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Coronary Artery Calcification (CAC) and Post-Trial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) Estrogen-Alone Trial.
Poornima IG, Mackey RH, Allison MA, Manson JE, Carr JJ, LaMonte MJ, Chang Y, Kuller LH, WHI and WHI‐CAC Study Investigators
(2017) J Am Heart Assoc 6:
MeSH Terms: Chi-Square Distribution, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Estrogen Replacement Therapy, Estrogens, Conjugated (USP), Female, Humans, Incidence, Middle Aged, Multivariate Analysis, Postmenopause, Proportional Hazards Models, Risk Factors, Time Factors, Treatment Outcome, United States, Vascular Calcification, Women's Health
Show Abstract · Added January 10, 2020
BACKGROUND - Among women aged 50 to 59 years at baseline in the Women's Health Initiative (WHI) Estrogen-Alone (E-Alone) trial, randomization to conjugated equine estrogen-alone versus placebo was associated with lower risk of myocardial infarction and mortality, and, in an ancillary study, the WHI-CACS (WHI Coronary Artery Calcification Study) with lower CAC, measured by cardiac computed tomography ≈8.7 years after baseline randomization. We hypothesized that higher CAC would be related to post-trial coronary heart disease (CHD), cardiovascular disease (CVD), and total mortality, independent of baseline randomization or risk factors.
METHODS AND RESULTS - WHI-CACS participants (n=1020) were followed ≈8 years from computed tomography scan in 2005 (mean age=64.4) through 2013 for incident CHD (myocardial infarction and fatal CHD, n=17), CVD (n=69), and total mortality (n=55). Incident CHD and CVD analyses excluded women with CVD before scan (n=89). Women with CAC=0 (n=54%) had very low age-adjusted rates/1000 person-years of CHD (0.91), CVD (5.56), and mortality (3.45). In comparison, rates were ≈2-fold higher for women with any CAC (>0). Associations were not modified by baseline randomization to conjugated equine estrogen-alone versus placebo. Adjusted for baseline randomization and risk factors, the hazard ratio (95% confidence interval) for CAC >100 (19%) was 4.06 (2.11, 7.80) for CVD and 2.70 (1.26, 5.79) for mortality.
CONCLUSIONS - Among a subset of postmenopausal women aged 50 to 59 years at baseline in the WHI E-Alone Trial, CAC at mean age of 64 years was strongly related to incident CHD, CVD, and to total mortality over ≈8 years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors.
CLINICAL TRIAL REGISTRATION - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000611.
© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
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MeSH Terms
Alcohol Use and Cardiovascular Disease Risk in Patients With Nonalcoholic Fatty Liver Disease.
VanWagner LB, Ning H, Allen NB, Ajmera V, Lewis CE, Carr JJ, Lloyd-Jones DM, Terrault NA, Siddique J
(2017) Gastroenterology 153: 1260-1272.e3
MeSH Terms: Adolescent, Adult, Age Factors, Alcohol Drinking, Binge Drinking, Chi-Square Distribution, Coronary Artery Disease, Cross-Sectional Studies, Echocardiography, Doppler, Female, Humans, Linear Models, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multidetector Computed Tomography, Multivariate Analysis, Non-alcoholic Fatty Liver Disease, Odds Ratio, Prognosis, Protective Factors, Risk Assessment, Risk Factors, Time Factors, Underage Drinking, United States, Young Adult
Show Abstract · Added September 11, 2017
BACKGROUND & AIMS - Cardiovascular disease (CVD) is the leading cause of death among patients with nonalcoholic fatty liver disease (NAFLD). Moderate drinking (vs abstinence) is associated with lower risk of CVD in the general population. We assessed whether alcohol use is associated with CVD risk in patients with NAFLD.
