1
|
Le VT, Knight S, Watrous JD, Najhawan M, Dao K, McCubrey RO, Bair TL, Horne BD, May HT, Muhlestein JB, Nelson JR, Carlquist JF, Knowlton KU, Jain M, Anderson JL. Higher docosahexaenoic acid levels lower the protective impact of eicosapentaenoic acid on long-term major cardiovascular events. Front Cardiovasc Med 2023; 10:1229130. [PMID: 37680562 PMCID: PMC10482040 DOI: 10.3389/fcvm.2023.1229130] [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: 05/25/2023] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Long-chain omega-3 polyunsaturated fatty acids (OM3 PUFA) are commonly used for cardiovascular disease prevention. High-dose eicosapentaenoic acid (EPA) is reported to reduce major adverse cardiovascular events (MACE); however, a combined EPA and docosahexaenoic acid (DHA) supplementation has not been proven to do so. This study aimed to evaluate the potential interaction between EPA and DHA levels on long-term MACE. Methods We studied a cohort of 987 randomly selected subjects enrolled in the INSPIRE biobank registry who underwent coronary angiography. We used rapid throughput liquid chromatography-mass spectrometry to quantify the EPA and DHA plasma levels and examined their impact unadjusted, adjusted for one another, and fully adjusted for comorbidities, EPA + DHA, and the EPA/DHA ratio on long-term (10-year) MACE (all-cause death, myocardial infarction, stroke, heart failure hospitalization). Results The average subject age was 61.5 ± 12.2 years, 57% were male, 41% were obese, 42% had severe coronary artery disease (CAD), and 311 (31.5%) had a MACE. The 10-year MACE unadjusted hazard ratio (HR) for the highest (fourth) vs. lowest (first) quartile (Q) of EPA was HR = 0.48 (95% CI: 0.35, 0.67). The adjustment for DHA changed the HR to 0.30 (CI: 0.19, 0.49), and an additional adjustment for baseline differences changed the HR to 0.36 (CI: 0.22, 0.58). Conversely, unadjusted DHA did not significantly predict MACE, but adjustment for EPA resulted in a 1.81-fold higher risk of MACE (CI: 1.14, 2.90) for Q4 vs. Q1. However, after the adjustment for baseline differences, the risk of MACE was not significant for DHA (HR = 1.37; CI: 0.85, 2.20). An EPA/DHA ratio ≥1 resulted in a lower rate of 10-year MACE outcomes (27% vs. 37%, adjusted p-value = 0.013). Conclusions Higher levels of EPA, but not DHA, are associated with a lower risk of MACE. When combined with EPA, higher DHA blunts the benefit of EPA and is associated with a higher risk of MACE in the presence of low EPA. These findings can help explain the discrepant results of EPA-only and EPA/DHA mixed clinical supplementation trials.
Collapse
Affiliation(s)
- Viet T. Le
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- Department of Physician Assistant Studies, Rocky Mountain University of Health Professions, Provo, UT, United States
| | - Stacey Knight
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Jeramie D. Watrous
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Mahan Najhawan
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Khoi Dao
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Raymond O. McCubrey
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
| | - Tami L. Bair
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
| | - Benjamin D. Horne
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Heidi T. May
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
| | - Joseph B. Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - John R. Nelson
- California Cardiovascular Institute, Fresno, CA, United States
| | - John F. Carlquist
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Kirk U. Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- The University of Utah, School of Medicine, Salt Lake City, UT, United States
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Mohit Jain
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Jeffrey L. Anderson
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, United States
- The University of Utah, School of Medicine, Salt Lake City, UT, United States
| |
Collapse
|
2
|
McCubrey RO, Mason SM, Le VT, Bride DL, Horne BD, Meredith KG, Sekaran NK, Anderson JL, Knowlton KU, Min DB, Knight S. A highly predictive cardiac positron emission tomography (PET) risk score for 90-day and one-year major adverse cardiac events and revascularization. J Nucl Cardiol 2023; 30:46-58. [PMID: 36536088 PMCID: PMC10035554 DOI: 10.1007/s12350-022-03028-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND With the increase in cardiac PET/CT availability and utilization, the development of a PET/CT-based major adverse cardiovascular events, including death, myocardial infarction (MI), and revascularization (MACE-Revasc) risk assessment score is needed. Here we develop a highly predictive PET/CT-based risk score for 90-day and one-year MACE-Revasc. METHODS AND RESULTS 11,552 patients had a PET/CT from 2015 to 2017 and were studied for the training and development set. PET/CT from 2018 was used to validate the derived scores (n = 5049). Patients were on average 65 years old, half were male, and a quarter had a prior MI or revascularization. Baseline characteristics and PET/CT results were used to derive the MACE-Revasc risk models, resulting in models with 5 and 8 weighted factors. The PET/CT 90-day MACE-Revasc risk score trended toward outperforming ischemic burden alone [P = .07 with an area under the curve (AUC) 0.85 vs 0.83]. The PET/CT one-year MACE-Revasc score was better than the use of ischemic burden alone (P < .0001, AUC 0.80 vs 0.76). Both PET/CT MACE-Revasc risk scores outperformed risk prediction by cardiologists. CONCLUSION The derived PET/CT 90-day and one-year MACE-Revasc risk scores were highly predictive and outperformed ischemic burden and cardiologist assessment. These scores are easy to calculate, lending to straightforward clinical implementation and should be further tested for clinical usefulness.
Collapse
Affiliation(s)
- Raymond O McCubrey
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Steve M Mason
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Viet T Le
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Daniel L Bride
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Kent G Meredith
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Nishant K Sekaran
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Jeffrey L Anderson
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kirk U Knowlton
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - David B Min
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA
| | - Stacey Knight
- Intermountain Medical Center Heart Institute, Intermountain Healthcare, 5121 Cottonwood St Bldg. 1 Floor 4, Murray, UT, 84107, USA.
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
3
|
Anderson JL, Knight S, McCubrey RO, May HT, Mason S, Bunch TJ, Min DB, Cutler MJ, Le VT, Muhlestein JB, Knowlton KU. Absent or Mild Coronary Calcium Predicts Low-Risk Stress Test Results and Outcomes in Patients Considered for Flecainide Therapy. J Cardiovasc Pharmacol Ther 2021; 26:648-655. [PMID: 34546822 DOI: 10.1177/10742484211046671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Flecainide is a useful antiarrhythmic for atrial fibrillation (AF). However, because of ventricular proarrhythmia risk, a history of myocardial infarction (MI) or coronary artery disease (CAD) is a flecainide exclusion, and stress testing is used to exclude ischemia. We assessed whether absent/mild coronary artery calcium (CAC) can supplement or avoid the need for stress testing. METHODS We assessed ischemic burden using regadenoson Rb-82 PET/CT in 1372 AF patients ≥50 years old without symptoms or signs of clinical CAD. CAC was determined qualitatively by low dose attenuation computed tomography (CT) (n = 816) or by quantitative CT (n = 556). Ischemic burden and clinical outcomes were compared by CAC burden. RESULTS Patients with CAC absent or mild (n = 766, 57.2%) were younger, more frequently female, and had higher BMI but lower rates of diabetes, hypertension, and dyslipidemia. Average ischemic burden was lower in CAC-absent/mild patients, and CAC-absent/mild patients showed greater coronary flow reserve, had fewer referrals for coronary angiography, and less often had obstructive CAD. Revascularization at 90 days was lower, and the rate of longer-term major adverse cardiovascular events was favorable. CONCLUSIONS An easily administered, inexpensive, low radiation CAC scan can identify a subset of flecainide candidates with a low ischemic burden on PET stress testing that rarely needs coronary angiography/intervention and has favorable outcomes. Absent or mild CAC-burden combined with other clinical information may avoid or complement routine stress testing. However, additional, ideally randomized and multicenter trials are indicated to confirm these findings before replacing stress testing with CAC screening in selecting patients for flecainide therapy in clinical practice.
Collapse
Affiliation(s)
- Jeffrey L Anderson
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Stacey Knight
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Raymond O McCubrey
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Heidi T May
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Steve Mason
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Thomas J Bunch
- 14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - David B Min
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Michael J Cutler
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Viet T Le
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,Rocky Mountain University of Health Professionals, Provo, UT, USA
| | - Joseph B Muhlestein
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Kirk U Knowlton
- Intermountain Medical Center, 98078Intermountain Heart Institute, Salt Lake City, UT, USA.,14434University of Utah, School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
4
|
Mahmoodi BK, Tragante V, Kleber ME, Holmes MV, Schmidt AF, McCubrey RO, Howe LJ, Direk K, Allayee H, Baranova EV, Braund PS, Delgado GE, Eriksson N, Gijsberts CM, Gong Y, Hartiala J, Heydarpour M, Pasterkamp G, Kotti S, Kuukasjärvi P, Lenzini PA, Levin D, Lyytikäinen LP, Muehlschlegel JD, Nelson CP, Nikus K, Pilbrow AP, Tang W, van der Laan SW, van Setten J, Vilmundarson RO, Deanfield J, Deloukas P, Dudbridge F, James S, Mordi IR, Teren A, Bergmeijer TO, Body SC, Bots M, Burkhardt R, Cooper-DeHoff RM, Cresci S, Danchin N, Doughty RN, Grobbee DE, Hagström E, Hazen SL, Held C, Hoefer IE, Hovingh GK, Johnson JA, Kaczor MP, Kähönen M, Klungel OH, Laurikka JO, Lehtimäki T, Maitland-van der Zee AH, McPherson R, Palmer CN, Kraaijeveld AO, Pepine CJ, Sanak M, Sattar N, Scholz M, Simon T, Spertus JA, Stewart AFR, Szczeklik W, Thiery J, Visseren FL, Waltenberger J, Richards AM, Lang CC, Cameron VA, Åkerblom A, Pare G, März W, Samani NJ, Hingorani AD, ten Berg JM, Wallentin L, Asselbergs FW, Patel R. Association of Factor V Leiden With Subsequent Atherothrombotic Events: A GENIUS-CHD Study of Individual Participant Data. Circulation 2020; 142:546-555. [PMID: 32654539 PMCID: PMC7493828 DOI: 10.1161/circulationaha.119.045526] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies examining the role of factor V Leiden among patients at higher risk of atherothrombotic events, such as those with established coronary heart disease (CHD), are lacking. Given that coagulation is involved in the thrombus formation stage on atherosclerotic plaque rupture, we hypothesized that factor V Leiden may be a stronger risk factor for atherothrombotic events in patients with established CHD. METHODS We performed an individual-level meta-analysis including 25 prospective studies (18 cohorts, 3 case-cohorts, 4 randomized trials) from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease) consortium involving patients with established CHD at baseline. Participating studies genotyped factor V Leiden status and shared risk estimates for the outcomes of interest using a centrally developed statistical code with harmonized definitions across studies. Cox proportional hazards regression models were used to obtain age- and sex-adjusted estimates. The obtained estimates were pooled using fixed-effect meta-analysis. The primary outcome was composite of myocardial infarction and CHD death. Secondary outcomes included any stroke, ischemic stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality. RESULTS The studies included 69 681 individuals of whom 3190 (4.6%) were either heterozygous or homozygous (n=47) carriers of factor V Leiden. Median follow-up per study ranged from 1.0 to 10.6 years. A total of 20 studies with 61 147 participants and 6849 events contributed to analyses of the primary outcome. Factor V Leiden was not associated with the combined outcome of myocardial infarction and CHD death (hazard ratio, 1.03 [95% CI, 0.92-1.16]; I2=28%; P-heterogeneity=0.12). Subgroup analysis according to baseline characteristics or strata of traditional cardiovascular risk factors did not show relevant differences. Similarly, risk estimates for the secondary outcomes including stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality were also close to identity. CONCLUSIONS Factor V Leiden was not associated with increased risk of subsequent atherothrombotic events and mortality in high-risk participants with established and treated CHD. Routine assessment of factor V Leiden status is unlikely to improve atherothrombotic events risk stratification in this population.
