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Jancev M, Vissers TACM, Visseren FLJ, van Bon AC, Serné EH, DeVries JH, de Valk HW, van Sloten TT. Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2024; 67:798-810. [PMID: 38363342 PMCID: PMC10954850 DOI: 10.1007/s00125-024-06107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
AIMS/HYPOTHESIS Continuous glucose monitoring (CGM) is increasingly used in the treatment of type 2 diabetes, but the effects on glycaemic control are unclear. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the effect of CGM on glycaemic control in adults with type 2 diabetes. METHODS We performed a systematic review using Embase, MEDLINE, Web of Science, Scopus and ClinicalTrials.gov from inception until 2 May 2023. We included RCTs investigating real-time CGM (rtCGM) or intermittently scanned CGM (isCGM) compared with self-monitoring of blood glucose (SMBG) in adults with type 2 diabetes. Studies with an intervention duration <6 weeks or investigating professional CGM, a combination of CGM and additional glucose-lowering treatment strategies or GlucoWatch were not eligible. Change in HbA1c and the CGM metrics time in range (TIR), time below range (TBR), time above range (TAR) and glycaemic variability were extracted. We evaluated the risk of bias using the Cochrane risk-of-bias tool version 2. Data were synthesised by performing a meta-analysis. We also explored the effects of CGM on severe hypoglycaemia and micro- and macrovascular complications. RESULTS We found 12 RCTs comprising 1248 participants, with eight investigating rtCGM and four isCGM. Compared with SMBG, CGM use (rtCGM or isCGM) led to a mean difference (MD) in HbA1c of -3.43 mmol/mol (-0.31%; 95% CI -4.75, -2.11, p<0.00001, I2=15%; moderate certainty). This effect was comparable in studies that included individuals using insulin with or without oral agents (MD -3.27 mmol/mol [-0.30%]; 95% CI -6.22, -0.31, p=0.03, I2=55%), and individuals using oral agents only (MD -3.22 mmol/mol [-0.29%]; 95% CI -5.39, -1.05, p=0.004, I2=0%). Use of rtCGM showed a trend towards a larger effect (MD -3.95 mmol/mol [-0.36%]; 95% CI -5.46 to -2.44, p<0.00001, I2=0%) than use of isCGM (MD -1.79 mmol/mol [-0.16%]; 95% CI -5.28, 1.69, p=0.31, I2=64%). CGM was also associated with an increase in TIR (+6.36%; 95% CI +2.48, +10.24, p=0.001, I2=9%) and a decrease in TBR (-0.66%; 95% CI -1.21, -0.12, p=0.02, I2=45%), TAR (-5.86%; 95% CI -10.88, -0.84, p=0.02, I2=37%) and glycaemic variability (-1.47%; 95% CI -2.94, -0.01, p=0.05, I2=0%). Three studies reported one or more events of severe hypoglycaemia and macrovascular complications. In comparison with SMBG, CGM use led to a non-statistically significant difference in the incidence of severe hypoglycaemia (RR 0.66, 95% CI 0.15, 3.00, p=0.57, I2=0%) and macrovascular complications (RR 1.54, 95% CI 0.42, 5.72, p=0.52, I2=29%). No trials reported data on microvascular complications. CONCLUSIONS/INTERPRETATION CGM use compared with SMBG is associated with improvements in glycaemic control in adults with type 2 diabetes. However, all studies were open label. In addition, outcome data on incident severe hypoglycaemia and incident microvascular and macrovascular complications were scarce. REGISTRATION This systematic review was registered on PROSPERO (ID CRD42023418005).
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Affiliation(s)
- Milena Jancev
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tessa A C M Vissers
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arianne C van Bon
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - J Hans DeVries
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Harold W de Valk
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Helmink MAG, Peters SAE, Westerink J, Harris K, Tillmann T, Woodward M, van Sloten TT, van der Meer MG, Teraa M, Dorresteijn JAN, Ruigrok YM, Visseren FLJ, Hageman SHJ. Development and validation of a lifetime prediction model for incident type 2 diabetes in patients with established cardiovascular disease: the CVD2DM model. Eur J Prev Cardiol 2024:zwae096. [PMID: 38584392 DOI: 10.1093/eurjpc/zwae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
AIMS Identifying patients with established cardiovascular disease (CVD) who are at high risk of type 2 diabetes (T2D) may allow for early interventions, reducing the development of T2D and associated morbidity. The aim of this study was to develop and externally validate the CVD2DM model to estimate the 10-year and lifetime risks of T2D in patients with established CVD. METHODS AND RESULTS Sex-specific, competing risk-adjusted Cox proportional hazard models were derived in 19 281 participants with established CVD and without diabetes at baseline from the UK Biobank. The core model's pre-specified predictors were age, current smoking, family history of diabetes mellitus, body mass index, systolic blood pressure, fasting plasma glucose, and HDL cholesterol. The extended model also included HbA1c. The model was externally validated in 3481 patients from the UCC-SMART study. During a median follow-up of 12.2 years (interquartile interval 11.3-13.1), 1628 participants with established CVD were diagnosed with T2D in the UK Biobank. External validation c-statistics were 0.79 [95% confidence interval (CI) 0.76-0.82] for the core model and 0.81 (95% CI 0.78-0.84) for the extended model. Calibration plots showed agreement between predicted and observed 10-year risk of T2D. CONCLUSION The 10-year and lifetime risks of T2D can be estimated with the CVD2DM model in patients with established CVD, using readily available clinical predictors. The model would benefit from further validation across diverse ethnic groups to enhance its applicability. Informing patients about their T2D risk could motivate them further to adhere to a healthy lifestyle.
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Affiliation(s)
- Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Taavi Tillmann
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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van Gennip ACE, Gupta MD, Houben AJHM, Berendschot TTJM, Webers CAB, van Greevenbroek MMJ, van der Kallen CJH, Koster A, Wesselius A, Eussen SJPM, Schalkwijk CG, de Galan BE, Köhler S, Schram MT, Stehouwer CDA, van Sloten TT. Retinal microvascular function and incidence and trajectories of clinically relevant depressive symptoms: the Maastricht Study. Psychol Med 2024:1-10. [PMID: 38469703 DOI: 10.1017/s0033291724000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Cerebral microvascular dysfunction may contribute to depression via disruption of brain structures involved in mood regulation, but evidence is limited. We investigated the association of retinal microvascular function, a proxy for microvascular function in the brain, with incidence and trajectories of clinically relevant depressive symptoms. METHODS Longitudinal data are from The Maastricht Study of 5952 participants (59.9 ± 8.5 years/49.7% women) without clinically relevant depressive symptoms at baseline (2010-2017). Central retinal arteriolar equivalent and central retinal venular equivalent (CRAE and CRVE) and a composite score of flicker light-induced retinal arteriolar and venular dilation were assessed at baseline. We assessed incidence and trajectories of clinically relevant depressive symptoms (9-item Patient Health Questionnaire score ⩾10). Trajectories included continuously low prevalence (low, n = 5225 [87.8%]); early increasing, then chronic high prevalence (early-chronic, n = 157 [2.6%]); low, then increasing prevalence (late-increasing, n = 247 [4.2%]); and remitting prevalence (remitting, n = 323 [5.4%]). RESULTS After a median follow-up of 7.0 years (range 1.0-11.0), 806 (13.5%) individuals had incident clinically relevant depressive symptoms. After full adjustment, a larger CRAE and CRVE were each associated with a lower risk of clinically relevant depressive symptoms (hazard ratios [HRs] per standard deviation [s.d.]: 0.89 [95% confidence interval (CI) 0.83-0.96] and 0.93 [0.86-0.99], respectively), while a lower flicker light-induced retinal dilation was associated with a higher risk of clinically relevant depressive symptoms (HR per s.d.: 1.10 [1.01-1.20]). Compared to the low trajectory, a larger CRAE was associated with lower odds of belonging to the early-chronic trajectory (OR: 0.83 [0.69-0.99]) and a lower flicker light-induced retinal dilation was associated with higher odds of belonging to the remitting trajectory (OR: 1.23 [1.07-1.43]). CONCLUSIONS These findings support the hypothesis that cerebral microvascular dysfunction contributes to the development of depressive symptoms.
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Affiliation(s)
- April C E van Gennip
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Monideepa D Gupta
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Alfons J H M Houben
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Tos T J M Berendschot
- School for Mental Health and Neuroscience, MHENS, Maastricht University, Maastricht, Netherlands
- Ophthalmology, Maastricht University Medical Centre, Maastricht, Netherlands
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University, Maastricht, Netherlands
| | - Carroll A B Webers
- Ophthalmology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marleen M J van Greevenbroek
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Carla J H van der Kallen
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute, CAPHRI, Maastricht University, Maastricht, Netherlands
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Anke Wesselius
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University, Maastricht, Netherlands
- Genetics and Cell Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute, CAPHRI, Maastricht University, Maastricht, Netherlands
- Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Casper G Schalkwijk
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Bastiaan E de Galan
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
- Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, MHENS, Maastricht University, Maastricht, Netherlands
- Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Miranda T Schram
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience, MHENS, Maastricht University, Maastricht, Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Coen D A Stehouwer
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
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Helmink MAG, Hageman SHJ, Eliasson B, Sattar N, Visseren FLJ, Dorresteijn JAN, Harris K, Peters SAE, Woodward M, Szentkúti P, Højlund K, Henriksen JE, Sørensen HT, Serné EH, van Sloten TT, Thomsen RW, Westerink J. Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model. Diabetes Obes Metab 2024. [PMID: 38456579 DOI: 10.1111/dom.15531] [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] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
AIMS To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes. MATERIALS AND METHODS A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank. RESULTS During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts. CONCLUSIONS The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.
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Affiliation(s)
- Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Sciences, University of Glasgow, Glasgow, UK
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, UK
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik H Serné
- Department of Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
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van Gennip ACE, van Sloten TT, Fayosse A, Sabia S, Singh‐Manoux A. Age at cardiovascular disease onset, dementia risk, and the role of lifestyle factors. Alzheimers Dement 2024; 20:1693-1702. [PMID: 38085549 PMCID: PMC10947967 DOI: 10.1002/alz.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/25/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION We first examined the role of age at cardiovascular disease (CVD) onset for incident dementia, and then examined whether lifestyle factors at guideline-recommended levels in individuals with CVD mitigates dementia risk. METHODS We used population-based data (Whitehall II: n = 10,308/baseline 1985-1988/examinations every 4-5 years). Lifestyle factors (non-smoking, body mass index [BMI], physical activity, diet) were extracted post-CVD. RESULTS Over a median of 31.6 years, 3275 (32.1%) developed CVD. At age 70, risk of dementia was higher in individuals with CVD onset before (hazard ratio [HR] of incident dementia for participants with CVD before age 60, using participants without CVD at age 70 as the reference: 1.56, 95% confidence interal [CI] 1.18-2.08) but not after 60 years. In participants with CVD, a greater number of lifestyle factors at recommended levels post-CVD was associated with a lower dementia risk (per lifestyle factor at recommended level HR: 0.73, 95% CI 0.59-0.92). DISCUSSION Our results suggest that early onset CVD is associated with a higher dementia risk at older ages. In those with CVD, the dementia risk was lower if lifestyle factors are at recommended levels following CVD diagnosis. HIGHLIGHTS CVD in midlife but not in late life is associated with a higher risk of dementia. Dementia risk in CVD patients is lower if their lifestyle factors are at recommended levels. These findings provide evidence to promote CVD prevention in midlife or earlier. Study findings also show the importance of a healthy lifestyle in those with CVD.
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Affiliation(s)
- April C. E. van Gennip
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Thomas T. van Sloten
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
| | - Séverine Sabia
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
- Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Archana Singh‐Manoux
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
- Faculty of Brain SciencesUniversity College LondonLondonUK
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Been RA, Noordstar E, Helmink MAG, van Sloten TT, de Ranitz-Greven WL, van Beek AP, Houweling ST, van Dijk PR, Westerink J. HbA 1c and fasting plasma glucose levels are equally related to incident cardiovascular risk in a high CVD risk population without known diabetes. Diagnosis (Berl) 2024; 0:dx-2024-0017. [PMID: 38414181 DOI: 10.1515/dx-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Type 2 diabetes (T2DM) is associated with increased risk for cardiovascular disease (CVD). Whether screen-detected T2DM, based on fasting plasma glucose (FPG) or on HbA1c, are associated with different risks of incident CVD in high-risk populations and which one is preferable for diabetes screening in these populations, remains unclear. METHODS 8,274 high-risk CVD participants were included from the UCC-SMART cohort. Participants were divided into groups based on prior T2DM diagnosis, and combinations of elevated/non-elevated FPG and HbA1c (cut-offs at 7 mmol/L and 48 mmol/mol, respectively): Group 0: known T2DM; group 1: elevated FPG/HbA1c; group 2: elevated FPG, non-elevated HbA1c; group 3: non-elevated FPG, elevated HbA1c; group 1 + 2: elevated FPG, regardless of HbA1c; group 1 + 3: elevated HbA1c, regardless of FPG; and group 4 (reference), non-elevated FPG/HbA1c. RESULTS During a median follow-up of 6.3 years (IQR 3.3-9.8), 712 cardiovascular events occurred. Compared to the reference (group 4), group 0 was at increased risk (HR 1.40; 95 % CI 1.16-1.68), but group 1 (HR 1.16; 95 % CI 0.62-2.18), 2 (HR 1.18; 95 % CI 0.84-1.67), 3 (HR 0.61; 95 % CI 0.15-2.44), 1 + 2 (HR 1.17; 95 % CI 0.86-1.59) and 1 + 3 (HR 1.01; 95 % CI 0.57-1.79) were not. However, spline interpolation showed a linearly increasing risk with increasing HbA1c/FPG, but did not allow for identification of other cut-off points. CONCLUSIONS Based on current cut-offs, FPG and HbA1c at screening were equally related to incident CVD in high-risk populations without known T2DM. Hence, neither FPG, nor HbA1c, is preferential for diabetes screening in this population with respect to risk of incident CVD.
