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Mahoney MC, Rivard C, Kimmel HL, Hammad HT, Sharma E, Halenar MJ, Sargent J, Cummings KM, Niaura R, Goniewicz ML, Bansal-Travers M, Hatsukami D, Gaalema D, Fong G, Gravely S, Christensen CH, Haskins R, Silveira ML, Blanco C, Compton W, Stanton CA, Hyland A. Cardiovascular Outcomes among Combustible-Tobacco and Electronic Nicotine Delivery System (ENDS) Users in Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) Study, 2013-2019. Int J Environ Res Public Health 2022; 19:4137. [PMID: 35409819 PMCID: PMC8998731 DOI: 10.3390/ijerph19074137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior studies have not clearly established risk of cardiovascular disease (CVD) among smokers who switch to exclusive use of electronic nicotine delivery systems (ENDS). We compared cardiovascular disease incidence in combustible-tobacco users, those who transitioned to ENDS use, and those who quit tobacco with never tobacco users. METHODS This prospective cohort study analyzes five waves of Population Assessment of Tobacco and Health (PATH) Study data, Wave 1 (2013-2014) through Wave 5 (2018-2019). Cardiovascular disease (CVD) incidence was captured over three intervals (Waves 1 to 3, Waves 2 to 4, and Waves 3 to 5). Participants were adults (40+ years old) without a history of CVD for the first two waves of any interval. Change in tobacco use status, from exclusive past 30 day use of any combustible-tobacco product to either exclusive past 30 day ENDS use, dual past 30 day use of ENDS and combustible-tobacco, or no past 30 day use of any tobacco, between the first two waves of an interval was used to predict onset of CVD between the second and third waves in the interval. CVD incidence was defined as a new self-report of being told by a health professional that they had congestive heart failure, stroke, or a myocardial infarction. Generalized estimating equation (GEE) analyses combined 10,548 observations across intervals from 7820 eligible respondents. RESULTS Overall, there were 191 observations of CVD among 10,548 total observations (1.7%, standard error (SE) = 0.2), with 40 among 3014 never users of tobacco (1.5%, SE = 0.3). In multivariable models, CVD incidence was not significantly different for any tobacco user groups compared to never users. There were 126 observations of CVD among 6263 continuing exclusive combustible-tobacco users (adjusted odds ratio [AOR] = 1.44; 95% confidence interval (CI) 0.87-2.39), 15 observations of CVD among 565 who transitioned to dual use (AOR = 1.85; 0.78-4.37), and 10 observations of CVD among 654 who quit using tobacco (AOR = 1.18; 0.33-4.26). There were no observations of CVD among 53 who transitioned to exclusive ENDS use. CONCLUSIONS This study found no difference in CVD incidence by tobacco status over three 3 year intervals, even for tobacco quitters. It is possible that additional waves of PATH Study data, combined with information from other large longitudinal cohorts with careful tracking of ENDS use patterns may help to further clarify this relationship.
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Affiliation(s)
- Martin C. Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
| | - Hoda T. Hammad
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (H.T.H.); (C.H.C.); (R.H.)
| | - Eva Sharma
- Westat, Rockville, MD 20850, USA; (E.S.); (M.J.H.); (C.A.S.)
| | | | - Jim Sargent
- The C. Everette Koop Institute at Dartmouth, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA;
| | | | - Ray Niaura
- NYU School of Global Public Health, New York, NY 10003, USA;
| | - Maciej L. Goniewicz
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | - Maansi Bansal-Travers
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | | | | | - Geoffrey Fong
- University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.F.); (S.G.)
| | - Shannon Gravely
- University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.F.); (S.G.)
| | - Carol H. Christensen
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (H.T.H.); (C.H.C.); (R.H.)
| | - Ryan Haskins
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (H.T.H.); (C.H.C.); (R.H.)
