegetables was also inversely associated with weight change: total vegetables -0.25 lb per daily serving (95% CI -0.35, -0.14), tofu/soy -2.47 lb (95% CI, -3.09 to -1.85 lb) and cauliflower -1.37 lb (95% CI -2.27, -0.47). On the other hand, increased intake of starchy vegetables, including corn, peas, and potatoes, was associated with weight gain. Vegetables having both higher fiber and lower glycemic load were more strongly inversely associated with weight change compared with lower-fiber, higher-glycemic-load vegetables (p < 0.0001). Despite the measurement of key confounders in our analyses, the potential for residual confounding cannot be ruled out, and although our food frequency questionnaire specified portion size, the assessment of diet using any method will have measurement error. CONCLUSIONS Increased consumption of fruits and non-starchy vegetables is inversely associated with weight change, with important differences by type suggesting that other characteristics of these foods influence the magnitude of their association with weight change.
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Affiliation(s)
- Monica L. Bertoia
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kenneth J. Mukamal
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Leah E. Cahill
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tao Hou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - David S. Ludwig
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Dariush Mozaffarian
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Walter C. Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank B. Hu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Eric B. Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Bertoia ML, Bertrand KA, Sawyer SJ, Rimm EB, Mukamal KJ. Reproducibility of Circulating MicroRNAs in Stored Plasma Samples. PLoS One 2015; 10:e0136665. [PMID: 26313271 PMCID: PMC4552013 DOI: 10.1371/journal.pone.0136665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 04/06/2015] [Accepted: 08/06/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most studies of microRNA (miRNA) and disease have examined tissue-specific expression in limited numbers of samples. The presence of circulating miRNAs in plasma samples provides the opportunity to examine prospective associations between miRNA expression and disease in initially healthy individuals. However, little data exist on the reproducibility of miRNAs in stored plasma. METHODS We used Real-Time PCR to measure 61 pre-selected microRNA candidates in stored plasma. Coefficients of variation (CVs) were used to assess inter-assay reliability (n = 15) and within-person stability over one year (n = 80). Intraclass correlation coefficients (ICCs) and polychoric correlation coefficients were used to assess within-person stability and delayed processing reproducibility (whole blood stored at 4°C for 0, 24 and 48 hours; n = 12 samples). RESULTS Of 61 selected miRNAs, 23 were detected in at least 50% of samples and had average CVs below 20% for inter-assay reproducibility and 31 for delayed processing reproducibility. Ten miRNAs were detected in at least 50% of samples, had average CVs below 20% and had ICCs above 0.4 for within-person stability over 1-2 years, six of which satisfied criteria for both interassay reproducibility and short-term within-person stability (miR-17-5p, -191-5p, -26a-5p, -27b-3p, -320a, and -375) and two all three types of reproducibility (miR-27b-3p and -26a-5p). However, many miRNAs with acceptable average CVs had high maximum CVs, most had low expression levels, and several had low ICCs with delayed processing. CONCLUSIONS About a tenth of miRNAs plausibly related to chronic disease were reliably detected in stored samples of healthy adults.