Collapse
Affiliation(s)
- Bakhtawar K. Mahmoodi
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
- Division of Hemostasis and Thrombosis, Department of Hematology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Vinicius Tragante
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcus E. Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael V. Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Amand F. Schmidt
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Raymond O. McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Laurence J. Howe
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Kenan Direk
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Ekaterina V. Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Peter S. Braund
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Graciela E. Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | | | | | - Yan Gong
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
| | - Jaana Hartiala
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
- Institute for Genetic Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Gerard Pasterkamp
- Department of Clinical Chemistry, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), Paris, France
| | - Pekka Kuukasjärvi
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Arvo Ylpön katu 34, Tampere 33014, Finland
| | - Petra A. Lenzini
- Washington University School of Medicine, Department of Genetics, Statistical Genomics Division, Saint Louis, Missouri, USA
| | - Daniel Levin
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Arvo Ylpön katu 34, Tampere 33014, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Jochen D. Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Christopher P. Nelson
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Kjell Nikus
- Department of Cardiology, Heart Center, Tampere University Hospital, Ensitie 4, 33520 Tampere, Finland
- Department of Cardiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Anna P. Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - W.H.Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institue, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Sander W. van der Laan
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jessica van Setten
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ragnar O. Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - John Deanfield
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London, London, UK
- Centre for Genomic Health, Queen Mary University of London, London, UK
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Andrej Teren
- Heart Center Leipzig, Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Thomas O. Bergmeijer
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Simon C. Body
- Department of Anaesthesiology, Boston University School of Medicine, 750 Albany St, Boston, MA 02118, USA
| | - Michiel Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Ralph Burkhardt
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Rhonda M. Cooper-DeHoff
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Sharon Cresci
- Washington University School of Medicine, Department of Genetics, Statistical Genomics Division, Saint Louis, Missouri, USA
- Washington University School of Medicine, Department of Medicine, Cardiovascular Division, Saint Louis, Missouri, USA
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France; FACT (french Alliance for cardiovascular trials); Université Paris Descartes, Paris, France
- Université Paris-Descartes, Paris, France
| | - Robert N. Doughty
- Heart Health Research Group, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala University, Dept of Cardiology, Uppsala, Sweden and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institue, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, and Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Claes Held
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Imo E. Hoefer
- Department of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Julie A. Johnson
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Marcin P. Kaczor
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, FM1 3rd floor, Tampere 33521, Finland
- Department of Clinical Physiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Jari O. Laurikka
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Arvo Ylpön katu 6, Tampere 33521, Finland
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Arvo Ylpön katu 34, Tampere 33014, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Anke H. Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Departments of Medicine and Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - Colin N. Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Division of Molecular and Clinical Medicine, Level 5, Mailbox 12, Ninewells Hospital and Medical School, Dundee, UK
| | - Adriaan O. Kraaijeveld
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carl J. Pepine
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Markus Scholz
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular trials); Sorbonne Université, Paris-06, France
- Paris-Sorbonne University, UPMC-Site St Antoine, 27 Rue Chaligny, 75012, Paris, France
| | - John A. Spertus
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, 9th Floor, Kansas City, MO 64111, USA
| | - Alexandre F. R. Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - Wojciech Szczeklik
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Joachim Thiery
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | | | - A. Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
- Cardiovascular Research Institute, National University of Singapore, 1 E Kent Ridge Road, Singapore
| | - Chim C. Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Vicky A. Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Guillaume Pare
- McMaster University, Department of Pathology and Molecular Medicine, Hamilton, Canada
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Aroon D. Hingorani
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Jurriën M. ten Berg
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Riyaz Patel
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
- Bart’s Heart Centre, St Bartholomew’s Hospital, London, EC1A2DA, UK
| |
Collapse
|
5
|
Anderson JL, Le VT, Min DB, Biswas S, Minder CM, McCubrey RO, Knight S, Horne BD, Mason S, Lappe DL, Muhlestein JB, Knowlton KU. Comparison of Three Atherosclerotic Cardiovascular Disease Risk Scores With and Without Coronary Calcium for Predicting Revascularization and Major Adverse Coronary Events in Symptomatic Patients Undergoing Positron Emission Tomography-Stress Testing. Am J Cardiol 2020; 125:341-348. [PMID: 31806210 DOI: 10.1016/j.amjcard.2019.10.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 09/24/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/19/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the most important cause of morbidity and mortality nationally and internationally. Improving ASCVD risk prediction is a high clinical priority. We sought to determine which of 3 ASCVD risk scores best predicts the need for revascularization and incident major adverse coronary events (MACE) in symptomatic patients at low-to-intermediate primary ASCVD risk referred for regadenoson-stress positron emission tomography (PET). Risk scores included the standard ASCVD pooled cohort equation (PCE), the multiethnic study of atherosclerosis (MESA) risk equation, and the coronary artery calcium score (CACS), obtained by PET. All qualifying patients in our institution at primary ASCVD risk referred for PET-stress tests in whom PCE, MESA, and CAC scores could be calculated were studied. CACS categories were: 0, 1 to 10, 11 to 299, 300 to 999, and 1000+. MESA and PCE scores were divided into quartiles. Logistic regression modeling was used to predict clinical/PET-driven early revascularization (within 90 days) and 1-year MACE (death, myocardial infarction, or any-time revascularization). A total of 981 patients (54% men, age 67 ± 10 years) qualified and were studied. Scores including CAC (MESA, CACS) performed better than PCE for predicting overall 1-year MACE (MESA p <0.001, CACS p = 0.012 vs PCE), which was driven by early revascularization. In conclusion, in a large population of patients at primary ASCVD risk referred for PET-stress testing, risk scores including CAC (CACS, MESA), which better predicted early revascularization and 1-year MACE, may be particularly useful in primary coronary risk assessment when considering whom to refer for PET-stress testing.
Collapse
Affiliation(s)
- Jeffrey L Anderson
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, School of Medicine, Salt Lake City, Utah.
| | - Viet T Le
- Rocky Mountain University of Health Professions, Provo, Utah
| | - David B Min
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Santanu Biswas
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - C Michael Minder
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Raymond O McCubrey
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Stacey Knight
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, School of Medicine, Salt Lake City, Utah
| | - Benjamin D Horne
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, School of Medicine, Salt Lake City, Utah
| | - Steve Mason
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Donald L Lappe
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, School of Medicine, Salt Lake City, Utah
| | - Joseph B Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, School of Medicine, Salt Lake City, Utah
| | - Kirk U Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, School of Medicine, Salt Lake City, Utah
| |
Collapse
|
6
|
Le VT, Knight S, Min DB, McCubrey RO, Horne BD, Jensen KR, Meredith KG, Mason SM, Lappé DL, Anderson JL, Muhlestein JB, Knowlton KU. Absence of Coronary Artery Calcium During Positron Emission Tomography Stress Testing in Patients Without Known Coronary Artery Disease Identifies Individuals With Very Low Risk of Cardiac Events. Circ Cardiovasc Imaging 2020; 13:e009907. [DOI: 10.1161/circimaging.119.009907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Myocardial perfusion imaging, including positron emission tomography/computed tomography (PET/CT), is often used to assess for high-grade coronary artery disease (CAD) requiring revascularization. The use of coronary artery calcium (CAC) to predict risk of major adverse cardiovascular events in asymptomatic patients is accepted. However, little is known regarding the use of CAC in PET/CT patients without known CAD in identifying patients unlikely to need revascularization. Here, we determined whether the absence of CAC, using low-dose attenuation correction CT obtained during the PET/CT, identifies patients unlikely to undergo coronary revascularization within 90 days of a PET/CT.
Methods:
Patients, without a history of CAD and no elevation in troponin, referred for PET/CT at Intermountain Medical Center were studied (n=5528). The presence of CAC was visually assessed using low-dose attenuation correction CT. The association between CAC and 90-day high-grade CAD and revascularization were assessed. Longer-term (up to 4 years) major adverse cardiovascular events, including all-cause death, myocardial infarction, and late revascularization (>90 days), were examined.
Results:
There were 2510 (45.4%) patients in CAC-present group and 3018 (54.6%) patients in CAC-absent group. The CAC-absent group, compared with the CAC-present group, was less likely to undergo coronary angiography (3.4% versus 10.2%,
P
<0.0001), have high-grade CAD (0.5% versus 6.5%,
P
<0.0001), and receive revascularization (0.4% versus 5.8%, [adjusted odds ratio =0.09; 95% CI, 0.05–0.16];
P
<0.0001). In patients with an ischemic burden >10%, the CAC-absent group was associated with reduced revascularization (
P
<0.0001). Longer-term major adverse cardiovascular events were lower in the CAC-absent (2.4%) compared with the CAC-present (6.9%) group (adjusted hazard ratio, 0.45 [95% CI, 0.34–0.60];
P
<0.0001).
Conclusions:
The absence of CAC on low-dose attenuation correction CT identifies PET/CT patients unlikely to have high-grade CAD or require revascularization within 90 days and unlikely to experience longer-term major adverse cardiovascular events. The prognostic value of CAC, beyond ischemic burden, suggests its potential as a first-step screening tool in intermediate-risk patients to identify those who do not need coronary revascularization.
Collapse
Affiliation(s)
- Viet T. Le
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
- College of Medical Sciences, Rocky Mountain University of Health Professions Physician Assistant Program, Provo, UT (V.T.L.)
| | - Stacey Knight
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City (S.K.)
| | - David B. Min
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
| | - Raymond O. McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
| | - Benjamin D. Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA (B.D.H.)
| | - Kurt R. Jensen
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
| | - Kent G. Meredith
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
| | - Steven M. Mason
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
| | - Donald L. Lappé
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
| | - Jeffrey L. Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
- Division of Cardiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City (J.L.A., J.B.M., K.U.K.)
| | - Joseph B. Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
- Division of Cardiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City (J.L.A., J.B.M., K.U.K.)
| | - Kirk U. Knowlton
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (V.T.L., S.K., D.B.M., R.O.M., B.D.H., K.R.J., K.G.M., S.M.M., D.L.L., J.L.A., J.B.M., K.U.K.)
