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Obisesan OH, Boakye E, Wang FM, Dardari Z, Dzaye O, Cainzos-Achirica M, Meyer ML, Gottesman R, Palta P, Coresh J, Howard-Claudio CM, Lin FR, Punjabi N, Nasir K, Matsushita K, Blaha MJ. Coronary artery calcium as a marker of healthy and unhealthy aging in adults aged 75 and older: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2024:117475. [PMID: 38408881 DOI: 10.1016/j.atherosclerosis.2024.117475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND AIMS Coronary artery calcium (CAC) is validated for risk prediction among middle-aged adults, but there is limited research exploring implications of CAC among older adults. We used data from the Atherosclerosis Risk in Communities (ARIC) study to evaluate the association of CAC with domains of healthy and unhealthy aging in adults aged ≥75 years. METHODS We included 2,290 participants aged ≥75 years free of known coronary heart disease who underwent CAC scoring at study visit 7. We examined the cross-sectional association of CAC = 0, 1-999 (reference), and ≥1000 with seven domains of aging: cognitive function, hearing, ankle-brachial index (ABI), pulse-wave velocity (PWV), forced vital capacity (FVC), physical functioning, and grip strength. RESULTS The mean age was 80.5 ± 4.3 years, 38.6% male, and 77.7% White. 10.3% had CAC = 0 and 19.2% had CAC≥1000. Individuals with CAC = 0 had the lowest while those with CAC≥1000 had the highest proportion with dementia (2% vs 8%), hearing impairment (46% vs 67%), low ABI (3% vs 18%), high PWV (27% vs 41%), reduced FVC (34% vs 42%), impaired grip strength (66% vs 74%), and mean composite abnormal aging score (2.6 vs 3.7). Participants with CAC = 0 were less likely to have abnormal ABI (aOR:0.15, 95%CI:0.07-0.34), high PWV (aOR:0.57, 95%CI:0.41-0.80), and reduced FVC (aOR:0.69, 95%CI:0.50-0.96). Conversely, participants with CAC≥1000 were more likely to have low ABI (aOR:1.74, 95%CI:1.27-2.39), high PWV (aOR:1.52, 95%CI:1.15-2.00), impaired physical functioning (aOR:1.35, 95%CI:1.05-1.73), and impaired grip strength (aOR:1.46, 95%CI:1.08-1.99). CONCLUSIONS Our findings highlight CAC as a simple measure broadly associated with biological aging, with clinical and research implications for estimating the physical and physiological aging trajectory of older individuals.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Division of Cardiology, Hospital del Mar- Parc de Salut Mar, Barcelona, Spain
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Gottesman
- Stroke, Cognition, and Neuroepidemiology Section of the National Institutes of Health, Bethesda, MD, USA
| | - Priya Palta
- Department of Medicine, Columbia University School of Medicine, New York, NY, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Frank R Lin
- Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, MD, USA
| | - Naresh Punjabi
- Division of Critical Care Medicine, Pulmonology, Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Mei H, Simino J, Li L, Jiang F, Bis JC, Davies G, Hill WD, Xia C, Gudnason V, Yang Q, Lahti J, Smith JA, Kirin M, De Jager P, Armstrong NJ, Ghanbari M, Kolcic I, Moran C, Teumer A, Sargurupremraj M, Mahmud S, Fornage M, Zhao W, Satizabal CL, Polasek O, Räikkönen K, Liewald DC, Homuth G, Callisaya M, Mather KA, Windham BG, Zemunik T, Palotie A, Pattie A, van der Auwera S, Thalamuthu A, Knopman DS, Rudan I, Starr JM, Wittfeld K, Kochan NA, Griswold ME, Vitart V, Brodaty H, Gottesman R, Cox SR, Psaty BM, Boerwinkle E, Chasman DI, Grodstein F, Sachdev PS, Srikanth V, Hayward C, Wilson JF, Eriksson JG, Kardia SLR, Grabe HJ, Bennett DA, Ikram MA, Deary IJ, van Duijn CM, Launer L, Fitzpatrick AL, Seshadri S, Bressler J, Debette S, Mosley TH. Multi-omics and pathway analyses of genome-wide associations implicate regulation and immunity in verbal declarative memory performance. Alzheimers Res Ther 2024; 16:14. [PMID: 38245754 PMCID: PMC10799499 DOI: 10.1186/s13195-023-01376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Uncovering the functional relevance underlying verbal declarative memory (VDM) genome-wide association study (GWAS) results may facilitate the development of interventions to reduce age-related memory decline and dementia. METHODS We performed multi-omics and pathway enrichment analyses of paragraph (PAR-dr) and word list (WL-dr) delayed recall GWAS from 29,076 older non-demented individuals of European descent. We assessed the relationship between single-variant associations and expression quantitative trait loci (eQTLs) in 44 tissues and methylation quantitative trait loci (meQTLs) in the hippocampus. We determined the relationship between gene associations and transcript levels in 53 tissues, annotation as immune genes, and regulation by transcription factors (TFs) and microRNAs. To identify significant pathways, gene set enrichment was tested in each cohort and meta-analyzed across cohorts. Analyses of differential expression in brain tissues were conducted for pathway component genes. RESULTS The single-variant associations of VDM showed significant linkage disequilibrium (LD) with eQTLs across all tissues and meQTLs within the hippocampus. Stronger WL-dr gene associations correlated with reduced expression in four brain tissues, including the hippocampus. More robust PAR-dr and/or WL-dr gene associations were intricately linked with immunity and were influenced by 31 TFs and 2 microRNAs. Six pathways, including type I diabetes, exhibited significant associations with both PAR-dr and WL-dr. These pathways included fifteen MHC genes intricately linked to VDM performance, showing diverse expression patterns based on cognitive status in brain tissues. CONCLUSIONS VDM genetic associations influence expression regulation via eQTLs and meQTLs. The involvement of TFs, microRNAs, MHC genes, and immune-related pathways contributes to VDM performance in older individuals.
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Affiliation(s)
- Hao Mei
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Jeannette Simino
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Lianna Li
- Department of Biology, Tougaloo College, Jackson, MS, USA
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joshua C Bis
- Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Gail Davies
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - W David Hill
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Charley Xia
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Jari Lahti
- Turku Institute for Advanced Research, University of Turku, Turku, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Mirna Kirin
- Work completed while at The University of Edinburgh, Edinburgh, UK
| | - Philip De Jager
- Taub Institute for Research On Alzheimer's Disease and the Aging Brain, Columbia Irving University Medical Center, New York, NY, USA
- Center for Translational and Computational Neuro-Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | | | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands
| | - Ivana Kolcic
- School of Medicine, University of Split, Split, Croatia
| | - Christopher Moran
- Department of Geriatric Medicine, Frankston Hospital, Peninsula Health, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Murali Sargurupremraj
- Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Shamsed Mahmud
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Claudia L Satizabal
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ozren Polasek
- School of Medicine, University of Split, Split, Croatia
- Algebra University College, Ilica 242, Zagreb, Croatia
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David C Liewald
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Michele Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - B Gwen Windham
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine, Division of Geriatrics, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Aarno Palotie
- Department of Medicine, Department of Neurology and Department of Psychiatry, Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- The Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alison Pattie
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Sandra van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | | | - Igor Rudan
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Rostock, Germany
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Michael E Griswold
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Veronique Vitart
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca Gottesman
- Stroke, Cognition, and Neuroepidemiology (SCAN) Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon R Cox
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Bruce M Psaty
- Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Daniel I Chasman
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Francine Grodstein
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
| | - Velandai Srikanth
- Department of Geriatric Medicine, Frankston Hospital, Peninsula Health, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - James F Wilson
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Rostock, Germany
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands
| | - Ian J Deary
- Department of Psychology, Lothian Birth Cohorts Group, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Cornelia M van Duijn
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Bethesda, MD, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sudha Seshadri
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jan Bressler
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephanie Debette
- Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, University of Bordeaux, Bordeaux, France
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, CHU de Bordeaux, Bordeaux, France
| | - Thomas H Mosley
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
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Wang Y, Sharrett AR, Schneider ALC, Knopman D, Hu J, Gottesman R, Sullivan KJ, Coresh J. Timing of Cognitive Test Score Decline Prior to Incident Dementia Diagnosis in Blacks and Whites: The Atherosclerosis Risk in Communities Neurocognitive Study. Neuroepidemiology 2023; 58:23-30. [PMID: 37918374 PMCID: PMC10910615 DOI: 10.1159/000533851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/10/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Commonly occurring dementias include those of Alzheimer's, vascular, and mixtures of these and other pathologies. They are believed to evolve over many years, but that time interval has been difficult to establish. Our objective was to determine how many years in advance of a dementia diagnosis cognitive scores begin to change. METHODS 14,086 dementia-free ARIC participants underwent a cognitive exam at baseline visit 2 (1990-1992, mean age 57 ± 5.72), and 11,244 at visit 4 (1996-1998), 5,640 at visit 5 (2011-2013), and 3,574 at visit 6 (2016-2017) with surveillance for dementias of all-causes combined. Within 5-year intervals after each visit, we compared performance on the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST), the Word Fluency Test (WFT), and the combined mean of three cognitive tests at baseline in participants who were diagnosed with dementia within each interval versus those who survived the interval without a dementia diagnosis. Z-scores were adjusted for demographics and education in separate regression models for each visit. We plotted adjusted z-score means by time interval following each visit. RESULTS During follow-up 3,334, 2,821, 1,218, and 329 dementia cases were ascertained after visits 2, 4, 5, and 6, respectively. Adjusted DWRT z-scores were significantly lower 20-25 years before dementia than those who did not experience dementia within 25 years. DSST z-scores were significantly lower at 25-30 years and 3-test combination z-scores were significantly lower as early as 30-31 years before onset. The difference between dementia and non-dementia group in the visit 2 3-test combination z-score was -0.20 at 30-31 years prior to dementia diagnosis. As expected, differences between the dementia and non-dementia groups increased closer to the time of dementia occurrence, up to their widest point at 0-5 years prior to dementia diagnosis. The difference between dementia and non-dementia groups in the visit 2 3-test combination z-score at 0-5 years was -0.90. WFT z-score differences were smaller than for the DSST or DWRT and began later. Patterns were similar in Black and White participants. CONCLUSION DWRT, DSST, and combined 3-test z-scores were significantly lower more than 20 years prior to diagnosis in the dementia group versus the non-dementia group. Findings contribute to our knowledge of the long prodromal period in Blacks and Whites.
