1
|
Patel SS, Winkle P, Faccin A, Nordio F, LeFevre I, Tsoukas CG. An open-label, Phase 3 trial of TAK-003, a live attenuated dengue tetravalent vaccine, in healthy US adults: immunogenicity and safety when administered during the second half of a 24-month shelf-life. Hum Vaccin Immunother 2023; 19:2254964. [PMID: 37846724 PMCID: PMC10583633 DOI: 10.1080/21645515.2023.2254964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023] Open
Abstract
Dengue is caused by a mosquito-transmitted flavivirus. The disease is now endemic to many tropical and subtropical regions, manifesting as approximately 96 million symptomatic cases of dengue each year. Clinical trials have shown TAK-003 (Qdenga®), a live attenuated dengue tetravalent vaccine, to be well-tolerated, immunogenic, and efficacious in adults with no prior exposure to dengue virus infection living in non-endemic regions, as well as in adults and children living in dengue-endemic areas. This open-label, single-arm phase 3 trial (NCT03771963) was conducted in two dengue non-endemic areas of the USA, and it evaluated the immunogenicity and safety of naturally-aged TAK-003 administered to adult participants. Overall, the immunogenicity data from this trial are consistent with those reported from other TAK-003 phase 2 and 3 trials, and the safety data are consistent with the broader integrated safety data analysis. The data show that naturally-aged TAK-003 had a well-tolerated reactogenicity and adverse events profile when administered in the second half of its clinical 24-month shelf-life and that it still elicited an immune response that persisted up to 6 months after the second dose against all four dengue serotypes, with no important safety risks identified during the trial.
Collapse
Affiliation(s)
- Sanjay S. Patel
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Alice Faccin
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Inge LeFevre
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | |
Collapse
|
2
|
Acosta CJ, Diaz C, Nordio F, Han HH, Moss KJ, Bohning K, Kumar P, Liu M, Patel H, Pacciarini F, Mwangi V, Walter E, Powell TD, El Sahly HM, Baldwin WR, Santangelo J, Anderson EJ, Dubin G. Persistence of Immunogenicity of a Purified Inactivated Zika Virus Vaccine Candidate in Healthy Adults: 2 Years of Follow-up Compared With Natural Infection. J Infect Dis 2023; 227:1303-1312. [PMID: 36484441 PMCID: PMC10226659 DOI: 10.1093/infdis/jiac482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND We report 2-year persistence of immune response to Takeda's prophylactic purified formalin-inactivated whole Zika virus vaccine candidate (TAK-426) compared with that observed after natural infection. METHODS A randomized, observer-blind, placebo-controlled, dose-selection, phase 1 trial was conducted in 18-49-year-old adults at 9 centers (7 in the United States, 2 in Puerto Rico) from 13 November 2017 to 24 November 2020. Primary objectives were safety, tolerability, and immunogenicity of 3 increasing doses of TAK-426 administered as 2 doses 28 days apart to flavivirus (FV)-naive and FV-primed adults. Here, we report on safety and persistence of immunity up to 2 years after primary vaccination with 10-μg TAK-426, the highest dose, and compare neutralizing antibody responses with those observed after natural infection. RESULTS TAK-426 at 10-μg had an acceptable safety profile in FV-naive and FV-primed adults up to 24 months after dose 2. Seropositivity for neutralizing antibodies was 100% at 1 year, and 93.8% and 76.2% at 2 years in FV-naive and FV-primed groups, respectively. TAK-426 responses were comparable in magnitude and kinetics with those elicited by natural Zika virus infection. CONCLUSIONS These results support the further clinical development of TAK-426 for both FV-naive and FV-primed populations. CLINICAL TRIALS REGISTRATION NCT03343626.
Collapse
Affiliation(s)
| | - Clemente Diaz
- Puerto Rico Clinical and Translational Research Consortium, San Juan, Puerto Rico
| | | | | | | | | | - Pradeep Kumar
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Mengya Liu
- Takeda Vaccines Inc, Cambridge, Massachusetts, USA
| | - Hetal Patel
- Takeda Vaccines Inc, Cambridge, Massachusetts, USA
| | | | | | - Elke Walter
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Tim D Powell
- Takeda Vaccines Inc, Cambridge, Massachusetts, USA
| | | | | | | | | | - Gary Dubin
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| |
Collapse
|
3
|
LeFevre I, Bravo L, Folschweiller N, Medina EL, Moreira ED, Nordio F, Sharma M, Tharenos LM, Tricou V, Watanaveeradej V, Winkle PJ, Biswal S. Bridging the immunogenicity of a tetravalent dengue vaccine (TAK-003) from children and adolescents to adults. NPJ Vaccines 2023; 8:75. [PMID: 37230978 DOI: 10.1038/s41541-023-00670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Immunobridging is an important methodology that can be used to extrapolate vaccine efficacy estimates to populations not evaluated in clinical studies, and that has been successfully used in developing many vaccines. Dengue, caused by a mosquito-transmitted flavivirus endemic to many tropical and subtropical regions, is traditionally thought of as a pediatric disease but is now a global threat to both children and adults. We bridged immunogenicity data from a phase 3 efficacy study of a tetravalent dengue vaccine (TAK-003), performed in children and adolescents living in endemic areas, with an immunogenicity study in adults in non-endemic areas. Neutralizing antibody responses were comparable in both studies following receipt of a two-dose TAK-003 schedule (months 0 and 3). Similar immune responses were observed across exploratory assessments of additional humoral responses. These data support the potential for clinical efficacy of TAK-003 in adults.
Collapse
Affiliation(s)
- Inge LeFevre
- Vaccines Business Unit, Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Lulu Bravo
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Nicolas Folschweiller
- Vaccines Business Unit, Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Eduardo Lopez Medina
- Centro de Estudios en Infectología Pediatrica CEIP; Department of Pediatrics, Universidad Del Valle; Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | | | - Leslie M Tharenos
- The Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Vianney Tricou
- Vaccines Business Unit, Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Veerachai Watanaveeradej
- Department of Pediatrics, Phramongkutklao Hospital and Faculty of Medicine, Kasetsart University, Bangkok, Thailand
| | | | | |
Collapse
|
4
|
Inciardi RM, Giugliano RP, Park JG, Nordio F, Ruff CT, Chen C, Lanz HJ, Antman EM, Braunwald E, Solomon SD. Risks of Heart Failure, Stroke, and Bleeding in Atrial Fibrillation According to Heart Failure Phenotypes. JACC Clin Electrophysiol 2023; 9:569-580. [PMID: 37100536 DOI: 10.1016/j.jacep.2022.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND The risks of heart failure (HF) events compared with stroke/systemic embolic events (SEE) or major bleeding (MB) in heart failure with reduced ejection fraction (HFrEF) vs heart failure with preserved ejection fraction (HFpEF) in a large atrial fibrillation (AF) population have not been well-studied. OBJECTIVES This study sought to assess HF outcomes, according to HF history and HF phenotypes (HFrEF vs HFpEF), and compare these events with SEE and MB, among patients with AF. METHODS We analyzed patients enrolled in the ENGAGE-AF TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in AF-Thrombolysis in Myocardial Infarction 48) trial. Cumulative incidence of heart failure hospitalization (HHF) or HF death was assessed and compared with the rates of fatal and nonfatal stroke/SEE and MB over a median follow-up of 2.8 years. RESULTS Overall, 12,124 (57.4%) had a history of HF (37.7% HFrEF, 40.1% HFpEF, 22.1% with unknown ejection fraction). The rate per 100 person-years (py) of HHF or HF death (4.95; 95% CI: 4.70-5.20) was higher than of fatal and nonfatal stroke/SEE (1.77; 95% CI: 1.63-1.92) and MB (2.66; 95% CI: 2.47-2.86) among patients with HF history. HFrEF patients experienced a higher rate of HHF or HF death compared with HFpEF patients (7.15 vs 3.65; P < 0.001), while the rates of fatal and nonfatal stroke/SEE and MB were similar by HF phenotype. Patients with HF history had a higher rate of mortality after a HHF (1.29; 95% CI: 1.17-1.42) than after a stroke/SEE (0.69; 95% CI: 0.60-0.78) or after MB (0.61; 95% CI: 0.53-0.70). Overall, patients with nonparoxysmal AF had a higher rate of HF and stroke/SEE events regardless of HF history. CONCLUSIONS Patients with AF and HF, regardless of ejection fraction, are at a higher risk of HF events with higher subsequent mortality rates than of stroke/SEE or MB. While HFrEF is associated with a higher risk of HF events than HFpEF, the risk of stroke/SEE and MB is similar between HFrEF and HFpEF.
Collapse
|
5
|
Gencer B, Eisen A, Berger D, Nordio F, Murphy SA, Grip LT, Chen C, Lanz H, Ruff CT, Antman EM, Braunwald E, Giugliano RP. Edoxaban versus Warfarin in high-risk patients with atrial fibrillation: A comprehensive analysis of high-risk subgroups. Am Heart J 2022; 247:24-32. [PMID: 34990581 DOI: 10.1016/j.ahj.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND To compare the efficacy and safety of edoxaban vs warfarin in high-risk subgroups. METHODS ENGAGE AF-TIMI 48 was a multicenter randomized, double-blind, controlled trial in 21,105 patients with atrial fibrillation (AF) within 12 months and CHADS2 score >2 randomized to higher-dose edoxaban regimen (HDER) 60 mg/reduced 30 mg, lower-dose edoxaban regimen (LDER) 30 mg/reduced 15 mg, or warfarin, and followed for 2.8 years (median). The primary outcome for this analysis was the net clinical outcome (NCO), a composite of stroke/systemic embolism events, major bleeding, or death. Multivariable risk-stratification analysis was used to categorize patients by the number of high-risk features. RESULTS The annualized NCO rates in the warfarin arm were highest in patients with malignancy (19.2%), increased fall risk (14.0%), and very-low body weight (13.5%). The NCO rates increased with the numbers of high-risk factors in the warfarin arm: 4.5%, 7.2%, 9.9% and 14.6% in patients with 0 to 1, 2, 3, and >4 risk factors, respectively (Ptrend <0.001). Versus warfarin, HDER was associated with significant reductions of NCO in most of the subgroups: elderly, patients with moderate renal dysfunction, prior stroke/TIA, of Asian race, very-low body weight, concomitant single antiplatelet therapy, and VKA-naïve. With more high-risk features (0->4+), the absolute risk reductions favoring edoxaban over warfarin increased: 0.3%->2.0% for HDER; 0.4%->3.4% for LDER vs warfarin (P = .065 and P < .001, respectively). CONCLUSIONS While underuse of anticoagulation in high-risk patients with AF remains common, substitution of effective and safer alternatives to warfarin, such as edoxaban, represents an opportunity to improve clinical outcomes.
Collapse
Affiliation(s)
- Baris Gencer
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA; Cardiology Division, Geneva University Hospitals, Geneva, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Alon Eisen
- Cardiology Department, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Berger
- Cardiology Department, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA
| | - Laura T Grip
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Hans Lanz
- Daiichi Sankyo Europe GmbH, Munich, Germany
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA
| | - Elliott M Antman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA.
| |
Collapse
|
6
|
Marston NA, Patel PN, Kamanu FK, Nordio F, Melloni GM, Roselli C, Gurmu Y, Weng LC, Bonaca MP, Giugliano RP, Scirica BM, O'Donoghue ML, Cannon CP, Anderson CD, Bhatt DL, Gabriel Steg P, Cohen M, Storey RF, Sever P, Keech AC, Raz I, Mosenzon O, Antman EM, Braunwald E, Ellinor PT, Lubitz SA, Sabatine MS, Ruff CT. Clinical Application of a Novel Genetic Risk Score for Ischemic Stroke in Patients With Cardiometabolic Disease. Circulation 2020; 143:470-478. [PMID: 33185476 DOI: 10.1161/circulationaha.120.051927] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genome-wide association studies have identified single-nucleotide polymorphisms that are associated with an increased risk of stroke. We sought to determine whether a genetic risk score (GRS) could identify subjects at higher risk for ischemic stroke after accounting for traditional clinical risk factors in 5 trials across the spectrum of cardiometabolic disease. METHODS Subjects who had consented for genetic testing and who were of European ancestry from the ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation), SOLID-TIMI 52 (Stabilization of Plaques Using Darapladib), SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus), PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin), and FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk) trials were included in this analysis. A set of 32 single-nucleotide polymorphisms associated with ischemic stroke was used to calculate a GRS in each patient and identify tertiles of genetic risk. A Cox model was used to calculate hazard ratios for ischemic stroke across genetic risk groups, adjusted for clinical risk factors. RESULTS In 51 288 subjects across the 5 trials, a total of 960 subjects had an ischemic stroke over a median follow-up period of 2.5 years. After adjusting for clinical risk factors, a higher GRS was strongly and independently associated with increased risk for ischemic stroke (P trend=0.009). In comparison with individuals in the lowest third of the GRS, individuals in the middle and top tertiles of the GRS had adjusted hazard ratios of 1.15 (95% CI, 0.98-1.36) and 1.24 (95% CI 1.05-1.45) for ischemic stroke, respectively. Stratification into subgroups revealed that the performance of the GRS appeared stronger in the primary prevention cohort with an adjusted hazard ratio for the top versus lowest tertile of 1.27 (95% CI, 1.04-1.53), in comparison with an adjusted hazard ratio of 1.06 (95% CI, 0.81-1.41) in subjects with previous stroke. In an exploratory analysis of patients with atrial fibrillation and CHA2DS2-VASc score of 2, high genetic risk conferred a 4-fold higher risk of stroke and an absolute risk equivalent to those with CHA2DS2-VASc score of 3. CONCLUSIONS Across a broad spectrum of subjects with cardiometabolic disease, a 32-single-nucleotide polymorphism GRS was a strong, independent predictor of ischemic stroke. In patients with atrial fibrillation but lower CHA2DS2-VASc scores, the GRS identified patients with risk comparable to those with higher CHA2DS2-VASc scores.
Collapse
Affiliation(s)
- Nicholas A Marston
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Parth N Patel
- Department of Medicine (P.N.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Frederick K Kamanu
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Francesco Nordio
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Takeda Pharmaceuticals, Cambridge, MA (F.N.)
| | - Giorgio M Melloni
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., L.-C.W., P.T.E., S.A.L.)
| | - Yared Gurmu
- US Food and Drug Administration, Silver Spring, MD (Y.G.)
