1
|
Ji R, Gu Y, Zhang J, Gao C, Gao W, Zang X, Zhao Y. TRIM7 promotes proliferation and migration of vascular smooth muscle cells in atherosclerosis through activating c-Jun/AP-1. IUBMB Life 2019; 72:247-258. [PMID: 31625258 DOI: 10.1002/iub.2181] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/23/2019] [Indexed: 01/04/2023]
Abstract
Atherosclerosis (AS), with associated risk of stroke or cerebrovascular disease, is one of the most common causes of death globally. It has been well established that tripartite motif-containing protein 7 Tripartite Motif-containing 7 (Trim7), as an E3 ubiquitin protein ligase, is involved in protein ubiquitination and thus regulating cellular proliferation. Moreover, TRIM7 is upregulated in advanced carotid AS. However, the detailed mechanism of TRIM7 on regulation of AS remains unclear. In the present study, we firstly discovered that TRIM7 expression was robustly induced in platelet-derived growth factor type BB-treated vascular smooth muscle cells (VSMCs) and human atherosclerotic plaques. Functional approaches established that knockdown of TRIM7 inhibited proliferation and migration of VSMCs, as well as arrested the cell cycle at G1-S, thus suppressing AS progression. Our results also identified that c-Jun/activator protein 1 (AP-1) signaling pathway was activated by TRIM7. Moreover, gain- and loss-of-function studies revealed that TRIM7 could promote proliferation and migration of VSMCs via activation of c-Jun/AP-1 signaling pathway. Finally, by using atherogenic apolipoprotein E-deficient (apoE-/-) C57BL/6 mice with high-fat diet AS model, we demonstrated that interference of TRIM7 could effectively mitigate in vivo AS via inactivation of c-Jun/AP-1 signaling pathway. In general, activation of c-Jun/AP-1 signaling pathway via TRIM7 could be an important mechanism in AS progression, thus shedding light on the development of novel therapeutics to the treatment of the disease.
Collapse
Affiliation(s)
- Rongjing Ji
- Department of Cardiology, FuWai Central China Cardiovascular Hospital, Zhengzhou, China.,Department of Cardiology, Medical School of Jinzhou Medical University, Jinzhou, China.,Department of Cardiology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Gu
- Department of neurology, The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jing Zhang
- Department of Cardiology, FuWai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Chuanyu Gao
- Department of Cardiology, FuWai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Wanli Gao
- Department of Cardiology, FuWai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaobiao Zang
- Department of Cardiology, FuWai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yonghui Zhao
- Department of Cardiology, FuWai Central China Cardiovascular Hospital, Zhengzhou, China.,Department of Cardiology, The People's Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Pumill CA, Bush CG, Greiner MA, Hall ME, Dunlay SM, Correa A, Curtis LH, Suzuki T, Hardy C, Blackshear CT, O'Brien EC, Mentz RJ. Neck circumference and cardiovascular outcomes: Insights from the Jackson Heart Study. Am Heart J 2019; 212:72-79. [PMID: 30954832 DOI: 10.1016/j.ahj.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emerging data suggest that neck circumference (NC) is associated with cardiometabolic risk factors. Limited research is available regarding the association between NC and cardiovascular outcomes in African Americans. METHODS Using data from the Jackson Heart Study, we included participants with recorded NC measurements at baseline (2000-2004). Baseline characteristics for the included population were summarized by tertiles of NC. We then calculated age- and sex-adjusted cumulative incidence of clinical cardiovascular outcomes and performed Cox proportional-hazards with stepwise models. RESULTS Overall, 5,290 participants were categorized into tertiles of baseline NC defined as ≤37 cm (n = 2179), 38-40 cm (n = 1552), and >40 cm (n = 1559). After adjusting for age and sex, increasing NC was associated with increased risk of heart failure (HF) hospitalization (cumulative incidence = 13.4% [99% CI, 10.7-16.7] in the largest NC tertile vs 6.5% [99% CI, 4.7-8.8] in the smallest NC tertile), but not mortality, stroke, myocardial infarction, or coronary heart disease (all P ≥ .1). Following full risk adjustment, there was a nominal increase in the risk of HF hospitalization with increasing NC, but this was not statistically significant (hazard ratio per 1-cm increase, 1.04 [99% CI, 0.99-1.10], P = .06). CONCLUSIONS In this large cohort of African American individuals, a larger NC was associated with increased risk for HF hospitalization following adjustment for age and sex, but this risk was not statistically significant after adjusting for other clinical variables. Although NC is not independently associated with increased risk for cardiovascular events, it may offer prognostic information particularly related to HF hospitalization.