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Affiliation(s)
- Yunzhi Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jiaqi Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Kevin J Sullivan
- Department of Medicine, The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Sun P, Markovic D, Ibish A, Faigle R, Gottesman R, Towfighi A. Effects of System-Level Factors on Race/Ethnic Differences in In-Hospital Mortality after Acute Ischemic Stroke. medRxiv 2023:2023.10.20.23297343. [PMID: 37904925 PMCID: PMC10615015 DOI: 10.1101/2023.10.20.23297343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Introduction Stroke mortality has declined, with differential changes by race; stroke is now the 5th leading cause of death overall, but 2nd leading cause of death in Black individuals. Little is known about recent race/ethnic and sex trends in in-hospital mortality after acute ischemic stroke (AIS) and whether system-level factors contribute to possible differences. Methods Using the National Inpatient Sample, adults (≥18 years) with a primary diagnosis of AIS from 2006 to 2017 (n=643,912) were identified. We assessed in-hospital mortality by race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander [API], other), sex, and age. Hospitals were categorized by proportion of non-White patients served: <25% ("predominantly White patients"), 25-50% ("mixed race/ethnicity profile"), and ≥50% ("predominantly non-White patients"). Using survey adjusted logistic regression, the association between race/ethnicity and odds of mortality was assessed, adjusting for key sociodemographic, clinical, and hospital characteristics (e.g., age, comorbidities, stroke severity, do not resuscitate orders, and palliative care). Results Overall, mortality decreased from 5.0% in 2006 to 2.9% in 2017 (p<0.001). Comparing 2012-2017 to 2006-2011, there was a 68% reduction in mortality odds overall after adjusting for covariates, most prominent in White individuals (69%) and smallest in Black individuals (57%). Compared to White patients, Black and Hispanic patients had lower odds of mortality (adjusted odds ratio (aOR) 0.82, 95% CI 0.78-0.87 and aOR 0.93, 95% CI 0.87-1.00), primarily driven by those >65 years (age x ethnicity interaction p < 0.0001). Compared to White men, Black, Hispanic, and API men, and Black women had lower aOR of mortality. The differences in mortality between White and non-White patients were most pronounced in hospitals predominantly serving White patients (aOR 0.80, 0.74-0.87) compared to mixed hospitals (aOR 0.85, 0.79-0.91) and predominantly non-White hospitals (aOR 0.88, 0.81-0.95; interaction effect: p=0.005). Discussion AIS mortality decreased dramatically in recent years in all race/ethnic subgroups. Overall, non-White AIS patients had lower mortality than their White counterparts, a difference that was most striking in hospitals predominantly serving White patients. Further study is needed to understand these differences and to what extent biological, sociocultural, and system-level factors play a role.
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Affiliation(s)
- Philip Sun
- Department of Neurology, David Geffen School of Medicine at University of California - Los Angeles, Los Angeles, CA
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Daniela Markovic
- Department of Internal Medicine, University of California - Los Angeles, Los Angeles, CA
| | - Abdullah Ibish
- Department of Neurology, David Geffen School of Medicine at University of California - Los Angeles, Los Angeles, CA
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Roland Faigle
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amytis Towfighi
- Department of Neurology, David Geffen School of Medicine at University of California - Los Angeles, Los Angeles, CA
- Keck School of Medicine of University of Southern California, Los Angeles, CA
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Onuegbu A, Calicchio F, Kinninger A, Nakanishi R, Carr JJ, Nasir K, Gottesman R, Budoff M. Mitral annular calcification as a predictor of stroke in the multiethnic study of atherosclerosis. J Cardiovasc Med (Hagerstown) 2023; 24:680-688. [PMID: 37409651 DOI: 10.2459/jcm.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Mitral annular calcification (MAC) is associated with an increased risk for cardiovascular morbidity and mortality. This study provides recent data on the association between cardiac computed tomography (CT) derived MAC and 15 years of stroke risk in a racially diverse cohort. METHODS All multiethnic studies of atherosclerosis participants ( n = 6814) who completed a cardiac CT at baseline were included in this analysis. MAC score was calculated from cardiac CT using the Agatston and volume score methods. Multivariable Cox proportional hazard regression models were used to compute hazard ratios for the association between MAC and stroke after adjusting for traditional cardiovascular risk factors, inflammatory markers, coronary artery calcium score, atrial fibrillation, and left atrial size. RESULTS Overall, 9% of participants (644/6814) had MAC at baseline. Over a surveillance period of 15 years, 304 strokes occurred, and 79% were ischemic strokes. After adjusting for age, sex, race/ethnicity, SBP, diabetes, smoking, fibrinogen, IL-6, high-sensitivity C-reactive protein, and coronary artery calcium score, baseline MAC was associated with increased risk for all strokes [hazard ratio 1.68; 95% confidence interval (CI) 1.22-2.30: P = 0.0013]. When atrial fibrillation/flutter and left atrial size were included in the final multivariable model, MAC remained a predictor of all strokes (hazard ratio 1.93; 95% CI 1.22-3.05: P < 0.0051) and ischemic stroke (hazard ratio 2.03; 95% CI 1.24-3.31: P < 0.0046). CONCLUSION MAC is an independent predictor of long-term stroke risk in a racially diverse population beyond conventional cardiovascular risk factors and atrial fibrillation.
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Affiliation(s)
- Afiachukwu Onuegbu
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Francesca Calicchio
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - April Kinninger
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - John J Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Matthew Budoff
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
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6
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Hussain A, Blaha MJ, Al-Mallah MH, Johansen M, Cainzos-Achirica M, Nambi V, Rotter J, Guo X, Rich S, Patel J, Mcevoy JW, Nasir K, Gottesman R, Blumenthal RS, Ballantyne CM, Virani SS, Rifai MA. DETERMINANTS OF INCIDENT STROKE AMONG THOSE WITH ABSENT CORONARY ARTERY CALCIFICATION: RESULTS FROM THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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7
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Tung S, Kendrick J, Surapaneni A, Scheppach JB, Coresh J, Gottesman R, Sharrett AR, Daya N, Grams ME. Association Between Acute Kidney Injury and Dementia in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2022; 80:495-501. [PMID: 35390426 PMCID: PMC9509404 DOI: 10.1053/j.ajkd.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Acute kidney injury (AKI) causes biochemical changes in the brain in animal models and is associated with adverse neurological complications in hospitalized patients. This study tested the association between AKI and incident dementia in a community-based cohort. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Adult participants in the Atherosclerosis Risk in Communities (ARIC) study who experienced hospitalized AKI compared with participants hospitalized for other reasons (primary analysis, mean follow-up period 4.3 years) or participants without hospitalized AKI (secondary analysis). PREDICTORS Incident AKI, defined by ICD codes from hospital records. OUTCOME Incident dementia, diagnosed based on a combination of neurocognitive testing, informant interviews, ICD codes, and death certificates. ANALYTICAL APPROACH In the primary analysis, we estimated the propensity for hospitalized AKI and matched these participants with those hospitalized for another reason to examine the association of AKI with subsequent onset of dementia (N = 1,708). In the secondary analysis, we estimated the association between time-varying hospitalized AKI and subsequent onset of dementia using multivariable Cox proportional hazards regression models, adjusted for age, sex, race/center, education, smoking status, body mass index, baseline estimated glomerular filtration rate, baseline urinary albumin-creatinine ratio, systolic blood pressure, coronary heart disease, diabetes, hypertension, apolipoprotein E (APOE) ε4 allele, and C-reactive protein. RESULTS The mean age in the propensity-matched cohort was 76.1 ± 6.5 (SD) years, and 53.2% of the participants were women. People who were hospitalized with AKI had a higher risk of dementia (HR, 1.25 [95% CI, 1.02-1.52]; P = 0.03) compared with those without a hospitalization for AKI. The associations were slightly stronger in the time-varying analysis (HR, 1.69 [95% CI, 1.48-1.92]; P < 0.001). Other risk factors for dementia included older age, male sex, higher albuminuria, diabetes, current smoker status, and presence of the APOE risk alleles. LIMITATIONS Observational study, with AKI identified through diagnosis codes. CONCLUSIONS Participants who experienced a hospitalization for AKI were at increased risk of dementia.
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Affiliation(s)
- Sarah Tung
- Whiting School of Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado
| | - Aditya Surapaneni
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Johannes B Scheppach
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Gottesman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - A Richey Sharrett
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalie Daya
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan E Grams
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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8
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Bianco F, De Caterina R, Chandra A, Aquila I, Claggett B, Johansen MC, Gonçalves A, Norby FL, Cogswell R, Soliman EZ, Gottesman R, Mosley T, Alonso A, Shah A, Solomon SD, Chen LY. Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS. J Am Heart Assoc 2022; 11:e024292. [PMID: 35491988 PMCID: PMC9238625 DOI: 10.1161/jaha.121.024292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. Methods and Results We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardiographic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging-detectable infarcts (n=315), magnetic resonance imaging-diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain-a 3-dimensional echocardiographic index of LA reservoir function-and E/e' divided by LA global longitudinal strain-an index of LA stiffness-worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e' divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. Conclusions In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.