- Division of Cardiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City (J.L.A., J.B.M., K.U.K.)
| |
Collapse
|
7
|
Patel RS, Tragante V, Schmidt AF, McCubrey RO, Holmes MV, Howe LJ, Direk K, Åkerblom A, Leander K, Virani SS, Kaminski KA, Muehlschlegel JD, Allayee H, Almgren P, Alver M, Baranova EV, Behloui H, Boeckx B, Braund PS, Breitling LP, Delgado G, Duarte NE, Dubé MP, Dufresne L, Eriksson N, Foco L, Scholz M, Gijsberts CM, Glinge C, Gong Y, Hartiala J, Heydarpour M, Hubacek JA, Kleber M, Kofink D, Kotti S, Kuukasjärvi P, Lee VV, Leiherer A, Lenzini PA, Levin D, Lyytikäinen LP, Martinelli N, Mons U, Nelson CP, Nikus K, Pilbrow AP, Ploski R, Sun YV, Tanck MWT, Tang WHW, Trompet S, van der Laan SW, Van Setten J, Vilmundarson RO, Viviani Anselmi C, Vlachopoulou E, Al Ali L, Boerwinkle E, Briguori C, Carlquist JF, Carruthers KF, Casu G, Deanfield J, Deloukas P, Dudbridge F, Engstrøm T, Fitzpatrick N, Fox K, Gigante B, James S, Lokki ML, Lotufo PA, Marziliano N, Mordi IR, Muhlestein JB, Newton-Cheh C, Pitha J, Saely CH, Samman-Tahhan A, Sandesara PB, Teren A, Timmis A, Van de Werf F, Wauters E, Wilde AAM, Ford I, Stott DJ, Algra A, Andreassi MG, Ardissino D, Arsenault BJ, Ballantyne CM, Bergmeijer TO, Bezzina CR, Body SC, Boersma EH, Bogaty P, Bots ML, Brenner H, Brugts JJ, Burkhardt R, Carpeggiani C, Condorelli G, Cooper-DeHoff RM, Cresci S, Danchin N, de Faire U, Doughty RN, Drexel H, Engert JC, Fox KAA, Girelli D, Grobbee DE, Hagström E, Hazen SL, Held C, Hemingway H, Hoefer IE, Hovingh GK, Jabbari R, Johnson JA, Jukema JW, Kaczor MP, Kähönen M, Kettner J, Kiliszek M, Klungel OH, Lagerqvist B, Lambrechts D, Laurikka JO, Lehtimäki T, Lindholm D, Mahmoodi BK, Maitland-van der Zee AH, McPherson R, Melander O, Metspalu A, Niemcunowicz-Janica A, Olivieri O, Opolski G, Palmer CN, Pasterkamp G, Pepine CJ, Pereira AC, Pilote L, Quyyumi AA, Richards AM, Sanak M, Siegbahn A, Simon T, Sinisalo J, Smith JG, Spertus JA, Stender S, Stewart AFR, Szczeklik W, Szpakowicz A, Tardif JC, Ten Berg JM, Tfelt-Hansen J, Thanassoulis G, Thiery J, Torp-Pedersen C, van der Graaf Y, Visseren FLJ, Waltenberger J, Weeke PE, Van der Harst P, Lang CC, Sattar N, Cameron VA, Anderson JL, Brophy JM, Pare G, Horne BD, März W, Wallentin L, Samani NJ, Hingorani AD, Asselbergs FW. Subsequent Event Risk in Individuals With Established Coronary Heart Disease. Circ Genom Precis Med 2019; 12:e002470. [PMID: 30896328 PMCID: PMC6629546 DOI: 10.1161/circgen.119.002470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Supplemental Digital Content is available in the text. Background: The Genetics of Subsequent Coronary Heart Disease (GENIUS-CHD) consortium was established to facilitate discovery and validation of genetic variants and biomarkers for risk of subsequent CHD events, in individuals with established CHD. Methods: The consortium currently includes 57 studies from 18 countries, recruiting 185 614 participants with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. All studies collected biological samples and followed-up study participants prospectively for subsequent events. Results: Enrollment into the individual studies took place between 1985 to present day with a duration of follow-up ranging from 9 months to 15 years. Within each study, participants with CHD are predominantly of self-reported European descent (38%–100%), mostly male (44%–91%) with mean ages at recruitment ranging from 40 to 75 years. Initial feasibility analyses, using a federated analysis approach, yielded expected associations between age (hazard ratio, 1.15; 95% CI, 1.14–1.16) per 5-year increase, male sex (hazard ratio, 1.17; 95% CI, 1.13–1.21) and smoking (hazard ratio, 1.43; 95% CI, 1.35–1.51) with risk of subsequent CHD death or myocardial infarction and differing associations with other individual and composite cardiovascular endpoints. Conclusions: GENIUS-CHD is a global collaboration seeking to elucidate genetic and nongenetic determinants of subsequent event risk in individuals with established CHD, to improve residual risk prediction and identify novel drug targets for secondary prevention. Initial analyses demonstrate the feasibility and reliability of a federated analysis approach. The consortium now plans to initiate and test novel hypotheses as well as supporting replication and validation analyses for other investigators.
Collapse
Affiliation(s)
- Riyaz S Patel
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom.,Bart's Heart Centre, St Bartholomew's Hospital, London (R.S.P., J.D., A. Timmis)
| | - Vinicius Tragante
- Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands
| | - Amand F Schmidt
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom.,Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H)
| | - Michael V Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Medical Research Council Population Health Research Unit, University of Oxford, United Kingdom (M.V.H).,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, United Kingdom (M.V.H.)
| | - Laurence J Howe
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Kenan Direk
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (K.L., B.G., U.d.F.)
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.).,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V., C.M.B.)
| | - Karol A Kaminski
- Department of Population Medicine and Civilization Disease Prevention (K.A.K.), Medical University of Bialystok, Poland.,Department of Cardiology (K.A.K., A. Szpakowicz), Medical University of Bialystok, Poland
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA (J.D.M., M.H.).,Harvard Medical School, Boston, MA (J.D.M., M.H., S.C.B)
| | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine (H.A., J.H.), Keck School of Medicine of USC, Los Angeles, CA
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden (P.A., O.M.)
| | - Maris Alver
- Estonian Genome Centre, Department of Biotechnology, Institute of Genomics, Institute of Molecular and Cell Biology, University of Tartu, Estonia (M.A., A.M.)
| | - Ekaterina V Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands (E.V.B., O.H.K., A.H.M.-v.d.Z.)
| | - Hassan Behloui
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.)
| | - Bram Boeckx
- Laboratory for Translational Genetics, Department of Human Genetics (B.B., D. Lambrechts), Katholieke Universiteit Leuven, Belgium.,Laboratory for Translational Genetics, VIB Center for Cancer Biology, Belgium (B.B., D. Lambrechts)
| | - Peter S Braund
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, United Kingdom (P.S.B., C.P.N., N.J.S.).,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (P.S.B., C.P.N., N.J.S.)
| | - Lutz P Breitling
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M.)
| | - Graciela Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany (G.D., M. Kleber, W.M.)
| | - Nubia E Duarte
- Heart Institute, University of Sao Paulo, Brazil (N.E.D., A.C.P.)
| | - Marie-Pierre Dubé
- Montreal Heart Institute, OC, Canada (M.-P.D., J.-C.T.).,Faculty of Medicine, Université de Montréal, QC, Canada (M.-P.D., J.-C.T.)
| | - Line Dufresne
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.)
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.)
| | - Luisa Foco
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy (L.F.)
| | - Markus Scholz
- Institute for Medical Informatics, Statistics, and Epidemiology (M.S.), University of Leipzig, Germany.,LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany
| | - Crystel M Gijsberts
- Laboratory of Experimental Cardiology (C.M.G.), UMC Utrecht, the Netherlands
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (C.G., T.E., R.J.).,Amsterdam UMC, University of Amsterdam, Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, AMC Heart Center, the Netherlands (C.G., A.A.M.W., C.R.B.)
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, Centre for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.), University of Florida, Gainesville
| | - Jaana Hartiala
- Institute for Genetic Medicine (J.H.), Keck School of Medicine of USC, Los Angeles, CA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA (J.D.M., M.H.).,Harvard Medical School, Boston, MA (J.D.M., M.H., S.C.B)
| | - Jaroslav A Hubacek
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.A.H., J.P.)
| | - Marcus Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany (G.D., M. Kleber, W.M.)
| | - Daniel Kofink
- Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), France (S.K.)
| | - Pekka Kuukasjärvi
- Department of Cardio-Thoracic Surgery (P.K.), University of Tampere, Finland
| | - Vei-Vei Lee
- Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston (V.-V.L.)
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A. Leiherer, C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen (A. Leiherer, C.H.S., H.D.).,Medical Central Laboratories, Feldkirch, Austria (A. Leiherer)
| | - Petra A Lenzini
- Statistical Genomics Division, Department of Genetics (P.A. Lenzini, S.C.), Washington University School of Medicine, Saint Louis, MO
| | - Daniel Levin
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry (L.-P.L., T.L.), University of Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland (L.-P.L., T.L.)
| | - Nicola Martinelli
- Department of Medicine, University of Verona, Italy (N.M., D.G., O.O.)
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M.)
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, United Kingdom (P.S.B., C.P.N., N.J.S.).,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (P.S.B., C.P.N., N.J.S.)
| | - Kjell Nikus
- Department of Cardiology (K.N.), University of Tampere, Finland.,Department of Cardiology, Heart Center (K.N.), Tampere University Hospital, Finland
| | - Anna P Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.P., A.M.R., V.A.C.)
| | - Rafal Ploski
- Department of Medical Genetics (R. Ploski), Medical University of Warsaw, Poland
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (Y.V.S.).,Department of Biomedical Informatics (Y.V.S.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Michael W T Tanck
- Amsterdam UMC, University of Amsterdam, Clinical Epidemiology and Biostatistics, The Netherlands (M.W.T.T.)
| | - W H Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (W.H.W.T., S.L.H.).,Department of Cardiovascular Medicine, Heart and Vascular Institute, and Centre for Clinical Genomics, Cleveland Clinic, OH (W.H.W.T.)
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine (S.T.), Leiden University Medical Centre, the Netherlands.,Department of Cardiology (S.T., J.W.J.), Leiden University Medical Centre, the Netherlands
| | - Sander W van der Laan
- Division Laboratories, Pharmacy, and Biomedical Genetics, Laboratory of Clinical Chemistry and Hematology (S.W.v.d.L.), UMC Utrecht, Utrecht University, the Netherlands
| | - Jessica Van Setten
- Division Heart and Lungs, Department of Cardiology, UMC Utrecht, University of Utrecht, the Netherlands (J.V.S.)
| | - Ragnar O Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada (R.O.V., R.M., A.F.R.S.).,Department of Biochemistry, Microbiology and Immunology (R.O.V., A.F.R.S.), University of Ottawa, ON, Canada
| | - Chiara Viviani Anselmi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Centre, Milan, Italy (C.V.A., G.C.)
| | - Efthymia Vlachopoulou
- Transplantation Laboratory (E.V., M.-L.L.), Helsinki University Hospital and University of Helsinki, Finland
| | - Lawien Al Ali
- University Medical Centre, University of Groningen, the Netherlands (L.A.A., P.V.d.H.)
| | | | | | - John F Carlquist
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.), University of Utah, Salt Lake City
| | | | - Gavino Casu
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Centre, Milan, Italy (C.V.A., G.C.).,ATS Sardegna, ASSL Nuoro-Ospedale San Francesco, Nuoro, Italy (G.C.).,Department of Biomedical Sciences, Humanitas University, Milan, Italy (G.C.)
| | - John Deanfield
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom.,Bart's Heart Centre, St Bartholomew's Hospital, London (R.S.P., J.D., A. Timmis)
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London Medical School (P.D), Queen Mary University of London, United Kingdom.,Centre for Genomic Health (P.D.), Queen Mary University of London, United Kingdom
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, United Kingdom (F.D.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (C.G., T.E., R.J.).,Department of Cardiology, University of Lund, Sweden (T.E.)
| | - Natalie Fitzpatrick
- Institute of Health Informatics (N.F., A. Timmis, H.H., F.W.A.), Faculty of Population Health Science, University College London, United Kingdom
| | - Kim Fox
- National Heart and Lung Institute, Imperial College and Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom (K.F.)
| | - Bruna Gigante
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (K.L., B.G., U.d.F.)
| | - Stefan James
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Marja-Liisa Lokki
- Transplantation Laboratory (E.V., M.-L.L.), Helsinki University Hospital and University of Helsinki, Finland
| | - Paulo A Lotufo
- Centro de Pesquisa Clinica, Hospital Universitario, Universidade de Sao Paulo, São Paulo, Brazil (P.A. Lotufo, )
| | | | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.), University of Utah, Salt Lake City
| | - Christopher Newton-Cheh
- Cardiovascular Research Center, Center for Human Genetic Research, Massachusetts General Hospital, Boston (C.N.-C.).,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.N.-C.)
| | - Jan Pitha
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.A.H., J.P.)