Collapse
Affiliation(s)
- Christopher A Pumill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Christopher G Bush
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Shannon M Dunlay
- Departments of Cardiovascular Medicine and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Lesley H Curtis
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Takeki Suzuki
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Chad T Blackshear
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
| |
Collapse
|
3
|
Parikh KS, Greiner MA, Suzuki T, DeVore AD, Blackshear C, Maher JF, Curtis LH, Hernandez AF, O'Brien EC, Mentz RJ. Resting Heart Rate and Long-term Outcomes Among the African American Population: Insights From the Jackson Heart Study. JAMA Cardiol 2019; 2:172-180. [PMID: 27681113 DOI: 10.1001/jamacardio.2016.3234] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Increased resting heart rate is associated with worse outcomes in studies of mostly white populations, but its significance is not well established in African Americans persons whose cardiac comorbidities and structural abnormalities differ. Objective To study the prognostic utility of heart rate in a community-based African American cohort in the Jackson Heart Study. Design, Setting, and Participants A total of 5261 participants in the Jackson Heart Study, a prospective, community-based study in Jackson, Mississippi, were evaluated. Baseline heart rate was assessed by quintiles and as a continuous variable. All participants with baseline heart rate documented by a 12-lead electrocardiogram without pacing or atrial fibrillation noted on their baseline Jackson Heart Study examination were included in the study. Follow-up began September 26, 2000, and was completed December 31, 2011. Data analysis was performed from July to October 2015. Main Outcomes and Measures Unadjusted and adjusted associations between heart rate and all-cause mortality and heart failure hospitalization using Cox proportional hazards regression models. Results Of the 5261 individuals included in the analysis, 1921 (36.5%) were men; median (25th-75th percentile) age was 55.7 (45.4-64.8) years. Median (25th-75th percentile) baseline heart rate was 63 beats per minute (bpm) (57-71 bpm). The highest heart rate quintile (73-118 bpm) had higher rates of diabetes (398 [37.4%]; P < .001) and hypertension (735 [69.1%]; P < .001), higher body mass index (median [IQR], 32.4 [28.1-38.3]; P < .001), less physical activity (0 hours per week, 561 [52.8%]; P < .001), and lower β-blocker use (73 [6.9%]; P < .001) compared with lower quintiles. Caffeine intake (from 80.7 to 85.5 mg/d; P = .57) and left ventricular ejection fraction (from 62% to 62.3%; P = .01) were similar between groups. As a continuous variable, elevated heart rate was associated with increased mortality and heart failure hospitalizations, with adjusted hazard ratios for every 5-bpm increase of 1.14 (95% CI, 1.10-1.19) and 1.10 (95% CI, 1.05-1.16), respectively. Similar patterns were observed in comparisons between the highest and lowest quintiles. Conclusions and Relevance Higher baseline heart rate was associated with increased mortality and heart failure hospitalizations among African American participants in the Jackson Heart Study. These findings are similar to those seen in white populations, but further study is needed to understand whether African American individuals benefit from interventions targeting heart rate reduction.