| | - Marushka L. Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
- Kelly Government Solutions, Troy, MI 48084, USA
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
| | - Wilson Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
| | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
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Alencar GF, Owsiany KM, Karnewar S, Sukhavasi K, Mocci G, Nguyen AT, Williams CM, Shamsuzzaman S, Mokry M, Henderson CA, Haskins R, Baylis RA, Finn AV, McNamara CA, Zunder ER, Venkata V, Pasterkamp G, Björkegren J, Bekiranov S, Owens GK. Stem Cell Pluripotency Genes Klf4 and Oct4 Regulate Complex SMC Phenotypic Changes Critical in Late-Stage Atherosclerotic Lesion Pathogenesis. Circulation 2020; 142:2045-2059. [PMID: 32674599 PMCID: PMC7682794 DOI: 10.1161/circulationaha.120.046672] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Rupture and erosion of advanced atherosclerotic lesions with a resultant myocardial infarction or stroke are the leading worldwide cause of death. However, we have a limited understanding of the identity, origin, and function of many cells that make up late-stage atherosclerotic lesions, as well as the mechanisms by which they control plaque stability. Methods: We conducted a comprehensive single-cell RNA sequencing of advanced human carotid endarterectomy samples and compared these with single-cell RNA sequencing from murine microdissected advanced atherosclerotic lesions with smooth muscle cell (SMC) and endothelial lineage tracing to survey all plaque cell types and rigorously determine their origin. We further used chromatin immunoprecipitation sequencing (ChIP-seq), bulk RNA sequencing, and an innovative dual lineage tracing mouse to understand the mechanism by which SMC phenotypic transitions affect lesion pathogenesis. Results: We provide evidence that SMC-specific Klf4- versus Oct4-knockout showed virtually opposite genomic signatures, and their putative target genes play an important role regulating SMC phenotypic changes. Single-cell RNA sequencing revealed remarkable similarity of transcriptomic clusters between mouse and human lesions and extensive plasticity of SMC- and endothelial cell-derived cells including 7 distinct clusters, most negative for traditional markers. In particular, SMC contributed to a Myh11-, Lgals3+ population with a chondrocyte-like gene signature that was markedly reduced with SMC-Klf4 knockout. We observed that SMCs that activate Lgals3 compose up to two thirds of all SMC in lesions. However, initial activation of Lgals3 in these cells does not represent conversion to a terminally differentiated state, but rather represents transition of these cells to a unique stem cell marker gene–positive, extracellular matrix-remodeling, “pioneer” cell phenotype that is the first to invest within lesions and subsequently gives rise to at least 3 other SMC phenotypes within advanced lesions, including Klf4-dependent osteogenic phenotypes likely to contribute to plaque calcification and plaque destabilization. Conclusions: Taken together, these results provide evidence that SMC-derived cells within advanced mouse and human atherosclerotic lesions exhibit far greater phenotypic plasticity than generally believed, with Klf4 regulating transition to multiple phenotypes including Lgals3+ osteogenic cells likely to be detrimental for late-stage atherosclerosis plaque pathogenesis.
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Affiliation(s)
- Gabriel F Alencar
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,Department of Biochemistry and Molecular Genetics (G.F.A., K.M.O., C.A.H., R.A.B., S.B.), University of Virginia, Charlottesville
| | - Katherine M Owsiany
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,Department of Biochemistry and Molecular Genetics (G.F.A., K.M.O., C.A.H., R.A.B., S.B.), University of Virginia, Charlottesville
| | - Santosh Karnewar
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville
| | | | - Giuseppe Mocci
- Integrated Cardio Metabolic Centre, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden (G.M., V.V., J.B.)
| | - Anh T Nguyen
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville
| | - Corey M Williams
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,Department of Biomedical Engineering (C.M.W., E.R.Z.), University of Virginia, Charlottesville
| | - Sohel Shamsuzzaman
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville
| | - Michal Mokry
- Laboratory of Clinical Chemistry and Hematology, Division Laboratories and Pharmacy (M.M., G.P.), University Medical Center Utrecht, University Utrecht, The Netherlands.,Department of Cardiology (M.M.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Christopher A Henderson
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,Department of Biochemistry and Molecular Genetics (G.F.A., K.M.O., C.A.H., R.A.B., S.B.), University of Virginia, Charlottesville
| | - Ryan Haskins
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville
| | - Richard A Baylis
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,Department of Biochemistry and Molecular Genetics (G.F.A., K.M.O., C.A.H., R.A.B., S.B.), University of Virginia, Charlottesville
| | - Aloke V Finn
- CVPath Institute, Inc, Gaithersburg, MD (A.V.F.)
| | - Coleen A McNamara
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,School of Medicine, Division of Cardiovascular Medicine, Department of Medicine (C.A.M.), University of Virginia, Charlottesville
| | - Eli R Zunder
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville.,Department of Biomedical Engineering (C.M.W., E.R.Z.), University of Virginia, Charlottesville
| | - Vamsidhar Venkata
- Integrated Cardio Metabolic Centre, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden (G.M., V.V., J.B.)