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., L.-C.W., P.T.E., S.A.L.)
| | | | - Robert P Giugliano
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin M Scirica
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michelle L O'Donoghue
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher P Cannon
- Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Deepak L Bhatt
- Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Marc Cohen
- Newark Beth Israel Medical Center, NJ (M.C.)
| | - Robert F Storey
- University of Sheffield Medical School, United Kingdom (R.F.S.)
| | - Peter Sever
- Imperial College London, United Kingdom (P.S.)
| | | | - Itamar Raz
- Hebrew University Hospital, Jerusalem, Israel (I.R., O.M.)
| | - Ofri Mosenzon
- Hebrew University Hospital, Jerusalem, Israel (I.R., O.M.)
| | - Elliott M Antman
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., L.-C.W., P.T.E., S.A.L.)
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., L.-C.W., P.T.E., S.A.L.)
| | - Marc S Sabatine
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christian T Ruff
- TIMI Study Group, Boston, MA (N.A.M., F.K.K., F.N., G.M.M., R.P.G., B.M.S., M.L.O'D., E.M.A., E.B., M.S.S., C.T.R.).,Division of Cardiovascular Medicine (N.A.M., F.K.K., F.N., G.M.M., R.P.G, B.M.S., M.L.O'D., C.P.C., D.L.B., E.M.A., E.B., M.S.S., C.T.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
Li R, Nordio F, Huang CC, Contreras C, Calderon R, Yataco R, Galea JT, Zhang Z, Becerra MC, Lecca L, Murray MB. Two Clinical Prediction Tools to Improve Tuberculosis Contact Investigation. Clin Infect Dis 2020; 71:e338-e350. [PMID: 31905406 PMCID: PMC7643741 DOI: 10.1093/cid/ciz1221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Efficient contact investigation strategies are needed for the early diagnosis of tuberculosis (TB) disease and treatment of latent TB infections. METHODS Between September 2009 and August 2012, we conducted a prospective cohort study in Lima, Peru, in which we enrolled and followed 14 044 household contacts of adults with pulmonary TB. We used information from a subset of this cohort to derive 2 clinical prediction tools that identify contacts of TB patients at elevated risk of progressing to active disease by training multivariable models that predict (1) coprevalent TB among all household contacts and (2) 1-year incident TB among adult contacts. We validated the models in a geographically distinct subcohort and compared the relative utilities of clinical decisions based on these tools to existing strategies. RESULTS In our cohort, 296 (2.1%) household contacts had coprevalent TB and 145 (1.9%) adult contacts developed incident TB within 1 year of index patient diagnosis. We predicted coprevalent disease using information that could be readily obtained at the time an index patient was diagnosed and predicted 1-year incident TB by including additional contact-specific characteristics. The area under the receiver operating characteristic curves for coprevalent TB and incident TB were 0.86 (95% confidence interval [CI], .83-.89]) and 0.72 (95% CI, .67-.77), respectively. These clinical tools give 5%-10% higher relative utilities than existing methods. CONCLUSIONS We present 2 tools that identify household contacts at high risk for TB disease based on reportable information from patient and contacts alone. The performance of these tools is comparable to biomarkers that are both more costly and less feasible than this approach.
Collapse
Affiliation(s)
- Ruoran Li
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Francesco Nordio
- TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Chuan-Chin Huang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | | | - Jerome T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zibiao Zhang
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonid Lecca
- Socios En Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Qamar A, Antman EM, Ruff CT, Nordio F, Murphy SA, Grip LT, Greenberger NJ, Yin OQP, Choi Y, Lanz HJ, Mercuri MF, Braunwald E, Giugliano RP. Edoxaban Versus Warfarin in Patients With Atrial Fibrillation and History of Liver Disease. J Am Coll Cardiol 2020; 74:179-189. [PMID: 31296289 DOI: 10.1016/j.jacc.2019.04.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 03/02/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with liver disease have increased risk of thrombosis and bleeding but are typically excluded from trials of direct oral anticoagulant agents. OBJECTIVES This study evaluated the pharmacokinetics (PK), pharmacodynamics (PD), clinical efficacy and safety of edoxaban versus warfarin in patients with atrial fibrillation (AF) and history of liver disease. METHODS ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction Study 48) was a randomized, double-blind trial comparing edoxaban with warfarin in patients with AF followed for 2.8 years. History of liver disease was defined as investigator-reported liver disease or >2-fold transaminase elevation at randomization. The primary efficacy and safety endpoints of stroke or systemic embolic event (SSEE) and major bleeding were assessed stratified by history of liver disease. PK/PD assessments of edoxaban included endogenous and extrinsic factor Xa activity and edoxaban concentration. RESULTS Among 21,105 patients, 1,083 (5.1%) had a history of liver disease; they had a higher prevalence of many comorbidities. The adjusted risks of SSEE were similar (adjusted hazard ratio [HRadj]: 0.90; 95% confidence interval [CI]: 0.67 to 1.22; p = 0.50), but major bleeding was more common in patients with liver disease (HRadj: 1.38; 95% CI: 1.10 to 1.74; p = 0.005). There were no significant differences in PK/PD assessment of edoxaban in patients with versus without liver disease. The HRs for higher-dose edoxaban versus warfarin for SSEE were 0.86 (95% CI: 0.73 to 1.01) in patients without and 1.11 (95% CI: 0.54 to 2.30) with liver disease (p for interaction [pint] = 0.47), major bleeding 0.80 (95% CI: 0.70 to 0.91) in patients without and 0.91 (95% CI: 0.56 to 1.47) with liver disease (pint = 0.63). There were no significant differences in hepatic adverse events between the 2 treatment groups. CONCLUSIONS Among patients with AF receiving oral anticoagulation, bleeding, but not thromboembolic events, was increased in patients with liver disease. A history of liver disease did not alter the relative efficacy and safety of edoxaban compared with warfarin. Hepatic adverse events were similar between edoxaban and warfarin.
Collapse
Affiliation(s)
- Arman Qamar
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. https://twitter.com/AqamarMD
| | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. https://twitter.com/eantman
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sabina A Murphy
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura T Grip
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Norton J Greenberger
- Gastroenterology, Hepatology, and Endoscopy Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ophelia Q P Yin
- Daiichi-Sankyo Pharma Development, Basking Ridge, New Jersey
| | - Youngsook Choi
- Daiichi-Sankyo Pharma Development, Basking Ridge, New Jersey
| | - Hans J Lanz
- Daiichi-Sankyo Pharma Development, Basking Ridge, New Jersey
| | | | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
9
|
Berg DD, Ruff CT, Jarolim P, Giugliano RP, Nordio F, Lanz HJ, Mercuri MF, Antman EM, Braunwald E, Morrow DA. Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients With Atrial Fibrillation in ENGAGE AF-TIMI 48. Circulation 2019; 139:760-771. [PMID: 30586727 DOI: 10.1161/circulationaha.118.038312] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The ABC (age, biomarker, clinical history)-stroke and ABC-bleeding risk scores incorporate clinical variables and cardiovascular biomarkers to estimate risk of stroke or systemic embolic events and bleeding, respectively, in patients with atrial fibrillation. These scores have been proposed for routine clinical use, but their performance in external cohorts remains uncertain. METHODS ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) was a multinational randomized trial of the oral factor Xa inhibitor edoxaban in patients with atrial fibrillation and a CHADS2 score ≥2. We performed a nested prospective biomarker study in 8705 patients, analyzing baseline high-sensitivity troponin T (hsTnT), NT-proBNP (N-terminal B-type natriuretic peptide), and growth differentiation factor-15 (GDF-15), as well as in serial samples after 12 months. The ABC-stroke (age, prior stroke/transient ischemic attack, hsTnT, NT-proBNP) and ABC-bleeding (age, prior bleeding, hemoglobin, hsTnT, and GDF-15) scores were tested. Hazard ratios were adjusted for estimated glomerular filtration rate and the components of the CHA2DS2-VASc and HAS-BLED scores, respectively. Discrimination and reclassification were compared with these established scores. RESULTS Median baseline hsTnT, NT-proBNP, and GDF-15 levels were 13.7 ng/L (25th-75th percentiles, 9.6-20.4 ng/L), 811 pg/mL (386-1436 pg/mL), and 1661 pg/mL (1179-2427 pg/mL), respectively. Elevated hsTnT, NT-proBNP, and GDF-15 were independently associated with higher rates of stroke or systemic embolic events, and elevated hsTnT and GDF-15 were independently associated with higher rates of major bleeding ( P<0.001 for each). The ABC-stroke and ABC-bleeding scores were well calibrated and yielded higher c indexes than the CHA2DS2-VASc score for stroke or systemic embolic events (0.67 [95% CI, 0.65-0.70] versus 0.59 [95% CI, 0.57-0.62]; P<0.001) and HAS-BLED score for major bleeding (0.69 [95% CI, 0.66-0.71] versus 0.62 [95% CI, 0.60-0.64]; P<0.001), respectively. The ABC-stroke and ABC-bleeding scores stratified patients within CHA2DS2-VASc and HAS-BLED risk categories ( P<0.001 for both). Patients with ABC-bleeding scores predicting a high 1-year risk of bleeding (>2%) derived greater benefit from treatment with edoxaban compared with warfarin. CONCLUSIONS The ABC-stroke and ABC-bleeding scores evaluated in this anticoagulated clinical trial cohort were well calibrated and outperformed the CHA2DS2-VASc and HAS-BLED scores, respectively. These scores may help identify patients most likely to derive a benefit from treatment with non-vitamin K antagonist oral anticoagulants. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00781391.
Collapse
Affiliation(s)
- David D Berg
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Petr Jarolim
- Department of Pathology (P.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Department of Medicine (D.D.B., C.T.R., R.P.G., F.N., E.M.A., E.B., D.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Marston NA, Kamanu FK, Nordio F, Gurmu Y, Roselli C, Sever PS, Pedersen TR, Keech AC, Wang H, Lira Pineda A, Giugliano RP, Lubitz SA, Ellinor PT, Sabatine MS, Ruff CT. Predicting Benefit From Evolocumab Therapy in Patients With Atherosclerotic Disease Using a Genetic Risk Score: Results From the FOURIER Trial. Circulation 2019; 141:616-623. [PMID: 31707849 DOI: 10.1161/circulationaha.119.043805] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The ability of a genetic risk score to predict risk in established cardiovascular disease and identify individuals who derive greater benefit from PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition has not been established. METHODS We studied 14 298 patients with atherosclerotic cardiovascular disease from the FOURIER trial (Further Cardiovascular Outcomes Researh With PCSK9 Inhibition in Subjects With Elevated Risk). A 27-single-nucleotide polymorphism genetic risk score defined low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk. Patients were also categorized by major atherosclerotic risk factors including diabetes mellitus, hypertension, low-density lipoprotein cholesterol ≥100 mg/dl, and smoking; multiple (≥2) risk factors was considered high clinical risk. Outcomes consisted of major coronary events (coronary heart death, myocardial infarction, or coronary revascularization) and major vascular events (major coronary events and ischemic stroke). Median follow-up was 2.3 years. RESULTS After we adjusted for clinical factors, the genetic risk score was associated with risk for both major vascular events (Ptrend=0.005) and major coronary events (Ptrend<0.0001). Individuals with intermediate and high genetic risk scores had 1.23- and 1.65-fold increased hazard for major coronary events, respectively. Elevated genetic risk was additive to major atherosclerotic risk factors and identified patients more likely to benefit from evolocumab. There was no benefit for major vascular events in patients without multiple clinical risk factors or high genetic risk (hazard ratio [HR], 1.02; absolute risk reduction [ARR], -0.2%, P=0.86). In contrast, there was a 13% relative risk reduction (HR, 0.87 [0.75-0.998], P=0.047) and a 1.4% ARR in patients with multiple clinical risk factors but without high genetic risk and a 31% relative risk reduction (HR, 0.69 [0.55-0.86], P=0.0012), and 4.0% ARR in patients with high genetic risk, irrespective of clinical risk (Ptrend for HR=0.017, ARR Ptrend=0.004). Patients with high genetic risk who received evolocumab had event rates similar to patients with a low burden of both genetic and clinical risk. CONCLUSION Patients without multiple clinical risk factors or high genetic risk had a low event rate and did not appear to derive benefit from evolocumab over 2.3 years. Conversely, patients with multiple clinical risk factors but without high genetic risk had intermediate risk and intermediate risk reduction. Patients with high genetic risk, regardless of clinical risk, had a high event rate and derived the greatest relative and absolute benefit from evolocumab, which mitigated this risk.
Collapse
Affiliation(s)
- Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| | - Frederick K Kamanu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| | - Yared Gurmu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.).,University Medical Center Groningen, University of Groningen, the Netherlands (C.R.)
| | - Peter S Sever
- National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.)
| | - Terje R Pedersen
- Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.)
| | - Anthony C Keech
- Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.)
| | - Huei Wang
- Amgen, Thousand Oaks, CA (H.W., A.L.P.)
| | | | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.).,Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.).,Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.)
| |
Collapse
|
11
|
Inciardi RM, Giugliano R, Nordio F, Ruff C, Antman E, Rutman H, Braunwald E, Solomon SD. P3526Heart Failure hospitalization and mortality in non-valvular Atrial Fibrillation: The ENGAGE-AF TIMI 48 Trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Atrial Fibrillation (AF) is associated with increased risk of cardiovascular (CV) morbidity and mortality. Heart Failure (HF) represents the most common CV complication, more common than thromboembolic events.
Purpose
We aimed to determine clinical factors associated with HF hospitalization and mortality in a contemporary cohort of patients with AF without previous history of HF.
Methods
The Effective Anticoagulation with Factor Xa Next Generation in AF–Thrombolysis in Myocardial Infarction 48 (ENGAGE-AF TIMI 48) study tested the oral factor Xa inhibitor edoxaban in comparison with warfarin for the prevention of stroke or systemic embolism, in 21,105 patients with AF. We assessed the composite endpoint of HF hospitalization, death due to HF or sudden cardiac death in 8981 patients without a history of HF. Cox proportional hazard models were used to evaluate the significant clinical predictors associated with the endpoint of interest.