METHODS - We analyzed data from participants in the Coronary Artery Risk Development in Young Adults longitudinal cohort study of 5115 black and white young adults, 18-30 years old, recruited from 4 cities in the United States from 1985 through 1986. Participants self-reported alcohol use at study entry and then again after 15, 20, and 25 years. At year 25 (2010-2011), participants underwent computed tomography examination of the thorax and abdomen and tissue Doppler echocardiography with myocardial strain measured by speckle tracking. Coronary artery calcification was defined as an Agatston score above 0. NAFLD was defined as liver attenuation <51 Hounsfield Units after exclusions. Drinkers reported 1-21 (men) or 1-14 (women) standard drinks/week at years 15, 20, or 25. Nondrinkers reported no alcohol use at years 15, 20, and 25.
RESULTS - Of the 570 participants with NAFLD (mean age, 50 years; 54% black; 46% female), 332 (58%) were drinkers; significantly higher proportions of drinkers were white, male, and with higher levels of education compared with nondrinkers (P < .05 for all). Higher proportions of drinkers had obesity, diabetes, and metabolic syndrome compared with nondrinkers (P < .01). There was no difference in liver attenuation between groups (P = .12). After multivariable adjustment, there was no association between alcohol use and CVD risk factors (diabetes, hypertension, hyperlipidemia) or subclinical CVD measures (coronary artery calcification, early transmitral velocity/late (atrial) transmitral velocity (E/A) ratio, global longitudinal strain).
CONCLUSIONS - In a population-based sample of individuals with NAFLD in midlife, prospectively assessed alcohol use is not associated with significant differences in risk factors for CVD or markers of subclinical CVD. In contrast to general population findings, alcohol use may not reduce the risk of CVD in patients with NAFLD.
Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
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28 MeSH Terms
Association of ectopic fat with abdominal aorto-illiac and coronary artery calcification in african ancestry men.
Kuipers AL, Zmuda JM, Carr JJ, Terry JG, Nair S, Cvejkus R, Bunker CH, Patrick AL, Wassel CL, Miljkovic I
(2017) Atherosclerosis 263: 198-204
MeSH Terms: Absorptiometry, Photon, Adiposity, Adult, African Continental Ancestry Group, Aged, Aorta, Abdominal, Aortic Diseases, Aortography, Chi-Square Distribution, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Humans, Iliac Artery, Intra-Abdominal Fat, Liver, Logistic Models, Male, Middle Aged, Muscle, Skeletal, Odds Ratio, Prospective Studies, Risk Factors, Trinidad and Tobago, Vascular Calcification
Show Abstract · Added September 11, 2017
BACKGROUND AND AIMS - There is strong evidence that fat accumulating in non-adipose sites, "ectopic fat", is associated with cardiovascular disease (CVD), including vascular calcification. Most previous studies of this association have assessed only a single ectopic fat depot. Therefore, our aim was to assess the association of total, regional, and ectopic fat with abdominal aorto-illiac calcification (AAC) and coronary artery calcification (CAC) in 798 African ancestry men.
METHODS - Participants (mean age 62) were from the Tobago Bone Health Study cohort. Adiposity was assessed via clinical examination, dual x-ray absorptiometry, and computed tomography (CT). Ectopic fat depots included: abdominal visceral adipose tissue (VAT), liver attenuation, and calf intermuscular adipose tissue (IMAT). Vascular calcification was assessed by CT and quantified as present versus absent. Associations were tested using multiple logistic regression adjusted for traditional cardiovascular risk factors. Models of ectopic fat were additionally adjusted for total body fat and standing height.
RESULTS - All adiposity measures, except VAT, were associated with AAC. Lower liver attenuation or greater calf IMAT was associated with 1.2-1.3-fold increased odds of AAC (p < 0.03 for both), though calf IMAT was a stronger predictor than liver attenuation (p < 0.001) when entered in a single model. No ectopic fat measure was associated with CAC.
CONCLUSIONS - Greater adiposity in the skeletal muscle and liver, but not in the visceral compartment, was associated with increased odds of AAC in African ancestry men. These results highlight the potential importance of both quantity and location of adiposity accumulation throughout the body.
Copyright © 2017 Elsevier B.V. All rights reserved.
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25 MeSH Terms
Defining a Contemporary Ischemic Heart Disease Genetic Risk Profile Using Historical Data.