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Affiliation(s)
- Monica L. Bertoia
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kimberly A. Bertrand
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sherilyn J. Sawyer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eric B. Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Kenneth J. Mukamal
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Cassano PA, Guertin KA, Kristal AR, Ritchie KE, Bertoia ML, Arnold KB, Crowley JJ, Hartline J, Goodman PJ, Tangen CM, Minasian LM, Lippman SM, Klein E. A randomized controlled trial of vitamin E and selenium on rate of decline in lung function. Respir Res 2015; 16:35. [PMID: 25889509 PMCID: PMC4404242 DOI: 10.1186/s12931-015-0195-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/22/2015] [Indexed: 12/28/2022] Open
Abstract
Background The intake of nutrients with antioxidant properties is hypothesized to augment antioxidant defenses, decrease oxidant damage to tissues, and attenuate age-related rate of decline in lung function. The objective was to determine whether long-term intervention with selenium and/or vitamin E supplements attenuates the annual rate of decline in lung function, particularly in cigarette smokers. Methods The Respiratory Ancillary Study (RAS) tested the single and joint effects of selenium (200 μg/d L-selenomethionine) and vitamin E (400 IU/day all rac-α-tocopheryl acetate) in a randomized double-blind placebo-controlled trial. At the end of the intervention, 1,641 men had repeated pulmonary function tests separated by an average of 3 years. Linear mixed-effects regression models estimated the effect of intervention on annual rate of decline in lung function. Results Compared to placebo, intervention had no main effect on either forced expiratory volume in the first second (FEV1) or forced expiratory flow (FEF25–75). There was no evidence for a smoking by treatment interaction for FEV1, but selenium attenuated rate of decline in FEF25–75 in current smokers (P = 0.0219). For current smokers randomized to selenium, annual rate of decline in FEF25–75 was similar to the annual decline experienced by never smokers randomized to placebo, with consistent effects for selenium alone and combined with vitamin E. Conclusions Among all men, there was no effect of selenium and/or vitamin E supplementation on rate of lung function decline. However, current smokers randomized to selenium had an attenuated rate of decline in FEF25–75, a marker of airflow. Trial registration Clinicaltrials.gov identifier: NCT00241865. Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0195-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia A Cassano
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY, 14853, USA. .,Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
| | - Kristin A Guertin
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY, 14853, USA. .,Current address: Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, MD, USA.
| | - Alan R Kristal
- Department of Epidemiology, University of Washington, Seattle, WA, USA. .,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Kathryn E Ritchie
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY, 14853, USA. .,Current address: Loyola Department of Oral and Maxillofacial Surgery, Loyola University, Chicago, IL, USA.
| | - Monica L Bertoia
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY, 14853, USA. .,Current address: Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | | | | | | | | | | | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
| | - Scott M Lippman
- University of California San Diego, Moores Cancer Center, La Jolla, CA, USA.
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Abstract
Coronary heart disease (CHD) accounts for one in every six deaths in US individuals. Great advances have been made in identifying important risk factors for CHD, such as hypertension, diabetes mellitus, smoking and hypercholesterolaemia, which have led to major developments in therapy. In particular, statins represent one of the greatest successes in the prevention of CHD. While these standard risk factors are important, an obvious opportunity exists to take advantage of ongoing scientific research to better risk-stratify individuals and to identify new treatment targets. In this Review, we summarize ongoing scientific research in a number of metabolic molecules or features, including lipoproteins, homocysteine, calcium metabolism and glycaemic markers. We evaluate the current state of the research and the strength of evidence supporting each emerging biomarker. We also discuss whether the associations with CHD are strong and consistent enough to improve current risk stratification metrics, and whether these markers enhance our understanding of the underlying biology of CHD and thus point towards new treatment options.
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Affiliation(s)
- Majken K Jensen
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA, USA
| | - Monica L Bertoia
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA, USA
| | - Leah E Cahill
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA, USA
| | - Isha Agarwal
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA, USA
| | - Eric B Rimm
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, 02115 Boston, MA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Centre, 1309 Beacon Street, 02446 Brookline, MA, USA