Results
Over a median follow-up of 2.8 years, 589 patients (6.5%) experienced the composite endpoint. Older patients, cardiovascular risk factors (hypertension, diabetes, heart valve disease), history of stroke and coronary artery disease, impaired renal function (ClCr ≤50 ml/min), heart rate at baseline and diuretic use were associated with increased risk of the composite endpoint (model c-statistic 0.66) (Figure 1). Outcomes were not affected by randomization to edoxaban or warfarin. In patients with available cardiac-derived biomarkers, elevated levels of both NT-proBNP and Troponin I were significantly associated with the endpoint after adjustment for the clinical predictors (Figure 1). The addition of the biomarkers to clinical predictors enhanced risk estimation (c-statistics 0.69, NRI 0.40, IDI 0.01, all p<0.001 for NT-proBNP and c-statistics 0.70, NRI 0.43, IDI 0.03, all p<0.001 for Troponin I).
Figure 1
Conclusions
HF hospitalization and mortality are important complications in AF patients without a history of HF. The addition of cardiac biomarkers to clinical characteristics enhances risk estimation. These findings may improve risk stratification.
Collapse
Affiliation(s)
- R M Inciardi
- Brigham and Womens Hospital, Boston, United States of America
| | - R Giugliano
- Brigham and Womens Hospital, Boston, United States of America
| | - F Nordio
- Brigham and Womens Hospital, Boston, United States of America
| | - C Ruff
- Brigham and Womens Hospital, Boston, United States of America
| | - E Antman
- Brigham and Womens Hospital, Boston, United States of America
| | - H Rutman
- Daiichi Sankyo, Inc., Global Clinical Development Department, Basking Ridge, United States of America
| | - E Braunwald
- Brigham and Womens Hospital, Boston, United States of America
| | - S D Solomon
- Brigham and Womens Hospital, Boston, United States of America
| |
Collapse
|
12
|
Bergmark BA, Kamphuisen PW, Wiviott SD, Ruff CT, Antman EM, Nordio F, Kuder JF, Mercuri MF, Lanz HJ, Braunwald E, Giugliano RP. Comparison of Events Across Bleeding Scales in the ENGAGE AF-TIMI 48 Trial. Circulation 2019; 140:1792-1801. [PMID: 31597460 DOI: 10.1161/circulationaha.119.041346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Numerous scales exist for the classification of major bleeding events. Limited data compare the most commonly used bleeding scales within a single at-risk cohort of patients with atrial fibrillation. Here, we analyze bleeding outcomes according to the ISTH (International Society on Thrombosis and Hemostasis), TIMI (Thrombolysis in Myocardial Infarction), GUSTO (Global Usage of Strategies to Open Occluded Arteries), and BARC (Bleeding Academic Research Consortium) bleeding scales in the ENGAGE AF (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation)-TIMI 48 trial (NCT00781391) of edoxaban versus warfarin. METHODS A total of 21 105 patients with atrial fibrillation at risk for stroke (CHADS2 score ≥2) were enrolled in the ENGAGE AF-TIMI 48 trial comparing warfarin with a higher- (60/30 mg daily) or lower- (30/15 mg daily) dose edoxaban regimen. Median follow-up was 2.8 years. Bleeding events occurring among on-treatment patients were examined. Annualized event rates were calculated by the ISTH, TIMI, GUSTO, and BARC scales and compared across treatment arms. Cox proportional hazards for a first bleeding event of each type were calculated for higher-dose edoxaban regimen vs warfarin and lower-dose edoxaban regimen versus warfarin. RESULTS A total of 10 311 bleeding events were reported. In a comparison of the most severe events in each scale, ISTH major bleeding was the most common (n=1289), followed by TIMI major (n=548), GUSTO severe/life-threatening (n=347), and BARC 3c+5 (n=276) bleeding. Lower bleeding risk with edoxaban compared with warfarin was seen regardless of bleeding scale (higher-dose edoxaban regimen range: hazard ratio [HR], 0.47 [95% CI, 0.35-0.62] for BARC 3c+5 versus HR, 0.80 [95% CI, 0.71-0.91] for ISTH major; lower-dose edoxaban regimen range: HR, 0.32 [95% CI, 0.23-0.45] for BARC 3c+5 versus HR, 0.47 [95% CI, 0.41-0.55] for ISTH major). Furthermore, a gradient of more pronounced risk reduction with edoxaban was observed with greater severity of first bleeding event (higher-dose edoxaban regimen: HR, 0.47 [95% CI, 0.35-0.62] for BARC 3c+5 bleeds versus HR, 0.86 [95% CI, 0.81-0.91] for any BARC bleed; lower-dose edoxaban regimen: HR, 0.32 [95% CI, 0.23-0.45] for BARC 3c+5 bleeds versus HR, 0.68 [95% CI, 0.63-0.72] for any BARC bleed). The direction of this trend was consistent for both gastrointestinal bleeding and nongastrointestinal bleeding. CONCLUSIONS Among patients with atrial fibrillation at risk for stroke, there was a >4-fold difference in the frequency of the most severe bleeding events across commonly used bleeding scales. Furthermore, the relative safety of edoxaban compared with warfarin tended to increase with greater severity of bleeding. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391.
Collapse
Affiliation(s)
- Brian A Bergmark
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | - Pieter W Kamphuisen
- Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands (P.W.K.)
| | - Stephen D Wiviott
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | - Julia F Kuder
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | | | - Hans J Lanz
- Daiichi Sankyo Europe GmbH, Munich, Germany (H.J.L.)
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.A.B., S.D.W., C.T.R., E.M.A., F.N., J.F.K., E.B., R.P.C.)
| |
Collapse
|
13
|
Kessler T, Wolf B, Eriksson N, Kofink D, Mahmoodi BK, Rai H, Tragante V, Åkerblom A, Becker RC, Bernlochner I, Bopp R, James S, Katus HA, Mayer K, Munz M, Nordio F, O’Donoghue ML, Sager HB, Sibbing D, Solakov L, Storey RF, Wobst J, Asselbergs FW, Byrne RA, Erdmann J, Koenig W, Laugwitz KL, ten Berg JM, Wallentin L, Kastrati A, Schunkert H. Association of the coronary artery disease risk gene GUCY1A3 with ischaemic events after coronary intervention. Cardiovasc Res 2019; 115:1512-1518. [DOI: 10.1093/cvr/cvz015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractAimA common genetic variant at the GUCY1A3 coronary artery disease locus has been shown to influence platelet aggregation. The risk of ischaemic events including stent thrombosis varies with the efficacy of aspirin to inhibit platelet reactivity. This study sought to investigate whether homozygous GUCY1A3 (rs7692387) risk allele carriers display higher on-aspirin platelet reactivity and risk of ischaemic events early after coronary intervention.Methods and resultsThe association of GUCY1A3 genotype and on-aspirin platelet reactivity was analysed in the genetics substudy of the ISAR-ASPI registry (n = 1678) using impedance aggregometry. The clinical outcome cardiovascular death or stent thrombosis within 30 days after stenting was investigated in a meta-analysis of substudies of the ISAR-ASPI registry, the PLATO trial (n = 3236), and the Utrecht Coronary Biobank (n = 1003) comprising a total 5917 patients. Homozygous GUCY1A3 risk allele carriers (GG) displayed increased on-aspirin platelet reactivity compared with non-risk allele (AA/AG) carriers [150 (interquartile range 91–209) vs. 134 (85–194) AU⋅min, P < 0.01]. More homozygous risk allele carriers, compared with non-risk allele carriers, were assigned to the high-risk group for ischaemic events (>203 AU⋅min; 29.5 vs. 24.2%, P = 0.02). Homozygous risk allele carriers were also at higher risk for cardiovascular death or stent thrombosis (hazard ratio 1.70, 95% confidence interval 1.08–2.68; P = 0.02). Bleeding risk was not altered.ConclusionWe conclude that homozygous GUCY1A3 risk allele carriers are at increased risk of cardiovascular death or stent thrombosis within 30 days after coronary stenting, likely due to higher on-aspirin platelet reactivity. Whether GUCY1A3 genotype helps to tailor antiplatelet treatment remains to be investigated.
Collapse
Affiliation(s)
- Thorsten Kessler
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Bernhard Wolf
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Daniel Kofink
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | | | - Himanshu Rai
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Vinicius Tragante
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Division of Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, University of Cincinnati Heart, Lung & Vascular Institute, Cincinnati, OH, USA
| | - Isabell Bernlochner
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Roman Bopp
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Division of Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hugo A Katus
- Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universität Heidelberg, and DZHK e.V., Partner Site Heidelberg, Heidelberg, Germany
| | - Katharina Mayer
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Matthias Munz
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
- University Heart Center Lübeck, Lübeck, Germany
- DZHK e.V., Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Charité—University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Periodontology and Synoptic Dentistry, Berlin Institute of Health, Institute for Dental and Craniofacial Sciences, Berlin, Germany
| | | | | | - Hendrik B Sager
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Dirk Sibbing
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Linda Solakov
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Robert F Storey
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jana Wobst
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Folkert W Asselbergs
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Robert A Byrne
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
- University Heart Center Lübeck, Lübeck, Germany
- DZHK e.V., Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Wolfgang Koenig
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jurrien M ten Berg
- Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
14
|
Lei C, Berra L, Rezoagli E, Yu B, Dong H, Yu S, Hou L, Chen M, Chen W, Wang H, Zheng Q, Shen J, Jin Z, Chen T, Zhao R, Christie E, Sabbisetti VS, Nordio F, Bonventre JV, Xiong L, Zapol WM. Nitric Oxide Decreases Acute Kidney Injury and Stage 3 Chronic Kidney Disease after Cardiac Surgery. Am J Respir Crit Care Med 2018; 198:1279-1287. [PMID: 29932345 PMCID: PMC6290943 DOI: 10.1164/rccm.201710-2150oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 06/22/2018] [Indexed: 12/29/2022] Open
Abstract
RATIONALE No medical intervention has been identified that decreases acute kidney injury and improves renal outcome at 1 year after cardiac surgery. OBJECTIVES To determine whether administration of nitric oxide reduces the incidence of postoperative acute kidney injury and improves long-term kidney outcomes after multiple cardiac valve replacement requiring prolonged cardiopulmonary bypass. METHODS Two hundred and forty-four patients undergoing elective, multiple valve replacement surgery, mostly due to rheumatic fever, were randomized to receive either nitric oxide (treatment) or nitrogen (control). Nitric oxide and nitrogen were administered via the gas exchanger during cardiopulmonary bypass and by inhalation for 24 hours postoperatively. MEASUREMENTS AND MAIN RESULTS The primary outcome was as follows: oxidation of ferrous plasma oxyhemoglobin to ferric methemoglobin was associated with reduced postoperative acute kidney injury from 64% (control group) to 50% (nitric oxide group) (relative risk [RR], 0.78; 95% confidence interval [CI], 0.62-0.97; P = 0.014). Secondary outcomes were as follows: at 90 days, transition to stage 3 chronic kidney disease was reduced from 33% in the control group to 21% in the treatment group (RR, 0.64; 95% CI, 0.41-0.99; P = 0.024) and at 1 year, from 31% to 18% (RR, 0.59; 95% CI, 0.36-0.96; P = 0.017). Nitric oxide treatment reduced the overall major adverse kidney events at 30 days (RR, 0.40; 95% CI, 0.18-0.92; P = 0.016), 90 days (RR, 0.40; 95% CI, 0.17-0.92; P = 0.015), and 1 year (RR, 0.47; 95% CI, 0.20-1.10; P = 0.041). CONCLUSIONS In patients undergoing multiple valve replacement and prolonged cardiopulmonary bypass, administration of nitric oxide decreased the incidence of acute kidney injury, transition to stage 3 chronic kidney disease, and major adverse kidney events at 30 days, 90 days, and 1 year. Clinical trial registered with ClinicalTrials.gov (NCT01802619).
Collapse
Affiliation(s)
- Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuele Rezoagli
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Binglan Yu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Shiqiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | - Lihong Hou
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Min Chen
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Wensheng Chen
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | - Hongbing Wang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | - Qijun Zheng
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | - Jie Shen
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhenxiao Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | - Tao Chen
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | - Rong Zhao
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China; and
| | | | | | - Francesco Nordio
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Warren M. Zapol
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Consonni D, Carugno M, De Matteis S, Nordio F, Randi G, Bazzano M, Caporaso NE, Tucker MA, Bertazzi PA, Pesatori AC, Lubin JH, Landi MT. Outdoor particulate matter (PM10) exposure and lung cancer risk in the EAGLE study. PLoS One 2018; 13:e0203539. [PMID: 30216350 PMCID: PMC6157824 DOI: 10.1371/journal.pone.0203539] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Cohort studies in Europe, but not in North-America, showed an association between exposure to outdoor particulate matter with aerodynamic diameter ≤10 μm (PM10) and lung cancer risk. Only a case-control study on lung cancer and PM10 in South Korea has so far been performed. For the first time in Europe we analyzed quantitatively this association using a case-control study design in highly polluted areas in Italy. Methods The Environment And Genetics in Lung cancer Etiology (EAGLE) study, a population-based case-control study performed in the period 2002–2005 in the Lombardy Region, north-west Italy, enrolled 2099 cases and 2120 controls frequency-matched for area of residence, gender, and age. For this study we selected subjects with complete active and passive smoking history living in the same municipality since 1980 until study enrollment. Fine resolution annual PM10 estimates obtained by applying land use regression modeling to satellite data calibrated with fixed site monitor measurements were used. We assigned each subject the PM10 average estimates for year 2000 based on enrollment address. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI) adjusted for matching variables, education, smoking, and dietary and occupational variables. Results We included 3473 subjects, 1665 cases (1318 men, 347 women) and 1808 controls (1368 men, 440 women), with PM10 individual levels ranging from 2.3 to 53.8 μg/m3 (mean: 46.3). We found increasing lung cancer risk with increasing PM10 category (P-value for trend: 0.04). The OR per 10 μg/m3 was 1.28 (95% CI: 0.95–1.72). The association appeared stronger for squamous cell carcinoma (OR 1.44, 95% CI: 0.90–2.29). Conclusion In a population living in highly polluted areas in Italy, our study added suggestive evidence of a positive association between PM10 exposure and lung cancer risk. This study emphasizes the need to strengthen policies to reduce airborne pollution.
