1
|
Chong S, Huynh B, Wong S, Woldeyesus T, Faulks M, El-Amin K, Thibeaux J, Lewis J, Harlin R, Carter M, Shatara R, Zhou C, Oni-Orisan A. Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings. Health Equity 2023; 7:835-842. [PMID: 38145054 PMCID: PMC10739686 DOI: 10.1089/heq.2023.0157] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. Methods We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Results Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Discussion Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.
Collapse
Affiliation(s)
- Sarah Chong
- Department of Clinical Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Brittany Huynh
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Wong
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Temesgen Woldeyesus
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | - Melvin Faulks
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | | | | | - Joseph Lewis
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Robert Harlin
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Mario Carter
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Ramy Shatara
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Crystal Zhou
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Ferguson EL, Zimmerman SC, Jiang C, Choi M, Swinnerton K, Choudhary V, Meyers TJ, Hoffmann TJ, Gilsanz P, Oni-Orisan A, Whitmer RA, Risch N, Krauss RM, Schaefer CA, Glymour MM. Low- and High-Density Lipoprotein Cholesterol and Dementia Risk Over 17 Years of Follow-up Among Members of a Large Health Care Plan. Neurology 2023; 101:e2172-e2184. [PMID: 37793911 PMCID: PMC10663022 DOI: 10.1212/wnl.0000000000207876] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The associations of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) with dementia risk in later life may be complex, and few studies have sufficient data to model nonlinearities or adequately adjust for statin use. We evaluated the observational associations of HDL-C and LDL-C with incident dementia in a large and well-characterized cohort with linked survey and electronic health record (EHR) data. METHODS Kaiser Permanente Northern California health plan members aged 55 years and older who completed a health behavior survey between 2002 and 2007, had no history of dementia before the survey, and had laboratory measurements of cholesterol within 2 years after survey completion were followed up through December 2020 for incident dementia (Alzheimer disease-related dementia [ADRD]; Alzheimer disease, vascular dementia, and/or nonspecific dementia) based on ICD-9 or ICD-10 codes in EHRs. We used Cox models for incident dementia with follow-up time beginning 2 years postsurvey (after cholesterol measurement) and censoring at end of membership, death, or end of study period. We evaluated nonlinearities using B-splines, adjusted for demographic, clinical, and survey confounders, and tested for effect modification by baseline age or prior statin use. RESULTS A total of 184,367 participants [mean age at survey = 69.5 years, mean HDL-C = 53.7 mg/dL (SD = 15.0), mean LDL-C = 108 mg/dL (SD = 30.6)] were included. Higher and lower HDL-C values were associated with elevated ADRD risk compared with the middle quantile: HDL-C in the lowest quintile was associated with an HR of 1.07 (95% CI 1.03-1.11), and HDL-C in the highest quintile was associated with an HR of 1.15 (95% CI 1.11-1.20). LDL-C was not associated with dementia risk overall, but statin use qualitatively modified the association. Higher LDL-C was associated with a slightly greater risk of ADRD for statin users (53% of the sample, HR per 10 mg/dL increase = 1.01, 95% CI 1.01-1.02) and a lower risk for nonusers (HR per 10 mg/dL increase = 0.98; 95% CI 0.97-0.99). There was evidence for effect modification by age with linear HDL-C (p = 0.003) but not LDL-C (p = 0.59). DISCUSSION Both low and high levels of HDL-C were associated with elevated dementia risk. The association between LDL-C and dementia risk was modest.
Collapse
Affiliation(s)
- Erin L Ferguson
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA.
| | - Scott C Zimmerman
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Chen Jiang
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Minhyuk Choi
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Kaitlin Swinnerton
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Vidhu Choudhary
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Travis J Meyers
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Thomas J Hoffmann
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Paola Gilsanz
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Akinyemi Oni-Orisan
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Rachel A Whitmer
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Neil Risch
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Ronald M Krauss
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - Catherine A Schaefer
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| | - M Maria Glymour
- From the Department of Epidemiology and Biostatistics (E.L.F., S.C.Z., M.C., K.S., T.J.H., N.R., M.M.G.), University of California, San Francisco; Kaiser Permanente Division of Research (C.J., V.C., T.J.M., P.G., C.A.S.), Oakland; Institute for Human Genetics (A.O.-O., N.R.); Department of Clinical Pharmacy (A.O.-O.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; and Departments of Pediatrics and Medicine (R.M.K.), University of California, San Francisco. K.S. is currently affiliated with the VA Boston Healthcare System, MA. T.J.H. is currently affiliated with the Department of Epidemiology and Biostatistics, University of California, San Francisco, and the Institute for Human Genetics, University of California, San Francisco. P.G. is currently affiliated with the Kaiser Permanente Division of Research, Oakland, CA, and the Department of Epidemiology and Biostatistics, University of California, San Francisco. N.R. is currently affiliated with the Department of Epidemiology and Biostatistics, the Institute for Human Genetics, University of California, San Francisco, and the Kaiser Permanente Division of Research, Oakland, CA. M.M.G. is currently affiliated with the Department of Epidemiology, Boston University School of Public Health, MA
| |
Collapse
|
3
|
Zimmerman SC, Ferguson EL, Choudhary V, Ranatunga DK, Oni-Orisan A, Hayes-Larson E, Duarte Folle A, Mayeda ER, Whitmer RA, Gilsanz P, Power MC, Schaefer C, Glymour MM, Ackley SF. Metformin Cessation and Dementia Incidence. JAMA Netw Open 2023; 6:e2339723. [PMID: 37878309 PMCID: PMC10600586 DOI: 10.1001/jamanetworkopen.2023.39723] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/14/2023] [Indexed: 10/26/2023] Open
Abstract
Importance Prior studies suggested that metformin may be associated with reduced dementia incidence, but associations may be confounded by disease severity and prescribing trends. Cessation of metformin therapy in people with diabetes typically occurs due to signs of kidney dysfunction but sometimes is due to less serious adverse effects associated with metformin. Objective To investigate the association of terminating metformin treatment for reasons unrelated to kidney dysfunction with dementia incidence. Design, Setting, and Participants This cohort study was conducted at Kaiser Permanente Northern California, a large integrated health care delivery system, among a cohort of metformin users born prior to 1955 without history of diagnosed kidney disease at metformin initiation. Dementia follow-up began with the implementation of electronic health records in 1996 and continued to 2020. Data were analyzed from November 2021 through September 2023. Exposures A total of 12 220 early terminators, individuals who stopped metformin with normal estimated glomerular filtration rate (eGFR), were compared with routine metformin users, who had not yet terminated metformin treatment or had terminated (with or without restarting) after their first abnormal eGFR measurement. Early terminators were matched with routine users of the same age and gender who had diabetes for the same duration. Main outcomes and measures The outcome of interest was all-cause incident dementia. Follow-up for early terminators and their matched routine users was started at age of termination for the early terminator. Survival models adjusted for sociodemographic characteristics and comorbidities at the time of metformin termination (or matched age). Mediation models with HbA1c level and insulin usage 1 and 5 years after termination tested whether changes in blood glucose or insulin usage explained associations between early termination of metformin and dementia incidence. Results The final analytic sample consisted of 12 220 early terminators (5640 women [46.2%]; mean [SD] age at start of first metformin prescription, 59.4 [9.0] years) and 29 126 routine users (13 582 women [46.6%]; mean [SD] age at start of first metformin prescription, 61.1 [8.9] years). Early terminators had 1.21 times the hazard of dementia diagnosis compared with routine users (hazard ratio, 1.21; 95% CI, 1.12 to 1.30). In mediation analysis, contributions to this association by changes in HbA1c level or insulin use ranged from no contribution (0.00 years; 95% CI, -0.02 to 0.02 years) for insulin use at 5 years after termination to 0.07 years (95% CI, 0.02 to 0.13 years) for HbA1c level at 1 year after termination, suggesting that the association was largely independent of changes in HbA1c level and insulin usage. Conclusions and Relevance In this study, terminating metformin treatment was associated with increased dementia incidence. This finding may have important implications for clinical treatment of adults with diabetes and provides additional evidence that metformin is associated with reduced dementia risk.
