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Dugani SB, Moorthy MV, Demler OV, Li C, Ridker PM, Glynn RJ, Mora S. Plasma Biomarker Profiles for Premature and Nonpremature Coronary Heart Disease in Women. Clin Chem 2024; 70:768-779. [PMID: 38472127 PMCID: PMC11062763 DOI: 10.1093/clinchem/hvae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/18/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Premature coronary heart disease (CHD) is a major cause of death in women. We aimed to characterize biomarker profiles of women who developed CHD before and after age 65 years. METHODS In the Women's Health Study (median follow-up 21.5 years), women were grouped by age and timing of incident CHD: baseline age <65 years with premature CHD by age 65 years (25 042 women; 447 events) and baseline age ≥65 years with nonpremature CHD (2982 women; 351 events). Associations of 44 baseline plasma biomarkers measured using standard assays and a nuclear magnetic resonance (NMR)-metabolomics assay were analyzed using Cox models adjusted for clinical risk factors. RESULTS Twelve biomarkers showed associations only with premature CHD and included lipoprotein(a), which was associated with premature CHD [adjusted hazard ratio (HR) per SD: 1.29 (95% CI 1.17-1.42)] but not with nonpremature CHD [1.09(0.98-1.22)](Pinteraction = 0.02). NMR-measured lipoprotein insulin resistance was associated with the highest risk of premature CHD [1.92 (1.52-2.42)] but was not associated with nonpremature CHD (Pinteraction <0.001). Eleven biomarkers showed stronger associations with premature vs nonpremature CHD, including apolipoprotein B. Nine NMR biomarkers showed no association with premature or nonpremature CHD, whereas 12 biomarkers showed similar significant associations with premature and nonpremature CHD, respectively, including low-density lipoprotein (LDL) cholesterol [1.30(1.20-1.45) and 1.22(1.10-1.35)] and C-reactive protein [1.34(1.19-1.50) and 1.25(1.08-1.44)]. CONCLUSIONS In women, a profile of 12 biomarkers was selectively associated with premature CHD, driven by lipoprotein(a) and insulin-resistant atherogenic dyslipoproteinemia. This has implications for the development of biomarker panels to screen for premature CHD.
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Affiliation(s)
- Sagar B Dugani
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, United States
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - M Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Olga V Demler
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Chunying Li
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Paul M Ridker
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert J Glynn
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Boston, MA, United States
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Hoshi RA, Plavša B, Liu Y, Trbojević-Akmačić I, Glynn RJ, Ridker PM, Cummings RD, Gudelj I, Lauc G, Demler OV, Mora S. N-Glycosylation Profiles of Immunoglobulin G and Future Cardiovascular Events. Circ Res 2024; 134:e3-e14. [PMID: 38348651 PMCID: PMC10923145 DOI: 10.1161/circresaha.123.323623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Posttranslational glycosylation of IgG can modulate its inflammatory capacity through structural variations. We examined the association of baseline IgG N-glycans and an IgG glycan score with incident cardiovascular disease (CVD). METHODS IgG N-glycans were measured in 2 nested CVD case-control studies: JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; NCT00239681; primary prevention; discovery; Npairs=162); and TNT trial (Treating to New Targets; NCT00327691; secondary prevention; validation; Npairs=397). Using conditional logistic regression, we investigated the association of future CVD with baseline IgG N-glycans and a glycan score adjusting for clinical risk factors (statin treatment, age, sex, race, lipids, hypertension, and smoking) in JUPITER. Significant associations were validated in TNT, using a similar model further adjusted for diabetes. Using least absolute shrinkage and selection operator regression, an IgG glycan score was derived in JUPITER as a linear combination of selected IgG N-glycans. RESULTS Six IgG N-glycans were associated with CVD in both studies: an agalactosylated glycan (IgG-GP4) was positively associated, while 3 digalactosylated glycans (IgG glycan peaks 12, 13, 14) and 2 monosialylated glycans (IgG glycan peaks 18, 20) were negatively associated with CVD after multiple testing correction (overall false discovery rate <0.05). Four selected IgG N-glycans comprised the IgG glycan score, which was associated with CVD in JUPITER (adjusted hazard ratio per glycan score SD, 2.08 [95% CI, 1.52-2.84]) and validated in TNT (adjusted hazard ratio per SD, 1.20 [95% CI, 1.03-1.39]). The area under the curve changed from 0.693 for the model without the score to 0.728 with the score in JUPITER (PLRT=1.1×10-6) and from 0.635 to 0.637 in TNT (PLRT=0.017). CONCLUSIONS An IgG N-glycan profile was associated with incident CVD in 2 populations (primary and secondary prevention), involving an agalactosylated glycan associated with increased risk of CVD, while several digalactosylated and sialylated IgG glycans associated with decreased risk. An IgG glycan score was positively associated with future CVD.
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Affiliation(s)
- Rosangela A. Hoshi
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Branimir Plavša
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Yanyan Liu
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Robert J. Glynn
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul M Ridker
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard D. Cummings
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Gordan Lauc
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Olga V. Demler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Computer Science Department, ETH Zurich, Zurich, Switzerland
| | - Samia Mora
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Ahmad S, Moorthy MV, Lee IM, Ridker PM, Manson JE, Buring J, Demler OV, Mora S. The Mediterranean Diet, Cardiometabolic Biomarkers, and Risk of All-Cause Mortality: A 25-Year Follow-Up Study of the Women's Health Study. medRxiv 2023:2023.10.02.23296458. [PMID: 37873228 PMCID: PMC10593038 DOI: 10.1101/2023.10.02.23296458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Higher consumption of Mediterranean diet (MED) intake has been associated with reduced risk of all-cause mortality but limited data are available examining long-term outcomes in women or the underlying molecular mechanisms of this inverse association in human populations. We aimed to investigate the association of MED intake with long-term risk of all-cause mortality in women and to better characterize the relative contribution of traditional and novel cardiometabolic factors to the MED-related risk reduction in morality. Methods In a prospective cohort study of 25,315 initially healthy women from the Women's Health Study, we assessed dietary MED intake using a validated semiquantitative food frequency questionnaire according to the usual 9-category measure of MED adherence. Baseline levels of more than thirty cardiometabolic biomarkers were measured using standard assays and targeted nuclear magnetic resonance spectroscopy, including lipids, lipoproteins, apolipoproteins, inflammation, glucose metabolism and insulin resistance, branched-chain amino acids, small metabolites, and clinical factors. Mortality and cause of death was ascertained prospectively through medical and death records. Results During a mean follow-up of 25 years, 3,879 deaths were ascertained. Compared to the reference group of low MED intake (0-3, approximately the bottom tertile), and adjusting for age, treatment, and energy intake, risk reductions were observed for the middle and upper MED groups with respective HRs of 0.84 (95% CI 0.78-0.90) and 0.77 (95% CI 0.70-0.84), p for trend <0.0001. Further adjusting for smoking, physical activity, alcohol intake and menopausal factors attenuated the risk reductions which remained significant with respective HRs of 0.92 (95% CI 0.85-0.99) and 0.89 (95% CI 0.82-0.98), p for trend 0.0011. Risk reductions were generally similar for CVD and non-CVD mortality. Small molecule metabolites (e.g., alanine and homocysteine) and inflammation made the largest contributions to lower mortality risk (accounting for 14.8% and 13.0% of the benefit of the MED-mortality association, respectively), followed by triglyceride-rich lipoproteins (10.2%), adiposity (10.2%) and insulin resistance (7.4%), with lesser contributions (<3%) from other pathways including branched-chain amino acids, high-density lipoproteins, low-density lipoproteins, glycemic measures, and hypertension. Conclusions In the large-scale prospective Women's Health Study of 25,315 initially healthy US women followed for 25 years, higher MED intake was associated with approximately one fifth relative risk reduction in mortality. The inverse association was only partially explained by known novel and traditional cardiometabolic factors.
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Affiliation(s)
- Shafqat Ahmad
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Sweden
| | - M. Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julie Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olga V. Demler
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Sweden
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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McGrath JJ, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Bromet EJ, Bruffaerts R, de Almeida JMC, Chardoul S, Chiu WT, Degenhardt L, Demler OV, Ferry F, Gureje O, Haro JM, Karam EG, Karam G, Khaled SM, Kovess-Masfety V, Magno M, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Nishi D, Plana-Ripoll O, Posada-Villa J, Rapsey C, Sampson NA, Stagnaro JC, Stein DJ, Ten Have M, Torres Y, Vladescu C, Woodruff PW, Zarkov Z, Kessler RC. Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries. Lancet Psychiatry 2023; 10:668-681. [PMID: 37531964 PMCID: PMC10529120 DOI: 10.1016/s2215-0366(23)00193-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [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: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. METHODS In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. FINDINGS We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9-29·2) for male respondents and 29·8% (29·2-30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9-47·8) for male respondents and 53·1% (51·9-54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14-32) for male respondents and 20 years (12-36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. INTERPRETATION By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. FUNDING None.
