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Parra-Rodriguez L, O'Halloran J, Wang Y, Jin W, Dastgheyb RM, Spence AB, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Maki PM, Xu Y, Rubin LH. Common antiretroviral combinations are associated with somatic depressive symptoms in women with HIV. AIDS 2024; 38:167-176. [PMID: 37773048 DOI: 10.1097/qad.0000000000003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVE While modern antiretroviral therapy (ART) is highly effective and safe, depressive symptoms have been associated with certain ART drugs. We examined the association between common ART regimens and depressive symptoms in women with HIV (WWH) with a focus on somatic vs. nonsomatic symptoms. DESIGN Analysis of longitudinal data from the Women's Interagency HIV Study. METHODS Participants were classified into three groups based on the frequency of positive depression screening (CES-D ≥16): chronic depression (≥50% of visits since study enrollment), infrequent depression (<50% of visits), and never depressed (no visits). Novel Bayesian machine learning methods building upon a subset-tree kernel approach were developed to estimate the combined effects of ART regimens on depressive symptoms in each group after covariate adjustment. RESULTS The analysis included 1538 WWH who participated in 12 924 (mean = 8.4) visits. The mean age was 49.9 years, 72% were Black, and 14% Hispanic. In the chronic depression group, combinations including tenofovir alafenamide and cobicistat-boosted elvitegravir and/or darunavir were associated with greater somatic symptoms of depression, whereas those combinations containing tenofovir disoproxil fumarate and efavirenz or rilpivirine were associated with less somatic depressive symptoms. ART was not associated with somatic symptoms in the infrequent depression or never depressed groups. ART regimens were not associated with nonsomatic symptoms in any group. CONCLUSIONS Specific ART combinations are associated with somatic depressive symptoms in WWH with chronic depression. Future studies should consider specific depressive symptoms domains as well as complete drug combinations when assessing the relationship between ART and depression.
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Affiliation(s)
- Luis Parra-Rodriguez
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jane O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Yuezhe Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University
| | - Wei Jin
- Department of Applied Mathematics and Statistics, Johns Hopkins University
| | - Raha M Dastgheyb
- Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Tropical Medicine, Georgetown University, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Joel Milam
- Department of Epidemiology and Biostatistics, University of California, Irvine, California
| | - Kathleen M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, Illinois
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Margaret A Fischl
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, Mississippi
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center
| | - Leah H Rubin
- Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Gustafson DR, Shi Q, Thurn M, Holman S, Kuniholm MH, Fischl M, Floris-Moore M, Gange S, Konkle-Parker D, Plankey M, Price JC, Ross RD, Rubtsova A, Sharma A, Hoover DR. Frailty-Related Factors among Women Living with and without HIV Aged 40 Years and Older. The Women's Interagency HIV Study. J Frailty Aging 2024; 13:40-49. [PMID: 38305442 DOI: 10.14283/jfa.2023.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Frailty is a clinical, geriatric syndrome linked to disability and mortality; and may be associated with a variety of factors among underrepresented and underserved women living with HIV (WLWH) and without HIV (WLWOH) transitioning through the adult life course. OBJECTIVES Determine whether a published set of factors associated cross-sectionally with frailty in WLWH and similar WLWOH at average age 39 years in 2005/2006 were associated with frailty in 2018/2019 among women who initiated frailty assessments at age ≥40 years, or whether a new set of factors were associated with frailty. DESIGN Cross-sectional analyses within a longitudinal cohort study. SETTING The multi-center Women's Interagency HIV Study (WIHS). PARTICIPANTS 1285 participants (951 WLWH, 334 WLWOH), median age 53 years (interquartile range 47-58 years). MEASUREMENTS The Fried Frailty Phenotype (FFP) in association with 23 factors representing HIV serostatus, other infections, sociodemographic factors, health behaviors, and chronic diseases. RESULTS Frailty prevalence was 11.1% in 2018/2019 (12.6% among WLWOH, 9.6% among WLWH, p=0.121). The published 2005/2006 final multivariable stepwise regression model contained 9 predictors of frailty. When refit to women in 2018/2019, only age ≥50 years and annual income ≤$12,000 were independently positively associated with frailty; other significant 2005/2006 factors, HIV serostatus, CD4+ count <500 cells/mL among WLWH, smoking, drinking, FIB-4 and eGFR, were not. A newly-derived stepwise model considering all 23 predictors measured in 2018/2019, showed independent positive associations between frailty and age ≥50 years, annual income ≤$12,000, obesity (body mass index (BMI) ≥30kg/m2), and history of tuberculosis and cancer. CONCLUSION Different chronic and infectious disease factors were associated with frailty among WLWH and WLWOH over the adult life course. Understanding factors associated with frailty by adult life stage, allows identification and implementation of novel, temporal interventions to alleviate frailty-associated outcomes and enhance quality of life among WLWH and WLWOH.
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Affiliation(s)
- D R Gustafson
- Deborah R. Gustafson, MS, PhD, Professor, Department of Neurology, SUNY Downstate Health Sciences University, MSC 1213, 450 Clarkson Avenue, Brooklyn, New York 11203, Phone: 718-270-2051, FAX: 718-270-3840,
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Li X, Yucel R, Clervius H, Kamalakar K, Zetterberg H, Blennow K, Zhang J, Adimora A, Collins L, Fischl M, Kassaye S, Maki P, Seaberg E, Sharma A, Vance D, Gustafson DR. Plasma Biomarkers of Alzheimer Disease in Women With and Without HIV. JAMA Netw Open 2023; 6:e2344194. [PMID: 38019518 PMCID: PMC10687654 DOI: 10.1001/jamanetworkopen.2023.44194] [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: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023] Open
Abstract
Importance Blood-based biomarkers associated with increased risk of Alzheimer disease (AD) are understudied in people living with and without HIV, particularly women. Objective To determine whether baseline or 1-year changes in plasma amyloid-β40 (Aβ40), Aβ42, ratio of Aβ42 to Aβ40, total tau (t-tau), phosphorylated tau 231 (p-tau231), glial fibrillary acidic protein (GFAP), and/or neurofilament light chain (NFL) are associated with neuropsychological performance (NP) among women living with HIV (WLWH) and women living without HIV (WLWOH). Design, Setting, and Participants This longitudinal, prospective, cohort study with 1-year repeated clinical measures (NP only measured once) and biospecimen collection occurred between 2017 and 2019. Participants were women aged 40 years or older from 10 clinical research sites in cities across the US that were part of the Women's Interagency HIV Study. Data analysis was conducted from April to December 2022. Exposure Laboratory-confirmed HIV status and AD biomarkers. Main Outcomes and Measures Sociodemographically adjusted NP T-scores (attention and working memory, executive function, processing speed, memory, learning, verbal fluency, motor function, and global performance) were the primary outcomes. Baseline and 1-year fasting plasma Aβ40, Aβ42, t-tau, p-tau231, GFAP, and NFL levels were measured and analyzed using multivariable linear regression. Results The study consisted of 307 participants (294 aged ≥50 years [96%]; 164 African American or Black women [53%]; 214 women with a high school education or higher [70%]; 238 women who were current or former smokers [78%]; and 236 women [77%] who were overweight or obese [body mass index >25]) including 209 WLWH and 98 WLWOH. Compared with WLWOH at baseline, WLWH performed worse on learning (mean [SD] T-score 47.8 [11.3] vs 51.4 [10.5]), memory (mean [SD] T-score 48.3 [11.6] vs 52.4 [10.2]), verbal fluency (mean [SD] T-score 48.3 [9.8] vs 50.7 [8.5]), and global (mean [SD] T-score 49.2 [6.8] vs 51.1 [5.9]) NP assessments. Baseline median Aβ40, GFAP, and NFL levels were higher among WLWH vs WLWOH. There were no differences in 1-year biomarker change by HIV serostatus. Lower learning, memory, and motor NP were associated with 1-year Aβ40 increase; lower learning and motor with Aβ42 increase; lower motor with p-tau231 increase; and lower processing speed, verbal fluency and motor with NFL increase in the entire sample. Among WLWH, a 1-year increase in Aβ40 from baseline to follow-up was associated with worse learning, memory, and global NP; a 1-year increase in t-tau with worse executive function; and a 1-year increase in NFL with worse processing speed. Among WLWOH, a 1-year increase in Aβ40 and Aβ42 were associated with poorer memory performance and NFL was associated with poorer motor performance. Conclusions and Relevance These findings suggest that increases in certain plasma AD biomarkers are associated with NP in WLWH and WLWOH and may be associated with later onset of AD, and measuring these biomarkers could be a pivotal advancement in monitoring aging brain health and development of AD among women with and without HIV.
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Affiliation(s)
- Xuantao Li
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
| | - Recai Yucel
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
| | - Helene Clervius
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn
- Downstate Neurology at One Brooklyn Health, Brookdale Hospital, Brooklyn, New York
| | - Kundun Kamalakar
- School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jinbing Zhang
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Adaora Adimora
- Department of Medicine, School of MedicineUniversity of North Carolina at Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Lauren Collins
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Margaret Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, Florida
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC
| | - Pauline Maki
- Department of Psychiatry, University of Illinois College of Medicine, Chicago
- Department of Psychology, University of Illinois College of Medicine, Chicago
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago
| | - Eric Seaberg
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Anjali Sharma
- Division of General Internal Medicine, Albert Einstein College of Medicine, New York, New York
- Division of Infectious Diseases, Albert Einstein College of Medicine, New York, New York
| | - David Vance
- Department of Acute, Chronic and Continuing Care, University of Alabama at Birmingham
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
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Vásquez E, Kuniholm MH, Appleton AA, Rubin LH, Adimora AA, Fischl MA, Fox E, Mack WJ, Holman S, Moran CA, Minkoff H, Plankey MW, Sharma A, Tien PC, Weber KM, Gustafson DR. Midlife body mass index, central adiposity and neuropsychological performance over 10 years in women living with and without HIV. Front Endocrinol (Lausanne) 2023; 14:1108313. [PMID: 37484940 PMCID: PMC10361616 DOI: 10.3389/fendo.2023.1108313] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Background and objective Observations of overweight and obesity in association with neuropsychological performance (NP) vary over the adult life course depending on baseline levels, biological sex, age, race, temporality of measurements, and other factors. Therefore, similar published analyses across cohorts are inconsistent. In our sample of women living with HIV (WLWH) and women without HIV (WWOH), we conducted comparable analyses as those published in men with and without HIV. We examined cross-sectional and longitudinal associations between body mass index (BMI) and waist circumference (WC) and NP. Methods Four hundred thirty two 432 virologically-suppressed WLWH and 367 WWOH, ≥40 years in the Women's Interagency HIV Study (WIHS) with anthropometry and NP assessments every two years from 2009-2019 were included in the study. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear regression models stratified by HIV status were used to examine cross-sectional associations of BMI and WC by NP domain; repeated measures analyses assessed baseline BMI and WC in association with longitudinal change in NP. Covariates included sociodemographic, behavioral, and HIV-related characteristics. Results At baseline among all women, the median age was 45 years, 65% were Non-Latinx Black women, and 45% were obese women. Obese WLWH (BMI≥30.0 kg/m2) had poorer executive function (β=-2.27, 95%CI [-4.46, -0.07]) versus WLWH with healthy BMI (18.5-24.9 kg/m2). Longitudinally over ~8 years, obese versus overweight WWOH improved on memory (β=2.19, 95%CI [0.13, 4.26]), however overweight versus healthy WWOH experienced declining memory (β= -2.67, 95%CI [-5.40, -0.07]). Increasing WC was associated with declining executive, processing speed, and motor function (p's<0.05); an at-risk WC was associated with improved memory (β=1.81, 95%CI [0.19, 3.44]) among WWOH. Among WLWH, increasing BMI was associated with improved learning (β=0.07, 95%CI [0.00, 0.15]. Conclusion Our cross-sectional and longitudinal analyses evaluating the associations of BMI and WC and NP were mixed compared to previous reports. This illustrates the importance of sociodemographic characteristics, baseline levels of exposures and outcomes, HIV status, temporality of measurements, and other factors when evaluating aging HIV epidemiology study results.