Collapse
Affiliation(s)
- Scott C. Zimmerman
- Department of Epidemiology and Statistics, University of California, San Francisco
| | - Erin L. Ferguson
- Department of Epidemiology and Statistics, University of California, San Francisco
| | | | - Dilrini K. Ranatunga
- Kaiser Permanente Division of Research, Oakland, California
- Now with Kaiser Permanente Research Bank, Oakland, CA
| | | | - Eleanor Hayes-Larson
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Aline Duarte Folle
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Rachel A. Whitmer
- Kaiser Permanente Division of Research, Oakland, California
- Department of Public Health Sciences, University of California, Davis
| | - Paola Gilsanz
- Department of Epidemiology and Statistics, University of California, San Francisco
- Kaiser Permanente Division of Research, Oakland, California
| | - Melinda C. Power
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, District of Columbia
| | | | - M. Maria Glymour
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Sarah F. Ackley
- Department of Epidemiology, Boston University, Boston, Massachusetts
| |
Collapse
|
4
|
Oni-Orisan A, Tuteja S, Hoffecker G, Smith DM, Castrichini M, Crews KR, Murphy WA, Nguyen NHK, Huang Y, Lteif C, Friede KA, Tantisira K, Aminkeng F, Voora D, Cavallari LH, Whirl-Carrillo M, Duarte JD, Luzum JA. An Introductory Tutorial on Cardiovascular Pharmacogenetics for Healthcare Providers. Clin Pharmacol Ther 2023; 114:275-287. [PMID: 37303270 PMCID: PMC10406163 DOI: 10.1002/cpt.2957] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Pharmacogenetics can improve clinical outcomes by reducing adverse drug effects and enhancing therapeutic efficacy for commonly used drugs that treat a wide range of cardiovascular diseases. One of the major barriers to the clinical implementation of cardiovascular pharmacogenetics is limited education on this field for current healthcare providers and students. The abundance of pharmacogenetic literature underscores its promise, but it can also be challenging to learn such a wealth of information. Moreover, current clinical recommendations for cardiovascular pharmacogenetics can be confusing because they are outdated, incomplete, or inconsistent. A myriad of misconceptions about the promise and feasibility of cardiovascular pharmacogenetics among healthcare providers also has halted clinical implementation. Therefore, the main goal of this tutorial is to provide introductory education on the use of cardiovascular pharmacogenetics in clinical practice. The target audience is any healthcare provider (or student) with patients that use or have indications for cardiovascular drugs. This tutorial is organized into the following 6 steps: (1) understand basic concepts in pharmacogenetics; (2) gain foundational knowledge of cardiovascular pharmacogenetics; (3) learn the different organizations that release cardiovascular pharmacogenetic guidelines and recommendations; (4) know the current cardiovascular drugs/drug classes to focus on clinically and the supporting evidence; (5) discuss an example patient case of cardiovascular pharmacogenetics; and (6) develop an appreciation for emerging areas in cardiovascular pharmacogenetics. Ultimately, improved education among healthcare providers on cardiovascular pharmacogenetics will lead to a greater understanding for its potential in improving outcomes for a leading cause of morbidity and mortality.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Sony Tuteja
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Glenda Hoffecker
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D. Max Smith
- MedStar Health, Columbia, Maryland, USA
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Matteo Castrichini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristine R. Crews
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - William A. Murphy
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nam H. K. Nguyen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Yimei Huang
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Christelle Lteif
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A. Friede
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kelan Tantisira
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Folefac Aminkeng
- Departments of Medicine and Biomedical Informatics (DBMI), Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
- Centre for Precision Health (CPH), National University Health System (NUHS), Singapore City, Singapore
| | - Deepak Voora
- Precision Medicine Program, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Julio D. Duarte
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
| | - Jasmine A. Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
- Center for Individualized and Genomic Medicine Research, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
5
|
Kachuri L, Mak ACY, Hu D, Eng C, Huntsman S, Elhawary JR, Gupta N, Gabriel S, Xiao S, Keys KL, Oni-Orisan A, Rodríguez-Santana JR, LeNoir MA, Borrell LN, Zaitlen NA, Williams LK, Gignoux CR, Burchard EG, Ziv E. Gene expression in African Americans, Puerto Ricans and Mexican Americans reveals ancestry-specific patterns of genetic architecture. Nat Genet 2023; 55:952-963. [PMID: 37231098 PMCID: PMC10260401 DOI: 10.1038/s41588-023-01377-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 08/18/2021] [Accepted: 03/21/2023] [Indexed: 05/27/2023]
Abstract
We explored ancestry-related differences in the genetic architecture of whole-blood gene expression using whole-genome and RNA sequencing data from 2,733 African Americans, Puerto Ricans and Mexican Americans. We found that heritability of gene expression significantly increased with greater proportions of African genetic ancestry and decreased with higher proportions of Indigenous American ancestry, reflecting the relationship between heterozygosity and genetic variance. Among heritable protein-coding genes, the prevalence of ancestry-specific expression quantitative trait loci (anc-eQTLs) was 30% in African ancestry and 8% for Indigenous American ancestry segments. Most anc-eQTLs (89%) were driven by population differences in allele frequency. Transcriptome-wide association analyses of multi-ancestry summary statistics for 28 traits identified 79% more gene-trait associations using transcriptome prediction models trained in our admixed population than models trained using data from the Genotype-Tissue Expression project. Our study highlights the importance of measuring gene expression across large and ancestrally diverse populations for enabling new discoveries and reducing disparities.
Collapse
Affiliation(s)
- Linda Kachuri
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Angel C Y Mak
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer R Elhawary
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Namrata Gupta
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Shujie Xiao
- Center for Individualized and Genomic Medicine Research, Henry Ford Health System, Detroit, MI, USA
| | - Kevin L Keys
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Berkeley Institute for Data Science, University of California, Berkeley, Berkeley, CA, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Noah A Zaitlen
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - L Keoki Williams
- Center for Individualized and Genomic Medicine Research, Henry Ford Health System, Detroit, MI, USA
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Christopher R Gignoux
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Esteban González Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Elad Ziv
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
6
|
Oni-Orisan A, Lu M, Peng JA, Krauss RM, Iribarren C, Medina MW. Development and application of an algorithm for statin-induced myopathy based on electronic health record-derived structured elements. medRxiv 2023:2023.04.24.23289059. [PMID: 37162948 PMCID: PMC10168492 DOI: 10.1101/2023.04.24.23289059] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective Considering the non-specific nature of muscle symptoms, studies of statin-induced myopathy (SIM) in electronic health records require accurate algortihms that can reliably identify true statin-related cases. However, prior algorithms have been constructed in study populations that preclude broad applicability. Here we developed and validated an algorithm that accurately defines SIM from electronic health records using structured data elements and conducted a study of determinants of SIM after applying the algorithm. Materials and Methods We used electronic records from an integrated health care delivery system (including comprehensive pharmacy dispensing records) and defined SIM as elevated creatine kinase (CK) ≥4 x upper limit of normal. A diverse cohort of participants receiving a variety of statin regimens met the criteria for study inclusion. Results We identified multiple conditions strongly associated with elevated CK independent of statin use. A 2-step algorithm was developed using these all-cause conditions as secondary causes (step 1) along with evidence of a statin regimen change (step 2). We identified 1,262 algorithm-derived statin-induced elevated CK cases. Gold standard SIM cases determined from manual chart reviews on a random subset of the all-cause elevated CK cases were used to validate the algorithm, which had a 76% sensitivity and 77% specificity for detecting the most certain cases. Pravastatin use was associated with a 2.18 odds (95% confidence interval 1.39-3.40, P=0.0007) for statin-induced CK elevation compared to lovastatin use after adjusting for dose and other factors. Conclusions We have produced an efficient, easy-to-apply methodological tool that can improve the quality of future research on statin-induced myopathy.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, Institute for Human Genetics, University of California San Francisco, San Francisco CA 94143, USA
| | - Meng Lu
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Jonathan A. Peng
- Department of Cardiology, Kaiser Permanente, Santa Rosa, CA 95403, USA
| | - Ronald M. Krauss
- Department of Medicine, Department of Pediatrics, University of California San Francisco, Oakland CA 94609, USA
| | - Carlos Iribarren
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Marisa W. Medina
- Department of Pediatrics, University of California San Francisco, Oakland CA 94609, USA
| |
Collapse
|
7
|
Kehinde O, Ramsey LB, Gaedigk A, Oni-Orisan A. Advancing CYP2D6 Pharmacogenetics Through a Pharmacoequity Lens. Clin Pharmacol Ther 2023. [PMID: 36924260 DOI: 10.1002/cpt.2890] [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] [Received: 09/10/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
Over 20% of Food and Drug Administration (FDA)-approved drugs in the United States are metabolized by the hepatic enzyme cytochrome P450 2D6 (CYP2D6). The gene encoding CYP2D6 is highly polymorphic and genetic variation has been shown to impact drug response for many commonly dispensed drugs including opioids and antidepressants. Thus, it is important to understand an individual's CYP2D6 metabolizer status to optimize treatment outcomes for patients taking medications that are metabolized by this enzyme. Consequently, clinical CYP2D6 pharmacogenetic testing is being implemented by a growing number of health centers. Furthermore, clinical guidelines currently recommend adapting therapeutic regimens based on CYP2D6 genotype-informed phenotype. However, CYP2D6 genetic variation varies considerably across global populations and many allelic variants, or star alleles, are predominantly found in certain ancestral populations. Although CYP2D6 genetic variation has been extensively studied, there is still a paucity of information for many non-European populations. As has been shown for other pharmacogenes in randomized controlled trials, results from European populations cannot simply be extrapolated to other groups and in some cases even has the potential to cause harm. Therefore, enhanced inclusion in pharmacogenetic studies is urgently needed to increase ancestral representation, determine the extent of global CYP2D6 genetic variation (e.g., ancestry-specific variants), and determine the clinical impact of this variation on clinical treatment outcome. This review highlights knowledge gaps, challenges, and future directions in CYP2D6 pharmacogenomics through a unique pharmacoequity lens to address health inequities that hamper our ability to optimize drug therapy for improved pharmacological outcomes in diverse populations globally.