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Hematology, Division Laboratories and Pharmacy (M.M., G.P.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Johan Björkegren
- Integrated Cardio Metabolic Centre, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden (G.M., V.V., J.B.).,Department of Genetics and Genomic Sciences (J.B.), Icahn School of Medicine at Mount Sinai, New York.,Icahn Institute of Genomics and Multiscale Biology (J.B.), Icahn School of Medicine at Mount Sinai, New York
| | - Stefan Bekiranov
- Department of Biochemistry and Molecular Genetics (G.F.A., K.M.O., C.A.H., R.A.B., S.B.), University of Virginia, Charlottesville
| | - Gary K Owens
- Robert M. Berne Cardiovascular Research Center (G.F.A., K.M.O, S.K., A.N., C.M.W., S.S., C.A.H., R.H., R.A.B., C.A.M., E.R.Z., G.K.O.), University of Virginia, Charlottesville
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O'Brien KM, Wiggers J, Williams A, Campbell E, Hodder RK, Wolfenden L, Yoong SL, Robson EK, Haskins R, Kamper SJ, Rissel C, Williams CM. Telephone-based weight loss support for patients with knee osteoarthritis: a pragmatic randomised controlled trial. Osteoarthritis Cartilage 2018; 26:485-494. [PMID: 29330101 DOI: 10.1016/j.joca.2018.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 08/09/2017] [Revised: 11/30/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effectiveness of telephone-based weight loss support in reducing the intensity of knee pain in patients with knee osteoarthritis, who are overweight or obese, compared to usual care. DESIGN We conducted a parallel randomised controlled trial (RCT), embedded within a cohort multiple RCT of patients on a waiting list for outpatient orthopaedic consultation at a tertiary referral hospital in NSW, Australia. Patients with knee osteoarthritis, classified as overweight or obese [body mass index (BMI) between ≥27 kg/m2 and <40 kg/m2] were randomly allocated to receive referral to an existing non-disease specific government funded 6-month telephone-based weight management and healthy lifestyle service or usual care. The primary outcome was knee pain intensity measured using an 11-point numerical rating scale (NRS) over 6-month follow-up. A number of secondary outcomes, including self-reported weight were measured. Data analysis was by intention-to-treat according to a pre-published analysis plan. RESULTS Between May 19 and June 30 2015, 120 patients were randomly assigned to the intervention (59 analysed, one post-randomisation exclusion) or usual care (60 analysed). We found no statistically significant between group differences in pain intensity [area under the curve (AUC), mean difference 5.4, 95%CI: -13.7 to 24.5, P = 0.58] or weight change at 6 months (self-reported; mean difference -0.4, 95%CI: -2.6 to 1.8, P = 0.74). CONCLUSIONS Among patients with knee osteoarthritis who are overweight, telephone-based weight loss support, provided using an existing 6-month weight management and healthy lifestyle service did not reduce knee pain intensity or weight, compared with usual care. TRIAL REGISTRATION NUMBER ACTRN12615000490572.
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Affiliation(s)
- K M O'Brien
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia; Centre for Pain, Health and Lifestyle, NSW, Australia.
| | - J Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia.
| | - A Williams
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia; Centre for Pain, Health and Lifestyle, NSW, Australia.
| | - E Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia.
| | - R K Hodder
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia; Centre for Pain, Health and Lifestyle, NSW, Australia.
| | - L Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia.
| | - S L Yoong
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia.
| | - E K Robson
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia; Centre for Pain, Health and Lifestyle, NSW, Australia.
| | - R Haskins
- Outpatient Services, John Hunter Hospital, Hunter New England Local Health District, Locked Bag 1, New Lambton, NSW, 2305, Australia.
| | - S J Kamper
- Centre for Pain, Health and Lifestyle, NSW, Australia; Musculoskeletal Health Sydney, University of Sydney, Lvl 10, King George V Building, Camperdown, NSW, 2050, UK.
| | - C Rissel
- NSW Office of Preventive Health, Liverpool Hospital, South West Sydney Local Health District, Locked Bag 7279, Liverpool, BC 1871, Australia.
| | - C M Williams
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia; School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2308, Australia; Centre for Pain, Health and Lifestyle, NSW, Australia.
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