Collapse
Affiliation(s)
| | | | - Takeki Suzuki
- Department of Medicine, University of Mississippi School of Medicine, Jackson
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Chad Blackshear
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson
| | - Joseph F Maher
- Department of Medicine, University of Mississippi School of Medicine, Jackson
| | - Lesley H Curtis
- Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Emily C O'Brien
- Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
4
|
Kelly JP, Greiner M, Soliman EZ, Randolph TC, Thomas KL, Dunlay SM, Curtis LH, O'Brien EC, Mentz RJ. Relation of Early Repolarization (J Point Elevation) to Mortality in Blacks (from the Jackson Heart Study). Am J Cardiol 2018; 122:340-346. [PMID: 29866580 DOI: 10.1016/j.amjcard.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
Conflicting data exist regarding the associations of early repolarization (ER) with electrocardiogram (ECG) and clinical outcomes in blacks. We examined the association of ER defined by J point elevation (JPE) and all-cause mortality, and heart failure (HF) hospitalization in blacks in the Jackson Heart Study (JHS) cohort. We included JHS participants with ECGs from the baseline visit coding JPE and excluded participants with paced rhythms or QRS duration ≥120 ms. We compared the cumulative incidence of 10-year all-cause mortality and 8-year HF hospitalization by presence of JPE ≥0.1 mV in any ECG lead at baseline using Kaplan-Meier estimates and multivariable Cox models. Of the 4,978 participants, 1,410 (28%) had JPE at baseline: anterior leads 97.8%, lateral leads 8.3%, and inferior leads 2.9%. Compared with participants without JPE, those with JPE were younger, more likely to be male and current smokers, and less likely to have hypertension. Over a median follow-up of 8 years, there were no significant differences in the cumulative incidence or multivariable-adjusted hazards of all-cause mortality or HF hospitalization in participants with and without JPE in any lead (adjusted hazard ratio 0.97, 95% confidence interval 0.89 to 1.52, and adjusted hazard ratio 1.18, 95% confidence interval 0.9 to 1.54, respectively). Of the 2,523 participants who completed Exam 3 without JPE at baseline, 246 (10%) developed JPE over follow-up. In conclusion, JPE on ECG was not associated with long-term mortality or HF hospitalization in a large prospective black community cohort, suggesting that ER may represent a benign ECG finding in blacks.
Collapse
|
5
|
Sickle cell trait is not associated with an increased risk of heart failure or abnormalities of cardiac structure and function. Blood 2016; 129:799-801. [PMID: 27932373 DOI: 10.1182/blood-2016-08-705541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
6
|
Randolph TC, Greiner MA, Egwim C, Hernandez AF, Thomas KL, Curtis LH, Muntner P, Wang W, Mentz RJ, O'Brien EC. Associations Between Blood Pressure and Outcomes Among Blacks in the Jackson Heart Study. J Am Heart Assoc 2016; 5:e003928. [PMID: 27927632 PMCID: PMC5210402 DOI: 10.1161/jaha.116.003928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND In 2014, new hypertension guidelines liberalized blood pressure goals for persons 60 years and older. Little is known about the implications for blacks. METHODS AND RESULTS Using data from 2000 through 2011 for 5280 participants in the Jackson Heart Study, a community-based black cohort in Jackson, Mississippi, we examined whether higher blood pressure was associated with greater risk of mortality and heart failure hospitalization, and whether the risk was the same across age groups. We investigated associations between baseline blood pressure and both mortality and heart failure hospitalization. We also tested for interactions between age and blood pressure in the mortality model. Median systolic and diastolic blood pressures at baseline were 125 mm Hg (25th-75th percentile, 114-137 mm Hg) and 79 mm Hg (72-86 mm Hg), respectively. Median follow-up was 9 years for mortality and 7 years for heart failure hospitalization. After multivariable adjustment, every 10 mm Hg increase in systolic blood pressure was associated with greater risks of mortality (hazard ratio, 1.12; 95% CI, 1.06-1.17) and heart failure hospitalization (1.07; 95% CI, 1.00-1.14). The mortality risk per 10 mm Hg increase in systolic blood pressure was greater in participants younger than 60 years (1.26; 95% CI, 1.13-1.42) than among participants 60 years and older (1.09; 95% CI, 1.03-1.15). CONCLUSIONS Adults in all age groups were at greater risk of mortality as systolic blood pressure increased. In the context of the 2014 hypertension guidelines, these findings should be considered when determining treatment goals in black patients.