Collapse
Affiliation(s)
- Oyinlade Kehinde
- Child and Adolescents Mental Health Service Center, Federal Neuro-Psychiatric Hospital, Lagos, Nigeria
| | - Laura B Ramsey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Divisions of Clinical Pharmacology and Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Research Institute (CMRI), Kansas City, Missouri, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA.,Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
8
|
Brown K, Etrouth S, Jayachandran P, Moore J, Oni-Orisan A, Vasist L, Zheng S, Zhou Z, Dresser M. Diversity in Clinical Pharmacology: A Call to Action. Clin Pharmacol Ther 2023; 113:483-485. [PMID: 36710622 PMCID: PMC10024964 DOI: 10.1002/cpt.2852] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
Prioritization of diversity, equity, and inclusion in all facets of our work is long overdue for the clinical pharmacology community. Increasing diversity in clinical research will deepen our understanding of nuanced patient populations and help improve all patient outcomes. Fostering an inclusive and diverse workforce will lead to broader perspectives that can better inform critical decisions and create work environments where everyone can thrive. In this call to action, we invite you to join us.
Collapse
Affiliation(s)
- Karen Brown
- University of Montana, Missoula, Montana, USA
| | | | | | - Jason Moore
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | | | - Zhu Zhou
- York College, The City University of New York, Jamaica, New York, USA
| | - Mark Dresser
- University of California San Francisco, San Francisco, California, USA
- Gilead Sciences Inc, Foster City, California, USA
| |
Collapse
|
9
|
Hoffmann TJ, Lu M, Oni-Orisan A, Lee C, Risch N, Iribarren C. A large genome-wide association study of QT interval length utilizing electronic health records. Genetics 2022; 222:iyac157. [PMID: 36271874 PMCID: PMC9713425 DOI: 10.1093/genetics/iyac157] [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: 07/09/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
QT interval length is an important risk factor for adverse cardiovascular outcomes; however, the genetic architecture of QT interval remains incompletely understood. We conducted a genome-wide association study of 76,995 ancestrally diverse Kaiser Permanente Northern California members enrolled in the Genetic Epidemiology Research on Adult Health and Aging cohort using 448,517 longitudinal QT interval measurements, uncovering 9 novel variants, most replicating in 40,537 individuals in the UK Biobank and Population Architecture using Genomics and Epidemiology studies. A meta-analysis of all 3 cohorts (n = 117,532) uncovered an additional 19 novel variants. Conditional analysis identified 15 additional variants, 3 of which were novel. Little, if any, difference was seen when adjusting for putative QT interval lengthening medications genome-wide. Using multiple measurements in Genetic Epidemiology Research on Adult Health and Aging increased variance explained by 163%, and we show that the ≈6 measurements in Genetic Epidemiology Research on Adult Health and Aging was equivalent to a 2.4× increase in sample size of a design with a single measurement. The array heritability was estimated at ≈17%, approximately half of our estimate of 36% from family correlations. Heritability enrichment was estimated highest and most significant in cardiovascular tissue (enrichment 7.2, 95% CI = 5.7-8.7, P = 2.1e-10), and many of the novel variants included expression quantitative trait loci in heart and other relevant tissues. Comparing our results to other cardiac function traits, it appears that QT interval has a multifactorial genetic etiology.
Collapse
Affiliation(s)
- Thomas J Hoffmann
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Meng Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Akinyemi Oni-Orisan
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Neil Risch
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| |
Collapse
|
10
|
Oni-Orisan A, Haldar T, Cayabyab MA, Ranatunga DK, Hoffmann TJ, Iribarren C, Krauss RM, Risch N. Polygenic Risk Score and Statin Relative Risk Reduction for Primary Prevention of Myocardial Infarction in a Real-World Population. Clin Pharmacol Ther 2022; 112:1070-1078. [PMID: 35862449 PMCID: PMC10112337 DOI: 10.1002/cpt.2715] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
Genetic substudies of randomized controlled trials demonstrate that high coronary heart disease (CHD) polygenic risk score modifies statin CHD relative risk reduction; it is unknown if the association extends to statin users undergoing routine care. We sought to determine how statin effectiveness is modified by CHD polygenic risk score in a real-world cohort of participants without previous myocardial infarction. We determined CHD polygenic risk scores in participants of the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Covariate-adjusted Cox regression models were used to compare the risk of cardiovascular outcomes between statin users and matched nonusers. Statin effectiveness on incident myocardial infarction showed no gradient with increasing 10-year Pooled Cohort Equations atherosclerotic cardiovascular disease (ASCVD) risk across low, borderline, intermediate, and high ASCVD risk score groups. In contrast, statin effectiveness by polygenic risk was largest in the high polygenic risk score group (hazard ratio (HR) 0.41, 95% confidence interval (CI), 0.31-0.53; P = 1.5E-11), intermediate in the intermediate polygenic risk score group (HR 0.56, 95% CI, 0.47-0.66; P = 8.4E-12), and smallest in the low polygenic risk score group (HR 0.67, 95% CI, 0.47-0.97; P = 0.03; P for high vs. low = 0.01). ASCVD risk and statin low-density lipoprotein cholesterol (LDL-C) lowering did not differ across polygenic risk score groups. In patients undergoing routine care, CHD polygenic risk modified statin relative risk reduction of incident myocardial infarction independent of LDL-C lowering. Our findings extend prior work by identifying a subset (i.e., self-identified White individuals with low CHD polygenic risk scores) with attenuated clinical benefit from statins.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Tanushree Haldar
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Mari A.S. Cayabyab
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | | | - Thomas J. Hoffmann
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Carlos Iribarren
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Ronald M. Krauss
- Department of Pediatrics, University of California San Francisco, Oakland, California, USA
- Department of Medicine, University of California San Francisco, Oakland, California, USA
| | - Neil Risch
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Kaiser Permanente Division of Research, Oakland, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
11
|
Haldar T, Oni-Orisan A, Hoffmann TJ, Schaefer C, Iribarren C, Krauss RM, Medina MW, Risch N. Modest effect of statins on fasting glucose in a longitudinal electronic health record based cohort. Cardiovasc Diabetol 2022; 21:132. [PMID: 35836181 PMCID: PMC9284686 DOI: 10.1186/s12933-022-01566-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prior studies of the glycemic effect of statins have been inconsistent. Also, most studies have only considered a short duration of statin use; the effect of long-term statin use on fasting glucose (FG) has not been well examined. The aim of this work is to investigate the effect of long-term statin exposure on FG levels. METHODS Using electronic health record (EHR) data from a large and diverse longitudinal cohort, we defined long-term statin exposure in two ways: the cumulative years of statin use (cumulative supply) and the years' supply-weighted sum of doses (cumulative dose). Simvastatin, lovastatin, atorvastatin and pravastatin were included in the analysis. The relationship between statin exposure and FG was examined using linear regression with mixed effects modeling, comparing statin users before and after initiating statins and statin never-users. RESULTS We examined 593,130 FG measurements from 87,151 individuals over a median follow up of 20 years. Of these, 42,678 were never-users and 44,473 were statin users with a total of 730,031 statin prescriptions. FG was positively associated with cumulative supply of statin but not comulative dose when both measures were in the same model. While statistically significant, the annual increase in FG attributable to statin exposure was modest at only 0.14 mg/dl, with only slight and non-significant differences among statin types. CONCLUSIONS Elevation in FG level is associated with statin exposure, but the effect is modest. The results suggest that the risk of a clinically significant increase in FG attributable to long-term statin use is small for most individuals.