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Affiliation(s)
- Riemer A Been
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen Noordstar
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - André P van Beek
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Peter R van Dijk
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Westerink
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
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Beran M, van Gennip AC, Stehouwer CD, Jansen JF, Gupta MD, Houben AJ, Berendschot TT, Webers CA, Wesselius A, Schalkwijk CG, Backes WH, de Jong JJ, van der Kallen CJ, van Greevenbroek MM, Köhler S, Vonk JM, Geerlings MI, Schram MT, van Sloten TT. Microvascular Dysfunction and Whole-Brain White Matter Connectivity: The Maastricht Study. J Am Heart Assoc 2024; 13:e9112. [PMID: 38240213 PMCID: PMC11056139 DOI: 10.1161/jaha.123.031573] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/16/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Microvascular dysfunction is involved in the development of various cerebral disorders. It may contribute to these disorders by disrupting white matter tracts and altering brain connectivity, but evidence is scarce. We investigated the association between multiple biomarkers of microvascular function and whole-brain white matter connectivity. METHODS AND RESULTS Cross-sectional data from The Maastricht Study, a Dutch population-based cohort (n=4326; age, 59.4±8.6 years; 49.7% women). Measures of microvascular function included urinary albumin excretion, central retinal arteriolar and venular calibers, composite scores of flicker light-induced retinal arteriolar and venular dilation, and plasma biomarkers of endothelial dysfunction (intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, and von Willebrand factor). White matter connectivity was calculated from 3T diffusion magnetic resonance imaging to quantify the number (average node degree) and organization (characteristic path length, global efficiency, clustering coefficient, and local efficiency) of white matter connections. A higher plasma biomarkers of endothelial dysfunction composite score was associated with a longer characteristic path length (β per SD, 0.066 [95% CI, 0.017-0.114]) after adjustment for sociodemographic, lifestyle, and cardiovascular factors but not with any of the other white matter connectivity measures. After multiple comparison correction, this association was nonsignificant. None of the other microvascular function measures were associated with any of the connectivity measures. CONCLUSIONS These findings suggest that microvascular dysfunction as measured by indirect markers is not associated with whole-brain white matter connectivity.
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Affiliation(s)
- Magdalena Beran
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - April C.E. van Gennip
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Jacobus F.A. Jansen
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Monideepa D. Gupta
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Alfons J.H.M. Houben
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Tos T.J.M. Berendschot
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of OphthalmologyMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
| | - Carroll A.B. Webers
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of OphthalmologyMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
| | - Anke Wesselius
- Department of EpidemiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Casper G. Schalkwijk
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Walter H. Backes
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Joost J.A. de Jong
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
| | - Carla J.H. van der Kallen
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M.J. van Greevenbroek
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Alzheimer Centrum LimburgMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Jet M.J. Vonk
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Mirjam I. Geerlings
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of General PracticeAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized MedicineAmsterdamThe Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and SleepAmsterdamThe Netherlands
| | - Miranda T. Schram
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular Centre, Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Thomas T. van Sloten
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
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8
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van Gennip ACE, Satizabal CL, Tracy RP, Sigurdsson S, Gudnason V, Launer LJ, van Sloten TT. Associations of plasma NfL, GFAP, and t-tau with cerebral small vessel disease and incident dementia: longitudinal data of the AGES-Reykjavik Study. GeroScience 2024; 46:505-516. [PMID: 37530894 PMCID: PMC10828267 DOI: 10.1007/s11357-023-00888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
We investigated the associations of plasma neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and total tau (t-tau) with markers of cerebral small vessel disease (SVD) and with incident dementia. We also investigated whether associations of NfL, GFAP, and t-tau with incident dementia were explained by SVD. Data are from a random subsample (n = 1069) of the population-based AGES-Reykjavik Study who underwent brain MRI and in whom plasma NfL, GFAP, and t-tau were measured at baseline (76.1 ± 5.4 years/55.9% women/baseline 2002-2006/follow-up until 2015). A composite SVD burden score was calculated using white matter hyperintensity volume (WMHV), subcortical infarcts, cerebral microbleeds, and large perivascular spaces. Dementia was assessed in a 3-step process and adjudicated by specialists. Higher NfL was associated with a higher SVD burden score. Dementia occurred in 225 (21.0%) individuals. The SVD burden score significantly explained part of the association between NfL and incident dementia. WMHV mostly strongly contributed to the explained effect. GFAP was not associated with the SVD burden score, but was associated with WMHV, and WMHV significantly explained part of the association between GFAP and incident dementia. T-tau was associated with WMHV, but not with incident dementia. In conclusion, the marker most strongly related to SVD is plasma NfL, for which the association with WMHV appeared to explain part of its association with incident dementia. This study suggests that plasma NfL may reflect the contribution of co-morbid vascular disease to dementia. However, the magnitude of the explained effect was relatively small, and further research is required to investigate the clinical implications of this finding.
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Affiliation(s)
- April C E van Gennip
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Russell P Tracy
- Laboratory for Clinical Biochemistry Research, The Robert Larner M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Thomas T van Sloten
- Department of Vascular Medicine, Utrecht University Medical Center, Utrecht, The Netherlands.
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9
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Bonekamp NE, Visseren FLJ, Cramer MJ, Dorresteijn JAN, van der Meer MG, Ruigrok YM, van Sloten TT, Teraa M, Geleijnse JM, Koopal C. Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease. Eur J Prev Cardiol 2024; 31:205-213. [PMID: 37774501 DOI: 10.1093/eurjpc/zwad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
AIMS To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD). METHODS AND RESULTS Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92). CONCLUSION These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.
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Affiliation(s)
- Nadia E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
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10
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van der Heide FCT, Steens ILM, Limmen B, Mokhtar S, van Boxtel MPJ, Schram MT, Köhler S, Kroon AA, van der Kallen CJH, Dagnelie PC, van Dongen MCJM, Eussen SJPM, Berendschot TTJM, Webers CAB, van Greevenbroek MMJ, Koster A, van Sloten TT, Jansen JFA, Backes WH, Stehouwer CDA. Thinner inner retinal layers are associated with lower cognitive performance, lower brain volume, and altered white matter network structure-The Maastricht Study. Alzheimers Dement 2024; 20:316-329. [PMID: 37611119 PMCID: PMC10917009 DOI: 10.1002/alz.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The retina may provide non-invasive, scalable biomarkers for monitoring cerebral neurodegeneration. METHODS We used cross-sectional data from The Maastricht study (n = 3436; mean age 59.3 years; 48% men; and 21% with type 2 diabetes [the latter oversampled by design]). We evaluated associations of retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer thicknesses with cognitive performance and magnetic resonance imaging indices (global grey and white matter volume, hippocampal volume, whole brain node degree, global efficiency, clustering coefficient, and local efficiency). RESULTS After adjustment, lower thicknesses of most inner retinal layers were significantly associated with worse cognitive performance, lower grey and white matter volume, lower hippocampal volume, and worse brain white matter network structure assessed from lower whole brain node degree, lower global efficiency, higher clustering coefficient, and higher local efficiency. DISCUSSION The retina may provide biomarkers that are informative of cerebral neurodegenerative changes in the pathobiology of dementia.
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Grants
- 31O.041 OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs
- Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), the Cardiovascular Center (CVC, Maastricht, the Netherlands), CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands), CAPHRI School for Public Health and Primary Care (Maastricht, the Netherlands), NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), Health Foundation Limburg (Maastricht, the Netherlands), Perimed (Järfälla, Sweden), and by unrestricted grants from Janssen-Cilag B.V. (Tilburg, the Netherlands), Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands), and Sanofi-Aventis Netherlands B.V. (Gouda, the Netherlands)
- 916.19.074 VENI research
- 2018T025 Netherlands Organization for Scientific Research and the Netherlands Organization for Health Research and Development, and a Dutch Heart Foundation research
- 2021.81.004 Diabetes Fonds Fellowship
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11
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Helmink MAG, Hageman SHJ, Visseren FLJ, de Ranitz-Greven WL, de Valk HW, van Sloten TT, Westerink J. Variability in benefit from intensive insulin therapy on cardiovascular events in individuals with type 1 diabetes: A post hoc analysis of the DCCT/EDIC study. Diabet Med 2023; 40:e15183. [PMID: 37470718 DOI: 10.1111/dme.15183] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
AIM To evaluate presence of treatment effect heterogeneity of intensive insulin therapy (INT) on occurrence of major adverse cardiovascular events (MACE) in individuals with type 1 diabetes. METHODS In participants from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study, individual treatment effect of INT (≥3 daily insulin injections/insulin pump therapy) versus conventional therapy (once/twice daily insulin) on the risk of MACE was estimated using a penalized Cox regression model including treatment-by-covariate interaction terms. RESULTS In 1441 participants, 120 first MACE events were observed and 1279 individuals (89%) were predicted to benefit from INT with regard to MACE risk reduction. The study population was divided into four groups based on predicted treatment effect: one group with no predicted benefit and three tertiles with predicted treatment benefit. The median absolute reduction in 30-year risk of MACE across groups of predicted treatment effect ranged from -0.2% (i.e. risk increase; interquartile range [IQR] -0.1% to -0.3%) in the group with no predicted benefit to 6.6% (i.e. risk reduction; IQR 3.8%-10.9%; number needed to treat 15) in the highest tertile of predicted benefit. The observed benefit of preventing microvascular complications was stable across all subgroups of predicted MACE benefit. CONCLUSIONS Although INT reduces the risk of MACE in the majority of individuals with type 1 diabetes, benefit varies substantially. These individual differences in the effect of INT underline the necessity for a better understanding of the individual response to intensive treatment.
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Affiliation(s)
- Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harold W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands
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12
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Geraets AFJ, Köhler S, Vergoossen LWM, Backes WH, Stehouwer CD, Verhey FRJ, Jansen JFA, van Sloten TT, Schram MT. The association of white matter connectivity with prevalence, incidence and course of depressive symptoms: The Maastricht Study. Psychol Med 2023; 53:5558-5568. [PMID: 36069192 PMCID: PMC10493191 DOI: 10.1017/s0033291722002768] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/27/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Altered white matter brain connectivity has been linked to depression. The aim of this study was to investigate the association of markers of white matter connectivity with prevalence, incidence and course of depressive symptoms. METHODS Markers of white matter connectivity (node degree, clustering coefficient, local efficiency, characteristic path length, and global efficiency) were assessed at baseline by 3 T MRI in the population-based Maastricht Study (n = 4866; mean ± standard deviation age 59.6 ± 8.5 years, 49.0% women; 17 406 person-years of follow-up). Depressive symptoms (9-item Patient Health Questionnaire; PHQ-9) were assessed at baseline and annually over seven years of follow-up. Major depressive disorder (MDD) was assessed with the Mini-International Neuropsychiatric Interview at baseline only. We used negative binominal, logistic and Cox regression analyses, and adjusted for demographic, cardiovascular, and lifestyle risk factors. RESULTS A lower global average node degree at baseline was associated with the prevalence and persistence of clinically relevant depressive symptoms [PHQ-9 ⩾ 10; OR (95% confidence interval) per standard deviation = 1.21 (1.05-1.39) and OR = 1.21 (1.02-1.44), respectively], after full adjustment. On the contrary, no associations were found of global average node degree with the MDD at baseline [OR 1.12 (0.94-1.32) nor incidence or remission of clinically relevant depressive symptoms [HR = 1.05 (0.95-1.17) and OR 1.08 (0.83-1.41), respectively]. Other connectivity measures of white matter organization were not associated with depression. CONCLUSIONS Our findings suggest that fewer white matter connections may contribute to prevalent depressive symptoms and its persistence but not to incident depression. Future studies are needed to replicate our findings.
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Affiliation(s)
- Anouk F. J. Geraets
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Alzheimer Centrum Limburg, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Alzheimer Centrum Limburg, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Laura WM Vergoossen
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Walter H. Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Frans RJ Verhey
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Alzheimer Centrum Limburg, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Jacobus FA Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Thomas T. van Sloten
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
| | - Miranda T. Schram
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
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13
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Jancev M, Snoek FJ, Frederix GWJ, Knottnerus H, Blauw H, Witkop M, Moons KGM, van Bon AC, DeVries JH, Serné EH, van Sloten TT, de Valk HW. Dual hormone fully closed loop in type 1 diabetes: a randomised trial in the Netherlands - study protocol. BMJ Open 2023; 13:e074984. [PMID: 37612114 PMCID: PMC10450048 DOI: 10.1136/bmjopen-2023-074984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The management of type 1 diabetes (T1DM) has undergone significant advancements with the availability of novel technologies, notably continuous and flash glucose monitoring (CGM and FGM, respectively) and hybrid closed loop (HCL) therapy. The dual hormone fully closed loop (DHFCL) approach with insulin and glucagon infusion has shown promising effects in small studies on glycaemic regulation and quality of life in T1DM. METHODS AND ANALYSIS The Dual Hormone Fully Closed Loop for Type 1 Diabetes (DARE) study is a non-commercial 12-month open-label, two-arm randomised parallel-group trial. The primary aim of this study is to determine the long-term effects on glycaemic control, patient-reported outcome measurements and cost-effectiveness of the DHFCL compared with usual care, that is, HCL or treatment with multiple daily insulin injections+FGM/CGM. We will include 240 adult patients with T1DM in 14 hospitals in the Netherlands. Individuals will be randomised 1:1 to the DHFCL or continuation of their current care. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Medical Research Ethics Committee NedMec, Utrecht, the Netherlands. Findings will be disseminated through peer-reviewed publications and presentations at local, national and international conferences. TRIAL REGISTRATION NUMBER NCT05669547.
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Affiliation(s)
- Milena Jancev
- Vascular Medicine and Endocrinology, UMC Utrecht, Utrecht, The Netherlands
| | - Frank J Snoek
- Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Geert W J Frederix
- Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Karel G M Moons
- Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arianne C van Bon
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - J Hans DeVries
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik H Serné
- Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Harold W de Valk
- Vascular Medicine and Endocrinology, UMC Utrecht, Utrecht, The Netherlands
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14
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van Sloten TT, Climie RED, Deraz O, Périer MC, Valentin E, Fayosse A, Sabia S, Weiderpass E, Jouven X, Goldberg M, Zins M, Touvier M, Deschasaux-Tanguy M, Fezeu L, Hercberg S, Singh-Manoux A, Empana JP. Is the number of ideal cardiovascular health metrics in midlife associated with lower risk of cancer? Evidence from 3 European prospective cohorts. CMAJ Open 2023; 11:E774-E781. [PMID: 37607746 PMCID: PMC10449017 DOI: 10.9778/cmajo.20220175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Primordial prevention may be a relevant strategy for the prevention of cancer. Given the commonality of risk factors and mechanisms between cancer and cardiovascular disease, we examined the associations between the number of ideal cardiovascular health metrics in midlife and incident cancer. METHODS In 3 European cohorts (NutriNet-Santé and GAZEL, France; Whitehall II, United Kingdom), the number of ideal cardiovascular health metrics was determined at baseline (range 0-7). Follow-up for cancer events was until October 2020 (NutriNet-Santé), March 2017 (Whitehall II) and December 2015 (GAZEL). Cox regression was conducted in each cohort, and results were thereafter pooled using a random-effects model. RESULTS Data were available on 39 718 participants. A total of 16 237 were from NutriNet-Santé (mean age 51.3 yr; 28% men), 9418 were from Whitehall II (mean age 44.8 yr; 68% men) and 14 063 were from GAZEL (mean age 45.2 yr; 75% men). The median follow-up was 8.1 years in NutriNet-Santé, 29.6 years in Whitehall II and 24.8 years in GAZEL, and yielded a total of 4889 cancer events. A greater number of ideal cardiovascular health metrics was associated with a lower overall cancer risk in each cohort, with an aggregate hazard ratio (HR) per 1 increment in number of ideal metrics of 0.91 (95% confidence interval [CI] 0.88-0.93). This association remained after removal of the smoking metric (aggregate HR per unit increment in number of ideal metrics: 0.94, 95% CI 0.90-0.97), and site-specific analysis demonstrated a significant association with lung cancer. INTERPRETATION A greater number of ideal cardiovascular health metrics in midlife was associated with lower cancer risk, notably lung cancer. Primordial prevention of cardiovascular risk factors in midlife may be a complementary strategy to prevent the onset of cancer.