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Affiliation(s)
- John J McGrath
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia; National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Ali Al-Hamzawi
- College of Medicine, University of Al-Qadisiya, Al Diwaniya, Iraq
| | - Jordi Alonso
- Health Services Research Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura H Andrade
- Section of Psychiatric Epidemiology, Institute of Psychiatry, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Leuven, Belgium
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olga V Demler
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Computer Science, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Finola Ferry
- School of Psychology, Ulster University, Belfast, UK
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Centre for Biomedical Research on Mental Health, Madrid, Spain; Departament de Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, University of Balamand, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, University of Balamand, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Salma M Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar
| | | | - Marta Magno
- Unit of Epidemiological and Evaluation Psychiatry, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Salud Mental, Servicio Murciano de Salud, Murcia, Spain; Murcia Biomedical Research Institute, Murcia, Spain; Centro de Investigación Biomédica en Red Epidemiology and Public Health-Murcia, Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dan J Stein
- Department of Psychiatry and Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, Instituto de Ciencias de la Salud, Medellín, Colombia
| | - Cristian Vladescu
- National Institute for Health Services Management, Bucharest, Romania
| | - Peter W Woodruff
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
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5
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Kessler RC, Bauer MS, Bishop TM, Bossarte RM, Castro VM, Demler OV, Gildea SM, Goulet JL, King AJ, Kennedy CJ, Landes SJ, Liu H, Luedtke A, Mair P, Marx BP, Nock MK, Petukhova MV, Pigeon WR, Sampson NA, Smoller JW, Miller A, Haas G, Benware J, Bradley J, Owen RR, House S, Urosevic S, Weinstock LM. Evaluation of a Model to Target High-risk Psychiatric Inpatients for an Intensive Postdischarge Suicide Prevention Intervention. JAMA Psychiatry 2023; 80:230-240. [PMID: 36652267 PMCID: PMC9857842 DOI: 10.1001/jamapsychiatry.2022.4634] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/09/2022] [Accepted: 11/09/2022] [Indexed: 01/19/2023]
Abstract
Importance The months after psychiatric hospital discharge are a time of high risk for suicide. Intensive postdischarge case management, although potentially effective in suicide prevention, is likely to be cost-effective only if targeted at high-risk patients. A previously developed machine learning (ML) model showed that postdischarge suicides can be predicted from electronic health records and geospatial data, but it is unknown if prediction could be improved by adding additional information. Objective To determine whether model prediction could be improved by adding information extracted from clinical notes and public records. Design, Setting, and Participants Models were trained to predict suicides in the 12 months after Veterans Health Administration (VHA) short-term (less than 365 days) psychiatric hospitalizations between the beginning of 2010 and September 1, 2012 (299 050 hospitalizations, with 916 hospitalizations followed within 12 months by suicides) and tested in the hospitalizations from September 2, 2012, to December 31, 2013 (149 738 hospitalizations, with 393 hospitalizations followed within 12 months by suicides). Validation focused on net benefit across a range of plausible decision thresholds. Predictor importance was assessed with Shapley additive explanations (SHAP) values. Data were analyzed from January to August 2022. Main Outcomes and Measures Suicides were defined by the National Death Index. Base model predictors included VHA electronic health records and patient residential data. The expanded predictors came from natural language processing (NLP) of clinical notes and a social determinants of health (SDOH) public records database. Results The model included 448 788 unique hospitalizations. Net benefit over risk horizons between 3 and 12 months was generally highest for the model that included both NLP and SDOH predictors (area under the receiver operating characteristic curve range, 0.747-0.780; area under the precision recall curve relative to the suicide rate range, 3.87-5.75). NLP and SDOH predictors also had the highest predictor class-level SHAP values (proportional SHAP = 64.0% and 49.3%, respectively), although the single highest positive variable-level SHAP value was for a count of medications classified by the US Food and Drug Administration as increasing suicide risk prescribed the year before hospitalization (proportional SHAP = 15.0%). Conclusions and Relevance In this study, clinical notes and public records were found to improve ML model prediction of suicide after psychiatric hospitalization. The model had positive net benefit over 3-month to 12-month risk horizons for plausible decision thresholds. Although caution is needed in inferring causality based on predictor importance, several key predictors have potential intervention implications that should be investigated in future studies.
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Affiliation(s)
- Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Mark S. Bauer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Todd M. Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Robert M. Bossarte
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa
| | - Victor M. Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts
| | - Olga V. Demler
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Joseph L. Goulet
- Pain, Research, Informatics, Multi-morbidities and Education Center, VA Connecticut Healthcare System, West Haven
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Andrew J. King
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Chris J. Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Sara J. Landes
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordan W. Smoller
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Gretchen Haas
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - John Bradley
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Richard R. Owen
- Central Arkansas Veterans Healthcare System, Little Rock
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Samuel House
- Central Arkansas Veterans Healthcare System, Little Rock
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Snezana Urosevic
- Minneapolis VA Healthcare System, Minneapolis, Minnesota
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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Hoshi RA, Liu Y, Luttmann-Gibson H, Tiwari S, Giulianini F, Andres AM, Watrous JD, Cook NR, Costenbader KH, Okereke OI, Ridker PM, Manson JE, Lee IM, Vinayagamoorthy M, Cheng S, Copeland T, Jain M, Chasman DI, Demler OV, Mora S. Association of Physical Activity With Bioactive Lipids and Cardiovascular Events. Circ Res 2022; 131:e84-e99. [PMID: 35862024 PMCID: PMC9357171 DOI: 10.1161/circresaha.122.320952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To clarify the mechanisms underlying physical activity (PA)-related cardioprotection, we examined the association of PA with plasma bioactive lipids (BALs) and cardiovascular disease (CVD) events. We additionally performed genome-wide associations. METHODS PA-bioactive lipid associations were examined in VITAL (VITamin D and OmegA-3 TriaL)-clinical translational science center (REGISTRATION: URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01169259; N=1032) and validated in JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin)-NC (NCT00239681; N=589), using linear models adjusted for age, sex, race, low-density lipoprotein-cholesterol, total-C, and smoking. Significant BALs were carried over to examine associations with incident CVD in 2 nested CVD case-control studies: VITAL-CVD (741 case-control pairs) and JUPITER-CVD (415 case-control pairs; validation). RESULTS We detected 145 PA-bioactive lipid validated associations (false discovery rate <0.1). Annotations were found for 6 of these BALs: 12,13-diHOME, 9,10-diHOME, lysoPC(15:0), oxymorphone-3b-D-glucuronide, cortisone, and oleoyl-glycerol. Genetic analysis within JUPITER-NC showed associations of 32 PA-related BALs with 22 single-nucleotide polymorphisms. From PA-related BALs, 12 are associated with CVD. CONCLUSIONS We identified a PA-related bioactive lipidome profile out of which 12 BALs also had opposite associations with incident CVD events.
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Affiliation(s)
- Rosangela A Hoshi
- Center for Lipid Metabolomics, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., P.M.R., O.V.D., S.M.).,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Yanyan Liu
- Center for Lipid Metabolomics, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., P.M.R., O.V.D., S.M.).,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Heike Luttmann-Gibson
- Center for Lipid Metabolomics, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., P.M.R., O.V.D., S.M.).,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.L.-G., O.I.O., J.E.M., I.-M.L., M.J.)
| | - Saumya Tiwari
- Department of Pharmacology, University of California San Diego, La Jolla (S.T., A.M.A., J.D.W.)
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Allen M Andres
- Department of Pharmacology, University of California San Diego, La Jolla (S.T., A.M.A., J.D.W.)
| | - Jeramie D Watrous
- Department of Pharmacology, University of California San Diego, La Jolla (S.T., A.M.A., J.D.W.)
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (K.H.C.)
| | - Olivia I Okereke
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.L.-G., O.I.O., J.E.M., I.-M.L., M.J.).,Department of Psychiatry, Massachusetts General Hospital, Boston (O.I.O.)
| | - Paul M Ridker
- Center for Lipid Metabolomics, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., P.M.R., O.V.D., S.M.).,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.L.-G., O.I.O., J.E.M., I.-M.L., M.J.)
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.L.-G., O.I.O., J.E.M., I.-M.L., M.J.)
| | - Manickavasagar Vinayagamoorthy
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (S.C.)
| | - Trisha Copeland
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Mohit Jain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.L.-G., O.I.O., J.E.M., I.-M.L., M.J.)
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
| | - Olga V Demler
- Center for Lipid Metabolomics, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., P.M.R., O.V.D., S.M.).,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.).,Department of Computer Science, ETH Zurich, Switzerland (O.V.D.)
| | - Samia Mora
- Center for Lipid Metabolomics, Division of Preventive Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., P.M.R., O.V.D., S.M.).,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (R.A.H., Y.L., H.L.-G., F.G., N.R.C., P.M.R., J.E.M., I.-M.L., M.V., T.C., D.I.C., O.V.D., S.M.)