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Joosten MM, Pai JK, Bertoia ML, Gansevoort RT, Bakker SJL, Cooke JP, Rimm EB, Mukamal KJ. β2-microglobulin, cystatin C, and creatinine and risk of symptomatic peripheral artery disease. J Am Heart Assoc 2014; 3:jah3523. [PMID: 24980133 PMCID: PMC4310365 DOI: 10.1161/jaha.114.000803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background β2‐Microglobulin and cystatin C may have advantages over creatinine in assessing risk associated with kidney function. We therefore investigated whether emerging filtration markers, β2‐microglobulin and cystatin C, are prospectively associated with risk of the development of peripheral artery disease (PAD). Methods and Results We conducted nested case‐control studies among women within the Nurses’ Health Study (1990–2010) and among men within the Health Professionals Follow‐up Study (1994–2008) with the use of archived blood samples collected before PAD diagnosis. During follow‐up, symptomatic PAD was confirmed in 144 women and 143 men. Controls were matched 3:1 based on age, race, smoking status, fasting status, and date of blood sampling. Conditional logistic regression models were used to estimate relative risks (RRs) and were adjusted for plasma creatinine and cardiovascular risk factors. In women, the RRs (95% CI) per 1‐SD) increment were 1.16 (0.85 to 1.58) for β2‐microglobulin and 0.94 (0.69 to 1.28) for cystatin C. Corresponding RRs in men were 1.50 (1.08 to 2.09) for β2‐microglobulin and 1.54 (1.07 to 2.22) for cystatin C. There was no association between creatinine and PAD risk in women, whereas the association in men (RR 1.41, 95% CI 1.10 to 1.81) disappeared after adjustment for either β2‐microglobulin or cystatin C. In pooled analyses of men and women, only β2‐microglobulin was associated with PAD risk (RR 1.31, 95% CI 1.04 to 1.64). Conclusions In pooled analyses, β2‐microglobulin was associated with an increased risk of symptomatic PAD; a similar association with cystatin C was observed only in men. The findings suggest that β2‐microglobulin may capture the atherosclerosis‐promoting or atherosclerosis‐related elements of kidney dysfunction better than creatinine.
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Affiliation(s)
- Michel M Joosten
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.M.J., M.L.B., K.J.M.) Department of Nutrition, Harvard School of Public Health, Boston, MA (M.M.J., M.L.B., E.B.R.) Top Institute Food and Nutrition, Wageningen, The Netherlands (M.M.J., S.L.B.) University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands (M.M.J., R.T.G., S.L.B.)
| | - Jennifer K Pai
- Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.K.P., E.B.R.) Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (J.K.P., J.P.C., E.B.R.)
| | - Monica L Bertoia
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.M.J., M.L.B., K.J.M.) Department of Nutrition, Harvard School of Public Health, Boston, MA (M.M.J., M.L.B., E.B.R.)
| | - Ron T Gansevoort
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands (M.M.J., R.T.G., S.L.B.)
| | - Stephan J L Bakker
- Top Institute Food and Nutrition, Wageningen, The Netherlands (M.M.J., S.L.B.) University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands (M.M.J., R.T.G., S.L.B.)
| | - John P Cooke
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (J.K.P., J.P.C., E.B.R.) Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, TX (J.P.C.)
| | - Eric B Rimm
- Department of Nutrition, Harvard School of Public Health, Boston, MA (M.M.J., M.L.B., E.B.R.) Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.K.P., E.B.R.) Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (J.K.P., J.P.C., E.B.R.)
| | - Kenneth J Mukamal
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.M.J., M.L.B., K.J.M.)
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Bertoia ML, Pai JK, Cooke JP, Joosten MM, Mittleman MA, Rimm EB, Mukamal KJ. Plasma homocysteine, dietary B vitamins, betaine, and choline and risk of peripheral artery disease. Atherosclerosis 2014; 235:94-101. [PMID: 24819748 DOI: 10.1016/j.atherosclerosis.2014.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Few studies have examined the roles of homocysteine and related nutrients in the development of peripheral artery disease (PAD). We examined the associations between plasma homocysteine, dietary B vitamins, betaine, choline, and supplemental folic acid use and incidence of PAD. METHODS We used two cohort studies of 72,348 women in the Nurses' Health Study (NHS, 1990-2010) and 44,504 men in the Health Professionals Follow-up Study (HPFS, 1986-2010). We measured plasma homocysteine in nested matched case-control studies of clinically recognized PAD within both cohorts, including 143 PAD cases and 424 controls within the NHS (1990-2010) and 143 PAD cases and 428 controls within the HPFS (1994-2008). We examined the association between diet and risk of incident PAD in the cohorts using a food frequency questionnaire and 790 cases of PAD over 3.1 million person-years of follow-up. RESULTS Higher homocysteine levels were positively associated with risk of PAD in men (adjusted IRR 2.17; 95% CI, 1.08-4.38 for tertile 3 vs. 1). There was no evidence of an association in women (adjusted IRR 1.14; 95% CI, 0.61-2.12). Similarly, higher folate intake, including supplements, was inversely associated with risk of PAD in men (adjusted HR 0.90; 95% CI, 0.82-0.98 for each 250 μg increase) but not women (HR 1.01, 95% CI, 0.88-1.15). Intakes of the other B vitamins, betaine, and choline were not consistently associated with risk of PAD in men or women. CONCLUSION Homocysteine levels were positively associated and dietary folate intake was inversely associated with risk of PAD in men but not in women.