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Affiliation(s)
- Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Psychology, Johns Hopkins University, Baltimore, MD, United States
- Department Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Ada A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Margaret A. Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Wendy J. Mack
- Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Health Sciences University, Brooklyn, NY, United States
| | - Caitlin Anne Moran
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Grady Healthcare System, Infectious Diseases Program, Atlanta, United States
| | - Howard Minkoff
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Michael W. Plankey
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Veterans Affairs, San Francisco, CA, United States
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL, United States
| | - Deborah R. Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, United States
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Rubin LH, O'Halloran JA, Williams DW, Li Y, Fitzgerald KC, Dastgheyb R, Damron AL, Maki PM, Spence AB, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Xu Y. Integrase Inhibitors are Associated with Neuropsychiatric Symptoms in Women with HIV. J Neuroimmune Pharmacol 2023; 18:1-8. [PMID: 35178611 PMCID: PMC9381649 DOI: 10.1007/s11481-021-10042-3] [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: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with HIV(WWH) are more likely to discontinue/change antiretroviral therapy(ART) due to side effects including neuropsychiatric symptoms. Efavirenz and integrase strand transfer inhibitors(INSTIs) are particularly concerning. We focused on these ART agents and neuropsychiatric symptoms in previously developed subgroups of WWH that differed on key sociodemographic factors as well as longitudinal behavioral and clinical profiles. WWH from the Women's Interagency HIV Study were included if they had ART data available, completed the Perceived Stress Scale-10 and PTSD Checklist-Civilian. Questionnaires were completed biannually beginning in 2008 through 2016. To examine ART-symptom associations, constrained continuation ratio model via penalized maximum likelihood were fit within 5 subgroups of WWH. Data from 1882 WWH contributed a total of 4598 observations. 353 women were previously defined as primarily having well-controlled HIV with vascular comorbidities, 463 with legacy effects(CD4 nadir < 250cells/mL), 274 aged ≤ 45 with hepatitis, 453 between 35-55 years, and 339 with poorly-controlled HIV/substance users. INSTIs, but not efavirenz, were associated with symptoms among key subgroups of WWH. Among those with HIV legacy effects, dolutegravir and elvitegravir were associated with greater stress/anxiety and avoidance symptoms(P's < 0.01); dolutegravir was also associated with greater re-experiencing symptoms(P = 0.005). Elvitegravir related to greater re-experiencing and hyperarousal among women with well-controlled HIV with vascular comorbidities(P's < 0.022). Raltegravir was associated with less hyperarousal, but only among women aged ≤ 45 years(P = 0.001). The adverse neuropsychiatric effects of INSTIs do not appear to be consistent across all WWH. Key characteristics (e.g., age, hepatitis positivity) may need consideration to fully weight the risk-benefit ratio of dolutegravir and elvitegravir in WWH.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MDD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MDD, USA.
| | - Jane A O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra L Damron
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, ILD, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DCD, USA
| | | | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York City, , USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
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Xue X, Hua S, Weber K, Qi Q, Kaplan R, Gustafson DR, Sharma A, French A, Burgess HJ. Jointly modeling of sleep variables that are objectively measured by wrist actigraphy. Stat Med 2022; 41:2804-2821. [PMID: 35417078 PMCID: PMC9942772 DOI: 10.1002/sim.9385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023]
Abstract
Recently developed actigraphy devices have made it possible for continuous and objective monitoring of sleep over multiple nights. Sleep variables captured by wrist actigraphy devices include sleep onset, sleep end, total sleep time, wake time after sleep onset, number of awakenings, etc. Currently available statistical methods to analyze such actigraphy data have limitations. First, averages over multiple nights are used to summarize sleep activities, ignoring variability over multiple nights from the same subject. Second, sleep variables are often analyzed independently. However, sleep variables tend to be correlated with each other. For example, how long a subject sleeps at night can be correlated with how long and how frequent he/she wakes up during that night. It is important to understand these inter-relationships. We therefore propose a joint mixed effect model on total sleep time, number of awakenings, and wake time. We develop an estimating procedure based upon a sequence of generalized linear mixed effects models, which can be implemented using existing software. The use of these models not only avoids computational intensity and instability that may occur by directly applying a numerical algorithm on a complicated joint likelihood function, but also provides additional insights on sleep activities. We demonstrated in simulation studies that the proposed estimating procedure performed well in estimating both fixed and random effects' parameters. We applied the proposed model to data from the Women's Interagency HIV Sleep Study to examine the association of employment status and age with overall sleep quality assessed by several actigraphy measured sleep variables.
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Affiliation(s)
- Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Simin Hua
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathleen Weber
- Core Center of Cook County Health, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Qibin Qi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Deborah R. Gustafson
- Department of Neurology, Section for Neuro Epidemiology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Audrey French
- Core Center of Cook County Health, Stroger Hospital of Cook County, Chicago, Illinois, USA,Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Helen J. Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Yu EA, Alemán JO, Hoover DR, Shi Q, Verano M, Anastos K, Tien PC, Sharma A, Kardashian A, Cohen MH, Golub ET, Michel KG, Gustafson DR, Glesby MJ. Plasma metabolomic analysis indicates flavonoids and sorbic acid are associated with incident diabetes: A nested case-control study among Women's Interagency HIV Study participants. PLoS One 2022; 17:e0271207. [PMID: 35802662 PMCID: PMC9269977 DOI: 10.1371/journal.pone.0271207] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/26/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Lifestyle improvements are key modifiable risk factors for Type 2 diabetes mellitus (DM) however specific influences of biologically active dietary metabolites remain unclear. Our objective was to compare non-targeted plasma metabolomic profiles of women with versus without confirmed incident DM. We focused on three lipid classes (fatty acyls, prenol lipids, polyketides). MATERIALS AND METHODS Fifty DM cases and 100 individually matched control participants (80% with human immunodeficiency virus [HIV]) were enrolled in a case-control study nested within the Women's Interagency HIV Study. Stored blood samples (1-2 years prior to DM diagnosis among cases; at the corresponding timepoint among matched controls) were assayed in triplicate for metabolomics. Time-of-flight liquid chromatography mass spectrometry with dual electrospray ionization modes was utilized. We considered 743 metabolomic features in a two-stage feature selection approach with conditional logistic regression models that accounted for matching strata. RESULTS Seven features differed by DM case status (all false discovery rate-adjusted q<0.05). Three flavonoids (two flavanones, one isoflavone) were respectively associated with lower odds of DM (all q<0.05), and sorbic acid was associated with greater odds of DM (all q<0.05). CONCLUSION Flavonoids were associated with lower odds of incident DM while sorbic acid was associated with greater odds of incident DM.
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Affiliation(s)
- Elaine A. Yu
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - José O. Alemán
- Laboratory of Translational Obesity Research, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Donald R. Hoover
- Department of Statistics and Biostatistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Qiuhu Shi
- New York Medical College, Valhalla, New York, United States of America
| | - Michael Verano
- Laboratory of Translational Obesity Research, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Kathryn Anastos
- Montefiore Medical Center, Bronx, New York, United States of America
| | - Phyllis C. Tien
- University of California, San Francisco, California, United States of America
- Department of Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - Anjali Sharma
- Montefiore Medical Center, Bronx, New York, United States of America
| | - Ani Kardashian
- University of Southern California, Los Angeles, California, United States of America
| | - Mardge H. Cohen
- Cook County Health & Hospitals System and Rush University, Chicago, Illinois, United States of America
| | - Elizabeth T. Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine G. Michel
- Georgetown University School of Medicine, District of Columbia, United States of America
| | - Deborah R. Gustafson
- State University of New York Downstate Health Sciences University, New York, New York, United States of America
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, United States of America
- * E-mail:
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Gustafson DR, Yucel R, Apple SJ, Cirrone G, Gao H, Huang AJ, Ma X, Saad A, Wilson J, Kabariti S, Motov S. Mental Health of Emergency Department Healthcare Workers During COVID-19 in Brooklyn, New York. Med Res Arch 2022; 10:2903. [PMID: 36465877 PMCID: PMC9718537 DOI: 10.18103/mra.v10i7.2903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Maintaining good mental health among Emergency Department healthcare workers (ED HCW) is paramount to well-functioning healthcare. We measured mental health and COVID-19 symptoms in ED HCW at a COVID-19 epicenter. METHODS A cross-sectional, convenience sample of adult (≥18 years) ED HCW in Brooklyn, New York, USA, who were employed at ≥50% of a full-time effort, was surveyed September-December, 2020 with reference period March-May 2020. An anonymous email-distributed survey assessed gender, age, race, healthcare worker status (clinical versus non-clinical), SARS-CoV-2 testing, number of people to talk to, COVID-19-related home problems, mental health care interruption during COVID-19, loneliness, and survey date. Outcomes included symptoms of depression, psychological distress, perceived stress, post-traumatic stress disorder (PTSD), anxiety, and resilience measured using validated scales. RESULTS Of 774 HCW, 247 (31.9%) responded (mean age 38.2±10.8 years; 59.4% White; 52.5% men; 80.1% clinical; 61.6% SARS-CoV-2 tested). Average mental health scores were significantly higher among clinical vs non-clinical HCW (P's<0.0001-0.019). The proportion reporting a clinically-relevant psychological distress symptom burden was higher among clinical vs non-clinical HCW (35.8% vs 13.8%, p=0.019); and suggested for depression (53.9% clinical vs 35.7% non-clinical, p=0.072); perceived stress (63.6% clinical vs 44.8% non-clinical, p=0.053); and PTSD (18.2% clinical vs 3.6% non-clinical, p=0.064). Compared to non-clinical staff, Medical Doctors and Doctors of Osteopathy reported 4.8-fold higher multivariable-adjusted odds of clinically-relevant perceived stress (95%CI 1.8-12.9, p=0.002); Emergency Medical Technicians reported 15.5-fold higher multivariable-adjusted odds of clinically-relevant PTSD (95%CI 1.6-150.4, p=0.018). Increasing age, number of COVID-19-related home problems and people to talk to, loneliness and mental health care interruption were adversely associated with mental health; being male and SARS-CoV-2 testing were beneficial. CONCLUSIONS COVID-19-related mental health burden was high among ED HCW in Brooklyn. Mental health support services are essential for ED HCW.
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Affiliation(s)
- Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Recai Yucel
- Department of Biostatistics, Temple University, Philadelphia, Pennsylvania
| | - Samuel J Apple
- State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Gianna Cirrone
- State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Haoyuan Gao
- Department of Biostatistics, Temple University, Philadelphia, Pennsylvania
| | - Aaron J Huang
- State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Xinrui Ma
- Department of Biostatistics, Temple University, Philadelphia, Pennsylvania
| | - Ayesha Saad
- State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Jeremy Wilson
- State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Sarah Kabariti
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
- Department of Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn New York
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
- Department of Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn New York
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Affiliation(s)
- Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Deborah R Gustafson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
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10
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Macaluso F, Weber KM, Rubin LH, Dellinger E, Holman S, Minkoff H, Keating S, Merlin LR, Gustafson DR. Body Mass Index and Leptin Are Related to Cognitive Performance Over 10 Years in Women With and Without HIV Infection. J Clin Endocrinol Metab 2022; 107:e1126-e1135. [PMID: 34677589 PMCID: PMC8851924 DOI: 10.1210/clinem/dgab759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT It is not yet understood whether people living with HIV infection have an increased risk of Alzheimers Disease and Related Dementias due to enhanced survivorship with highly effective antiretroviral therapies and/or increasing adiposity with aging. OBJECTIVE This work aimed to determine whether body mass index (BMI) and leptin were longitudinally associated over 10 years with neuropsychological performance (NP) among middle-aged women with HIV (WWH) vs without HIV. METHODS Women's Interagency HIV Study (WIHS) participants (301 WWH, 113 women without HIV from Brooklyn, New York City, and Chicago had baseline and 10-year BMI and fasting plasma leptin levels using commercial enzyme-linked immunosorbent assay (ng/mL); and demographically adjusted NP T scores (attention/working memory, executive function [EF], processing speed, memory, learning, verbal fluency, motor function, global) at 10-year follow-up. Multivariable linear regression analyses, stratified by HIV serostatus, examined associations between BMI, leptin, and NP. RESULTS Over 10 years, women (baseline age 39.8 ± 9.2 years, 73% Black, 73% WWH) transitioned from average overweight (29.1 ± 7.9) to obese (30.5 ± 7.9) BMI. Leptin increased 11.4 ± 26.4 ng/mL (P < .001). Higher baseline BMI and leptin predicted poorer 10-year EF among all women (BMI β = -6.97, 95% CI (-11.5 to -2.45) P = .003; leptin β = -1.90, 95% CI (-3.03 to -0.76), P = .001); higher baseline BMI predicted better memory performance (β = 6.35, 95% CI (1.96-10.7), P = .005). Greater 10-year leptin increase predicted poorer EF (P = .004), speed (P = .03), and verbal (P = .02) and global (P = 0.005) performance among all women, and WWH. Greater 10-year BMI increase predicted slower processing speed (P = .043) among all women; and among WWH, poorer EF (P = .01) and global (P = .04) performance. CONCLUSION In middle-aged WIHS participants, 10-year increases in BMI and leptin were associated with poorer performance across multiple NP domains among all women and WWH. Trajectories of adiposity measures over time may provide insight into the role of adipose tissue in brain health with aging.
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Affiliation(s)
- Francesca Macaluso
- College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Leah H Rubin
- Departments of Neurology, Psychiatry, and Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elaine Dellinger
- College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
- Maimonides Hospital, Brooklyn, New York, USA
| | - Sheila Keating
- GigaGen Medical Laboratory, San Francisco, California, USA
| | - Lisa R Merlin
- Department of Neurology, New York City Health and Hospitals/Kings County, Brooklyn, New York, USA
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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11
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Whitehead SN, Bruno A, Burns JM, Carmichael ST, Csiszar A, Edwards JD, Elahi FM, Faraco G, Gould DB, Gustafson DR, Hachinski V, Rosenberg G, Sorond FA, Shih AY, Tse KH, Ungvari Z, Wilcock DM, Zuloaga KL, Barone FC. Expanding the horizon of research into the pathogenesis of the white matter diseases: Proceedings of the 2021 Annual Workshop of the Albert Research Institute for White Matter and Cognition. GeroScience 2022; 44:25-37. [PMID: 34606040 PMCID: PMC8488071 DOI: 10.1007/s11357-021-00461-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
White matter pathologies are critically involved in the etiology of vascular cognitive impairment-dementia (VCID), Alzheimer's disease (AD), and Alzheimer's disease and related diseases (ADRD), and therefore need to be considered a treatable target ( Roseborough A, Hachinski V, Whitehead S. White matter degeneration - a treatable target? Roseborough et al. JAMA Neurol [Internet]. 2020 Apr 27;77(7):793-4, [1] . To help address this often-missed area of research, several workshops have been sponsored by the Leo and Anne Albert Charitable Trust since 2015, resulting in the incorporation of "The Albert Research Institute for White Matter and Cognition" in 2020. The first annual "Institute" meeting was held virtually on March 3-4, 2021. The Institute provides a forum and workspace for communication and support of the advancement of white matter science and research to better understand the evolution and prevention of dementia. It serves as a platform for young investigator development, to introduce new data and debate biology mechanisms and new ideas, and to encourage and support new research collaborations and directions to clarify how white matter changes, with other genetic and health risk factors, contribute to cognitive impairment. Similar to previous Albert Trust-sponsored workshops (Barone et al. in J Transl Med 14:1-14, [2]; Sorond et al. in GeroScience 42:81-96, [3]), established expert investigators were identified and invited to present. Opportunities to attend and present were also extended by invitation to talented research fellows and younger scientists. Also, updates on institute-funded research collaborations were provided and discussed. The summary that follows is a synopsis of topics and discussion covered in the workshop.