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7
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Dugani SB, Moorthy MV, Li C, Demler OV, Alsheikh-Ali AA, Ridker PM, Glynn RJ, Mora S. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol 2021; 6:437-447. [PMID: 33471027 PMCID: PMC7818181 DOI: 10.1001/jamacardio.2020.7073] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Risk profiles for premature coronary heart disease (CHD) are unclear. Objective To examine baseline risk profiles for incident CHD in women by age at onset. Design, Setting, and Participants A prospective cohort of US female health professionals participating in the Women's Health Study was conducted; median follow-up was 21.4 years. Participants included 28 024 women aged 45 years or older without known cardiovascular disease. Baseline profiles were obtained from April 30, 1993, to January 24, 1996, and analyses were conducted from October 1, 2017, to October 1, 2020. Exposures More than 50 clinical, lipid, inflammatory, and metabolic risk factors and biomarkers. Main Outcomes and Measures Four age groups were examined (<55, 55 to <65, 65 to <75, and ≥75 years) for CHD onset, and adjusted hazard ratios (aHRs) were calculated using stratified Cox proportional hazard regression models with age as the time scale and adjusting for clinical factors. Women contributed to different age groups over time. Results Of the clinical factors in the women, diabetes had the highest aHR for CHD onset at any age, ranging from 10.71 (95% CI, 5.57-20.60) at CHD onset in those younger than 55 years to 3.47 (95% CI, 2.47-4.87) at CHD onset in those 75 years or older. Risks that were also noted for CHD onset in participants younger than 55 years included metabolic syndrome (aHR, 6.09; 95% CI, 3.60-10.29), hypertension (aHR, 4.58; 95% CI, 2.76-7.60), obesity (aHR, 4.33; 95% CI, 2.31-8.11), and smoking (aHR, 3.92; 95% CI, 2.32-6.63). Myocardial infarction in a parent before age 60 years was associated with 1.5- to 2-fold risk of CHD in participants up to age 75 years. From approximately 50 biomarkers, lipoprotein insulin resistance had the highest standardized aHR: 6.40 (95% CI, 3.14-13.06) for CHD onset in women younger than 55 years, attenuating with age. In comparison, weaker but significant associations with CHD in women younger than 55 years were noted (per SD increment) for low-density lipoprotein cholesterol (aHR, 1.38; 95% CI, 1.10-1.74), non-high-density lipoprotein cholesterol (aHR, 1.67; 95% CI, 1.36-2.04), apolipoprotein B (aHR, 1.89; 95% CI, 1.52-2.35), triglycerides (aHR, 2.14; 95% CI, 1.72-2.67), and inflammatory biomarkers (1.2- to 1.8-fold)-all attenuating with age. Some biomarkers had similar CHD age associations (eg, physical inactivity, lipoprotein[a], total high-density lipoprotein particles), while a few had no association with CHD onset at any age. Most risk factors and biomarkers had associations that attenuated with increasing age at onset. Conclusions and Relevance In this cohort study, diabetes and insulin resistance, in addition to hypertension, obesity, and smoking, appeared to be the strongest risk factors for premature onset of CHD. Most risk factors had attenuated relative rates at older ages.
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Affiliation(s)
- Sagar B Dugani
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chunying Li
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olga V Demler
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert J Glynn
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Ahmad S, Demler OV, Sun Q, Moorthy MV, Li C, Lee IM, Ridker PM, Manson JE, Hu FB, Fall T, Chasman DI, Cheng S, Pradhan A, Mora S. Association of the Mediterranean Diet With Onset of Diabetes in the Women's Health Study. JAMA Netw Open 2020; 3:e2025466. [PMID: 33211107 PMCID: PMC7677766 DOI: 10.1001/jamanetworkopen.2020.25466] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Higher Mediterranean diet (MED) intake has been associated with reduced risk of type 2 diabetes, but underlying biological mechanisms are unclear. OBJECTIVE To characterize the relative contribution of conventional and novel biomarkers in MED-associated type 2 diabetes risk reduction in a US population. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among 25 317 apparently healthy women. The participants with missing information regarding all traditional and novel metabolic biomarkers or those with baseline diabetes were excluded. Participants were invited for baseline assessment between September 1992 and May 1995. Data were collected from November 1992 to December 2017 and analyzed from December 2018 to December 2019. EXPOSURES MED intake score (range, 0 to 9) was computed from self-reported dietary intake, representing adherence to Mediterranean diet intake. MAIN OUTCOMES AND MEASURES Incident cases of type 2 diabetes, identified through annual questionnaires; reported cases were confirmed by either telephone interview or supplemental questionnaire. Proportion of reduced risk of type 2 diabetes explained by clinical risk factors and a panel of 40 biomarkers that represent different physiological pathways was estimated. RESULTS The mean (SD) age of the 25 317 female participants was 52.9 (9.9) years, and they were followed up for a mean (SD) of 19.8 (5.8) years. Higher baseline MED intake (score ≥6 vs ≤3) was associated with as much as a 30% lower type 2 diabetes risk (age-adjusted and energy-adjusted hazard ratio, 0.70; 95% CI, 0.62-0.79; when regression models were additionally adjusted with body mass index [BMI]: hazard ratio, 0.85; 95% CI, 0.76-0.96). Biomarkers of insulin resistance made the largest contribution to lower risk (accounting for 65.5% of the MED-type 2 diabetes association), followed by BMI (55.5%), high-density lipoprotein measures (53.0%), and inflammation (52.5%), with lesser contributions from branched-chain amino acids (34.5%), very low-density lipoprotein measures (32.0%), low-density lipoprotein measures (31.0%), blood pressure (29.0%), and apolipoproteins (23.5%), and minimal contribution (≤2%) from hemoglobin A1c. In post hoc subgroup analyses, the inverse association of MED diet with type 2 diabetes was seen only among women who had BMI of at least 25 at baseline but not those who had BMI of less than 25 (eg, women with BMI <25, age- and energy-adjusted HR for MED score ≥6 vs ≤3, 1.01; 95% CI, 0.77-1.33; P for trend = .92; women with BMI ≥25: HR, 0.76; 95% CI, 0.67-0.87; P for trend < .001). CONCLUSIONS AND RELEVANCE In this cohort study, higher MED intake scores were associated with a 30% relative risk reduction in type 2 diabetes during a 20-year period, which could be explained in large part by biomarkers of insulin resistance, BMI, lipoprotein metabolism, and inflammation.
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Affiliation(s)
- Shafqat Ahmad
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Olga V. Demler
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - M. Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chunying Li
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul M. Ridker
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Cheng
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Framingham Heart Study, Framingham, Massachusetts
| | - Aruna Pradhan
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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9
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Demler OV, Liu Y, Luttmann-Gibson H, Watrous JD, Lagerborg KA, Dashti H, Giulianini F, Heath M, Camargo CA, Harris WS, Wohlgemuth JG, Andres AM, Tivari S, Long T, Najhawan M, Dao K, Prentice JG, Larsen JA, Okereke OI, Costenbader KH, Buring JE, Manson JE, Cheng S, Jain M, Mora S. One-Year Effects of Omega-3 Treatment on Fatty Acids, Oxylipins, and Related Bioactive Lipids and Their Associations with Clinical Lipid and Inflammatory Biomarkers: Findings from a Substudy of the Vitamin D and Omega-3 Trial (VITAL). Metabolites 2020; 10:metabo10110431. [PMID: 33120862 PMCID: PMC7693376 DOI: 10.3390/metabo10110431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Omega-3 (n-3) treatment may lower cardiovascular risk, yet its effects on the circulating lipidome and relation to cardiovascular risk biomarkers are unclear. We hypothesized that n-3 treatment is associated with favorable changes in downstream fatty acids (FAs), oxylipins, bioactive lipids, clinical lipid and inflammatory biomarkers. We examined these VITAL200, a nested substudy of 200 subjects balanced on demographics and treatment and randomly selected from the Vitamin D and Omega-3 Trial (VITAL). VITAL is a randomized double-blind trial of 840 mg/d eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) vs. placebo among 25,871 individuals. Small polar bioactive lipid features, oxylipins and FAs from plasma and red blood cells were measured using three independent assaying techniques at baseline and one year. The Women's Health Study (WHS) was used for replication with dietary n-3 intake. Randomized n-3 treatment led to changes in 143 FAs, oxylipins and bioactive lipids (False Discovery Rate (FDR) < 0.05 in VITAL200, validated (p-values < 0.05)) in WHS with increases in 95 including EPA, DHA, n-3 docosapentaenoic acid (DPA-n3), and decreases in 48 including DPA-n6, dihomo gamma linolenic (DGLA), adrenic and arachidonic acids. N-3 related changes in the bioactive lipidome were heterogeneously associated with changes in clinical lipid and inflammatory biomarkers. N-3 treatment significantly modulates the bioactive lipidome, which may contribute to its clinical benefits.
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Affiliation(s)
- Olga V. Demler
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Correspondence:
| | - Yanyan Liu
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
| | - Heike Luttmann-Gibson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
| | - Jeramie D. Watrous
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Kim A. Lagerborg
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Hesam Dashti
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
| | - Mallory Heath
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Jay G. Wohlgemuth
- Quest Diagnostics, San Juan Capistrano, CA 92673, USA; (J.G.W.); (J.G.P.); (J.A.L.)
| | - Allen M. Andres
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Saumya Tivari
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Tao Long
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Mahan Najhawan
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Khoi Dao
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - James G. Prentice
- Quest Diagnostics, San Juan Capistrano, CA 92673, USA; (J.G.W.); (J.G.P.); (J.A.L.)
| | - Julia A. Larsen
- Quest Diagnostics, San Juan Capistrano, CA 92673, USA; (J.G.W.); (J.G.P.); (J.A.L.)
| | - Olivia I. Okereke
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Karen H. Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (C.A.C.J.); (O.I.O.)