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Affiliation(s)
- Thomas T van Sloten
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Rachel E D Climie
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Omar Deraz
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Marie-Cécile Périer
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Eugenie Valentin
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Aurore Fayosse
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Séverine Sabia
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Elisabete Weiderpass
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Marcel Goldberg
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Marie Zins
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Mathilde Touvier
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Léopold Fezeu
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Serge Hercberg
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Archana Singh-Manoux
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Jean-Philippe Empana
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
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Sedaghat S, Ji Y, Empana JP, Hughes TM, Mosley TH, Gottesman RF, Griswold M, Jack CR, Lutsey PL, van Sloten TT. Changes in Cardiovascular Health Across Midlife and Late-Life and Magnetic Resonance Imaging Markers of Cerebral Vascular Disease in Late-Life. Stroke 2023; 54:1280-1288. [PMID: 36951053 PMCID: PMC10133201 DOI: 10.1161/strokeaha.122.041374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cardiovascular health may be used for prevention of cerebral vascular disease; however, data on the association of cardiovascular health across midlife and late-life with late-life cerebral vascular disease are lacking. Our aim was to examine whether midlife or late-life cardiovascular health as well as changes of cardiovascular health within midlife and between midlife and late-life were associated with prevalence of magnetic resonance imaging markers of cerebral vascular disease at late-life. METHODS Prospective cohort study including 1638 participants from the Atherosclerosis Risk in Communities Study who took part in 2 visits at midlife (mean ages, 53 and 59 years), and a late-life visit (mean age, 76 years). A cardiovascular health Life's Simple 7 score (range, 0-12/0-14, depending on diet availability) including 6 out of 7 items was calculated at each visit, with weight assigned to each item as poor (0), intermediate (1), or ideal (2). Participants underwent 3T brain magnetic resonance imaging scans in late-life visit. Outcomes were white matter hyperintensity volume, microbleeds, and lacunar, subcortical, and cortical infarcts at late-life. Linear and logistic regression models were used to assess the associations of cardiovascular health in midlife and late-life, and improvement of cardiovascular health within midlife, and from midlife to late-life with magnetic resonance imaging markers of cerebral vascular disease, adjusting for potential confounders. RESULTS A higher cardiovascular health in midlife, improvement of cardiovascular health within midlife, higher cardiovascular health at late-life, and improvement of cardiovascular health from midlife to late-life were associated with a lower prevalence of cerebral vascular disease markers. For example, improvement in cardiovascular health (per point) from midlife to late-life was associated with smaller white matter hyperintensity volume (β, -0.07 [95% CI, -0.10 to -0.04]) and lower odds of microbleeds (odds ratio, 0.93 [0.90-0.97]), lacunar (odds ratio, 0.93 [0.89-0.97]), subcortical (odds ratio, 0.93 [0.89-0.97]), and cortical infarcts (odds ratio, 0.92 [0.87-0.97]). CONCLUSIONS Improving cardiovascular health within midlife and from midlife to late-life may prevent development of cerebral vascular disease.
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Affiliation(s)
- Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Jean-Philippe Empana
- Université de Paris, INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | | | - Thomas H Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, MS, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Michael Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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16
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Sedaghat S, Lutsey PL, Ji Y, Empana JP, Sorond F, Hughes T, Mosley TH, Gottesman RF, Knopman DS, Walker KA, Gudnason V, Launer LJ, van Sloten TT. Association of change in cardiovascular risk factors with incident dementia. Alzheimers Dement 2023; 19:1821-1831. [PMID: 36303296 PMCID: PMC10782572 DOI: 10.1002/alz.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We evaluated whether better cardiovascular health at midlife and improvement of cardiovascular health within midlife were associated with dementia risk. METHODS Two longitudinal population-based studies were used: Atherosclerosis Risk in Communities (ARIC) (n = 11,460/visits at ages 54 and 60), and Age, Gene/Environment Susceptibility (AGES)-Reykjavik (n = 3907/visit at age 51). A cardiovascular health score (range 0-12/0-14, depending on diet availability) including six/seven items was calculated at each visit, with weight assigned to each item as poor (0), intermediate (1), or ideal (2). Cardiovascular health was defined as low (score 0-4/0-5), intermediate (5-7/6-9), or high (8-12/10-14). Incident dementia was ascertained through linkage to health records and with neuropsychological examinations. RESULTS Midlife high compared to low cardiovascular health (hazard ratios [HRs]: for ARIC: 0.60 [95% confidence interval: 0.52, 0.69]); for AGES-Reykjavik: 0.83 [0.66, 0.99] and improvement of cardiovascular health score within midlife (HR per one-point increase: ARIC: 0.94 [0.92, 0.96]) were associated with lower dementia risk. DISCUSSION Better cardiovascular health at midlife and improvement of cardiovascular health within midlife are associated with lower dementia risk. HIGHLIGHTS Cardiovascular health and dementia were studied in two large cohort studies. Better cardiovascular health at midlife relates to lower dementia risk. Improvement of cardiovascular health within midlife relates to lower dementia risk. Promotion of cardiovascular health at midlife can help to reduce dementia risk.
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Affiliation(s)
- Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Jean-Philippe Empana
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | - Farzaneh Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, IL, USA
| | | | - Thomas H Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, MS, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | | | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Laboratory for Epidemiology, Demography and Biometry of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Thomas T van Sloten
- School for Cardiovascular Diseases, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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van Sloten TT, Martens FMAC, Visseren FLJ. [The PROMINENT trial: swan song of the fibrates]. Ned Tijdschr Geneeskd 2023; 167. [PMID: 37022121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Post hoc analyses of previous fibrate trials have suggested that individuals with type 2 diabetes mellitus with high triglyceride levels and low HDL-cholesterol levels benefit from fibrate therapy even when the overall trial results were neutral. However the PROMINENT (Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes) trial seems to close the door for fibrates. The trial found that fibrates do not reduce the risk of cardiovascular disease among individuals with type 2 diabetes and high triglyceride levels and low HDL cholesterol levels, despite triglyceride lowering. The results of PROMINENT suggest that triglyceride lowering without decreases in the plasma concentration of atherogenic lipoproteins are unlikely to decrease the risk of cardiovascular disease. These results also highlight the importance of rigorously confirmation of post hoc findings before implementation in clinical practice.
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Affiliation(s)
- Thomas T van Sloten
- UMC Utrecht, afd. Vasculaire Geneeskunde, Utrecht
- Contact: Thomas T. van Sloten
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18
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van Sloten TT, Valentin E, Climie RE, Jouven X, Lemogne C, Goldberg M, Zins M, Empana JP. Association of Cardiovascular Health With Risk of Clinically Relevant Depressive Symptoms. JAMA Psychiatry 2023; 80:342-349. [PMID: 36790776 PMCID: PMC9932942 DOI: 10.1001/jamapsychiatry.2022.5056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/11/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Importance Cardiovascular health may be used for prevention of depressive symptoms. However, data on the association of cardiovascular health across midlife with depressive symptoms are lacking. Objective To evaluate whether better baseline cardiovascular health and improvement of cardiovascular health over time are associated with a lower risk of both incident depressive symptoms and unfavorable trajectories of depressive symptoms. Design, Setting, and Participants Participants without depressive symptoms were included from a prospective community-based cohort in France (GAZEL cohort). Cardiovascular health examinations occurred in 1990 and 1997 and assessment of depressive symptoms in 1997 and every 3 years thereafter until 2015. Data were analyzed from January to October 2022. Exposures Number of cardiovascular health metrics (smoking, body mass index, physical activity, diet, blood pressure, glucose, and cholesterol) at an intermediate or ideal level in 1997 (range, 0-7) and 7-year change in cardiovascular health between 1990 and 1997. Main Outcomes and Measures Primary outcome was incident depressive symptoms (20-item Center for Epidemiologic Studies-Depression Scale [CES-D] score of 17 or greater in men or 23 or greater in women); secondary outcome was trajectories of depressive symptoms scores. Trajectories included consistently low scores, moderately elevated scores, low starting then increasing scores, moderately high starting, increasing, then remitting scores, and moderately high starting then increasing scores. Results Of 6980 included patients, 1671 (23.9%) were women, and the mean (SD) age was 53.3 (3.5) years. During a follow-up spanning 19 years after 1997, 1858 individuals (26.5%) had incident depressive symptoms. Higher baseline cardiovascular health in 1997 and improvement in cardiovascular health over 7 years were each associated with lower risk of depressive symptoms (odds ratio [OR] per additional metric at intermediate or ideal level at baseline, 0.87; 95% CI, 0.84-0.91; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.91; 95% CI, 0.86-0.96). Also, better cardiovascular health was associated with lower risk of unfavorable depressive symptoms trajectories. Compared with the consistently low score trajectory, the lowest risks were observed for the low starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.70; 95% CI, 0.64-0.76; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.73; 95% CI, 0.68-0.79) and the moderately high starting then increasing score trajectory (OR per additional metric at intermediate or ideal level at baseline, 0.71; 95% CI, 0.64-0.79; OR per 1 higher metric at intermediate or ideal level over 7 years, 0.71; 95% CI, 0.64-0.77). Conclusions and Relevance In this prospective community-based cohort study of adults, higher cardiovascular health was associated with a lower risk of depressive symptoms over time. Elucidating which set of cardiovascular factors may affect depression risk could be important for prevention.
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Affiliation(s)
- Thomas T. van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eugénie Valentin
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
| | - Rachel E. Climie
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
- Menzies Institute for Medical Research, University of Tasmania, Hobert, Australia
| | - Xavier Jouven
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
| | - Cedric Lemogne
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, Paris, France
- Service de Psychiatrie de l’Adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Marcel Goldberg
- Université Paris Cité, Population-based Cohorts Unit, INSERM, Paris-Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, UMS 011, Paris, France
| | - Marie Zins
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, Paris, France
| | - Jean-Philippe Empana
- Université Paris Cité, INSERM, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), UMR-S970, Paris, France
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van Gennip ACE, Schram MT, Köhler S, Kroon AA, Koster A, Eussen SJPM, de Galan BE, van Sloten TT, Stehouwer CDA. Association of type 2 diabetes according to the number of risk factors within the recommended range with incidence of major depression and clinically relevant depressive symptoms: a prospective analysis. Lancet Healthy Longev 2023; 4:e63-e71. [PMID: 36738746 DOI: 10.1016/s2666-7568(22)00291-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Type 2 diabetes is associated with an increased risk of depression, but the extent to which risk factor modification can mitigate this risk is unclear. We aimed to examine the association between the incidence of major depression and clinically relevant depressive symptoms among individuals with type 2 diabetes, according to the number of risk factors within the recommended target range, compared with individuals without diabetes. METHODS We did a prospective analysis of population-based data from the UK Biobank and the Maastricht Study. Individuals with type 2 diabetes were categorised according to the number of risk factors within the recommended target range (non-smoking, guideline-recommended levels of glycated haemoglobin (HbA1c), blood pressure, BMI, albuminuria, physical activity, and diet). The primary outcome, based on data from the UK Biobank, was the incidence of major depression ascertained from hospital records; the secondary outcome, based on data from the UK Biobank and the Maastricht Study, was clinically relevant depressive symptoms based on a score of 10 or higher on the Patient Health Questionnaire (PHQ-9). FINDINGS The study population of the UK Biobank comprised 77 786 individuals (9047 with type 2 diabetes and 68 739 without diabetes; median age 59 years [IQR 51-64]; 34 136 [43·9%] women and 43 650 [56·1%] men). A median of 12·7 years (IQR 11·8-13·4) after recruitment (between March 13, 2006, and Oct 1, 2010), 493 (5·5%) of 9047 individuals with type 2 diabetes and 2574 (3·7%) of 68 739 individuals without diabetes developed major depression. Compared with individuals without diabetes, those with type 2 diabetes had a higher risk of major depression (hazard ratio [HR] 1·61 [95% CI 1·49-1·77]). Among individuals with type 2 diabetes, the excess risk of depression decreased stepwise with an increasing number of risk factors within the recommended target range (HR 2·04 [95% CI 1·65-2·52] for up to two risk factors within the recommended target range; 1·95 [1·65-2·30] for three risk factors within the recommended target range; 1·38 [1·16-1·65] for four risk factors within the recommended target range; and 1·34 [1·12-1·62] for five to seven risk factors within the recommended target range). In the UK Biobank dataset, a median of 7·5 years (IQR 6·8-8·2) after the baseline examination, 147 (7·5%) of 1953 individuals with type 2 diabetes and 954 (4·5%) of 21 413 individuals without diabetes had developed clinically relevant depressive symptoms. The study population of the Maastricht Study comprised 4530 individuals (1158 with type 2 diabetes and 3372 without diabetes; median age 60 years [IQR 53-66]; 2244 [49·5%] women and 2286 [50·1%] men). A median of 5·1 years (IQR 4·1-6·1) after recruitment (between Sept 1, 2010, and Dec 7, 2017), 170 (14·7%) of 1158 individuals with type 2 diabetes and 227 (6·7%) of 3372 individuals without diabetes developed clinically relevant depressive symptoms. Similarly, in both the UK Biobank dataset and the Maastricht Study cohort, among individuals with type 2 diabetes, the excess risk of clinically relevant depressive symptoms decreased stepwise with an increasing number of risk factors within the recommended target range. INTERPRETATION Among individuals with type 2 diabetes, the excess risk of major depression and clinically relevant depressive symptoms decreased stepwise with an increasing number of risk factors within the recommended target range. This study provides further evidence to promote risk factor modification strategies in individuals with type 2 diabetes and to encourage the adoption of a healthy lifestyle. FUNDING ZonMW, Hartstichting, and Diabetes Fonds.