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Affiliation(s)
- Shawn N Whitehead
- Department of Anatomy and Cell Biology, Western University, London, ON, N6A 3K7, Canada.
| | - Askiel Bruno
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Jodi D Edwards
- University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada
| | - Fanny M Elahi
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Giuseppe Faraco
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Douglas B Gould
- Departments of Ophthalmology and Anatomy, and Institute for Human Genetics, School of Medicine, University of California, San Francisco, 94143, USA
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York Downstate Health Sciences University, New York, Brooklyn, 11203, USA
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, N6A 5C1, Canada
| | - Gary Rosenberg
- UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, 87106, USA
| | | | - Andy Y Shih
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute; Department of Pediatrics; Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kai Hei Tse
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Donna M Wilcock
- Sanders-Brown Center on Aging; Department of Neurology, Department of Behavioral Science, University of Kentucky, Lexington, KY, 40536, USA
| | - Kristen L Zuloaga
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, 12208, USA
| | - Frank C Barone
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
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12
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Kuniholm MH, Vásquez E, Appleton AA, Kingsley L, Palella FJ, Budoff M, Michos ED, Fox E, Jones D, Adimora AA, Ofotokun I, D'souza G, Weber KM, Tien PC, Plankey M, Sharma A, Gustafson DR. Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS 2022; 36:237-347. [PMID: 34934019 PMCID: PMC8711611 DOI: 10.1097/qad.0000000000003107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
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Affiliation(s)
- Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gypsyamber D'souza
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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13
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Duarte-Abritta B, Sánchez SM, Abulafia C, Gustafson DR, Vázquez S, Sevlever G, Castro MN, Fiorentini L, Villarreal MF, Guinjoan SM. Amyloid and anatomical correlates of executive functioning in middle-aged offspring of patients with late-onset Alzheimer's disease. Psychiatry Res Neuroimaging 2021; 316:111342. [PMID: 34365076 DOI: 10.1016/j.pscychresns.2021.111342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/02/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
A traditional hallmark of cognitive impairment associated with late-onset Alzheimer´s disease (LOAD) is episodic memory impairment. However, early alterations have been identified in brain regions associated with executive function in asymptomatic, middle-age offspring of patients with LOAD (O-LOAD) compared to those with no family history. We hypothesized that executive function among O-LOAD would correlate with structural and amyloid brain imaging differently from those without a family history of LOAD (control subjects, CS). Executive function, cortical thickness, and in-vivo Aβ deposits were quantified in 30 O-LOAD and 25 CS. Associations were observed among O-LOAD only. Cortical thickness in the left lateral orbitofrontal cortex was positively associated with Design Fluency. The Stroop Color and Word Test, correlated positively with right rostral mid-frontal cortex thickness. Trails Making Test-B was inversely related to left medial orbitofrontal thickness. Tower of London total time was positively associated with β-amyloid deposition in the right precuneus. These results support previous evidence that early executive dysfunction might reflect subtle, early changes in persons at risk of LOAD and suggests that executive function alterations deserve further exploration in the LOAD literature.
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Affiliation(s)
- Bárbara Duarte-Abritta
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Stella-Maris Sánchez
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Carolina Abulafia
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Institute for Biomedical Research (BIOMED), Pontifical Catholic University of Argentina, Buenos Aires, Argentina
| | - Deborah R Gustafson
- Department of Neurology, State University of New York University Downstate Health Sciences University, United States
| | - Silvia Vázquez
- Centro de imágenes moleculares (CIM), Fundación FLENI, Argentina
| | - Gustavo Sevlever
- Departamento de Neuropatología y Biología Molecular, Fundación FLENI, Buenos Aires, Argentina
| | - Mariana N Castro
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Servicio de Psiquiatría, Fundación FLENI, Buenos Aires, Argentina
| | - Leticia Fiorentini
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Servicio de Psiquiatría, Fundación FLENI, Buenos Aires, Argentina
| | - Mirta F Villarreal
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Salvador M Guinjoan
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Neurofisiología I, Facultad de Psicología, Universidad de Buenos Aires, Argentina; Laureate Institute for Brain Research, OK, United States.
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14
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Sharma A, Hoover DR, Shi Q, Gustafson DR, Plankey M, Tien PC, Weber KM, Vance DE, Floris-Moore M, Bolivar HH, Golub ET, Holstad MM, Yin MT. High Frequency of Recurrent Falls Among Prefrail and Frail Women With and Without HIV. J Acquir Immune Defic Syndr 2021; 87:842-850. [PMID: 33538528 PMCID: PMC8697712 DOI: 10.1097/qai.0000000000002651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/10/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Frailty may occur at younger ages among HIV+ populations. We evaluated associations of the frailty status with self-reported single and recurrent falls in the Women's Interagency HIV Study (WIHS). METHODS The frailty status was defined using the Fried Frailty Phenotype (FFP) among 897 HIV+ and 392 HIV- women; median age 53 years. Women were classified as robust (FFP 0), prefrail (FFP 1-2), and frail (FFP 3-5). Stepwise logistic regression models adjusting for the HIV status and study site were fit to evaluate associations of the FFP with self-reported single (1 vs. 0) and recurrent falls (≥2 vs. 0) over the prior 12 months. RESULTS HIV+ women were less likely to be frail (9% vs. 14% vs. P = 0.009), but frequency of falls did not differ by the HIV status. In multivariate analyses, recurrent falls were more common among prefrail [adjusted odds ratio (AOR) 2.23, 95% confidence interval (CI): 1.40 to 3.57, P = 0.0008] and frail (AOR 3.61, 95% CI: 1.90 to 6.89, P < 0.0001) than robust women. Among HIV+ women, single (AOR 2.88, 95% CI: 1.16 to 7.20, P = 0.023) and recurrent falls (AOR 3.50, 95% CI: 1.24 to 9.88, P = 0.018) were more common among those who were frail; recurrent, but not single falls, were more common among prefrail than robust HIV+ women (AOR 2.00, 95% CI: 1.03 to 3.91, P = 0.042). CONCLUSIONS HIV+ women were less likely to be frail. Compared with robust women, prefrail and frail women with and without HIV were more likely to experience single or recurrent falls within a 12-month period. Additional studies are needed to develop interventions that decrease development of frailty and reduce risk of recurrent falls among HIV+ women.
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Affiliation(s)
- Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donald R Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ, USA
| | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, Valhalla, NY, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington DC, USA
| | - Phyllis C Tien
- Department of Veterans Affairs Medical Center
- University of California San Francisco, San Francisco, CA, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, IL, USA
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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Lahiri CD, Xu Y, Wang K, Alvarez JA, Sheth AN, O'Halloran J, Spence AB, Tien P, Gustafson DR, Milam J, Fischl MA, Konkle-Parker D, Adimora AA, Sharma A, Weber KM, Ofotokun I, Rubin LH. Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV. AIDS Res Hum Retroviruses 2021; 37:461-467. [PMID: 33231474 PMCID: PMC8213005 DOI: 10.1089/aid.2020.0197] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Indexed: 12/29/2022] Open
Abstract
Weight and body mass index (BMI) change was assessed among women after switch to integrase inhibitors (INSTIs) and/or tenofovir alafenamide (TAF). From 2006 to 2019, 1,458 women living with HIV enrolled in the Women's Interagency HIV Study and on antiretroviral therapy (ART) with ≥1 study visit before and after switching to INSTIs and/or TAF were included. Weight and BMI were compared pre- and postswitch to INSTI (by class and type) and/or TAF using multivariable linear mixed effects models; all models were also stratified by preswitch presence or absence of obesity (BMI ≥30 vs. <30 kg/m2). Mean age preswitch was 47 ± 6 years, 64% were black, mean CD4 = 475 ± 201 cells/mm3, 56% had HIV RNA <200 copies/mL, 36% switched to TAF but not INSTI, 60% to INSTI but not TAF, and 3.5% to TAF+INSTI. Time from pre- to postswitch was 12.8 ± 11.8 months. The INSTI-only group but not TAF groups had small but significant increases in weight and BMI: mean 79.2-80.6 kg and 30.2-30.7 kg/m2, p's < .001, respectively, with congruent findings by INSTI type (p's ≤ .01). In stratified (preswitch BMI) analyses, only nonobese subgroups experienced increases in weight and BMI across all ART treatment groups (p's < .05). Significant, although small-to-medium, increases in weight and BMI occurred among nonobese women who switched to INSTIs and/or TAF over short follow-up. Given long-term health consequences of obesity particularly as a low-grade inflammatory condition, identifying women at highest risk of ART-associated weight gain is imperative.
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Affiliation(s)
- Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Biostatistics and Bioinformatics at the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jane O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Amanda B. Spence
- Division of Infectious Disease and Travel Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Phyllis Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York, New York, USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California, USA
| | - Margaret A. Fischl
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Kathleen M. Weber
- CORE Center, Cook County Health, Chicago, Illinois, USA
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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O’Halloran JA, Wang K, Spence AB, Williams DW, Dastgheyb R, Fitzgerald KC, Kamkwalala AR, Maki PM, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Lahiri CD, Sheth AN, Xu Y, Rubin LH. Integrase Strand Transfer Inhibitor Start or Switch Impacts Learning in Women With HIV. J Acquir Immune Defic Syndr 2021; 86:593-599. [PMID: 33394812 PMCID: PMC8319920 DOI: 10.1097/qai.0000000000002608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are first-line regimens for HIV treatment. We aimed to examine their impact on cognitive performance and depressive symptoms in women with HIV (WWH). SETTING Women's Interagency HIV Study, a multisite, prospective, cohort study. METHODS WWH who started or switched to INSTI-based antiretroviral therapy (ART) and completed neuropsychological testing and the Center for Epidemiological Studies-Depression (CES-D) scale before and after INSTI start/switch were included in the analyses. Primary outcomes were demographically corrected cognitive domain T-scores. Linear mixed-effects models adjusted for relevant covariates were used to examine effects of start/switch of any INSTI and individual INSTI drugs on cognition and CES-D scores. RESULTS Six hundred thirty-nine WWH, median age 49 (interquartile range 12) years, 66% Black non-Hispanic, had neuropsychological and CES-D scale data before and after INSTI start/switch. Although 14% started INSTI-based ART, the remainder switched to INSTI-based ART from another regimen. Overall, any INSTI use was associated with poorer learning post-INSTI. Specifically, use of dolutegravir and elvitegravir, but not raltegravir, was associated with poorer learning. In analyses restricted to INSTI switch, any INSTI use, and dolutegravir use, was associated with poorer learning. Among those switching from a PI-based regimen, INSTIs overall and dolutegravir remained associated with poorer learning; switching from a nonnucleoside reverse transcriptase inhibitor to dolutegravir was also associated with poorer learning. INSTI start/switch was not related to depressive symptom changes. CONCLUSIONS INSTI use was associated with poorer learning among WWH. These changes were mainly observed in elvitegravir and dolutegravir users, indicating that the impact of INSTI on cognition in WWH may not be a class effect.
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Affiliation(s)
- Jane A O’Halloran
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Amanda B. Spence
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | - Anandi N. Sheth
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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17
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Rubin LH, Gustafson DR, Warrior L, Sheira L, Fitzgerald KC, Dastgheyb R, Weber KM, Tien PC, French A, Spence AB, Sharma A, Williams DW, White CJ, Seaberg EC, Frongillo EA, Weiser SD. Dietary intake is associated with neuropsychological impairment in women with HIV. Am J Clin Nutr 2021; 114:378-389. [PMID: 33829235 PMCID: PMC8246600 DOI: 10.1093/ajcn/nqab038] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/02/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diet is a modifiable risk factor that may influence cognition in people with HIV. OBJECTIVES We examined the association between dietary intake and cognition in women with HIV (WWH) and HIV-seronegative women. METHODS An 18-item dietary National Cancer Institute screener was completed by 729 WWH and 346 HIV-seronegative Women's Interagency HIV Study participants. Daily intake frequencies of processed meats, sweet beverages, fish, whole milk, and vegetables were calculated. Participants completed biennial neuropsychological (NP) testing. NP domains included attention/working memory, executive function, processing speed, memory, learning, fluency, and motor function. NP impairment was defined as demographically adjusted T-scores (mean = 50; SD = 10) ≤40 at ≥1 visit after completing the dietary screener. Multivariable logistic regression, stratified by HIV serostatus, examined associations between intake frequency tertile (referent = lowest intake) and NP performance. RESULTS Dietary intake frequencies of individual food line items were similar between WWH and HIV-seronegative women, except for sweet beverages, for which HIV-seronegative women reported higher intake frequencies than WWH (P values < 0.05). In WWH, multivariable-adjusted models indicated higher odds of NP impairment with higher intake frequencies of processed meat [P = 0.006; ORupper tertile = 1.91 (95% CI: 1.23-2.95; P = 0.003); ORmiddle tertile = 1.66 (95% CI: 1.14-2.42; P = 0.01)], sweet beverages [P = 0.02; ORupper tertile = 1.75 (95% CI: 1.17-2.64; P = 0.007)], fish [P = 0.01; ORupper tertile = 1.70 (95% CI: 1.10-2.64; P = 0.02)], and whole milk [P = 0.029; ORupper tertile = 1.66 (95% CI: 1.14-2.42; P = 0.008)]. Lower odds of NP impairment [P = 0.005; ORupper tertile = 0.65 (95% CI: 0.45-0.95; P = 0.02); ORmiddle tertile = 0.42 (95% CI: 0.24-0.73; P = 0.002)] were associated with higher vegetable intakes. In HIV-seronegative women, multivariable-adjusted models did not show associations between food line items/diet quality score and NP outcomes. CONCLUSIONS Intakes of processed meat, sweet beverages, whole milk, fish, and vegetables may be associated with NP functions among WWH. Associations among WWH are not directly comparable to those among HIV-seronegative women, because models were conducted on each group separately given controls for HIV-specific covariates in WWH. Further studies are needed using more rigorous dietary assessment methods and lengthier longitudinal follow-ups.