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Ctr, Los Angeles, CA 90048, USA;
| | - Mohit Jain
- Department of Pharmacology, University of California San Diego, La Jolla, CA 92037, USA; (J.D.W.); (K.A.L.); (A.M.A.); (S.T.); (T.L.); (M.N.); (K.D.); (M.J.)
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (Y.L.); (H.L.-G.); (H.D.); (F.G.); (J.E.B.); (J.E.M.); (S.M.)
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
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10
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Ajala ON, Demler OV, Liu Y, Farukhi Z, Adelman SJ, Collins HL, Ridker PM, Rader DJ, Glynn RJ, Mora S. Anti-Inflammatory HDL Function, Incident Cardiovascular Events, and Mortality: A Secondary Analysis of the JUPITER Randomized Clinical Trial. J Am Heart Assoc 2020; 9:e016507. [PMID: 32799709 PMCID: PMC7660788 DOI: 10.1161/jaha.119.016507] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background High‐density lipoprotein (HDL) cholesterol has inverse association with cardiovascular disease. HDL possesses anti‐inflammatory properties in vitro, but it is unknown whether this may be protective in individuals with inflammation. Methods and Results The functional capacity of HDL to inhibit oxidation of oxidized low‐density lipoprotein (ie, the HDL inflammatory index; HII) was measured at baseline and 12 months after random allocation to rosuvastatin or placebo in a nested case‐control study of the JUPITER (Justification for the Use of Statins in Prevention: An Intervention Evaluating Rosuvastatin) trial. There were 517 incident cases of cardiovascular disease and all‐cause mortality compared to 517 age‐ and sex‐matched controls. Multivariable conditional logistic regression was used to examine associations of HII with events. Median baseline HII was 0.54 (interquartile range, 0.50–0.59). Twelve months of rosuvastatin decreased HII by a mean of 5.3% (95% CI, −8.9% to −1.7%; P=0.005) versus 1.3% (95% CI, −6.5% to 4.0%; P=0.63) with placebo (P=0.22 for between‐group difference). HII had a nonlinear relationship with incident events. Compared with the reference group (HII 0.5–1.0) with the lowest event rates, participants with baseline HII ≤0.5 had significantly increased risk of cardiovascular disease/mortality (adjusted hazard ratio, 1.53; 95% CI, 1.06–2.21; P=0.02). Furthermore, there was significant (P=0.002) interaction for HDL particle number with HII, such that having more HDL particles was associated with decreased risk only when HDL was anti‐inflammatory. Conclusions In JUPITER participants recruited on the basis of chronic inflammation, HII was associated with incident cardiovascular disease/mortality, with an optimal anti‐inflammatory HII range between 0.5 and 1.0. This nonlinear relationship of anti‐inflammatory HDL function with risk may account in part for the HDL paradox. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00239681.
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Affiliation(s)
- Oluremi N Ajala
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Olga V Demler
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Yanyan Liu
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA
| | - Zareen Farukhi
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | | | | | - Paul M Ridker
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA.,Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA
| | - Daniel J Rader
- Department of Genetics University of Pennsylvania Philadelphia PA
| | - Robert J Glynn
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Samia Mora
- Center for Lipid Metabolomics and Division of Preventive Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA.,Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA
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11
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Dashti H, Westler WM, Wedell JR, Demler OV, Eghbalnia HR, Markley JL, Mora S. Probabilistic identification of saccharide moieties in biomolecules and their protein complexes. Sci Data 2020; 7:210. [PMID: 32620933 PMCID: PMC7335193 DOI: 10.1038/s41597-020-0547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The chemical composition of saccharide complexes underlies their biomedical activities as biomarkers for cardiometabolic disease, various types of cancer, and other conditions. However, because these molecules may undergo major structural modifications, distinguishing between compounds of saccharide and non-saccharide origin becomes a challenging computational problem that hinders the aggregation of information about their bioactive moieties. We have developed an algorithm and software package called "Cheminformatics Tool for Probabilistic Identification of Carbohydrates" (CTPIC) that analyzes the covalent structure of a compound to yield a probabilistic measure for distinguishing saccharides and saccharide-derivatives from non-saccharides. CTPIC analysis of the RCSB Ligand Expo (database of small molecules found to bind proteins in the Protein Data Bank) led to a substantial increase in the number of ligands characterized as saccharides. CTPIC analysis of Protein Data Bank identified 7.7% of the proteins as saccharide-binding. CTPIC is freely available as a webservice at (http://ctpic.nmrfam.wisc.edu).
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Affiliation(s)
- Hesam Dashti
- Center for Lipid Metabolomics, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, 02215, Massachusetts, USA
- Department of Biochemistry, National Magnetic Resonance Facility at Madison and BioMagResBank, University of Wisconsin Madison, Madison, 53706, Wisconsin, USA
| | - William M Westler
- Department of Biochemistry, National Magnetic Resonance Facility at Madison and BioMagResBank, University of Wisconsin Madison, Madison, 53706, Wisconsin, USA
| | - Jonathan R Wedell
- Department of Biochemistry, National Magnetic Resonance Facility at Madison and BioMagResBank, University of Wisconsin Madison, Madison, 53706, Wisconsin, USA
| | - Olga V Demler
- Center for Lipid Metabolomics, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, 02215, Massachusetts, USA
| | - Hamid R Eghbalnia
- Department of Biochemistry, National Magnetic Resonance Facility at Madison and BioMagResBank, University of Wisconsin Madison, Madison, 53706, Wisconsin, USA
| | - John L Markley
- Department of Biochemistry, National Magnetic Resonance Facility at Madison and BioMagResBank, University of Wisconsin Madison, Madison, 53706, Wisconsin, USA.
| | - Samia Mora
- Center for Lipid Metabolomics, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, 02215, Massachusetts, USA.
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, 02215, Massachusetts, USA.
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12
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Chasman DI, Giulianini F, Demler OV, Udler MS. Pleiotropy-Based Decomposition of Genetic Risk Scores: Association and Interaction Analysis for Type 2 Diabetes and CAD. Am J Hum Genet 2020; 106:646-658. [PMID: 32302534 DOI: 10.1016/j.ajhg.2020.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/25/2020] [Indexed: 12/24/2022] Open
Abstract
Genetic risk for a disease in the population may be represented as a genetic risk score (GRS) constructed as the sum of inherited risk alleles, weighted by allelic effects established in an independent population. While this formulation captures overall genetic risk, it typically does not address risk due to specific biological mechanisms or pathways that may nevertheless be important for interpretation or treatment response. Here, a GRS for disease is resolved into independent or nearly independent components pertaining to biological mechanisms inferred from pleiotropic relationships. The component GRSs' weights are derived from the singular value decomposition (SVD) of the matrix of appropriately scaled genetic effects, i.e., beta coefficients, of the disease variants across a panel of the disease-related phenotypes. The SVD-based formalism also associates combinations of disease-related phenotypes with inferred disease pathways. Applied to incident type 2 diabetes (T2D) in the Women's Genome Health Study (N = 23,294), component GRSs discriminate glycemic control and lipid-based genetic risk, while revealing significant interactions between specific components and BMI or physical activity, the latter not observed with a GRS for overall T2D genetic liability. Applied to coronary artery disease (CAD) in both the WGHS and in JUPITER (N = 8,749), a randomized trial of rosuvastatin for primary prevention of CVD, component GRSs discriminate genetic risk associated with LDL-C from risk associated with reciprocal genetic effects on triglycerides and HDL-C. They also inform the pharmacogenetics of statin treatment by demonstrating that benefit from rosuvastatin is as strongly related to genetic risk from triglycerides and HDL-C as from LDL-C.
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Affiliation(s)
- Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA; Division of Genetics, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA; Medical and Population Genetics Program, Broad Institute, Cambridge, MA 02142, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Miriam S Udler
- Harvard Medical School, Boston, MA 02115, USA; Medical and Population Genetics Program, Broad Institute, Cambridge, MA 02142, USA; Massachusetts General Hospital, Boston, MA 02114, USA
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13
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Farukhi ZM, Demler OV, Caulfield MP, Kulkarni K, Wohlgemuth J, Cobble M, Luttmann-Gibson H, Li C, Nelson JR, Cook NR, Buring JE, Krauss RM, Manson JE, Mora S. Comparison of nonfasting and fasting lipoprotein subfractions and size in 15,397 apparently healthy individuals: An analysis from the VITamin D and OmegA-3 TriaL. J Clin Lipidol 2020; 14:241-251. [PMID: 32205068 DOI: 10.1016/j.jacl.2020.02.005] [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] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elevated postprandial triglycerides reflect a proatherogenic milieu, but underlying mechanisms are unclear. OBJECTIVE We examined differences between fasting and nonfasting profiles of directly measured lipoprotein size and subfractions to assess if postprandial triglycerides reflected increases in very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL) and remnants, or small dense lipid depleted LDL (sdLDL) particles. METHODS We conducted a cross-sectional analysis of 15,397 participants (10,135 fasting; 5262 nonfasting [<8 hours since last meal]) from the VITamin D and OmegA-3 TriaL. Baseline cholesterol subfractions were measured by the vertical auto profile method and particle subfractions by ion mobility. We performed multivariable linear regression adjusting for cardiovascular and lipoprotein-modifying risk factors. RESULTS Mean age (SD) was 68.0 years (±7.0), with 50.9% women. Adjusted mean triglyceride concentrations were higher nonfasting by 17.8 ± 1.3%, with higher nonfasting levels of directly measured VLDL cholesterol (by 3.5 ± 0.6%) and total VLDL particles (by 2.0 ± 0.7%), specifically large VLDL (by 12.3 ± 1.3%) and medium VLDL particles (by 5.3 ± 0.8%), all P < .001. By contrast, lower concentrations of low density lipoprotein (LDL) and IDL cholesterol and particles were noted for nonfasting participants. sdLDL cholesterol levels and particle concentrations showed no statistically significant difference by fasting status (-1.3 ± 2.1% and 0.07 ± 0.6%, respectively, P > .05). CONCLUSIONS Directly measured particle and cholesterol concentrations of VLDL, not sdLDL, were higher nonfasting and may partly contribute to the proatherogenicity of postprandial hypertriglyceridemia. These differences, although statistically significant, were small and may not fully explain the increased risk of postprandial hypertriglyceridemia.