Collapse
Affiliation(s)
- Tiffany C Randolph
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Melissa A Greiner
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Chidiebube Egwim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Robert J Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| |
Collapse
|
7
|
The Obesity and Heart Failure Epidemics Among African Americans: Insights From the Jackson Heart Study. J Card Fail 2016; 22:589-97. [PMID: 26975941 DOI: 10.1016/j.cardfail.2016.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Higher rates of obesity and heart failure have been observed in African Americans, but associations with mortality are not well-described. We examined intermediate and long-term clinical implications of obesity in African Americans and associations between obesity and all-cause mortality, heart failure, and heart failure hospitalization. METHODS AND RESULTS We conducted a retrospective analysis of a community sample of 5292 African Americans participating in the Jackson Heart Study between September 2000 and January 2013. The main outcomes were associations between body mass index (BMI) and all-cause mortality at 9 years and heart failure hospitalization at 7 years using Cox proportional hazards models and interval development of heart failure (median 8 years' follow-up) using a modified Poisson model. At baseline, 1406 (27%) participants were obese and 1416 (27%) were morbidly obese. With increasing BMI, the cumulative incidence of mortality decreased (P= .007), whereas heart failure increased (P < .001). Heart failure hospitalization was more common among morbidly obese participants (9.0%; 95% confidence interval [CI] 7.6-11.7) than among normal-weight patients (6.3%; 95% CI 4.7-8.4). After risk adjustment, BMI was not associated with mortality. Each 1-point increase in BMI was associated with a 5% increase in the risk of heart failure (hazard ratio 1.05; 95% CI 1.03-1.06; P < .001) and the risk of heart failure hospitalization for BMI greater than 32 kg/m(2) (hazard ratio 1.05; 95% CI 1.03-1.07; P < .001). CONCLUSIONS Obesity and morbid obesity were common in a community sample of African Americans, and both were associated with increased heart failure and heart failure hospitalization.
Collapse
|
8
|
Mentz RJ, Greiner MA, DeVore AD, Dunlay SM, Choudhary G, Ahmad T, Khazanie P, Randolph TC, Griswold ME, Eapen ZJ, O'Brien EC, Thomas KL, Curtis LH, Hernandez AF. Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study. Circ Heart Fail 2014; 8:243-51. [PMID: 25550439 DOI: 10.1161/circheartfailure.114.001729] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. METHODS AND RESULTS We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. CONCLUSIONS QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.
Collapse
Affiliation(s)
- Robert J Mentz
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
| | - Melissa A Greiner
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Adam D DeVore
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Shannon M Dunlay
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Gaurav Choudhary
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Tariq Ahmad
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Prateeti Khazanie
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Tiffany C Randolph
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Michael E Griswold
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Zubin J Eapen
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Emily C O'Brien
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Kevin L Thomas
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Lesley H Curtis
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Adrian F Hernandez
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| |
Collapse
|
9
|
Heart failure with preserved ejection fraction in African Americans: The ARIC (Atherosclerosis Risk In Communities) study. JACC-HEART FAILURE 2014; 1:156-63. [PMID: 23671819 DOI: 10.1016/j.jchf.2013.01.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES In an entirely African-American cohort, we compared clinical characteristics, cardiac structure and function, and all-cause mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF) in relation to patients with heart failure with reduced ejection fraction (HFrEF) and those without HF. BACKGROUND African Americans are at increased risk for HF. Nevertheless, there are limited phenotypic and prognostic data in African Americans with HFpEF compared with those with HFrEF and those without HF. METHODS Middle-aged African Americans from the Jackson, Mississippi, cohort of the ARIC (Atherosclerosis Risk In Communities) study (n = 2,445) underwent echocardiography between 1993 and 1995. HF prevalence was available in 1,962 patients for whom left ventricular ejection fraction (LVEF) could be quantified. Participants with HF were categorized as having HFpEF (LVEF ≥50%), HFrEF (LVEF <50%), or no HF, with comparisons made between groups. RESULTS HF was identified in 116 (5.9%) participants (HFpEF n = 85 [73%]; HFrEF n = 31 [27%]). Compared with those without HF, those with HFpEF were older, were more likely to be female, and had more frequent comorbidities and concentric hypertrophy. In relation to HFrEF, those with HFpEF were more likely to be female but less likely to have coronary heart disease, diabetes mellitus, chronic kidney disease, left atrial enlargement, and eccentric hypertrophy. Over a median 13.7 years of follow-up, risk of death differed between groups, with age- and sex-adjusted hazard ratios of 1.51 (95% confidence interval: 1.01 to 2.25) for HFpEF versus those without HF and 2.50 (95% confidence interval: 1.37 to 4.58) for HFrEF versus HFpEF. CONCLUSIONS In this cohort of middle-aged African Americans, HFpEF was the most common form of HF and was associated with a substantially better prognosis than HFrEF but worse than those without HF.