Mosley JD, van Driest SL, Wells QS, Shaffer CM, Edwards TL, Bastarache L, McCarty CA, Thompson W, Chute CG, Jarvik GP, Crosslin DR, Larson EB, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Linneman JG, Denny JC, Roden DM
(2016) Circ Cardiovasc Genet 9: 521-530
MeSH Terms: Aged, Aged, 80 and over, Atherosclerosis, Blood Pressure, Case-Control Studies, Chi-Square Distribution, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Electronic Health Records, Female, Genetic Markers, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Hypertension, Incidence, Linear Models, Lipids, Male, Middle Aged, Molecular Epidemiology, Myocardial Ischemia, Phenotype, Polymorphism, Single Nucleotide, Prevalence, Prognosis, Proportional Hazards Models, Risk Assessment, Risk Factors, Time Factors, United States
Show Abstract · Added April 6, 2017
BACKGROUND - Continued reductions in morbidity and mortality attributable to ischemic heart disease (IHD) require an understanding of the changing epidemiology of this disease. We hypothesized that we could use genetic correlations, which quantify the shared genetic architectures of phenotype pairs and extant risk factors from a historical prospective study to define the risk profile of a contemporary IHD phenotype.
METHODS AND RESULTS - We used 37 phenotypes measured in the ARIC study (Atherosclerosis Risk in Communities; n=7716, European ancestry subjects) and clinical diagnoses from an electronic health record (EHR) data set (n=19 093). All subjects had genome-wide single-nucleotide polymorphism genotyping. We measured pairwise genetic correlations (rG) between the ARIC and EHR phenotypes using linear mixed models. The genetic correlation estimates between the ARIC risk factors and the EHR IHD were modestly linearly correlated with hazards ratio estimates for incident IHD in ARIC (Pearson correlation [r]=0.62), indicating that the 2 IHD phenotypes had differing risk profiles. For comparison, this correlation was 0.80 when comparing EHR and ARIC type 2 diabetes mellitus phenotypes. The EHR IHD phenotype was most strongly correlated with ARIC metabolic phenotypes, including total:high-density lipoprotein cholesterol ratio (rG=-0.44, P=0.005), high-density lipoprotein (rG=-0.48, P=0.005), systolic blood pressure (rG=0.44, P=0.02), and triglycerides (rG=0.38, P=0.02). EHR phenotypes related to type 2 diabetes mellitus, atherosclerotic, and hypertensive diseases were also genetically correlated with these ARIC risk factors.
CONCLUSIONS - The EHR IHD risk profile differed from ARIC and indicates that treatment and prevention efforts in this population should target hypertensive and metabolic disease.
© 2016 American Heart Association, Inc.
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31 MeSH Terms
Activation of Human T Cells in Hypertension: Studies of Humanized Mice and Hypertensive Humans.
Itani HA, McMaster WG, Saleh MA, Nazarewicz RR, Mikolajczyk TP, Kaszuba AM, Konior A, Prejbisz A, Januszewicz A, Norlander AE, Chen W, Bonami RH, Marshall AF, Poffenberger G, Weyand CM, Madhur MS, Moore DJ, Harrison DG, Guzik TJ
(2016) Hypertension 68: 123-32
MeSH Terms: Adult, Analysis of Variance, Angiotensin II, Animals, Antibodies, Monoclonal, Humanized, Cells, Cultured, Chi-Square Distribution, Disease Models, Animal, Humans, Hypertension, Kidney, Lymphocyte Activation, Mice, Middle Aged, Random Allocation, Reference Values, Sampling Studies, Statistics, Nonparametric, T-Lymphocytes, Regulatory
Show Abstract · Added May 25, 2016
Emerging evidence supports an important role for T cells in the genesis of hypertension. Because this work has predominantly been performed in experimental animals, we sought to determine whether human T cells are activated in hypertension. We used a humanized mouse model in which the murine immune system is replaced by the human immune system. Angiotensin II increased systolic pressure to 162 versus 116 mm Hg for sham-treated animals. Flow cytometry of thoracic lymph nodes, thoracic aorta, and kidney revealed increased infiltration of human leukocytes (CD45(+)) and T lymphocytes (CD3(+) and CD4(+)) in response to angiotensin II infusion. Interestingly, there was also an increase in the memory T cells (CD3(+)/CD45RO(+)) in the aortas and lymph nodes. Prevention of hypertension using hydralazine and hydrochlorothiazide prevented the accumulation of T cells in these tissues. Studies of isolated human T cells and monocytes indicated that angiotensin II had no direct effect on cytokine production by T cells or the ability of dendritic cells to drive T-cell proliferation. We also observed an increase in circulating interleukin-17A producing CD4(+) T cells and both CD4(+) and CD8(+) T cells that produce interferon-γ in hypertensive compared with normotensive humans. Thus, human T cells become activated and invade critical end-organ tissues in response to hypertension in a humanized mouse model. This response likely reflects the hypertensive milieu encountered in vivo and is not a direct effect of the hormone angiotensin II.