Collapse
Affiliation(s)
- Tanushree Haldar
- Institute for Human Genetics, University of California San Francisco, 513 Parnassus Ave., San Francisco, CA, USA
| | - Akinyemi Oni-Orisan
- Institute for Human Genetics, University of California San Francisco, 513 Parnassus Ave., San Francisco, CA, USA
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - Thomas J Hoffmann
- Institute for Human Genetics, University of California San Francisco, 513 Parnassus Ave., San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | - Ronald M Krauss
- Departments of Pediatrics and Medicine, University of California, San Francisco, CA, USA
| | - Marisa W Medina
- Department of Pediatrics, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Neil Risch
- Institute for Human Genetics, University of California San Francisco, 513 Parnassus Ave., San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Kaiser Permanente Division of Research, Oakland, CA, USA.
| |
Collapse
|
12
|
Wang EY, Breyer BN, Lee AW, Rios N, Oni-Orisan A, Steinman MA, Sim I, Kenfield SA, Bauer SR. Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study. JMIR Hum Factors 2021; 8:e30767. [PMID: 34951599 PMCID: PMC8742207 DOI: 10.2196/30767] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients’ individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians’ visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully.
Collapse
Affiliation(s)
- Elizabeth Y Wang
- Columbia Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Benjamin N Breyer
- University of California San Francisco, San Francisco, CA, United States
| | - Austin W Lee
- University of California San Francisco, San Francisco, CA, United States
| | - Natalie Rios
- University of California San Francisco, San Francisco, CA, United States
| | | | - Michael A Steinman
- University of California San Francisco, San Francisco, CA, United States
| | - Ida Sim
- University of California San Francisco, San Francisco, CA, United States
| | - Stacey A Kenfield
- University of California San Francisco, San Francisco, CA, United States
| | - Scott R Bauer
- University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
13
|
Lee AW, Kenfield SA, Wang EY, Enriquez A, Oni-Orisan A, Steinman MA, Sim I, Breyer BN, Bauer SR. Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study. JMIR Form Res 2021; 5:e30762. [PMID: 34889745 PMCID: PMC8709917 DOI: 10.2196/30762] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men.
Objective We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy.
Methods We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility.
Results We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms.
Conclusions This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men.
Collapse
Affiliation(s)
- Austin W Lee
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth Y Wang
- Columbia University Vagelos College of Physicians and Surgeons, New York City, CA, United States
| | - Anthony Enriquez
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A Steinman
- Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Scott R Bauer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
14
|
Mantri N, Lu M, Zaroff JG, Risch N, Hoffmann T, Oni-Orisan A, Lee C, Jorgenson E, Iribarren C. QT Interval Dynamics and Cardiovascular Outcomes: A Cohort Study in an Integrated Health Care Delivery System. J Am Heart Assoc 2021; 10:e018513. [PMID: 34581201 PMCID: PMC8649135 DOI: 10.1161/jaha.120.018513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Long QT has been associated with ventricular dysrhythmias, cardiovascular disease (CVD) mortality, and sudden cardiac death. However, no studies to date have investigated the dynamics of within‐person QT change over time in relation to risk of incident CVD and all‐cause mortality in a real‐world setting. Methods and Results A cohort study among members of an integrated health care delivery system in Northern California including 61 455 people (mean age, 62 years; 60% women, 42% non‐White) with 3 or more ECGs (baseline in 2005–2009; mean±SD follow‐up time, 7.6±2.6 years). In fully adjusted models, tertile 3 versus tertile 1 of average QT corrected (using the Fridericia correction) was associated with cardiac arrest (hazard ratio [HR], 1.66), heart failure (HR, 1.62), ventricular dysrhythmias (HR, 1.56), all CVD (HR, 1.31), ischemic heart disease (HR, 1.28), total stroke (HR, 1.18), and all‐cause mortality (HR, 1.24). Tertile 3 versus tertile 2 of the QT corrected linear slope was associated with cardiac arrest (HR, 1.22), ventricular dysrhythmias (HR, 1.12), and all‐cause mortality (HR, 1.09). Tertile 3 versus tertile 1 of the QT corrected root mean squared error was associated with ventricular dysrhythmias (HR, 1.34), heart failure (HR, 1.28), all‐cause mortality (HR, 1.20), all CVD (HR, 1.14), total stroke (HR, 1.08), and ischemic heart disease (HR, 1.07). Conclusions Our results demonstrate improved predictive ability for CVD outcomes using longitudinal information from serial ECGs. Long‐term average QT corrected was more strongly associated with CVD outcomes than the linear slope or the root mean squared error. This new evidence is clinically relevant because ECGs are frequently used, noninvasive, and inexpensive.
Collapse
Affiliation(s)
- Neha Mantri
- Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA
| | - Meng Lu
- Division of Research Kaiser Permanente Oakland CA
| | - Jonathan G Zaroff
- Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA
| | - Neil Risch
- Institute for Human Genetics University of California, San Francisco CA
| | - Thomas Hoffmann
- Institute for Human Genetics University of California, San Francisco CA
| | | | | | | | | |
Collapse
|
15
|
Mantri N, Lu M, Zaroff JG, Risch N, Hoffmann T, Oni-Orisan A, Lee C, Iribarren C. Torsade de pointes: A nested case-control study in an integrated healthcare delivery system. Ann Noninvasive Electrocardiol 2021; 27:e12888. [PMID: 34547155 PMCID: PMC8739596 DOI: 10.1111/anec.12888] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background TdP is a form of polymorphic ventricular tachycardia which develops in the setting of a prolonged QT interval. There are limited data describing risk factors, treatment, and outcomes of this potentially fatal arrhythmia. Objective Our goals were as follows: (1) to validate cases presenting with Torsade de Pointes (TdP), (2) to identify modifiable risk factors, and (3) to describe the management strategies used for TdP and its prognosis in a real‐world healthcare setting. Methods Case–control study (with 2:1 matching on age, sex, and race/ethnicity) nested within the Genetic Epidemiology Research on Aging (GERA) cohort. Follow‐up of the cohort for case ascertainment was between January 01, 2005 and December 31, 2018. Results A total of 56 cases of TdP were confirmed (incidence rate = 3.6 per 100,000 persons/years). The average (SD) age of the TdP cases was 74 (13) years, 55 percent were female, and 16 percent were non‐white. The independent predictors of TdP were potassium concentration <3.6 mEq/L (OR = 10.6), prior history of atrial fibrillation/flutter (OR = 6.2), QTc >480 ms (OR = 4.4) and prior history of coronary artery disease (OR = 2.6). Exposure to furosemide and amiodarone was significantly greater in cases than in controls. The most common treatment for TdP was IV magnesium (78.6%) and IV potassium repletion (73.2%). The in‐hospital and 1‐year mortality rates for TdP cases were 10.7% and 25.0% percent, respectively. Conclusions These findings may inform quantitative multivariate risk indices for the prediction of TdP and could guide practitioners on which patients may qualify for continuous ECG monitoring and/or electrolyte replacement therapy.