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A. Leiherer, C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen (A. Leiherer, C.H.S., H.D.).,Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Austria (C.H.S.)
| | - Ayman Samman-Tahhan
- Division of Cardiology, Department of Medicine (A.S.-T., P.B.S., A.A.Q.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine (A.S.-T., P.B.S., A.A.Q.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Andrej Teren
- LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany.,Heart Centre Leipzig, Germany (A. Teren)
| | - Adam Timmis
- Institute of Health Informatics (N.F., A. Timmis, H.H., F.W.A.), Faculty of Population Health Science, University College London, United Kingdom.,Bart's Heart Centre, St Bartholomew's Hospital, London (R.S.P., J.D., A. Timmis)
| | - Frans Van de Werf
- Department of Cardiovascular Sciences (F.V.d.W.), Katholieke Universiteit Leuven, Belgium
| | - Els Wauters
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Belgium (E.W.)
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, AMC Heart Center, the Netherlands (C.G., A.A.M.W., C.R.B.).,Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia (A.A.M.W.)
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (I.F.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.J.S., N.S.)
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus and Julius Centre for Health Sciences and Primary Care (A. Algra), UMC Utrecht, Utrecht University, the Netherlands
| | | | - Diego Ardissino
- Cardiology Department, Parma University Hospital, Italy (D.A.)
| | - Benoit J Arsenault
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Canada (B.J.A.).,Department of Medicine, Faculty of Medicine, Université Laval, QC, Canada (B.J.A.)
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V., C.M.B.)
| | - Thomas O Bergmeijer
- St Antonius Hospital, Department Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Connie R Bezzina
- Amsterdam UMC, University of Amsterdam, Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, AMC Heart Center, the Netherlands (C.G., A.A.M.W., C.R.B.)
| | - Simon C Body
- Harvard Medical School, Boston, MA (J.D.M., M.H., S.C.B).,Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.B.)
| | - Eric H Boersma
- Department of Cardiology, Erasmus MC, Thoraxcenter (E.H.B., J.J.B.).,Cardiovascular Research School, Erasmus Medical Center (COEUR), Rotterdam, the Netherlands(E.H.B.)
| | - Peter Bogaty
- Laval University, Institute universitaire de cardiologie et de pneumologie de Québec, Canada (P.B.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care (M.B., D.E.G., Y.v.d.G.), UMC Utrecht, Utrecht University, the Netherlands
| | - Hermann Brenner
- Network Aging Research (NAR), University of Heidelberg (H.B.)
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, Thoraxcenter (E.H.B., J.J.B.)
| | - Ralph Burkhardt
- LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany (R.B.)
| | | | - Gianluigi Condorelli
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, Centre for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.), University of Florida, Gainesville.,Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J., C.J.P.), University of Florida, Gainesville
| | - Sharon Cresci
- Statistical Genomics Division, Department of Genetics (P.A. Lenzini, S.C.), Washington University School of Medicine, Saint Louis, MO.,Cardiovascular Division, Department of Medicine (S.C.), Washington University School of Medicine, Saint Louis, MO
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou & FACT (French Alliance For Cardiovascular Trials), Université Paris Descartes, France (N.D.).,Université Paris-Descartes, France (N.D.)
| | - Ulf de Faire
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (K.L., B.G., U.d.F.)
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, New Zealand (R.N.D.)
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A. Leiherer, C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen (A. Leiherer, C.H.S., H.D.).,Drexel University College of Medicine, Philadelphia PA (H.D.)
| | - James C Engert
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada (J.C.E.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.).,Division of Cardiology, Department of Medicine, Royal Victoria Hospital, McGill Univ Health Centre, Montreal, QC, Canada (J.C.E., G.T.)
| | - Keith A A Fox
- The University of Edinburgh, United Kingdom (K.A.A.F)
| | - Domenico Girelli
- Department of Medicine, University of Verona, Italy (N.M., D.G., O.O.)
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care (M.B., D.E.G., Y.v.d.G.), UMC Utrecht, Utrecht University, the Netherlands
| | - Emil Hagström
- Department of Cardiology, Uppsala Clinical Research Centre, Uppsala University, Sweden (E.H.)
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (W.H.W.T., S.L.H.).,Department of Cardiovascular Medicine, Centre for Microbiome and Human Health, Heart and Vascular Institute, Cleveland Clinic, OH (S.L.H.)
| | - Claes Held
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Harry Hemingway
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Imo E Hoefer
- Department of Clinical Chemistry and Hematology (I.E.H.), UMC Utrecht, the Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam (G.K.H.)
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (C.G., T.E., R.J.)
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, Centre for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.), University of Florida, Gainesville.,Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J., C.J.P.), University of Florida, Gainesville
| | - J Wouter Jukema
- Department of Cardiology (S.T., J.W.J.), Leiden University Medical Centre, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden (J.W.J.).,Interuniversity Cardiology Institute of the Netherlands, Utrecht (J.W.J.)
| | - Marcin P Kaczor
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M.S., W.S)
| | - Mika Kähönen
- Department of Clinical Physiology (M. Kähönen), University of Tampere, Finland.,Department of Clinical Physiology (M. Kähönen), Tampere University Hospital, Finland
| | - Jiri Kettner
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.)
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland (M. Kiliszek)
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands (E.V.B., O.H.K., A.H.M.-v.d.Z.)
| | - Bo Lagerqvist
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics (B.B., D. Lambrechts), Katholieke Universiteit Leuven, Belgium
| | - Jari O Laurikka
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center, Faculty of Medicine & Life Sciences (J.O.L.), University of Tampere, Finland.,Department of Cardio-Thoracic Surgery, Heart Centre (J.O.L.), Tampere University Hospital, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry (L.-P.L., T.L.), University of Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland (L.-P.L., T.L.)
| | - Daniel Lindholm
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - B K Mahmoodi
- St Antonius Hospital, Department Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands (E.V.B., O.H.K., A.H.M.-v.d.Z.).,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam (A.H.M.-v.d.Z.)
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada (R.O.V., R.M., A.F.R.S.).,Departments of Medicine and Biochemistry, Microbiology and Immunology(R.M.), University of Ottawa, ON, Canada
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden (P.A., O.M.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (O.M.)
| | - Andres Metspalu
- Estonian Genome Centre, Department of Biotechnology, Institute of Genomics, Institute of Molecular and Cell Biology, University of Tartu, Estonia (M.A., A.M.)
| | | | - Oliviero Olivieri
- Department of Medicine, University of Verona, Italy (N.M., D.G., O.O.)
| | - Grzegorz Opolski
- first Chair and Department of Cardiology (G.O.), Medical University of Warsaw, Poland
| | - Colin N Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (C.N.P.)
| | - Gerard Pasterkamp
- Department of Clinical Chemistry (G.P.), UMC Utrecht, the Netherlands
| | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J., C.J.P.), University of Florida, Gainesville
| | | | - Louise Pilote
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Department of Medicine, McGill University Health Centre, Montreal, QC, Canada (L.P., J.M.B.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine (A.S.-T., P.B.S., A.A.Q.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - A Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.P., A.M.R., V.A.C.).,Cardiovascular Research Institute, National University of Singapore (A.M.R.)
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M.S., W.S)
| | - Agneta Siegbahn
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Clinical Chemistry, Department of Medical Sciences (A. Siegbahn), Uppsala University, Sweden
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular Trials), Sorbonne Université (T.S.).,Paris-Sorbonne University, UPMC-Site St Antoine, France (T.S.)
| | - Juha Sinisalo
- Heart and Lung Centre (J.S.), Helsinki University Hospital and University of Helsinki, Finland
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital (J.G.S.).,Wallenberg Centre for Molecular Medicine, Lund University Diabetes Centre, Lund University, Sweden (J.G.S.).,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (J.G.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (J.A.S.).,Saint Luke's Mid America Heart Insti Kansas City, MO (J.A.S.)
| | - Steen Stender
- Department of Clinical Biochemistry, Copenhagen University Hospital, Gentofte (S.S.)
| | - Alexandre F R Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada (R.O.V., R.M., A.F.R.S.).,Department of Biochemistry, Microbiology and Immunology (R.O.V., A.F.R.S.), University of Ottawa, ON, Canada
| | - Wojciech Szczeklik
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M.S., W.S)
| | - Anna Szpakowicz
- Department of Cardiology (K.A.K., A. Szpakowicz), Medical University of Bialystok, Poland
| | - Jean-Claude Tardif
- Montreal Heart Institute, OC, Canada (M.-P.D., J.-C.T.).,Faculty of Medicine, Université de Montréal, QC, Canada (M.-P.D., J.-C.T.)
| | - Jurriën M Ten Berg
- St Antonius Hospital, Department Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (J.T.-H.).,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (J.T.-Hansen)
| | - George Thanassoulis
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.).,Division of Cardiology, Department of Medicine, Royal Victoria Hospital, McGill Univ Health Centre, Montreal, QC, Canada (J.C.E., G.T.)
| | - Joachim Thiery
- LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany (J.T.)
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Department of Health Science and Technology, Aalborg University Hospital, Denmark (C.T.-Pedersen)
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care (M.B., D.E.G., Y.v.d.G.), UMC Utrecht, Utrecht University, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine (F.L.J.V), UMC Utrecht, Utrecht University, the Netherlands
| | | | - Peter E Weeke
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark (P.E.W.)
| | - Pim Van der Harst
- University Medical Centre, University of Groningen, the Netherlands (L.A.A., P.V.d.H.)
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.J.S., N.S.)
| | - Vicky A Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.P., A.M.R., V.A.C.)
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.), University of Utah, Salt Lake City
| | - James M Brophy
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Department of Medicine, McGill University Health Centre, Montreal, QC, Canada (L.P., J.M.B.)
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University (G.P.).,Population Health Research Institute, Hamilton, ON, Canada (G.P.)