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Affiliation(s)
- Francesco Bianco
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Raffaele De Caterina
- Cardio‐Thoracic and Vascular Department, Pisa University Hospital, University of PisaPisaItaly
| | - Alvin Chandra
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Iolanda Aquila
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Brian Claggett
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Michelle C. Johansen
- Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Alexandra Gonçalves
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
- University of Porto Medical SchoolPortoPortugal
| | - Faye L. Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology,Cedars‐Sinai Smidt Heart Institute,Los AngelesCA
| | - Rebecca Cogswell
- Lillehei Heart Institute and Cardiovascular DivisionDepartment of MedicineUniversity of MinnesotaMinneapolisMN
| | | | - Rebecca Gottesman
- Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Thomas Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Amil Shah
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Scott D. Solomon
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular DivisionDepartment of MedicineUniversity of MinnesotaMinneapolisMN
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Parikh R, Wang W, Zhang M, Norby F, Hof JV, Matsushita K, Soliman EZ, Windham BG, Mosley TH, Pike J, Wasserman B, Johansen M, Gottesman R, Alonso A, Chen LY. RISK OF COGNITIVE IMPAIRMENT AND ANTICOAGULANT USE ACROSS THE SPECTRUM OF ATRIAL FIBRILLATION BURDEN IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Casanova R, Anderson A, Justice J, Windham G, Gottesman R, Mosley T, Wagenknecht L, Kritchevsky S. Can a Data-Driven Measure of Neuroanatomic Dementia Risk be Considered a Measure of Brain Aging? Innov Aging 2021. [PMCID: PMC8681922 DOI: 10.1093/geroni/igab046.3470] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There is an increasing interest in identifying aging-related factors which may be permissive of Alzheimer’s Disease (AD) emergence. We previously used machine learning to derive an index of neuroanatomic risk of dementia called AD pattern similarity (AD-PS) score using MRIs obtained in the Atherosclerosis Risk in Communities (ARIC) study. Here, we investigate the potential of the AD-PS scores as a brain-focused measure of biologic age. Among 1970 ARIC participants with MRI collected at ARIC Visit 5, we related AD-PS scores to three measures of aging: mortality (n=356) over 8 years of follow-up; an a priori panel of 32 proteins related to aging (N=1647); and a deficit accumulation index (DAI) based on 38 health-related measures. We found lower AD-PS scores associated with significantly lower mortality (HR=0.58, CI-95%, [0.45 - 0.75], p < 0.001) after adjusting for age, race, smoking and hypertension. Among the 32 proteins, nine were significantly associated to AD-PS scores (p < 0.05) with 4 remaining significant adjusting for multiple comparisons (Growth/differentiation factor 15, Tumor necrosis factor receptor superfamily member 1A and 1B and Collagen alpha-1(XVIII) chain). Finally, in a linear regression model after adjusting for age, race, sex, hypertension and smoking, AD-PS scores were associated with the DAI (p < 0.001). The consistent patterns of associations suggest that a data-driven measure of AD neuroanatomic risk may be capturing aspects of biologic age in older adults.
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Affiliation(s)
- Ramon Casanova
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Andrea Anderson
- Wake Forest School of Medicine, Wake Forest School of Medicine, North Carolina, United States
| | - Jamie Justice
- Wake Forest School of Medicine, Wake Forest School of Medicine, North Carolina, United States
| | - Gwen Windham
- University of Mississippi Medical Center, Jackson, Mississippi, United States
| | | | - Thomas Mosley
- The University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Lynne Wagenknecht
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Wake Forest School of Medicine, North Carolina, United States
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11
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Sullivan K, Blackshear C, Hughes T, Gottesman R, Vemuri P, Mosley T, Griswold M, Windham BG. Regional Microstructural Integrity in Relation to Gait Speed: The Atherosclerosis Risk in Communities Study. Innov Aging 2021. [PMCID: PMC8680760 DOI: 10.1093/geroni/igab046.275] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Brain imaging-based biomarkers of neuropathology are associated with mobility in older adults, but the relation of regional microstructural integrity to gait speed in the context of a broader neuropathological profile is less understood. We examined cross-sectional associations of microstructural integrity with 4-meter usual-pace gait speed (cm/s) in a subsample of ARIC study participants who completed 3T MRI brain scans with diffusion tensor imaging(2011-13; n=1785; mean age=76.2±5.3, 60% Female, 28% Black). We considered total brain and six regional averages of fractional anisotropy (FA; lower=worse microstructural integrity) and mean diffusivity (MD; higher=worse microstructural integrity): frontal, temporal, parietal, occipital, anterior and posterior corpus callosum. Associations were tested in multivariable linear regression models adjusted for demographics, cardiovascular risk factors, and with and without additional neuropathological indices: total brain volume, white matter hyperintensities, infarcts, and microhemorrhages. When modeled separately, all neuropathology indices were associated with slower gait speed. Every standard deviation(SD) higher total brain FA was associated with +2.56 cm/s gait speed (95%CI: 1.64,3.48) and every SD higher MD was associated with -4.27 cm/s gait speed (-5.34,-3.20). All regional estimates were comparable. When adjusted for all other neuropathology indices, only posterior corpus callosum FA (β=1.72; 0.67,2.77), total MD (β=-1.63; -3.02,-0.25), frontal lobe MD (β=-1.76; -3.03,-0.48), and temporal lobe MD (β=-1.40; -2.78,-0.02) remained significantly associated with gait speed. Microstructural integrity is an informative measure of brain pathology in relation to mobility, with regional measures tied to executive, memory, and somatosensory function being more informative when a broader neuropathological profile is considered.
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Affiliation(s)
- Kevin Sullivan
- The University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Chad Blackshear
- University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Timothy Hughes
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | | | | | - Thomas Mosley
- The University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Michael Griswold
- The University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - B Gwen Windham
- University of Mississippi Medical Center, Jackson, Mississippi, United States
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12
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Powell DS, Kuo PL, Qureshi R, Coburn SB, Knopman DS, Palta P, Gottesman R, Griswold M, Albert M, Deal JA, Gross AL. The Relationship of APOE ε4, Race, and Sex on the Age of Onset and Risk of Dementia. Front Neurol 2021; 12:735036. [PMID: 34744974 PMCID: PMC8564142 DOI: 10.3389/fneur.2021.735036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate whether APOE ε4 genotype—an established risk factor for dementia—is associated with earlier age at diagnosis in addition to increased risk overall and in secondary analysis by race and sex. Methods: We followed up 13,782 dementia-free individuals (n = 10,137 White, n = 3,645 Black, baseline age 60–66 years) in the Atherosclerosis Risk in Communities study for up to 30 years. Dementia was operationalized using standardized algorithms incorporating longitudinal cognitive change, proxy report, and hospital or death certificate dementia codes. We used a mixture of generalized gamma distributions to simultaneously estimate time to dementia, time to dementia-free death, and the proportion of individuals with dementia, by APOE ε4 status (≥1 vs. no alleles). Results: Median age of dementia onset among APOE ε4 carriers was 81.7 (Blacks) and 83.3 years (Whites) compared with 82.6 (Blacks) and 85.7 years (Whites) in non-APOE ε4 carriers (p > 0.05 Blacks; p < 0.01 Whites). Age of dementia diagnosis did not differ by sex in ε4 carriers, but among non-carriers, average age was earlier in males than females regardless of race. APOE ε4 carriers had on average a higher proportion of diagnoses; results did not differ by race or sex. Conclusions:APOE ε4 carrier status is associated with earlier age of dementia diagnosis with differences across race and sex. These findings clarify the causal role of APOE in dementia etiology, which could help better identify at-risk subgroups and may help facilitate better research trial recruitment and design.
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Affiliation(s)
- Danielle S Powell
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States.,Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States
| | - Pei-Lun Kuo
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Riaz Qureshi
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Priya Palta
- Division of General Medicine, Columbia University Medical Center, New York, NY, United States
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Griswold
- Biostatistics, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States.,Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States
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13
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Faigle R, Gottesman R. Author Response: Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage. Neurology 2021. [DOI: 10.1212/wnl.0000000000012680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Stroke is a leading cause of the adult disability epidemic in the United States, with a major contribution from poststroke cognitive impairment and dementia (PSCID), the rates of which are disproportionally high among the health disparity populations. Despite the PSCID's overwhelming impact on public health, a knowledge gap exists with regard to the complex interaction between the acute stroke event and highly prevalent preexisting brain pathology related to cerebrovascular and Alzheimer disease or related dementia. Understanding the factors that modulate PSCID risk in relation to index stroke event is critically important for developing personalized prognostication of PSCID, targeted interventions to prevent it, and for informing future clinical trial design. The DISCOVERY study (Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recovery), a collaborative network of thirty clinical performance clinical sites with access to acute stroke populations and the expertise and capacity for systematic assessment of PSCID will address this critical challenge. DISCOVERY is a prospective, multicenter, observational, nested-cohort study of 8000 nondemented ischemic and hemorrhagic stroke patients enrolled at the time of index stroke and followed for a minimum of 2 years, with serial cognitive evaluations and assessments of functional outcome, with subsets undergoing research magnetic resonance imaging and positron emission tomography and comprehensive genetic/genomic and fluid biomarker testing. The overall scientific objective of this study is to elucidate mechanisms of brain resilience and susceptibility to PSCID in diverse US populations based on complex interplay between life-course exposure to multiple vascular risk factors, preexisting burden of microvascular and neurodegenerative pathology, the effect of strategic acute stroke lesions, and the mediating effect of genomic and epigenomic variation.