Collapse
Affiliation(s)
- Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Michele Carugno
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sara De Matteis
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Giorgia Randi
- European Commission, DG Joint Research Centre, Ispra, Varese, Italy
| | - Martina Bazzano
- Master Program in Cognitive Sciences and Decision Making, Università degli Studi di Milano, Milan, Italy
| | - Neil E. Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States of America
| | - Margaret A. Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States of America
| | - Pier Alberto Bertazzi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Angela C. Pesatori
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Jay H. Lubin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States of America
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States of America
| |
Collapse
|
16
|
Zelniker TA, Ruff CT, Wiviott SD, Blanc JJ, Cappato R, Nordio F, Mercuri MF, Lanz H, Antman EM, Braunwald E, Giugliano RP. Edoxaban in atrial fibrillation patients with established coronary artery disease: Insights from ENGAGE AF–TIMI 48. European Heart Journal: Acute Cardiovascular Care 2018; 8:176-185. [DOI: 10.1177/2048872618790561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: The relative efficacy and safety profile of the oral Factor Xa inhibitor edoxaban compared with warfarin in patients with atrial fibrillation and established coronary artery disease (CAD) has not been analyzed. Materials and methods: In the ENGAGE AF–TIMI 48 trial, two edoxaban regimens were compared with warfarin in 21,105 patients with atrial fibrillation and CHADS2 ⩾2. We analyzed the primary trial endpoints (efficacy: stroke or systemic embolic event, safety: International Society on Thrombosis and Haemostasis major bleeding) in patients with versus without CAD, and used interaction testing to assess for treatment effect modification. Results: The 4510 patients (21.4%) with known CAD were older, more likely male, on aspirin, with lower creatinine clearance and higher CHADS2 and HAS-BLED scores ( p <0.001 for each). Treatment with the higher-dose edoxaban regimen (versus warfarin) in patients with known CAD tended to have a greater reduction in stroke/systemic embolic event compared with patients without CAD (CAD: hazard ratio 0.65 (0.46–0.92) versus no CAD: hazard ratio 0.94 (0.79–1.12), p-INT 0.062) and also in myocardial infarction (CAD: hazard ratio 0.69 (0.49–0.98) versus no CAD: hazard ratio 1.24 (0.89–1.72), p-INT 0.017), while there was a similar reduction in bleeding irrespective of CAD status (hazard ratio 0.81 and 0.80, p-INT 0.97). Presence or absence of CAD did not modify the efficacy or safety profile of the lower-dose edoxaban regimen (versus warfarin). Conclusion: The reduction in ischemic events with the higher-dose edoxaban regimen versus warfarin was greater in patients with CAD, while bleeding was significantly reduced with edoxaban regardless of CAD status. The efficacy and safety profile of the lower-dose edoxaban regimen relative to warfarin was unaffected by CAD status.
Collapse
Affiliation(s)
- Thomas A Zelniker
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | | | - Riccardo Cappato
- Arrhythmia and Electrophysiology Research Center, IRCCS Humanitas Research Center, Milan, Italy
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | | | - Hans Lanz
- Daiichi Sankyo Europe GmbH, München, Germany
| | - Elliott M Antman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
17
|
Fanola CL, Giugliano RP, Ruff CT, Trevisan M, Nordio F, Mercuri MF, Antman EM, Braunwald E. A novel risk prediction score in atrial fibrillation for a net clinical outcome from the ENGAGE AF-TIMI 48 randomized clinical trial. Eur Heart J 2018; 38:888-896. [PMID: 28064150 DOI: 10.1093/eurheartj/ehw565] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/07/2016] [Accepted: 10/31/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The choice between initiating a non-vitamin K antagonist oral anticoagulant (NOAC) and a vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) may be challenging. To assist in this decision, we developed a risk score to identify patients for whom a therapeutic benefit of NOACs over VKA is predicted. Methods and results ENGAGE AF-TIMI 48 was a randomized clinical trial of edoxaban vs. warfarin in 21 105 patients with AF. Cox proportional hazard models identified factors associated with a serious net clinical outcome (NCO) of disabling stroke, life-threatening bleeding, and all-cause mortality in VKA naïve patients from the warfarin arm. These were used to develop an integer risk score. Performance was assessed by C-indices and validation by bootstrapping. Kaplan-Meier analyses were stratified by three score categories and treatment arm. Over a median of 2.7 years, 457 NCO events occurred in 2898 patients with a total person-time of 7549.5 years (6.05%/year). The risk prediction model (C = 0.693) for the NCO was translated into a 17-point integer score, with annualized event rates for the low, intermediate, and high-risk categories in the warfarin arm of 3.5%, 9.9%, and 20.8%, respectively. Therapeutic benefit of higher- and lower-dose edoxaban over warfarin was demonstrated in the high- and intermediate-risk, with equal benefit in the low-risk categories (P-interaction 0.008 and 0.014, respectively). Conclusion In VKA naive patients with AF, the TIMI-AF score can assist in the prediction of a poor composite outcome and guide selection of anticoagulant therapy by identifying a differential clinical benefit with a NOAC or VKA.
Collapse
Affiliation(s)
- Christina L Fanola
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| | - Robert P Giugliano
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| | - Christian T Ruff
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| | - Marco Trevisan
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| | - Francesco Nordio
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| | - Michele F Mercuri
- Daiichi Sankyo Pharma Development 399 Thornall Street, Edison, NJ 08837, USA
| | - Elliott M Antman
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| | - Eugene Braunwald
- Department of Medicine, TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA
| |
Collapse
|
18
|
Aisenberg J, Chatterjee-Murphy P, Friedman Flack K, Weitz JI, Ruff CT, Nordio F, Mercuri MF, Choi Y, Antman EM, Braunwald E, Giugliano RP. Gastrointestinal Bleeding With Edoxaban Versus Warfarin. Circ Cardiovasc Qual Outcomes 2018; 11:e003998. [DOI: 10.1161/circoutcomes.117.003998] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- James Aisenberg
- Department of Medicine, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (J.A., P.C.-M.)
| | - Prapti Chatterjee-Murphy
- Department of Medicine, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY (J.A., P.C.-M.)
| | | | - Jeffrey I. Weitz
- McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada (J.I.W.)
| | - Christian T. Ruff
- TIMI Study Group, Division of Cardiovascular Medicine and Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (C.T.R., F.N., E.M.A., E.B., R.P.G.)
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine and Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (C.T.R., F.N., E.M.A., E.B., R.P.G.)
| | | | - Youngsook Choi
- Daiichi Sankyo Pharma Development, Basking Ridge, NJ (M.F.M., Y.C.)
| | - Elliott M. Antman
- TIMI Study Group, Division of Cardiovascular Medicine and Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (C.T.R., F.N., E.M.A., E.B., R.P.G.)
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine and Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (C.T.R., F.N., E.M.A., E.B., R.P.G.)
| | - Robert P. Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine and Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (C.T.R., F.N., E.M.A., E.B., R.P.G.)
| |
Collapse
|
19
|
Cavallari I, Ruff CT, Nordio F, Deenadayalu N, Shi M, Lanz H, Rutman H, Mercuri MF, Antman EM, Braunwald E, Giugliano RP. Clinical events after interruption of anticoagulation in patients with atrial fibrillation: An analysis from the ENGAGE AF-TIMI 48 trial. Int J Cardiol 2018; 257:102-107. [PMID: 29395361 DOI: 10.1016/j.ijcard.2018.01.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/24/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) who interrupt anticoagulation are at high risk of thromboembolism and death. METHODS AND RESULTS Patients enrolled in the ENGAGE AF-TIMI 48 trial (randomized comparison of edoxaban vs. warfarin) who interrupted study anticoagulant for >3 days were identified. Clinical events (ischemic stroke/systemic embolism, major cardiac and cerebrovascular events [MACCE]) were analyzed from day 4 after interruption until day 34 or study drug resumption. During 2.8 years median follow-up, 13,311 (63%) patients interrupted study drug for >3 days. After excluding those who received open-label anticoagulation during the at-risk window, the population for analysis included 9148 patients. The rates of ischemic stroke/systemic embolism and MACCE post interruption were substantially greater than in patients who never interrupted (15.42 vs. 0.26 and 60.82 vs. 0.36 per 100 patient-years, respectively, padj < .001). Patients who interrupted study drug for an adverse event (44.1% of the cohort), compared to those who interrupted for other reasons, had an increased risk of MACCE (HRadj 2.75; 95% CI 2.02-3.74, p < .0001), but similar rates of ischemic stroke/systemic embolism. Rates of clinical events after interruption of warfarin and edoxaban were similar. CONCLUSION Interruption of study drug was frequent in patients with AF and was associated with a substantial risk of major cardiac and cerebrovascular events over the ensuing 30 days. This risk was particularly high in patients who interrupted as a result of an adverse event; these patients deserve close monitoring and resumption of anticoagulation as soon as it is safe to do so.
Collapse
Affiliation(s)
- Ilaria Cavallari
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Cardiovascular Science, Campus Bio-Medico University of Rome, Rome, Italy
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Naveen Deenadayalu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Minggao Shi
- Daiichi Sankyo Pharma Development, Edison, NJ, United States
| | - Hans Lanz
- Daiichi Sankyo Pharma Development, Edison, NJ, United States
| | | | | | - Elliott M Antman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
20
|
Wang Y, Nordio F, Nairn J, Zanobetti A, Schwartz JD. Accounting for adaptation and intensity in projecting heat wave-related mortality. Environ Res 2018; 161:464-471. [PMID: 29220799 DOI: 10.1016/j.envres.2017.11.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/06/2017] [Accepted: 11/28/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND How adaptation and intensity of heat waves affect heat wave-related mortality is unclear, making health projections difficult. METHODS We estimated the effect of heat waves, the effect of the intensity of heat waves, and adaptation on mortality in 209 U.S. cities with 168 million people during 1962-2006. We improved the standard time-series models by incorporating the intensity of heat waves using excess heat factor (EHF) and estimating adaptation empirically using interactions with yearly mean summer temperature (MST). We combined the epidemiological estimates for heat wave, intensity, and adaptation with the Coupled Model Intercomparison Project Phase 5 (CMIP5) multi-model dataset to project heat wave-related mortality by 2050. RESULTS The effect of heat waves increased with its intensity. Adaptation to heat waves occurred, which was shown by the decreasing effect of heat waves with MST. However, adaptation was lessened as MST increased. Ignoring adaptation in projections would result in a substantial overestimate of the projected heat wave-related mortality (by 277-747% in 2050). Incorporating the empirically estimated adaptation into projections would result in little change in the projected heat wave-related mortality between 2006 and 2050. This differs regionally, however, with increasing mortality over time for cities in the southern and western U.S. but decreasing mortality over time for the north. CONCLUSIONS Accounting for adaptation is important to reduce bias in the projections of heat wave-related mortality. The finding that the southern and western U.S. are the areas that face increasing heat-related deaths is novel, and indicates that more regional adaptation strategies are needed.
Collapse
Affiliation(s)
- Yan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francesco Nordio
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John Nairn
- Australian Bureau of Meteorology, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel D Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
21
|
Carnicelli AP, De Caterina R, Halperin JL, Renda G, Ruff CT, Trevisan M, Nordio F, Mercuri MF, Antman E, Giugliano RP. Edoxaban for the Prevention of Thromboembolism in Patients With Atrial Fibrillation and Bioprosthetic Valves. Circulation 2017; 135:1273-1275. [DOI: 10.1161/circulationaha.116.026714] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anthony P. Carnicelli
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Raffaele De Caterina
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Jonathan L. Halperin
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Giulia Renda
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Christian T. Ruff
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Marco Trevisan
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Francesco Nordio
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Michele F. Mercuri
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Elliott Antman
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| | - Robert P. Giugliano
- From Brigham & Women’s Hospital, Harvard Medical School, Boston, MA (A.P.C.); Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, Chieti, Italy (R.D.C., G.R.); Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (J.L.H.); TIMI Study Group (Thrombolysis in Myocardial Infarction), Boston, MA (C.T.R., M.T., F.N., E.A., R.P.G.); and Daiichi Sankyo Pharma Development, Edison, NJ (M.P.M.)
| |
Collapse
|
22
|
De Caterina R, Renda G, Carnicelli AP, Nordio F, Trevisan M, Mercuri MF, Ruff CT, Antman EM, Braunwald E, Giugliano RP. Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE AF-TIMI 48 Trial. J Am Coll Cardiol 2017; 69:1372-1382. [DOI: 10.1016/j.jacc.2016.12.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/04/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
|
23
|
Eisen A, Ruff CT, Braunwald E, Nordio F, Corbalán R, Dalby A, Dorobantu M, Mercuri M, Lanz H, Rutman H, Wiviott SD, Antman EM, Giugliano RP. Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF-TIMI 48 Trial. J Am Heart Assoc 2016; 5:JAHA.116.003735. [PMID: 27402235 PMCID: PMC5015407 DOI: 10.1161/jaha.116.003735] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 12/11/2022]
Abstract
Background Recent findings suggest that atrial fibrillation is associated with sudden cardiac death (SCD). We examined the incidence, characteristics, and factors associated with SCD in patients with atrial fibrillation. Methods and Results SCD was defined as witnessed death ≤60 minutes from the onset of new symptoms or unwitnessed death 1 to 24 hours after being observed alive, without another known cause of death. Predictors of SCD were examined using multivariate competing risks models. Over 2.8 years (median), 2349 patients died (40.5 per 1000 patient‐years), of which 1668 (71%) were cardiovascular deaths. SCD was the most common cause of cardiovascular death (n=749; median age 73 years; 70.6% male). Most SCD events occurred out of hospital (92.8%) and without prior symptoms (66.0%). Predictors of SCD included low ejection fraction, heart failure, and prior myocardial infarction (P<0.001 for each). Additional significant baseline predictors of SCD, but not of other causes of death, included male sex, electrocardiographic left ventricular hypertrophy, higher heart rate, nonuse of beta blockers, and use of digitalis. The latter was associated with SCD in patients with or without heart failure (adjusted hazard ratio 1.55 [95% CI 1.29–1.86] and 1.56 [95% CI 1.14–2.11], respectively; Pinteraction=0.73). The rate of SCD was numerically but not statistically lower with edoxaban (1.20% per year with lower dose edoxaban; 1.28% per year with higher dose edoxaban) compared with warfarin (1.40% per year). Conclusion SCD is the most common cause of cardiovascular death in patients with atrial fibrillation and has several distinct predictors, some of which are modifiable. These findings may be considered in planning research and treatment strategies for patients with atrial fibrillation. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391.