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Department of Biomedical Informatics (B.D.H.), University of Utah, Salt Lake City
| | - Winfried März
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany (G.D., M. Kleber, W.M.).,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany (W.M.).,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria (W.M.)
| | - Lars Wallentin
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, United Kingdom (P.S.B., C.P.N., N.J.S.).,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (P.S.B., C.P.N., N.J.S.)
| | - Aroon D Hingorani
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Folkert W Asselbergs
- Institute of Health Informatics (N.F., A. Timmis, H.H., F.W.A.), Faculty of Population Health Science, University College London, United Kingdom.,Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands.,Durrer Centre of Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W.A.)
| |
Collapse
|
8
|
Patel RS, Schmidt AF, Tragante V, McCubrey RO, Holmes MV, Howe LJ, Direk K, Åkerblom A, Leander K, Virani SS, Kaminski KA, Muehlschlegel JD, Dubé MP, Allayee H, Almgren P, Alver M, Baranova EV, Behlouli H, Boeckx B, Braund PS, Breitling LP, Delgado G, Duarte NE, Dufresne L, Eriksson N, Foco L, Gijsberts CM, Gong Y, Hartiala J, Heydarpour M, Hubacek JA, Kleber M, Kofink D, Kuukasjärvi P, Lee VV, Leiherer A, Lenzini PA, Levin D, Lyytikäinen LP, Martinelli N, Mons U, Nelson CP, Nikus K, Pilbrow AP, Ploski R, Sun YV, Tanck MWT, Tang WHW, Trompet S, van der Laan SW, van Setten J, Vilmundarson RO, Viviani Anselmi C, Vlachopoulou E, Boerwinkle E, Briguori C, Carlquist JF, Carruthers KF, Casu G, Deanfield J, Deloukas P, Dudbridge F, Fitzpatrick N, Gigante B, James S, Lokki ML, Lotufo PA, Marziliano N, Mordi IR, Muhlestein JB, Newton Cheh C, Pitha J, Saely CH, Samman-Tahhan A, Sandesara PB, Teren A, Timmis A, Van de Werf F, Wauters E, Wilde AAM, Ford I, Stott DJ, Algra A, Andreassi MG, Ardissino D, Arsenault BJ, Ballantyne CM, Bergmeijer TO, Bezzina CR, Body SC, Bogaty P, de Borst GJ, Brenner H, Burkhardt R, Carpeggiani C, Condorelli G, Cooper-DeHoff RM, Cresci S, de Faire U, Doughty RN, Drexel H, Engert JC, Fox KAA, Girelli D, Hagström E, Hazen SL, Held C, Hemingway H, Hoefer IE, Hovingh GK, Johnson JA, de Jong PA, Jukema JW, Kaczor MP, Kähönen M, Kettner J, Kiliszek M, Klungel OH, Lagerqvist B, Lambrechts D, Laurikka JO, Lehtimäki T, Lindholm D, Mahmoodi BK, Maitland-van der Zee AH, McPherson R, Melander O, Metspalu A, Pepinski W, Olivieri O, Opolski G, Palmer CN, Pasterkamp G, Pepine CJ, Pereira AC, Pilote L, Quyyumi AA, Richards AM, Sanak M, Scholz M, Siegbahn A, Sinisalo J, Smith JG, Spertus JA, Stewart AFR, Szczeklik W, Szpakowicz A, Ten Berg JM, Thanassoulis G, Thiery J, van der Graaf Y, Visseren FLJ, Waltenberger J, Van der Harst P, Tardif JC, Sattar N, Lang CC, Pare G, Brophy JM, Anderson JL, März W, Wallentin L, Cameron VA, Horne BD, Samani NJ, Hingorani AD, Asselbergs FW. Association of Chromosome 9p21 With Subsequent Coronary Heart Disease Events. Circ Genom Precis Med 2019; 12:e002471. [PMID: 30897348 PMCID: PMC6625876 DOI: 10.1161/circgen.119.002471] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Genetic variation at chromosome 9p21 is a recognized risk factor for coronary heart disease (CHD). However, its effect on disease progression and subsequent events is unclear, raising questions about its value for stratification of residual risk. Methods: A variant at chromosome 9p21 (rs1333049) was tested for association with subsequent events during follow-up in 103 357 Europeans with established CHD at baseline from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease) Consortium (73.1% male, mean age 62.9 years). The primary outcome, subsequent CHD death or myocardial infarction (CHD death/myocardial infarction), occurred in 13 040 of the 93 115 participants with available outcome data. Effect estimates were compared with case/control risk obtained from the CARDIoGRAMplusC4D consortium (Coronary Artery Disease Genome-wide Replication and Meta-analysis [CARDIoGRAM] plus The Coronary Artery Disease [C4D] Genetics) including 47 222 CHD cases and 122 264 controls free of CHD. Results: Meta-analyses revealed no significant association between chromosome 9p21 and the primary outcome of CHD death/myocardial infarction among those with established CHD at baseline (GENIUS-CHD odds ratio, 1.02; 95% CI, 0.99–1.05). This contrasted with a strong association in CARDIoGRAMPlusC4D odds ratio 1.20; 95% CI, 1.18–1.22; P for interaction <0.001 compared with the GENIUS-CHD estimate. Similarly, no clear associations were identified for additional subsequent outcomes, including all-cause death, although we found a modest positive association between chromosome 9p21 and subsequent revascularization (odds ratio, 1.07; 95% CI, 1.04–1.09). Conclusions: In contrast to studies comparing individuals with CHD to disease-free controls, we found no clear association between genetic variation at chromosome 9p21 and risk of subsequent acute CHD events when all individuals had CHD at baseline. However, the association with subsequent revascularization may support the postulated mechanism of chromosome 9p21 for promoting atheroma development.
Collapse
Affiliation(s)
- Riyaz S Patel
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.).,Bart's Heart Centre, St Bartholomew's Hospital, London, United Kingdom (R.S.P., J.D., A. Timmis)
| | - Amand F Schmidt
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.).,Division Heart and Lungs, Department of Cardiology (A.F.S., V.T. D.K., F.W.A.)
| | - Vinicius Tragante
- Division Heart and Lungs, Department of Cardiology (A.F.S., V.T. D.K., F.W.A.)
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A.)
| | - Michael V Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (M.V.H.), University of Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (M.V.H.), University of Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre (M.V.H.), University of Oxford, United Kingdom
| | - Laurence J Howe
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.)
| | - Kenan Direk
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.)
| | - Axel Åkerblom
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (A.A., E.H., C.H., D. Lindholm), Uppsala University, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (K.L., U.d.F.)
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiovascular Research, and Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V., C.M.B.)
| | - Karol A Kaminski
- Department of Population Medicine and Civilization Disease Prevention (K.A.K.).,Department of Cardiology (K.A.K., A. Szpakowicz)
| | | | | | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine (H.A., J.H.), Keck School of Medicine of USC, Los Angeles, CA
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden (P.A., O.M.)
| | - Maris Alver
- Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Estonia (M.A., A.M.)
| | - Ekaterina V Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology (E.V.B., O.H.K., A.H.M.-v.d.Z.), University Medical Center Utrecht, the Netherlands
| | - Hassan Behlouli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (H.B., L.D., L.P., J.M.B.)
| | - Bram Boeckx
- Laboratory for Translational Genetics, Department of Human Genetics (B.B., D. Lambrechts).,Laboratory for Translational Genetics, VIB Center for Cancer Biology, VIB, Belgium (B.B., D. Lambrechts)
| | - Peter S Braund
- Department of Cardiovascular Sciences (P.S.B., C.P.N., N.J.S.) and Department of Health Sciences, University of Leicester, United Kingdom.,National Institute of Health Research (NIHR) Leicester Biomedical Research Centre (P.S.B., C.P.N.), Glenfield Hospital, Leicester, United Kingdom
| | - Lutz P Breitling
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M., H.B.)
| | - Graciela Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (G.D., M. Kleber, W.M.)
| | - Nubia E Duarte
- Heart Institute, University of Sao Paulo, Brazil (N.E.D., A.C.P.)
| | - Line Dufresne
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (H.B., L.D., L.P., J.M.B.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.)
| | - Niclas Eriksson
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden
| | - Luisa Foco
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy (L.F.)
| | | | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.)
| | - Jaana Hartiala
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine (H.A., J.H.), Keck School of Medicine of USC, Los Angeles, CA.,Institute for Genetic Medicine (J.H.), Keck School of Medicine of USC, Los Angeles, CA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital (M.H.).,Harvard Medical School, Boston, MA (J.D.M., M.H. S.C.B.)
| | - Jaroslav A Hubacek
- Centre for Experimental Medicine, Institut for Clinical and Experimental Medicine, Prague, Czech Republic (J.A.H., J.P.)
| | - Marcus Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (G.D., M. Kleber, W.M.)
| | - Daniel Kofink
- Division Heart and Lungs, Department of Cardiology (A.F.S., V.T. D.K., F.W.A.)
| | | | - Vei-Vei Lee
- Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston (V.-V.L.)
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A.L., C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein (A.L., C.H.S., H.D.).,Medical Central Laboratories, Feldkirch, Austria (A.L.)
| | - Petra A Lenzini
- Department of Genetics, Statistical Genomics Division (P.A.L., S.C.)
| | - Daniel Levin
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry (L.-P.L., T.L.).,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland (L.-P.L., T.L.)
| | - Nicola Martinelli
- Department of Medicine, University of Verona, Italy (N. Martinelli, D.G., O.O.)
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M., H.B.)
| | - Christopher P Nelson
- Department of Cardiovascular Sciences (P.S.B., C.P.N., N.J.S.) and Department of Health Sciences, University of Leicester, United Kingdom.,National Institute of Health Research (NIHR) Leicester Biomedical Research Centre (P.S.B., C.P.N.), Glenfield Hospital, Leicester, United Kingdom
| | - Kjell Nikus
- Department of Cardiology (K.N.).,Department of Cardiology, Heart Center (K.N.)
| | - Anna P Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.B., A.M.R., V.A.C.)
| | | | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health (Y.V.S.).,Department of Biomedical Informatics (Y.V.S.)
| | | | - W H Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T., S.L.H.).,Department of Cardiovascular Medicine, Heart and Vascular Institute and Center for Clinical Genomics (W.H.W.T.)
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine (S.T.), Leiden University Medical Center.,Department of Cardiology (S.T., J.W.J.), Leiden University Medical Center
| | - Sander W van der Laan
- Laboratory of Clinical Chemistry and Hematology, Division Laboratories, Pharmacy, and Biomedical Genetics (S.W.v.d.L.)
| | - Jessica van Setten
- Durrer Centre of Cardiogenetic Research, ICIN-Netherlands Heart Institute, Netherlands (J.v.S., F.W.B.)
| | - Ragnar O Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre (R.O.V., A.F.R.S.).,Department of Biochemistry, Microbiology and Immunology (R.O.V., A.F.R.S.)
| | - Chiara Viviani Anselmi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milan, Italy (C.V.A., G.C)
| | | | | | | | - John F Carlquist
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A.).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.)
| | | | - Gavino Casu
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milan, Italy (C.V.A., G.C).,ATS Sardegna, ASL 3, Nuoro (G. Casu, N. Marziliano)
| | - John Deanfield
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.).,Bart's Heart Centre, St Bartholomew's Hospital, London, United Kingdom (R.S.P., J.D., A. Timmis)
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London Medical School (P.D.), Queen Mary University of London.,Centre for Genomic Health (P.D.), Queen Mary University of London
| | - Frank Dudbridge
- BHF Cardiovascular Research Centre (F.D.), Glenfield Hospital, Leicester, United Kingdom
| | - Natalie Fitzpatrick
- Institute of Health Informatics, Faculty of Population Health Science, University College London, United Kingdom (N.F., C.H.S., A. Timmis, H.H., F.W.A.)
| | - Bruna Gigante
- Department of Clinical Chemistry and Hematology (B.G., I.E.H.)
| | - Stefan James
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (S.J., B.L., L.W.), Uppsala University, Sweden
| | | | - Paulo A Lotufo
- Centro de Pesquisa Clinica, Hospital Universitario, Universidade de Sao Paulo, Brazil (P.A.L.)
| | | | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A.).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.)
| | - Chris Newton Cheh
- Cardiovascular Research Center and Center for Human Genetic Research, Massachusetts General Hospital, Boston and Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.N.C.)
| | - Jan Pitha
- Centre for Experimental Medicine, Institut for Clinical and Experimental Medicine, Prague, Czech Republic (J.A.H., J.P.)
| | - Christoph H Saely
- Institute of Health Informatics, Faculty of Population Health Science, University College London, United Kingdom (N.F., C.H.S., A. Timmis, H.H., F.W.A.).,Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A.L., C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein (A.L., C.H.S., H.D.)
| | - Ayman Samman-Tahhan
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.S.-T., P.B.S., A.A.Q.)