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Affiliation(s)
- Zareen M Farukhi
- Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Olga V Demler
- Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Heike Luttmann-Gibson
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chunying Li
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John R Nelson
- California Cardiovascular Institute, Fresno, CA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Samia Mora
- Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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14
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Kessler RC, Bauer MS, Bishop TM, Demler OV, Dobscha SK, Gildea SM, Goulet JL, Karras E, Kreyenbuhl J, Landes SJ, Liu H, Luedtke AR, Mair P, McAuliffe WHB, Nock M, Petukhova M, Pigeon WR, Sampson NA, Smoller JW, Weinstock LM, Bossarte RM. Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System. Front Psychiatry 2020; 11:390. [PMID: 32435212 PMCID: PMC7219514 DOI: 10.3389/fpsyt.2020.00390] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is a very high suicide rate in the year after psychiatric hospital discharge. Intensive postdischarge case management programs can address this problem but are not cost-effective for all patients. This issue can be addressed by developing a risk model to predict which inpatients might need such a program. We developed such a model for the 391,018 short-term psychiatric hospital admissions of US veterans in Veterans Health Administration (VHA) hospitals 2010-2013. Records were linked with the National Death Index to determine suicide within 12 months of hospital discharge (n=771). The Super Learner ensemble machine learning method was used to predict these suicides for time horizon between 1 week and 12 months after discharge in a 70% training sample. Accuracy was validated in the remaining 30% holdout sample. Predictors included VHA administrative variables and small area geocode data linked to patient home addresses. The models had AUC=.79-.82 for time horizons between 1 week and 6 months and AUC=.74 for 12 months. An analysis of operating characteristics showed that 22.4%-32.2% of patients who died by suicide would have been reached if intensive case management was provided to the 5% of patients with highest predicted suicide risk. Positive predictive value (PPV) at this higher threshold ranged from 1.2% over 12 months to 3.8% per case manager year over 1 week. Focusing on the low end of the risk spectrum, the 40% of patients classified as having lowest risk account for 0%-9.7% of suicides across time horizons. Variable importance analysis shows that 51.1% of model performance is due to psychopathological risk factors accounted, 26.2% to social determinants of health, 14.8% to prior history of suicidal behaviors, and 6.6% to physical disorders. The paper closes with a discussion of next steps in refining the model and prospects for developing a parallel precision treatment model.
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Affiliation(s)
- Ronald C Kessler
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Mark S Bauer
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, United States
| | - Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven K Dobscha
- VA Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Sarah M Gildea
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Joseph L Goulet
- Pain, Research, Informatics, Multimorbidities & Education Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, United States.,Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sara J Landes
- South Central Mental Illness Research Education Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Howard Liu
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States.,Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Alex R Luedtke
- Department of Statistics, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | | | - Matthew Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Maria Petukhova
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Nancy A Sampson
- Deparment of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Lauren M Weinstock
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States.,West Virginia University Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, United States
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15
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Luttmann-Gibson H, Mora S, Camargo CA, Cook NR, Demler OV, Ghoshal A, Wohlgemuth J, Kulkarni K, Larsen J, Prentice J, Cobble M, Bubes V, Li C, Friedenberg G, Lee IM, Buring JE, Manson JE. Serum 25-hydroxyvitamin D in the VITamin D and OmegA-3 TriaL (VITAL): Clinical and demographic characteristics associated with baseline and change with randomized vitamin D treatment. Contemp Clin Trials 2019; 87:105854. [PMID: 31669447 PMCID: PMC6875603 DOI: 10.1016/j.cct.2019.105854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The VITamin D and OmegA-3 TriaL (VITAL) is a completed randomized, placebo-controlled trial of vitamin D3 (2000 IU/day) and marine omega-3 (1 g/day) supplements in the primary prevention of cancer and cardiovascular disease. Here we examine baseline and change in 25-hydroxyvitamin D (25(OH)D) and related biomarkers with randomized treatment and by clinical factors. METHODS Baseline 25(OH)D was measured in 15,804 participants (mean age 68 years.; 50.8% women; 15.7% African Americans) and in 1660 1-year follow-up samples using liquid chromatography-tandem mass spectrometry and chemiluminescence. Calcium and parathyroid hormone (iPTH) were measured by chemiluminescence and spectrophotometry respectively. RESULTS Mean baseline total 25(OH)D (ng/mL ± SD) was 30.8 ± 10.0 ng/mL, and correlated inversely with iPTH (r = -0.28), p < .001. After adjusting for clinical factors, 25(OH)D (ng/mL ± SE) was lower in men vs women (29.7 ± 0.30 vs 31.4 ± 0.30, p < .0001) and in African Americans vs whites (27.9 ± 0.29 vs 32.5 ± 0.22, p < .0001). It was also lower with increasing BMI, smoking, and latitude, and varied by season. Mean 1-year 25(OH)D increased by 11.9 ng/mL in the active group and decreased by 0.7 ng/mL in placebo. The largest increases were noted among individuals with low baseline and African Americans. Results were similar for chemiluminescent immunoassay. Mean calcium was unchanged, and iPTH decreased with treatment. CONCLUSION In VITAL, baseline 25(OH)D varied by clinical subgroups, was lower in men and African Americans. Concentrations increased with vitamin D supplementation, with the greatest increases in those with lower baseline 25(OH)D. The seasonal trends in 25(OH)D, iPTH, and calcium may be relevant when interpreting 25(OH)D levels for clinical treatment decisions. CLINICAL TRIAL REGISTRATION VITAL ClinicalTrials.gov number NCT01169259.
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Affiliation(s)
- Heike Luttmann-Gibson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Landmark Center West, 401 Park Drive, Boston, MA 02215, USA
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Division of Cardiovascular Medicine and Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Amit Ghoshal
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - Jay Wohlgemuth
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - Kris Kulkarni
- Atherotech Diagnostics, 201 London Pkwy #400, Birmingham, AL 35211, USA; VAP Diagnostics R&D Laboratory, 201 London Pkwy, Birmingham, AL 3521, USA
| | - Julia Larsen
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - James Prentice
- Quest Diagnostics, 27027 Tourney Road, Valencia, CA 91355, USA
| | - Michael Cobble
- Atherotech Diagnostics, 201 London Pkwy #400, Birmingham, AL 35211, USA
| | - Vadim Bubes
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Chunying Li
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02215, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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16
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Antonelli J, Claggett BL, Henglin M, Kim A, Ovsak G, Kim N, Deng K, Rao K, Tyagi O, Watrous JD, Lagerborg KA, Hushcha PV, Demler OV, Mora S, Niiranen TJ, Pereira AC, Jain M, Cheng S. Statistical Workflow for Feature Selection in Human Metabolomics Data. Metabolites 2019; 9:metabo9070143. [PMID: 31336989 PMCID: PMC6680705 DOI: 10.3390/metabo9070143] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 04/30/2019] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 01/02/2023] Open
Abstract
High-throughput metabolomics investigations, when conducted in large human cohorts, represent a potentially powerful tool for elucidating the biochemical diversity underlying human health and disease. Large-scale metabolomics data sources, generated using either targeted or nontargeted platforms, are becoming more common. Appropriate statistical analysis of these complex high-dimensional data will be critical for extracting meaningful results from such large-scale human metabolomics studies. Therefore, we consider the statistical analytical approaches that have been employed in prior human metabolomics studies. Based on the lessons learned and collective experience to date in the field, we offer a step-by-step framework for pursuing statistical analyses of cohort-based human metabolomics data, with a focus on feature selection. We discuss the range of options and approaches that may be employed at each stage of data management, analysis, and interpretation and offer guidance on the analytical decisions that need to be considered over the course of implementing a data analysis workflow. Certain pervasive analytical challenges facing the field warrant ongoing focused research. Addressing these challenges, particularly those related to analyzing human metabolomics data, will allow for more standardization of as well as advances in how research in the field is practiced. In turn, such major analytical advances will lead to substantial improvements in the overall contributions of human metabolomics investigations.