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Affiliation(s)
- April C E van Gennip
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, Netherlands; Department of Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, Netherlands; Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands; Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, Netherlands.
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, Netherlands
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Machado-Fragua MD, Fayosse A, Yerramalla MS, van Sloten TT, Tabak AG, Kivimaki M, Sabia S, Singh-Manoux A. Association of Metabolic Syndrome With Incident Dementia: Role of Number and Age at Measurement of Components in a 28-Year Follow-up of the Whitehall II Cohort Study. Diabetes Care 2022; 45:2127-2135. [PMID: 35819815 PMCID: PMC9472484 DOI: 10.2337/dc22-0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous research suggests an inconsistent association between Metabolic syndrome (MetS) and incident dementia. We examined the role of number of MetS components and age at their assessment for incident dementia. RESEARCH DESIGN AND METHODS MetS components (fasting glucose, triglycerides, waist circumference, blood pressure, and HDL cholesterol) on 7,265, 6,660, and 3,608 participants at <60, 60 to <70, and ≥70 years of age were used to examine associations with incident dementia using cause-specific Cox regression. RESULTS Analyses of MetS measured at <60, 60 to <70, and ≥70 years involved 393 (5.4%), 497 (7.5%), and 284 (7.9%) dementia cases over a median follow-up of 20.8, 10.4, and 4.2 years, respectively. Every additional MetS component before 60 (hazard ratio [HR] 1.13 [95% CI 1.05, 1.23]) and 60 to <70 (HR 1.08 [95% CI 1.00, 1.16]) but not ≥70 years (HR 1.04 [95% CI 0.96, 1.13]) was associated with higher dementia risk. MetS defined conventionally (≥3 components) before 60 years (HR 1.23 [95% CI 0.96, 1.57]), between 60 and 70 years (HR 1.14 [95% CI 0.91, 1.42]), or >70 years of age (HR 1.10 [95% CI 0.86, 1.40]) was not associated with incident dementia. Multistate models showed higher risk of dementia in those with ≥1 (HR 1.99 [95% CI 1.08, 3.66]) and ≥2 MetS components (HR 1.69 [95% CI 1.12, 2.56]) before 60 years of age, even when they remained free of cardiovascular disease over the follow-up. CONCLUSIONS Risk of incident dementia increases with every additional MetS component present in midlife rather than after accumulation of three components; only part of this risk is mediated by cardiovascular disease.
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Affiliation(s)
- Marcos D Machado-Fragua
- INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aurore Fayosse
- INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Manasa Shanta Yerramalla
- INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Thomas T van Sloten
- School for Cardiovascular Diseases (CARIM) and Department of Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, U.K.,Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary.,Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - Séverine Sabia
- INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France.,Department of Epidemiology and Public Health, University College London, London, U.K
| | - Archana Singh-Manoux
- INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France.,Department of Epidemiology and Public Health, University College London, London, U.K
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van Sloten TT, Souverein PC, Stehouwer CDA, Driessen JHM. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and risk of depression among older people with hypertension. J Psychopharmacol 2022; 36:594-603. [PMID: 35388727 PMCID: PMC9112619 DOI: 10.1177/02698811221082470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited. AIMS We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders. METHODS We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient's transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm. RESULTS/OUTCOMES Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs). CONCLUSIONS/INTERPRETATION New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.
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Affiliation(s)
- Thomas T van Sloten
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands,School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands,Thomas T van Sloten, Department of Internal Medicine, Maastricht University Medical Center+, P. Debyelaan 25, P.O. Box 5800, 6202AZ Maastricht, The Netherlands.
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Coen DA Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands,School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Johanna HM Driessen
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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van Gennip ACE, Sedaghat S, Carnethon MR, Allen NB, Klein BEK, Cotch MF, Chirinos DA, Stehouwer CDA, van Sloten TT. Retinal Microvascular Caliber and Incident Depressive Symptoms: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2022; 191:843-855. [PMID: 34652423 PMCID: PMC9071571 DOI: 10.1093/aje/kwab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/05/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Cerebral microvascular dysfunction may contribute to depression via disruption of brain structures involved in mood regulation, but evidence is limited. The retina allows for visualization of a microvascular bed that shares similarities with the cerebral microvasculature. We investigated the associations between baseline retinal arteriolar and venular calibers (central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively) and incident depressive symptoms in the Multi-Ethnic Study of Atherosclerosis (MESA). We used longitudinal data on 4,366 participants (mean age = 63.2 years; 48.5% women, 28.4% Black) without baseline depressive symptoms. Depressive symptoms, defined as Center for Epidemiologic Studies Depression Scale score ≥16 and/or use of antidepressant medication, were determined between 2002 and 2004 (baseline; MESA visit 2) and at 3 follow-up examinations conducted every 1.5–2 years thereafter. Fundus photography was performed at baseline. After a mean follow-up period of 6.1 years, 21.9%
(n = 958) had incident depressive symptoms. After adjustment for sociodemographic, lifestyle, and cardiovascular factors, a 1–standard-deviation larger baseline CRVE was associated with a higher risk of depressive symptoms (hazard ratio = 1.10, 95% confidence interval: 1.02, 1.17), and a 1–standard-deviation larger baseline CRAE was not statistically significantly associated with incident
depressive symptoms (hazard ratio = 1.04, 95% confidence interval: 0.97, 1.11). In this study, larger baseline CRVE, but not CRAE, was associated with a higher incidence of depressive symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Thomas T van Sloten
- Correspondence to Dr. Thomas T. van Sloten, Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands (e-mail: )
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van der Heide FCT, van Sloten TT, Willekens N, Stehouwer CDA. Neurovascular coupling unit dysfunction and dementia: Retinal measurements as tools to move towards population-based evidence. Front Endocrinol (Lausanne) 2022; 13:1014287. [PMID: 36506058 PMCID: PMC9727310 DOI: 10.3389/fendo.2022.1014287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Dysfunction of the neurovascular coupling unit may be an important contributor to dementia. The neurovascular coupling unit comprises neuronal structures (e.g. astrocytes) and vascular structures (e.g. endothelial cells) that functionally interact both at the level of the arterioles as well as at the capillary level (blood-brain barrier) to regulate optimal metabolic conditions in the brain. However, it remains unclear how and to what extent dysfunction of the neurovascular coupling unit contributes to the early-stage pathobiology of dementia. Currently, limited data are available on the association between neurovascular coupling unit dysfunction, as quantified by cerebral imaging techniques, and cognitive performance. In particular, there is a lack of population-based human data (defined as studies with a sample size ~n>500). This is an important limitation because population-based studies, in comparison with smaller clinical studies, provide data which is better representative of the general population; are less susceptible to selection bias; and have a larger statistical power to detect small associations. To acquire population-based data, however, alternative imaging techniques than cerebral imaging techniques may be required. Disadvantages of cerebral imaging techniques, which limit use in population-based studies, are that these techniques are relatively expensive, time-consuming, and/or invasive. In this review, we propose that retinal imaging techniques can be used for population-based studies: on the one hand the retina and brain have many anatomical and physiological similarities; and on the other hand retinal imaging techniques are non-invasive, highly accurate, relatively inexpensive, and require relatively short measurement time. To provide support for this concept, we provide an overview on the human (population-based) evidence on the associations of retinal indices of neurodegeneration, microvascular dysfunction, and dysfunction of the neurovascular coupling unit with magnetic resonance imaging (MRI) features of structural brain abnormalities and cognitive performance.
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Affiliation(s)
- Frank C. T. van der Heide
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, MUMC+, Maastricht, Netherlands
- School of Mental Health and Neuroscience, MUMC+, Maastricht, Netherlands
- *Correspondence: Frank C. T. van der Heide,
| | - Thomas T. van Sloten
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Nele Willekens
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Coen D. A. Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University (UM), Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
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van Gennip ACE, Stehouwer CDA, van Boxtel MPJ, Verhey FRJ, Koster A, Kroon AA, Köhler S, van Greevenbroek MMJ, Wesselius A, Eussen SJPM, Backes WH, Jansen JF, Schram MT, Henry RMA, Singh-Manoux A, van Sloten TT. Association of Type 2 Diabetes, According to the Number of Risk Factors Within Target Range, With Structural Brain Abnormalities, Cognitive Performance, and Risk of Dementia. Diabetes Care 2021; 44:2493-2502. [PMID: 34588209 PMCID: PMC9612883 DOI: 10.2337/dc21-0149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is associated with increased risks of cognitive dysfunction and brain abnormalities. The extent to which risk factor modification can mitigate these risks is unclear. We investigated the associations between incident dementia, cognitive performance, and brain abnormalities among individuals with type 2 diabetes, according to the number of risk factors on target, compared with control subjects without diabetes. RESEARCH DESIGN AND METHODS Prospective data were from UK Biobank of 87,856 individuals (n = 10,663 diabetes, n = 77,193 control subjects; baseline 2006-2010), with dementia follow-up until February 2018. Individuals with diabetes were categorized according to the number of seven selected risk factors within the guideline-recommended target range (nonsmoking; guideline-recommended levels of glycated hemoglobin, blood pressure, BMI, albuminuria, physical activity, and diet). Outcomes were incident dementia, domain-specific cognitive performance, white matter hyperintensities, and total brain volume. RESULTS After a mean follow-up of 9.0 years, 147 individuals (1.4%) with diabetes and 412 control subjects (0.5%) had incident dementia. Among individuals with diabetes, excess dementia risk decreased stepwise for a higher number of risk factors on target. Compared with control subjects (incidence rate per 1,000 person-years 0.62 [95% CI 0.56; 0.68]), individuals with diabetes who had five to seven risk factors on target had no significant excess dementia risk (absolute rate difference per 1,000 person-years 0.20 [-0.11; 0.52]; hazard ratio 1.32 [0.89; 1.95]). Similarly, differences in processing speed, executive function, and brain volumes were progressively smaller for a higher number of risk factors on target. These results were replicated in the Maastricht Study. CONCLUSIONS Among individuals with diabetes, excess dementia risk, lower cognitive performance, and brain abnormalities decreased stepwise for a higher number of risk factors on target.
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Affiliation(s)
- April C E van Gennip
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands
| | - Martin P J van Boxtel
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, the Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, the Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands.,Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, the Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- School of Nutrition and Translational Research in Metabolism NUTRIM, Maastricht University, Maastricht, the Netherlands.,Department of Genetics and Cell Biology, Complex Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands.,Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Walter H Backes
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, the Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jacobus F Jansen
- School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, the Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands.,School for Mental Health and Neuroscience MHENS, Maastricht University, Maastricht, the Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands
| | - Archana Singh-Manoux
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, INSERM U1153, Paris, France.,Department of Epidemiology and Public Health, University College London, London, U.K
| | - Thomas T van Sloten
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands .,School for Cardiovascular Diseases CARIM, Maastricht University, Maastricht, the Netherlands
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25
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van der Heide FCT, Steens ILM, Geraets AFJ, Foreman YD, Henry RMA, Kroon AA, van der Kallen CJH, van Sloten TT, Dagnelie PC, van Dongen MCJM, Eussen SJPM, Berendschot TTJM, Schouten JSAG, Webers CAB, van Greevenbroek MMJ, Wesselius A, Koster A, Schaper NC, Schram MT, Köhler S, Stehouwer CDA. Association of Retinal Nerve Fiber Layer Thickness, an Index of Neurodegeneration, With Depressive Symptoms Over Time. JAMA Netw Open 2021; 4:e2134753. [PMID: 34783825 PMCID: PMC8596200 DOI: 10.1001/jamanetworkopen.2021.34753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Whether neurodegeneration contributes to the early pathobiology of late-life depression remains incompletely understood. OBJECTIVE To investigate whether lower retinal nerve fiber layer (RNFL) thickness, a marker of neurodegeneration, is associated with the incidence of clinically relevant depressive symptoms and depressive symptoms over time. DESIGN, SETTING, AND PARTICIPANTS This is a population-based cohort study from the Netherlands (The Maastricht Study) with baseline examination between 2010 and 2020 and median (IQR) follow-up of 5.0 (3.0-6.0) years. Participants were recruited from the general population. Individuals with type 2 diabetes were oversampled by design. Data analysis was performed from September 2020 to January 2021. EXPOSURES RNFL, an index of neurodegeneration, assessed with optical coherence tomography. MAIN OUTCOMES AND MEASURES Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)-9 (continuous score, 0-27) at baseline and over time via annual assessments. The presence of clinically relevant depressive symptoms was defined as a PHQ-9 score of 10 or higher. RESULTS We used data from 4934 participants with depressive symptoms over time (mean [SD] age, 59.7 [8.4] years; 2159 women [50.8%]; 870 had type 2 diabetes [20.5%]). Lower RNFL thickness was associated with higher incidence of clinically relevant depressive symptoms (per 1 SD, hazard ratio 1.11; 95% CI, 1.01-1.23) and more depressive symptoms over time (per 1 SD, rate ratio, 1.04; 95% CI, 1.01-1.06), after adjustment for demographic, cardiovascular, and lifestyle factors. CONCLUSIONS AND RELEVANCE The findings of this study suggest that lower RNFL thickness is associated with higher incidence of clinically relevant depressive symptoms and more depressive symptoms over time. Hence, neurodegeneration may be associated with the early pathobiology of late-life depression.