Collapse
Affiliation(s)
- Alon Eisen
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| | - Ramón Corbalán
- Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Maria Dorobantu
- Emergency Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| | - Elliott M Antman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
24
|
Magnani G, Giugliano RP, Ruff CT, Murphy SA, Nordio F, Metra M, Moccetti T, Mitrovic V, Shi M, Mercuri M, Antman EM, Braunwald E. Efficacy and safety of edoxaban compared with warfarin in patients with atrial fibrillation and heart failure: insights from ENGAGE AF-TIMI 48. Eur J Heart Fail 2016; 18:1153-61. [PMID: 27349698 DOI: 10.1002/ejhf.595] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 01/26/2016] [Revised: 04/28/2016] [Accepted: 05/15/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS In the ENGAGE AF-TIMI 48 trial, edoxaban, a factor Xa inhibitor, was not found to be inferior to warfarin for the prevention of stroke or systemic embolic events (SEE) in patients with atrial fibrillation (AF) and was associated with significantly less bleeding. The higher-dose edoxaban regimen (HDER; 60 mg dose-reduced to 30 mg once daily) has been approved in various countries in Europe, the USA, and Japan. Among patients treated with vitamin K antagonists (VKAs), symptomatic heart failure (HF) is an independent risk factor for lower time-in-therapeutic range, which reduces the efficacy and safety of VKA therapy. We evaluated the efficacy and safety of edoxaban compared with warfarin across the spectrum of HF severity in the ENGAGE AF-TIMI 48 trial. METHODS AND RESULTS Of 14 071 patients randomized to well-controlled warfarin or the HDER, 5926 (42%) had no history of HF, 6344 (45%) were in New York Heart Association (NYHA) class I-II, and 1801 (13%) were in NYHA class III-IV. The efficacy of edoxaban compared with warfarin in preventing stroke/SEE was similar in patients without and with HF regardless of the severity of HF; [HDER vs. warfarin: No-HF: hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.69-1.11; NYHA class I-II: HR 0.88, 95% CI 0.69-1.12; NYHA class III-IV: HR 0.83, 95% CI 0.55-1.25; Pinteraction = 0.97]. Compared with warfarin, HDER was consistently associated with lower risk of major bleeding (No-HF: HR 0.82, 95% CI 0.68-0.99; NYHA class I-II: HR 0.79, 95% CI 0.65-0.96; NYHA class III-IV: HR 0.79, 95% CI 0.54-1.17; Pinteraction = 0.96). CONCLUSION The relative efficacy and safety of HDER compared with well-managed warfarin in AF patients with HF were similar to those without HF.
Collapse
Affiliation(s)
- Giulia Magnani
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| | - Sabina A Murphy
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| | | | | | | | | | | | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA, 02115, USA
| |
Collapse
|
25
|
Kato ET, Giugliano RP, Ruff CT, Koretsune Y, Yamashita T, Kiss RG, Nordio F, Murphy SA, Kimura T, Jin J, Lanz H, Mercuri M, Braunwald E, Antman EM. Efficacy and Safety of Edoxaban in Elderly Patients With Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial. J Am Heart Assoc 2016; 5:JAHA.116.003432. [PMID: 27207971 PMCID: PMC4889207 DOI: 10.1161/jaha.116.003432] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Elderly patients with atrial fibrillation are at higher risk of both ischemic and bleeding events compared to younger patients. In a prespecified analysis from the ENGAGE AF‐TIMI 48 trial, we evaluate clinical outcomes with edoxaban versus warfarin according to age. Methods and Results Twenty‐one thousand one‐hundred and five patients enrolled in the ENGAGE AF‐TIMI 48 trial were stratified into 3 prespecified age groups: <65 (n=5497), 65 to 74 (n=7134), and ≥75 (n=8474) years. Older patients were more likely to be female, with lower body weight and reduced creatinine clearance, leading to higher rates of edoxaban dose reduction (10%, 18%, and 41% for the 3 age groups, P<0.001). Stroke or systemic embolic event (1.1%, 1.8%, and 2.3%) and major bleeding (1.8%, 3.3%, and 4.8%) rates with warfarin increased across age groups (Ptrend<0.001 for both). There were no interactions between age group and randomized treatment in the primary efficacy and safety outcomes. In the elderly (≥75 years), the rates of stroke/systemic embolic event were similar with edoxaban versus warfarin (hazard ratio 0.83 [0.66–1.04]), while major bleeding was significantly reduced with edoxaban (hazard ratio 0.83 [0.70–0.99]). The absolute risk difference in major bleeding (−82 events/10 000 pt‐yrs) and in intracranial hemorrhage (−73 events/10 000 pt‐yrs) both favored edoxaban over warfarin in older patients. Conclusions Age has a greater influence on major bleeding than thromboembolic risk in patients with atrial fibrillation. Given the higher rates of bleeding and death with increasing age, treatment of elderly patients with edoxaban provides an even greater absolute reduction in safety events over warfarin, compared to treatment with edoxaban versus warfarin in younger patients. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00781391.
Collapse
Affiliation(s)
- Eri Toda Kato
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA Tokai University Hospital, Isehara, Japan
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Sabina A Murphy
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
26
|
Renda G, De Caterina R, Carnicelli A, Nordio F, Mercuri M, Ruff C, Giugliano R. OUTCOMES IN 2824 PATIENTS WITH VALVULAR HEART DISEASE TREATED WITH EDOXABAN OR WARFARIN IN THE ENGAGE AF-TIMI 48 TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32195-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
27
|
Plitt A, Ezekowitz MD, De Caterina R, Nordio F, Peterson N, Giugliano RP. Cardioversion of Atrial Fibrillation in ENGAGE AF-TIMI 48. Clin Cardiol 2016; 39:345-6. [PMID: 27028520 DOI: 10.1002/clc.22537] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anna Plitt
- Department of Medicine (Plitt), Sinai Medical Center, New York, New York
| | - Michael D Ezekowitz
- Department of Cardiovascular Medicine (Ezekowitz), Jefferson Medical College, Wynnewood, Pennsylvania
| | - Raffaele De Caterina
- Department of Cardiology (De Caterina), Institute of Cardiology and Center of Excellence on Aging, "G. D'Annunzio" University, Chieti, Italy
| | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital (Nordio, Giugliano), Boston, Massachusetts
| | - Nancy Peterson
- Department of Clinical Development (Peterson), Daiichi Sankyo Pharma Development, Edison, New Jersey
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital (Nordio, Giugliano), Boston, Massachusetts
| | | |
Collapse
|
28
|
Carreras ET, Hochholzer W, Frelinger AL, Nordio F, O'Donoghue ML, Wiviott SD, Angiolillo DJ, Michelson AD, Sabatine MS, Mega JL. Diabetes mellitus, CYP2C19 genotype, and response to escalating doses of clopidogrel. Insights from the ELEVATE-TIMI 56 Trial. Thromb Haemost 2016; 116:69-77. [PMID: 27009617 DOI: 10.1160/th15-12-0981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
Both diabetes mellitus (DM) and carriage of the CYP2C19*2 allele are associated with a reduced response to clopidogrel. The relative contributions of these factors and whether higher clopidogrel doses can overcome both factors remain unknown. The objective of this study was to test the ability of clopidogrel doses up to 300 mg daily to decrease platelet reactivity in patients with DM and/or CYP2C19*2. ELEVATE-TIMI 56 randomised 333 patients with coronary artery disease to different maintenance doses of clopidogrel in four treatment periods, each lasting approximately 14 days. On-treatment platelet reactivity was compared between patients stratified by DM, CYP2C19*2 status and clopidogrel dose. Both DM and CYP2C19*2 were independently associated with elevated on-treatment platelet reactivity with clopidogrel 75 mg daily (p<0.0001 for each). With 75 mg, mean on-treatment PRU was progressively higher (p trend <0.001) when evaluating patients: with neither DM nor CYP2C19*2 (150.7; 95 % CI 140.5-162.6), with only DM (187.2; 95 % CI, 171.3-206.9), with only CYP2C19*2 (227.9; 95 % CI, 205.1-250.8), and with both DM and CYP2C19*2 (239.9; 95 % CI, 209.7-270.1). Notably, with 75 mg, patients with only CYP2C19*2 had higher on-treatment platelet reactivity than those with only DM (p=0.0068). To achieve on-treatment platelet reactivity similar to that seen with clopidogrel 75 mg in patients with neither DM nor CYP2C19*2, the following doses were required: 150 mg with only DM, 225 mg with only CYP2C19*2, and 300 mg with both DM and CYP2C19*2. Patients with both DM and CYP2C19*2 required a four-fold increase in clopidogrel maintenance dose as compared to patients without these factors to achieve a similar antiplatelet response.
Collapse
Affiliation(s)
- Edward T Carreras
- Edward T. Carreras, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA, Tel.: +1 617 732 5500, E-mail:
| | | | | | | | | | | | | | | | - Marc S Sabatine
- Marc S. Sabatine, MD, MPH, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA, E-mail:
| | | |
Collapse
|
29
|
Xu H, Ruff CT, Giugliano RP, Murphy SA, Nordio F, Patel I, Shi M, Mercuri M, Antman EM, Braunwald E. Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF-TIMI48 Trial. J Am Heart Assoc 2016; 5:JAHA.115.002587. [PMID: 26908401 PMCID: PMC4802446 DOI: 10.1161/jaha.115.002587] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background We studied the concomitant use of single antiplatelet therapy (SAPT) on the efficacy and safety of the anti‐Xa agent edoxaban in patients with atrial fibrillation (AF). Methods and Results ENGAGE AF‐TIMI 48 was a randomized trial that compared 2 dose regimens of edoxaban with warfarin. We studied both the approved high‐dose edoxaban regimen (HDER; 60 mg daily reduced by one half in patients with anticipated increased drug exposure), as well as a lower‐dose edoxaban regimen (LDER; 30 mg daily, also reduced by one half in patients with anticipated increased drug regimen). SAPT (aspirin in 92.5%) was administered at the discretion of the treating physician. Cox proportional hazard regressions stratified by SAPT at 3 months with treatment as a covariate were performed. The 4912 patients who received SAPT were more frequently male, with histories of coronary artery disease and diabetes, and had higher CHADS2Vasc and HAS BLED scores than did the 14 977 patients not receiving SAPT. When compared to patients not receiving SAPT, those receiving SAPT had a higher incidence of major bleeding; (adjusted hazard ratio [HRadj]=1.46; 95% CI, 1.27–1.67, P<0.001). SAPT did not alter the relative efficacy of edoxaban compared to warfarin in preventing stroke or systemic embolic events (SEEs): edoxaban versus warfarin without SAPT, hazard ratio (HRadj for HDER)=0.94; (95% CI: 0.77–1.15) with SAPT, HRadj=0.70 (95% CI: 0.50–0.98), P interaction (Pint)=0.14. (HRadj for LDER versus warfarin without SAPT=1.19 (95% CI 0.99–1.43) With SAPT, 1.03 (95% CI, 0.76–1.39) Pint=0.42. Major bleeding was lower with edoxaban than warfarin both without SAPT, HRadj for HDER=0.80 (95% CI, 0.68–0.95), and with SAPT, HRadj=0.82 (95% CI, 0.65–1.03; Pint=0.91). For LDER without SAPT (HRadj=0.56 [95% CI 0.46–0.67]) and with SAPT (HRadj=0.51 [95% CI 0.39–0.66]). Conclusions Patients with AF who were selected by their physicians to receive SAPT in addition to an anticoagulant had a similar risk of stroke/SEE and higher rates of bleeding than those not receiving SAPT. Edoxaban exhibited similar relative efficacy and reduced bleeding compared to warfarin, with or without concomitant SAPT. Clinical Trial Registration URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00781391.
Collapse
Affiliation(s)
- Haiyan Xu
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sabina A Murphy
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Francesco Nordio
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Minggao Shi
- Daiichi Sankyo Pharma Development, Edison, NJ
| | | | - Elliott M Antman
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
30
|
Eisen A, Giugliano RP, Ruff CT, Nordio F, Gogia HS, Awasty VR, Henderson DA, Mercuri MF, Rutman H, Antman EM, Braunwald E. Edoxaban vs warfarin in patients with nonvalvular atrial fibrillation in the US Food and Drug Administration approval population: An analysis from the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) trial. Am Heart J 2016; 172:144-51. [PMID: 26856226 DOI: 10.1016/j.ahj.2015.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Edoxaban is a specific anti-Xa inhibitor that, in comparison to warfarin, has been found to be noninferior for the prevention of stroke or systemic embolism (SSE) and to reduce bleeding significantly in patients with nonvalvular atrial fibrillation (AF). The US Food and Drug Administration (FDA) approved the higher-dose edoxaban regimen (60/30 mg) in patients with AF and a creatinine clearance of ≤95 mL/min. We report for the first time the clinical characteristics, efficacy, and safety of the FDA-approved population in the ENGAGE AF--TIMI 48 trial. METHODS The patients included had been treated with either warfarin or edoxaban 60/30 mg and had a creatinine clearance of ≤95 mL/min. The primary efficacy was SSE, and the principal safety end point was major bleeding (International Society on Thrombosis and Haemostasis classification). Median follow-up was 2.8 years. RESULTS Patients in the FDA-approved cohort were older, were more likely female, and had higher CHADS2 and HAS-BLED scores, as compared with patients not included in the FDA label. The primary end point occurred in 1.63%/y with edoxaban vs 2.02%/y with warfarin (hazard ratio [HR] 0.81, 95% CI 0.67-0.97, P = .023). Edoxaban significantly reduced the rate of hemorrhagic stroke (HR 0.47, 95% CI 0.31-0.72, P < .001) and cardiovascular death (HR 0.84, 95% CI 0.73-0.97, P = .015). Ischemic stroke rates were similar between the treatment groups (1.31%/y vs 1.39%/y, P = .97). Major bleeding was significantly lower with edoxaban (3.16%/y vs 3.77%/y; HR 0.84, 95% CI 0.72-0.98, P = .023). CONCLUSION In the FDA-approved cohort of the ENGAGE AF--TIMI 48 trial, treatment with edoxaban 60/30 mg was superior to warfarin in the prevention of SSE and significantly reduced cardiovascular death and bleeding, especially fatal bleeding and hemorrhagic stroke.
