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Slaughter JL, Klebanoff MA, Hade EM. Estimating the effect of diuretics and inhaled corticosteroids for evolving bronchopulmonary dysplasia in preterm infants. Paediatr Perinat Epidemiol 2024. [PMID: 38192005 DOI: 10.1111/ppe.13038] [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: 05/15/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Off-label treatment of extremely preterm infants with diuretics and inhaled corticosteroids (ICS) for evolving bronchopulmonary dysplasia (BPD) is common. Their effectiveness in reducing mortality or BPD severity, and optimal treatment timing, are unclear. OBJECTIVES To determine whether diuretic treatment or ICS administration for infants with early evolving (between 10-27 days postnatal) and progressively evolving (28th-day-36th-week postnatal) BPD are independently associated with reduced mortality and moderate or severe BPD at 36-weeks postmenstrual age (PMA). METHODS We examined neonates born before 28 weeks' gestation and admitted to neonatal intensive care units on postnatal Day 0 between 2006 and 2016 using data collected during routine care recorded within the Paediatric Health Information System (PHIS). An early evolving BPD cohort consisted of infants treated with oxygen, positive pressure or mechanical ventilation at 10 days postnatal. The progressively evolving BPD cohort consisted of infants treated with these modalities at 28 days. In new users, we evaluated the effect of diuretic and ICS treatment on mortality or BPD severity at 36 weeks PMA, adjusting for time-dependent confounding by respiratory status using marginal structural models. RESULTS Early evolving BPD was present in 10,135 patients; progressively evolving BPD in 11,728. New diuretic exposure during early evolving BPD (adjusted risk ratio [aRR] 0.77, 95% confidence interval [CI] 0.65, 0.93) was associated with decreased mortality or moderate/severe BPD risk. New diuretics (aRR 0.86, 95% CI 0.75, 0.99) during progressively evolving BPD between 28-days-36-weeks PMA were less strongly associated with mortality or moderate/severe BPD reduction. There was no strong association for ICS in patients with early evolving (aRR: 1.40; 95% CI: 0.79, 2.51) or progressively evolving BPD (aRR 1.16, 95% CI 0.95, 1.49). CONCLUSION Diuretics, but not ICS, for evolving BPD were associated with mortality and BPD risk reduction.
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Affiliation(s)
- Jonathan L Slaughter
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Mark A Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Division of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Erinn M Hade
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Goldberger JJ, Zaatari G, Mitrani RD, Blandon C, Bohorquez J, Ng J, Ng J, Velasquez A, Lambrakos L, Arora R. Comparison of electrogram characteristics in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:182-197. [PMID: 38031313 DOI: 10.1111/jce.16133] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Multiple analysis techniques evaluate electrograms during atrial fibrillation (AF), but none have been established to guide catheter ablation. This study compares electrogram properties recorded from multiple right (RA) and left atrial (LA) sites. METHODS Multisite LA/RA mapping (281 ± 176/239 ± 166 sites/patient) was performed in 42 patients (30 males, age 63 ± 9 years) undergoing first (n = 32) or redo-AF ablation (n = 10). All electrogram recordings were visually reviewed and artifactual signals were excluded leaving a total of 21 846 for analysis. Electrogram characteristics evaluated were cycle length (CL), amplitude, Shannon's entropy (ShEn), fractionation interval, dominant frequency, organizational index, and cycle length of most recurrent morphology (CLR ) from morphology recurrence plot analysis. RESULTS Electrogram characteristics were correlated to each other. All pairwise comparisons were significant (p < .001) except for dominant frequency and CLR (p = .59), and amplitude and dominant frequency (p = .38). Only ShEn and fractionation interval demonstrated a strong negative correlation (r = -.94). All other pairwise comparisons were poor to moderately correlated. The relationships are highly conserved among patients, in the RA versus LA, and in those undergoing initial versus redo ablations. Antiarrhythmic drug therapy did not have a significant effect on electrogram characteristics, except minimum ShEn. Electrogram characteristics associated with ablation outcome were shorter minimum CLR , lower minimum ShEn, and longer mimimum CL. There was minimal overlap between the top 10 sites identified by one electrogram characteristic and the top 10 sites identified by the other 10 characteristics. CONCLUSION Multiple techniques can be employed for electrogram analysis in AF. In this analysis of eight different electrogram characteristics, seven were poorly to moderately correlated and do not identify similar locations. Only some characteristics were predictive of ablation outcome. Further studies to consider electrogram properties, perhaps in combination, for categorizing and/or mapping AF are warranted.