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Affiliation(s)
- Monica L Bertoia
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Jennifer K Pai
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John P Cooke
- Houston Methodist Research Institute, Houston, TX, USA
| | - Michel M Joosten
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Top Institute Food and Nutrition, Wageningen, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Murray A Mittleman
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
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Bertoia ML, Triche EW, Michaud DS, Baylin A, Hogan JW, Neuhouser ML, Tinker LF, Van Horn L, Waring ME, Li W, Shikany JM, Eaton CB. Mediterranean and Dietary Approaches to Stop Hypertension dietary patterns and risk of sudden cardiac death in postmenopausal women. Am J Clin Nutr 2014; 99:344-51. [PMID: 24351877 PMCID: PMC3893726 DOI: 10.3945/ajcn.112.056135] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 11/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets are characterized by higher intake of fruit, vegetables, whole grains, and unsaturated fatty acids. All of these foods and nutrients may affect cholesterol, inflammation, the development of atherosclerosis, and, therefore, risk of cardiac death. OBJECTIVE Our objective was to examine the association between the Mediterranean and DASH dietary patterns and risk of sudden cardiac death (SCD) in women. DESIGN We used a prospective cohort of 93,122 postmenopausal women enrolled in the Women's Health Initiative study between 1993 and 1998 and followed for an average of 10.5 y. Women completed a food-frequency questionnaire (FFQ) twice during follow-up. We scored their diets according to how closely the reported diet resembled each dietary pattern. SCD was defined as death that occurred within 1 h of symptom onset. RESULTS A higher Mediterranean diet score was associated with lower risk of SCD (HR: 0.64; 95% CI: 0.43, 0.94) when women in the highest quintile were compared with women in the lowest quintile after adjustment for age, total energy, race, income, smoking, and physical activity. After adjustment for potential mediators, the association was similar (HR: 0.67; 95% CI: 0.46, 0.99). A higher DASH diet score was not associated with risk of SCD. However, sodium intake, which is a crucial component of the DASH dietary pattern, was not well characterized by the FFQ. CONCLUSION The Mediterranean dietary pattern may be associated with lower risk of SCD in women. This trial was registered at clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Monica L Bertoia
- Department of Epidemiology (MLB, EWT, DSM, and CBE) and Biostatistics (JWH), School of Public Health, Brown University, Providence, RI; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI (AB); Fred Hutchinson Cancer Research Center, Seattle, WA (MLN and LFT); Department of Preventive Medicine, Northwestern University, Chicago, IL (LVH); Departments of Quantitative Health Sciences (MEW) and Medicine (WL), University of Massachusetts Medical School, Worcester, MA; Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL (JMS); and the Memorial Hospital of RI Center for Primary Care and Prevention, Pawtucket, RI (CBE)
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Bertoia ML, Triche EW, Michaud DS, Baylin A, Hogan JW, Neuhouser ML, Freiberg MS, Allison MA, Safford MM, Li W, Mossavar-Rahmani Y, Rosal MC, Eaton CB. Long-term alcohol and caffeine intake and risk of sudden cardiac death in women. Am J Clin Nutr 2013; 97:1356-63. [PMID: 23615825 PMCID: PMC3652927 DOI: 10.3945/ajcn.112.044248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Alcohol and caffeine intakes may play a role in the development of sudden cardiac death (SCD) because of their effects on cholesterol, blood pressure, heart rate variability, and