Collapse
|
10
|
Titze S, Schmid M, Köttgen A, Busch M, Floege J, Wanner C, Kronenberg F, Eckardt KU. Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohort. Nephrol Dial Transplant 2014; 30:441-51. [PMID: 25271006 DOI: 10.1093/ndt/gfu294] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A main challenge for targeting chronic kidney disease (CKD) is the heterogeneity of its causes, co-morbidities and outcomes. Patients under nephrological care represent an important reference population, but knowledge about their characteristics is limited. METHODS We enrolled 5217 carefully phenotyped patients with moderate CKD [estimated glomerular filtration rate (eGFR) 30-60 mL/min per 1.73 m(2) or overt proteinuria at higher eGFR] under routine care of nephrologists into the German Chronic Kidney Disease (GCKD) study, thereby establishing the currently worldwide largest CKD cohort. RESULTS The cohort has 60% men, a mean age (±SD) of 60 ± 12 years, a mean eGFR of 47 ± 17 mL/min per 1.73 m(2) and a median (IQR) urinary albumin/creatinine ratio of 51 (9-392) mg/g. Assessment of causes of CKD revealed a high degree of uncertainty, with the leading cause unknown in 20% and frequent suspicion of multifactorial pathogenesis. Thirty-five per cent of patients had diabetes, but only 15% were considered to have diabetic nephropathy. Cardiovascular disease prevalence was high (32%, excluding hypertension); prevalent risk factors included smoking (59% current or former smokers) and obesity (43% with BMI >30). Despite widespread use of anti-hypertensive medication, only 52% of the cohort had an office blood pressure <140/90 mmHg. Family histories for cardiovascular events (39%) and renal disease (28%) suggest familial aggregation. CONCLUSIONS Patients with moderate CKD under specialist care have a high disease burden. Improved diagnostic accuracy, rigorous management of risk factors and unravelling of the genetic predisposition may represent strategies for improving prognosis.
Collapse
Affiliation(s)
- Stephanie Titze
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, FAU, Erlangen, Germany
| | - Matthias Schmid
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany Department of Medical Biometry, Informatics, and Epidemiology, (IMBIE), University of Bonn, Bonn, Germany
| | - Anna Köttgen
- Division of Nephrology, University of Freiburg, Freiburg, Germany
| | - Martin Busch
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, FAU, Erlangen, Germany
| | | |
Collapse
|
11
|
Gupta DK, Skali H, Claggett B, Kasabov R, Cheng S, Shah AM, Loehr LR, Heiss G, Nambi V, Aguilar D, Wruck LM, Matsushita K, Folsom AR, Rosamond WD, Solomon SD. Heart failure risk across the spectrum of ankle-brachial index: the ARIC study (Atherosclerosis Risk In Communities). JACC-HEART FAILURE 2014; 2:447-54. [PMID: 25194293 DOI: 10.1016/j.jchf.2014.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to describe the relationship between ankle brachial index (ABI) and the risk for heart failure (HF). BACKGROUND The ABI is a simple, noninvasive measure associated with atherosclerotic cardiovascular disease and death; however, the relationship between ABI and risk for HF is less well characterized. METHODS Between 1987 and 1989 in the ARIC (Atherosclerosis Risk In Communities) study, an oscillometric device was used to measure blood pressure in a single upper and randomly chosen lower extremity to determine the ABI. Incident HF events were defined by the first hospitalization with an International Classification of Diseases, Ninth Revision, code of 428.x through 2008. The risk for HF was assessed across the ABI range using restricted cubic splines and Cox proportional hazards models. RESULTS ABI was available in 13,150 participants free from prevalent HF. Over a mean 17.7 years of follow-up, 1,809 incident HF events occurred. After adjustment for traditional HF risk factors, prevalent coronary heart disease, subclinical carotid atherosclerosis, and interim myocardial infarction, compared with an ABI of 1.01 to 1.40, participants with ABIs ≤0.90 were at increased risk for HF (hazard ratio: 1.40; 95% confidence interval: 1.12 to 1.74), as were participants with ABIs of 0.91 to 1.00 (hazard ratio: 1.36; 95% confidence interval: 1.17 to 1.59). CONCLUSIONS In a middle-age community cohort, an ABI ≤1.00 was significantly associated with an increased risk for HF, independent of traditional HF risk factors, prevalent coronary heart disease, carotid atherosclerosis, and interim myocardial infarction. Low ABI may reflect not only overt atherosclerosis but also pathologic processes in the development of HF beyond epicardial atherosclerotic disease and myocardial infarction alone. A low ABI, as a simple, noninvasive measure, may be a risk marker for HF.