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Affiliation(s)
- Natalia S. Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Karl Helmer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA
| | - Steven M. Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Lewis C, Levine A, Balmert LC, Chen L, Sherwani SS, Nemeth AJ, Grafman J, Gottesman R, Brown CH, Hogue CW. Neurocognitive, Quality of Life, and Behavioral Outcomes for Patients With Covert Stroke After Cardiac Surgery: Exploratory Analysis of Data From a Prospectively Randomized Trial. Anesth Analg 2021; 133:1187-1196. [PMID: 34319914 PMCID: PMC8542565 DOI: 10.1213/ane.0000000000005690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asymptomatic brain ischemic injury detected with diffusion-weighted magnetic resonance imaging (DWI) is reported in more than one-half of patients after cardiac surgery. There are conflicting findings on whether DWI-detected covert stroke is associated with neurocognitive dysfunction after surgery, and it is unclear whether such ischemic injury affects quality of life or behavioral outcomes. The purpose of this study was to perform exploratory analysis on whether covert stroke after cardiac surgery is associated with delayed neurocognitive recovery 1 month after surgery, impaired quality of life, anxiety, or depression. METHODS Analysis of data collected in a prospectively randomized study in patients undergoing cardiac surgery testing whether basing mean arterial pressure (MAP) targets during cardiopulmonary bypass to be above the lower limit of cerebral autoregulation versus usual practices reduces the frequency of adverse neurological outcomes. A neuropsychological testing battery was administered before surgery and then 1 month later. Patients underwent brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. The primary outcome was DWI-detected ischemic lesion; the primary end point was change from baseline in domain-specific neurocognitive Z scores 1 month after surgery. Secondary outcomes included a composite indicator of delayed neurocognitive recovery, quality of life measures, state and trait anxiety, and Beck Depression Inventory scores. RESULTS Of the 164 patients with postoperative MRI data, clinical stroke occurred in 10 patients. Of the remaining 154 patients, 85 (55.2%) had a covert stroke. There were no statistically significant differences for patients with or without covert stroke in the change from baseline in Z scores in any of the cognitive domains tested adjusted for sex, baseline cognitive score, and randomization treatment arm. The frequency of delayed neurocognitive recovery (no covert stroke, 15.1%; covert stroke, 17.6%; P = .392), self-reported quality of life measurements, anxiety rating, or depression scores were not different between those with or without DWI ischemic injury. CONCLUSIONS More than one-half of patients undergoing cardiac surgery demonstrated covert stroke. In this exploratory analysis, covert stroke was not found to be significantly associated with neurocognitive dysfunction 1 month after surgery; evidence of impaired quality of life, anxiety, or depression, albeit a type II error, cannot be excluded.
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Affiliation(s)
| | | | | | - Liqi Chen
- Division of Biostatistics, Department of Preventive Medicine
| | | | | | - Jordan Grafman
- Shirley Ryan Abilitylab and the Department of Rehabilitation and Physical Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Charles H Brown
- Department of Anesthesiology & Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Tin A, Walker KA, Bressler J, Windham BG, Griswold M, Sullivan K, Wu A, Gottesman R, Fornage M, Coresh J, Sharrett AR, Folsom AR, Mosley TH. Association between Circulating Protein C Levels and Incident Dementia: The Atherosclerosis Risk in Communities Study. Neuroepidemiology 2021; 55:306-315. [PMID: 34077937 PMCID: PMC8292178 DOI: 10.1159/000516287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/03/2021] [Accepted: 03/30/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Hemostasis depends on the delicate balance between coagulants and anticoagulants. Higher levels of circulating coagulants have been associated with higher risk of cerebral infarctions and dementia. In contrast, higher levels of circulating protein C, an endogenous anticoagulant, have been associated with lower risk of cerebral infarctions, and the association between protein C levels and the risk of dementia is unknown. The goal of this study was to evaluate the association of circulating protein C levels in midlife and late life with incident dementia. METHODS Circulating protein C levels were measured using blood samples collected at the midlife baseline (1987-1989) and the late-life baseline (2011-2013) among 14,462 and 3,614 participants, respectively, in the Atherosclerosis Risk in Communities study. Protein C levels were measured using enzyme-linked immunosorbent assay at midlife and a modified aptamer-based assay at late life. Participants were followed up to 2013 from midlife and up to 2017 from late life. Incident dementia was ascertained during the follow-up periods using in-person cognitive and functional assessment, informant interviews, and International Classification of Diseases codes at hospitalization discharge and on death certificates. Cause-specific Cox regression models were used to evaluate the association between quintiles of circulating protein C and incident dementia. RESULTS From midlife (mean age of 54), 1,389 incident dementia events were observed over a median follow-up of 23 years. From late life (mean age of 75), 353 incident dementia events were observed over a median follow-up of 4.9 years. At both midlife and late life, circulating protein C had an inverse association with incident dementia after adjusting for demographic, vascular, and hemostatic risk factors, incident stroke as time-dependent covariate, and incorporating stabilized weights based on propensity scores (quintile 5 vs. quintile 1 as the reference, midlife hazard ratio 0.80, 95% confidence interval 0.66-0.96, p value for trend 0.04; late-life hazard ratio 0.84, 95% confidence interval: 0.55-1.28, p value for trend 0.04). DISCUSSION/CONCLUSION Circulating protein C has an inverse association with incident dementia independent of established risk factors, including stroke. Our results suggest studying anticoagulants in addition to coagulants can increase our understanding on the relationship between hemostasis and dementia.
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Affiliation(s)
- Adrienne Tin
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Jan Bressler
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - B. Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kevin Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Myriam Fornage
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Thomas H. Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Ting J, Jiang K, Du S, Betz J, Reed N, Power MC, Gottesman R, Sharrett AR, Griswold M, Walker KA, Miller ER, Lin FR, Deal JA. Longitudinal Blood Pressure Patterns from Mid-to-Late Life and Late-life Hearing Loss in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2021; 77:640-646. [PMID: 34043799 DOI: 10.1093/gerona/glab153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hearing loss is prevalent and associated with adverse functional outcomes in older adults. Prevention thus has far-reaching implications, yet few modifiable risk factors have been identified. Hypertension may contribute to age-related hearing loss, but epidemiologic evidence is mixed. We studied a prospective cohort of 3,343 individuals from the Atherosclerosis Risk in Communities study, aged 44-65 years at baseline with up to 30 years of follow-up. METHODS Hearing was assessed in late-life (2016-17) using a better-ear audiometric pure tone average (PTA, 0.5, 1, 2, 4 kHz) and the Quick Speech-in-Noise (QuickSIN) test. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or antihypertensive medication use. Mid-life hypertension was defined by hypertension at two consecutive visits between 1987-89 and 1996-98. Late-life hypertension was defined in 2016-17. Late-life low blood pressure was defined as systolic blood pressure <90 mmHg or diastolic blood pressure <60 mmHg, irrespective of antihypertensive medication use. Associations between blood pressure patterns from mid-to-late-life and hearing outcomes were assessed using multivariable-adjusted linear regression. RESULTS Compared to persistent normotension, persistent hypertension from mid-to-late-life was associated with worse central auditory processing (difference in QuickSIN score = -0.66 points, 95% CI: -1.14, -0.17) but not with audiometric hearing. CONCLUSIONS Participants with persistent hypertension had poorer late-life central auditory processing. These findings suggest that hypertension may be more strongly related to hearing-related changes in the brain than in the cochlea.
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Affiliation(s)
- James Ting
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kening Jiang
- Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Simo Du
- Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Joshua Betz
- Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas Reed
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Griswold
- Department of Data Science, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Edgar Raymond Miller
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, USA
| | - Frank R Lin
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer A Deal
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing and Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Liu C, Williams NL, Chandra N, Rouf R, Gaddis A, Gomez Y, Simmons T, Gottesman R. Cognitive Impairment and Self-Care Among Congestive Heart Failure Patients in an Outpatient Clinic. Innov Aging 2020. [PMCID: PMC7740464 DOI: 10.1093/geroni/igaa057.507] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The burden of congestive heart failure (CHF) is the greatest among older adults. Cognition is important for carrying out self-care tasks such as monitoring sodium intake, but little is known about how cognition affects self-care in acutely ill CHF patients. We aimed to assess the association between cognition and self-care in CHF patients from an outpatient diuresis clinic. Cognitive function was measured using the Mini-Mental State Exam (MMSE) and other tests representing 5 cognitive domains. The Self-Care of Heart Failure Index (SCHFI), given to a subset of participants, consisted of 22 questions each scored on an ordinal scale of 1-4 with a total score ranging from 22-88; higher scores indicated better self-care. SCHFI questions were further categorized into maintenance, management and confidence sub-scores. Multiple linear regressions were used to analyze the association between neuropsychological test scores and SCHFI scores. A total of 68 CHF patients had complete SCHFI data, with a mean age of 65.6 years and a mean total SCHFI score of 70.9 points. Nine (13.2%) patients were cognitively impaired (MMSE<24). Older age, lower education and history of stroke were associated with cognitive impairment. After adjusting for age, education, diabetes, and depressive symptoms, no associations were observed between the other neuropsychological test scores and any of the SCHFI scores. Though findings suggest that cognition is not associated with self-care, the analysis may have been underpowered. Further evaluation of a greater number of CHF patients is needed to understand the implications of cognition on self-care and provide guidance for interventions.