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Affiliation(s)
- Frank C. T. van der Heide
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Indra L. M. Steens
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Anouk F. J. Geraets
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands
- School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Yuri D. Foreman
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Ronald M. A. Henry
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Abraham A. Kroon
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Carla J. H. van der Kallen
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Thomas T. van Sloten
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Pieter C. Dagnelie
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Martien C. J. M. van Dongen
- Care and Public Health Research Institute, Maastricht University, the Netherlands
- Department of Epidemiology, Maastricht University, the Netherlands
| | - Simone J. P. M. Eussen
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Epidemiology, Maastricht University, the Netherlands
| | - Tos T. J. M. Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jan S. A. G. Schouten
- Department of Ophthalmology, Canisius-Wilhelmina Ziekenhuis Nijmegen, the Netherlands
| | - Carroll A. B. Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marleen M. J. van Greevenbroek
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Nicolaas C. Schaper
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
| | - Miranda T. Schram
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
- School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Seb Köhler
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands
- School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D. A. Stehouwer
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, the Netherlands
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26
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Empana JP, Boutouyrie P, Lemogne C, Jouven X, van Sloten TT. Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives. Biol Psychiatry 2021; 90:214-225. [PMID: 34325805 DOI: 10.1016/j.biopsych.2021.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
Depression is common in older individuals and is associated with high disability and mortality. A major problem is treatment resistance: >50% of older patients do not respond to current antidepressants. Therefore, new effective interventions for prevention and treatment of depression in older individuals need to be developed, which requires a better understanding of the mechanisms underlying depression. The pathophysiology of depression is multifactorial and complex. Microvascular dysfunction may be an early and targetable mechanism in the development of depression, notably depression that initiates in late life (late-onset depression). Late-onset depression commonly co-occurs with other diseases or syndromes that may share a microvascular origin, including apathy, cognitive impairment, dementia, and stroke. Together, these disabilities may all be part of one large phenotype resulting from global cerebral microvascular dysfunction. In this review, we discuss the pathophysiology of microvascular dysfunction-related late-onset depression, summarize recent epidemiological evidence on the association between cerebral microvascular dysfunction and depression, and indicate potential drivers of cerebral microvascular dysfunction. We also propose the hypothesis that depression may be a manifestation of a larger phenotype of cerebral microvascular dysfunction, highlight potential therapeutic targets and interventions, and give directions for future research.
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Affiliation(s)
- Jean-Philippe Empana
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Thomas T van Sloten
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France; School for Cardiovascular Diseases Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
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27
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Vergoossen LWM, Jansen JFA, van Sloten TT, Stehouwer CDA, Schaper NC, Wesselius A, Dagnelie PC, Köhler S, van Boxtel MPJ, Kroon AA, de Jong JJA, Schram MT, Backes WH. Interplay of White Matter Hyperintensities, Cerebral Networks, and Cognitive Function in an Adult Population: Diffusion-Tensor Imaging in the Maastricht Study. Radiology 2020; 298:384-392. [PMID: 33350892 DOI: 10.1148/radiol.2021202634] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Lesions of cerebral small vessel disease, such as white matter hyperintensities (WMHs) in individuals with cardiometabolic risk factors, interfere with the trajectories of the white matter and eventually contribute to cognitive decline. However, there is no consensus yet about the precise underlying topological mechanism. Purpose To examine whether WMH and cognitive function are associated and whether any such association is mediated or explained by structural connectivity measures in an adult population. In addition, to investigate underlying local abnormalities in white matter by assessing the tract-specific WMH volumes and their tract-specific association with cognitive function. Materials and Methods In the prospective type 2 diabetes-enriched population-based Maastricht Study, structural and diffusion-tensor MRI was performed (December 2013 to February 2017). Total and tract-specific WMH volumes; network measures; cognition scores; and demographic, cardiovascular, and lifestyle characteristics were determined. Multivariable linear regression and mediation analyses were used to investigate the association of WMH volume, tract-specific WMH volumes, and network measures with cognitive function. Associations were adjusted for age, sex, education, diabetes status, and cardiovascular risk factors. Results A total of 5083 participants (mean age, 59 years ± 9 [standard deviation]; 2592 men; 1027 with diabetes) were evaluated. Larger WMH volumes were associated with stronger local (standardized β coefficient, 0.065; P < .001), but not global, network efficiency and lower information processing speed (standardized β coefficient, -0.073; P < .001). Moreover, lower local efficiency (standardized β coefficient, -0.084; P < .001) was associated with lower information processing speed. In particular, the relationship between WMHs and information processing speed was mediated (percentage mediated, 7.2% [95% CI: 3.5, 10.9]; P < .05) by the local network efficiency. Finally, WMH load was larger in the white matter tracts important for information processing speed. Conclusion White matter hyperintensity volume, local network efficiency, and information processing speed scores are interrelated, and local network properties explain lower cognitive performance due to white matter network alterations. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Laura W M Vergoossen
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Jacobus F A Jansen
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Thomas T van Sloten
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Coen D A Stehouwer
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Nicolaas C Schaper
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Anke Wesselius
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Pieter C Dagnelie
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Sebastiaan Köhler
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Martin P J van Boxtel
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Abraham A Kroon
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Joost J A de Jong
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Miranda T Schram
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
| | - Walter H Backes
- From the Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., W.H.B.); MHeNs School for Mental Health and Neuroscience (L.W.M.V., J.F.A.J., S.K., M.P.J.v.B., J.J.A.d.J., M.T.S., W.H.B.), Department of Internal Medicine (T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S.), School for Cardiovascular Disease (CARIM) (L.W.M.V., T.T.v.S., C.D.A.S., N.C.S., P.C.D., A.A.K., M.T.S., W.H.B.), Care and Public Health Institute (CAPHRI) (N.C.S.), School of Nutrition and Translational Research in Metabolism (NUTRIM) (A.W., M.T.S.), and Department of Complex Genetics & Epidemiology (A.W.), Maastricht University, Maastricht, the Netherlands; and Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (J.F.A.J.)
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Rensma SP, van Sloten TT, Ding J, Sigurdsson S, Stehouwer CDA, Gudnason V, Launer LJ. Type 2 Diabetes, Change in Depressive Symptoms Over Time, and Cerebral Small Vessel Disease: Longitudinal Data of the AGES-Reykjavik Study. Diabetes Care 2020; 43:1781-1787. [PMID: 32527799 PMCID: PMC7372064 DOI: 10.2337/dc19-2437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes has been associated with depression. However, the underlying pathophysiological mechanisms remain unknown. Cerebral small vessel disease, a consequence of diabetes, may lead to depression. Therefore, we evaluated whether cerebral small vessel disease mediates the association between type 2 diabetes and higher depressive symptoms. RESEARCH DESIGN AND METHODS We used longitudinal data from the population-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, with examinations from 2002 to 2006 and 5 years later. Type 2 diabetes was defined as self-reported history of type 2 diabetes, use of blood glucose-lowering drugs, or fasting blood glucose level ≥7.0 mmol/L. Cerebral small vessel disease load was quantified in a composite score based on MRI-defined presence of high white matter hyperintensity volume, low total brain parenchyma volume, and subcortical infarcts, cerebral microbleeds, and large perivascular spaces. The 5-year change in the 15-item Geriatric Depression Scale score (GDS-15) was measured between baseline and follow-up. RESULTS Included were 2,135 individuals without dementia and baseline depression (baseline age 74.5 [SD 4.6] years, 1,245 women [58.3%], and 197 [9.2%] with diabetes). The GDS-15 score increased 0.4 (SD 1.6) points over time. Baseline diabetes was associated with a greater increase in the GDS-15 score (β = 0.337; 95% CI 0.094; 0.579), adjusted for age, sex, education, and cardiovascular risk factors. Baseline cerebral small vessel disease and change of cerebral small vessel disease statistically significantly mediated a part of this association. CONCLUSIONS Type 2 diabetes is associated with a greater increase in depressive symptoms score over 5 years, and cerebral small vessel disease partly explains this association.
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Affiliation(s)
- Sytze P Rensma
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jennifer Ding
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kópavogur, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD
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29
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Geraets AF, van Agtmaal MJ, Stehouwer CD, Sörensen BM, Berendschot TT, Webers CA, Schaper NC, Henry RM, van der Kallen CJ, Eussen SJ, Koster A, van Sloten TT, Köhler S, Schram MT, Houben AJ. Association of Markers of Microvascular Dysfunction With Prevalent and Incident Depressive Symptoms. Hypertension 2020; 76:342-349. [DOI: 10.1161/hypertensionaha.120.15260] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The etiology of late-life depression (LLD) is still poorly understood. Microvascular dysfunction (MVD) has been suggested to play a role in the etiology of LLD, but direct evidence of this association is scarce. The aim of this study was to investigate whether direct and indirect markers of early microvascular dysfunction are associated with prevalent and incident LLD in the population-based Maastricht Study cohort. We measured microvascular dysfunction at baseline by use of flicker light-induced retinal vessel dilation response (Dynamic Vessel Analyzer), heat-induced skin hyperemic response (laser- Doppler flowmetry), and plasma markers of endothelial dysfunction (endothelial dysfunction; sICAM-1 [soluble intercellular adhesion molecule-1], sVCAM-1 [soluble vascular adhesion molecule-1], sE-selectin [soluble E-selectin], and vWF [Von Willebrand Factor]). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9) at baseline and annually over 4 years of follow-up (n=3029; mean age 59.6±8.2 years, 49.5% were women, n=132 and n=251 with prevalent and incident depressive symptoms [PHQ-9≥10]). We used logistic, negative binominal and Cox regression analyses, and adjusted for demographic, cardiovascular, and lifestyle factors. Retinal venular dilatation and plasma markers of endothelial dysfunction were associated with the more prevalent depressive symptoms after full adjustment (PHQ-9 score, RR, 1.05 [1.00–1.11] and RR 1.06 [1.01–1.11], respectively). Retinal venular dilatation was also associated with prevalent depressive symptoms (PHQ-9≥10; odds ratio, 1.42 [1.09–1.84]), after full adjustment. Retinal arteriolar dilatation and plasma markers of endothelial dysfunction were associated with incident depressive symptoms (PHQ-9≥10; HR, 1.23 [1.04–1.46] and HR, 1.19 [1.05–1.35]), after full adjustment. These findings support the concept that microvascular dysfunction in the retina, and plasma markers of endothelial dysfunction is involved in the etiology of LLD and might help in finding additional targets for the prevention and treatment of LLD.
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Affiliation(s)
- Anouk F.J. Geraets
- Department of Psychiatry and Neuropsychology (A.F.J.G., S.K., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Marnix J.M. van Agtmaal
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Ben M. Sörensen
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Tos T.J.M. Berendschot
- Department of Ophthalmology (T.T.J.M.B., C.A.B.W.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Carroll A.B. Webers
- Department of Ophthalmology (T.T.J.M.B., C.A.B.W.), Maastricht University Medical Center (MUMC+), the Netherlands
| | - Nicolaas C. Schaper
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Ronald M.A. Henry
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- Heart and Vascular Center (R.M.A.H., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Carla J.H. van der Kallen
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Simone J.P.M. Eussen
- Department of Epidemiology (S.J.P.M.E.), Maastricht University Medical Center (MUMC+), the Netherlands
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences (S.J.P.M.E., A.K.), Maastricht University, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine (A.K.), Maastricht University Medical Center (MUMC+), the Netherlands
- Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine & Life Sciences (S.J.P.M.E., A.K.), Maastricht University, the Netherlands
| | - Thomas T. van Sloten
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology (A.F.J.G., S.K., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
| | - Miranda T. Schram
- Department of Psychiatry and Neuropsychology (A.F.J.G., S.K., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- Heart and Vascular Center (R.M.A.H., M.T.S.), Maastricht University Medical Center (MUMC+), the Netherlands
- School of Mental Health and Neuroscience (MHeNs) (A.F.J.G., T.T.J.M.B., S.K., M.T.S.), Maastricht University, the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
| | - Alfons J.H.M. Houben
- Department of Internal Medicine (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University Medical Center (MUMC+), the Netherlands
- School for Cardiovascular Diseases (CARIM) (A.F.J.G., M.J.M.v.A., C.D.A.S., B.M.S., N.C.S., R.M.A.H., C.J.H.v.d.K., T.T.v.S., M.T.S., A.J.H.M.H.), Maastricht University, the Netherlands
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30
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Rensma SP, Stehouwer CD, Van Boxtel MP, Houben AJ, Berendschot TT, Jansen JF, Schalkwijk CG, Verhey FR, Kroon AA, Henry RM, Backes WH, Dagnelie PC, van Dongen MC, Eussen SJ, Bosma H, Köhler S, Reesink KD, Schram MT, van Sloten TT. Associations of Arterial Stiffness With Cognitive Performance, and the Role of Microvascular Dysfunction. Hypertension 2020; 75:1607-1614. [DOI: 10.1161/hypertensionaha.119.14307] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The mechanisms underlying cognitive impairment are incompletely understood but may include arterial stiffness and microvascular dysfunction. In the population-based Maastricht Study, we investigated the association between arterial stiffness and cognitive performance, and whether any such association was mediated by microvascular dysfunction. We included cross-sectional data of 2544 participants (age, 59.7 years; 51.0% men; 26.0% type 2 diabetes mellitus). We used carotid-femoral pulse wave velocity and carotid distensibility coefficient as measures of aortic and carotid stiffness, respectively. We calculated a composite score of microvascular dysfunction based on magnetic resonance imaging features of cerebral small vessel disease, flicker light-induced retinal arteriolar and venular dilation response, albuminuria, and plasma biomarkers of microvascular dysfunction (sICAM-1 [soluble intercellular adhesion molecule-1], sVCAM-1 [soluble vascular adhesion molecule-1], sE-selectin [soluble E-selectin], and vWF [von Willebrand factor]). Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the average of these domains. Higher aortic stiffness (per m/s) was associated with lower cognitive function (β, −0.018 SD [95% CI, −0.036 to −0.000]) independent of age, sex, education, and cardiovascular risk factors, but higher carotid stiffness was not. Higher aortic stiffness (per m/s) was associated with a higher microvascular dysfunction score (β, 0.034 SD [95% CI, 0.014 to 0.053]), and a higher microvascular dysfunction score (per SD) was associated with lower cognitive function (β, −0.089 SD [95% CI, −0.124 to −0.053]). Microvascular dysfunction significantly explained 16.2% of the total effect of aortic stiffness on cognitive function. The present study showed that aortic stiffness, but not carotid stiffness, is independently associated with worse cognitive performance, and that this association is in part explained by microvascular dysfunction.
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Affiliation(s)
- Sytze P. Rensma
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Coen D.A. Stehouwer
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Martin P.J. Van Boxtel
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Psychiatry and Neuropsychology (M.P.J.V.B., F.R.J.V.)
| | - Alfons J.H.M. Houben
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | | | - Jaap F.A. Jansen
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Radiology and Nuclear Medicine (J.F.A.J., W.H.B.)
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands (J.F.A.J.)
| | - Casper G. Schalkwijk
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Frans R.J. Verhey
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Psychiatry and Neuropsychology (M.P.J.V.B., F.R.J.V.)
| | - Abraham A. Kroon
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Ronald M.A. Henry
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Walter H. Backes
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Radiology and Nuclear Medicine (J.F.A.J., W.H.B.)
| | - Pieter C. Dagnelie
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
- Department of Epidemiology (P.C.D., M.C.J.M.v.D., S.J.P.M.E.)
| | - Martin C.J.M. van Dongen
- Department of Epidemiology (P.C.D., M.C.J.M.v.D., S.J.P.M.E.)