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Affiliation(s)
| | | | | | - Lila Sheira
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen M Weber
- Division of Neurology, Cook County Health, Chicago, IL, USA,Cook County Health, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Audrey French
- Division of Neurology, Cook County Health, Chicago, IL, USA,Cook County Health, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cory J White
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Sheri D Weiser
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
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18
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Rubin LH, Li Y, Fitzgerald KC, Dastgheyb R, Spence AB, Maki PM, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Haughey NJ, Ofotokun I, Fischl MA, Konkle-Parker D, Xu Y, Williams DW. Associations between Antiretrovirals and Cognitive Function in Women with HIV. J Neuroimmune Pharmacol 2021; 16:195-206. [PMID: 32212091 PMCID: PMC7511435 DOI: 10.1007/s11481-020-09910-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/14/2020] [Indexed: 02/01/2023]
Abstract
Cognitive complications persist in antiretroviral therapy(ART)-treated people with HIV. However, the pattern and severity of domain-specific cognitive performance is variable and may be exacerbated by ART-mediated neurotoxicity. 929 women with HIV(WWH) from the Women's Interagency HIV Study who were classified into subgroups based on sociodemographic and longitudinal behavioral and clinical data using semi-parametric latent class trajectory modelling. Five subgroups were comprised of: 1) well-controlled HIV with vascular comorbidities(n = 116); 2) profound HIV legacy effects(CD4 nadir <250 cells/μL; n = 275); 3) primarily <45 year olds with hepatitis C(n = 165); 4) primarily 35-55 year olds(n = 244), and 5) poorly-controlled HIV/substance use(n = 129). Within each subgroup, we fitted a constrained continuation ratio model via penalized maximum likelihood to examine adjusted associations between recent ART agents and cognition. Most drugs were not associated with cognition. However, among the few drugs, non-nucleoside reverse transcriptase inhibitor (NNRTIs) and protease inhibitors(PIs) were most commonly associated with cognition, followed by nucleoside reverse transcriptase inhibitors(NRTIs) and integrase inhibitors(IIs). Directionality of ART-cognition associations varied by subgroup. Better psychomotor speed and fluency were associated with ART for women with well-controlled HIV with vascular comorbidities. This pattern contrasts women with profound HIV legacy effects for whom poorer executive function and fluency were associated with ART. Motor function was associated with ART for younger WWH and primarily 35-55 year olds. Memory was associated with ART only for women with poorly-controlled HIV/substance abuse. Findings demonstrate interindividual variability in ART-cognition associations among WWH and highlight the importance of considering sociodemographic, clinical, and behavioral factors as an underlying contributors to cognition. Are antiretroviral agents a risk factor for cognitive complications in women with HIV? We examind associations between ART-agents and cognitive function among similar subgroups of women with HIV from the Women's Interagency HIV study. The patterns of associations depended on sociodemographic, clinical, and behavioral characteristics of women.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Deborah R Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine,, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Norman J Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Williams DW, Li Y, Dastgheyb R, Fitzgerald KC, Maki PM, Spence AB, Gustafson DR, Milam J, Sharma A, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Weber KM, Xu Y, Rubin LH. Associations between Antiretroviral Drugs on Depressive Symptomatology in Homogenous Subgroups of Women with HIV. J Neuroimmune Pharmacol 2021; 16:181-194. [PMID: 31933016 PMCID: PMC7430262 DOI: 10.1007/s11481-019-09899-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/09/2019] [Indexed: 12/31/2022]
Abstract
Antiretroviral therapy (ART) is inconsistently associated with depression. These associations may depend on factors such as biological sex, age, and health status. Identifying such factors may help optimize treatment of HIV and depression. We implemented a novel approach to examine interindividual variability in the association between ART agents and depressive symptoms. 3434 women living with HIV (WLWH) from the Women's Interagency HIV Study (WIHS) were computationally divided into subgroups based on sociodemographic (e.g., age) and longitudinal (from 1995 to 2016) behavioral and clinical profiles (e.g., substance use, HIV RNA, CD4 counts). Five subgroups (n's ranged from 482 to 802) were identified and characterized as those with: controlled HIV/vascular comorbidities; profound HIV legacy effects; younger women [<45 years of age] with hepatitis C; primarily 35-55 year olds; and poorly controlled HIV/substance use. Within each subgroup, we examined associations between ART agents used over the past 6 months and item-level depressive symptoms on the Center for Epidemiologic Studies Depression Scale. Tenofovir (4 of 5 subgroups) followed by efavirenz, emtricitabine, stavudine, lopinavir, etravirine, nelfinavir, ritonavir, and maraviroc were the most common agents associated with depressive symptoms, although the pattern and directionality varied by subgroup. For example, lopinavir was associated with fewer symptoms among the subgroup with a legacy HIV effect but more symptoms among the subgroup with well-controlled HIV/vascular comorbidities. Unexpectedly, dolutegravir and raltegravir were not associated with depressive symptoms among any subgroup. Findings underscore marked interindividual variability in ART agents on depression in WLWH. Sociodemographic, clinical, and behavioral factors are important determinants of the relationship between ART agents and depressive symptoms in WLWH. Graphical Abstract Are antiretroviral agents a risk factor for depressive symptoms in women with HIV? We examined associations between ART-agents and depressive symptoms among similar subgroups of women with HIV from the Women's Interagency HIV Study. The patterns of associations depended on sociodemographic, clinical, and behavioral characteristics of women.
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Affiliation(s)
- Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Deborah R Gustafson
- Department of Neurology, SUNY-Downstate Health Sciences University, Brooklyn, NY, USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | | | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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20
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Dastgheyb RM, Buchholz AS, Fitzgerald KC, Xu Y, Williams DW, Springer G, Anastos K, Gustafson DR, Spence AB, Adimora AA, Waldrop D, Vance DE, Milam J, Bolivar H, Weber KM, Haughey NJ, Maki PM, Rubin LH. Patterns and Predictors of Cognitive Function Among Virally Suppressed Women With HIV. Front Neurol 2021; 12:604984. [PMID: 33679577 PMCID: PMC7928382 DOI: 10.3389/fneur.2021.604984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment remains frequent and heterogeneous in presentation and severity among virally suppressed (VS) women with HIV (WWH). We identified cognitive profiles among 929 VS-WWH and 717 HIV-uninfected women from 11 Women's Interagency HIV Study sites at their first neuropsychological (NP) test battery completion comprised of: Hopkins Verbal Learning Test-Revised, Trail Making, Symbol Digit Modalities, Grooved Pegboard, Stroop, Letter/Animal Fluency, and Letter-Number Sequencing. Using 17 NP performance metrics (T-scores), we used Kohonen self-organizing maps to identify patterns of high-dimensional data by mapping participants to similar nodes based on T-scores and clustering those nodes. Among VS-WWH, nine clusters were identified (entropy = 0.990) with four having average T-scores ≥45 for all metrics and thus combined into an "unimpaired" profile (n = 311). Impaired profiles consisted of weaknesses in: (1) sequencing (Profile-1; n = 129), (2) speed (Profile-2; n = 144), (3) learning + recognition (Profile-3; n = 137), (4) learning + memory (Profile-4; n = 86), and (5) learning + processing speed + attention + executive function (Profile-5; n = 122). Sociodemographic, behavioral, and clinical variables differentiated profile membership using Random Forest models. The top 10 variables distinguishing the combined impaired vs. unimpaired profiles were: clinic site, age, education, race, illicit substance use, current and nadir CD4 count, duration of effective antiretrovirals, and protease inhibitor use. Additional variables differentiating each impaired from unimpaired profile included: depression, stress-symptoms, income (Profile-1); depression, employment (Profile 2); depression, integrase inhibitor (INSTI) use (Profile-3); employment, INSTI use, income, atazanavir use, non-ART medications with anticholinergic properties (Profile-4); and marijuana use (Profile-5). Findings highlight consideration of NP profile heterogeneity and potential modifiable factors contributing to impaired profiles.
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Affiliation(s)
- Raha M. Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alison S. Buchholz
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kathryn C. Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States
- Division of Biostatistics and Bioinformatics, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kathryn Anastos
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Amanda B. Spence
- Division of Infectious Disease and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC, United States
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, United States
| | - Hector Bolivar
- Department of Psychiatry & Behavioral Science, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kathleen M. Weber
- CORE Center, Cook County Health, Hektoen Institute of Medicine, Chicago, IL, United States
| | - Norman J. Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pauline M. Maki
- Department of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Maki PM, Springer G, Anastos K, Gustafson DR, Weber K, Vance D, Dykxhoorn D, Milam J, Adimora AA, Kassaye SG, Waldrop D, Rubin LH. Cognitive changes during the menopausal transition: a longitudinal study in women with and without HIV. Menopause 2021. [DOI: https:/doi.10.1097/gme.0000000000001725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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22
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Kamkwalala AR, Wang K, O’Halloran J, Williams DW, Dastgheyb R, Fitzgerald KC, Spence AB, Maki PM, Gustafson DR, Milam J, Sharma A, Weber KM, Adimora AA, Ofotokun I, Sheth AN, Lahiri CD, Fischl MA, Konkle-Parker D, Xu Y, Rubin LH. Starting or Switching to an Integrase Inhibitor-Based Regimen Affects PTSD Symptoms in Women with HIV. AIDS Behav 2021; 25:225-236. [PMID: 32638219 PMCID: PMC7948485 DOI: 10.1007/s10461-020-02967-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As the use of Integrase inhibitor (INSTI)-class antiretroviral medications becomes more common to maintain long-term viral suppression, early reports suggest the potential for CNS side-effects when starting or switching to an INSTI-based regimen. In a population already at higher risk for developing mood and anxiety disorders, these drugs may have significant effects on PTSD scale symptom scores, particularly in women with HIV (WWH). A total of 551 participants were included after completing ≥ 1 WIHS study visits before and after starting/switching to an INSTI-based ART regimen. Of these, 14% were ART naïve, the remainder switched from primarily a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Using multivariable linear mixed effects models, we compared PTSD Civilian Checklist subscale scores before and after a "start/switch" to dolutegravir (DTG), raltegravir (RAL), or elvitegravir (EVG). Start/switch to EVG improved re-experiencing subscale symptoms (P's < 0.05). Switching to EVG improved symptoms of avoidance (P = 0.01). Starting RAL improved arousal subscale symptoms (P = 0.03); however, switching to RAL worsened re-experiencing subscale symptoms (P < 0.005). Starting DTG worsened avoidance subscale symptoms (P = 0.03), whereas switching to DTG did not change subscale or overall PTSD symptoms (P's > 0.08). In WWH, an EVG-based ART regimen is associated with improved PTSD symptoms, in both treatment naïve patients and those switching from other ART. While a RAL-based regimen was associated with better PTSD symptoms than in treatment naïve patients, switching onto a RAL-based regimen was associated with worse PTSD symptoms. DTG-based regimens either did not affect, or worsened symptoms, in both naïve and switch patients. Further studies are needed to determine mechanisms underlying differential effects of EVG, RAL and DTG on stress symptoms in WWH.
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Affiliation(s)
- Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Jane O’Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Amanda B. Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC
| | - Pauline M. Maki
- Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | | | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Anandi N. Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Yanxun Xu
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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23
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Macaluso F, Gustafson DR. Commentary on Lahiri et al. Weight and Body Mass Index Change After Switching to Integrase Inhibitors or Tenofovir Alafenamide Among Women Living with HIV. J AIDS HIV Treat 2021; 3:21-23. [PMID: 34291233 PMCID: PMC8291731 DOI: 10.33696/aids.3.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Francesca Macaluso
- Department of Medicine, State University of New York at
Downstate Health Sciences University, Brooklyn NY, United States
| | - Deborah R. Gustafson
- Department of Neurology, Section for NeuroEpidemiology,
State University of New York Downstate Health Sciences University, Brooklyn, New
York, USA
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25
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Gustafson DR, Bäckman K, Scarmeas N, Stern Y, Manly JJ, Mayeux R, Gu Y. Dietary fatty acids and risk of Alzheimer's disease and related dementias: Observations from the Washington Heights-Hamilton Heights-Inwood Columbia Aging Project (WHICAP). Alzheimers Dement 2020; 16:1638-1649. [PMID: 32715635 PMCID: PMC8409226 DOI: 10.1002/alz.12154] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/13/2022]
Abstract
Introduction: High dietary intake of long chain, polyunsaturated fatty acids is associated with lower Alzheimer’s disease (AD) risk. Methods: Washington Heights-Hamilton Heights-Inwood Columbia Aging Project is a multiethnic, prospective observational study of aging and dementia among elderly (≥ 65 years). Dietary intake was measured using a food frequency questionnaire. Dietary short-, medium-, and long-chain fatty acid intakes were categorized by number of carbons and double bonds. Consensus AD diagnoses were made. Associations between AD risk and dietary fatty acid and cholesterol intakes were estimated using multivariable Cox proportional hazards regression models. Results: Of 2612 multiethnic women (67%) and men (baseline age 76.3 [6.4] years), 380 developed AD over an average 4.5 years follow-up. Lower risk of AD was associated with increasing intakes of docosahexaenoic acid (DHA; hazard ratio [HR] = 0.73, 95% confidence interval [CI]: 0.57 to 0.95, P = 0.018) and eicosapentaenoic acid (EPA; HR = 0.74, 95% CI: 0.57 to 0.95, P = 0.021), and longer AD-free survival (P < 0.05). Discussion: Higher intake of DHA and EPA are protective for AD.