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Affiliation(s)
- Jeffrey J Goldberger
- Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida, USA
| | - Ghaith Zaatari
- Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida, USA
| | - Raul D Mitrani
- Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida, USA
| | - Catherine Blandon
- Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida, USA
| | - Jorge Bohorquez
- Department of Biomedical Engineering, University of Miami, Miami, Florida, USA
| | - Jason Ng
- Department of Medicine, DIvision of Cardiology, Northwestern University, Evanston, Illinois, USA
| | - Justin Ng
- Department of Medicine, DIvision of Cardiology, Northwestern University, Evanston, Illinois, USA
| | - Alex Velasquez
- Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida, USA
| | - Litsa Lambrakos
- Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida, USA
| | - Rishi Arora
- Department of Medicine, DIvision of Cardiology, Northwestern University, Evanston, Illinois, USA
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Waitzfelder B, Palaniappan L, Varga A, Frankland TB, Li J, Daida YG, Kaholokula JK, Bacong AM, Rawlings AM, Chung S, Howick C, Fortmann SP. Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC Public Health 2023; 23:885. [PMID: 37189145 PMCID: PMC10184427 DOI: 10.1186/s12889-023-15795-5] [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: 09/02/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations. METHODS The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups. RESULTS The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos). CONCLUSIONS Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.
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Affiliation(s)
- Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Timothy B Frankland
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | | | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | - Connor Howick
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
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Li J, Peterson A, Auchincloss AH, Hirsch JA, Rodriguez DA, Melly SJ, Moore KA, Diez-Roux AV, Sánchez BN. Comparing effects of Euclidean buffers and network buffers on associations between built environment and transport walking: the Multi-Ethnic Study of Atherosclerosis. Int J Health Geogr 2022; 21:12. [PMID: 36115992 PMCID: PMC9482303 DOI: 10.1186/s12942-022-00310-7] [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: 05/31/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transport walking has drawn growing interest due to its potential to increase levels of physical activities and reduce reliance on vehicles. While existing studies have compared built environment-health associations between Euclidean buffers and network buffers, no studies have systematically quantified the extent of bias in health effect estimates when exposures are measured in different buffers. Further, prior studies have done the comparisons focusing on only one or two geographic regions, limiting generalizability and restricting ability to test whether direction or magnitude of bias are different by context. This study aimed to quantify the degree of bias in associations between built environment exposures and transport walking when exposures were operationalized using Euclidean buffers rather than network buffers in diverse contexts. METHODS We performed a simulations study to systematically evaluate the degree of bias in associations between built environment exposures in Euclidean buffers and network buffers and transport walking, assuming network buffers more accurately captured true exposures. Additionally, we used empirical data from a multi-ethnic, multi-site cohort to compare associations between built environment amenities and walking for transport where built environment exposures were derived using Euclidean buffers versus network buffers. RESULTS Simulation results found that the bias induced by using Euclidean buffer models was consistently negative across the six study sites (ranging from -80% to -20%), suggesting built environment exposures measured using Euclidean buffers underestimate health effects on transport walking. Percent bias was uniformly smaller for the larger 5 km scale than the 1 km and 0.25 km spatial scales, independent of site or built environment categories. Empirical findings aligned with the simulation results: built environment-health associations were stronger for built environment exposures operationalized using network buffers than using Euclidean buffers. CONCLUSION This study is the first to quantify the extent of bias in the magnitude of the associations between built environment exposures and transport walking when the former are measured in Euclidean buffers vs. network buffers, informing future research to carefully conceptualize appropriate distance-based buffer metrics in order to better approximate real geographic contexts. It also helps contextualize existing research in the field that used Euclidean buffers when that were the only option. Further, this study provides an example of the uncertain geographic context problem.