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Affiliation(s)
- Chelsea Liu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Nicole L Williams
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Nisha Chandra
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Rosanne Rouf
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Andrew Gaddis
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Yessenia Gomez
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Tanya Simmons
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States
| | - Rebecca Gottesman
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
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19
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Sullivan K, Blackshear C, Sharrett AR, Gottesman R, Knopman D, Windham BG, Griswold M, Mosley T. Midlife Plasma Aβ and Late-Life Risk of Cognitive Impairment: The Atherosclerosis Risk in Communities Study. Innov Aging 2020. [PMCID: PMC7740202 DOI: 10.1093/geroni/igaa057.810] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Plasma-based biomarkers of amyloid beta (Aβ), a neuropathological hallmark of Alzheimer’s disease, show promise in predicting cognitive impairment and mapping onto cerebral amyloidosis, but little is known about how midlife plasma Aβ associates with late-life cognitive outcomes. Midlife plasma variants Aβ42 and Aβ40 were measured using a fluorimetric bead-based immunoassay in a subsample of visit 3 ARIC participants (1993-95; n=2585, mean age=59.4±5.2, 57% female, 23% African American). We investigated the relationship between midlife plasma Aβ and late-life mild cognitive impairment (MCI; n=923) and dementia (n=628) diagnosed from 2011-19. Multinomial logistic regressions estimated relative risk ratios (RRR) of MCI, dementia, and death vs normal cognitive status as a function of:(1) Aβ42:Aβ40 ratio, (2) Aβ42 and Aβ40 included as separate terms, and (3) Protected Aβ group (participants with Aβ42≥46 pg/ml and Aβ40 <233 pg/ml). Adjusters included age, sex, education, site-race, and APOE4. Every doubling of midlife plasma Aβ42:Aβ40 up to a threshold of 0.20 was associated with 41% lower risk of developing MCI/dementia in comparison to cognitively normal (RRR=0.59 [95% CI:0.42, 0.82]), with no association for ratio values ≥0.20. Every standard deviation increase in plasma Aβ42 was associated with 17% lower risk of dementia (RRR=0.83 [0.70, 0.99]), whereas every standard deviation increase in plasma Aβ40 was associated with 16% higher risk of MCI (RRR=1.16 [1.02, 1.31]). The protected midlife plasma Aβ group had 86% lower risk of late-life dementia vs all others (RRR=0.14 [0.04, 0.47]). Early measurement of plasma Aβ may prove an accessible and effective population screener for future cognitive impairment.
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Affiliation(s)
- Kevin Sullivan
- University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Chad Blackshear
- University of Mississippi Medical Center, Jackson, Mississippi, United States
| | | | - Rebecca Gottesman
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | | | - B Gwen Windham
- University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Michael Griswold
- The University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Thomas Mosley
- University of Mississippi Medical Center, Jackson, Mississippi, United States
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20
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Moazzami K, Power MC, Gottesman R, Mosley T, Lutsey PL, Jack CR, Hoogeveen RC, West N, Knopman DS, Alonso A. Association of mid-life serum lipid levels with late-life brain volumes: The atherosclerosis risk in communities neurocognitive study (ARICNCS). Neuroimage 2020; 223:117324. [PMID: 32882383 PMCID: PMC9006082 DOI: 10.1016/j.neuroimage.2020.117324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Limited information exists regarding the association between midlife lipid levels and late-life total and regional brain volumes. METHODS We studied 1872 participants in the longitudinal community-based Atherosclerosis Risk in Communities Neurocognitive Study. Serum lipid levels were measured in 1987-1989 (mean age, 53 ± 5 years). Participants underwent 3T brain MRI scans in 2011-2013. Brain volumes were measured using FreeSurfer image analysis software. Linear regression models were used to assess the associations between serum lipids and brain volumes modeled in standard deviation (SD) units, adjusting for potential confounders. RESULTS In adjusted analyses, one SD higher low-density lipoprotein cholesterol (LDL) levels were associated with larger total brain volumes (β 0.033, 95% CI 0.006-0.060) as well as larger volumes of the temporal (β 0.038, 95% CI 0.003-0.074) and parietal lobes (β 0.044, 95% CI 0.009-0.07) and Alzheimer disease-related region (β 0.048, 95% CI 0.048-0.085). Higher triglyceride levels were associated with smaller total brain volumes (β -0.033, 95% CI -0.060, -0.007). The associations between LDL levels and brain volumes were modified by age (P for interaction <0.001), with higher LDL levels associated with larger total and regional brain volumes only among adults >53 years at baseline, and were attenuated after application of weights to account for informative attrition, although associations with the parietal and Alzheimer's disease-related region remained significant. High-density lipoprotein cholesterol was not associated with brain volumes. CONCLUSION Higher LDL levels in late midlife were associated with larger brain volumes later in life, while higher triglyceride levels were associated with smaller brain volumes. These associations were driven by adults >53 years at baseline.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
| | - Melinda C Power
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nancy West
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, United States
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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21
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Ruban A, Daya N, Schneider AL, Gottesman R, Selvin E, Coresh J, Lazo M, Koton S. Liver Enzymes and Risk of Stroke: The Atherosclerosis Risk in Communities (ARIC) Study. J Stroke 2020; 22:357-368. [PMID: 33053951 PMCID: PMC7568972 DOI: 10.5853/jos.2020.00290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/26/2020] [Accepted: 08/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma-glutamyl transpeptidase [GGT]) are glutamate-regulatory enzymes, and higher glutamate levels correlated with worse prognosis of patients with neurotrauma. However, less is known about the association between liver enzymes and incidence of stroke. We evaluated the association between serum levels of AST, ALT, and GGT and incidence of stroke in the Atherosclerosis Risk in Communities (ARIC) study cohort from 1990 to 1992 through December 31, 2016. METHODS We included 12,588 ARIC participants without prevalent stroke and with data on liver enzymes ALT, AST, and GGT at baseline. We used multivariable Cox regression models to examine the associations between liver enzymes levels at baseline and stroke risk (overall, ischemic stroke, and intracerebral hemorrhage [ICH]) through December 31, 2016, adjusting for potential confounders. RESULTS During a median follow-up time of 24.2 years, we observed 1,012 incident strokes (922ischemic strokes and 90 ICH). In age, sex, and race-center adjusted models, the hazard ratios (HRs; 95% confidence intervals [CIs]) for the highest compared to lowest GGT quartile were 1.94 (95% CI, 1.64 to 2.30) for all incident stroke and 2.01 (95% CI, 1.68 to 2.41) for ischemic stroke, with the results supporting a dose-response association (P for linear trend <0.001). Levels of AST were associated with increased risk of ICH, but the association was significant only when comparing the third quartile with the lowest quartile (adjusted HR, 1.82; 95% CI, 1.06 to 3.13). CONCLUSIONS Elevated levels of GGT (within normal levels), independent of liver disease, are associated with higher risk of incident stroke overall and ischemic stroke, but not ICH.
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Affiliation(s)
- Angela Ruban
- Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea L.C. Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Gottesman
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Silvia Koton
- Department of Nursing, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Faigle R, Gottesman R. Author response: Lower carotid revascularization rates after stroke in racial/ethnic minority-serving US hospitals. Neurology 2020; 94:897. [PMID: 32423984 DOI: 10.1212/wnl.0000000000009447] [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: 11/15/2022] Open
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23
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Keene KL, Hyacinth HI, Bis JC, Kittner SJ, Mitchell BD, Cheng YC, Pare G, Chong M, O’Donnell M, Meschia JF, Chen WM, Sale MM, Rich SS, Nalls MA, Zonderman AB, Evans MK, Wilson JG, Correa A, Markus HS, Traylor M, Lewis CM, Carty CL, Reiner A, Haessler J, Langefeld CD, Gottesman R, Mosley TH, Woo D, Yaffe K, Liu Y, Longstreth WT, Psaty BM, Kooperberg C, Lange LA, Sacco R, Rundek T, Lee JM, Cruchaga C, Furie KL, Arnett DK, Benavente OR, Grewal RP, Peddareddygari LR, Dichgans M, Malik R, Worrall BB, Fornage M. Genome-Wide Association Study Meta-Analysis of Stroke in 22 000 Individuals of African Descent Identifies Novel Associations With Stroke. Stroke 2020; 51:2454-2463. [PMID: 32693751 PMCID: PMC7387190 DOI: 10.1161/strokeaha.120.029123] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is a complex disease with multiple genetic and environmental risk factors. Blacks endure a nearly 2-fold greater risk of stroke and are 2× to 3× more likely to die from stroke than European Americans. METHODS The COMPASS (Consortium of Minority Population Genome-Wide Association Studies of Stroke) has conducted a genome-wide association meta-analysis of stroke in >22 000 individuals of African ancestry (3734 cases, 18 317 controls) from 13 cohorts. RESULTS In meta-analyses, we identified one single nucleotide polymorphism (rs55931441) near the HNF1A gene that reached genome-wide significance (P=4.62×10-8) and an additional 29 variants with suggestive evidence of association (P<1×10-6), representing 24 unique loci. For validation, a look-up analysis for a 100 kb region flanking the COMPASS single nucleotide polymorphism was performed in SiGN (Stroke Genetics Network) Europeans, SiGN Hispanics, and METASTROKE (Europeans). Using a stringent Bonferroni correction P value of 2.08×10-3 (0.05/24 unique loci), we were able to validate associations at the HNF1A locus in both SiGN (P=8.18×10-4) and METASTROKE (P=1.72×10-3) European populations. Overall, 16 of 24 loci showed evidence for validation across multiple populations. Previous studies have reported associations between variants in the HNF1A gene and lipids, C-reactive protein, and risk of coronary artery disease and stroke. Suggestive associations with variants in the SFXN4 and TMEM108 genes represent potential novel ischemic stroke loci. CONCLUSIONS These findings represent the most thorough investigation of genetic determinants of stroke in individuals of African descent, to date.