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Affiliation(s)
- Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Neurochemistry and Psychiatry, Neuropsychiatric Epidemiology Unit, at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Bäckman
- Department of Neurochemistry and Psychiatry, Neuropsychiatric Epidemiology Unit, at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N Scarmeas
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA.,1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Y Stern
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA
| | - J J Manly
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA
| | - R Mayeux
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Y Gu
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, New York, USA
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26
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Rubin LH, Xu Y, Norris PJ, Wang X, Dastgheyb R, Fitzgerald KC, Keating SM, Kaplan RC, Maki PM, Anastos K, Springer G, Benning L, Kassaye S, Gustafson DR, Valcour VG, Williams DW. Early Inflammatory Signatures Predict Subsequent Cognition in Long-Term Virally Suppressed Women With HIV. Front Integr Neurosci 2020; 14:20. [PMID: 32390808 PMCID: PMC7193823 DOI: 10.3389/fnint.2020.00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
Immunologic function is an important determinant of cognition. Here we examined the contribution of early immune signatures to cognitive performance among HIV-infected, virally suppressed women (HIV+VS) and in HIV-uninfected (HIV-) women. Specifically, we measured serum inflammatory markers, developed combinatory immune signatures, and evaluated their associations with cognition. Forty-nine HIV+VS women in the Women’s Interagency HIV Study (WIHS) who achieved viral suppression shortly after effective antiretroviral therapy (ART) initiation, and 56 matched HIV− women were selected. Forty-two serum inflammatory markers were measured within 2 years of effective ART initiation for HIV+VS women, and at an initial timepoint for HIV− women. The same inflammatory markers were also measured approximately 1, 7, and 12 years later for all women. Of the 105 women with complete immune data, 83 (34 HIV+VS, 49 HIV−) also had cognitive data available 12 years later at ≥1 time points (median = 3.1). We searched for combinatory immune signatures by adapting a dynamic matrix factorization analytic method that builds upon Tucker decomposition followed by Ingenuity® Pathway Analysis to facilitate data interpretation. Seven combinatory immune signatures emerged based on the Frobenius residual. Three signatures were common between HIV+VS and HIV− women, while four signatures were unique. These inflammatory signatures predicted subsequent cognitive performance in both groups using mixed-effects modeling, but more domain-specific associations were significant in HIV+VS than HIV− women. Leukocyte influx into brain was a major contributor to cognitive function in HIV+VS women, while T cell exhaustion, inflammatory response indicative of depressive/psychiatric disorders, microglial activity, and cytokine signaling predicted both global and domain-specific performance for HIV− women. Our findings suggest that immune signatures may be useful diagnostic, prognostic, and immunotherapeutic targets predictive of subsequent cognitive performance. Importantly, they also provide insight into common and distinct inflammatory mechanisms underlying cognition in HIV− and HIV+VS women.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States.,Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States.,Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
| | - Philip J Norris
- Department of Laboratory Medicine, Vitalant Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Xuzhi Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, United States
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | | | - Sheila M Keating
- Department of Laboratory Medicine, Vitalant Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Deborah R Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Victor G Valcour
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University, Baltimore, MD, United States.,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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27
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Sánchez SM, Duarte-Abritta B, Abulafia C, De Pino G, Bocaccio H, Castro MN, Sevlever GE, Fonzo GA, Nemeroff CB, Gustafson DR, Guinjoan SM, Villarreal MF. White matter fiber density abnormalities in cognitively normal adults at risk for late-onset Alzheimer's disease. J Psychiatr Res 2020; 122:79-87. [PMID: 31931231 DOI: 10.1016/j.jpsychires.2019.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022]
Abstract
Tau accumulation affecting white matter tracts is an early neuropathological feature of late-onset Alzheimer's disease (LOAD). There is a need to ascertain methods for the detection of early LOAD features to help with disease prevention efforts. The microstructure of these tracts and anatomical brain connectivity can be assessed by analyzing diffusion MRI (dMRI) data. Considering that family history increases the risk of developing LOAD, we explored the microstructure of white matter through dMRI in 23 cognitively normal adults who are offspring of patients with Late-Onset Alzheimer's Disease (O-LOAD) and 22 control subjects (CS) without family history of AD. We also evaluated the relation of white matter microstructure metrics with cortical thickness, volumetry, in vivo amyloid deposition (with the help of PiB positron emission tomography -PiB-PET) and regional brain metabolism (as FDG-PET) measures. Finally we studied the association between cognitive performance and white matter microstructure metrics. O-LOAD exhibited lower fiber density and fractional anisotropy in the posterior portion of the corpus callosum and right fornix when compared to CS. Among O-LOAD, reduced fiber density was associated with lower amyloid deposition in the right hippocampus, and greater cortical thickness in the left precuneus, while higher mean diffusivity was related with greater cortical thickness of the right superior temporal gyrus. Additionally, compromised white matter microstructure was associated with poorer semantic fluency. In conclusion, white matter microstructure metrics may reveal early differences in O-LOAD by virtue of parental history of the disorder, when compared to CS without a family history of LOAD. We demonstrate that these differences are associated with lower fiber density in the posterior portion of the corpus callosum and the right fornix.
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Affiliation(s)
- Stella M Sánchez
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Bárbara Duarte-Abritta
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina
| | - Carolina Abulafia
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Institute for Biomedical Research (BIOMED), Pontifical Catholic University of Argentina, Argentina
| | - Gabriela De Pino
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, Argentina; Laboratorio de Neuroimágenes, Departamento de Imágenes, Fundación FLENI, Argentina
| | - Hernan Bocaccio
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
| | - Mariana N Castro
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Gustavo E Sevlever
- Departamento de Neuropatología y Biología Molecular, Fundación FLENI, Argentina
| | - Greg A Fonzo
- Institute of Early Life Adversity Research, Department of Psychiatry, University of Texas at Austin, United States
| | - Charles B Nemeroff
- Institute of Early Life Adversity Research, Department of Psychiatry, University of Texas at Austin, United States
| | - Deborah R Gustafson
- Department of Neurology, State University of New York University Downstate Medical Center, United States; Department of Health and Education, University of Skövde, Sweden
| | - Salvador M Guinjoan
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Servicio de Psiquiatría, Fundación FLENI, Argentina; Neurofisiología I, Facultad de Psicología, Universidad de Buenos Aires, Argentina.
| | - Mirta F Villarreal
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta, Instituto de Neurociencias FLENI-CONICET, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Física, Facultad de Cs. Exactas y Naturales, Universidad de Buenos Aires, Argentina
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Tamraz B, Huang Y, French AL, Kassaye S, Anastos K, Nowicki MJ, Gange S, Gustafson DR, Bacchetti P, Greenblatt RM, Hysi PG, Aouizerat BE. Association of Pharmacogenetic Markers With Atazanavir Exposure in HIV-Infected Women. Clin Pharmacol Ther 2020; 107:315-318. [PMID: 31562781 PMCID: PMC10810687 DOI: 10.1002/cpt.1605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 02/03/2023]
Abstract
SORCS2 rs73208473 was recently associated with decreased atazanavir (ATV) concentration in the hair of women with seropositive HIV. Herein, we report on a pharmacogenetic study of women with seropositive HIV demonstrating a similar association between rs73208473 and dose-adjusted plasma ATV concentration in African Americans.
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Affiliation(s)
- Bani Tamraz
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Yong Huang
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York – Downstate Medical Center, Brooklyn, New York, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Ruth M. Greenblatt
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
- Great Ormand Street Institute for Child Health, University College London, London, UK
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA
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Arnoldussen IAC, Gustafson DR, Leijsen EMC, de Leeuw FE, Kiliaan AJ. Adiposity is related to cerebrovascular and brain volumetry outcomes in the RUN DMC study. Neurology 2019; 93:e864-e878. [PMID: 31363056 DOI: 10.1212/wnl.0000000000008002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/08/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Adiposity predictors, body mass index (BMI), waist circumference (WC), and blood leptin and total adiponectin levels were associated with components of cerebral small vessel disease (CSVD) and brain volumetry in 503 adults with CSVD who were ≥50 years of age and enrolled in the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC). METHODS RUN DMC participants were followed up for 9 years (2006-2015). BMI, WC, brain imaging, and dementia diagnoses were evaluated at baseline and follow-up. Adipokines were measured at baseline. Brain imaging outcomes included CSVD components, white matter hyperintensities, lacunes, microbleeds, gray and white matter, hippocampal, total brain, and intracranial volumes. RESULTS Cross-sectionally among men at baseline, higher BMI, WC, and leptin were associated with lower gray matter and total brain volumes, and higher BMI and WC were associated with lower hippocampal volume. At follow-up 9 years later, higher BMI was cross-sectionally associated with lower gray matter volume, and an obese WC (>102 cm) was protective for ≥1 lacune or ≥1 microbleed in men. In women, increasing BMI and overweight or obesity (BMI ≥25 kg/m2 or WC >88 cm) were associated with ≥1 lacune. Longitudinally, over 9 years, a baseline obese WC was associated with decreasing hippocampal volume, particularly in men, and increasing white matter hyperintensity volume in women and men. CONCLUSIONS Anthropometric and metabolic adiposity predictors were differentially associated with CSVD components and brain volumetry outcomes by sex. Higher adiposity is associated with a vascular-neurodegenerative spectrum among adults at risk for vascular forms of cognitive impairment and dementias.
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Affiliation(s)
- Ilse A C Arnoldussen
- From the Departments of Anatomy (I.A.C.A., A.J.K.) and Neurology (E.M.C.L., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, and Radboud Alzheimer Center (I.A.C.A., A.J.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (D.R.G.), The State University of New York Downstate Health Sciences University, Brooklyn; and Department of Health and Education (D.R.G.), University of Skövde, Sweden
| | - Deborah R Gustafson
- From the Departments of Anatomy (I.A.C.A., A.J.K.) and Neurology (E.M.C.L., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, and Radboud Alzheimer Center (I.A.C.A., A.J.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (D.R.G.), The State University of New York Downstate Health Sciences University, Brooklyn; and Department of Health and Education (D.R.G.), University of Skövde, Sweden.
| | - Esther M C Leijsen
- From the Departments of Anatomy (I.A.C.A., A.J.K.) and Neurology (E.M.C.L., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, and Radboud Alzheimer Center (I.A.C.A., A.J.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (D.R.G.), The State University of New York Downstate Health Sciences University, Brooklyn; and Department of Health and Education (D.R.G.), University of Skövde, Sweden
| | - Frank-Erik de Leeuw
- From the Departments of Anatomy (I.A.C.A., A.J.K.) and Neurology (E.M.C.L., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, and Radboud Alzheimer Center (I.A.C.A., A.J.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (D.R.G.), The State University of New York Downstate Health Sciences University, Brooklyn; and Department of Health and Education (D.R.G.), University of Skövde, Sweden
| | - Amanda J Kiliaan
- From the Departments of Anatomy (I.A.C.A., A.J.K.) and Neurology (E.M.C.L., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, and Radboud Alzheimer Center (I.A.C.A., A.J.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology (D.R.G.), The State University of New York Downstate Health Sciences University, Brooklyn; and Department of Health and Education (D.R.G.), University of Skövde, Sweden
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Gustafson DR, Rubin LH, Hawkins KL, Zhang L, Jacobson LP, Becker JT, Munro CA, Lake JE, Martin E, Levine A, Brown TT, Saktor N, Erlandson KM. P2-574: MIDLIFE ADIPOSITY PREDICTS COGNITIVE DECLINE IN THE PROSPECTIVE MULTICENTER AIDS COHORT STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Deborah R. Gustafson
- University of Skövde; Skövde Sweden
- University of Gothenburg; Gothenburg Sweden
- State University of New York Downstate Medical Center; Brooklyn NY USA
| | | | | | - Long Zhang
- Johns Hopkins University; Baltimore MD USA
| | | | | | | | - Jordan E. Lake
- University of Texas Health Science Center; Houston TX USA
| | | | - Andrew Levine
- University of California Los Angeles; Los Angeles CA USA
| | | | - Ned Saktor
- Johns Hopkins University; Baltimore MD USA
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Gustafson DR, Arnoldussen IA, van Leijsen E, de Leeuw FE, Kiliaan A. P1-537: ADIPOSITY IS RELATED TO VASCULAR AND VOLUMETRIC BRAIN OUTCOMES IN THE RUN DMC STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Deborah R. Gustafson
- State University of New York Downstate Medical Center; Brooklyn New York USA
- University of Skövde; Skövde Sweden
| | | | | | - Frank-Erik de Leeuw
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Nijmegen Netherlands
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Alber J, Alladi S, Bae HJ, Barton DA, Beckett LA, Bell JM, Berman SE, Biessels GJ, Black SE, Bos I, Bowman GL, Brai E, Brickman AM, Callahan BL, Corriveau RA, Fossati S, Gottesman RF, Gustafson DR, Hachinski V, Hayden KM, Helman AM, Hughes TM, Isaacs JD, Jefferson AL, Johnson SC, Kapasi A, Kern S, Kwon JC, Kukolja J, Lee A, Lockhart SN, Murray A, Osborn KE, Power MC, Price BR, Rhodius-Meester HF, Rondeau JA, Rosen AC, Rosene DL, Schneider JA, Scholtzova H, Shaaban CE, Silva NC, Snyder HM, Swardfager W, Troen AM, van Veluw SJ, Vemuri P, Wallin A, Wellington C, Wilcock DM, Xie SX, Hainsworth AH. White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities. Alzheimers Dement (N Y) 2019; 5:107-117. [PMID: 31011621 PMCID: PMC6461571 DOI: 10.1016/j.trci.2019.02.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer's disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia.