Collapse
Affiliation(s)
- Neha Mantri
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Meng Lu
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Jonathan G Zaroff
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Neil Risch
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas Hoffmann
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Akinyemi Oni-Orisan
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | |
Collapse
|
16
|
Lu B, Sun L, Seraydarian M, Hoffmann TJ, Medina MW, Iribarren C, Krauss RM, Risch N, Oni-Orisan A. Effect of SLCO1B1 T521C on Statin-Related Myotoxicity With Use of Lovastatin and Atorvastatin. Clin Pharmacol Ther 2021; 110:733-740. [PMID: 34114646 PMCID: PMC8376784 DOI: 10.1002/cpt.2337] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023]
Abstract
The association between the c.521T>C variant allele in SLCO1B1 (reference single nucleotide polymorphism (rs)4149056) and simvastatin-induced myotoxicity was discovered over a decade ago; however, whether this relationship represents a class effect is still not fully known. The aim of this study was to investigate the relationship between rs4149056 genotype and statin-induced myotoxicity in patients taking atorvastatin and lovastatin. Study participants were from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. A total of 233 statin-induced myopathy + rhabdomyolysis cases met the criteria for inclusion and were matched to 2,342 controls. To validate the drug response phenotype, we replicated the previously established association between rs4149056 genotype and simvastatin-induced myotoxicity. In particular, compared with homozygous T allele carriers, there was a significantly increased risk of simvastatin-induced myopathy + rhabdomyolysis in homozygous carriers of the C allele (CC vs. TT, odds ratio [OR] 4.62, 95% confidence interval [CI] 1.58-11.90, P = 0.003). For lovastatin users, homozygous carriers of the C allele were also at increased risk of statin-induced myopathy + rhabdomyolysis (CC vs. TT, OR 4.49, 95% CI 1.68-10.80, P = 0.001). In atorvastatin users, homozygous carriers of the C allele were twice as likely to experience statin-induced myopathy, though this association did not achieve statistical significance (CC vs. TT, OR 2.00, 95% CI 0.44-6.59, P = 0.30). In summary, our findings suggest that the association of rs4149056 with simvastatin-related myotoxicity may also extend to lovastatin. More data is needed to determine the extent of the association in atorvastatin users. Altogether, these data expand the evidence base for informing guidelines of pharmacogenetic-based statin prescribing practices.
Collapse
Affiliation(s)
- Brian Lu
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Laura Sun
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Manuel Seraydarian
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Thomas J. Hoffmann
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Marisa W. Medina
- Department of Pediatrics, University of California San Francisco, Oakland, California, USA
| | - Carlos Iribarren
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Ronald M. Krauss
- Department of Pediatrics, University of California San Francisco, Oakland, California, USA,Department of Medicine, University of California San Francisco, Oakland, California, USA
| | - Neil Risch
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,Kaiser Permanente Division of Research, Oakland, California, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA,Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
17
|
Giacomini KM, Karnes JH, Crews KR, Monte AA, Murphy WA, Oni-Orisan A, Ramsey LB, Yang JJ, Whirl-Carrillo M. Advancing Precision Medicine Through the New Pharmacogenomics Global Research Network. Clin Pharmacol Ther 2021; 110:559-562. [PMID: 34318925 DOI: 10.1002/cpt.2340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jason H Karnes
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Kristine R Crews
- Department of Pharmacy and Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew A Monte
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William A Murphy
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jun J Yang
- Department of Pharmacy and Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michelle Whirl-Carrillo
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
18
|
Affiliation(s)
- Akinyemi Oni-Orisan
- From the Departments of Clinical Pharmacy (A.O.-O.), Bioengineering and Therapeutic Sciences (A.O.-O.), and Epidemiology and Biostatistics (Y.M.), and the Institute for Human Genetics (A.O.-O.), University of California, San Francisco; and Ancestry LLC (Y.B.) - both in San Francisco; the Departments of Biostatistics and Statistics, University of Washington, Seattle (T.A.T.); and the Department of Radiology, Mayo Clinic, Jacksonville, FL (R.S.)
| | - Yusuph Mavura
- From the Departments of Clinical Pharmacy (A.O.-O.), Bioengineering and Therapeutic Sciences (A.O.-O.), and Epidemiology and Biostatistics (Y.M.), and the Institute for Human Genetics (A.O.-O.), University of California, San Francisco; and Ancestry LLC (Y.B.) - both in San Francisco; the Departments of Biostatistics and Statistics, University of Washington, Seattle (T.A.T.); and the Department of Radiology, Mayo Clinic, Jacksonville, FL (R.S.)
| | - Yambazi Banda
- From the Departments of Clinical Pharmacy (A.O.-O.), Bioengineering and Therapeutic Sciences (A.O.-O.), and Epidemiology and Biostatistics (Y.M.), and the Institute for Human Genetics (A.O.-O.), University of California, San Francisco; and Ancestry LLC (Y.B.) - both in San Francisco; the Departments of Biostatistics and Statistics, University of Washington, Seattle (T.A.T.); and the Department of Radiology, Mayo Clinic, Jacksonville, FL (R.S.)
| | - Timothy A Thornton
- From the Departments of Clinical Pharmacy (A.O.-O.), Bioengineering and Therapeutic Sciences (A.O.-O.), and Epidemiology and Biostatistics (Y.M.), and the Institute for Human Genetics (A.O.-O.), University of California, San Francisco; and Ancestry LLC (Y.B.) - both in San Francisco; the Departments of Biostatistics and Statistics, University of Washington, Seattle (T.A.T.); and the Department of Radiology, Mayo Clinic, Jacksonville, FL (R.S.)
| | - Ronnie Sebro
- From the Departments of Clinical Pharmacy (A.O.-O.), Bioengineering and Therapeutic Sciences (A.O.-O.), and Epidemiology and Biostatistics (Y.M.), and the Institute for Human Genetics (A.O.-O.), University of California, San Francisco; and Ancestry LLC (Y.B.) - both in San Francisco; the Departments of Biostatistics and Statistics, University of Washington, Seattle (T.A.T.); and the Department of Radiology, Mayo Clinic, Jacksonville, FL (R.S.)