Collapse
|
31
|
Abstract
OBJECTIVE We investigated the prevalence of xerostomia in dental patients and built a xerostomia risk prediction model by incorporating a wide range of risk factors. MATERIALS AND METHODS Socio-demographic data, past medical history, self-reported dry mouth and related symptoms were collected retrospectively from January 2010 to September 2013 for all new dental patients. A logistic regression framework was used to build a risk prediction model for xerostomia. External validation was performed using an independent data set to test the prediction power. RESULTS A total of 12 682 patients were included in this analysis (54.3%, females). Xerostomia was reported by 12.2% of patients. The proportion of people reporting xerostomia was higher among those who were taking more medications (OR = 1.11, 95% CI = 1.08-1.13) or recreational drug users (OR = 1.4, 95% CI = 1.1-1.9). Rheumatic diseases (OR = 2.17, 95% CI = 1.88-2.51), psychiatric diseases (OR = 2.34, 95% CI = 2.05-2.68), eating disorders (OR = 2.28, 95% CI = 1.55-3.36) and radiotherapy (OR = 2.00, 95% CI = 1.43-2.80) were good predictors of xerostomia. For the test model performance, the ROC-AUC was 0.816 and in the external validation sample, the ROC-AUC was 0.799. CONCLUSION The xerostomia risk prediction model had high accuracy and discriminated between high- and low-risk individuals. Clinicians could use this model to identify the classes of medications and systemic diseases associated with xerostomia.
Collapse
Affiliation(s)
- Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Francesco Nordio
- Department of Environmental Health-Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Anita Gohel
- Department of General Dentistry, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| |
Collapse
|
32
|
Kloog I, Melly SJ, Coull BA, Nordio F, Schwartz JD. Using Satellite-Based Spatiotemporal Resolved Air Temperature Exposure to Study the Association between Ambient Air Temperature and Birth Outcomes in Massachusetts. Environ Health Perspect 2015; 123:1053-8. [PMID: 25850104 PMCID: PMC4590741 DOI: 10.1289/ehp.1308075] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/02/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Studies looking at air temperature (Ta) and birth outcomes are rare. OBJECTIVES We investigated the association between birth outcomes and daily Ta during various prenatal exposure periods in Massachusetts (USA) using both traditional Ta stations and modeled addresses. METHODS We evaluated birth outcomes and average daily Ta during various prenatal exposure periods in Massachusetts (USA) using both traditional Ta stations and modeled address Ta. We used linear and logistic mixed models and accelerated failure time models to estimate associations between Ta and the following outcomes among live births > 22 weeks: term birth weight (≥ 37 weeks), low birth weight (LBW; < 2,500 g at term), gestational age, and preterm delivery (PT; < 37 weeks). Models were adjusted for individual-level socioeconomic status, traffic density, particulate matter ≤ 2.5 μm (PM2.5), random intercept for census tract, and mother's health. RESULTS Predicted Ta during multiple time windows before birth was negatively associated with birth weight: Average birth weight was 16.7 g lower (95% CI: -29.7, -3.7) in association with an interquartile range increase (8.4 °C) in Ta during the last trimester. Ta over the entire pregnancy was positively associated with PT [odds ratio (OR) = 1.02; 95% CI: 1.00, 1.05] and LBW (OR = 1.04; 95% CI: 0.96, 1.13). CONCLUSIONS Ta during pregnancy was associated with lower birth weight and shorter gestational age in our study population.
Collapse
Affiliation(s)
- Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | | | | | | |
Collapse
|
33
|
Nordio F, Zanobetti A, Colicino E, Kloog I, Schwartz J. Changing patterns of the temperature-mortality association by time and location in the US, and implications for climate change. Environ Int 2015; 81:80-6. [PMID: 25965185 PMCID: PMC4780576 DOI: 10.1016/j.envint.2015.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 05/20/2023]
Abstract
The shape of the non-linear relationship between temperature and mortality varies among cities with different climatic conditions. There has been little examination of how these curves change over space and time. We evaluated the short-term effects of hot and cold temperatures on daily mortality over six 7-year periods in 211 US cities, comprising over 42 million deaths. Cluster analysis was used to group the cities according to similar temperatures and relative humidity. Temperature-mortality functions were calculated using B-splines to model the heat effect (lag 0) and the cold effect on mortality (moving average lags 1-5). The functions were then combined through meta-smoothing and subsequently analyzed by meta-regression. We identified eight clusters. At lag 0, Cluster 5 (West Coast) had a RR of 1.14 (95% CI: 1.11,1.17) for temperatures of 27 °C vs 15.6 °C, and Cluster 6 (Gulf Coast) has a RR of 1.04 (95% CI: 1.03,1.05), suggesting that people are acclimated to their respective climates. Controlling for cluster effect in the multivariate-meta regression we found that across the US, the excess mortality from a 24-h temperature of 27 °C decreased over time from 10.6% to 0.9%. We found that the overall risk due to the heat effect is significantly affected by summer temperature mean and air condition usage, which could be a potential predictor in building climate-change scenarios.
Collapse
Affiliation(s)
- Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Elena Colicino
- Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Boston, MA, USA.
| |
Collapse
|
34
|
Mega JL, Walker JR, Ruff CT, Vandell AG, Nordio F, Deenadayalu N, Murphy SA, Lee J, Mercuri MF, Giugliano RP, Antman EM, Braunwald E, Sabatine MS. Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial. Lancet 2015; 385:2280-7. [PMID: 25769357 DOI: 10.1016/s0140-6736(14)61994-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Warfarin is the most widely used oral anticoagulant worldwide, but serious bleeding complications are common. We tested whether genetic variants can identify patients who are at increased risk of bleeding with warfarin and, consequently, those who would derive a greater safety benefit with a direct oral anticoagulant rather than warfarin. METHODS ENGAGE AF-TIMI 48 was a randomised, double-blind trial in which patients with atrial fibrillation were assigned to warfarin to achieve a target international normalised ratio of 2·0-3·0, or to higher-dose (60 mg) or lower-dose (30 mg) edoxaban once daily. A subgroup of patients was included in a prespecified genetic analysis and genotyped for variants in CYP2C9 and VKORC1. The results were used to create three genotype functional bins (normal, sensitive, and highly sensitive responders to warfarin). This trial is registered with ClinicalTrials.gov, number NCT00781391. FINDINGS 14,348 patients were included in the genetic analysis. Of 4833 taking warfarin, 2982 (61·7%) were classified as normal responders, 1711 (35·4%) as sensitive responders, and 140 (2·9%) as highly sensitive responders. Compared with normal responders, sensitive and highly sensitive responders spent greater proportions of time over-anticoagulated in the first 90 days of treatment (median 2·2%, IQR 0-20·2; 8·4%, 0-25·8; and 18·3%, 0-32·6; ptrend<0·0001) and had increased risks of bleeding with warfarin (sensitive responders hazard ratio 1·31, 95% CI 1·05-1·64, p=0·0179; highly sensitive responders 2·66, 1·69-4·19, p<0·0001). Genotype added independent information beyond clinical risk scoring. During the first 90 days, when compared with warfarin, treatment with edoxaban reduced bleeding more so in sensitive and highly sensitive responders than in normal responders (higher-dose edoxaban pinteraction=0·0066; lower-dose edoxaban pinteraction=0·0036). After 90 days, the reduction in bleeding risk with edoxaban versus warfarin was similarly beneficial across genotypes. INTERPRETATION CYP2C9 and VKORC1 genotypes identify patients who are more likely to experience early bleeding with warfarin and who derive a greater early safety benefit from edoxaban compared with warfarin. FUNDING Daiichi Sankyo.
Collapse
Affiliation(s)
- Jessica L Mega
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Naveen Deenadayalu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James Lee
- Daiichi Sankyo Pharma Development, Edison, NJ, USA
| | | | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elliott M Antman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
35
|
Mega JL, Stitziel NO, Smith JG, Chasman DI, Caulfield M, Devlin JJ, Nordio F, Hyde C, Cannon CP, Sacks F, Poulter N, Sever P, Ridker PM, Braunwald E, Melander O, Kathiresan S, Sabatine MS. Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials. Lancet 2015; 385:2264-2271. [PMID: 25748612 PMCID: PMC4608367 DOI: 10.1016/s0140-6736(14)61730-x] [Citation(s) in RCA: 459] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Genetic variants have been associated with the risk of coronary heart disease. In this study, we tested whether or not a composite of these variants could ascertain the risk of both incident and recurrent coronary heart disease events and identify those individuals who derive greater clinical benefit from statin therapy. METHODS A community-based cohort study (the Malmo Diet and Cancer Study) and four randomised controlled trials of both primary prevention (JUPITER and ASCOT) and secondary prevention (CARE and PROVE IT-TIMI 22) with statin therapy, comprising a total of 48,421 individuals and 3477 events, were included in these analyses. We studied the association of a genetic risk score based on 27 genetic variants with incident or recurrent coronary heart disease, adjusting for traditional clinical risk factors. We then investigated the relative and absolute risk reductions in coronary heart disease events with statin therapy stratified by genetic risk. We combined data from the different studies using a meta-analysis. FINDINGS When individuals were divided into low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk categories, a significant gradient in risk for incident or recurrent coronary heart disease was shown. Compared with the low genetic risk category, the multivariable-adjusted hazard ratio for coronary heart disease for the intermediate genetic risk category was 1·34 (95% CI 1·22-1·47, p<0·0001) and that for the high genetic risk category was 1·72 (1·55-1·92, p<0·0001). In terms of the benefit of statin therapy in the four randomised trials, we noted a significant gradient (p=0·0277) of increasing relative risk reductions across the low (13%), intermediate (29%), and high (48%) genetic risk categories. Similarly, we noted greater absolute risk reductions in those individuals in higher genetic risk categories (p=0·0101), resulting in a roughly threefold decrease in the number needed to treat to prevent one coronary heart disease event in the primary prevention trials. Specifically, in the primary prevention trials, the number needed to treat to prevent one such event in 10 years was 66 in people at low genetic risk, 42 in those at intermediate genetic risk, and 25 in those at high genetic risk in JUPITER, and 57, 47, and 20, respectively, in ASCOT. INTERPRETATION A genetic risk score identified individuals at increased risk for both incident and recurrent coronary heart disease events. People with the highest burden of genetic risk derived the largest relative and absolute clinical benefit from statin therapy. FUNDING National Institutes of Health.
Collapse
Affiliation(s)
- J L Mega
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - N O Stitziel
- Cardiovascular Division, Department of Medicine and Division of Statistical Genomics, Washington University School of Medicine, Saint Louis, MO
| | - J G Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT; Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - D I Chasman
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - M Caulfield
- William Harvey Research Institute, Queen Mary University of London and Barts NIHR CV Biomedical Research Institute, London, United Kingdom
| | | | - F Nordio
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - C Hyde
- Pfizer Research Laboratory, Groton, CT
| | - C P Cannon
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - F Sacks
- Department of Nutrition, Harvard School of Public Health and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - N Poulter
- International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - P Sever
- International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - P M Ridker
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - E Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - O Melander
- Department of Clinical Sciences, Faculty of Medicine, Lund University and Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - S Kathiresan
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT; Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - M S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
36
|
Kloog I, Zanobetti A, Nordio F, Coull BA, Baccarelli AA, Schwartz J. Effects of airborne fine particles (PM2.5 ) on deep vein thrombosis admissions in the northeastern United States. J Thromb Haemost 2015; 13:768-74. [PMID: 25678264 PMCID: PMC4424156 DOI: 10.1111/jth.12873] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Literature relating air pollution exposure to deep vein thrombosis (DVT) and pulmonary embolism (PE), despite biological plausibility, is sparse. No comprehensive study examining associations between both short- and long-term exposure to particulate matter (PM)2.5 and DVT or PE has been published. Using a novel PM2.5 prediction model, we study whether long- and short-term PM2.5 exposure is associated with DVT and PE admissions among elderly across the northeastern United States. METHODS We estimated daily exposure of PM2.5 in each ZIP code. We investigated the long- and short-term effects of PM2.5 on DVT and PE hospital admissions. There were 453,413 DVT and 151,829 PE admissions in the study. For short-term exposure, we performed a case crossover analysis matching month and year and defined the hazard period as lag 01 (exposure of day of admission and previous day). For the long-term association, we used a Poisson regression. RESULTS A 10-μg m(-3) increase in short-term exposure was associated with a 0.63% increase in DVT admissions (95% confidence interval [CI] = 0.03% to 1.25%) and a 6.98% (95% CI = 5.65% to 8.33%) increase in long-term exposure admissions. For PE, the associated risks were 0.38% (95% CI = -0.68% to 1.25%) and 2.67% (95% CI = 5.65% to 8.33%). These results persisted when analyses were restricted to location-periods meeting the current Environmental Protection Agency annual standard of 12 μg m(-3) . CONCLUSIONS Our findings showed that PM2.5 exposure was associated with DVT and PE hospital admissions and that current standards are not protective of this result.