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Affiliation(s)
- Joseph Antonelli
- Department of Statistics, University of Florida, Gainesville, FL 32611, USA
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mir Henglin
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Andy Kim
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Gavin Ovsak
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicole Kim
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine Deng
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kevin Rao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Octavia Tyagi
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jeramie D Watrous
- Departments of Medicine & Pharmacology, University of California San Diego, La Jolla, CA 92093, USA
| | - Kim A Lagerborg
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Pavel V Hushcha
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Olga V Demler
- Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Samia Mora
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Teemu J Niiranen
- National Institute for Health and Welfare, FI 00271 Helsinki, Finland
- Department of Medicine, Turku University Hospital and Univesity of Turku, FI 20521 Turrku, Finland
| | | | - Mohit Jain
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
| | - Susan Cheng
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
- Framingham Heart Study, Framingham, MA 01701, USA.
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Enserro DM, Demler OV, Pencina MJ, D'Agostino RB. Measures for evaluation of prognostic improvement under multivariate normality for nested and nonnested models. Stat Med 2019; 38:3817-3831. [PMID: 31211443 DOI: 10.1002/sim.8204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/21/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 12/22/2022]
Abstract
When comparing performances of two risk prediction models, several metrics exist to quantify prognostic improvement, including the change in the area under the Receiver Operating Characteristic curve, the Integrated Discrimination Improvement, the Net Reclassification Index at event rate, the change in Standardized Net Benefit, the change in Brier score, and the change in scaled Brier score. We explore the behavior and interrelationships between these metrics under multivariate normality in nested and nonnested model comparisons. We demonstrate that, within the framework of linear discriminant analysis, all six statistics are functions of squared Mahalanobis distance, a robust metric that properly measures discrimination by quantifying the separation between the risk scores of events and nonevents. These relationships are important for overall interpretability and clinical usefulness. Through simulation, we demonstrate that the performance of the theoretical estimators under normality is comparable or superior to empirical estimation methods typically used by investigators. In particular, the theoretical estimators for the Net Reclassification Index and the change in Standardized Net Benefit exhibit less variability in their estimates as compared to their empirically estimated counterparts. Finally, we explore how these metrics behave with potentially nonnormal data by applying these methods in a practical example based on the sex-specific cardiovascular disease risk models from the Framingham Heart Study. Our findings aim to give greater insight into the behavior of these measures and the connections existing among them and to provide additional estimation methods with less variability for the Net Reclassification Index and the change in Standardized Net Benefit.
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Affiliation(s)
- Danielle M Enserro
- NRG Oncology; Clinical Trials Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Michael J Pencina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Ralph B D'Agostino
- Department of Mathematics & Statistics, Boston University, Boston, Massachusetts
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18
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Tobias DK, Lawler PR, Harada PH, Demler OV, Ridker PM, Manson JE, Cheng S, Mora S. Circulating Branched-Chain Amino Acids and Incident Cardiovascular Disease in a Prospective Cohort of US Women. Circ Genom Precis Med 2019; 11:e002157. [PMID: 29572205 DOI: 10.1161/circgen.118.002157] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Circulating branched-chain amino acids (BCAAs; isoleucine, leucine, and valine) are strong predictors of type 2 diabetes mellitus (T2D), but their association with cardiovascular disease (CVD) is uncertain. We hypothesized that plasma BCAAs are positively associated with CVD risk and evaluated whether this was dependent on an intermediate diagnosis of T2D. METHODS Participants in the Women's Health Study prospective cohort were eligible if free of CVD at baseline blood collection (n=27 041). Plasma metabolites were measured via nuclear magnetic resonance spectroscopy. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for BCAAs with incident CVD (myocardial infarction, stroke, and coronary revascularization). RESULTS We confirmed 2207 CVD events over a mean 18.6 years of follow-up. Adjusting for age, body mass index, and other established CVD risk factors, total BCAAs were positively associated with CVD (per SD: HR, 1.13; 95% CI, 1.08-1.18), comparable to LDL-C (low-density lipoprotein cholesterol) with CVD (per SD: HR, 1.12; 95% CI, 1.07-1.17). BCAAs were associated with coronary events (myocardial infarction: HR, 1.16; 95% CI, 1.06-1.26; revascularization: HR, 1.17; 95% CI, 1.11-1.25), and borderline significant association with stroke (HR, 1.07; 95% CI, 0.99-1.15). The BCAA-CVD association was greater (P interaction=0.036) among women who developed T2D before CVD (HR, 1.20; 95% CI, 1.08-1.32) versus women without T2D (HR, 1.08; 95% CI, 1.03-1.14). Adjusting for LDL-C, an established CVD risk factor, did not attenuate these findings; however, adjusting for HbA1c and insulin resistance eliminated the associations of BCAAs with CVD. CONCLUSIONS Circulating plasma BCAAs were positively associated with incident CVD in women. Impaired BCAA metabolism may capture the long-term risk of the common cause underlying T2D and CVD.
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Affiliation(s)
- Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Patrick R Lawler
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Paulo H Harada
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Olga V Demler
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Paul M Ridker
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Susan Cheng
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
| | - Samia Mora
- Division of Preventive Medicine, Department of Medicine (D.K.T., P.H.H., O.V.D., P.M.R., J.E.M., S.C., S.M.), Center for Lipid Metabolomics (P.H.H., O.V.D., S.M.), Division of Cardiovascular Medicine (P.M.R., S.C., S.M.), Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (J.E.M.); Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, ON, Canada (P.R.L.); Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Brazil (P.H.H.); and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.E.M.)
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19
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Ahmad S, Moorthy MV, Demler OV, Hu FB, Ridker PM, Chasman DI, Mora S. Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet. JAMA Netw Open 2018; 1:e185708. [PMID: 30646282 PMCID: PMC6324327 DOI: 10.1001/jamanetworkopen.2018.5708] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Higher Mediterranean diet (MED) intake has been associated with lower risk of cardiovascular disease (CVD), but limited data are available about the underlying molecular mechanisms of this inverse disease association in human populations. OBJECTIVE To better characterize the relative contribution of traditional and novel factors to the MED-related risk reduction in CVD events in a US population. DESIGN, SETTING, AND PARTICIPANTS Using a prospective cohort design, baseline MED intake was assessed in 25 994 initially healthy US women in the Women's Health Study who were followed up to 12 years. Potential mediating effects of a panel of 40 biomarkers were evaluated, including lipids, lipoproteins, apolipoproteins, inflammation, glucose metabolism and insulin resistance, branched-chain amino acids, small-molecule metabolites, and clinical factors. Baseline study information and samples were collected between April 30, 1993, and January 24, 1996. Analyses were conducted between August 1, 2017, and October 30, 2018. EXPOSURES Intake of MED is a 9-category measure of adherence to a Mediterranean dietary pattern. Participants were categorized into 3 levels based on their adherence to the MED. MAIN OUTCOMES AND MEASURES Incident CVD confirmed through medical records and the proportion of CVD risk reduction explained by mediators. RESULTS Among 25 994 women (mean [SD] age, 54.7 [7.1] years), those with low, middle, and upper MED intakes composed 39.0%, 36.2%, and 24.8% of the study population and experienced 428 (4.2%), 356 (3.8%), and 246 (3.8%) incident CVD events, respectively. Compared with the reference group who had low MED intake, CVD risk reductions were observed for the middle and upper groups, with respective HRs of 0.77 (95% CI, 0.67-0.90) and 0.72 (95% CI, 0.61-0.86) (P for trend < .001). The largest mediators of the CVD risk reduction of MED intake were biomarkers of inflammation (accounting for 29.2% of the MED-CVD association), glucose metabolism and insulin resistance (27.9%), and body mass index (27.3%), followed by blood pressure (26.6%), traditional lipids (26.0%), high-density lipoprotein measures (24.0%) or very low-density lipoprotein measures (20.8%), with lesser contributions from low-density lipoproteins (13.0%), branched-chain amino acids (13.6%), apolipoproteins (6.5%), or other small-molecule metabolites (5.8%). CONCLUSIONS AND RELEVANCE In this study, higher MED intake was associated with approximately one-fourth relative risk reduction in CVD events, which could be explained in part by known risk factors, both traditional and novel.