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.S.-T., P.B.S., A.A.Q.)
| | - Andrej Teren
- Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Austria. Heart Center Leipzig (A. Teren).,LIFE Research Center for Civilization Diseases (A. Teren, R.B., M. Scholz, J.T.)
| | - Adam Timmis
- Institute of Health Informatics, Faculty of Population Health Science, University College London, United Kingdom (N.F., C.H.S., A. Timmis, H.H., F.W.A.).,Bart's Heart Centre, St Bartholomew's Hospital, London, United Kingdom (R.S.P., J.D., A. Timmis)
| | - Frans Van de Werf
- Departement of Cardiovascular Sciences, KU Leuven, Belgium (F.V.d.W.)
| | - Els Wauters
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Belgium (E.W.)
| | - Arthur A M Wilde
- AMC Heart Center (A.A.M.W., C.R.B.).,Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia (A.A.M.W.)
| | - Ian Ford
- Robertson Center for Biostatistics (I.F.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.J.S., N.S.)
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus and Julius Center for Health Sciences and Primary Care (A. Algra), University Medical Center Utrecht, the Netherlands
| | | | - Diego Ardissino
- Cardiology Department, Parma University Hospital, Italy (D.A.)
| | - Benoit J Arsenault
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec (B.J.A.).,Department of Medicine, Faculty of Medicine, Université Laval, Canada (B.J.A.)
| | - Christie M Ballantyne
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiovascular Research, and Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V., C.M.B.)
| | - Thomas O Bergmeijer
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | | | - Simon C Body
- Harvard Medical School, Boston, MA (J.D.M., M.H. S.C.B.).,Department of Anesthesia, Pain and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA (S.C.B.)
| | - Peter Bogaty
- Service de cardiologie, Département multidisciplinaire de cardiologie, Instituteitut universitaire de cardiologie et de pneumologie de Québec, Canada (P.B.).,Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal Canada (P.B.).,Instituteitut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Canada (P.B.)
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, University Utrecht, the Netherlands (G.J.d.B.)
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M., H.B.)
| | - Ralph Burkhardt
- LIFE Research Center for Civilization Diseases (A. Teren, R.B., M. Scholz, J.T.).,Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany (R.B.)
| | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (G. Condorelli)
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.)
| | - Sharon Cresci
- Department of Genetics, Statistical Genomics Division (P.A.L., S.C.).,Department of Medicine, Cardiovascular Division Washington University School of Medicine, St Louis, MO (S.C.)
| | - Ulf de Faire
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (K.L., U.d.F.)
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, New Zealand (R.N.D.)
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A.L., C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein (A.L., C.H.S., H.D.).,Drexel University College of Medicine, Philadelphia, PA (H.D.)
| | - James C Engert
- Research Institute of the McGill University Health Centre (J.C.E.).,Division of Cardiology, Department of Medicine, Royal Victoria Hospital (J.C.E., G.T.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.)
| | - Keith A A Fox
- Emeritus Professor of Cardiology (K.A.A.F.), University of Edinburgh
| | - Domenico Girelli
- Department of Medicine, University of Verona, Italy (N. Martinelli, D.G., O.O.)
| | - Emil Hagström
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (A.A., E.H., C.H., D. Lindholm), Uppsala University, Sweden
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T., S.L.H.).,Department of Cardiovascular Medicine, Heart and Vascular Institute and Center for Microbiome and Human Health, Cleveland Clinic, OH (S.L.H.)
| | - Claes Held
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (A.A., E.H., C.H., D. Lindholm), Uppsala University, Sweden
| | - Harry Hemingway
- Institute of Health Informatics, Faculty of Population Health Science, University College London, United Kingdom (N.F., C.H.S., A. Timmis, H.H., F.W.A.)
| | - Imo E Hoefer
- Department of Clinical Chemistry and Hematology (B.G., I.E.H.)
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands (G.K.H.)
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.).,Division of Cardiovascular Medicine, College of Medicine, University of Florida (J.A.J., C.J.P.)
| | - Pim A de Jong
- Department of Radiology (P.A.d.J.), University Medical Center Utrecht, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology (S.T., J.W.J.), Leiden University Medical Center.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden (J.W.J.).,Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.W.J.)
| | - Marcin P Kaczor
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M. Sanak, W.S.)
| | - Mika Kähönen
- Department of Clinical Physiology (M. Kähönen).,Department of Clinical Physiology (M. Kähönen)
| | - Jiri Kettner
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.)
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland (M. Kiliszek)
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology (E.V.B., O.H.K., A.H.M.-v.d.Z.), University Medical Center Utrecht, the Netherlands
| | - Bo Lagerqvist
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (S.J., B.L., L.W.), Uppsala University, Sweden
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics (B.B., D. Lambrechts).,Laboratory for Translational Genetics, VIB Center for Cancer Biology, VIB, Belgium (B.B., D. Lambrechts)
| | - Jari O Laurikka
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center, Faculty of Medicine and Life Sciences, University of Tampere (J.O.L.).,Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Finland (J.O.L)
| | - Terho Lehtimäki
- Department of Clinical Chemistry (L.-P.L., T.L.).,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland (L.-P.L., T.L.)
| | - Daniel Lindholm
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (A.A., E.H., C.H., D. Lindholm), Uppsala University, Sweden
| | - Bakhtawar K Mahmoodi
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology (E.V.B., O.H.K., A.H.M.-v.d.Z.), University Medical Center Utrecht, the Netherlands.,Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, the Netherlands (A.H.M.-v.d.Z.)
| | - Ruth McPherson
- University of Ottawa Heart Institute (R.M.).,Departments of Medicine and Biochemistry, Microbiology and Immunology, University of Ottawa, ON, Canada (R.M.)
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden (P.A., O.M.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (O.M.)
| | - Andres Metspalu
- Estonian Genome Center, Institute of Genomics (A.M.).,Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Estonia (M.A., A.M.)
| | - Witold Pepinski
- Department of Forensic Medicine, Medical University of Bialystok, Poland (W.P., G.T.)
| | - Oliviero Olivieri
- Department of Medicine, University of Verona, Italy (N. Martinelli, D.G., O.O.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Colin N Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (C.N.P.)
| | - Gerard Pasterkamp
- Department of Clinical Chemistry, UMC Utrecht, Netherlands (G. Pasterkamp)
| | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida (J.A.J., C.J.P.)
| | | | - Louise Pilote
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (H.B., L.D., L.P., J.M.B.).,Department of Medicine (L.P., J.M.B.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.S.-T., P.B.S., A.A.Q.)
| | - A Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.B., A.M.R., V.A.C.).,Cardiovascular Research Institute, National University of Singapore (A.M.R.)
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M. Sanak, W.S.)
| | - Markus Scholz
- LIFE Research Center for Civilization Diseases (A. Teren, R.B., M. Scholz, J.T.).,Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany (M. Scholz)
| | - Agneta Siegbahn
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Clinical Chemistry (A. Siegbahn), Uppsala University, Sweden
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital University of Helsinki, Finland (J.S.)
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital (J.G.S.), Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine (J.G.S.), Lund University, Lund, Sweden.,Lund University Diabetes Center (J.G.S.), Lund University, Lund, Sweden
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City and Saint Luke's Health System, Kansas City, MO (J.A.S.)
| | - Alexandre F R Stewart
- Ruddy Canadian Cardiovascular Genetics Centre (R.O.V., A.F.R.S.).,Department of Biochemistry, Microbiology and Immunology (R.O.V., A.F.R.S.)
| | - Wojciech Szczeklik
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M. Sanak, W.S.)
| | | | - Jurriën M Ten Berg
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - George Thanassoulis
- Department of Forensic Medicine, Medical University of Bialystok, Poland (W.P., G.T.).,Division of Cardiology, Department of Medicine, Royal Victoria Hospital (J.C.E., G.T.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.)
| | - Joachim Thiery
- LIFE Research Center for Civilization Diseases (A. Teren, R.B., M. Scholz, J.T.).,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig (J.T.)
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care (Y.v.d.G.), University Medical Center Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, the Netherlands (F.L.J.V.)
| | | | | | - Pim Van der Harst
- CARDIoGRAMPlusC4D. University of Groningen, University Medical Center, Groningen, Netherlands (P.V.d.H.)
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.J.S., N.S.)
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University (G. Pare).,Population Health Research Institute, Hamilton, ON, Canada (G. Pare)
| | - James M Brophy
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre (H.B., L.D., L.P., J.M.B.).,Department of Medicine (L.P., J.M.B.)
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A.).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.)
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (G.D., M. Kleber, W.M.).,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany (W.M.).,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria (W.M.)
| | - Lars Wallentin
- Uppsala Clinical Research Center (A.A., N.E., S.J., E.H., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Cardiology (S.J., B.L., L.W.), Uppsala University, Sweden
| | - Vicky A Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.B., A.M.R., V.A.C.)
| | - Benjamin D Horne
- Laboratory of Experimental Cardiology (C.M.G., B.D.H.).,Department of Biomedical Informatics, University of Utah, Salt Lake City (B.D.H.)
| | - Nilesh J Samani
- Department of Cardiovascular Sciences (P.S.B., C.P.N., N.J.S.) and Department of Health Sciences, University of Leicester, United Kingdom
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.)
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science, Faculty of Population Health Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A.).,Institute of Health Informatics, Faculty of Population Health Science, University College London, United Kingdom (N.F., C.H.S., A. Timmis, H.H., F.W.A.).,Division Heart and Lungs, Department of Cardiology (A.F.S., V.T. D.K., F.W.A.).,Durrer Centre of Cardiogenetic Research, ICIN-Netherlands Heart Institute, Netherlands (J.v.S., F.W.B.)
| |
Collapse
|
9
|
Graves KG, Muhlestein JB, Lappé DL, McCubrey RO, May HT, Knight S, Le VT, Bair TL, Anderson JL, Horne BD. Practical laboratory-based clinical decision tools and associations with short-term bleeding and mortality outcomes. Clin Chim Acta 2018; 482:166-171. [PMID: 29627489 DOI: 10.1016/j.cca.2018.04.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The red cell distribution width (RDW) predicts mortality in numerous populations. The Intermountain Risk Scores (IMRS) predict patient outcomes using laboratory measurements including RDW. Whether the RDW or IMRS predicts in-hospital outcomes is unknown. METHODS The predictive abilities of RDW and two IMRS formulations (the complete blood count [CBC] risk score [CBC-RS] or full IMRS using CBC plus the basic metabolic profile) were studied among percutaneous coronary intervention patients at Intermountain (males: N = 6007, females: N = 2165). Primary endpoints were a composite bleeding outcome and in-hospital mortality. RESULTS IMRS predicted the composite bleeding endpoint (females: χ2 = 47.1, odds ratio [OR] = 1.13 per +1 score, p < 0.001; males: χ2 = 108.7, OR = 1.13 per +1 score, p < 0.001) more strongly than RDW (females: χ2 = 1.6, OR = 1.04 per +1%, p = 0.20; males: χ2 = 11.2, OR = 1.09 per +1%, p < 0.001). For in-hospital mortality, RDW was predictive in females (χ2 = 4.3, OR = 1.13 per +1%, p = 0.037) and males (χ2 = 4.4, OR = 1.11 per +1%, p = 0.037), but IMRS was profoundly more predictive (females: χ2 = 35.5, OR = 1.36 per +1 score, p < 0.001; males: χ2 = 72.9, OR = 1.40 per+1 score, p < 0.001). CBC-RS was more predictive than RDW but not as powerful as IMRS. CONCLUSIONS The IMRS, the CBC-RS, and RDW predict in-hospital outcomes. Risk score-directed personalization of in-hospital clinical care should be studied.