| |
Collapse
|
19
|
Oni-Orisan A, Srinivas N, Mehta K, Das JL, Nguyen TT, Tison GH, Bauer SR, Burian M, Funk RS, Graham RA. Leveraging innovative technology to generate drug response phenotypes for the advancement of biomarker-driven precision dosing. Clin Transl Sci 2021; 14:784-790. [PMID: 33421282 PMCID: PMC8212753 DOI: 10.1111/cts.12973] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022] Open
Abstract
Although traditional approaches to biomarker discovery have elucidated key molecular markers that have improved drug selection (precision medicine), the discovery of biomarkers that inform optimal dose selection (precision dosing) continues to be a challenge in many therapeutic areas. Larger and more diverse study populations are necessary to discover additional biomarkers that provide the resolution needed for a more tailored dose. To generate and accommodate large datasets of drug response phenotypes, time- and cost-efficient strategies are necessary. In particular, a multitude of technological advances that originated for purposes outside of biomedical research (electronic health records, direct-to-consumer genetic testing, social media, mobile devices, and machine learning) have made it easier to communicate, connect, and gather information from consumers. Although these technologies have been used with success in the health sciences for an array of purposes, these resources have not been fully capitalized on for precision dosing. This perspective will touch on how these innovations can be used as data sources, data collection tools, and data processing tools for drug-response phenotypes with a unique focus on advancing biomarker-driven precision dosing.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA.,Institute for Human Genetics, University of California, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California, USA
| | | | | | | | - Thu T Nguyen
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Geoffrey H Tison
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Scott R Bauer
- Department of Medicine, University of California, San Francisco, California, USA.,Department of Urology, University of California, San Francisco, California, USA.,Veterans Affairs Medical Center, San Francisco, California, USA
| | - Maria Burian
- Translational Medicine Neuroscience, UCB Biopharma SRL, Braine-l'Alleud, Belgium
| | - Ryan S Funk
- Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | |
Collapse
|
20
|
Bauer SR, Breyer BN, Oni-Orisan A, Steinman MA, Sim I, McCulloch CE, Kenfield SA. PERSONAL: Feasibility Study Protocol for Placebo-Controlled, Randomized n-of-1 Trials of Tamsulosin for Lower Urinary Tract Symptoms. Front Digit Health 2020; 2:7. [PMID: 34713020 PMCID: PMC8521798 DOI: 10.3389/fdgth.2020.00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Lower urinary tract symptoms (LUTS) affect more than half of men over age 70 and contribute to both poor health-related quality of life and polypharmacy. Tamsulosin hydrochloride, a selective α1-blocker, is the most common medication used to treat LUTS due to presumed benign prostatic hyperplasia and is often prescribed indefinitely, although not all men benefit from long-term therapy. N-of-1 trials allow for individualized estimates of benefit and harm and could facilitate decisions regarding chronic tamsulosin therapy for LUTS, particularly among older men. Our team developed the PERSONAL (PlacEbo-controlled, Randomized, patient-Selected Outcomes, N-of-1 triALs) app to track daily urinary symptoms and medication side effects for n-of-1 trials among older men with LUTS. Materials and Methods: We will conduct a feasibility study of 20 individual randomized n-of-1 trials using the PERSONAL app to compare tamsulosin (0.4 or 0.8 mg) vs. placebo among older men taking tamsulosin for LUTS. We will include men over age 65 with a smartphone for whom temporary discontinuation of tamsulosin is safe, (e.g., no history of acute retention). Participants will work with research staff to prospectively identify the most important urinary symptoms and medication side effects that they would like to digitally track. Men will then be randomized to 2-week treatment periods of tamsulosin or placebo followed by a 1-week wash-out with placebo, for 4 distinct treatment periods and 3 wash-out periods, totaling 11 weeks. Study medications will be blinded using over-encapsulation of tamsulosin pills and matching placebo. Our primary outcomes for this study will be recruitment and retention of eligible men, completion rates of n-of-1 trials and daily questionnaires using the PERSONAL app, and participants' perceived usefulness of their n-of-1 trial for determining whether tamsulosin is effective for them. Linear mixed effects models with individual-specific intercepts and intervention effects will also be used to estimate within-individual effects of tamsulosin. Discussion: The goal of this innovative study is to establish feasibility and acceptability of using a mobile health app and n-of-1 trials to provide older men with individualized estimates of benefits and harms of chronic tamsulosin therapy for LUTS.
Collapse
Affiliation(s)
- Scott R Bauer
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A Steinman
- Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
21
|
Oni-Orisan A, Hoffmann TJ, Ranatunga D, Medina MW, Jorgenson E, Schaefer C, Krauss RM, Iribarren C, Risch N. Characterization of Statin Low-Density Lipoprotein Cholesterol Dose-Response Using Electronic Health Records in a Large Population-Based Cohort. Circ Genom Precis Med 2019; 11:e002043. [PMID: 30354326 DOI: 10.1161/circgen.117.002043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) response to statin therapy has not been fully elucidated in real-world populations. The primary objective of this study was to characterize statin LDL-C dose-response and its heritability in a large, multiethnic population of statin users. METHODS We determined the effect of statin dosing on lipid measures utilizing electronic health records in 33 139 statin users from the Kaiser Permanente GERA cohort (Genetic Epidemiology Research on Adult Health and Aging). The relationship between statin defined daily dose and lipid parameter response (percent change) was determined. RESULTS Defined daily dose and LDL-C response was associated in a log-linear relationship (β, -6.17; SE, 0.09; P<10-300) which remained significant after adjusting for prespecified covariates (adjusted β, -5.59; SE, 0.12; P<10-300). Statin type, sex, age, smoking status, diabetes mellitus, and East Asian race/ethnicity were significant independent predictors of statin-induced changes in LDL-C. Based on a variance-component method within the subset of statin users who had at least 1 first-degree relative who was also a statin user (n=1036), heritability of statin LDL-C response was estimated at 11.7% (SE, 8.6%; P=0.087). CONCLUSIONS Using electronic health record data, we observed a statin LDL-C dose-response consistent with the rule of 6% from prior clinical trial data. Clinical and demographic predictors of statin LDL-C response exhibited highly significant but modest effects. Finally, statin-induced changes in LDL-C were not found to be strongly inherited. Ultimately, these findings demonstrate (1) the utility of electronic health records as a reliable source to generate robust phenotypes for pharmacogenomic research and (2) the potential role of statin precision medicine in lipid management.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy (A.O.), University of California, San Francisco, CA.,Institute for Human Genetics (A.O., T.J.H., N.R.), University of California, San Francisco, CA
| | - Thomas J Hoffmann
- Institute for Human Genetics (A.O., T.J.H., N.R.), University of California, San Francisco, CA.,Department of Epidemiology and Biostatistics (T.J.H., C.I., N.R.), University of California, San Francisco, CA
| | - Dilrini Ranatunga
- Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Marisa W Medina
- Children's Hospital Oakland Research Institute, Oakland, CA (M.W.M., R.M.K.)
| | - Eric Jorgenson
- Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Catherine Schaefer
- Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Ronald M Krauss
- Department of Medicine (R.M.K.), University of California, San Francisco, CA.,Children's Hospital Oakland Research Institute, Oakland, CA (M.W.M., R.M.K.)
| | - Carlos Iribarren
- Department of Epidemiology and Biostatistics (T.J.H., C.I., N.R.), University of California, San Francisco, CA.,Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Neil Risch
- Institute for Human Genetics (A.O., T.J.H., N.R.), University of California, San Francisco, CA.,Department of Epidemiology and Biostatistics (T.J.H., C.I., N.R.), University of California, San Francisco, CA.,Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| |
Collapse
|
22
|
Oni-Orisan A, Cresci S, Jones PG, Theken KN, Spertus JA, Lee CR. Association between the EPHX2 p.Lys55Arg polymorphism and prognosis following an acute coronary syndrome. Prostaglandins Other Lipid Mediat 2018; 138:15-22. [PMID: 30096423 DOI: 10.1016/j.prostaglandins.2018.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/06/2018] [Accepted: 07/31/2018] [Indexed: 01/14/2023]
Abstract
Inhibition of soluble epoxide hydrolase (sEH, EPHX2) elicits potent cardiovascular protective effects in preclinical models of ischemic cardiovascular disease (CVD), and genetic polymorphisms in EPHX2 have been associated with developing ischemic CVD in humans. However, it remains unknown whether EPHX2 variants are associated with prognosis following an ischemic CVD event. We evaluated the association between EPHX2 p.Lys55Arg and p.Arg287Gln genotype with survival in 667 acute coronary syndrome (ACS) patients. No association with p.Arg287Gln genotype was observed (P = 0.598). Caucasian EPHX2 Arg55 carriers (Lys/Arg or Arg/Arg) had a significantly higher risk of 5-year mortality (adjusted hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.01-2.55, P = 0.045). In an independent population of 2712 ACS patients, this association was not replicated (adjusted HR 0.92, 95% CI 0.70-1.21, P = 0.559). In a secondary analysis, Caucasian homozygous Arg55 allele carriers (Arg/Arg) appeared to exhibit a higher risk of cardiovascular mortality (adjusted HR 2.60, 95% CI 1.09-6.17). These results demonstrate that EPHX2 p.Lys55Arg and p.Arg287Gln polymorphisms do not significantly modify survival after an ACS event. Investigation of other sEH metabolism biomarkers in ischemic CVD appears warranted.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, UCSF School of Pharmacy, University of California San Francisco, San Francisco, CA, USA; Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Sharon Cresci
- Department of Medicine and Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Philip G Jones
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Katherine N Theken
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Spertus
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
23
|
Dong OM, Li A, Suzuki O, Oni-Orisan A, Gonzalez R, Stouffer GA, Lee CR, Wiltshire T. Projected impact of a multigene pharmacogenetic test to optimize medication prescribing in cardiovascular patients. Pharmacogenomics 2018; 19:771-782. [PMID: 29793377 PMCID: PMC6367721 DOI: 10.2217/pgs-2018-0049] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To determine the projected impact of a multigene pharmacogenetic (PGx) test on medication prescribing. MATERIALS & METHODS A retrospective analysis was conducted with 122 cardiac catheterization laboratory patients undergoing angiography for eligibility of potential PGx-guided interventions that could have occurred if multigene PGx information was pre-emptively available at the time of the procedure. Medication data and presence of actionable at-risk genotypes were used to determine eligibility of a PGx intervention. RESULTS 20% of the study population (n = 24) would have qualified for at least one PGx-based medication intervention per US FDA or Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines within 6 months of their cardiac catheterization procedure. Commonly encountered gene-drug pairs for these interventions included: CYP2C19 for clopidogrel and antidepressants, CYP2D6 for antidepressants and codeine, SLCO1B1 for simvastatin, and VKORC1/CYP2C9 for warfarin. CONCLUSION Pre-emptive use of a multigene PGx test in the cardiac catheterization laboratory offers potential to reduce adverse medication outcomes.