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Affiliation(s)
- Keith L. Keene
- Department of Biology; Brody School of Medicine Center for Health Disparities, East Carolina University, Greenville, NC
| | - Hyacinth I. Hyacinth
- Aflac Cancer and Blood Disorder Center of Emory University and Children’s Healthcare of Atlanta University, Atlanta, GA
| | | | - Steven J. Kittner
- Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD
| | - Braxton D. Mitchell
- Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD
| | - Yu-Ching Cheng
- Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD
| | - Guillaume Pare
- McMaster University and Population Health Research Institute, Hamilton Ontario
| | - Michael Chong
- McMaster University and Population Health Research Institute, Hamilton Ontario
| | | | | | - Wei-Min Chen
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Michele M. Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Mike A. Nalls
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD
- Data Tecnica International, Glen Echo, MD
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Baltimore, MD
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Baltimore, MD
| | | | - Adolfo Correa
- University of Mississippi Medical Center, Jackson, MS
| | | | - Matthew Traylor
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Cara L. Carty
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Alexander Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeff Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carl D. Langefeld
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | - Daniel Woo
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | | | - YongMei Liu
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA; Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Ralph Sacco
- University of Miami, Miller School of Medicine, Miami, FL
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Miami, FL
| | - Jin-Moo Lee
- Washington University School of Medicine, St. Louis, MO
| | | | - Karen L. Furie
- Brown University Warren Alpert Medical School, Providence, RI
| | - Donna K. Arnett
- University of Kentucky, College of Public Health, Lexington, KY
| | | | - Raji P. Grewal
- Neuroscience Institute, Saint Francis Medical Center, Trenton, NJ
| | | | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | | | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX
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Brown CH, Neufeld KJ, Tian J, Probert J, LaFlam A, Max L, Hori D, Nomura Y, Mandal K, Brady K, Hogue CW, Shah A, Zehr K, Cameron D, Conte J, Bienvenu OJ, Gottesman R, Yamaguchi A, Kraut M. Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients: A Nested Randomized Clinical Trial. JAMA Surg 2020; 154:819-826. [PMID: 31116358 DOI: 10.1001/jamasurg.2019.1163] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Delirium occurs in up to 52% of patients after cardiac surgery and may result from changes in cerebral perfusion. Using intraoperative cerebral autoregulation monitoring to individualize and optimize cerebral perfusion may be a useful strategy to reduce the incidence of delirium after cardiac surgery. Objective To determine whether targeting mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral autoregulation monitoring reduces the incidence of delirium compared with usual care. Design, Setting, and Participants This randomized clinical trial nested within a larger trial enrolled patients older than 55 years who underwent nonemergency cardiac surgery at a single US academic medical center between October 11, 2012, and May 10, 2016, and had a high risk for neurologic complications. Patients, physicians, and outcome assessors were masked to the assigned intervention. A total of 2764 patients were screened, and 199 were eligible for analysis in this study. Intervention In the intervention group, the patient's lower limit of cerebral autoregulation was identified during surgery before CPB. On CPB, the patient's mean arterial pressure was targeted to be greater than that patient's lower limit of autoregulation. In the control group, mean arterial pressure targets were determined according to institutional practice. Main Outcomes and Measures The main outcome was any incidence of delirium on postoperative days 1 through 4, as adjudicated by a consensus expert panel. Results Among the 199 participants in this study, mean (SD) age was 70.3 (7.5) years and 150 (75.4%) were male. One hundred sixty-two (81.4%) were white, 26 (13.1%) were black, and 11 (5.5%) were of other race. Of 103 patients randomized to usual care, 94 were analyzed, and of 102 patients randomized to the intervention 105 were analyzed. Excluding 5 patients with coma, delirium occurred in 48 of the 91 patients (53%) in the usual care group compared with 39 of the 103 patients (38%) in the intervention group (P = .04). The odds of delirium were reduced by 45% in patients randomized to the autoregulation group (odds ratio, 0.55; 95% CI, 0.31-0.97; P = .04). Conclusions and Relevance The results of this study suggest that optimizing mean arterial pressure to be greater than the individual patient's lower limit of cerebral autoregulation during CPB may reduce the incidence of delirium after cardiac surgery, but further study is needed. Trial Registration ClinicalTrials.gov identifier: NCT00981474.
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Affiliation(s)
- Charles H Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karin J Neufeld
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Andrew LaFlam
- Medical Student, School of Medicine, Tufts University, Medford Massachusetts
| | - Laura Max
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaushik Mandal
- Division of Cardiac Surgery, Department of Surgery, Penn State University Hershey Medical Center, Hershey, Pennsylvania
| | - Ken Brady
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles W Hogue
- Bluhm Cardiovascular Institute, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Ashish Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kenton Zehr
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Duke Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - John Conte
- Division of Cardiac Surgery, Department of Surgery, Penn State University Hershey Medical Center, Hershey, Pennsylvania
| | - O Joseph Bienvenu
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Michael Kraut
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Armstrong NJ, Mather KA, Sargurupremraj M, Knol MJ, Malik R, Satizabal CL, Yanek LR, Wen W, Gudnason VG, Dueker ND, Elliott LT, Hofer E, Bis J, Jahanshad N, Li S, Logue MA, Luciano M, Scholz M, Smith AV, Trompet S, Vojinovic D, Xia R, Alfaro-Almagro F, Ames D, Amin N, Amouyel P, Beiser AS, Brodaty H, Deary IJ, Fennema-Notestine C, Gampawar PG, Gottesman R, Griffanti L, Jack CR, Jenkinson M, Jiang J, Kral BG, Kwok JB, Lampe L, C M Liewald D, Maillard P, Marchini J, Bastin ME, Mazoyer B, Pirpamer L, Rafael Romero J, Roshchupkin GV, Schofield PR, Schroeter ML, Stott DJ, Thalamuthu A, Trollor J, Tzourio C, van der Grond J, Vernooij MW, Witte VA, Wright MJ, Yang Q, Morris Z, Siggurdsson S, Psaty B, Villringer A, Schmidt H, Haberg AK, van Duijn CM, Jukema JW, Dichgans M, Sacco RL, Wright CB, Kremen WS, Becker LC, Thompson PM, Mosley TH, Wardlaw JM, Ikram MA, Adams HHH, Seshadri S, Sachdev PS, Smith SM, Launer L, Longstreth W, DeCarli C, Schmidt R, Fornage M, Debette S, Nyquist PA. Common Genetic Variation Indicates Separate Causes for Periventricular and Deep White Matter Hyperintensities. Stroke 2020; 51:2111-2121. [PMID: 32517579 DOI: 10.1161/strokeaha.119.027544] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Periventricular white matter hyperintensities (WMH; PVWMH) and deep WMH (DWMH) are regional classifications of WMH and reflect proposed differences in cause. In the first study, to date, we undertook genome-wide association analyses of DWMH and PVWMH to show that these phenotypes have different genetic underpinnings. METHODS Participants were aged 45 years and older, free of stroke and dementia. We conducted genome-wide association analyses of PVWMH and DWMH in 26,654 participants from CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology), ENIGMA (Enhancing Neuro-Imaging Genetics Through Meta-Analysis), and the UKB (UK Biobank). Regional correlations were investigated using the genome-wide association analyses -pairwise method. Cross-trait genetic correlations between PVWMH, DWMH, stroke, and dementia were estimated using LDSC. RESULTS In the discovery and replication analysis, for PVWMH only, we found associations on chromosomes 2 (NBEAL), 10q23.1 (TSPAN14/FAM231A), and 10q24.33 (SH3PXD2A). In the much larger combined meta-analysis of all cohorts, we identified ten significant regions for PVWMH: chromosomes 2 (3 regions), 6, 7, 10 (2 regions), 13, 16, and 17q23.1. New loci of interest include 7q36.1 (NOS3) and 16q24.2. In both the discovery/replication and combined analysis, we found genome-wide significant associations for the 17q25.1 locus for both DWMH and PVWMH. Using gene-based association analysis, 19 genes across all regions were identified for PVWMH only, including the new genes: CALCRL (2q32.1), KLHL24 (3q27.1), VCAN (5q27.1), and POLR2F (22q13.1). Thirteen genes in the 17q25.1 locus were significant for both phenotypes. More extensive genetic correlations were observed for PVWMH with small vessel ischemic stroke. There were no associations with dementia for either phenotype. CONCLUSIONS Our study confirms these phenotypes have distinct and also shared genetic architectures. Genetic analyses indicated PVWMH was more associated with ischemic stroke whilst DWMH loci were implicated in vascular, astrocyte, and neuronal function. Our study confirms these phenotypes are distinct neuroimaging classifications and identifies new candidate genes associated with PVWMH only.
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Affiliation(s)
- Nicola J Armstrong
- Mathematics and Statistics, Murdoch University, Perth, Australia (N.J.A.)
| | - Karen A Mather
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia (K.A.M., P.R.S., A.T.)
| | | | - Maria J Knol
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU Munich, Germany (R.M., M.D.)
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX (C.L.S., S.S.).,The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA
| | - Lisa R Yanek
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia
| | - Vilmundur G Gudnason
- Icelandic Heart Association, Kopavogur (V.G.G., S.S.).,University of Iceland, Reykjavik, Iceland (V.G.G., A.V.S.)
| | - Nicole D Dueker
- Dr. John T. Macdonald Foundation Department of Human Genetics (R.L.S.), University of Miami, FL
| | - Lloyd T Elliott
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada (L.T.E.).,Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Edith Hofer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria (E.H., R.S.).,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria (E.H.)
| | - Joshua Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (J.B., B.P., W.L.)
| | - Neda Jahanshad
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey (N.J., P.M.T.)
| | - Shuo Li
- Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.)
| | - Mark A Logue
- Department of Psychiatry and Biomedical Genetics Section (M.A.L.), Boston University School of Medicine, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.).,National Center for PTSD: Behavioral Science Division, VA Boston Healthcare System, Boston, MA (M.A.L.)
| | - Michelle Luciano
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.)
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology (M.S.)
| | - Albert V Smith
- University of Iceland, Reykjavik, Iceland (V.G.G., A.V.S.)