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Affiliation(s)
- Shafqat Ahmad
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
- Preventive Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M. Vinayaga Moorthy
- Preventive Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olga V. Demler
- Preventive Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul M Ridker
- Preventive Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel I. Chasman
- Preventive Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samia Mora
- Preventive Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Lipid Metabolomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Abstract
Three papers in this issue focus on the role of calibration in model fit statistics, including the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). This commentary reviews the development of such reclassification statistics along with more recent advances in our understanding of these measures. We show how the two-category NRI and the IDI are affected by changes in the event rate in theory and in an applied example. We also describe the role of calibration and how it may be assessed. Finally, we discuss the relevance of the event rate NRI for clinical use. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nancy R Cook
- Harvard Medical School, Brigham & Women's Hospital, Boston, MA, 02215, U.S.A
| | - Olga V Demler
- Harvard Medical School, Brigham & Women's Hospital, Boston, MA, 02215, U.S.A
| | - Nina P Paynter
- Harvard Medical School, Brigham & Women's Hospital, Boston, MA, 02215, U.S.A
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21
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Abstract
BACKGROUND The risk reclassification table assesses clinical performance of a biomarker in terms of movements across relevant risk categories. The Reclassification-Calibration (RC) statistic has been developed for binary outcomes, but its performance for survival data with moderate to high censoring rates has not been evaluated. METHODS We develop an RC statistic for survival data with higher censoring rates using the Greenwood-Nam-D'Agostino approach (RC-GND). We examine its performance characteristics and compare its performance and utility to the Hosmer-Lemeshow goodness-of-fit test under various assumptions about the censoring rate and the shape of the baseline hazard. RESULTS The RC-GND test was robust to high (up to 50%) censoring rates and did not exceed the targeted 5% Type I error in a variety of simulated scenarios. It achieved 80% power to detect better calibration with respect to clinical categories when an important predictor with a hazard ratio of at least 1.7 to 2.2 was added to the model, while the Hosmer-Lemeshow goodness of fit (gof) test had power of 5% in this scenario. CONCLUSIONS The RC-GND test should be used to test the improvement in calibration with respect to clinically-relevant risk strata. When an important predictor is omitted, the Hosmer-Lemeshow goodness-of-fit test is usually not significant, while the RC-GND test is sensitive to such an omission.
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Affiliation(s)
- Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave, Brookline MA 02115, (617) 278-0861,
| | - Nina P Paynter
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave, Brookline MA 02115, (617) 278-0798,
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave, Brookline MA 02115, (617) 278-0796
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22
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Harada PHN, Demler OV, Dugani SB, Akinkuolie AO, Moorthy MV, Ridker PM, Cook NR, Pradhan AD, Mora S. Lipoprotein insulin resistance score and risk of incident diabetes during extended follow-up of 20 years: The Women's Health Study. J Clin Lipidol 2017; 11:1257-1267.e2. [PMID: 28733174 DOI: 10.1016/j.jacl.2017.06.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/24/2017] [Accepted: 06/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Type II diabetes (T2D) is preceded by prolonged insulin resistance and relative insulin deficiency incompletely captured by glucose metabolism parameters, high-density lipoprotein (HDL) cholesterol and triglycerides. OBJECTIVE Whether lipoprotein insulin resistance (LPIR) score, a metabolomic marker, is associated with incident diabetes and improves risk reclassification over traditional markers on extended follow-up. METHODS Among 25,925 nondiabetic women aged 45 years or older, LPIR was measured by nuclear magnetic resonance spectroscopy as a weighted score of very low density lipoprotein, low-density lipoprotein, and HDL particle sizes, and their subsets concentrations. We run adjusted cox regression models for LPIR with incident T2D (20.4 years median follow-up). RESULTS Adjusting for demographics, body mass index, life style factors, blood pressure, and T2D family history, the LPIR hazard ratio for T2D (hazard ratio [HR] per standard deviation, 95% confidence interval) was 1.95 (1.85, 2.06). Further adjusting for HbA1c, C-reactive protein, triglycerides, HDL and low-density lipoprotein cholesterol, LPIR HR was attenuated to 1.41 (1.31, 1.53) and had the strongest association with T2D after HbA1C in mutually adjusted models. The association persisted even in those with optimal clinical profiles, adjusted HR per standard deviation 1.91 (1.17, 3.13). In participants deemed at intermediate T2D risk by the Framingham Offspring T2D score, LPIR led to a net reclassification of 0.145 (0.117, 0.175). CONCLUSION In middle-aged or older healthy women followed prospectively for over 20 years, LPIR was robustly associated with incident T2D, including among those with an optimal clinical metabolic profile. LPIR improved T2D risk classification and may guide early and targeted prevention strategies.
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Affiliation(s)
- Paulo H N Harada
- Division of Preventive Medicine, Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical and Epidemiological Research, Hospital Universitario at University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Olga V Demler
- Division of Preventive Medicine, Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA
| | - Sagar B Dugani
- Division of Preventive Medicine, Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA; Division of Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Akintunde O Akinkuolie
- Division of Preventive Medicine, Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA
| | - Manickavasagar V Moorthy
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Aruna D Pradhan
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA; Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Samia Mora
- Division of Preventive Medicine, Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard Medical School, Boston, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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23
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Abstract
The change in area under the curve (∆AUC), the integrated discrimination improvement (IDI), and net reclassification index (NRI) are commonly used measures of risk prediction model performance. Some authors have reported good validity of associated methods of estimating their standard errors (SE) and construction of confidence intervals, whereas others have questioned their performance. To address these issues, we unite the ∆AUC, IDI, and three versions of the NRI under the umbrella of the U-statistics family. We rigorously show that the asymptotic behavior of ∆AUC, NRIs, and IDI fits the asymptotic distribution theory developed for U-statistics. We prove that the ∆AUC, NRIs, and IDI are asymptotically normal, unless they compare nested models under the null hypothesis. In the latter case, asymptotic normality and existing SE estimates cannot be applied to ∆AUC, NRIs, or IDI. In the former case, SE formulas proposed in the literature are equivalent to SE formulas obtained from U-statistics theory if we ignore adjustment for estimated parameters. We use Sukhatme-Randles-deWet condition to determine when adjustment for estimated parameters is necessary. We show that adjustment is not necessary for SEs of the ∆AUC and two versions of the NRI when added predictor variables are significant and normally distributed. The SEs of the IDI and three-category NRI should always be adjusted for estimated parameters. These results allow us to define when existing formulas for SE estimates can be used and when resampling methods such as the bootstrap should be used instead when comparing nested models. We also use the U-statistic theory to develop a new SE estimate of ∆AUC. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA, 02115, U.S.A
| | - Michael J Pencina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, 27708, U.S.A
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA, 02115, U.S.A
| | - Ralph B D'Agostino
- Department of Mathematics and Statistics, Boston University, 111 Cummington Mall, Boston, MA, 02215, U.S.A
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Khera AV, Demler OV, Adelman SJ, Collins HL, Glynn RJ, Ridker PM, Rader DJ, Mora S. Cholesterol Efflux Capacity, High-Density Lipoprotein Particle Number, and Incident Cardiovascular Events: An Analysis From the JUPITER Trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin). Circulation 2017; 135:2494-2504. [PMID: 28450350 DOI: 10.1161/circulationaha.116.025678] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [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: 09/27/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent failures of drugs that raised high-density lipoprotein (HDL) cholesterol levels to reduce cardiovascular events in clinical trials have led to increased interest in alternative indices of HDL quality, such as cholesterol efflux capacity, and HDL quantity, such as HDL particle number. However, no studies have directly compared these metrics in a contemporary population that includes potent statin therapy and low low-density lipoprotein cholesterol. METHODS HDL cholesterol levels, apolipoprotein A-I, cholesterol efflux capacity, and HDL particle number were assessed at baseline and 12 months in a nested case-control study of the JUPITER trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin), a randomized primary prevention trial that compared rosuvastatin treatment to placebo in individuals with normal low-density lipoprotein cholesterol but increased C-reactive protein levels. In total, 314 cases of incident cardiovascular disease (CVD) (myocardial infarction, unstable angina, arterial revascularization, stroke, or cardiovascular death) were compared to age- and gender-matched controls. Conditional logistic regression models adjusting for risk factors evaluated associations between HDL-related biomarkers and incident CVD. RESULTS Cholesterol efflux capacity was moderately correlated with HDL cholesterol, apolipoprotein A-I, and HDL particle number (Spearman r= 0.39, 0.48, and 0.39 respectively; P<0.001). Baseline HDL particle number was inversely associated with incident CVD (adjusted odds ratio per SD increment [OR/SD], 0.69; 95% confidence interval [CI], 0.56-0.86; P<0.001), whereas no significant association was found for baseline cholesterol efflux capacity (OR/SD, 0.89; 95% CI, 0.72-1.10; P=0.28), HDL cholesterol (OR/SD, 0.82; 95% CI, 0.66-1.02; P=0.08), or apolipoprotein A-I (OR/SD, 0.83; 95% CI, 0.67-1.03; P=0.08). Twelve months of rosuvastatin (20 mg/day) did not change cholesterol efflux capacity (average percentage change -1.5%, 95% CI, -13.3 to +10.2; P=0.80), but increased HDL cholesterol (+7.7%), apolipoprotein A-I (+4.3%), and HDL particle number (+5.2%). On-statin cholesterol efflux capacity was inversely associated with incident CVD (OR/SD, 0.62; 95% CI, 0.42-0.92; P=0.02), although HDL particle number again emerged as the strongest predictor (OR/SD, 0.51; 95% CI, 0.33-0.77; P<0.001). CONCLUSIONS In JUPITER, cholesterol efflux capacity was associated with incident CVD in individuals on potent statin therapy but not at baseline. For both baseline and on-statin analyses, HDL particle number was the strongest of 4 HDL-related biomarkers as an inverse predictor of incident events and biomarker of residual risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.