Collapse
Affiliation(s)
- Olivia M Dong
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Center for Pharmacogenomics & Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amy Li
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Oscar Suzuki
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Center for Pharmacogenomics & Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, UCSF School of Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA.,Institute for Human Genetics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Ricardo Gonzalez
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Center for Pharmacogenomics & Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - George A Stouffer
- UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Division of Cardiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Craig R Lee
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Center for Pharmacogenomics & Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tim Wiltshire
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Center for Pharmacogenomics & Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|
24
|
Oni-Orisan A, Hoffmann T, Medina M, Jorgenson E, Schaefer C, Krauss R, Iribarren C, Risch N. Validation of Electronic Health Records for the Assessment of Statin Dosing In Research. J Clin Lipidol 2017. [DOI: 10.1016/j.jacl.2017.04.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
Bai X, Mangum KD, Dee RA, Stouffer GA, Lee CR, Oni-Orisan A, Patterson C, Schisler JC, Viera AJ, Taylor JM, Mack CP. Blood pressure-associated polymorphism controls ARHGAP42 expression via serum response factor DNA binding. J Clin Invest 2017; 127:670-680. [PMID: 28112683 PMCID: PMC5272192 DOI: 10.1172/jci88899] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/01/2016] [Indexed: 12/18/2022] Open
Abstract
We recently demonstrated that selective expression of the Rho GTPase-activating protein ARHGAP42 in smooth muscle cells (SMCs) controls blood pressure by inhibiting RhoA-dependent contractility, providing a mechanism for the blood pressure-associated locus within the ARHGAP42 gene. The goals of the current study were to identify polymorphisms that affect ARHGAP42 expression and to better assess ARHGAP42's role in the development of hypertension. Using DNase I hypersensitivity methods and ENCODE data, we have identified a regulatory element encompassing the ARHGAP42 SNP rs604723 that exhibits strong SMC-selective, allele-specific activity. Importantly, CRISPR/Cas9-mediated deletion of this element in cultured human SMCs markedly reduced endogenous ARHGAP42 expression. DNA binding and transcription assays demonstrated that the minor T allele variation at rs604723 increased the activity of this fragment by promoting serum response transcription factor binding to a cryptic cis-element. ARHGAP42 expression was increased by cell stretch and sphingosine 1-phosphate in a RhoA-dependent manner, and deletion of ARHGAP42 enhanced the progression of hypertension in mice treated with DOCA-salt. Our analysis of a well-characterized cohort of untreated borderline hypertensive patients suggested that ARHGAP42 genotype has important implications in regard to hypertension risk. Taken together, our data add insight into the genetic mechanisms that control blood pressure and provide a potential target for individualized antihypertensive therapies.
Collapse
MESH Headings
- Animals
- Blood Pressure
- CRISPR-Cas Systems
- GTPase-Activating Proteins/genetics
- GTPase-Activating Proteins/metabolism
- Gene Expression Regulation
- Humans
- Hypertension/chemically induced
- Hypertension/genetics
- Hypertension/metabolism
- Hypertension/physiopathology
- Mice
- Mice, Transgenic
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Polymorphism, Single Nucleotide
- Serum Response Factor/genetics
- Serum Response Factor/metabolism
- Sodium Chloride, Dietary/adverse effects
- Sodium Chloride, Dietary/pharmacology
- rho GTP-Binding Proteins/genetics
- rho GTP-Binding Proteins/metabolism
- rhoA GTP-Binding Protein/genetics
- rhoA GTP-Binding Protein/metabolism
Collapse
Affiliation(s)
| | | | | | | | - Craig R. Lee
- McAllister Heart Institute, and
- Department of Pharmacy, University of North Carolina at Chapel Hill, Durham, North Carolina, USA
| | - Akinyemi Oni-Orisan
- Department of Pharmacy, University of North Carolina at Chapel Hill, Durham, North Carolina, USA
| | - Cam Patterson
- New York–Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | | | - Anthony J. Viera
- Department of Family Medicine, University of North Carolina at Chapel Hill, Durham, North Carolina, USA
| | | | | |
Collapse
|
26
|
Oni-Orisan A, Edin ML, Lee JA, Wells MA, Christensen ES, Vendrov KC, Lih FB, Tomer KB, Bai X, Taylor JM, Stouffer GA, Zeldin DC, Lee CR. Cytochrome P450-derived epoxyeicosatrienoic acids and coronary artery disease in humans: a targeted metabolomics study. J Lipid Res 2015; 57:109-19. [PMID: 26555503 DOI: 10.1194/jlr.m061697] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 12/15/2022] Open
Abstract
Cytochrome P450 (CYP)-derived epoxyeicosatrienoic acids (EETs) exhibit potent cardiovascular protective effects in preclinical models, and promoting the effects of EETs has emerged as a potential therapeutic strategy for coronary artery disease (CAD). The relationship between circulating EET levels and CAD extent in humans, however, remains unknown. A panel of free (unesterified) plasma eicosanoid metabolites was quantified in 162 patients referred for coronary angiography, and associations with extent of CAD [no apparent CAD (N = 39), nonobstructive CAD (N = 51), and obstructive CAD (N = 72)] were evaluated. A significant relationship between free EET levels and CAD extent was observed (P = 0.003) such that the presence of obstructive CAD was associated with lower circulating EET levels. This relationship was confirmed in multiple regression analysis where CAD extent was inversely and significantly associated with EET levels (P = 0.013), and with a biomarker of EET biosynthesis (P < 0.001), independent of clinical and demographic factors. Furthermore, quantitative enrichment analysis revealed that these associations were the most pronounced compared with other eicosanoid metabolism pathways. Collectively, these findings suggest that the presence of obstructive CAD is associated with lower EET metabolite levels secondary to suppressed EET biosynthesis. Novel strategies that promote the effects of EETs may have therapeutic promise for patients with obstructive CAD.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC Center for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew L Edin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - John Andrew Lee
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael A Wells
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erin S Christensen
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kimberly C Vendrov
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fred B Lih
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Kenneth B Tomer
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Xue Bai
- Department of Pathology and Lab Medicine, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joan M Taylor
- Department of Pathology and Lab Medicine, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC McAllister Heart Institute, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - George A Stouffer
- McAllister Heart Institute, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC Division of Cardiology, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC Center for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC McAllister Heart Institute, University of North Carolina at Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
27
|
Abstract
Heart failure is becoming increasingly prevalent in the United States and is a significant cause of morbidity and mortality. Several therapies are currently available to treat this chronic illness; however, clinical response to these treatment options exhibit significant interpatient variation. It is now clearly understood that genetics is a key contributor to diversity in therapeutic response, and evidence that genetic polymorphisms alter the pharmacokinetics, pharmacodynamics, and clinical response of heart failure drugs continues to accumulate. This suggests that pharmacogenomics has the potential to help clinicians improve the management of heart failure by choosing the safest and most effective medications and doses. Unfortunately, despite much supportive data, pharmacogenetic optimization of heart failure treatment regimens is not yet a reality. In order to attenuate the rising burden of heart failure, particularly in the context of the recent paucity of new effective interventions, there is an urgent need to extend pharmacogenetic knowledge and leverage these associations in order to enhance the effectiveness of existing heart failure therapies. This review focuses on the current state of pharmacogenomics in heart failure and provides a glimpse of the aforementioned future needs.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Center for Pharmacogenomics and Individualized Therapy
| | - David Lanfear
- Section Head, Advanced Heart Failure and Cardiac Transplantation, Research Scientist, Center for Health Services Research, Henry Ford Hospital, 2799 W. Grand Boulevard Detroit, MI 48202, Phone: 313-916-6375, Fax: 313-916-8799
| |
Collapse
|
28
|
Bai X, Stouffer GA, Lee CR, Schisler J, Patterson C, Lee JA, Oni-Orisan A, Mack CP, Taylor JM. Abstract 627: The Smooth Muscle-selective RhoGAP Graf3 Is A Critical Regulator Of Vascular Tone And Hypertension. Hypertension 2014. [DOI: 10.1161/hyp.64.suppl_1.627] [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
Our ability to effectively treat hypertensive patients is limited by an incomplete understanding of its origin. Activation of RhoA in vascular smooth muscle cells (SMC) has been implicated in the development of vasoconstrictor-induced hypertension (HTN), but until now, the extent that RhoA contributed to basal BP was unknown and the mechanisms that limit RhoA activity in SMC were undetermined. We identified GRAF3 as a RhoA-GAP expressed specifically in SMC in mice and humans and reported that our novel global GRAF3-deficient mice exhibit significant basal HTN (+ 25 mm Hg) that was fully reversed by treatment with a Rho-kinase inhibitor (
Nature Comm. 2013;4:2910
). One objective of this new study was to test if elevated RhoA-dependent myogenic tone was causal for HTN in global GRAF3-deficient (GRAF3
gt/gt
) mice. Importantly, normal GRAF3 expression can be permanently restored by Cre recombinase-dependent excision in our model. Thus, we crossed the GRAF3
gt/gt
mice to the tamoxifen-inducible SM-specific SM MHC- CreER
T2
line and measured BP before and after tamoxifen treatment (1mg
i.p.