- CAPHRI Care and Public Health Research Institute (M.C.J.M.v.D., H.B.)
| | - Simone J.P.M. Eussen
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Epidemiology (P.C.D., M.C.J.M.v.D., S.J.P.M.E.)
| | - Hans Bosma
- CAPHRI Care and Public Health Research Institute (M.C.J.M.v.D., H.B.)
- Department of Social Medicine (H.B.)
| | - Sebastian Köhler
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
| | - Koen D. Reesink
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Biomedical Engineering, Maastricht University Medical Centre, Maastricht, the Netherlands (K.D.R.)
| | - Miranda T. Schram
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
| | - Thomas T. van Sloten
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
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van Sloten TT, Sedaghat S, Carnethon MR, Launer LJ, Stehouwer CDA. Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression. Lancet Diabetes Endocrinol 2020; 8:325-336. [PMID: 32135131 DOI: 10.1016/s2213-8587(19)30405-x] [Citation(s) in RCA: 242] [Impact Index Per Article: 60.5] [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: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022]
Abstract
Adults with type 2 diabetes are at an increased risk of developing certain brain or mental disorders, including stroke, dementia, and depression. Although these disorders are not usually considered classic microvascular complications of diabetes, evidence is growing that microvascular dysfunction is one of the key underlying mechanisms. Microvascular dysfunction is a widespread phenomenon in people with diabetes, including effects on the brain. Cerebral microvascular dysfunction is also apparent in adults with prediabetes, suggesting that cerebral microvascular disease processes start before the onset of diabetes. The microvasculature is involved in the regulation of many cerebral processes that when impaired predispose to lacunar and haemorrhagic stroke, cognitive dysfunction, and depression. Main drivers of diabetes-related cerebral microvascular dysfunction are hyperglycaemia, obesity and insulin resistance, and hypertension. Increasing amounts of data from observational studies suggest that diabetes-related microvascular dysfunction is associated with a higher risk of stroke, cognitive dysfunction, and depression. Cerebral outcomes in diabetes might be improved following treatments targeting the pathways through which diabetes damages the microcirculation. These treatments might include drugs that reduce dicarbonyl compounds, augment cerebral insulin signalling, or improve blood-brain barrier permeability and cerebral vasoreactivity.
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Affiliation(s)
- Thomas T van Sloten
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sanaz Sedaghat
- Department of Preventive Medicine and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.
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Rensma SP, van Sloten TT, Houben AJ, Köhler S, van Boxtel MP, Berendschot TT, Jansen JF, Verhey FR, Kroon AA, Koster A, Backes WH, Schaper N, Dinant GJ, Schalkwijk CG, Henry RM, Wolfs EM, van Heumen MJ, Schram MT, Stehouwer CD. Microvascular Dysfunction Is Associated With Worse Cognitive Performance. Hypertension 2020; 75:237-245. [DOI: 10.1161/hypertensionaha.119.13023] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Microvascular dysfunction may be associated with worse cognitive performance. Most previous studies did not adjust for important confounders, evaluated only individual measures of microvascular dysfunction, and showed inconsistent results. We evaluated the association between a comprehensive set of measures of microvascular dysfunction and cognitive performance in the population-based Maastricht Study. We used cross-sectional data including 3011 participants (age 59.5±8.2; 48.9% women; 26.5% type 2 diabetes mellitus [oversampled by design]). Measures of microvascular dysfunction included magnetic resonance imaging features of cerebral small vessel disease, plasma biomarkers of microvascular dysfunction, albuminuria, flicker light-induced retinal arteriolar and venular dilation response and heat-induced skin hyperemia. These measures were summarized into a microvascular dysfunction composite score. Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the sum of the scores on these 3 cognitive domains. The microvascular dysfunction score was associated with a worse cognitive function score (standardized β, −0.087 [95% CI, −0.127 to −0.047]), independent of age, education level, sex, type 2 diabetes mellitus, smoking, alcohol use, hypertension, total/HDL (high-density lipoprotein) cholesterol ratio, triglycerides, lipid-modifying medication, prior cardiovascular disease, depression and plasma biomarkers of low-grade inflammation. The fully adjusted β-coefficient of the association between the microvascular dysfunction score and the cognitive function score was equivalent to 2 (range, 1–3) years of aging for each SD higher microvascular dysfunction score. The microvascular dysfunction score was associated with worse memory and processing speed but not with worse executive function. The present study shows that microvascular dysfunction is associated with worse cognitive performance.
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Affiliation(s)
- Sytze P. Rensma
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Thomas T. van Sloten
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Alfons J.H.M. Houben
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Sebastian Köhler
- MHeNs School for Mental Health and Neuroscience (S.K., M.P.J.v.B., J.F.A.J., F.R.J.V., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Martin P.J. van Boxtel
- MHeNs School for Mental Health and Neuroscience (S.K., M.P.J.v.B., J.F.A.J., F.R.J.V., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Psychiatry and Neuropsychology (M.P.J.v.B., F.R.J.V.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Tos T.J.M. Berendschot
- Department of Ophthalmology (T.T.J.M.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Jacobus F.A. Jansen
- MHeNs School for Mental Health and Neuroscience (S.K., M.P.J.v.B., J.F.A.J., F.R.J.V., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Radiology & Nuclear Medicine (J.F.A.J., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, North Brabant, the Netherlands (J.F.A.J.)
| | - Frans R.J. Verhey
- MHeNs School for Mental Health and Neuroscience (S.K., M.P.J.v.B., J.F.A.J., F.R.J.V., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Psychiatry and Neuropsychology (M.P.J.v.B., F.R.J.V.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Abraham A. Kroon
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine (A.K.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- School for Public Health and Primary Care (CAPHRI) (A.K., N.S., G.-J.D.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Walter H. Backes
- MHeNs School for Mental Health and Neuroscience (S.K., M.P.J.v.B., J.F.A.J., F.R.J.V., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Radiology & Nuclear Medicine (J.F.A.J., W.H.B.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Nicolaas Schaper
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- School for Public Health and Primary Care (CAPHRI) (A.K., N.S., G.-J.D.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Geert-Jan Dinant
- School for Public Health and Primary Care (CAPHRI) (A.K., N.S., G.-J.D.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Casper G. Schalkwijk
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Ronald M.A. Henry
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- The Netherlands Heart and Vascular Center (R.M.A.H., M.T.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Elze M.L. Wolfs
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Mike J.A. van Heumen
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Miranda T. Schram
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- The Netherlands Heart and Vascular Center (R.M.A.H., M.T.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
| | - Coen D.A. Stehouwer
- From the CARIM School for Cardiovascular Diseases (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., R.M.A.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
- Department of Internal Medicine (S.P.R., T.T.v.S., A.J.H.M.H., A.A.K., N.S., C.G.S., R.M.A.H., E.M.L.W., M.J.A.v.H., M.T.S., C.D.A.S.), Maastricht University Medical Center+, Maastricht, Limburg, the Netherlands
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van Gennip AC, Sedeghat S, Carnethon MR, Allen NB, Klein BE, Cotch MF, Chirinos DA, Stehouwer CD, van Sloten TT. YI 1.3 Retinal Microvascular Calibers and Incident Depressive Symptoms: The Multi-Ethnic Study of Atherosclerosis. Artery Res 2020. [DOI: 10.2991/artres.k.201209.003] [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: 10/31/2022] Open
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Climie RE, Boutouyrie P, Perier MC, Chaussade E, Plichart M, Offredo L, Guibout C, van Sloten TT, Thomas F, Pannier B, Sharman JE, Laurent S, Jouven X, Empana JP. Association Between Occupational, Sport, and Leisure Related Physical Activity and Baroreflex Sensitivity. Hypertension 2019; 74:1476-1483. [DOI: 10.1161/hypertensionaha.119.13461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical activity (PA) is a preventative behavior for noncommunicable disease. However, little consideration is given as to whether different domains of PA have differing associations with health outcomes. We sought to determine the association between occupational, sport, leisure, and total PA with baroreflex sensitivity (BRS), distinguishing between neural (nBRS) and mechanical (mBRS) BRS. In a cross-sectional analysis of 8649 adults aged 50 to 75 years, resting nBRS (estimated by low-frequency gain, from carotid distension rate and heart rate) and mBRS (carotid stiffness) were measured by high-precision carotid echo-tracking. PA was self-reported using the validated Baecke questionnaire. The associations between PA and nBRS and mBRS were quantified using multivariate linear regression analysis, separately in the working and nonworking population. In working adults (n=5039), occupational PA was associated with worse nBRS (unstandardized β=−0.02; [95% CI, −0.04 to −0.003];
P
=0.022) whereas sport PA was associated with better nBRS (β=0.04; [95% CI, 0.02–0.07];
P
=0.003) and mBRS (β=−0.05; [95% CI, −0.09 to −0.00001];
P
=0.049). Neither leisure PA nor total PA was associated with nBRS or mBRS. In nonworking adults (n=3610), sport PA and total PA were associated with better mBRS (β=−0.08; [95% CI, −0.15 to 0.02];
P
=0.012 and β=−0.05; [95% CI, −0.10 to 0.009];
P
=0.018) but not nBRS. These findings suggest differential associations between domains of PA and BRS and may provide insights into the mechanisms underlying the association between occupational PA and cardiovascular disease.
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Affiliation(s)
- Rachel E. Climie
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.)
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Pierre Boutouyrie
- INSERM U970, Department of Pharmacology, APHP, Paris Descartes University, France (P.B., S.L.)
| | - Marie-Cecile Perier
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
| | | | | | - Lucile Offredo
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
| | - Catherine Guibout
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
| | - Thomas T. van Sloten
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
- Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, the Netherlands (T.T.v.S.)
| | - Frederique Thomas
- Investigations Préventives et cliniques (IPC), Paris, France (F.T., B.P.)
| | - Bruno Pannier
- Investigations Préventives et cliniques (IPC), Paris, France (F.T., B.P.)
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Stephane Laurent
- INSERM U970, Department of Pharmacology, APHP, Paris Descartes University, France (P.B., S.L.)
| | - Xavier Jouven
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
| | - Jean-Philippe Empana
- From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.)
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Lisan Q, van Sloten TT, Lemogne C, Offredo L, Climie RE, Boutouyrie P, Guibout C, Thomas F, Danchin N, Jouven X, Empana JP. Association of Hearing Impairment with Incident Depressive Symptoms: A Community-Based Prospective Study. Am J Med 2019; 132:1441-1449.e4. [PMID: 31247178 DOI: 10.1016/j.amjmed.2019.05.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim was to investigate the potential association between hearing impairment and incident depressive symptoms. METHODS Using a prospective community-based cohort study in France (the Paris Prospective Study III), participants aged 50-75 years were recruited between 2008 and 2012 and thereafter followed up every 2 years up to 2018. Hearing impairment, measured at study recruitment by audiometry testing, was defined as a pure tone average >25 decibels in the better ear. Incident depressive symptoms, measured using the validated 13-item Questionnaire of Depression 2nd version, was assessed during follow-up. Multivariate generalized estimating equations were used to compute odds ratio (OR) and 95% confidence intervals (CI). RESULTS Among 7591 participants free of depressive symptoms at baseline (mean age 59.8 years, 63% of men), 14.3% had hearing impairment. Over 6 years of follow-up, 479 subjects (6.3%) had incident depressive symptoms. The OR for incident depressive symptoms was 1.36 for subjects with baseline hearing impairment (95% CI, 1.06-1.73). A pooled analysis of 4 published prospective studies yielded a multivariable relative risk of baseline hearing impairment for incident depressive symptoms of 1.29 (95% CI, 1.09-1.53). CONCLUSIONS In this community-based prospective cohort study of participants aged 50 to 75 years, baseline hearing impairment was associated with a 36% increased odds of incident depressive symptoms.
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Affiliation(s)
- Quentin Lisan
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France.
| | - Thomas T van Sloten
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Department of Psychiatry, Georges Pompidou European Hospital, Paris, France; INSERM, U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Lucille Offredo
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | - Rachel E Climie
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; Baker Heart and Diabetes Institute, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia
| | - Pierre Boutouyrie
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; AP-HP, Department of Pharmacology, Georges Pompidou European Hospital, Paris, France
| | - Catherine Guibout
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | | | - Nicolas Danchin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Preventive and Clinical Investigation Center, Paris, France; AP-HP, Department of Cardiology, Georges Pompidou European Hospital, Paris, France
| | - Xavier Jouven
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; AP-HP, Department of Cardiology, Georges Pompidou European Hospital, Paris, France
| | - Jen-Philippe Empana
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
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Climie RE, Gallo A, Picone DS, Di Lascio N, van Sloten TT, Guala A, Mayer CC, Hametner B, Bruno RM. Measuring the Interaction Between the Macro- and Micro-Vasculature. Front Cardiovasc Med 2019; 6:169. [PMID: 31824963 PMCID: PMC6882776 DOI: 10.3389/fcvm.2019.00169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023] Open
Abstract
Structural and functional dysfunction in both the macro- and microvasculature are a feature of essential hypertension. In a healthy cardiovascular system, the elastic properties of the large arteries ensure that pulsations in pressure and flow generated by cyclic left ventricular contraction are dampened, so that less pulsatile pressure and flow are delivered at the microvascular level. However, in response to aging, hypertension, and other disease states, arterial stiffening limits the buffering capacity of the elastic arteries, thus exposing the microvasculature to increased pulsatile stress. This is thought to be particularly pertinent to high flow/low resistance organs such as the brain and kidney, which may be sensitive to excess pressure and flow pulsatility, damaging capillary networks, and resulting in target organ damage. In this review, we describe the clinical relevance of the pulsatile interaction between the macro- and microvasculature and summarize current methods for measuring the transmission of pulsatility between the two sites.