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics (S.T.), Leiden University Medical Center, the Netherlands.,Department of Cardiology (S.T.), Leiden University Medical Center, the Netherlands
| | - Dina Vojinovic
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Rui Xia
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, TX (R.X., M.F.)
| | - Fidel Alfaro-Almagro
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - David Ames
- National Ageing Research Institute, Parkville, Victoria, Australia (D.A.).,Academic Unit for Psychiatry of Old Age, University of Melbourne, St George's Hospital, Kew, Australia (D.A.)
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Philippe Amouyel
- Lille University, Inserm, Institut Pasteur de Lille, RID-AGE - Risk Factors and Molecular Determinants of Aging-Related Diseases and Labex Distalz, France (P.A.).,Lille University, Inserm, CHU Lille, Institut Pasteur de Lille, RID-AGE (P.A.)
| | - Alexa S Beiser
- The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.)
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration (H.B.), University of New South Wales, Sydney, Australia
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.)
| | - Christine Fennema-Notestine
- Department of Psychiatry (C.F.-N.), University of California, San Diego, La Jolla, CA.,Center for Behavior Genetics of Aging (C.F.-N.), University of California, San Diego, La Jolla, CA
| | - Piyush G Gampawar
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Medical University of Graz, Austria (P.G.G., H.S.)
| | - Rebecca Gottesman
- Department of Neurology, Cerebrovascular and stroke Division (R.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN (C.R.J.J.)
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia
| | - Brian G Kral
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - John B Kwok
- School of Medical Sciences (J.B.K., P.R.S.), University of New South Wales, Sydney, Australia.,Brain and Mind Centre - The University of Sydney, Camperdown, NSW, Australia (J.B.K.)
| | - Leonie Lampe
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (L.L., V.A.W.)
| | - David C M Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.)
| | - Pauline Maillard
- Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology, University of California-Davis, Davis, CA (P.M.)
| | - Jonathan Marchini
- Statistical Genetics and Methods at Regeneron Pharmaceuticals, Inc, New York, NY (J.M.)
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.).,Centre for Clinical Brain Sciences, Edinburgh Imaging, Centre for Cognitive Ageing, University of Edinburgh, United Kingdom (M.E.B., J.M.W.)
| | - Bernard Mazoyer
- Institut des Maladies Neurodégénératives, University of Bordeaux, France (B.M.)
| | - Lukas Pirpamer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria (L.P.)
| | - José Rafael Romero
- The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA
| | - Gennady V Roshchupkin
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Department of Radiology and Nuclear Medicine (G.V.R., M.W.V., H.H.H.A.)
| | - Peter R Schofield
- School of Medical Sciences (J.B.K., P.R.S.), University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia (K.A.M., P.R.S., A.T.)
| | - Matthias L Schroeter
- LIFE Research Center for Civilization Disease, Leipzig, Germany (M.S.).,Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (M.L.S., A.V.).,Day Clinic for Cognitive Neurology, University Hospital Leipzig, Germany (M.L.S., A.V.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (D.J.S.)
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia (K.A.M., P.R.S., A.T.)
| | - Julian Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry (J.T.), University of New South Wales, Sydney, Australia
| | - Christophe Tzourio
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, France (M.S., C.T., S.D.).,CHU de Bordeaux, Public Health Department, Medical information Department, Bordeaux, France (C.T.)
| | - Jeroen van der Grond
- Department of Radiology (J.v.d.G.), Leiden University Medical Center, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Department of Radiology and Nuclear Medicine (G.V.R., M.W.V., H.H.H.A.)
| | - Veronica A Witte
- Collaborative Research Center 1052 Obesity Mechanisms, Faculty of Medicine, University of Leipzig, Germany (V.A.W).,Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (L.L., V.A.W.)
| | - Margaret J Wright
- Queensland Brain Institute (M.J.W.), The University of Queensland, St Lucia, QLD, Australia.,Centre for Advanced Imaging (M.J.W.), The University of Queensland, St Lucia, QLD, Australia
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA (S.L., M.A.L., A.S.B., Q.Y.)
| | - Zoe Morris
- Neuroradiology Department, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (Z.M.)
| | - Siggi Siggurdsson
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX (C.L.S., S.S.).,The Framingham Heart Study, MA (C.L.S., A.S.B., J.R.R., S.S.).,Department of Neurology (C.L.S., A.S.B., J.R.R., S.S.), Boston University School of Medicine, MA
| | - Bruce Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (J.B., B.P., W.L.)
| | - Arno Villringer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (M.L.S., A.V.).,Day Clinic for Cognitive Neurology, University Hospital Leipzig, Germany (M.L.S., A.V.)
| | - Helena Schmidt
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Medical University of Graz, Austria (P.G.G., H.S.)
| | - Asta K Haberg
- Department of Neuromedicine and Movement Science (A.K.H.), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine (A.K.H.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Nuffield Department of Population Health (C.M.v.D.), University of Oxford, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, the Netherlands (J.W.J.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU Munich, Germany (R.M., M.D.).,German Center for Neurodegenerative Diseases, Munich, Germany (M.D.).,Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.)
| | - Ralph L Sacco
- Department of Public Health Sciences, Miller School of Medicine (R.L.S.), University of Miami, FL.,Department of Neurology, Miller School of Medicine (R.L.S.), University of Miami, FL.,Evelyn F. McKnight Brain Institute, Department of Neurology (R.L.S.), University of Miami, FL
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke (C.B.W.), National Institutes of Health, Bethesda, MD
| | - William S Kremen
- Center for Behavior Genetics of Aging (W.S.K.), University of California, San Diego, La Jolla, CA.,Department of Psychiatry (W.S.K.), University of California, San Diego, La Jolla, CA
| | - Lewis C Becker
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul M Thompson
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey (N.J., P.M.T.)
| | - Thomas H Mosley
- Department of Geriatric Medicine, Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson (T.H.M.)
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (M.L., I.J.D., D.C.M.L., M.E.B., J.M.W.).,Centre for Clinical Brain Sciences, Edinburgh Imaging, Centre for Cognitive Ageing, University of Edinburgh, United Kingdom (M.E.B., J.M.W.)
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.)
| | - Hieab H H Adams
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (M.J.K., D.V., N.A., G.V.R., M.W.V., C.M.v.D., M.A.I., H.H.H.A.).,Department of Radiology and Nuclear Medicine (G.V.R., M.W.V., H.H.H.A.).,Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands (H.H.H.A.)
| | | | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry (K.A.M., W.W., H.B., J.J., A.T., J.T., P.S.S.), University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (P.S.S.)
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB) (L.T.E., F.A.-A., L.G., M.J., S.M.S.), University of Oxford, United Kingdom
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program (L.L.), National Institutes of Health, Bethesda, MD
| | - William Longstreth
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (J.B., B.P., W.L.)
| | - Charles DeCarli
- Alzheimer's Disease Center and Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology and Center for Neuroscience University of California at Davis (C.D.)
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria (E.H., R.S.)
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, TX (R.X., M.F.).,Human Genetics Center, School of Public Health UT, Houston, TX (M.F.)
| | - Stephanie Debette
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, France (M.S., C.T., S.D.).,Department of Neurology, CHU de Bordeaux (University Hospital), Bordeaux, France (S.D.)
| | - Paul A Nyquist
- GeneSTAR Research Program (L.R.Y., B.G.K., L.C.B., P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD.,Departments of Neurology, Critical Care Medicine, Neurosurgery (P.A.N.), Johns Hopkins University School of Medicine, Baltimore, MD.,Critical Care Medicine Department (P.A.N.), National Institutes of Health, Bethesda, MD
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Li D, Misialek JR, Jing M, Tsai MY, Eckfeldt JH, Steffen LM, Knopman D, Wruck L, Gottesman R, Mosley TH, Sharrett AR, Alonso A. Plasma phospholipid very-long-chain SFAs in midlife and 20-year cognitive change in the Atherosclerosis Risk in Communities (ARIC): a cohort study. Am J Clin Nutr 2020; 111:1252-1258. [PMID: 32320012 PMCID: PMC7266687 DOI: 10.1093/ajcn/nqaa048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Very-long-chain SFAs (VLSFAs) have recently gained considerable attention as having beneficial effects on health and aging. OBJECTIVES The objective of this study was to assess the associations of plasma phospholipid VLSFAs [arachidic acid (20:0), behenic acid (22:0), tricosanoic acid (23:0), and lignoceric acid (24:0)] with 20-y cognitive decline in the Atherosclerosis Risk in Communities (ARIC) participants. Furthermore, this study compared the associations of plasma phospholipid VLSFAs with 5 common groups of fatty acids [i.e., total SFAs, total MUFAs, total ω-3 (n-3) PUFAs, total marine-derived ω-3 PUFAs, total ω-6 PUFAs]. METHODS This study used a cohort study design of 3229 ARIC participants enrolled at the Minnesota field center. Fatty acids were measured at visit 1 (1987-1989); and cognition was assessed at visits 2 (1990-1992), 4 (1996-1998), and 5 (2011-2013) using 3 tests: the Delayed Word Recall Test (DWRT), the Digit-Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). RESULTS Higher proportions of plasma phospholipid total VLSFAs and each individual VLSFA were associated with less decline in WFT, a test of verbal fluency. For example, 1 SD higher in total VLSFAs at baseline was associated with 0.057 SD (95% CI: 0.018, 0.096, P = 0.004) less cognitive decline over 20 y as measured by WFT score. None of the 5 common fatty acid groups were associated with change in WFT, but a higher proportion of plasma phospholipid total MUFAs was associated with greater decline in DWRT; higher total ω-6 PUFAs with less decline in DWRT; and higher total ω-3 and total marine-derived ω-3 PUFAs with less decline in DSST. CONCLUSIONS This study suggests that higher proportions of plasma phospholipid VLSFAs in midlife may be associated with less 20-y cognitive decline.