inflammation. OBJECTIVE Our objective was to examine the association between long-term alcohol and caffeine intakes and risk of SCD in women. DESIGN We examined 93,676 postmenopausal women who participated in the Women's Health Initiative Observational Study. Women were enrolled between 1993 and 1998 and were followed until August 2009. Women completed a food-frequency questionnaire at baseline and again at year 3. We modeled exposure to alcohol 3 ways: by using baseline intake only, a cumulative average of baseline and year 3 intake, and the most recent reported intake (a simple time-varying analysis). RESULTS Intake of 5-15 g alcohol/d (about one drink) was associated with a nonsignificantly reduced risk of SCD compared with 0.1-5 g/d of baseline intake (HR: 0.64; 95% CI: 0.40, 1.02), of cumulative average intake (HR: 0.69; 95% CI: 0.43, 1.11), and of most recent intake (HR: 0.58; 95% CI: 0.35, 0.96), with adjustment for age, race, income, smoking, body mass index, physical activity, hormone use, and total energy. No association was found between SCD and total caffeine intake (mg/d) or cups of caffeinated coffee, decaffeinated coffee, and caffeinated tea. CONCLUSIONS Our results suggest that about one drink per day (or 5.1-15 g/d) may be associated with a reduced risk of SCD in this population; however, this association was only statistically significant for a model using the most recent alcohol intake. Total caffeine, regular coffee, decaffeinated coffee, and regular tea intake were not associated with the risk of SCD. This trial was registered at clinicaltrials.gov as NCT00000611.
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Bertoia ML, Pai JK, Lee JH, Taleb A, Joosten MM, Mittleman MA, Yang X, Witztum JL, Rimm EB, Tsimikas S, Mukamal KJ. Oxidation-specific biomarkers and risk of peripheral artery disease. J Am Coll Cardiol 2013; 61:2169-79. [PMID: 23541965 DOI: 10.1016/j.jacc.2013.02.047] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/28/2013] [Accepted: 02/02/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The goal of this study was to examine the prospective association between oxidation-specific biomarkers, primarily oxidized phospholipids (OxPL) on apolipoprotein B-100-containing lipoproteins (OxPL/apoB) and lipoprotein (a) [Lp(a)], and risk of peripheral artery disease (PAD). We examined, as secondary analyses, indirect measures of oxidized lipoproteins, including autoantibodies to malondialdehyde-modified low-density lipoprotein (MDA-LDL) and apolipoprotein B-100 immune complexes (ApoB-IC). BACKGROUND Biomarkers to predict the development of PAD are lacking. OxPL circulate in plasma, are transported by Lp(a), and deposit in the vascular wall and induce local inflammation. METHODS The study population included 2 parallel nested case-control studies of 143 men within the Health Professionals Follow-up Study (1994 to 2008) and 144 women within the Nurses' Health Study (1990 to 2010) with incident confirmed cases of clinically significant PAD, matched 1:3 to control subjects. RESULTS Levels of OxPL/apoB were positively associated with risk of PAD in men and women: pooled relative risk: 1.37, 95% confidence interval: 1.19 to 1.58 for each 1-SD increase after adjusting age, smoking, fasting status, month of blood draw, lipids, body mass index, and other cardiovascular disease risk factors. Lp(a) was similarly associated with risk of PAD (pooled adjusted relative risk: 1.36; 95% confidence interval: 1.18 to 1.57 for each 1-SD increase). Autoantibodies to MDA-LDL and ApoB-IC were not consistently associated with risk of PAD. CONCLUSIONS OxPL/apoB were positively associated with risk of PAD in men and women. The major lipoprotein carrier of OxPL, Lp(a), was also associated with risk of PAD, reinforcing the key role of OxPL in the pathophysiology of atherosclerosis mediated by Lp(a).