Collapse
Affiliation(s)
- Deepak K Gupta
- Vanderbilt Heart and Vascular Institute, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Hicham Skali
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Claggett
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rumen Kasabov
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amil M Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura R Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Vijay Nambi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - David Aguilar
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Lisa Miller Wruck
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Agarwal SK, Alonso A, Whelton SP, Soliman EZ, Rose KM, Chamberlain AM, Simpson RJ, Coresh J, Heiss G. Orthostatic change in blood pressure and incidence of atrial fibrillation: results from a bi-ethnic population based study. PLoS One 2013; 8:e79030. [PMID: 24244409 PMCID: PMC3823988 DOI: 10.1371/journal.pone.0079030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/17/2013] [Indexed: 01/09/2023] Open
Abstract
Background Autonomic fluctuations are associated with the initiation and possibly maintenance of atrial fibrillation (AF). However, little is known about the relationship between orthostatic blood pressure change, a common manifestation of autonomic dysfunction, and incident AF. Methods We examined whether supine-to-standing changes in systolic blood pressure (SBP) are associated with incident AF in 12,071 African American and white men and women aged 45–64 years, enrolled in the Atherosclerosis Risks in Communities (ARIC) study. Orthostatic hypotension (OH) was defined as a supine-standing drop in SBP by ≥20 mmHg or diastolic blood pressure by ≥10 mmHg. AF cases were identified based on study scheduled 12-lead ECG, hospital discharge ICD codes, and death certificates through 2009. Results OH was seen in 603 (5%) at baseline. During an average follow-up of 18.1 years, 1438 (11.9%) study participants developed AF. Incident AF occurred more commonly among those with OH than those without, a rate of 9.3 vs. 6.3 per 1000 person years, (p<0.001). The age, gender, and race adjusted hazard ratio (95%CI) of AF among those with OH compared to those without was 1.62 (1.34, 2.14). This association was attenuated after adjustment for common AF risk factors to HR 1.40 (1.15, 1.71), a strength similar to that of diabetes or hypertension with AF in the same model. A non-linear relationship between orthostatic change in SBP and incident AF was present after multivariable adjustment. Conclusions OH is associated with higher AF incidence. Whether interventions that decrease OH can reduce AF risk remains unknown.