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Affiliation(s)
- Jessica Alber
- Department of Biomedical and Pharmaceutical Sciences, George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hee-Joon Bae
- Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - David A. Barton
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Laurel A. Beckett
- Department of Public Health Sciences, School of Medicine University of California, Davis, CA, USA
| | | | - Sara E. Berman
- Wisconsin Alzheimer's Disease Research Center, Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra E. Black
- Department of Medicine, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Isabelle Bos
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gene L. Bowman
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Brandy L. Callahan
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Roderick A. Corriveau
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Silvia Fossati
- Departments of Neurology and Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Rebecca F. Gottesman
- Division of Cerebrovascular Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deborah R. Gustafson
- Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | | | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alex M. Helman
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
| | - Timothy M. Hughes
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeremy D. Isaacs
- St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Angela L. Jefferson
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sterling C. Johnson
- Department of Medicine-Geriatrics, Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Alifiya Kapasi
- Department of Pathology (Neuropathology), Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Silke Kern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jay C. Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Samuel N. Lockhart
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, 20298 Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Katie E. Osborn
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Brittani R. Price
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Hanneke F.M. Rhodius-Meester
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Allyson C. Rosen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Douglas L. Rosene
- Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago IL, USA
| | | | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health & Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Narlon C.B.S. Silva
- School of Kinesiology, Western Centre for Public Health & Family Medicine, London, ON, Canada
| | - Heather M. Snyder
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Walter Swardfager
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Aron M. Troen
- Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susanne J. van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Donna M. Wilcock
- Sanders-Brown Center on Aging, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Sharon Xiangwen Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Atticus H. Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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Babulal GM, Quiroz YT, Albensi BC, Arenaza-Urquijo E, Astell AJ, Babiloni C, Bahar-Fuchs A, Bell J, Bowman GL, Brickman AM, Chételat G, Ciro C, Cohen AD, Dilworth-Anderson P, Dodge HH, Dreux S, Edland S, Esbensen A, Evered L, Ewers M, Fargo KN, Fortea J, Gonzalez H, Gustafson DR, Head E, Hendrix JA, Hofer SM, Johnson LA, Jutten R, Kilborn K, Lanctôt KL, Manly JJ, Martins RN, Mielke MM, Morris MC, Murray ME, Oh ES, Parra MA, Rissman RA, Roe CM, Santos OA, Scarmeas N, Schneider LS, Schupf N, Sikkes S, Snyder HM, Sohrabi HR, Stern Y, Strydom A, Tang Y, Terrera GM, Teunissen C, Melo van Lent D, Weinborn M, Wesselman L, Wilcock DM, Zetterberg H, O'Bryant SE. Perspectives on ethnic and racial disparities in Alzheimer's disease and related dementias: Update and areas of immediate need. Alzheimers Dement 2019; 15:292-312. [PMID: 30555031 PMCID: PMC6368893 DOI: 10.1016/j.jalz.2018.09.009] [Citation(s) in RCA: 291] [Impact Index Per Article: 58.2] [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: 03/19/2018] [Revised: 07/12/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise "state-of-the-science" report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.
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Affiliation(s)
- Ganesh M Babulal
- Department of Neurology and Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada; Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Arlene J Astell
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, CA; School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy; Department of Neuroscience, IRCCS-Hospital San Raffaele Pisana of Rome and Cassino, Rome and Cassino, Italy
| | - Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, the University of Melbourne, Australia
| | | | - Gene L Bowman
- Nutrition and Brain Health Laboratory, Nestlé Institute of Health Sciences, Lausanne, Switzerland; Department of Neurology, Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Adam M Brickman
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Gaël Chételat
- Inserm, Inserm UMR-S U1237, Université de Caen-Normandie, GIP Cyceron, Caen, France
| | - Carrie Ciro
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Hiroko H Dodge
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Simone Dreux
- Undergraduate Program of History and Science, Harvard College, Cambridge, MA, USA
| | - Steven Edland
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Anna Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine & Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisbeth Evered
- Melbourne Medical School, University of Melbourne, Australia
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
| | - Keith N Fargo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Hector Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of San Diego, CA, USA
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | - Elizabeth Head
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - James A Hendrix
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Scott M Hofer
- Adult Development and Aging, University of Victoria, British Columbia, CA, USA
| | - Leigh A Johnson
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Roos Jutten
- VU University Medical Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Kerry Kilborn
- Department of Psychology, University of Glasgow, Glasgow, Scotland, UK
| | - Krista L Lanctôt
- Sunnybrook Research Institute of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jennifer J Manly
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Ralph N Martins
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Michelle M Mielke
- Department of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Esther S Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario A Parra
- School of Social Sciences, Department of Psychology, Heriot-Watt University, UK; Universidad Autónoma del Caribe, Barranquilla, Colombia; Neuroprogressive and Dementia Network, UK
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego School of Medicine, CA, USA
| | - Catherine M Roe
- Department of Neurology and Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Octavio A Santos
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Nikolaos Scarmeas
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA; Aiginition Hospital, 1st Neurology Clinic, Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Lon S Schneider
- Department of Psychiatry and The Behavioral Sciences, University of Southern California, CA, USA
| | - Nicole Schupf
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, NY, USA
| | - Sietske Sikkes
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | - Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Hamid R Sohrabi
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Yaakov Stern
- Department of Neurology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Graciela Muniz Terrera
- Centers for Clinical Brain Sciences and Dementia Prevention, University in Edinburgh, Scotland, UK
| | - Charlotte Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Debora Melo van Lent
- Department of Clinical Research, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Michael Weinborn
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Donna M Wilcock
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, UK; Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Sid E O'Bryant
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA.
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Kane JA, Mehmood T, Munir I, Kamran H, Kariyanna PT, Zhyvotovska A, Yusupov D, Suleman UJ, Gustafson DR, McFarlane SI. Cardiovascular Risk Reduction Associated with Pharmacological Weight Loss: A Meta-Analysis. Int J Clin Res Trials 2019; 4. [PMID: 31058246 DOI: 10.15344/2456-8007/2019/131] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity is a growing pandemic that is associated with multiple cardiovascular disease (CVD) risk factors such as hypertension, diabetes, dyslipidemia and obstructive sleep apnea. With the increase in obesity rates where nearly two thirds of Americans are either obese or overweight, there has been an increase in the use of pharmacological therapy weight loss. While these therapies have shown benefit in weight reduction, the clinical impact these pharmacological agents on overall CVD outcomes has yet to be determined. AIM We aimed to assess the effect of pharmacological agents used for weight reduction on CVD risk and all-cause mortality. METHODS We conducted a meta-analysis of peer-reviewed literature that evaluated the impact of anti-obesity drugs on cardiovascular outcomes. Key words used included: "orlistat", "lorcaserin", "phentermine/topiramate" or "naltrexone/bupropion" and "cardiovascular outcomes" among others. We reviewed 791 articles, only 47 studies were randomized controlled trials and only 7 studies fulfilled all the inclusion criteria including, quantitative data on cardiovascular risk factors such as, Hemoglobin A1C (A1C), changes in body mass index (BMI), blood pressure and CVD morbidity and mortality. Data was retrieved from these studies and evaluated with comprehensive meta-analysis software® to assess pooled effects for medical management versus placebo. RESULTS There were 7 studies included in the final analysis, with a total of 18,598 subjects, of which 8,685 were in the intervention (INT) group and 9,913 in the control (CTRL) group. For all cause mortality, there were 45 events in the INT and 55 in the CTRL groups, suggesting no significant difference between the two groups (OR: 0.843, 95%CI: 0.571-1.244, Z: -0.860, P: 0.390). For CVD mortality, there were 17 events in the INT and 36 events in the CTRL groups suggesting a significant mortality benefit in the INT group (OR:0.496, 95% CI: 0.282-0.873, Z: -2.433, P: 0.015). There was a significant absolute reduction in A1C in the INT group (Hg: -0.238, 95%CI: -0.291 to -0.186, Z: -8.937, P< 0.001). The percentage weight reduction was significantly higher for the INT group compared to the CTRL group (Hg: -0.431, 95%CI: -0.477 to -0.385, Z: -18.472, P< 0.001) and the blood pressure reduction was higher for the INT group compared to the CTRL group. (Hg: -0.052, 95%CI: -0.101- -0.003, Z: -2.086, P: 0.037). The heterogeneity observed for our meta analysis is Q: 1.884, df: 6, P: 0.930. CONCLUSIONS Our study demonstrated the favorable and significant effect of pharmacological weight reduction strategies on weight loss, blood pressure reduction, glycemic control (A1C reduction), and CVD mortality.While weight loss without pharmacological means has been shown to reduce CVD risk, the mechanism by which weight loss medications impact CVD risk reduction could be a direct effect of these agents or merely an effect of weight reduction itself. Weight loss has been noted to modify risk factors via improving insulin sensitivity, reducing inflammation, decreasing blood pressure and modifying the lipid profile, In addition, the mechanism of action of the medications are not directly anti-inflammatory, and do not directly modify insulin sensitivity, blood pressure or the lipid profile. Thus, it is most likely that the benefit on cardiovascular disease from these therapies is via weight reduction and not direct medication effect.Given the limited efficacy of the lifestyle modification on sustained weight loss and the surgical risk and limited availability of bariatric surgical options. Our data suggests pharmacological weight loss therapy may be a valuable treatment option to reduce CVD risk in obese patients. Further research is needed to clarify the effects these therapies on overall mortality and evaluate the mechanisms by which these medications reduce CVD risk factors and mortality.
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Affiliation(s)
- Jesse A Kane
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Talha Mehmood
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Irsa Munir
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Haroon Kamran
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Pramod Theetha Kariyanna
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Angelina Zhyvotovska
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Denis Yusupov
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Umer Javed Suleman
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY 11203, USA.,Neuropsychiatric Epidemiology Unit, University of Gothenburg, Gothenburg, Sweden
| | - Samy I McFarlane
- Department of Internal Medicine, Divisions of Cardiovascular Disease and Endocrinology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
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Sharma A, Hoover DR, Shi Q, Gustafson DR, Plankey MW, Tien PC, Weber KM, Yin MT. Frailty as a predictor of falls in HIV-infected and uninfected women. Antivir Ther 2019; 24:51-61. [PMID: 30604692 PMCID: PMC10141570 DOI: 10.3851/imp3286] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Frailty and falls occur commonly and prematurely in HIV-infected populations. Whether frailty in middle-age predicts future falls among HIV-infected women is unknown. METHODS We evaluated associations of frailty with single and recurrent falls 10 years later among 729 HIV-infected and 326 uninfected women in the Women's Interagency HIV Study (WIHS) with frailty measured in 2005 and self-reported falls in 2014-2016. Frailty was defined as ≥3 of 5 Fried Frailty Index components: slow gait, reduced grip strength, exhaustion, unintentional weight loss and low physical activity. Stepwise logistic regression models determined odds of single (versus 0) or recurrent falls (≥2 versus 0) during the 2-year period; separate models evaluated frailty components. RESULTS HIV-infected women were older (median 42 versus 39 years; P<0.0001) and more often frail (14% versus 9%; P=0.04) than uninfected women. Over 2 years, 40% of HIV-infected versus 39% of uninfected women reported a fall (single fall in 15% HIV+ versus 18% HIV- women; recurrent falls in 25% HIV+ versus 20% HIV- women [overall P=0.20]). In multivariate models, frailty independently predicted recurrent falls (adjusted odds ratio [aOR] 1.84, 95% CI: 1.13, 2.97; P=0.01), but not a single fall. Among frailty components, unintentional weight loss independently predicted single fall (aOR 2.31, 95% CI: 1.28, 4.17; P=0.005); unintentional weight loss (aOR 2.26, 95% CI: 1.32, 3.86; P=0.003) and exhaustion (aOR 1.66, 95% CI: 1.10, 2.50; P=0.02) independently predicted recurrent falls. CONCLUSIONS Early frailty measurement among middle-aged women with or at-risk for HIV may be a useful tool to assess future fall risk.