© 2016 American Heart Association, Inc.
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19 MeSH Terms
Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes.
Miller ST, Cunningham-Erves J, Akohoue SA
(2016) Ethn Dis 26: 229-34
MeSH Terms: Adult, African Americans, Chi-Square Distribution, Counseling, Diabetes Mellitus, Type 2, Diet, Exercise, Female, Health Education, Humans, Middle Aged, Obesity, Self Care, Self Report, Weight Loss
Show Abstract · Added July 28, 2016
OBJECTIVE - Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden.
PARTICIPANTS - African American women with type 2 diabetes enrolled in dietary and weight management interventions.
MAIN OUTCOME MEASURES - Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests.
RESULTS - Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m(2)), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65).
CONCLUSIONS - Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed.
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15 MeSH Terms
Treatment Gaps in Adults With Heterozygous Familial Hypercholesterolemia in the United States: Data From the CASCADE-FH Registry.
deGoma EM, Ahmad ZS, O'Brien EC, Kindt I, Shrader P, Newman CB, Pokharel Y, Baum SJ, Hemphill LC, Hudgins LC, Ahmed CD, Gidding SS, Duffy D, Neal W, Wilemon K, Roe MT, Rader DJ, Ballantyne CM, Linton MF, Duell PB, Shapiro MD, Moriarty PM, Knowles JW
(2016) Circ Cardiovasc Genet 9: 240-9
MeSH Terms: Adult, Aged, Biomarkers, Chi-Square Distribution, Cholesterol, LDL, Comorbidity, Coronary Disease, Cross-Sectional Studies, Diabetes Mellitus, Down-Regulation, Early Diagnosis, Female, Genetic Predisposition to Disease, Guideline Adherence, Heterozygote, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hyperlipoproteinemia Type II, Hypertension, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Phenotype, Practice Guidelines as Topic, Practice Patterns, Physicians', Predictive Value of Tests, Prevalence, Professional Practice Gaps, Registries, Risk Factors, Time Factors, Treatment Outcome, United States
Show Abstract · Added April 10, 2018
BACKGROUND - Cardiovascular disease burden and treatment patterns among patients with familial hypercholesterolemia (FH) in the United States remain poorly described. In 2013, the FH Foundation launched the Cascade Screening for Awareness and Detection (CASCADE) of FH Registry to address this knowledge gap.
METHODS AND RESULTS - We conducted a cross-sectional analysis of 1295 adults with heterozygous FH enrolled in the CASCADE-FH Registry from 11 US lipid clinics. Median age at initiation of lipid-lowering therapy was 39 years, and median age at FH diagnosis was 47 years. Prevalent coronary heart disease was reported in 36% of patients, and 61% exhibited 1 or more modifiable risk factors. Median untreated low-density lipoprotein cholesterol (LDL-C) was 239 mg/dL. At enrollment, median LDL-C was 141 mg/dL; 42% of patients were taking high-intensity statin therapy and 45% received >1 LDL-lowering medication. Among FH patients receiving LDL-lowering medication(s), 25% achieved an LDL-C <100 mg/dL and 41% achieved a ≥50% LDL-C reduction. Factors associated with prevalent coronary heart disease included diabetes mellitus (adjusted odds ratio 1.74; 95% confidence interval 1.08-2.82) and hypertension (2.48; 1.92-3.21). Factors associated with a ≥50% LDL-C reduction from untreated levels included high-intensity statin use (7.33; 1.86-28.86) and use of >1 LDL-lowering medication (1.80; 1.34-2.41).