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Affiliation(s)
- Amit V Khera
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Olga V Demler
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Steven J Adelman
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Heidi L Collins
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Robert J Glynn
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Paul M Ridker
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Daniel J Rader
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Samia Mora
- From Cardiology Division and Center for Genomic Medicine, Massachusetts General Hospital, Boston (A.V.K.); Harvard Medical School, Boston, MA (A.V.K., O.V.D., P.MR., S.M.); Center for Lipid Metabolomics and Division of Preventive Medicine (A.V.K., O.V.D., R.J.G., P.MR., S.M.), Division of Cardiovascular Medicine (P.MR., S.M.), Brigham and Women's Hospital, Boston, MA; Vascular Strategies, Plymouth Meeting, PA (S.J.A., H.L.C.); and Department of Genetics, University of Pennsylvania, Philadelphia (D.J.R.).
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Khera AV, Demler OV, Adelman SJ, Collins H, Glynn R, Ridker P, Rader D, Mora S. CHOLESTEROL EFFLUX CAPACITY, HDL-PARTICLE NUMBER, AND INCIDENT CARDIOVASCULAR EVENTS: RESULTS FROM THE JUPITER TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Demler OV, Paynter NP, Cook NR. Tests of calibration and goodness-of-fit in the survival setting. Stat Med 2015; 34:1659-80. [PMID: 25684707 DOI: 10.1002/sim.6428] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/22/2014] [Accepted: 01/06/2015] [Indexed: 12/19/2022]
Abstract
To access the calibration of a predictive model in a survival analysis setting, several authors have extended the Hosmer-Lemeshow goodness-of-fit test to survival data. Grønnesby and Borgan developed a test under the proportional hazards assumption, and Nam and D'Agostino developed a nonparametric test that is applicable in a more general survival setting for data with limited censoring. We analyze the performance of the two tests and show that the Grønnesby-Borgan test attains appropriate size in a variety of settings, whereas the Nam-D'Agostino method has a higher than nominal Type 1 error when there is more than trivial censoring. Both tests are sensitive to small cell sizes. We develop a modification of the Nam-D'Agostino test to allow for higher censoring rates. We show that this modified Nam-D'Agostino test has appropriate control of Type 1 error and comparable power to the Grønnesby-Borgan test and is applicable to settings other than proportional hazards. We also discuss the application to small cell sizes.
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Affiliation(s)
- Olga V Demler
- Division of Preventive Medicine, Brigham and Women's Hospital Harvard Medical School, 900 Commonwealth Ave., East Boston, MA, 02215, U.S.A
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Demler OV, Pencina MJ, D'Agostino RB. Impact of correlation on predictive ability of biomarkers. Stat Med 2013; 32:4196-210. [PMID: 23640729 DOI: 10.1002/sim.5824] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/12/2022]
Abstract
In this paper, we investigate how the correlation structure of independent variables affects the discrimination of risk prediction model. Using multivariate normal data and binary outcome, we prove that zero correlation among predictors is often detrimental for discrimination in a risk prediction model and negatively correlated predictors with positive effect sizes are beneficial. A very high multiple R-squared from regressing the new predictor on the old ones can also be beneficial. As a practical guide to new variable selection, we recommend to select predictors that have negative correlation with the risk score based on the existing variables. This step is easy to implement even when the number of new predictors is large. We illustrate our results by using real-life Framingham data suggesting that the conclusions hold outside of normality. The findings presented in this paper might be useful for preliminary selection of potentially important predictors, especially is situations where the number of predictors is large.
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Affiliation(s)
- Olga V Demler
- Brigham and Women's Hospital, Division of Preventive Medicine, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02118, USA
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Pencina MJ, D'Agostino RB, Demler OV, Janssens ACJW, Greenland P. Pencina et al. respond to "The incremental value of new markers" and "Clinically relevant measures? A note of caution". Am J Epidemiol 2012; 176:492-4. [PMID: 22875757 DOI: 10.1093/aje/kws206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Demler OV, Pencina MJ, D'Agostino RB. Misuse of DeLong test to compare AUCs for nested models. Stat Med 2012; 31:2577-87. [PMID: 22415937 DOI: 10.1002/sim.5328] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/06/2012] [Indexed: 11/07/2022]
Abstract
The area under the receiver operating characteristics curve (AUC of ROC) is a widely used measure of discrimination in risk prediction models. Routinely, the Mann-Whitney statistics is used as an estimator of AUC, while the change in AUC is tested by the DeLong test. However, very often, in settings where the model is developed and tested on the same dataset, the added predictor is statistically significantly associated with the outcome but fails to produce a significant improvement in the AUC. No conclusive resolution exists to explain this finding. In this paper, we will show that the reason lies in the inappropriate application of the DeLong test in the setting of nested models. Using numerical simulations and a theoretical argument based on generalized U-statistics, we show that if the added predictor is not statistically significantly associated with the outcome, the null distribution is non-normal, contrary to the assumption of DeLong test. Our simulations of different scenarios show that the loss of power because of such a misuse of the DeLong test leads to a conservative test for small and moderate effect sizes. This problem does not exist in cases of predictors that are associated with the outcome and for non-nested models. We suggest that for nested models, only the test of association be performed for the new predictors, and if the result is significant, change in AUC be estimated with an appropriate confidence interval, which can be based on the DeLong approach.
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Affiliation(s)
- Olga V Demler
- Department of Biostatistics, Boston University School of Public Health Crosstown, Boston, MA 02118, USA.
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Pencina MJ, D'Agostino RB, Demler OV. Novel metrics for evaluating improvement in discrimination: net reclassification and integrated discrimination improvement for normal variables and nested models. Stat Med 2011; 31:101-13. [PMID: 22147389 DOI: 10.1002/sim.4348] [Citation(s) in RCA: 232] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/30/2011] [Indexed: 11/12/2022]
Abstract
Net reclassification and integrated discrimination improvements have been proposed as alternatives to the increase in the area under the curve for evaluating improvement in the performance of risk assessment algorithms introduced by the addition of new phenotypic or genetic markers. In this paper, we demonstrate that in the setting of linear discriminant analysis, under the assumptions of multivariate normality, all three measures can be presented as functions of the squared Mahalanobis distance. This relationship affords an interpretation of the magnitude of these measures in the familiar language of effect size for uncorrelated variables. Furthermore, it allows us to conclude that net reclassification improvement can be viewed as a universal measure of effect size. Our theoretical developments are illustrated with an example based on the Framingham Heart Study risk assessment model for high-risk men in primary prevention of cardiovascular disease.
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Affiliation(s)
- Michael J Pencina
- Department of Biostatistics, Boston University, Cross Town, Boston, MA, USA.
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Demler OV, Pencina MJ, D'Agostino RB. Equivalence of improvement in area under ROC curve and linear discriminant analysis coefficient under assumption of normality. Stat Med 2011; 30:1410-8. [PMID: 21337594 DOI: 10.1002/sim.4196] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 12/15/2010] [Indexed: 11/10/2022]
Abstract
In this paper we investigate the addition of new variables to an existing risk prediction model and the subsequent impact on discrimination quantified by the area under the receiver operating characteristics curve (AUC of ROC). Based on practical experience, concerns have emerged that the significance of association of the variable under study with the outcome in the risk model does not correspond to the significance of the change in AUC: that is, often the variable is significant, but the change in AUC is not. This paper demonstrates that under the assumption of multivariate normality and employing linear discriminant analysis (LDA) to construct the risk prediction tool, statistical significance of the new predictor(s) is equivalent to the statistical significance of the increase in AUC. Under these assumptions the result extends asymptotically to logistic regression. We further show that equality of variance-covariance matrices of predictors within cases and non-cases is not necessary when LDA is used. However, our practical example from the Framingham Heart Study data suggests that the finding might be sensitive to the assumption of normality.
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Affiliation(s)
- Olga V Demler
- Department of Biostatistics, Boston University, 801 Massachusetts Avenue, Boston, MA 02118, USA.
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Kessler RC, Andrade LH, Bijl RV, Offord DR, Demler OV, Stein DJ. The effects of co-morbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys. International Consortium in Psychiatric Epidemiology. Psychol Med 2002; 32:1213-1225. [PMID: 12420891 DOI: 10.1017/s0033291702006104] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although it is well known that generalized anxiety disorder (GAD) is highly co-morbid with other mental disorders, little is known about the extent to which earlier disorders predict the subsequent first onset and persistence of GAD. These associations are examined in the current report using data from four community surveys in the World Health Organization (WHO) International Consortium in Psychiatric Epidemiology (ICPE). METHOD The surveys come from Brazil, Canada, the Netherlands and the United States. The Composite International Diagnostic Interview (CIDI) was used to assess DSM-III-R anxiety, mood and substance use disorders in these surveys. Discrete-time survival analysis was used to examine the associations of retrospectively reported earlier disorders with first onset of GAD. Logistic regression analysis was used to examine the associations of the disorders with persistence of GAD. RESULTS Six disorders predict first onset of GAD in all four surveys: agoraphobia, panic disorder, simple phobia, dysthymia, major depression and mania. With the exception of simple phobia, only respondents with active disorders have elevated risk of GAD. In the case of simple phobia, in comparison, respondents with a history of remitted disorder also have consistently elevated risk of GAD. Simple phobia is also the only disorder that predicts the persistence of GAD. CONCLUSIONS The causal processes linking temporally primary disorders to onset of GAD are likely to be state-dependent. History of simple phobia might be a GAD risk marker. Further research is needed to explore the mechanisms involved in the relationship between simple phobia and subsequent GAD.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA
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