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Affiliation(s)
- Jingjing Li
- Department of Land Resources Management, School of Public Administration, China University of Geosciences, 388 Lumo Rd., Hubei, 430074, Wuhan, China.
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA.
| | - Adam Peterson
- Department of Biostatistics, the University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
| | - Daniel A Rodriguez
- Department of City & Regional Planning and Institute for Transportation Studies, University of California Berkeley, 230 Wurster Hall #1820, Berkeley, CA, 94720, USA
| | - Steven J Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
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Peila R, Chlebowski RT, Ballinger TJ, Kamensky V, Richey PA, Saquib N, Shadyab AH, Wassertheil-Smoller S, Rohan TE. Physical activity and risk of benign proliferative epithelial disorders of the breast, in the Women's Health Initiative. Int J Epidemiol 2022; 50:1948-1958. [PMID: 34999850 PMCID: PMC9020476 DOI: 10.1093/ije/dyab113] [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] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recreational physical activity (PA) has been shown to be inversely associated with breast cancer risk. However, the association of recreational PA with benign proliferative epithelial disorders (BPED) of the breast, conditions associated with increased risk of breast cancer, has not been adequately studied. METHODS We used data from an ancillary study of benign breast disease conducted among the 68 132 postmenopausal women (aged 50-79 at recruitment) participating in the Women's Health Initiative randomized clinical trials. All clinical trial participants underwent annual or biennial mammogram screening. During the follow-up, for women who reported breast biopsies but were cancer free, the associated histological sections were obtained and subjected to standardized central pathology review. Self-reported recreational PA at baseline (n = 61 684) and at 3 years of the follow-up (n = 55 923) were quantified as metabolic equivalents [MET]-h/week. There were 1624 confirmed BPED cases during an average follow-up time of 7.7 years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Higher average PA over 4 years was associated with lower risk of non-atypical BPED (P-trend = 0.02). There was a 6% lower risk of non-atypical BPED for every 5 MET-h/week increase between baseline and year 3 (HR = 0.94, 95% CI 0.89-0.99). Compared with women who remained inactive (PAbaseline and PAyear3 <9 MET-h/week), those who became active (PAbaseline<9 MET-h/week to PAyear3 ≥9 MET-h/weekee), remained active (PAbaseline and PAyear3 ≥9 MET-h/week), or decreased activity (PAbaseline ≥9 MET-h/week to PAyear3 <9 MET-h/week) had lower BPED risk. CONCLUSIONS Recreational physical activity after menopause was associated with lower BPED risk among postmenopausal women.
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Affiliation(s)
- Rita Peila
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tarah J Ballinger
- Indiana University Simon Comprehensive Center, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Victor Kamensky
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nazmus Saquib
- Department of Epidemiology, College of Medicine at Sulaiman, Al Rajhi University, Saudi Arabia
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
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Vereen RN, Lazard AJ, Frank SC, Pulido M, Richter APC, Higgins ICA, Shelus VS, Vandegrift SM, Hall MG, Ribisl KM. Motivations, barriers, and communication recommendations for promoting face coverings during the COVID-19 pandemic: Survey findings from a diverse sample. PLoS One 2021; 16:e0251169. [PMID: 33961657 PMCID: PMC8104408 DOI: 10.1371/journal.pone.0251169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
State and local health departments have been tasked with promoting the use of face coverings to decrease the spread of COVID-19 in their respective communities. However, little is known about motivations and barriers to wearing face coverings in the context of COVID-19 prevention, particularly among communities of color who are at an increased risk of serious illness from the disease. The purpose of this study was to identify common motivations and barriers to face covering use, as well as explore perceptions of messages encouraging the use of face coverings among a racially and ethnically diverse sample. A survey was distributed electronically to North Carolina (NC) residents through NC Department of Health and Human Services listservs in July 2020. Participants self-categorized as Latino/a (33.5%), Black (39.1%), or white or another race (27.5%). The most commonly endorsed motivations for wearing face coverings were to avoid spreading COVID-19 (77%), as well as to protect people who are vulnerable (76%) and one's community (72%). Being uncomfortable (40%) was the most commonly endorsed barrier. Messages that included a clear request (ex. please wear a face covering) and a direct benefit (ex. keep community safe) were more commonly endorsed than those that did not. Commonly endorsed motivations, behaviors, and messages differed by race and ethnicity. Increased attention to message content, message structure, and access to information and resources may aid local officials in increasing consistent use of face coverings.