CONCLUSIONS - FH patients in the CASCADE-FH Registry are diagnosed late in life and often do not achieve adequate LDL-C lowering, despite a high prevalence of coronary heart disease and risk factors. These findings highlight the need for earlier diagnosis of FH and initiation of lipid-lowering therapy, more consistent use of guideline-recommended LDL-lowering therapy, and comprehensive management of traditional coronary heart disease risk factors.
© 2016 American Heart Association, Inc.
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MeSH Terms
Predictors of major amputation despite patent bypass grafts.
Smith AD, Hawkins AT, Schaumeier MJ, de Vos MS, Conte MS, Nguyen LL
(2016) J Vasc Surg 63: 1279-88
MeSH Terms: Aged, Aged, 80 and over, Amputation, Chi-Square Distribution, Comorbidity, Critical Illness, Disease Progression, Double-Blind Method, Female, Humans, Ischemia, Limb Salvage, Lower Extremity, Male, Middle Aged, Multivariate Analysis, Nutritional Status, Peripheral Arterial Disease, Proportional Hazards Models, Prospective Studies, Quality of Life, Reoperation, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Grafting, Vascular Patency, Veins
Show Abstract · Added September 27, 2016
OBJECTIVE - Despite patent vein bypass grafts, some patients with critical limb ischemia (CLI) receive major amputations. We analyzed the predictive factors leading to major amputation in the presence of patent lower extremity bypass (LEB) grafts.
METHODS - Data from the Project of Ex-Vivo vein graft Engineering via Transfection III (PREVENT III), a large prospective randomized trial of 1404 patients who underwent LEB with vein graft for CLI, were queried for outcomes. The primary outcome was major amputation with patent (PMA) LEB compared with patients with patent LEB who achieved limb salvage (PLS). The population excluded those who received amputation for occluded grafts. A Cox proportional hazard model identified independent predictors.
RESULTS - Of 1404 LEB patients, 162 (11.5%) had major amputation: 89 (6.3%) with patent and 73 (5.2%) with occluded LEB. For PMA, 21 of 89 (23.6%) developed critical stenosis and 11 of 21 (52.4%) were revised. For PLS, 460 of 1242 (37.0%) developed critical stenosis and 351 of 460 (76.3%) were revised. Predictive patient factors included having preoperative gangrene (vs rest pain; hazard ratio [HR], 3.504; 95% confidence interval [CI], 1.533-8.007; P = .0029), diabetes (HR, 1.800; 95% CI, 1.006-3.219; P = .0477), black (vs white) race (HR, 1.779; 95% CI, 1.051-3.011; P = .0321), baseline creatinine clearance <25 mL/min (vs >65 mL/min; HR, 1.759; 95% CI, 1.016-3.048; P = .0439), prior history of coronary artery bypass grafting (HR, 1.702; 95% CI, 1.080-2.683; P = .0221), and lower baseline activity quality of life score (HR, 1.401; 95% CI, 1.105-1.778; P = .0054). Postoperative wound factors included gangrenous changes (HR, 5.830; 95% CI, 1.647-20.635; P = .0063), surgical wound necrosis (HR, 5.319; 95% CI, 1.478-19.146; P = .0105), deep (vs superficial) wound infection (HR, 3.815; 95% CI, 1.220-11.927; P = .0213), and wound healing abnormally (HR, 3.754; 95% CI, 1.061-13.278; P = .0402). Associated postoperative consequences leading to PMA included having recurrent CLI symptoms (HR, 2.915; 95% CI, 1.816-4.681; P < .0001), a severe (vs mild) adverse event (HR, 2.751; 95% CI, 1.391-5.443; P = .0036), fewer percutaneous revisions (HR, 2.425; 95% CI, 1.573-3.740; P < .0001), discharge on low-molecular-weight heparin (HR, 2.087; 95% CI, 1.309-3.326; P = .0020), and decreasing days to critical stenosis/occlusion/revision/amputation (HR, 1.010; 95% CI, 1.007-1.012; P < .0001).