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Affiliation(s)
- Monica L Bertoia
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Joosten MM, Joshipura KJ, Pai JK, Bertoia ML, Rimm EB, Mittleman MA, Mukamal KJ. Total adiponectin and risk of symptomatic lower extremity peripheral artery disease in men. Arterioscler Thromb Vasc Biol 2013; 33:1092-7. [PMID: 23448969 DOI: 10.1161/atvbaha.112.301089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Lower concentrations of adiponectin have been linked to subsequent risk of coronary heart disease in healthy individuals. Whether similar relationships exist for the development of systemic atherosclerosis, such as peripheral artery disease (PAD), is uncertain. We investigated the association between total adiponectin and risk of lower extremity PAD. APPROACH AND RESULTS We performed a prospective, nested case-control study among 18,225 male participants of the Health Professionals Follow-up Study who were free of diagnosed cardiovascular disease at the time of blood draw (1993-1995). During 14 years of follow-up, 143 men developed PAD. Using risk set sampling, controls were selected in a 3:1 ratio and matched on age, smoking status, fasting status, and date of blood draw (n=429). Median (interquartile range) adiponectin concentrations at baseline were lower among cases compared with controls (4.1 [3.2-5.5] versus 5.4 [3.8-7.5] µg/mL; P<0.001). A log-linear inverse association was evident over the full spectrum of adiponectin concentrations with PAD risk after controlling for baseline cardiovascular risk factors using restricted spline conditional logistic regression. Adiponectin was associated with a 42% lower risk of PAD per SD increase in natural log-transformed adiponectin (relative risk, 0.58; 95% confidence interval, 0.45-0.74) after adjustment for cardiovascular risk factors. The relative risk was attenuated (relative risk, 0.68; 95% confidence interval, 0.51-0.92) after further accounting for high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, and cystatin C. Additional adjustment for hemoglobin A(1c), triglycerides, and γ-glutamyltransferase had little impact on this association (relative risk, 0.68; 95% confidence interval, 0.50-0.92). CONCLUSIONS Total adiponectin is inversely associated with risk of symptomatic lower extremity PAD in men.
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Affiliation(s)
- Michel M Joosten
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Bertoia ML, Allison MA, Manson JE, Freiberg MS, Kuller LH, Solomon AJ, Limacher MC, Johnson KC, Curb JD, Wassertheil-Smoller S, Eaton CB. Risk factors for sudden cardiac death in post-menopausal women. J Am Coll Cardiol 2012. [PMID: 23177296 DOI: 10.1016/j.jacc.2012.09.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the annual incidence rate of sudden cardiac death (SCD) and to identify risk factors for SCD in post-menopausal women. BACKGROUND With the aging U.S. population, post-menopausal women now have the greatest population burden of cardiovascular disease including SCD. METHODS We examined 161,808 women who participated in the Women's Health Initiative clinical trials and observational study. The women were recruited at 40 clinical sites across the United States, enrolled between 1993 and 1998, and followed until August 2009. Our primary endpoint is incident SCD, defined as death occurring within 1 h of symptom onset or within 1 h after the participant was last seen without symptoms and death that occurred in the absence of a potentially lethal non-coronary disease process. RESULTS Four hundred eighteen women experienced adjudicated SCD. The incidence rate of SCD was 2.4/10,000 women/year (95% confidence interval: 2.2 to 2.7). We identified the following independent risk factors for SCD: older age, African-American race, tobacco use, higher pulse, higher waist-to-hip ratio, elevated white blood cell count, history of heart failure, diabetes, history of myocardial infarction, previous carotid artery disease, and hypertension. Population-attributable fractions were greatest for hypertension, waist-to-hip ratio, and myocardial infarction. CONCLUSIONS Besides traditional risk factors for coronary heart disease, risk factors for sudden cardiac death in post-menopausal women include African-American race, higher pulse, higher waist-to-hip ratio, elevated white blood cell count, and heart failure. Nearly one-half of women who experienced sudden cardiac death had no previous diagnosis of coronary heart disease.
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Affiliation(s)
- Monica L Bertoia
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA.