Collapse
Affiliation(s)
- Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, P.O.B. 653 Beer Sheva, Israel
| | - Antonella Zanobetti
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Dr West, Boston MA USA 02215
| | - Francesco Nordio
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Dr West, Boston MA USA 02215
| | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA, 02215
| | - Andrea A. Baccarelli
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Dr West, Boston MA USA 02215
| | - Joel Schwartz
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Dr West, Boston MA USA 02215
| |
Collapse
|
37
|
Hassan S, Petrella TM, Zhang T, Kamel-Reid S, Nordio F, Baccarelli A, Sade S, Naert K, Al Habeeb A, Ghazarian D, Wright FC. Erratum to: Pathologic Complete Response to Intralesional Interleukin-2 Therapy Associated with Improved Survival in Melanoma Patients with In-Transit Disease. Ann Surg Oncol 2014; 22 Suppl 3:S1603. [PMID: 25503348 DOI: 10.1245/s10434-014-4303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Saima Hassan
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada. .,Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA.
| | - Teresa M Petrella
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tong Zhang
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | | | - Francesco Nordio
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea Baccarelli
- Department of Environmental Health and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Shachar Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Karen Naert
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Ayman Al Habeeb
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Danny Ghazarian
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Frances C Wright
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada.
| |
Collapse
|
38
|
Hassan S, Petrella TM, Zhang T, Kamel-Reid S, Nordio F, Baccarelli A, Sade S, Naert K, Habeeb AA, Ghazarian D, Wright FC. Pathologic complete response to intralesional interleukin-2 therapy associated with improved survival in melanoma patients with in-transit disease. Ann Surg Oncol 2014; 22:1950-8. [PMID: 25366584 DOI: 10.1245/s10434-014-4199-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Melanoma patients with in-transit disease have a high mortality rate despite various treatment strategies. The aim of this study was to validate the role of intralesional interleukin (IL)-2, to understand its mechanism of action, and to better understand factors that may influence its response. METHODS We retrospectively collected the clinicopathological data of 31 consecutive patients who presented to a tertiary care cancer center for treatment of in-transit melanoma with intralesional IL-2. Kaplan-Meier survival curves and multivariable Cox regression analysis were performed. Immunohistochemistry (IHC) was used to better understand the immune response to localized IL-2 therapy. Targeted next-generation sequencing was performed to genomically characterize the tumors. RESULTS Ten patients (10/31, 32 %) achieved a pathologic complete response (pCR), 17/21 (55 %) had a partial response, and 4/21 (19 %) had progressive disease on treatment. pCR to IL-2 therapy was associated with overall survival (log-rank p = 0.004) and improved progression-free survival (PFS) [adjusted hazard ratio (HR) 0.11; 95 % CI 0.02-0.47; p = 0.003). A higher CD8+ T cell infiltrate was identified in in-transit lesions with a pCR compared with the other lesions (mean IHC score 3.78 vs. 2.61; p = 0.01). Patients with an elevated CD8+ infiltrate demonstrated an improved PFS (unadjusted HR 0.08; 95 % CI 0.01-0.52; p = 0.008). CONCLUSIONS Thirty-two percent of patients achieved pCR with intralesional IL-2 therapy and had a significantly improved PFS compared with the rest of the cohort, which may be explained by a systemic CD8+ T-cell response.
Collapse
Affiliation(s)
- Saima Hassan
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Lee M, Nordio F, Zanobetti A, Kinney P, Vautard R, Schwartz J. Acclimatization across space and time in the effects of temperature on mortality: a time-series analysis. Environ Health 2014; 13:89. [PMID: 25352015 PMCID: PMC4271464 DOI: 10.1186/1476-069x-13-89] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/14/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Climate change has increased the days of unseasonal temperature. Although many studies have examined the association between temperature and mortality, few have examined the timing of exposure where whether this association varies depending on the exposure month even at the same temperature. Therefore, we investigated monthly differences in the effects of temperature on mortality in a study comprising a wide range of weather and years, and we also investigated heterogeneity among regions. METHODS We analyzed 38,005,616 deaths from 148 cities in the U.S. from 1973 through 2006. We fit city specific Poisson regressions to examine the effect of temperature on mortality separately for each month of the year, using penalized splines. We used cluster analysis to group cities with similar weather patterns, and combined results across cities within clusters using meta-smoothing. RESULTS There was substantial variation in the effects of the same temperature by month. Heat effects were larger in the spring and early summer and cold effects were larger in late fall. In addition, heat effects were larger in clusters where high temperatures were less common, and vice versa for cold effects. CONCLUSIONS The effects of a given temperature on mortality vary spatially and temporally based on how unusual it is for that time and location. This suggests changes in variability of temperature may be more important for health as climate changes than changes of mean temperature. More emphasis should be placed on warnings targeted to early heat/cold temperature for the season or month rather than focusing only on the extremes.
Collapse
Affiliation(s)
- Mihye Lee
- />Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, 401 Park Drive, Landmark Center West 4th fl, Boston, MA 02215 USA
| | - Francesco Nordio
- />Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, 401 Park Drive, Landmark Center West 4th fl, Boston, MA 02215 USA
| | - Antonella Zanobetti
- />Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, 401 Park Drive, Landmark Center West 4th fl, Boston, MA 02215 USA
| | - Patrick Kinney
- />Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY USA
| | - Robert Vautard
- />LSCE/IPSL, laboratoire CEA/CNRS/UVSQ, Orme des merisiers, 91191 Gif sur Yvette, Cedex, France
| | - Joel Schwartz
- />Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, 401 Park Drive, Landmark Center West 4th fl, Boston, MA 02215 USA
| |
Collapse
|
40
|
Kloog I, Chudnovsky AA, Just AC, Nordio F, Koutrakis P, Coull BA, Lyapustin A, Wang Y, Schwartz J. A New Hybrid Spatio-Temporal Model For Estimating Daily Multi-Year PM 2.5 Concentrations Across Northeastern USA Using High Resolution Aerosol Optical Depth Data. Atmos Environ (1994) 2014; 95:581-590. [PMID: 28966552 PMCID: PMC5621749 DOI: 10.1016/j.atmosenv.2014.07.014] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The use of satellite-based aerosol optical depth (AOD) to estimate fine particulate matter (PM2.5) for epidemiology studies has increased substantially over the past few years. These recent studies often report moderate predictive power, which can generate downward bias in effect estimates. In addition, AOD measurements have only moderate spatial resolution, and have substantial missing data. METHODS We make use of recent advances in MODIS satellite data processing algorithms (Multi-Angle Implementation of Atmospheric Correction (MAIAC), which allow us to use 1 km (versus currently available 10 km) resolution AOD data. We developed and cross validated models to predict daily PM2.5 at a 1×1km resolution across the northeastern USA (New England, New York and New Jersey) for the years 2003-2011, allowing us to better differentiate daily and long term exposure between urban, suburban, and rural areas. Additionally, we developed an approach that allows us to generate daily high-resolution 200 m localized predictions representing deviations from the area 1×1 km grid predictions. We used mixed models regressing PM2.5 measurements against day-specific random intercepts, and fixed and random AOD and temperature slopes. We then use generalized additive mixed models with spatial smoothing to generate grid cell predictions when AOD was missing. Finally, to get 200 m localized predictions, we regressed the residuals from the final model for each monitor against the local spatial and temporal variables at each monitoring site. RESULTS Our model performance was excellent (mean out-of-sample R2=0.88). The spatial and temporal components of the out-of-sample results also presented very good fits to the withheld data (R2=0.87, R2=0.87). In addition, our results revealed very little bias in the predicted concentrations (Slope of predictions versus withheld observations = 0.99). CONCLUSION Our daily model results show high predictive accuracy at high spatial resolutions and will be useful in reconstructing exposure histories for epidemiological studies across this region.
Collapse
Affiliation(s)
- Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University, Israel
| | | | - Allan C. Just
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Drive West, Boston MA USA 02215
| | - Francesco Nordio
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Drive West, Boston MA USA 02215
| | - Petros Koutrakis
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Drive West, Boston MA USA 02215
| | - Brent A. Coull
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Drive West, Boston MA USA 02215
| | - Alexei Lyapustin
- GEST/UMBC, NASA Goddard Space Flight Center, Baltimore, Maryland, USA
| | - Yujie Wang
- University of Maryland Baltimore County, Baltimore, MD, USA
| | - Joel Schwartz
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Drive West, Boston MA USA 02215
| |
Collapse
|
41
|
Kloog I, Nordio F, Zanobetti A, Coull BA, Koutrakis P, Schwartz JD. Short term effects of particle exposure on hospital admissions in the Mid-Atlantic states: a population estimate. PLoS One 2014; 9:e88578. [PMID: 24516670 PMCID: PMC3917892 DOI: 10.1371/journal.pone.0088578] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background Many studies report significant associations between PM2.5 (particulate matter <2.5 micrometers) and hospital admissions. These studies mostly rely on a limited number of monitors which introduces exposure error, and excludes rural and suburban populations from locations where monitors are not available, reducing generalizability and potentially creating selection bias. Methods Using prediction models developed by our group, daily PM2.5 exposure was estimated across the Mid-Atlantic (Washington D.C., and the states of Delaware, Maryland, New Jersey, Pennsylvania, Virginia, New York and West Virginia). We then investigated the short-term effects of PM2.5 exposures on emergency hospital admissions of the elderly in the Mid-Atlantic region.We performed case-crossover analysis for each admission type, matching on day of the week, month and year and defined the hazard period as lag01 (a moving average of day of admission exposure and previous day exposure). Results We observed associations between short-term exposure to PM2.5 and hospitalization for all outcomes examined. For example, for every 10-µg/m3 increase in short-term PM 2.5 there was a 2.2% increase in respiratory diseases admissions (95% CI = 1.9 to 2.6), and a 0.78% increase in cardiovascular disease (CVD) admission rate (95% CI = 0.5 to 1.0). We found differences in risk for CVD admissions between people living in rural and urban areas. For every10-µg/m3 increase in PM 2.5 exposure in the ‘rural’ group there was a 1.0% increase (95% CI = 0.6 to 1.5), while for the ‘urban’ group the increase was 0.7% (95% CI = 0.4 to 1.0). Conclusions Our findings showed that PM2.5 exposure was associated with hospital admissions for all respiratory, cardio vascular disease, stroke, ischemic heart disease and chronic obstructive pulmonary disease admissions. In addition, we demonstrate that our AOD (Aerosol Optical Depth) based exposure models can be successfully applied to epidemiological studies investigating the health effects of short-term exposures to PM2.5.
Collapse
Affiliation(s)
- Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Francesco Nordio
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Antonella Zanobetti
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Petros Koutrakis
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Joel D. Schwartz
- Department of Environmental Health - Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
42
|
Bollati V, Angelici L, Rizzo G, Pergoli L, Rota F, Hoxha M, Nordio F, Bonzini M, Tarantini L, Cantone L, Pesatori AC, Apostoli P, Baccarelli AA, Bertazzi PA. Microvesicle-associated microRNA expression is altered upon particulate matter exposure in healthy workers and in A549 cells. J Appl Toxicol 2014; 35:59-67. [PMID: 24515752 PMCID: PMC4125569 DOI: 10.1002/jat.2987] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/12/2013] [Accepted: 12/14/2013] [Indexed: 01/03/2023]
Abstract
Cardiovascular disease risk has been consistently linked with particulate matter (PM) exposure. Cell-derived microvesicles (MVs) are released into plasma and transfer microRNAs (miRNAs) between tissues. MVs can be produced by the respiratory system in response to proinflammatory triggers, enter the circulatory system and remotely modify gene expression in cardiovascular tissues. However, whether PM affects MV signaling has never been investigated. In this study, we evaluated expression of microRNAs contained within plasma MVs upon PM exposure both in vivo and in vitro. In the in vivo study, we isolated plasma MVs from healthy steel plant workers before and after workplace PM exposure. We measured the expression of 88 MV-associated miRNAs by real-time polymerase chain reaction. To assess a possible source of the MV miRNAs identified in vivo, we measured their miRNA expression in PM-treated A549 pulmonary cell lines in vitro. MiRNA profiling of plasma MVs showed 5.62- and 13.95-fold increased expression of miR-128 and miR-302c, respectively, after 3 days of workplace PM exposure (P < 0.001). According to Ingenuity Pathway Analysis, miR-128 is part of coronary artery disease pathways, and miR-302c is part of coronary artery disease, cardiac hypertrophy and heart failure pathways. In vitro experiments confirmed a dose-dependent expression of miR-128 in MVs released from A549 cells after 6 h of PM treatment (P = 0.030). MiR-302c was expressed neither from A549 cells nor in reference lung RNA. These results suggest novel PM-activated molecular mechanisms that may mediate the effects of air pollution and could lead to the identification of new diagnostic and therapeutic interventions.
Collapse
Affiliation(s)
- Valentina Bollati
- Center of Molecular and Genetic Epidemiology, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Epidemiology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Byun HM, Panni T, Motta V, Hou L, Nordio F, Apostoli P, Bertazzi PA, Baccarelli AA. Effects of airborne pollutants on mitochondrial DNA methylation. Part Fibre Toxicol 2013; 10:18. [PMID: 23656717 PMCID: PMC3660297 DOI: 10.1186/1743-8977-10-18] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 05/01/2013] [Indexed: 11/23/2022] Open
Abstract
Background Mitochondria have small mitochondrial DNA (mtDNA) molecules independent from the nuclear DNA, a separate epigenetic machinery that generates mtDNA methylation, and are primary sources of oxidative-stress generation in response to exogenous environments. However, no study has yet investigated whether mitochondrial DNA methylation is sensitive to pro-oxidant environmental exposures. Methods We sampled 40 male participants (20 high-, 20 low-exposure) from each of three studies on airborne pollutants, including investigations of steel workers exposed to metal-rich particulate matter (measured as PM1) in Brescia, Italy (Study 1); gas-station attendants exposed to air benzene in Milan, Italy (Study 2); and truck drivers exposed to traffic-derived Elemental Carbon (EC) in Beijing, China (Study 3). We have measured DNA methylation from buffy coats of the participants. We measured methylation by bisulfite-Pyrosequencing in three mtDNA regions, i.e., the transfer RNA phenylalanine (MT-TF), 12S ribosomal RNA (MT-RNR1) gene and “D-loop” control region. All analyses were adjusted for age and smoking. Results In Study 1, participants with high metal-rich PM1 exposure showed higher MT-TF and MT-RNR1 methylation than low-exposed controls (difference = 1.41, P = 0.002); MT-TF and MT-RNR1 methylation was significantly associated with PM1 exposure (beta = 1.35, P = 0.025); and MT-RNR1 methylation was positively correlated with mtDNA copy number (r = 0.36; P = 0.02). D-loop methylation was not associated with PM1 exposure. We found no effects on mtDNA methylation from air benzene (Study 2) and traffic-derived EC exposure (Study 3). Conclusions Mitochondrial MT-TF and MT-RNR1 DNA methylation was associated with metal-rich PM1 exposure and mtDNA copy number. Our results suggest that locus-specific mtDNA methylation is correlated to selected exposures and mtDNA damage. Larger studies are needed to validate our observations.