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Affiliation(s)
- Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, New Brunswick, NJ, USA
| | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, Valhalla, NY, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Phyllis C Tien
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, IL, USA
| | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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Sweeney MD, Montagne A, Sagare AP, Nation DA, Schneider LS, Chui HC, Harrington MG, Pa J, Law M, Wang DJJ, Jacobs RE, Doubal FN, Ramirez J, Black SE, Nedergaard M, Benveniste H, Dichgans M, Iadecola C, Love S, Bath PM, Markus HS, Al-Shahi Salman R, Allan SM, Quinn TJ, Kalaria RN, Werring DJ, Carare RO, Touyz RM, Williams SCR, Moskowitz MA, Katusic ZS, Lutz SE, Lazarov O, Minshall RD, Rehman J, Davis TP, Wellington CL, González HM, Yuan C, Lockhart SN, Hughes TM, Chen CLH, Sachdev P, O'Brien JT, Skoog I, Pantoni L, Gustafson DR, Biessels GJ, Wallin A, Smith EE, Mok V, Wong A, Passmore P, Barkof F, Muller M, Breteler MMB, Román GC, Hamel E, Seshadri S, Gottesman RF, van Buchem MA, Arvanitakis Z, Schneider JA, Drewes LR, Hachinski V, Finch CE, Toga AW, Wardlaw JM, Zlokovic BV. Vascular dysfunction-The disregarded partner of Alzheimer's disease. Alzheimers Dement 2019; 15:158-167. [PMID: 30642436 PMCID: PMC6338083 DOI: 10.1016/j.jalz.2018.07.222] [Citation(s) in RCA: 421] [Impact Index Per Article: 84.2] [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: 06/13/2018] [Accepted: 07/31/2018] [Indexed: 12/30/2022]
Abstract
Increasing evidence recognizes Alzheimer's disease (AD) as a multifactorial and heterogeneous disease with multiple contributors to its pathophysiology, including vascular dysfunction. The recently updated AD Research Framework put forth by the National Institute on Aging-Alzheimer's Association describes a biomarker-based pathologic definition of AD focused on amyloid, tau, and neuronal injury. In response to this article, here we first discussed evidence that vascular dysfunction is an important early event in AD pathophysiology. Next, we examined various imaging sequences that could be easily implemented to evaluate different types of vascular dysfunction associated with, and/or contributing to, AD pathophysiology, including changes in blood-brain barrier integrity and cerebral blood flow. Vascular imaging biomarkers of small vessel disease of the brain, which is responsible for >50% of dementia worldwide, including AD, are already established, well characterized, and easy to recognize. We suggest that these vascular biomarkers should be incorporated into the AD Research Framework to gain a better understanding of AD pathophysiology and aid in treatment efforts.
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Affiliation(s)
- Melanie D Sweeney
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Axel Montagne
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abhay P Sagare
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Nation
- Department of Psychology, University of Southern California, Los Angeles, CA, USA; Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Lon S Schneider
- Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Helena C Chui
- Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Judy Pa
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Meng Law
- Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Danny J J Wang
- Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Russell E Jacobs
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Fergus N Doubal
- Neuroimaging Sciences and Brain Research Imaging Center, Division of Neuroimaging Sciences, Center for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, UK
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Hurvitz Brain Sciences Program, Canadian Partnership for Stroke Recovery, and LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto Dementia Research Alliance, University of Toronto, Toronto, Canada
| | - Maiken Nedergaard
- Section for Translational Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Glia Disease and Therapeutics, Center for Translational Neuromedicine, University of Rochester Medical School, Rochester, NY, USA
| | - Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), Ludwing-Maximilians-University Munich, Munich, Germany
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Seth Love
- Institute of Clinical Neurosciences, University of Bristol, School of Medicine, Level 2 Learning and Research, Southmead Hospital, Bristol, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK; Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Rustam Al-Shahi Salman
- Neuroimaging Sciences and Brain Research Imaging Center, Division of Neuroimaging Sciences, Center for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, UK
| | - Stuart M Allan
- Faculty of Biology, Medicine and Health, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rajesh N Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rhian M Touyz
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Steve C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael A Moskowitz
- Stroke and Neurovascular Regulation Laboratory, Departments of Radiology and Neurology Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Zvonimir S Katusic
- Department of Anesthesiology and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sarah E Lutz
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, USA
| | - Orly Lazarov
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard D Minshall
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA; Department of Pharmacology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jalees Rehman
- Department of Pharmacology, The Center for Lung and Vascular Biology, The University of Illinois College of Medicine, Chicago, IL, USA; Department of Medicine, The Center for Lung and Vascular Biology, The University of Illinois College of Medicine, Chicago, IL, USA
| | - Thomas P Davis
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Cheryl L Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hector M González
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Samuel N Lockhart
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Alzheimer's Disease Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Alzheimer's Disease Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher L H Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Australia, Sydney, Australia
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Leonardo Pantoni
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Deborah R Gustafson
- Department of Neurology, State University of New York-Downstate Medical Center, Brooklyn, NY, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anders Wallin
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenberg, Sweden
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Vincent Mok
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong SAR, China; Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter Passmore
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Frederick Barkof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands; Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Majon Muller
- Section of Geriatrics, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Monique M B Breteler
- Department of Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Gustavo C Román
- Department of Neurology, Methodist Neurological Institute, Houston, TX, USA
| | - Edith Hamel
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Rebecca F Gottesman
- Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zoe Arvanitakis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Lester R Drewes
- Laboratory of Cerebral Vascular Biology, Department of Biomedical Sciences, University of Minnesota Medical School Duluth, Duluth, MN, USA
| | - Vladimir Hachinski
- Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Caleb E Finch
- Leonard Davis School of Gerontology, Dornsife College, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA; Laboratory of Neuro Imaging (LONI), Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joanna M Wardlaw
- Neuroimaging Sciences and Brain Research Imaging Center, Division of Neuroimaging Sciences, Center for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, UK
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Alzheimer's Disease Research Center, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
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Tamraz B, Huang Y, French AL, Kassaye S, Anastos K, Nowicki MJ, Gange S, Gustafson DR, Bacchetti P, Greenblatt RM, Hysi PG, Aouizerat BE. A Genome-Wide Association Study Identifies a Candidate Gene Associated With Atazanavir Exposure Measured in Hair. Clin Pharmacol Ther 2018; 104:949-956. [PMID: 29315502 PMCID: PMC6037621 DOI: 10.1002/cpt.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/03/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
Hair provides a direct measure of long-term exposure of atazanavir (ATV). We report the results of the first genome-wide association study (GWAS) of ATV exposure measured in hair in an observational cohort representative of US women living with HIV; the Women's Interagency HIV Study. Approximately 14.1 million single nucleotide polymorphisms (SNPs) were analyzed in linear regression-based GWAS, with replication, adjusted for nongenetic predictors collected under conditions of actual use of ATV in 398 participants. Lastly, the PharmGKB database was used to identify pharmacogene associations with ATV exposure. The rs73208473, within intron 1 of SORCS2, resulted in a 0.46-fold decrease in ATV exposure, with the strongest association (P = 1.71×10-8 ) in GWAS. A priori pharmacogene screening did not identify additional variants statistically significantly associated with ATV exposure, including those previously published in ATV plasma candidate pharmacogene studies. The findings demonstrate the potential value of pharmacogenomic GWAS in ethnically diverse populations under conditions of actual use.
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Affiliation(s)
- Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Yong Huang
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, IL
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, CA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY
| | - Peter Bacchetti
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Ruth M. Greenblatt
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology, King’s College London, United Kingdom
- Great Ormand Street Institute for Child Health, University College London, United Kingdom
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, NY
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Bekhbat M, Mehta CC, Kelly SD, Vester A, Ofotokun I, Felger J, Wingood G, Anastos K, Gustafson DR, Kassaye S, Milam J, Aouizerat B, Weber K, Golub ET, Moore MF, Diclemente R, Fischl M, Kempf MC, Maki P, Neigh GN. HIV and symptoms of depression are independently associated with impaired glucocorticoid signaling. Psychoneuroendocrinology 2018; 96:118-125. [PMID: 29936334 PMCID: PMC6131054 DOI: 10.1016/j.psyneuen.2018.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 11/27/2022]
Abstract
Chronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.
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Affiliation(s)
- Mandakh Bekhbat
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | - C Christina Mehta
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | - Sean D Kelly
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | - Aimee Vester
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | - Ighovwerha Ofotokun
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states; University of Illinois at Chicago, United states
| | - Jennifer Felger
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | - Gina Wingood
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states; Columbia University, Mailman School of Public Health, University of Illinois at Chicago, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | - Kathryn Anastos
- Albert Einstein College of Medicine and Montefiore Medical Center, Brooklyn NY, United states
| | - Deborah R Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn NY, United States
| | - Seble Kassaye
- Georgetown University, Washington, D.C., United states
| | - Joel Milam
- University of Southern California, United states
| | - Bradley Aouizerat
- New York University, Department of Medicine, Washington, D.C., United states
| | - Kathleen Weber
- Cook County Health & Hospitals System and Hektoen Institute of Medicine, Chicago IL, United states
| | - Elizabeth T Golub
- Johns Hopkins Bloomberg School of Medicine, Public Health, United states
| | | | - Ralph Diclemente
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states
| | | | | | - Pauline Maki
- University of Illinois at Chicago, United states
| | - Gretchen N Neigh
- Emory University, State University of New York - Downstate Medical Center, Brooklyn NY, United states; Virginia Commonwealth University, State University of New York - Downstate Medical Center, Brooklyn NY, United states.
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39
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Arnoldussen IA, Sundh V, Bäckman K, Kern S, Östling S, Blennow K, Zetterberg H, Skoog I, Kiliaan AJ, Gustafson DR. A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older. J Alzheimers Dis 2018; 63:1325-1335. [DOI: 10.3233/jad-180099] [Citation(s) in RCA: 6] [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] [Indexed: 01/03/2023]
Affiliation(s)
- Ilse A.C. Arnoldussen
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Valter Sundh
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Kristoffer Bäckman
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Svante Östling
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Kaj Blennow
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Henrik Zetterberg
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
| | - Amanda J. Kiliaan
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
- Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy at University of Gothenburg, Institute for Neuroscience and Physiology, Gothenburg, Sweden
- Department of Health and Education, University of Skövde, Sweden
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40
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Moran CA, Sheth AN, Mehta CC, Hanna DB, Gustafson DR, Plankey MW, Mack WJ, Tien PC, French AL, Golub ET, Quyyumi A, Kaplan RC, Ofotokun I. The association of C-reactive protein with subclinical cardiovascular disease in HIV-infected and HIV-uninfected women. AIDS 2018; 32:999-1006. [PMID: 29438198 PMCID: PMC5920777 DOI: 10.1097/qad.0000000000001785] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE HIV is a cardiovascular disease (CVD) risk factor. However, CVD risk is often underestimated in HIV-infected women. C-reactive protein (CRP) may improve CVD prediction in this population. We examined the association of baseline plasma CRP with subclinical CVD in women with and without HIV. DESIGN Retrospective cohort study. METHODS A total of 572 HIV-infected and 211 HIV-uninfected women enrolled in the Women's Interagency HIV Study underwent serial high-resolution B-mode carotid artery ultrasonography between 2004 and 2013 to assess carotid intima-media thickness (CIMT) and focal carotid artery plaques. We used multivariable linear and logistic regression models to assess the association of baseline high (≥3 mg/l) high-sensitivity (hs) CRP with baseline CIMT and focal plaques, and used multivariable linear and Poisson regression models for the associations of high hsCRP with CIMT change and focal plaque progression. We stratified our analyses by HIV status. RESULTS Median (interquartile range) hsCRP was 2.2 mg/l (0.8-5.3) in HIV-infected, and 3.2 mg/l (0.9-7.7) in HIV-uninfected, women (P = 0.005). There was no statistically significant association of hsCRP with baseline CIMT [adjusted mean difference -3.5 μm (95% confidence interval:-19.0 to 12.1)] or focal plaques [adjusted odds ratio: 1.31 (0.67-2.67)], and no statistically significant association of hsCRP with CIMT change [adjusted mean difference 11.4 μm (-2.3 to 25.1)]. However, hsCRP at least 3 mg/l was positively associated with focal plaque progression in HIV-uninfected [adjusted rate ratio: 5.97 (1.46-24.43)], but not in HIV-infected [adjusted rate ratio: 0.81 (0.47-1.42)] women (P = 0.042 for interaction). CONCLUSION In our cohort of women with similar CVD risk factors, higher baseline hsCRP is positively associated with carotid plaque progression in HIV-uninfected, but not HIV-infected, women, suggesting that subclinical CVD pathogenesis may be different HIV-infected women.