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Affiliation(s)
- Rachel E Climie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Antonio Gallo
- Cardiovascular Prevention Unit, Department of Endocrinology and Metabolism, Pitié-Salpêtrière Hospital, Paris, France.,Laboratoire d'imagerie Biomédicale, INSERM 1146 - CNRS 7371, Sorbonne University, Paris, France
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Thomas T van Sloten
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France.,Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Bernhard Hametner
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris Descartes University, Paris, France
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Zhou TL, Kroon AA, van Sloten TT, van Boxtel MPJ, Verhey FRJ, Schram MT, Köhler S, Stehouwer CDA, Henry RMA. Greater Blood Pressure Variability Is Associated With Lower Cognitive Performance. Hypertension 2019; 73:803-811. [PMID: 30739535 DOI: 10.1161/hypertensionaha.118.12305] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An increasing number of individuals will face age-related cognitive difficulties because life expectancy has increased. It is, therefore, important to identify modifiable risk factors for cognitive impairment. Very short-term to mid-term blood pressure variability (BPV) may be such a factor because it may cause cerebral ischemia. To this end, we investigated whether greater systolic and diastolic BPV are cross-sectionally associated with memory function (n=1804), information processing speed (n=1793), and executive function (n=1780) in 40- to 75-year-old individuals from The Maastricht Study. A composite BPV-index was derived by standardizing within-visit, 24-hour, and 7-day BPV. We performed linear regression with adjustments for age, sex, educational level, 24-hour systolic or diastolic pressure, and cardiovascular risk factors. We found that a 1-SD greater systolic BPV was not associated with information processing speed (β [SD difference], -0.10; 95% CI, -0.14 to 0.06), or executive function (-0.09; 95% CI, -0.20 to 0.02) but was marginally associated with lower memory function (-0.11; 95% CI, -0.21 to 0.00). A 1-SD greater diastolic BPV was associated with lower information processing speed (-0.10; 95% CI, -0.20 to -0.00) and executive function (-0.12; 95% CI, -0.22 to -0.01) and marginally associated with lower memory function (-0.09; 95% CI, -0.20 to 0.01). These effects on cognitive performance are equivalent to ≈3 additional years of aging. In conclusion, greater very short-term to mid-term diastolic and, to a lesser extent, systolic BPV may be a modifiable risk factor for cognitive deterioration in 40- to 75-year-old, community-dwelling individuals.
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Affiliation(s)
- Tan Lai Zhou
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Abraham A Kroon
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S.).,Department of Epidemiology and Department of Arterial Mechanics, INSERM, UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S.)
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Miranda T Schram
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,Heart and Vascular Centre (M.T.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University Medical Centre, the Netherlands.,MHeNs School for Mental Health and Neuroscience (M.P.J.v.B., F.R.J.V., S.K.), Maastricht University, the Netherlands
| | - Coen D A Stehouwer
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
| | - Ronald M A Henry
- From the Department of Internal Medicine (T.L.Z., A.A.K., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,Heart and Vascular Centre (M.T.S., R.M.A.H.), Maastricht University Medical Centre, the Netherlands.,CARIM School for Cardiovascular Diseases (T.L.Z., A.A.K., T.T.v.S., M.T.S., C.D.A.S., R.M.A.H.), Maastricht University, the Netherlands
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Climie RE, van Sloten TT, Périer MC, Tafflet M, Fayosse A, Dugravot A, Singh-Manoux A, Empana JP. Change in Cardiovascular Health and Incident Type 2 Diabetes and Impaired Fasting Glucose: The Whitehall II Study. Diabetes Care 2019; 42:1981-1987. [PMID: 31416895 PMCID: PMC7364667 DOI: 10.2337/dc19-0379] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Most previous studies on cardiovascular health (CVH) and incident type 2 diabetes (T2D) have used a single measure of CVH, and none have investigated the association with impaired fasting glucose (IFG). We examined the association between changes in CVH and incident T2D and IFG. RESEARCH DESIGN AND METHODS Within the Whitehall II study, CVH was examined every 5 years from 1991/93 until 2015/16. Subjects with 0-2, 3-4, and 5-6 ideal metrics of CVH from the American Heart Association were categorized as having low, moderate, or high CVH, respectively. RESULTS There were 6,234 participants (mean age 49.8 ± 6.0 years, 70% male) without prior cardiovascular disease and T2D, including 5,015 who were additionally free from IFG at baseline. Over a median follow-up of 24.8 (interquartile range 24.0-25.2) years, 895 and 1,703 incident cases of T2D and IFG occurred, respectively. Change in CVH between 1991/93 and 2002/04 was calculated among 4,464 participants free from CVD and T2D and among 2,795 participants additionally free from IFG. In multivariate analysis, compared with those with stable low CVH, risk of T2D was lower in those with initially high CVH (hazard ratio [HR] 0.21; 95% CI 0.09, 0.51), those who had persistently moderate CVH or changed from moderate to high CVH (moderate-moderate/high; HR 0.53; 95% CI 0.41, 0.69), low-moderate/high (HR 0.62; 95% CI 0.45, 0.86), and moderate-low (HR 0.74; 95% CI 0.56, 0.98). Results were similar for IFG, but the effect sizes were smaller. CONCLUSIONS Compared with stable low CVH, other patterns of change in CVH were associated with lower risk of T2D and IFG.
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Affiliation(s)
- Rachel E Climie
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Thomas T van Sloten
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
- Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marie-Cécile Périer
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | - Muriel Tafflet
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | - Aurore Fayosse
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aline Dugravot
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Archana Singh-Manoux
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College, London, U.K
| | - Jean-Philippe Empana
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
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Climie RE, Boutouyrie P, Perier MC, Guibout C, van Sloten TT, Thomas F, Danchin N, Sharman JE, Laurent S, Jouven X, Empana JP. Individual and Neighborhood Deprivation and Carotid Stiffness. Hypertension 2019; 73:1185-1194. [DOI: 10.1161/hypertensionaha.118.12186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rachel E. Climie
- From the INSERM, U970, Department of Epidemiology (R.E.C., MC.P., C.G., T.T.v.S., X.J., JP.E.)
- Baker Heart and Diabetes Institute; Melbourne, Australia (R.E.C.)
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | | | - Marie-Cecile Perier
- From the INSERM, U970, Department of Epidemiology (R.E.C., MC.P., C.G., T.T.v.S., X.J., JP.E.)
| | - Catherine Guibout
- From the INSERM, U970, Department of Epidemiology (R.E.C., MC.P., C.G., T.T.v.S., X.J., JP.E.)
| | - Thomas T. van Sloten
- From the INSERM, U970, Department of Epidemiology (R.E.C., MC.P., C.G., T.T.v.S., X.J., JP.E.)
- Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, the Netherlands (T.T.v.S.)
| | - Frederique Thomas
- Investigations Préventives et cliniques (IPC), Paris, France (F.T., N.D.)
| | - Nicolas Danchin
- Investigations Préventives et cliniques (IPC), Paris, France (F.T., N.D.)
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | | | - Xavier Jouven
- From the INSERM, U970, Department of Epidemiology (R.E.C., MC.P., C.G., T.T.v.S., X.J., JP.E.)
| | - Jean-Philippe Empana
- From the INSERM, U970, Department of Epidemiology (R.E.C., MC.P., C.G., T.T.v.S., X.J., JP.E.)
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Climie RE, van Sloten TT, Bruno RM, Taddei S, Empana JP, Stehouwer CD, Sharman JE, Boutouyrie P, Laurent S. Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension. Hypertension 2019; 73:1138-1149. [DOI: 10.1161/hypertensionaha.118.11769] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rachel E. Climie
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.)
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Thomas T. van Sloten
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - Rosa-Maria Bruno
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Jean-Philippe Empana
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Pierre Boutouyrie
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
| | - Stéphane Laurent
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
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van Sloten TT, Boutouyrie P, Lisan Q, Tafflet M, Thomas F, Guibout C, Climie RE, Pannier B, Sharman JE, Laurent S, Jouven X, Empana JP. Body Silhouette Trajectories Across the Lifespan and Vascular Aging. Hypertension 2019; 72:1095-1102. [PMID: 30354814 DOI: 10.1161/hypertensionaha.118.11442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Vascular aging is a major contributor to cardiovascular disease and can be quantified by higher carotid stiffness, intima-media thickness and diameter, and hypertension. Weight gain across the lifetime may be an important, modifiable determinant of vascular aging. We therefore aimed to assess lifetime body silhouette trajectories (a marker of weight change across the lifespan) in relation to vascular aging in late adulthood. We used cross-sectional data from a community-based cohort study (n=8243; age, 59.4; 38.7% women). A linear mixed model was used to assess trajectories of recalled body silhouettes from age 8 to 45 years. We assessed carotid artery properties (ultrasonography), resting hypertension (blood pressure ≥140/90 mm Hg or use of antihypertensives), and exaggerated exercise blood pressure, a marker of masked hypertension (systolic blood pressure ≥150 mm Hg during submaximal exercise) at study recruitment when the participants were 50 to 75 years of age. We identified 5 distinct body silhouette trajectories: lean stable (32.0%), lean increase (11.1%), moderate stable (32.5%), lean-marked increase (16.3%), and heavy stable (8.1%). Compared with individuals in the lean-stable trajectory, those in the moderate-stable, lean-marked increase, and heavy-stable trajectories had higher carotid stiffness, intima-media thickness and diameter (odds ratios between 1.23 and 2.10 for highest quartile versus lowest quartile of manifestations of vascular aging; P<0.05) and were more likely to have resting hypertension and exaggerated exercise blood pressure, after adjustment for potential confounders (odds ratios between 1.31 and 1.60; P<0.05). Vascular aging was most prominent among individuals who were lean in early life but markedly gained weight during young adulthood and among those who were heavy in early life and maintained weight.
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Affiliation(s)
- Thomas T van Sloten
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.).,Department of Arterial Mechanics, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., P.B., R.E.C., S.L.).,Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands (T.T.v.S.)
| | - Pierre Boutouyrie
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.)
| | - Quentin Lisan
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.)
| | - Muriel Tafflet
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.)
| | - Frédérique Thomas
- Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.)
| | - Catherine Guibout
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.)
| | - Rachel E Climie
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.).,Department of Arterial Mechanics, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., P.B., R.E.C., S.L.).,Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia (R.E.C., J.E.S.).,Physical Activity and Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.)
| | - Bruno Pannier
- Department of Arterial Mechanics, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., P.B., R.E.C., S.L.).,Department of Pharmacology, AP-HP, Georges Pompidou European Hospital, Paris, France (P.B., S.L.).,Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.)
| | - James E Sharman
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia (R.E.C., J.E.S.)
| | - Stéphane Laurent
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Arterial Mechanics, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., P.B., R.E.C., S.L.).,Department of Pharmacology, AP-HP, Georges Pompidou European Hospital, Paris, France (P.B., S.L.)
| | - Xavier Jouven
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.)
| | - Jean-Philippe Empana
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.).,Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.)
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van Sloten TT, Boutouyrie P, Tafflet M, Offredo L, Thomas F, Guibout C, Climie RE, Lemogne C, Pannier B, Laurent S, Jouven X, Empana JP. Carotid Artery Stiffness and Incident Depressive Symptoms: The Paris Prospective Study III. Biol Psychiatry 2019; 85:498-505. [PMID: 30409381 DOI: 10.1016/j.biopsych.2018.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/27/2018] [Accepted: 09/11/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Arterial stiffness may contribute to late-life depression via cerebral microvascular damage, but evidence is scarce. No longitudinal study has evaluated the association between arterial stiffness and risk of depressive symptoms. Therefore, we investigated the association between carotid artery stiffness and incident depressive symptoms in a large community-based cohort study. METHODS This longitudinal study included 7013 participants (mean age 59.7 ± 6.3 years; 35.8% women) free of depressive symptoms at baseline. Carotid artery stiffness (high-resolution echo tracking) was determined at baseline. Presence of depressive symptoms was determined at baseline and at 4 and 6 years of follow-up, and was defined as a score ≥7 on the validated Questionnaire of Depression, Second Version, Abridged and/or new use of antidepressant medication. Logistic regression and generalized estimating equations were used. RESULTS In total, 6.9% (n = 484) of the participants had incident depressive symptoms. Individuals in the lowest tertile of carotid distensibility coefficient (indicating greater carotid artery stiffness) compared with those in the highest tertile had a higher risk of incident depressive symptoms (odds ratio: 1.43; 95% confidence interval: 1.10-1.87), after adjustment for age, sex, living alone, education, lifestyle, cardiovascular risk factors, and baseline Questionnaire of Depression, Second Version, Abridged scores. Results were qualitatively similar when we used carotid Young's elastic modulus as a measure of carotid stiffness instead of carotid distensibility coefficient, and when we used generalized estimating equations instead of logistic regression. CONCLUSIONS Greater carotid stiffness is associated with a higher incidence of depressive symptoms. This supports the hypothesis that carotid stiffness may contribute to the development of late-life depression.
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Affiliation(s)
- Thomas T van Sloten
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Pierre Boutouyrie
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Pharmacology, Georges Pompidou European Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Muriel Tafflet
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | - Lucile Offredo
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | | | - Catherine Guibout
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | - Rachel E Climie
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Menzies Institute for Medical Research, University of Tasmania, Hobert, Australia
| | - Cédric Lemogne
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Psychiatry and Neuroscience Center, U894, French Institute of Health and Medical Research, Paris, France; Department of Psychiatry, Georges Pompidou European Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Bruno Pannier
- Preventive and Clinical Investigation Center, Paris, France
| | - Stéphane Laurent
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Arterial Mechanics, Paris Cardiovascular Research Center, UMR-S970, Paris, France; Department of Pharmacology, Georges Pompidou European Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Xavier Jouven
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
| | - Jean-Philippe Empana
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Department of Epidemiology, Paris Cardiovascular Research Center, UMR-S970, Paris, France
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van Sloten TT, Tafflet M, Périer MC, Dugravot A, Climie RED, Singh-Manoux A, Empana JP. Association of Change in Cardiovascular Risk Factors With Incident Cardiovascular Events. JAMA 2018; 320:1793-1804. [PMID: 30398604 PMCID: PMC6248104 DOI: 10.1001/jama.2018.16975] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022]
Abstract
Importance There is consistent evidence of the association between ideal cardiovascular health and lower incident cardiovascular disease (CVD); however, most studies used a single measure of cardiovascular health. Objective To examine how cardiovascular health changes over time and whether these changes are associated with incident CVD. Design, Setting, and Participants Prospective cohort study in a UK general community (Whitehall II), with examinations of cardiovascular health from 1985/1988 (baseline) and every 5 years thereafter until 2015/2016 and follow-up for incident CVD until March 2017. Exposures Using the 7 metrics of the American Heart Association (nonsmoking; and ideal levels of body mass index, physical activity, diet, blood pressure, fasting blood glucose, and total cholesterol), participants with 0 to 2, 3 to 4, and 5 to 7 ideal metrics were categorized as having low, moderate, and high cardiovascular health. Change in cardiovascular health over 10 years between 1985/1988 and 1997/1999 was considered. Main Outcome and Measure Incident CVD (coronary heart disease and stroke). Results The study population included 9256 participants without prior CVD (mean [SD] age at baseline, 44.8 [6.0] years; 2941 [32%] women), of whom 6326 had data about cardiovascular health change. Over a median follow-up of 18.9 years after 1997/1999, 1114 incident CVD events occurred. In multivariable analysis and compared with individuals with persistently low cardiovascular health (consistently low group, 13.5% of participants; CVD incident rate per 1000 person-years, 9.6 [95% CI, 8.4-10.9]), there was no significant association with CVD risk in the low to moderate group (6.8% of participants; absolute rate difference per 1000 person-years, -1.9 [95% CI, -3.9 to 0.1]; HR, 0.84 [95% CI, 0.66-1.08]), the low to high group, (0.3% of participants; absolute rate difference per 1000 person-years, -7.7 [95% CI, -11.5 to -3.9]; HR, 0.19 [95% CI, 0.03-1.35]), and the moderate to low group (18.0% of participants; absolute rate difference per 1000 person-years, -1.3 [95% CI, -3.0 to 0.3]; HR, 0.96 [95% CI, 0.80-1.15]). A lower CVD risk was observed in the consistently moderate group (38.9% of participants; absolute rate difference per 1000 person-years, -4.2 [95% CI, -5.5 to -2.8]; HR, 0.62 [95% CI, 0.53-0.74]), the moderate to high group (5.8% of participants; absolute rate difference per 1000 person-years, -6.4 [95% CI, -8.0 to -4.7]; HR, 0.39 [95% CI, 0.27-0.56]), the high to low group (1.9% of participants; absolute rate difference per 1000 person-years, -5.3 [95% CI, -7.8 to -2.8]; HR, 0.49 [95% CI, 0.29-0.83]), the high to moderate group (9.3% of participants; absolute rate difference per 1000 person-years, -4.5 [95% CI, -6.2 to -2.9]; HR, 0.66 [95% CI, 0.51-0.85]), and the consistently high group (5.5% of participants; absolute rate difference per 1000 person-years, -5.6 [95% CI, -7.4 to -3.9]; HR, 0.57 [95% CI, 0.40-0.80]). Conclusions and Relevance Among a group of participants without CVD who received follow-up over a median 18.9 years, there was no consistent relationship between direction of change in category of a composite metric of cardiovascular health and risk of CVD.