Collapse
Affiliation(s)
- Sunil K. Agarwal
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Seamus P. Whelton
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elsayed Z. Soliman
- Department of Epidemiology and Prevention EpiCare, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Kathryn M. Rose
- Department of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Alanna M. Chamberlain
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ross J. Simpson
- Department of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Josef Coresh
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Gerardo Heiss
- Department of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
13
|
Oluleye OW, Folsom AR, Nambi V, Lutsey PL, Ballantyne CM. Troponin T, B-type natriuretic peptide, C-reactive protein, and cause-specific mortality. Ann Epidemiol 2012; 23:66-73. [PMID: 23228375 DOI: 10.1016/j.annepidem.2012.11.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/02/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We sought to evaluate the associations of high-sensitivity troponin T (Hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high sensitivity C-reactive protein (Hs-CRP) with mortality from any cause, cardiovascular disease (CVD), coronary heart disease (CHD), stroke, cancer, and respiratory disease in the Atherosclerosis Risk in Communities cohort. METHODS We included 11,193 participants aged 54 to 74 years, initially free of the conditions being studied, and who had biomarkers measured. Participants were followed for a mean of 9.9 years. RESULTS Hazard ratios (HR), adjusted for multiple risk factors, for mortality in participants in the highest Hs-TnT category compared with those with undetectable levels were: Total 3.42 (95% confidence interval [CI], 2.75-4.26); CVD, 7.34 (95% CI, 4.64-11.6); CHD, 6.06 (95% CI, 2.91-12.6); stroke, 3.31 (95% CI, 1.26-8.66); cancer, 1.60 (95% CI, 1.08-2.38); and respiratory, 3.85 (95% CI, 1.39-10.7). Comparing the highest NT-proBNP quintile with those in the lowest quintile, the adjusted HRs for mortality were: Total, 3.05 (95% CI, 2.46-3.77); CVD, 7.48 (95% CI, 4.67-12.0); CHD, 4.07 (95% CI, 2.07-7.98); and stroke, 10.4 (95% CI, 2.26-47.7). Comparing extreme Hs-CRP quintiles, the adjusted HRs for mortality were: Total, 1.61 (95% CI, 1.32-1.97); CVD, 1.76 (95% CI, 1.19-2.62); and respiratory, 3.36 (95% CI, 1.34-8.45). Having multiple markers elevated simultaneously greatly increased cause-specific mortality risks. CONCLUSIONS Greater levels of Hs-TnT, NT-proBNP and Hs-CRP are associated with increased risk of death, not just from CVD, but also from some noncardiovascular causes.
Collapse
Affiliation(s)
- Oludamilola W Oluleye
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
| | | | | | | | | | | |
Collapse
|
14
|
Eckardt KU, Bärthlein B, Baid-Agrawal S, Beck A, Busch M, Eitner F, Ekici AB, Floege J, Gefeller O, Haller H, Hilge R, Hilgers KF, Kielstein JT, Krane V, Köttgen A, Kronenberg F, Oefner P, Prokosch HU, Reis A, Schmid M, Schaeffner E, Schultheiss UT, Seuchter SA, Sitter T, Sommerer C, Walz G, Wanner C, Wolf G, Zeier M, Titze S. The German Chronic Kidney Disease (GCKD) study: design and methods. Nephrol Dial Transplant 2011; 27:1454-60. [PMID: 21862458 DOI: 10.1093/ndt/gfr456] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is increasingly recognized as a global health problem. The conditions leading to CKD, the health impact of CKD and the prognosis differ markedly between affected individuals. In particular, renal failure and cardiovascular mortality are competing risks for CKD patients. Opportunities for targeted intervention are very limited so far and require an improved understanding of the natural course of CKD, of the risk factors associated with various clinical end points and co-morbidities as well as of the underlying pathogenic mechanisms. METHODS The German Chronic Kidney Disease (GCKD) study is a prospective observational national cohort study. It aims to enrol a total of 5000 patients with CKD of various aetiologies, who are under nephrological care, and to follow them for up to 10 years. At the time of enrolment, male and female patients have an estimated glomerular filtration rate (eGFR) of 30-60 mL/min×1.73 m2 or overt proteinuria in the presence of an eGFR>60 mL/min×1.73 m2. Standardized collection of biomaterials, including DNA, serum, plasma and urine will allow identification and validation of biomarkers associated with CKD, CKD progression and related complications using hypothesis-driven and hypothesis-free approaches. Patient recruitment and follow-up is organized through a network of academic nephrology centres collaborating with practising nephrologists throughout the country. CONCLUSIONS The GCKD study will establish one of the largest cohorts to date of CKD patients not requiring renal replacement therapy. Similarities in its design with other observational CKD studies, including cohorts that have already been established in the USA and Japan, will allow comparative and joint analyses to identify important ethnic and geographic differences and to enhance opportunities for identification of relevant risk factors and markers.
Collapse
Affiliation(s)
- Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|