CONCLUSIONS - Whereas a patent vein graft is important to all vascular surgeons, additional factors should be considered in trying to attain limb salvage for patients with CLI. These factors include intervening surgically before CLI has progressed to a state of gangrene or limited activity and optimizing nutrition, diabetes control, cardiac conditions, and activity level. Revision offers hope for clinical improvement but may be delayed when there is no graft lesion identified. The absence of a graft lesion to revise may also portend amputation despite a patent graft because of nongraft-related factors such as infection. Finally, the experience of a severe (vs mild) adverse event may also result in limb loss despite a patent graft. Systematic efforts to reduce severe adverse events among patients may also lead to increased limb salvage.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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29 MeSH Terms
Aquaporin 11 variant associates with kidney disease in type 2 diabetic patients.
Choma DP, Vanacore R, Naylor H, Zimmerman IA, Pavlichenko A, Pavlichenko A, Foye L, Carbone DP, Harris RC, Dikov MM, Tchekneva EE
(2016) Am J Physiol Renal Physiol 310: F416-25
MeSH Terms: Acute Kidney Injury, Aged, Aquaporins, Chi-Square Distribution, Databases, Genetic, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Disease Progression, Female, Gene Frequency, Genetic Association Studies, Genetic Predisposition to Disease, Glomerular Filtration Rate, Humans, Linear Models, Logistic Models, Male, Middle Aged, Models, Molecular, Multivariate Analysis, Phenotype, Polymorphism, Single Nucleotide, Prevalence, Protein Conformation, Renal Insufficiency, Chronic, Retrospective Studies, Risk Assessment, Risk Factors, Structure-Activity Relationship
Show Abstract · Added January 4, 2016
Kidney disease, a common complication of diabetes, associates with poor prognosis. Our previous animal model studies linked aquaporin (AQP)11 to acute kidney injury, hyperglycemia-induced renal impairment, and kidney disease in diabetes. Here, we report the AQP11 rs2276415 variant as a genetic factor placing type 2 diabetic patients at greater risk for the development of kidney disease. We performed two independent retrospective case-control studies in 1,075 diabetic and 1,619 nondiabetic individuals who were identified in the Synthetic Derivative Database with DNA samples in the BioVU DNA repository at Vanderbilt University (Nashville, TN). A χ(2)-test and multivariable logistic regression analysis with adjustments for age, sex, baseline serum creatinine, and underlying comorbid disease covariates showed a significant association between rs2276415 and the prevalence of any event of acute kidney injury and chronic kidney disease (CKD) in diabetic patients but not in patients without diabetes. This result was replicated in the second independent study. Diabetic CKD patients over 55 yrs old with the minor AQP11 allele had a significantly faster progression of estimated glomerular filtration rate decline than patients with the wild-type genotype. Three-dimensional structural analysis suggested a functional impairment of AQP11 with rs2276415, which could place diabetic patients at a higher risk for kidney disease. These studies identified rs2276415 as a candidate genetic factor predisposing patients with type 2 diabetes to CKD.
Copyright © 2016 the American Physiological Society.
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29 MeSH Terms
The effect of social integration on outcomes after major lower extremity amputation.
Hawkins AT, Pallangyo AJ, Herman AM, Schaumeier MJ, Smith AD, Hevelone ND, Crandell DM, Nguyen LL
(2016) J Vasc Surg 63: 154-62
MeSH Terms: Adult, Aged, Aged, 80 and over, Amputation, Amputees, Boston, Chi-Square Distribution, Cross-Sectional Studies, Exercise Test, Female, Humans, Linear Models, Lower Extremity, Male, Middle Aged, Mobility Limitation, Multivariate Analysis, Quality of Life, Recovery of Function, Risk Factors, Social Behavior, Social Support, Surveys and Questionnaires, Tanzania, Treatment Outcome, Walking, Young Adult
Show Abstract · Added September 27, 2016
OBJECTIVE - Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes.
METHODS - From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D.
RESULTS - We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (β, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis.
CONCLUSIONS - In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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27 MeSH Terms