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Joosten MM, Pai JK, Bertoia ML, Rimm EB, Spiegelman D, Mittleman MA, Mukamal KJ. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA 2012; 308:1660-7. [PMID: 23093164 PMCID: PMC3733106 DOI: 10.1001/jama.2012.13415] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Previous studies have examined the associations of individual clinical risk factors with risk of peripheral artery disease (PAD), but the combined effects of these risk factors are largely unknown. OBJECTIVE To estimate the degree to which the 4 conventional cardiovascular risk factors of smoking, hypertension, hypercholesterolemia, and type 2 diabetes are associated with the risk of PAD among men. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 44,985 men in the United States without a history of cardiovascular disease at baseline in 1986; participants in the Health Professionals Follow-up Study were followed up for 25 years until January 2011. The presence of risk factors was updated biennially during follow-up. MAIN OUTCOME MEASURE Clinically significant PAD defined as limb amputation or revascularization, angiogram reporting vascular obstruction of 50% or greater, ankle-brachial index of less than 0.90, or physician-diagnosed PAD. RESULTS During a median follow-up of 24.2 years (interquartile range, 20.8-24.7 years), there were 537 cases of incident PAD. Each risk factor was significantly and independently associated with a higher risk of PAD after adjustment for the other 3 risk factors and confounders. The age-adjusted incidence rates were 9 (95% CI, 6-14) cases/100,000 person-years (n = 19 incident cases) for 0 risk factors, 23 (95% CI, 18-28) cases/100,000 person-years (n = 99 incident cases) for 1 risk factor, 47 (95% CI, 39-56) cases/100,000 person-years (n = 176 incident cases) for 2 risk factors, 92 (95% CI, 76-111) cases/100,000 person-years (n = 180 incident cases) for 3 risk factors, and 186 (95% CI, 141-246) cases/100,000 person-years (n = 63 incident cases) for 4 risk factors. The multivariable-adjusted hazard ratio for each additional risk factor was 2.06 (95% CI, 1.88-2.26). Men without any of the 4 risk factors had a hazard ratio of PAD of 0.23 (95% CI, 0.14-0.36) compared with all other men in the cohort. In 96% of PAD cases (95% CI, 94%-98%), at least 1 of the 4 risk factors was present at the time of PAD diagnosis. The population-attributable risk associated with these 4 risk factors was 75% (95% CI, 64%-87%). The absolute incidence of PAD among men with all 4 risk factors was 3.5/1000 person-years. CONCLUSION Among men in this cohort, smoking, hypertension, hypercholesterolemia, and type 2 diabetes account for the majority of risk associated with development of clinically significant PAD.
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Affiliation(s)
- Michel M Joosten
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Affiliation(s)
- Monica L. Bertoia
- From the Departments of Epidemiology (M.L.B., C.B.E.) and Family Medicine (P.S.G., C.B.E.), Warren Alpert Medical School of Brown University, Providence, RI; Center for Primary Care and Prevention (M.L.B., M.B.R., C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Quantitative Health Sciences (M.E.W.), University of Massachusetts Medical School, Worcester, MA
| | - Molly E. Waring
- From the Departments of Epidemiology (M.L.B., C.B.E.) and Family Medicine (P.S.G., C.B.E.), Warren Alpert Medical School of Brown University, Providence, RI; Center for Primary Care and Prevention (M.L.B., M.B.R., C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Quantitative Health Sciences (M.E.W.), University of Massachusetts Medical School, Worcester, MA
| | - Priya S. Gupta
- From the Departments of Epidemiology (M.L.B., C.B.E.) and Family Medicine (P.S.G., C.B.E.), Warren Alpert Medical School of Brown University, Providence, RI; Center for Primary Care and Prevention (M.L.B., M.B.R., C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Quantitative Health Sciences (M.E.W.), University of Massachusetts Medical School, Worcester, MA
| | - Mary B. Roberts
- From the Departments of Epidemiology (M.L.B., C.B.E.) and Family Medicine (P.S.G., C.B.E.), Warren Alpert Medical School of Brown University, Providence, RI; Center for Primary Care and Prevention (M.L.B., M.B.R., C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Quantitative Health Sciences (M.E.W.), University of Massachusetts Medical School, Worcester, MA
| | - Charles B. Eaton