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Affiliation(s)
- Caitlin A Moran
- Department of Medicine, Emory University
- Department of Medicine, Grady Healthcare System
| | - Anandi N Sheth
- Department of Medicine, Emory University
- Department of Medicine, Grady Healthcare System
| | - C Christina Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York-Downstate, New York, New York
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Phyllis C Tien
- Department of Medicine, University of California-San Francisco
- Department of Veterans Affairs, San Francisco, California
| | - Audrey L French
- Department of Medicine, Stroger Hospital of Cook County
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - Ighovwerha Ofotokun
- Department of Medicine, Emory University
- Department of Medicine, Grady Healthcare System
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41
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Khachaturian AS, Hayden KM, Mielke MM, Tang Y, Lutz MW, Gustafson DR, Kukull WA, Mohs R, Khachaturian ZS. Future prospects and challenges for Alzheimer's disease drug development in the era of the NIA‐AA Research Framework. Alzheimers Dement 2018; 14:532-534. [DOI: 10.1016/j.jalz.2018.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ara S. Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association Rockville MD USA
| | - Kathleen M. Hayden
- Associate Professor, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Sticht Center for Healthy Aging and Alzheimer's Prevention Wake Forest School of Medicine Winston‐Salem NC USA
| | - Michelle M. Mielke
- Professor of Epidemiology, Department of Health Sciences Research Professor of Neurology, Mayo Clinic College of Medicine Rochester MN USA
| | - Yi Tang
- Associate Professor, Department of Neurology Xuan Wu Hospital Beijing China
| | - Michael W. Lutz
- Assistant Professor of Neurology, Department of Neurology Duke University School of Medicine Durham NC USA
| | - Deborah R. Gustafson
- Section for NeuroEpidemiology, Department of Neurology State University of New York–Downstate Medical Center Brooklyn NY USA
| | - Walter A. Kukull
- Department of Epidemiology, School of Public Health University of Washington Seattle WA USA
| | - Richard Mohs
- Senior Associate Editor Alzheimer's & Dementia: The Journal of the Alzheimer's Association Chicago IL USA
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Kamran H, Kupferstein E, Sharma N, Karam JG, Myers AK, Youssef I, Sowers JR, Gustafson DR, Salifu MO, McFarlane SI. Statins and New-Onset Diabetes in Cardiovascular and Kidney Disease Cohorts: A Meta-Analysis. Cardiorenal Med 2018; 8:105-112. [PMID: 29617000 DOI: 10.1159/000485196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 11/04/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Statins have long been prescribed for the primary and secondary prevention of cardiovascular disease (CVD) and kidney disease. Their benefits and efficacy are widely accepted in current clinical practice, but like any other therapeutic agents, they have adverse effects. One of the emerging concerns with statin therapy is the development of new-onset diabetes mellitus (NODM), a dreaded risk factor for CVD and kidney disease and widely viewed as CVD equivalent. Accumulating evidence indicates that NODM is a consequence of statin use. METHODS We conducted a meta-analysis of studies reporting on associations between NODM and statin use. Based on strict exclusion criteria, a total of 11 studies were selected. Their data were analyzed using Comprehensive Meta-Analysis® statistical software and reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS The cumulative fixed effect for use of statin therapy and incident NODM was an OR of 1.61 (95% CI 1.55-1.68, p < 0.001). Our results suggest that statin therapy is associated with NODM, such that there is a small but significant risk of NODM among patients receiving statin for CVD prevention therapy. However, this high-risk population also has other diabetes risk factors (such as obesity and hypertension) contributing to the development of NODM. CONCLUSIONS It is imperative that patients on statin therapy be monitored carefully for NODM. However, it can be argued that the risk of statin therapy is offset by the multitude of cardiovascular and kidney-protective effects provided by such an important and highly effective therapeutic agent.
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Affiliation(s)
- Haroon Kamran
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Eric Kupferstein
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Navneet Sharma
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Jocelyne G Karam
- Division of Endocrinology, Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Alyson K Myers
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Irini Youssef
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - James R Sowers
- Division of Endocrinology, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York, USA.,Neuropsychiatric Epidemiology Unit, University of Gothenburg, Gothenburg, Sweden
| | - Moro O Salifu
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Samy I McFarlane
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
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43
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Affiliation(s)
- Deborah R. Gustafson
- Department of Neurology, State University of New York, Downstate Medical Center, New York, USA
- Department of Health and Education, University of Skövde, Sweden
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Abstract
PURPOSE OF THE REVIEW The number of adults who are aging successfully and have HIV infection is increasing. More effective antiretroviral therapy (ART) regimens are preventing individuals infected with HIV from reaching end stages of the HIV infection and developing AIDS (acquired immunodeficiency syndrome). However, even at lower viral loads, chronic HIV infection appears to have consequences on aging processes, including the development of frailty. RECENT FINDINGS Frailty is a term used to describe vulnerability in aging. Frailty indices such as the Fried Frailty Index (FFI), the Veterans Aging Cohort Study (VACS) Index, and the Center for Epidemiologic Studies Depression scale (CES-D), an index of emotional frailty, associate with or predict clinical outcomes and death. However, even among existing frailty definitions, components require rigorous and consistent standardization. In the Women's Interagency HIV Study (WIHS), we have shown that frailty does not exist in isolation, even in midlife, and we use frailty to predict death. Frailty indices should be systematically used by health professionals to evaluate health and future risks for adverse events. Frailty prevention efforts, especially among those with HIV infection, appear to be essential for "successful aging" or aging without disability or loss of independence and may prevent HIV transmission. Taking care of elderly people is one of the major challenges of this century, and we must expect and be prepared for an increase in the number of aging adults, some of whom are patients with many co-morbidities and HIV infection.
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Affiliation(s)
- Marion Thurn
- Department of Neurology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA.
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Franx BAA, Arnoldussen IAC, Kiliaan AJ, Gustafson DR. Weight Loss in Patients with Dementia: Considering the Potential Impact of Pharmacotherapy. Drugs Aging 2017; 34:425-436. [PMID: 28478593 DOI: 10.1007/s40266-017-0462-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unintentional body weight loss is common in patients with dementia and is linked to cognitive impairment and poorer disease outcomes. It is proposed that some dementia medications with market approval, while aiming to improve cognitive and functional outcomes of a patient with dementia, are associated with reported body weight or body mass index loss. This review presents evidence in the published literature on body weight loss in dementia, describes selected theories behind body weight loss, evaluates the potential impact of approved dementia pharmacotherapies on body weight, considers the potential role for medical foods, understands the potential influence of treatments for neuropsychiatric symptoms and signs, and finally, summarizes this important area.
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Affiliation(s)
- Bart A A Franx
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse A C Arnoldussen
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA. .,Neuropsychiatric Epidemiology Unit (EPINEP), Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Department of Health and Education, University of Skövde, Skövde, Sweden.
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46
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Abulafia C, Duarte‐Abritta B, Villareal MF, Ladrón‐de‐Guevara S, Garcia C, Sequeyra G, Sevlever G, Fiorentini L, Bär K, Gustafson DR, Vigo DE, Guinjoan SM. [P2–323]: RELATIONSHIP BETWEEN COGNITIVE AND SLEEP‐WAKE VARIABLES IN ASYMPTOMATIC OFFSPRING OF PATIENTS WITH LATE‐ONSET ALZHEIMER's DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Deborah R. Gustafson
- SUNY Downstate Medical CenterBrooklynNYUSA
- University of GothenburgGothenburgSweden
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Gustafson DR, McFarlane SI, Mielke MM, Uglialoro A, Keating S, Holman S, Minkoff H, Crystal H. [P2–261]: GHRELIN, AMYLIN, GASTRIC INHIBITORY PEPTIDE AND COGNITION IN MIDDLE‐AGED HIV‐INFECTED AND UNINFECTED WOMEN: THE WOMEN's INTERAGENCY HIV STUDY. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Deborah R. Gustafson
- University of GothenburgGothenburgSweden
- SUNY Downstate Medical CenterBrooklynNYUSA
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Gustafson DR, Shi Q, Holman S, Minkoff H, Cohen MH, Plankey MW, Havlik R, Sharma A, Gange S, Gandhi M, Milam J, Hoover DR. Predicting death over 8 years in a prospective cohort of HIV-infected women: the Women's Interagency HIV Study. BMJ Open 2017; 7:e013993. [PMID: 28667199 PMCID: PMC5577878 DOI: 10.1136/bmjopen-2016-013993] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Predicting mortality in middle-aged HIV-infected (HIV+) women on antiretroviral therapies (ART) is important for understanding the impact of HIV infection. Several health indices have been used to predict mortality in women with HIV infection. We evaluated: (1) an HIV biological index, Veterans Aging Cohort Study (VACS); (2) a physical index, Fried Frailty Index (FFI); and (3) a mental health index, Center for Epidemiologic Studies-Depression (CES-D). Proportional hazards regression analyses were used to predict death and included relevant covariates. DESIGN Prospective, observational cohort. SETTING Multicentre, across six sites in the USA. PARTICIPANTS 1385 multirace/ethnic ART-experienced HIV+ women in 2005. PRIMARY AND SECONDARY OUTCOMES All deaths, AIDS deaths and non-AIDS deaths up to ~8 years from baseline. RESULTS Included together in one model, VACS Index was the dominant, significant independent predictor of all deaths within 3 years (HR=2.20, 95% CI 1.83, 2.65, χ2=69.04, p<0.0001), and later than 3 years (HR=1.55, 95% CI 1.30, 1.84, χ2=23.88, p<0.0001); followed by FFI within 3 years (HR=2.06, 95% CI 1.19, 3.57, χ2=6.73, p=0.01) and later than 3 years (HR=2.43, 95% CI 1.58, 3.75, χ2=16.18, p=0.0001). CES-D score was not independently associated with mortality. CONCLUSIONS AND RELEVANCE This is the first simultaneous evaluation of three common health indices in HIV+ adults. Indices reflecting physical and biological ageing were associated with death.
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Affiliation(s)
- Deborah R Gustafson
- Department of Neurology, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, Valhalla, New York, USA
| | - Susan Holman
- Department of Medicine, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Howard Minkoff
- Maimonides Medical Center, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County Health and Hospital System and Rush University, Chicago, Illinois, USA
| | - Michael W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Richard Havlik
- AIDS Community Research Initiative of America, New York, New York, USA
- Arrow Health, Bethesda, Maryland, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, California, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers the State University of New Jersey, New Brunswick, New Jersey, USA
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49
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Abulafia C, Duarte-Abritta B, Villarreal MF, Ladrón-de-Guevara MS, García C, Sequeyra G, Sevlever G, Fiorentini L, Bär KJ, Gustafson DR, Vigo DE, Guinjoan SM. Relationship between Cognitive and Sleep-wake Variables in Asymptomatic Offspring of Patients with Late-onset Alzheimer's Disease. Front Aging Neurosci 2017; 9:93. [PMID: 28424614 PMCID: PMC5380732 DOI: 10.3389/fnagi.2017.00093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Early neuropathological changes characteristic of late-onset Alzheimer's disease (LOAD) involve brain stem and limbic structures that regulate neurovegetative functions, including sleep-wake rhythm. Indeed, sleep pattern is an emerging biomarker and a potential pathophysiological mechanism in LOAD. We hypothesized that cognitively asymptomatic, middle-aged offspring of patients with LOAD (O-LOAD) would display a series of circadian rhythm abnormalities prior to the onset of objective cognitive alterations. We tested 31 children of patients with LOAD (O-LOAD) and 19 healthy individuals without family history of Alzheimer's disease (control subjects, CS) with basic tests of cognitive function, as well as actigraphy measures of sleep-wake rhythm, cardiac autonomic function, and bodily temperature. Unexpectedly, O-LOAD displayed subtle but significant deficits in verbal episodic memory (Rey Auditory Verbal Learning Test delayed recall 10.6 ± 0.4 vs. 8.6 ± 0.6, t = 4.97, df = 49, p < 0.01) and language (Weschler's vocabulary 51.4 ± 1.3 vs. 44.3 ± 1.5, t = 2.49, df = 49, p < 0.001) compared to CS, even though all participants had results within the clinically normal range. O-LOAD showed a phase-delayed rhythm of body temperature (2.56 ± 0.47 h vs. 3.8 ± 0.26 h, t = 2.48, df = 40, p = 0.031). Cognitive performance in O-LOAD was associated with a series of cardiac autonomic sleep-wake variables; specifically indicators of greater sympathetic activity at night were related to poorer cognition. The present results suggest sleep pattern deserves further study as a potential neurobiological signature in LOAD, even in middle-aged, at risk individuals.
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Affiliation(s)
- Carolina Abulafia
- FLENI Foundation Department of PsychiatryBuenos Aires, Argentina.,Applied Neuroscience Laboratory, Institute for Biomedical Research, School of Medical Sciences, Universidad Católica ArgentinaBuenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina
| | | | - Mirta F Villarreal
- FLENI Foundation Department of PsychiatryBuenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina
| | - María S Ladrón-de-Guevara
- FLENI Foundation Department of PsychiatryBuenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina
| | - Celeste García
- FLENI Foundation Department of PsychiatryBuenos Aires, Argentina
| | | | - Gustavo Sevlever
- FLENI Foundation Department of PsychiatryBuenos Aires, Argentina
| | | | - Karl-Jürgen Bär
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Jena, Friedrich-Schiller-UniversitätJena, Germany
| | - Deborah R Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, BrooklynNY, USA.,Neuropsychiatric Epidemiology Unit, University of GothenburgGothenburg, Sweden.,Department of Health and Education, University of SkövdeSkövde, Sweden
| | - Daniel E Vigo
- Applied Neuroscience Laboratory, Institute for Biomedical Research, School of Medical Sciences, Universidad Católica ArgentinaBuenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina
| | - Salvador M Guinjoan
- FLENI Foundation Department of PsychiatryBuenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina.,FLENI Teaching Unit, Department of Psychiatry and Mental Health, University of Buenos Aires School of MedicineBuenos Aires, Argentina.,Department of Neurophysiology, University of Buenos Aires School of PsychologyBuenos Aires, Argentina
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50
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Westreich D, Cates J, Cohen M, Weber KM, Seidman D, Cropsey K, Wright R, Milam J, Young MA, Mehta CC, Gustafson DR, Golub ET, Fischl MA, Adimora AA. Smoking, HIV, and risk of pregnancy loss. AIDS 2017; 31:553-560. [PMID: 27902507 PMCID: PMC5263172 DOI: 10.1097/qad.0000000000001342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. DESIGN We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014. METHODS We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach. RESULTS Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0-19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. CONCLUSION Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.
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Affiliation(s)
- Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina
| | - Jordan Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina
| | - Mardge Cohen
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County and Rush Medical College
| | - Kathleen M. Weber
- Hektoen Institute of Medicine/The CORE Center, Cook County Health & Hospital Systems, Chicago, Illinois
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Health Services, University of California San Francisco, San Francisco, California
| | - Karen Cropsey
- Department of Psychiatry and Behavior Neurobiology, University of Alabama Birmingham, Birmingham, Alabama
| | - Rodney Wright
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Mary A. Young
- Division of Infectious Diseases, Georgetown University, Washington, District of Columbia
| | - C. Christina Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | | | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Adaora A. Adimora
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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