for 5 consecutive days). Tamoxifen induced SMC-GRAF3 re-expression and resulted in a complete reversal of MAP (from 123 mmHg to 95 mm Hg). Moreover, RhoA activity and myosin light chain phosphorylation were elevated 2-fold in GRAF3-depleted SMC in vitro and in vivo and isolated vessel segments from GRAF3-deficient mice showed a 2.5 fold increase in Rho kinase-dependent Ang II-induced contractility. Collectively, these findings provide unequivocal evidence that GRAF3 levels in SMC control basal BP homeostasis and that elevated BP in
GRAF3
gt/gt
mice is due to an enhanced, reversible, SMC contractile phenotype. A second objective was to determine whether GRAF3 variations are causally linked to cardiovascular outcomes in hypertensive patients. We found a clear and significant increase in minor allele frequency of a hypertensive GRAF3 locus in patients with HTN and coronary artery disease versus healthy volunteers (0.19 versus 0.30; p<0.05; N=920) and this association was significant regardless of race. Our studies provide a potential mechanism for the hypertensive locus identified within GRAF3 and provide the foundation for the future development of innovative HTN therapies.
Collapse
Affiliation(s)
- Xue Bai
- Univ of North Carolina, Chapel Hill, NC
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Cicci JD, Reed BN, McNeely EB, Oni-Orisan A, Patterson JH, Rodgers JE. Acute decompensated heart failure: evolving literature and implications for future practice. Pharmacotherapy 2013; 34:373-88. [PMID: 24214219 DOI: 10.1002/phar.1369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute decompensated heart failure (ADHF) is associated with substantial morbidity and mortality, and represents a considerable financial burden to society. Historically, few prospective, randomized, double-blinded trials have investigated the optimal management of ADHF, and most guideline recommendations are based primarily on expert opinion. However, in the last decade, a considerable amount of research has added to the understanding of the management of ADHF in both patients with fluid overload and low cardiac output. In addition, as mechanical circulatory support devices and heart transplantation continue to evolve, significant advances have also been made with regard to the proper selection of patients for advanced surgical options. Finally, several novel pharmacologic agents have shown promise in early trials and may represent the next steps in ADHF management. Although advances have been made over the past decade, many questions remain.
Collapse
Affiliation(s)
- Jonathan D Cicci
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina
| | | | | | | | | | | |
Collapse
|
30
|
Oni-Orisan A, Deng Y, Schuck RN, Theken KN, Edin ML, Lih FB, Molnar K, DeGraff L, Tomer KB, Zeldin DC, Lee CR. Dual modulation of cyclooxygenase and CYP epoxygenase metabolism and acute vascular inflammation in mice. Prostaglandins Other Lipid Mediat 2012; 104-105:67-73. [PMID: 23000418 DOI: 10.1016/j.prostaglandins.2012.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/07/2012] [Accepted: 09/08/2012] [Indexed: 01/12/2023]
Abstract
Cyclooxygenase (COX)-derived prostaglandins and cytochrome P450 (CYP) epoxygenase-derived epoxyeicosatrienoic acids are important regulators of inflammation; however, functional interactions between these pathways in the regulation of vascular inflammation in vivo have not been studied. We investigated the relative and additive effects of endothelial CYP2J2 overexpression (Tie2-CYP2J2-Tr), global sEH disruption (Ephx2(-/-)), and pharmacologic COX inhibition with indomethacin on the acute vascular inflammatory response to endotoxin in mice. Compared to vehicle-treated wild-type C57BL/6 controls, induction of myeloperoxidase (MPO) activity in lung and liver was similarly attenuated in Tie2-CYP2J2-Tr mice, Ephx2(-/-) mice and wild-type mice treated with moderate dose indomethacin. Dual modulation of both pathways, however, did not produce an additive anti-inflammatory effect. These findings demonstrate that both COX and CYP epoxygenase-mediated eicosanoid metabolism are important regulators of the acute vascular inflammatory response in vivo, and suggest that the anti-inflammatory effects of modulating each pathway may be mediated, at least in part, by overlapping mechanisms.
Collapse
Affiliation(s)
- Akinyemi Oni-Orisan
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Theken KN, Deng Y, Schuck RN, Oni-Orisan A, Miller TM, Kannon MA, Poloyac SM, Lee CR. Enalapril reverses high-fat diet-induced alterations in cytochrome P450-mediated eicosanoid metabolism. Am J Physiol Endocrinol Metab 2012; 302:E500-9. [PMID: 22185841 PMCID: PMC3311291 DOI: 10.1152/ajpendo.00370.2011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Metabolism of arachidonic acid by cytochrome P450 (CYP) to biologically active eicosanoids has been recognized increasingly as an integral mediator in the pathogenesis of cardiovascular and metabolic disease. CYP epoxygenase-derived epoxyeicosatrienoic and dihydroxyeicosatrienoic acids (EET + DHET) and CYP ω-hydroxylase-derived 20-hydroxyeicosatetraenoic acid (20-HETE) exhibit divergent effects in the regulation of vascular tone and inflammation; thus, alterations in the functional balance between these parallel pathways in liver and kidney may contribute to the pathogenesis and progression of metabolic syndrome. However, the impact of metabolic dysfunction on CYP-mediated formation of endogenous eicosanoids has not been well characterized. Therefore, we evaluated CYP epoxygenase (EET + DHET) and ω-hydroxylase (20-HETE) metabolic activity in liver and kidney in apoE(-/-) and wild-type mice fed a high-fat diet, which promoted weight gain and increased plasma insulin levels significantly. Hepatic CYP epoxygenase metabolic activity was significantly suppressed, whereas renal CYP ω-hydroxylase metabolic activity was induced significantly in high-fat diet-fed mice regardless of genotype, resulting in a significantly higher 20-HETE/EET + DHET formation rate ratio in both tissues. Treatment with enalapril, but not metformin or losartan, reversed the suppression of hepatic CYP epoxygenase metabolic activity and induction of renal CYP ω-hydroxylase metabolic activity, thereby restoring the functional balance between the pathways. Collectively, these findings suggest that the kinin-kallikrein system and angiotensin II type 2 receptor are key regulators of hepatic and renal CYP-mediated eicosanoid metabolism in the presence of metabolic syndrome. Future studies delineating the underlying mechanisms and evaluating the therapeutic potential of modulating CYP-derived EETs and 20-HETE in metabolic diseases are warranted.
Collapse
Affiliation(s)
- Katherine N Theken
- Div. of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, Univ. of North Carolina, Chapel Hill, NC 27599, USA
| | | | | | | | | | | | | | | |
Collapse
|