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Affiliation(s)
- Thomas T. van Sloten
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
- Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Muriel Tafflet
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | - Marie-Cécile Périer
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Rachel E. D. Climie
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
- Menzies Institute for Medical Research, University of Tasmania, Hobert, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jean-Philippe Empana
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
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Zhou TL, Henry RM, Stehouwer CD, van Sloten TT, Reesink KD, Kroon AA. Blood Pressure Variability, Arterial Stiffness, and Arterial Remodeling. Hypertension 2018; 72:1002-1010. [DOI: 10.1161/hypertensionaha.118.11325] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tan Lai Zhou
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
| | - Ronald M.A. Henry
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
| | - Coen D.A. Stehouwer
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
| | - Thomas T. van Sloten
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (T.T.v.S.)
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology and Department of Arterial Mechanics, France (T.T.v.S.)
| | - Koen D. Reesink
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
- Department of Biomedical Engineering (K.D.R.), Maastricht University, The Netherlands
| | - Abraham A. Kroon
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Heart and Vascular Centre (A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
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van Sloten TT, Boutouyrie P, Tafflet M, Thomas F, Guibout C, Climie RE, Lemogne C, Pannier B, Laurent S, Jouven X, Empana JP. Abstract 112: Carotid Artery Stiffness Increases the Risk of Incident Depressive Symptoms: The Paris Prospective Study 3. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Late-life depression is related to poor quality of life, functional impairment, and increased risk of mortality and cardiovascular disease. Effective interventions for prevention and treatment of late-life depression need to be developed, which requires a better understanding of late-life depression risk factors. Arterial stiffness, an important cardiovascular disease risk factor, may contribute to late-life depression via cerebrovascular damage, but evidence is scarce.
Aim:
We investigated the association between carotid artery stiffness and incident depressive symptoms in a large community-based cohort study.
Methods:
This longitudinal study included 7,013 participants (60 (SD 6) years; 36% women) free of depressive symptoms at baseline. Carotid stiffness (high-resolution echotracking) was determined at baseline. Presence of depressive symptoms was determined at baseline and at 4 and 6 years of follow-up, and was defined as a score ≥7 on a validated 13-item questionnaire (Q2DA) and/or new use of antidepressants. Cox regression and generalized estimating equations (GEE) were used.
Results:
In total, 6.9% (n=484) of the participants had incident depressive symptoms at 4 or 6 years of follow-up. Greater carotid stiffness was associated with a higher incidence of depressive symptoms (Figure). Results were qualitatively similar when GEE was used instead of Cox regression.
Conclusions:
Greater carotid stiffness is associated with a higher incidence of depressive symptoms. This study supports the hypothesis that carotid stiffness contributes to the development of late-life depression.
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Affiliation(s)
| | | | | | | | | | | | - Cédric Lemogne
- AP-HP, Georges Pompidou European Hosp, Dept of Psychiatry, Paris, France
| | - Bruno Pannier
- Preventive and Clinical Investigation Cntr, Paris, France
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Sedaghat S, van Sloten TT, Laurent S, London GM, Pannier B, Kavousi M, Mattace-Raso F, Franco OH, Boutouyrie P, Ikram MA, Stehouwer CDA. Common Carotid Artery Diameter and Risk of Cardiovascular Events and Mortality: Pooled Analyses of Four Cohort Studies. Hypertension 2018; 72:85-92. [PMID: 29785959 DOI: 10.1161/hypertensionaha.118.11253] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/04/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Abstract
Carotid arterial diameter enlargement is a manifestation of arterial remodeling and may be a risk factor for cardiovascular disease (CVD). We evaluated the association between carotid artery diameter and risk of stroke, coronary heart disease, CVD, and all-cause mortality and explored whether the associations could be explained by processes involved in arterial remodeling, that is, blood pressure-related media thickening, arterial stiffness, arterial wall stress, and atherosclerosis. We included 4887 participants (mean age 67±9 years; 54% women) from 4 cohort studies: Rotterdam Study, NEPHROTEST, Hoorn Study, and a study by Blacher et al. Common carotid artery properties were measured using echotracking. Incident cases were recorded based on medical records. We used Cox proportional hazard models adjusting for cardiovascular risk factors and estimates of processes underlying arterial remodeling. During follow-up (mean, 11 years), 379 (8%) individuals had a stroke, 516 had a (11%) coronary heart disease, 807 had a (17%) CVD, and 1486 (30%) had died. After adjustment for cardiovascular risk factors, individuals in the highest tertile of carotid diameter (diameter >8 mm) compared with those in the lowest tertile (diameter <7 mm) had a higher incidence of stroke (hazard ratio, 1.5; 95% confidence interval, 1.1-2.0). From all estimates of processes underlying arterial remodeling, adjustment for carotid intima-media thickness attenuated this association (hazard ratio after adjustment for intima-media thickness, 1.2; 95% confidence interval, 0.9-1.6). Larger carotid diameter was associated with risk of CVD and mortality but not clearly with coronary heart disease risk. We showed that a larger carotid diameter is associated with incident stroke, CVD, and mortality. Carotid intima-media thickness, a measure of blood pressure-related media thickening, partially explained the association with stroke incidence.
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Affiliation(s)
- Sanaz Sedaghat
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.)
| | - Thomas T van Sloten
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.).,Inserm U970, HEGP, AP-HP, Université Paris-Descartes, France (T.T.v.S., S.L., P.B.)
| | - Stéphane Laurent
- Inserm U970, HEGP, AP-HP, Université Paris-Descartes, France (T.T.v.S., S.L., P.B.).,Department of Pharmacology, Georges Pompidou European Hospital, Paris, France (S.L., P.B.)
| | - Gérard M London
- Department of Nephrology, Hôpital Manhès, Paris, France (G.M.L.)
| | - Bruno Pannier
- Centre d'Investigations Préventives et Cliniques (IPC Center), Paris, France (B.P.)
| | - Maryam Kavousi
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.)
| | | | - Oscar H Franco
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.)
| | - Pierre Boutouyrie
- Inserm U970, HEGP, AP-HP, Université Paris-Descartes, France (T.T.v.S., S.L., P.B.).,Department of Pharmacology, Georges Pompidou European Hospital, Paris, France (S.L., P.B.)
| | - M Arfan Ikram
- From the Departments of Epidemiology (S.S., M.K., O.H.F., M.A.I.).,Neurology (M.A.I.).,Radiology (M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
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Rensma SP, van Sloten TT, Launer LJ, Stehouwer CDA. Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: A systematic review and meta-analysis. Neurosci Biobehav Rev 2018; 90:164-173. [PMID: 29656031 PMCID: PMC6123527 DOI: 10.1016/j.neubiorev.2018.04.003] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022]
Abstract
MRI features of cerebral small vessel disease (CSVD), i.e. white matter hyperintensities, lacunes, microbleeds, perivascular spaces, and cerebral atrophy, may be associated with clinical events, but the strength of these associations remains unclear. We conducted a systematic review and meta-analysis on the association between these features and incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. For the association with stroke, 36 studies were identified (number of individuals/events [n] = 38,432/4,136), for dementia 28 (n = 16,458/1,709), for depression nine (n = 9,538/1,746), and for mortality 28 (n = 23,031/2,558). Only two studies evaluated perivascular spaces; these results were not pooled. Pooled analyses showed that all other features were associated with all outcomes (hazard ratios ranged 1.22–2.72). Combinations of two features were more strongly associated with stroke than any individual feature. Individual features and combinations of CSVD features are strongly associated with incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. If these associations are causal, the strength of these associations suggests that a substantial burden of disease is attributable to CSVD.
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Affiliation(s)
- Sytze P Rensma
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Avenue, Bethesda, MD, USA.
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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van Sloten TT, de Klaver PAG, van den Wall Bake AWL. Co-administration of cyclosporine and ticagrelor may lead to a higher exposure to cyclosporine: a case report of a 49-year-old man. Br J Clin Pharmacol 2017; 84:208-210. [PMID: 28891590 DOI: 10.1111/bcp.13433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/15/2017] [Accepted: 09/01/2017] [Indexed: 01/18/2023] Open
Abstract
ADVERSE EVENT A drug interaction leading to higher exposure to cyclosporine. DRUGS IMPLICATED Cyclosporine and ticagrelor. THE PATIENT A 49-year-old man with a stable renal graft, managed with cyclosporine with stable trough blood concentrations for several years, was treated with ticagrelor for unstable angina pectoris. EVIDENCE THAT LINKS THE DRUG TO THE EVENT The timeline was consistent with the appearance of an interaction, the interaction was confirmed by an increase in trough concentration of cyclosporine, and there were no alternative causes that by themselves could have caused the increase in cyclosporine exposure. MANAGEMENT Cessation of ticagrelor. MECHANISM Inhibition of CYP3A4 and P-glycoprotein by ticagrelor. IMPLICATIONS FOR THERAPY Clinicians should be aware of this potential interaction as ticagrelor is frequently prescribed in individuals using cyclosporine. Close monitoring of cyclosporine serum concentrations is warranted to avoid overdosing of cyclosporine. A pharmacokinetic study is needed to further examine the probable interaction between cyclosporine and ticagrelor.
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Affiliation(s)
- Thomas T van Sloten
- Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Paul A G de Klaver
- Department of Pharmacology, Máxima Medical Center, Veldhoven, The Netherlands
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Stehouwer CDA, van Sloten TT. Microvascular outcomes in type 2 diabetes. Lancet Diabetes Endocrinol 2017; 5:579. [PMID: 28732662 DOI: 10.1016/s2213-8587(17)30187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/18/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, 6202 AZ, Netherlands.
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, 6202 AZ, Netherlands
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van Eupen MGA, Schram MT, van Sloten TT, Scheijen J, Sep SJS, van der Kallen CJ, Dagnelie PC, Koster A, Schaper N, Henry RMA, Kroon AA, Smit AJ, Stehouwer CDA, Schalkwijk CG. Skin Autofluorescence and Pentosidine Are Associated With Aortic Stiffening: The Maastricht Study. Hypertension 2016; 68:956-63. [PMID: 27550921 DOI: 10.1161/hypertensionaha.116.07446] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 03/16/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
Abstract
Arterial stiffening, as characterized by an increase in carotid-femoral pulse-wave velocity or pulse pressure, increases the risk of cardiovascular disease, especially among individuals with type 2 diabetes mellitus. Advanced glycation end products are hypothesized to play a role in the development of arterial stiffness. Therefore, we investigated the association between skin autofluorescence, an estimate of tissue advanced glycation end products, and plasma advanced glycation end products on the one hand and arterial stiffening on the other in 862 participants of The Maastricht Study (mean age of 60 years; 45% women) with normal glucose metabolism (n=469), impaired glucose metabolism (n=140), or type 2 diabetes (n=253). Associations were analyzed with linear regression analysis and adjusted for potential confounders. We found that higher skin autofluorescence as measured by the AGE Reader and plasma pentosidine were independently associated with higher carotid-femoral pulse-wave velocity (sβ 0.10; 95% confidence interval, 0.03-0.17 and 0.10; 0.04-0.16, respectively) and central pulse pressure (sβ 0.08; 95% confidence interval 0.01-0.15 and 0.07; 0.01-0.13, respectively). The associations between skin autofluorescence and pentosidine, and carotid-femoral pulse-wave velocity were more pronounced in individuals with type 2 diabetes mellitus (P-interaction<0.10). These results support the hypothesis that accumulation of advanced glycation end products is involved in arterial stiffening and may explain part of the increased risk of cardiovascular disease in individuals with type 2 diabetes mellitus.
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Affiliation(s)
- Marcelle G A van Eupen
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Miranda T Schram
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Thomas T van Sloten
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Jean Scheijen
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Simone J S Sep
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Carla J van der Kallen
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Pieter C Dagnelie
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Annemarie Koster
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Nicolaas Schaper
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Ronald M A Henry
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Abraham A Kroon
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Andries J Smit
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Coen D A Stehouwer
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.)
| | - Casper G Schalkwijk
- From the Department of Internal Medicine (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); Department of Epidemiology (P.C.D.); Department of Social Medicine (A.K.); Cardiovascular Research Institute Maastricht (CARIM) (M.G.A.v.E., M.T.S., T.T.v.S., J.S., S.J.S.S., C.J.v.d.K., P.C.D., N.S., R.M.A.H., A.A.K., C.D.A.S., C.G.S.); School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (P.C.D., A.K., N.S., C.D.A.S.); and Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, University of Groningen, The Netherlands (A.J.S.).
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