- From the Departments of Epidemiology (M.L.B., C.B.E.) and Family Medicine (P.S.G., C.B.E.), Warren Alpert Medical School of Brown University, Providence, RI; Center for Primary Care and Prevention (M.L.B., M.B.R., C.B.E.), Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Quantitative Health Sciences (M.E.W.), University of Massachusetts Medical School, Worcester, MA
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Abstract
The American Heart Association Task Force released a scientific statement in 2007 for the treatment of hypertension in the prevention of coronary artery disease (CAD). These guidelines recommend more aggressive control of blood pressure (BP) among those at high risk for CAD: individuals with diabetes mellitus, chronic kidney disease, cardiovascular disease, congestive heart failure, or a 10-year Framingham risk score ≥10%. These individuals are advised to maintain a BP <130/80 mm Hg. We estimated the burden of uncontrolled BP among those at an increased risk of CAD using the updated task force guidelines. We used a cross-sectional analysis of National Health and Nutrition Examination Survey 2005-2008 participants. Participants were 24 989 adults aged 18 to 85 years. Using the old definition of hypertension (>140/90 mm Hg), 98 million (21%) Americans have hypertension. Using the updated guidelines, an additional 52 million (11%) American adults now have elevated BP requiring treatment, for a total of 150 million adults (32%). Adults with diabetes mellitus have the greatest population burden of uncontrolled BP (50.6 million), followed by adults with chronic kidney disease (43.7 million) and cardiovascular disease (43.3 million). Although individuals at a higher risk for CAD are more likely to be aware of their hypertension and to be taking antihypertension medication, they are less likely to have their BP under control. Additional efforts are needed in the treatment of elevated BP, especially among individuals with an increased risk of CAD.
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Affiliation(s)
- Monica L Bertoia
- Department of Community Health, Warren Alpert Medical School of Brown University, 121 S Main St, Box G-S121, Providence, RI 02912, USA.
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Gramling R, Lash TL, Rothman KJ, Cabral HJ, Silliman R, Roberts M, Stefanick ML, Harrigan R, Bertoia ML, Eaton CB. Family history of later-onset breast cancer, breast healthy behavior and invasive breast cancer among postmenopausal women: a cohort study. Breast Cancer Res 2010; 12:R82. [PMID: 20939870 PMCID: PMC3096975 DOI: 10.1186/bcr2727] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 10/12/2010] [Indexed: 11/25/2022] Open
Abstract
Introduction A family history of later-onset breast cancer (FHLBC) may suggest multi-factorial inheritance of breast cancer risk, including unhealthy lifestyle behaviors that may be shared within families. We assessed whether adherence to lifestyle behaviors recommended for breast cancer prevention--including maintaining a healthful body weight, being physically active and limiting alcohol intake--modifies breast cancer risk attributed to FHLBC in postmenopausal women. Methods Breast cancer outcomes through August 2003 were analyzed in relationship to lifestyle and risk factors collected by questionnaire during enrollment (between 1993 and 1998) of 85,644 postmenopausal women into the Women's Health Initiative Observational Study. Results During a mean follow-up of 5.4 years, 1997 women were diagnosed with invasive breast cancer. The rate of invasive breast cancer among women with an FHLBC who participated in all three behaviors was 5.94 per 1,000 woman-years, compared with 6.97 per 1,000 woman-years among women who participated in none of the behaviors. The rate among women with no FHLBC who participated in all three behavioral conditions was 3.51 per 1,000 woman-years compared to 4.67 per 1,000 woman-years for those who participated in none. We did not observe a clinically important departure from additive effects (Interaction Contrast: 0.00014; 95% CI: -0.00359, 0.00388). Conclusions Participating in breast healthy behaviors was beneficial to postmenopausal women and the degree of this benefit was the same for women with and without an FHLBC.
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Affiliation(s)
- Robert Gramling
- Department of Family Medicine, University of Rochester, NY 14620, USA.
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