Collapse
Affiliation(s)
- Hyang-Min Byun
- Laboratory of Environmental Epigenetics, Exposure Epidemiology and Risk Program, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Tarantini L, Bonzini M, Tripodi A, Angelici L, Nordio F, Cantone L, Apostoli P, Bertazzi PA, Baccarelli AA. Blood hypomethylation of inflammatory genes mediates the effects of metal-rich airborne pollutants on blood coagulation. Occup Environ Med 2013; 70:418-25. [PMID: 23476046 DOI: 10.1136/oemed-2012-101079] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Recent investigations have associated airborne particulate matter (PM) with increased coagulation and thrombosis, but underlying biological mechanisms are still incompletely characterised. DNA methylation is an environmentally sensitive mechanism of gene regulation that could potentially contribute to PM-induced hypercoagulability. We aimed to test whether altered methylation mediates environmental effects on coagulation. METHODS We investigated 63 steel workers exposed to a wide range of PM levels, as a work-related condition with well-characterised prothrombotic exposure. We measured personal PM10 (PM≤10 µm in aerodynamic diameter), PM1 (≤1 µm) and air metal components. We determined leukocyte DNA methylation of NOS3 (nitric-oxide-synthase-3) and EDN1 (endothelin-1) through bisulfite-pyrosequencing and we measured ETP as a global coagulation-activation test after standardised triggers. RESULTS ETP increased in association with PM10 (β=20.0, 95% CI 3.0 to 37.0), PM1 (β=80.8 95% CI 14.9 to 146.7) and zinc (β=51.3, 95% CI 0.01 to 111.1) exposures. NOS3 methylation was negatively associated with PM10 (β=-0.2, 95% CI -0.4 to -0.03), PM1 (β=-0.8, 95% CI -1.4 to -0.1), zinc (β=-0.9, 95% CI -1.4 to -0.3) and iron (β=-0.7, 95% CI -1.4 to -0.01) exposures. Zinc exposure was negatively associated with EDN1 (β=-0.3, 95% CI -0.8 to -0.1) methylation. Lower NOS3 (β=-42.3; p<0.001) and EDN1 (β=-14.5; p=0.05) were associated with higher ETP. Statistical mediation analysis formally confirmed NOS3 and EDN1 hypomethylation as intermediate mechanisms for PM-related coagulation effects. CONCLUSIONS Our study showed for the first time, that gene hypomethylation contributes to environmentally induced hypercoagulability.
Collapse
Affiliation(s)
- Letizia Tarantini
- Department of Clinical and Community Sciences, Università degli Studi di Milano and IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Motta V, Angelici L, Nordio F, Bollati V, Fossati S, Frascati F, Tinaglia V, Bertazzi PA, Battaglia C, Baccarelli AA. Integrative Analysis of miRNA and inflammatory gene expression after acute particulate matter exposure. Toxicol Sci 2013; 132:307-16. [PMID: 23358196 DOI: 10.1093/toxsci/kft013] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
MicroRNAs (miRNAs) are environmentally sensitive inhibitors of gene expression that may mediate the effects of metal-rich particulate matter (PM) and toxic metals on human individuals. Previous environmental miRNA studies have investigated a limited number of candidate miRNAs and have not yet evaluated the functional effects on gene expression. In this study, we wanted to identify PM-sensitive miRNAs using microarray profiling on matched baseline and postexposure RNA from foundry workers with well-characterized exposure to metal-rich PM and to characterize miRNA relations with expression of candidate inflammatory genes. We applied microarray analysis of 847 human miRNAs and real-time PCR analysis of 18 candidate inflammatory genes on matched blood samples collected from foundry workers at baseline and after 3 days of work (postexposure). We identified differentially expressed miRNAs (fold change [FC] > 2 and p < 0.05) and correlated their expression with the inflammatory associated genes. We performed in silico network analysis in MetaCore v6.9 to characterize the biological pathways connecting miRNA-mRNA pairs. Microarray analysis identified four miRNAs that were differentially expressed in postexposure compared with baseline samples, including miR-421 (FC = 2.81, p < 0.001), miR-146a (FC = 2.62, p = 0.007), miR-29a (FC = 2.91, p < 0.001), and let-7g (FC = 2.73, p = 0.019). Using false discovery date adjustment for multiple comparisons, we found 11 miRNA-mRNA correlated pairs involving the 4 differentially expressed miRNAs and candidate inflammatory genes. In silico network analysis with MetaCore database identified biological interactions for all the 11 miRNA-mRNA pairs, which ranged from direct mRNA targeting to complex interactions with multiple intermediates. Acute PM exposure may affect gene regulation through PM-responsive miRNAs that directly or indirectly control inflammatory gene expression.
Collapse
Affiliation(s)
- Valeria Motta
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Laboratory of Environmental Epigenetics, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Kloog I, Nordio F, Coull BA, Schwartz J. Incorporating local land use regression and satellite aerosol optical depth in a hybrid model of spatiotemporal PM2.5 exposures in the Mid-Atlantic states. Environ Sci Technol 2012; 46:11913-21. [PMID: 23013112 PMCID: PMC4780577 DOI: 10.1021/es302673e] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Satellite-derived aerosol optical depth (AOD) measurements have the potential to provide spatiotemporally resolved predictions of both long and short-term exposures, but previous studies have generally shown moderate predictive power and lacked detailed high spatio- temporal resolution predictions across large domains. We aimed at extending our previous work by validating our model in another region with different geographical and metrological characteristics, and incorporating fine scale land use regression and nonrandom missingness to better predict PM(2.5) concentrations for days with or without satellite AOD measures. We start by calibrating AOD data for 2000-2008 across the Mid-Atlantic. We used mixed models regressing PM(2.5) measurements against day-specific random intercepts, and fixed and random AOD and temperature slopes. We used inverse probability weighting to account for nonrandom missingness of AOD, nested regions within days to capture spatial variation in the daily calibration, and introduced a penalization method that reduces the dimensionality of the large number of spatial and temporal predictors without selecting different predictors in different locations. We then take advantage of the association between grid-cell specific AOD values and PM(2.5) monitoring data, together with associations between AOD values in neighboring grid cells to develop grid cell predictions when AOD is missing. Finally to get local predictions (at the resolution of 50 m), we regressed the residuals from the predictions for each monitor from these previous steps against the local land use variables specific for each monitor. "Out-of-sample" 10-fold cross-validation was used to quantify the accuracy of our predictions at each step. For all days without AOD values, model performance was excellent (mean "out-of-sample" R(2) = 0.81, year-to-year variation 0.79-0.84). Upon removal of outliers in the PM(2.5) monitoring data, the results of the cross validation procedure was even better (overall mean "out of sample"R(2) of 0.85). Further, cross validation results revealed no bias in the predicted concentrations (Slope of observed vs predicted = 0.97-1.01). Our model allows one to reliably assess short-term and long-term human exposures in order to investigate both the acute and effects of ambient particles, respectively.
Collapse
Affiliation(s)
- Itai Kloog
- Department of Environmental Health-Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center 401 Park Drive West, Boston, Massachusetts 02215, USA.
| | | | | | | |
Collapse
|
47
|
Byun HM, Nordio F, Coull BA, Tarantini L, Hou L, Bonzini M, Apostoli P, Bertazzi PA, Baccarelli A. Temporal stability of epigenetic markers: sequence characteristics and predictors of short-term DNA methylation variations. PLoS One 2012; 7:e39220. [PMID: 22745719 PMCID: PMC3379987 DOI: 10.1371/journal.pone.0039220] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/21/2012] [Indexed: 01/27/2023] Open
Abstract
Background DNA methylation is an epigenetic mechanism that has been increasingly investigated in observational human studies, particularly on blood leukocyte DNA. Characterizing the degree and determinants of DNA methylation stability can provide critical information for the design and conduction of human epigenetic studies. Methods We measured DNA methylation in 12 gene-promoter regions (APC, p16, p53, RASSF1A, CDH13, eNOS, ET-1, IFNγ, IL-6, TNFα, iNOS, and hTERT) and 2 of non-long terminal repeat elements, i.e., L1 and Alu in blood samples obtained from 63 healthy individuals at baseline (Day 1) and after three days (Day 4). DNA methylation was measured by bisulfite-PCR-Pyrosequencing. We calculated intraclass correlation coefficients (ICCs) to measure the within-individual stability of DNA methylation between Day 1 and 4, subtracted of pyrosequencing error and adjusted for multiple covariates. Results Methylation markers showed different temporal behaviors ranging from high (IL-6, ICC = 0.89) to low stability (APC, ICC = 0.08) between Day 1 and 4. Multiple sequence and marker characteristics were associated with the degree of variation. Density of CpG dinucleotides nearby the sequence analyzed (measured as CpG(o/e) or G+C content within ±200bp) was positively associated with DNA methylation stability. The 3′ proximity to repeat elements and range of DNA methylation on Day 1 were also positively associated with methylation stability. An inverted U-shaped correlation was observed between mean DNA methylation on Day 1 and stability. Conclusions The degree of short-term DNA methylation stability is marker-dependent and associated with sequence characteristics and methylation levels.
Collapse
Affiliation(s)
- Hyang-Min Byun
- Laboratory of Environmental Epigenetics, Exposure Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts, United States of America.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Hou L, Zhang X, Tarantini L, Nordio F, Bonzini M, Angelici L, Marinelli B, Rizzo G, Cantone L, Apostoli P, Bertazzi PA, Baccarelli A. Ambient PM exposure and DNA methylation in tumor suppressor genes: a cross-sectional study. Part Fibre Toxicol 2011; 8:25. [PMID: 21878113 PMCID: PMC3180673 DOI: 10.1186/1743-8977-8-25] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 08/30/2011] [Indexed: 12/20/2022] Open
Abstract
Exposure to ambient air particles matter (PM) has been associated with increased risk of lung cancer. Aberrant tumor suppressor gene promoter methylation has emerged as a promising biomarker for cancers, including lung cancer. Whether exposure to PM is associated with peripheral blood leukocyte (PBL) DNA methylation in tumor suppressor genes has not been evaluated. In 63 male healthy steel workers with well-characterized exposure to metal-rich particles nearby Brescia, Italy, we evaluated whether exposure to PM and metal components was associated with PBL DNA methylation in 4 tumor suppressor genes (i.e., APC, p16, p53 and RASSF1A). Blood samples were obtained on the 1st (baseline) and 4th day (post-exposure) of the same work week and DNA methylation was measured using pyrosequencing. A linear mixed model was used to examine the correlations of the exposure with promoter methylation levels. Mean promoter DNA methylation levels of APC or p16 were significantly higher in post-exposure samples compared to that in baseline samples (p-values = 0.005 for APC, and p-value = 0.006 for p16). By contrast, the mean levels of p53 or RASSF1A promoter methylation was decreased in post-exposure samples compared to that in baseline samples (p-value = 0.015 for p53; and p-value < 0.001 for RASSF1A). In post-exposure samples, APC methylation was positively associated with PM10 (β = 0.27, 95% CI: 0.13-0.40), and PM1 (β = 0.23, 95% CI: 0.09-0.38). In summary, ambient PM exposure was associated with PBL DNA methylation levels of tumor suppressor genes of APC, p16, p53 and RASSF1A, suggesting that such methylation alterations may reflect processes related to PM-induced lung carcinogenesis.
Collapse
Affiliation(s)
- Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N, Lakeshore Drive, Chicago, 60611, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Zobbi VF, Calistri D, Consonni D, Nordio F, Costantini W, Mauri PA. Breastfeeding: validation of a reduced Breastfeeding Assessment Score in a group of Italian women. J Clin Nurs 2011; 20:2509-18. [DOI: 10.1111/j.1365-2702.2011.03767.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
50
|
Cantone L, Nordio F, Hou L, Apostoli P, Bonzini M, Tarantini L, Angelici L, Bollati V, Zanobetti A, Schwartz J, Bertazzi PA, Baccarelli A. Inhalable metal-rich air particles and histone H3K4 dimethylation and H3K9 acetylation in a cross-sectional study of steel workers. Environ Health Perspect 2011; 119:964-9. [PMID: 21385672 PMCID: PMC3222996 DOI: 10.1289/ehp.1002955] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 03/08/2011] [Indexed: 05/19/2023]
Abstract
BACKGROUND Epidemiology investigations have linked exposure to ambient and occupational air particulate matter (PM) with increased risk of lung cancer. PM contains carcinogenic and toxic metals, including arsenic and nickel, which have been shown in in vitro studies to induce histone modifications that activate gene expression by inducing open-chromatin states. Whether inhalation of metal components of PM induces histone modifications in human subjects is undetermined. OBJECTIVES We investigated whether the metal components of PM determined activating histone modifications in 63 steel workers with well-characterized exposure to metal-rich PM. METHODS We determined histone 3 lysine 4 dimethylation (H3K4me2) and histone 3 lysine 9 acetylation (H3K9ac) on histones from blood leukocytes. Exposure to inhalable metal components (aluminum, manganese, nickel, zinc, arsenic, lead, iron) and to total PM was estimated for each study subject. RESULTS Both H3K4me2 and H3K9ac increased in association with years of employment in the plant (p-trend = 0.04 and 0.006, respectively). H3K4me2 increased in association with air levels of nickel [β = 0.16; 95% confidence interval (CI), 0.03-0.3], arsenic (β = 0.16; 95% CI, 0.02-0.3), and iron (β = 0.14; 95% CI, 0.01-0.26). H3K9ac showed nonsignificant positive associations with air levels of nickel (β = 0.24; 95% CI, -0.02 to 0.51), arsenic (β = 0.21; 95% CI, -0.06 to 0.48), and iron (β = 0.22; 95% CI, -0.03 to 0.47). Cumulative exposures to nickel and arsenic, defined as the product of years of employment by metal air levels, were positively correlated with both H3K4me2 (nickel: β = 0.16; 95% CI, 0.01-0.3; arsenic: β = 0.16; 95% CI, 0.03-0.29) and H3K9ac (nickel: β = 0.27; 95% CI, 0.01-0.54; arsenic: β = 0.28; 95% CI, 0.04-0.51). CONCLUSIONS Our results indicate histone modifications as a novel epigenetic mechanism induced in human subjects by long-term exposure to inhalable nickel and arsenic.
Collapse
Affiliation(s)
- Laura Cantone
- Department of Environmental and Occupational Health, Università di Milano and Istituto Di Ricovero e Cura a Carattere Scientifico, and Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|