Collapse
Affiliation(s)
- Kevin G Graves
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA; Cardiology Division, Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, USA
| | - Donald L Lappé
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA; Cardiology Division, Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, USA
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA
| | - Heidi T May
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA
| | - Stacey Knight
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA; Genetic Epidemiology Division, Department of Internal Medicine, University of Utah, 391 Chipeta Way, Salt Lake City, UT, USA
| | - Viet T Le
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA
| | - Tami L Bair
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA; Cardiology Division, Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, USA
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, 5121 S Cottonwood St, Salt Lake City, UT, USA; Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT, USA.
| |
Collapse
|
10
|
Hu YJ, Schmidt AF, Dudbridge F, Holmes MV, Brophy JM, Tragante V, Li Z, Liao P, Quyyumi AA, McCubrey RO, Horne BD, Hingorani AD, Asselbergs FW, Patel R, Long Q. Impact of Selection Bias on Estimation of Subsequent Event Risk. Circ Cardiovasc Genet 2017; 10:e001616. [PMID: 28986451 PMCID: PMC5659743 DOI: 10.1161/circgenetics.116.001616] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 07/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies of recurrent or subsequent disease events may be susceptible to bias caused by selection of subjects who both experience and survive the primary indexing event. Currently, the magnitude of any selection bias, particularly for subsequent time-to-event analysis in genetic association studies, is unknown. METHODS AND RESULTS We used empirically inspired simulation studies to explore the impact of selection bias on the marginal hazard ratio for risk of subsequent events among those with established coronary heart disease. The extent of selection bias was determined by the magnitudes of genetic and nongenetic effects on the indexing (first) coronary heart disease event. Unless the genetic hazard ratio was unrealistically large (>1.6 per allele) and assuming the sum of all nongenetic hazard ratios was <10, bias was usually <10% (downward toward the null). Despite the low bias, the probability that a confidence interval included the true effect decreased (undercoverage) with increasing sample size because of increasing precision. Importantly, false-positive rates were not affected by selection bias. CONCLUSIONS In most empirical settings, selection bias is expected to have a limited impact on genetic effect estimates of subsequent event risk. Nevertheless, because of undercoverage increasing with sample size, most confidence intervals will be over precise (not wide enough). When there is no effect modification by history of coronary heart disease, the false-positive rates of association tests will be close to nominal.
Collapse
Affiliation(s)
- Yi-Juan Hu
- Dept of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Amand F Schmidt
- Institute of Cardiovascular Science & The Farr Institute, University College London, UK
| | - Frank Dudbridge
- Dept of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine & Dept of Health Sciences, University of Leicester, UK
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Dept of Population Health, University of Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, UK
| | - James M Brophy
- Dept of Medicine, McGill University, Montreal Quebec, Canada
| | - Vinicius Tragante
- Dept of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ziyi Li
- Dept of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Peizhou Liao
- Dept of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Arshed A Quyyumi
- Division of Cardiology, Dept of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Raymond O. McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, UT
| | - Benjamin D. Horne
- Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, UT
- Dept of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Aroon D Hingorani
- Institute of Cardiovascular Science & The Farr Institute, University College London, UK
| | - Folkert W. Asselbergs
- Institute of Cardiovascular Science & The Farr Institute, University College London, UK
- Dept of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Riyaz Patel
- Institute of Cardiovascular Science & The Farr Institute, University College London, UK
| | - Qi Long
- Dept of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
11
|
Zewinger S, Kleber ME, Tragante V, McCubrey RO, Schmidt AF, Direk K, Laufs U, Werner C, Koenig W, Rothenbacher D, Mons U, Breitling LP, Brenner H, Jennings RT, Petrakis I, Triem S, Klug M, Filips A, Blankenberg S, Waldeyer C, Sinning C, Schnabel RB, Lackner KJ, Vlachopoulou E, Nygård O, Svingen GFT, Pedersen ER, Tell GS, Sinisalo J, Nieminen MS, Laaksonen R, Trompet S, Smit RAJ, Sattar N, Jukema JW, Groesdonk HV, Delgado G, Stojakovic T, Pilbrow AP, Cameron VA, Richards AM, Doughty RN, Gong Y, Cooper-DeHoff R, Johnson J, Scholz M, Beutner F, Thiery J, Smith JG, Vilmundarson RO, McPherson R, Stewart AFR, Cresci S, Lenzini PA, Spertus JA, Olivieri O, Girelli D, Martinelli NI, Leiherer A, Saely CH, Drexel H, Mündlein A, Braund PS, Nelson CP, Samani NJ, Kofink D, Hoefer IE, Pasterkamp G, Quyyumi AA, Ko YA, Hartiala JA, Allayee H, Tang WHW, Hazen SL, Eriksson N, Held C, Hagström E, Wallentin L, Åkerblom A, Siegbahn A, Karp I, Labos C, Pilote L, Engert JC, Brophy JM, Thanassoulis G, Bogaty P, Szczeklik W, Kaczor M, Sanak M, Virani SS, Ballantyne CM, Lee VV, Boerwinkle E, Holmes MV, Horne BD, Hingorani A, Asselbergs FW, Patel RS, Krämer BK, Scharnagl H, Fliser D, März W, Speer T. Relations between lipoprotein(a) concentrations, LPA genetic variants, and the risk of mortality in patients with established coronary heart disease: a molecular and genetic association study. Lancet Diabetes Endocrinol 2017; 5:534-543. [PMID: 28566218 PMCID: PMC5651679 DOI: 10.1016/s2213-8587(17)30096-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/25/2017] [Accepted: 02/14/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPA genetic variants predict long-term mortality in patients with established coronary heart disease remains less clear. METHODS We obtained data from 3313 patients with established coronary heart disease in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We tested associations of tertiles of lipoprotein(a) concentration in plasma and two LPA single-nucleotide polymorphisms ([SNPs] rs10455872 and rs3798220) with all-cause mortality and cardiovascular mortality by Cox regression analysis and with severity of disease by generalised linear modelling, with and without adjustment for age, sex, diabetes diagnosis, systolic blood pressure, BMI, smoking status, estimated glomerular filtration rate, LDL-cholesterol concentration, and use of lipid-lowering therapy. Results for plasma lipoprotein(a) concentrations were validated in five independent studies involving 10 195 patients with established coronary heart disease. Results for genetic associations were replicated through large-scale collaborative analysis in the GENIUS-CHD consortium, comprising 106 353 patients with established coronary heart disease and 19 332 deaths in 22 studies or cohorts. FINDINGS The median follow-up was 9·9 years. Increased severity of coronary heart disease was associated with lipoprotein(a) concentrations in plasma in the highest tertile (adjusted hazard radio [HR] 1·44, 95% CI 1·14-1·83) and the presence of either LPA SNP (1·88, 1·40-2·53). No associations were found in LURIC with all-cause mortality (highest tertile of lipoprotein(a) concentration in plasma 0·95, 0·81-1·11 and either LPA SNP 1·10, 0·92-1·31) or cardiovascular mortality (0·99, 0·81-1·2 and 1·13, 0·90-1·40, respectively) or in the validation studies. INTERPRETATION In patients with prevalent coronary heart disease, lipoprotein(a) concentrations and genetic variants showed no associations with mortality. We conclude that these variables are not useful risk factors to measure to predict progression to death after coronary heart disease is established. FUNDING Seventh Framework Programme for Research and Technical Development (AtheroRemo and RiskyCAD), INTERREG IV Oberrhein Programme, Deutsche Nierenstiftung, Else-Kroener Fresenius Foundation, Deutsche Stiftung für Herzforschung, Deutsche Forschungsgemeinschaft, Saarland University, German Federal Ministry of Education and Research, Willy Robert Pitzer Foundation, and Waldburg-Zeil Clinics Isny.
Collapse
Affiliation(s)
- Stephen Zewinger
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Marcus E Kleber
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany; Institute of Nutrition, Friedrich-Schiller University, Jena, Germany
| | - Vinicius Tragante
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Utrecht, Netherlands
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amand F Schmidt
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | - Kenan Direk
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | - Ulrich Laufs
- Department of Internal Medicine III, Saarland University Hospital, Homburg/Saar, Germany
| | - Christian Werner
- Department of Internal Medicine III, Saarland University Hospital, Homburg/Saar, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Centre, Ulm, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre of Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Dietrich Rothenbacher
- Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany
| | - Lutz P Breitling
- Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany
| | - Herrmann Brenner
- Network Ageing Research, University Heidelberg, Mannheim, Germany; Division of Clinical Epidemiology and Ageing Research, German Cancer Centre (DKFZ), Heidelberg, Germany
| | - Richard T Jennings
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Ioannis Petrakis
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Sarah Triem
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Mira Klug
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Alexandra Filips
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Stefan Blankenberg
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Christoph Waldeyer
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Christoph Sinning
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Renate B Schnabel
- University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre Mainz, Germany
| | | | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Juha Sinisalo
- Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Reijo Laaksonen
- Medical School, Tampere University, Tampere, Finland; Finnish Clinical Biobank Tampere, University Hospital of Tampere, Tampere, Finland
| | - Stella Trompet
- Department of Geriatics and Gerontology, Leiden University Medical Centre, Leiden, Netherlands; Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Roelof A J Smit
- Department of Geriatics and Gerontology, Leiden University Medical Centre, Leiden, Netherlands; Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, BHF Glasgow, Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - J Wouter Jukema
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, Netherlands
| | - Heinrich V Groesdonk
- Department of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Graciela Delgado
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Anna P Pilbrow
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Vicky A Cameron
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, New Zealand
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, Colleges of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Rhonda Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, Colleges of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Julie Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, Colleges of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE Research Centre for Civilisation Diseases, University of Leipzig, Leipzig, Germany
| | | | - Joachim Thiery
- LIFE Research Centre for Civilisation Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - Ragnar O Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alexandre F R Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sharon Cresci
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA; Department of Genetics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Petra A Lenzini
- Statistical Genomics Division, Department of Genetics, Washington University School of Medicine, Saint Louis, MO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | | | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Peter S Braund
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
| | - Daniel Kofink
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Utrecht, Netherlands
| | - Imo E Hoefer
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht, Netherlands
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht, Netherlands
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Yi-An Ko
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - Niclas Eriksson
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Axel Åkerblom
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Igor Karp
- University of Montreal Hospital Research Centre (CRCHUM), University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Louise Pilote
- Department of Medicine, McGill University, Montreal, QC, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - James C Engert
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - James M Brophy
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Peter Bogaty
- Department of Medicine, Université Laval, QC, Canada
| | | | - Marcin Kaczor
- Jagielonian University Medical College, Kraków, Poland
| | - Marek Sanak
- Jagielonian University Medical College, Kraków, Poland
| | - Salim S Virani
- Section of Cardiology, Michael E DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Vei-Vei Lee
- Department of Biostatistics 7, Epidemiology, Texas Heart Institute, Houston, TX, USA
| | - Eric Boerwinkle
- School of Public Health, University of Texas, Houston, TX, USA
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit at the University of Oxford, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Aroon Hingorani
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | - Folkert W Asselbergs
- Department of Cardiology, Heart and Lungs Division, UMC Utrecht, Utrecht, Netherlands; Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK; Durrer Centre of Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, Netherlands
| | - Riyaz S Patel
- Institute of Cardiovascular Science Facultyof Population Health Science, University College London, London, UK
| | | | - Bernhard K Krämer
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Danilo Fliser
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| | - Winfried März
- Fifth Department of Medicine, University Heidelberg, Mannheim, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria; Synlab Academy, Synlab Holding, Mannheim, Germany.
| | - Thimoteus Speer
- Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany
| |
Collapse
|
12
|
Horne BD, Budge D, Masica AL, Savitz LA, Benuzillo J, Cantu G, Bradshaw A, McCubrey RO, Bair TL, Roberts CA, Rasmusson KD, Alharethi R, Kfoury AG, James BC, Lappé DL. Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization. Am Heart J 2017; 185:101-109. [PMID: 28267463 DOI: 10.1016/j.ahj.2016.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Received: 05/12/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk. METHODS HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated. RESULTS The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, red cell distribution width, and mean platelet volume. Among females, odds ratios (OR) were OR=1.99 for iHF tertile 3 vs. 1 (95% confidence interval [CI]=1.28, 3.08) for Intermountain validation (P-trend across tertiles=0.002) and OR=1.29 (CI=1.01, 1.66) for Baylor patients (P-trend=0.049). Among males, iHF had OR=1.95 (CI=1.33, 2.85) for tertile 3 vs. 1 in Intermountain (P-trend <0.001) and OR=2.03 (CI=1.52, 2.71) in Baylor (P-trend < 0.001). Expanded models using 182-183 variables had predictive abilities similar to iHF. CONCLUSIONS Sex-specific laboratory-based electronic health record-delivered iHF risk scores effectively predicted 30-day readmission among HF patients. Efficient to calculate and deliver to clinicians, recent clinical implementation of iHF scores suggest they are useful and useable for more precise clinical HF treatment.