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Affiliation(s)
- Rhyan N. Vereen
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Allison J. Lazard
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Simone C. Frank
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Marlyn Pulido
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Ana Paula C. Richter
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Isabella C. A. Higgins
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Victoria S. Shelus
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Sara M. Vandegrift
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Marissa G. Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kurt M. Ribisl
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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7
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Ford TJ, Corcoran D, Padmanabhan S, Aman A, Rocchiccioli P, Good R, McEntegart M, Maguire JJ, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Yii E, Sattar N, Hsu LY, Arai AE, Oldroyd KG, Touyz RM, Davenport AP, Berry C. Genetic dysregulation of endothelin-1 is implicated in coronary microvascular dysfunction. Eur Heart J 2020; 41:3239-3252. [PMID: 31972008 PMCID: PMC7557475 DOI: 10.1093/eurheartj/ehz915] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/12/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Endothelin-1 (ET-1) is a potent vasoconstrictor peptide linked to vascular diseases through a common intronic gene enhancer [(rs9349379-G allele), chromosome 6 (PHACTR1/EDN1)]. We performed a multimodality investigation into the role of ET-1 and this gene variant in the pathogenesis of coronary microvascular dysfunction (CMD) in patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease (CAD). METHODS AND RESULTS Three hundred and ninety-one patients with angina were enrolled. Of these, 206 (53%) with obstructive CAD were excluded leaving 185 (47%) eligible. One hundred and nine (72%) of 151 subjects who underwent invasive testing had objective evidence of CMD (COVADIS criteria). rs9349379-G allele frequency was greater than in contemporary reference genome bank control subjects [allele frequency 46% (129/280 alleles) vs. 39% (5551/14380); P = 0.013]. The G allele was associated with higher plasma serum ET-1 [least squares mean 1.59 pg/mL vs. 1.28 pg/mL; 95% confidence interval (CI) 0.10-0.53; P = 0.005]. Patients with rs9349379-G allele had over double the odds of CMD [odds ratio (OR) 2.33, 95% CI 1.10-4.96; P = 0.027]. Multimodality non-invasive testing confirmed the G allele was associated with linked impairments in myocardial perfusion on stress cardiac magnetic resonance imaging at 1.5 T (N = 107; GG 56%, AG 43%, AA 31%, P = 0.042) and exercise testing (N = 87; -3.0 units in Duke Exercise Treadmill Score; -5.8 to -0.1; P = 0.045). Endothelin-1 related vascular mechanisms were assessed ex vivo using wire myography with endothelin A receptor (ETA) antagonists including zibotentan. Subjects with rs9349379-G allele had preserved peripheral small vessel reactivity to ET-1 with high affinity of ETA antagonists. Zibotentan reversed ET-1-induced vasoconstriction independently of G allele status. CONCLUSION We identify a novel genetic risk locus for CMD. These findings implicate ET-1 dysregulation and support the possibility of precision medicine using genetics to target oral ETA antagonist therapy in patients with microvascular angina. TRIAL REGISTRATION ClinicalTrials.gov: NCT03193294.