Collapse
Affiliation(s)
- Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
| | - Deborah Budge
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Andrew L Masica
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX
| | - Lucy A Savitz
- Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - José Benuzillo
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT
| | - Gabriela Cantu
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX
| | - Alejandra Bradshaw
- Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Tami L Bair
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Colleen A Roberts
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT
| | - Kismet D Rasmusson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Rami Alharethi
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Abdallah G Kfoury
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Brent C James
- Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Donald L Lappé
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| |
Collapse
|
13
|
Knight S, McCubrey RO, Yuan Z, Woller SC, Horne BD, Bunch TJ, Le VT, Mills RM, Muhlestein JB. Adverse cardiovascular events in acute coronary syndrome with indications for anticoagulation. Ther Adv Cardiovasc Dis 2016; 10:231-41. [PMID: 26920371 DOI: 10.1177/1753944716634563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Randomized acute coronary syndrome (ACS) trials testing various antithrombotic (AT) regimens have largely excluded patients with coexisting conditions and indications for anticoagulation (AC). The purpose of this study is to examine the 2-year clinical outcomes of patients with ACS with indication for AC due to venous thromboembolism (VTE) during hospitalization for the ACS event or a prior or new diagnosis of atrial fibrillation (AF) with a CHADS2 (Congestive heart failure; Hypertension; Age; Diabetes; previous ischemic Stroke) score ⩾2. METHODS ACS patients with AC indication from 2004 to 2009 were identified (n = 619). A Cox proportional hazards model was used to examine the primary efficacy outcome of major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction (MI) or stroke. The primary explanatory variable was at-discharge antithrombotic strategy [single antiplatelet ± AC, dual antiplatelet (DAP) ± AC or AC only; referent DAP + AC]. RESULTS A total of 261 (42.2%) patients had a MACE event. AT strategy was not a significant factor for MACE (all p > 0.09). The factors associated with MACE were high mortality risk score [hazard ratio (HR)=1.87, 95% confidence interval (CI): 1.39- 2.52; p < 0.001), prior MI (HR = 1.44, 95% CI: 1.03-2.01; p= 0.033) and presentation of ST elevation MI (HR = 2.70, 95% CI: 1.61-4.51; p < 0.001) or non-ST elevation MI (HR = 1.70, 95% CI: 1.15-2.49; p < 0.001) compared with angina. CONCLUSIONS In this real world observational study, the at-discharge AT strategy was not significantly associated with the 2-year risk of MACE. These findings do not negate the need for randomized trials to generate evidence-based approaches to management of this important population.
Collapse
Affiliation(s)
- Stacey Knight
- Intermountain Medical Center, Intermountain Heart Institute, 5121 S., Cottonwood St, Murray, UT 84107, USAUniversity of Utah School of Medicine, Salt Lake City, UT, USA
| | - Raymond O McCubrey
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
| | - Zhong Yuan
- Janssen Research and Development LLC, Raritan, NJ, USA
| | - Scott C Woller
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USAUniversity of Utah School of Medicine, Salt Lake City, UT, USA
| | - Benjamin D Horne
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USAUniversity of Utah School of Medicine, Salt Lake City, UT, USA
| | - T Jared Bunch
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USAUniversity of Utah School of Medicine, Salt Lake City, UT, USA
| | - Viet T Le
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
| | - Roger M Mills
- Retired; at time of study was with Janssen Research and Development LLC, Raritan, NJ, USA
| | - Joseph B Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, 5121 S., Cottonwood St, Murray, UT 84107, USA
| |
Collapse
|
14
|
Rassa AC, Horne BD, McCubrey RO, Bair TL, Muhlestein JB, Morris DR, Anderson JL. Novel Stratification of Mortality Risk by Kidney Disease Stage. Am J Nephrol 2016; 42:443-50. [PMID: 26812216 DOI: 10.1159/000443776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/31/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common disorder with a variable clinical course and it is associated with increased mortality. The Intermountain Risk Score (IMRS) is an electronic risk calculator that utilizes complete blood count (CBC) and basic metabolic panel (BMP) values to predict mortality in various healthcare populations. We hypothesized that IMRS would predict mortality in patients with CKD even with adjustment for serum phosphate and urinary albumin. METHODS Three thousand eight hundred seventy-two patients with CKD classes IIIA-V had IMRS calculated retrospectively and survival analysis was performed investigating 1- and 5-year mortality. Kaplan-Meier survival curves were generated for predefined IMRS groups of low, medium and high risk for CKD patients overall and by sex and CKD stage. Serum phosphate and urinary albumin/creatinine ratios were modeled in multivariate Cox-proportional hazard models. Receiver operator characteristic curves were used to determine c-statistics for mortality. RESULTS For all patients with CKD, mortality was significantly greater for those with medium- or high-risk compared to low-risk IMRS categories, among each CKD stage. Overall, IMRS was predictive of mortality at both 1 and 5 years, even when adjusted for CKD stage and predicted mortality more accurately than CKD stage alone. Albuminuria was not independently associated with mortality and serum phosphate weakly predicted mortality. CONCLUSION IMRS is a strong predictor of mortality in patients with CKD and is robustly complementary to CKD stage in refining risk prediction. Given the universal availability and low cost of the CBC and BMP, IMRS may be of a substantial value in CKD risk assessment and management.
Collapse
Affiliation(s)
- Allen C Rassa
- Department of Internal Medicine, University of Utah, Utah, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
McCubrey RO, Knight S, Le V, Ethington JD, Mason S, Anderson J, Dhar R, Meredith KG, Raasch H. DIFFERENCES IN CORONARY FLOW RESERVES BY GENDER AND DIABETIC STATUS AS IDENTIFIED USING CARDIAC PET/CT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61108-1] [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]
|
16
|
McCubrey RO, Alharethi RA, Horne BD, Stehlik J, Reid B, Everitt M, Drakos SD, Budge D, Nativi-Nicolau J, Nixon JL, Fang J, Caine W, Kfoury AG. Determinants of Waiting List Time for Heart Transplantation: Is It All About Sensitization? J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.093] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Mason S, Ethington JD, McCubrey RO, Tonkin AE, Anderson JL. How much heating is associated with magnetic resonance imaging in patients with pacemakers and implantable cardioverter defibrillators? J Cardiovasc Magn Reson 2014. [PMCID: PMC4044969 DOI: 10.1186/1532-429x-16-s1-p374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
18
|
Nixon JL, Benuzillo J, McCubrey RO, Budge D, Rasmusson K, Brush S, Alharethi R, Dyer R, Lappe D, Roberts C, Kfoury A. Is 30-Day Readmission a Valid Measure for Quality Care or Simply an Indicator of Severe Disease in Patients Discharged after Heart Failure Hospitalization? J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
19
|
Jarboe JS, Anderson JC, Duarte CW, Mehta T, Nowsheen S, Hicks PH, Whitley AC, Rohrbach TD, McCubrey RO, Chiu S, Burleson TM, Bonner JA, Gillespie GY, Yang ES, Willey CD. MARCKS regulates growth and radiation sensitivity and is a novel prognostic factor for glioma. Clin Cancer Res 2012; 18:3030-41. [PMID: 22619307 DOI: 10.1158/1078-0432.ccr-11-3091] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study assessed whether myristoylated alanine-rich C-kinase substrate (MARCKS) can regulate glioblastoma multiforme (GBM) growth, radiation sensitivity, and clinical outcome. EXPERIMENTAL DESIGN MARCKS protein levels were analyzed in five GBM explant cell lines and eight patient-derived xenograft tumors by immunoblot, and these levels were correlated to proliferation rates and intracranial growth rates, respectively. Manipulation of MARCKS protein levels was assessed by lentiviral-mediated short hairpin RNA knockdown in the U251 cell line and MARCKS overexpression in the U87 cell line. The effect of manipulation of MARCKS on proliferation, radiation sensitivity, and senescence was assessed. MARCKS gene expression was correlated with survival outcomes in the Repository of Molecular Brain Neoplasia Data (REMBRANDT) Database and The Cancer Genome Atlas (TCGA). RESULTS MARCKS protein expression was inversely correlated with GBM proliferation and intracranial xenograft growth rates. Genetic silencing of MARCKS promoted GBM proliferation and radiation resistance, whereas MARCKS overexpression greatly reduced GBM growth potential and induced senescence. We found MARCKS gene expression to be directly correlated with survival in both the REMBRANDT and TCGA databases. Specifically, patients with high MARCKS expressing tumors of the proneural molecular subtype had significantly increased survival rates. This effect was most pronounced in tumors with unmethylated O(6)-methylguanine DNA methyltransferase (MGMT) promoters, a traditionally poor prognostic factor. CONCLUSIONS MARCKS levels impact GBM growth and radiation sensitivity. High MARCKS expressing GBM tumors are associated with improved survival, particularly with unmethylated MGMT promoters. These findings suggest the use of MARCKS as a novel target and biomarker for prognosis in the proneural subtype of GBM.
Collapse
Affiliation(s)
- John S Jarboe
- The Departments of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
The possible effects on body weight of chewing gum on a regular schedule have not been tested in a randomized controlled trial (RCT). We conducted an 8-week RCT in 201 overweight and obese adults to test the hypothesis that receiving printed material on good nutrition and chewing gum for a minimum of 90 min/day (n = 102) would lead to greater weight loss than receiving printed nutrition information only (n = 99). Changes in BMI, waist circumference, and blood pressure were secondary outcomes. Adherence to the gum-chewing protocol in the intervention group was >95%. In the intention-to-treat analysis, there were virtually no changes in weight or BMI in either group between baseline and the end of the intervention at 8 weeks. Waist circumference decreased significantly in the intervention group between baseline and 8 weeks (mean ± SD change = -1.4 ± 5.3 cm; P = 0.0128); however, there was no significant difference in change in waist circumference comparing the groups. Similarly, systolic and diastolic blood pressure decreased significantly in the intervention group between baseline and 8 weeks (-3.0 ± 9.9 mm Hg; P = 0.0032 and -3.2 ± 7.3 mm Hg; P = 0.0001, respectively); however, there were no significant differences in the changes in systolic or diastolic blood pressure between the groups. Analyses including completers only produced essentially the same results. We conclude that chewing gum on a regular schedule for 8 weeks did not facilitate weight loss in these overweight and obese adults.
Collapse
Affiliation(s)
- James M Shikany
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | | | | | | | | |
Collapse
|