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Affiliation(s)
- Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- Department of Cardiology, Gosford Hospital, NSW, Australia
- Faculty of Medicine, University of Newcastle, NSW, Australia
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Sandosh Padmanabhan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Alisha Aman
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Paul Rocchiccioli
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Richard Good
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Margaret McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Janet J Maguire
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Addenbrooke's Centre for Clinical Investigation (ACCI), Box 110, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Ross McGeoch
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert McDade
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Li-Yueh Hsu
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
| | - Rhian M Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
| | - Anthony P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Level 6, Addenbrooke's Centre for Clinical Investigation (ACCI), Box 110, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 9DH, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank G81 4DY, UK
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O’Callaghan-Gordo C, Shivashankar R, Anand S, Ghosh S, Glaser J, Gupta R, Jakobsson K, Kondal D, Krishnan A, Mohan S, Mohan V, Nitsch D, P A P, Tandon N, Narayan KMV, Pearce N, Caplin B, Prabhakaran D. Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population-based cross-sectional studies. BMJ Open 2019; 9:e023353. [PMID: 30850400 PMCID: PMC6429742 DOI: 10.1136/bmjopen-2018-023353] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/26/2018] [Accepted: 01/04/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To assess whether chronic kidney disease of unknown aetiology (CKDu) is present in India and to identify risk factors for it using population-based data and standardised methods. DESIGN Secondary data analysis of three population-based cross-sectional studies conducted between 2010 and 2014. SETTING Urban and rural areas of Northern India (states of Delhi and Haryana) and Southern India (states of Tamil Nadu and Andhra Pradesh). PARTICIPANTS 12 500 individuals without diabetes, hypertension or heavy proteinuria. OUTCOME MEASURES Mean estimated glomerular filtration rate (eGFR) and prevalence of eGFR below 60 mL/min per 1.73 m2 (eGFR <60) in individuals without diabetes, hypertension or heavy proteinuria (proxy definition of CKDu). RESULTS The mean eGFR was 105.0±17.8 mL/min per 1.73 m2. The prevalence of eGFR <60 was 1.6% (95% CI=1.4 to 1.7), but this figure varied markedly between areas, being highest in rural areas of Southern Indian (4.8% (3.8 to 5.8)). In Northern India, older age was the only risk factor associated with lower mean eGFR and eGFR <60 (regression coefficient (95% CI)=-0.94 (0.97 to 0.91); OR (95% CI)=1.10 (1.08 to 1.11)). In Southern India, risk factors for lower mean eGFR and eGFR <60, respectively, were residence in a rural area (-7.78 (-8.69 to -6.86); 4.95 (2.61 to 9.39)), older age (-0.90 (-0.93 to -0.86); 1.06 (1.04 to 1.08)) and less education (-0.94 (-1.32 to -0.56); 0.67 (0.50 to 0.90) for each 5 years at school). CONCLUSIONS CKDu is present in India and is not confined to Central America and Sri Lanka. Identified risk factors are consistent with risk factors previously reported for CKDu in Central America and Sri Lanka.
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Affiliation(s)
- Cristina O’Callaghan-Gordo
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Roopa Shivashankar
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
| | - Shuchi Anand
- StanfordUniversity School of Medicine, Stanford, CA, USA
| | | | - Jason Glaser
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- LaIsla Network, Ada, Michigan, USA
| | - Ruby Gupta
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Kristina Jakobsson
- Occupationaland Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Occupationaland Environmental Medicine, Lund University, Lund, Sweden
| | - Dimple Kondal
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
| | - Anand Krishnan
- Centrefor Community Medicine, All India Institute of Medical Sciences, New Delhi, Haryana, India
| | - Sailesh Mohan
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Viswanathan Mohan
- Diabetes Research, Madras Diabetes Research Foundation, Chennai, India
- Dr.Mohan’s Diabetes Specialities Centre, Chennai, India
| | - Dorothea Nitsch
- Departmentof Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Praveen P A
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
- Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K M Venkat Narayan
- EmoryGlobal Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centrefor Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centrefor Nephrology, University College London Medical School, London, UK
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
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9
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Grants
- R01 HL084064 NHLBI NIH HHS
- R01HL084064 National Heart, Lung, and Blood Institute, National Institutes of Health
- R01HL127077 National Heart, Lung, and Blood Institute, National Institutes of Health
- R40 MC 00319 Maternal and Child Health Bureau (Title V, Social Security Act) Health Resources and Services Administration, Department of Health and Human Services
- R01 HL116892 NHLBI NIH HHS
- R01HL116892 National Heart, Lung, and Blood Institute, National Institutes of Health
- R01 HL127077 NHLBI NIH HHS
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Affiliation(s)
- David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tian Hu
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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