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Affiliation(s)
- Danni Li
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ma Jing
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - John H Eckfeldt
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Tom H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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27
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Shin J, Ma S, Hofer E, Patel Y, Vosberg DE, Tilley S, Roshchupkin GV, Sousa AMM, Jian X, Gottesman R, Mosley TH, Fornage M, Saba Y, Pirpamer L, Schmidt R, Schmidt H, Carrion-Castillo A, Crivello F, Mazoyer B, Bis JC, Li S, Yang Q, Luciano M, Karama S, Lewis L, Bastin ME, Harris MA, Wardlaw JM, Deary IE, Scholz M, Loeffler M, Witte AV, Beyer F, Villringer A, Armstrong NJ, Mather KA, Ames D, Jiang J, Kwok JB, Schofield PR, Thalamuthu A, Trollor JN, Wright MJ, Brodaty H, Wen W, Sachdev PS, Terzikhan N, Evans TE, Adams HHHH, Ikram MA, Frenzel S, Auwera-Palitschka SVD, Wittfeld K, Bülow R, Grabe HJ, Tzourio C, Mishra A, Maingault S, Debette S, Gillespie NA, Franz CE, Kremen WS, Ding L, Jahanshad N, Sestan N, Pausova Z, Seshadri S, Paus T. Global and Regional Development of the Human Cerebral Cortex: Molecular Architecture and Occupational Aptitudes. Cereb Cortex 2020; 30:4121-4139. [PMID: 32198502 DOI: 10.1093/cercor/bhaa035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We have carried out meta-analyses of genome-wide association studies (GWAS) (n = 23 784) of the first two principal components (PCs) that group together cortical regions with shared variance in their surface area. PC1 (global) captured variations of most regions, whereas PC2 (visual) was specific to the primary and secondary visual cortices. We identified a total of 18 (PC1) and 17 (PC2) independent loci, which were replicated in another 25 746 individuals. The loci of the global PC1 included those associated previously with intracranial volume and/or general cognitive function, such as MAPT and IGF2BP1. The loci of the visual PC2 included DAAM1, a key player in the planar-cell-polarity pathway. We then tested associations with occupational aptitudes and, as predicted, found that the global PC1 was associated with General Learning Ability, and the visual PC2 was associated with the Form Perception aptitude. These results suggest that interindividual variations in global and regional development of the human cerebral cortex (and its molecular architecture) cascade-albeit in a very limited manner-to behaviors as complex as the choice of one's occupation.
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Affiliation(s)
- Jean Shin
- The Hospital for Sick Children, University of Toronto, Toronto, M5G 0A4 ON, M5G 0A4, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, M4G 1R8 ON, Canada
| | - Shaojie Ma
- Department of Genetics, Yale University School of Medicine, New Haven, 06510 CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, 06510 CT, USA
| | - Edith Hofer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, 8036 Graz, Austria.,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Yash Patel
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, M4G 1R8 ON, Canada
| | - Daniel E Vosberg
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, M4G 1R8 ON, Canada
| | - Steven Tilley
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, M4G 1R8 ON, Canada
| | - Gennady V Roshchupkin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC, 3015 Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - André M M Sousa
- Department of Neuroscience, Kavli Institute for Neuroscience, Yale School of Medicine, New Haven, 06510 CT, USA
| | - Xueqiu Jian
- Institute of Molecular Medicine and Human Genetics Center, University of Texas Health Science Center at Houston, 77030 Houston, 77030 TX, USA
| | | | - Thomas H Mosley
- University of Mississippi Medical Center, Jackson, 39216 MS, USA
| | - Myriam Fornage
- Institute of Molecular Medicine and Human Genetics Center, University of Texas Health Science Center at Houston, 77030 Houston, 77030 TX, USA
| | - Yasaman Saba
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Pirpamer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | - Helena Schmidt
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, 8036 Graz, Austria
| | - Amaia Carrion-Castillo
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, 6525 Nijmegen, The Netherlands
| | - Fabrice Crivello
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, et Université de Bordeaux, F-33000 Bordeaux, France
| | - Bernard Mazoyer
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, et Université de Bordeaux, F-33000 Bordeaux, France
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, 98101 WA, USA
| | - Shuo Li
- Department of Biostatistics, Boston University School of Public Health, Boston, 02118, MA, USA
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, 02118, MA, USA
| | - Michelle Luciano
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK.,Department of Psychology, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Sherif Karama
- Montreal Neurological Institute, McGill University, H3A 2B4 Montreal, QC, Canada
| | - Lindsay Lewis
- Montreal Neurological Institute, McGill University, H3A 2B4 Montreal, QC, Canada
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, EH8 9YL Edinburgh, UK
| | - Mathew A Harris
- Centre for Clinical Brain Sciences, University of Edinburgh, EH8 9YL Edinburgh, UK.,Division of Psychiatry, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Ian E Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, EH8 9YL Edinburgh, UK.,Department of Psychology, University of Edinburgh, EH8 9JZ Edinburgh, UK
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04109 Leipzig, Germany.,LIFE Research Center for Civilization Diseases, 04103 Leipzig, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04109 Leipzig, Germany.,LIFE Research Center for Civilization Diseases, 04103 Leipzig, Germany
| | - A Veronica Witte
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.,Faculty of Medicine, CRC 1052 Obesity Mechanisms, University of Leipzig, 04109 Leipzig, Germany.,Day Clinic for Cognitive Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Frauke Beyer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.,Faculty of Medicine, CRC 1052 Obesity Mechanisms, University of Leipzig, 04109 Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.,Faculty of Medicine, CRC 1052 Obesity Mechanisms, University of Leipzig, 04109 Leipzig, Germany.,Day Clinic for Cognitive Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Nicola J Armstrong
- Mathematics and Statistics, Murdoch University, 6150 Perth, WA, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia.,Neuroscience Research Australia, 2031 Sydney, NSW, Australia
| | - David Ames
- National Ageing Research Institute, Royal Melbourne Hospital, 3052 Melbourne, VIC, Australia.,Academic Unit for Psychiatry of Old Age, St. Vincent's Health, The University of Melbourne, 3010 Melbourne, VIC, Australia
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia
| | - John B Kwok
- Brain and Mind Centre, The University of Sydney, 2050 Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, 2052 Sydney, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, 2031 Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, 2052 Sydney, NSW, Australia
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, 2031 Sydney, NSW, Australia
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, 4072 St Lucia, QLD, Australia.,Centre for Advanced Imaging, The University of Queensland, 4072 St Lucia, QLD, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia.,Dementia Centre for Research Collaboration, University of New South Wales, 2052 Sydney, NSW, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, 2052 Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, 2031 Sydney, NSW, Australia
| | - Natalie Terzikhan
- Department of Epidemiology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Tavia E Evans
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Hieab H H H Adams
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Centre, 3015 Rotterdam, The Netherlands
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Sandra van der Auwera-Palitschka
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany.,44German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, 37075, Germany
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany.,44German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, 37075, Germany
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17489 Greifswald, Germany.,44German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, 37075, Germany
| | - Christophe Tzourio
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Team VINTAGE, UMR 1219, F-33000 Bordeaux, France.,Department of Neurology, CHU de Bordeaux, F-33000 Bordeaux, France
| | - Aniket Mishra
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Team VINTAGE, UMR 1219, F-33000 Bordeaux, France
| | - Sophie Maingault
- Institut des Maladies Neurodégénratives, UMR 5293, CEA, CNRS, University of Bordeaux, Ubordeaux, F-33000 Bordeaux, France
| | - Stephanie Debette
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Team VINTAGE, UMR 1219, F-33000 Bordeaux, France.,Department of Neurology, CHU de Bordeaux, F-33000 Bordeaux, France.,Department of Neurology, Boston University School of Medicine, Boston, 02118 MA, USA
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavioural Genetics, Virginia Commonwealth University, Richmond, 23284 VA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California, San Diego, 92093 CA, USA.,Center for Behavior Genetics of Aging, University of California, San Diego, 92093 CA, USA
| | - William S Kremen
- Department of Psychiatry, University of California, San Diego, 92093 CA, USA.,Center for Behavior Genetics of Aging, University of California, San Diego, 92093 CA, USA.,VA San Diego Center of Excellence for Stress and Mental Health, San Diego, 92161 CA, USA
| | - Linda Ding
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, 90033 CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, 90033 CA, USA
| | | | - Nenad Sestan
- Department of Genetics, Yale University School of Medicine, New Haven, 06510 CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, 06510 CT, USA
| | - Zdenka Pausova
- The Hospital for Sick Children, University of Toronto, Toronto, M5G 0A4 ON, M5G 0A4, Canada.,Department of Physiology, University of Toronto, Toronto, M5S 1A8 ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, M5S 1A8 ON, Canada
| | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, 02118 MA, USA.,55Department of Epidemiology and Biostatistics, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, 78229 TX, USA
| | - Tomas Paus
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, M4G 1R8 ON, Canada.,Department of Psychology, University of Toronto, Toronto, M5S 3G3 ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, M5T 1R8 ON, Canada
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Mathews L, Ishigami J, Ding N, Hoogeveen RC, Kucharska-Newton A, Ballantyne CM, Gottesman R, Selvin E, Matsushita K. Cardiac Biomarkers and Subsequent Risk of Hospitalization With Bleeding in the Community: Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2020; 9:e013560. [PMID: 32114886 PMCID: PMC7335570 DOI: 10.1161/jaha.119.013560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background hs‐cTnT (high‐sensitivity cardiac troponin T), but not NT‐proBNP (N‐terminal pro–B natriuretic peptide), has been shown to predict bleeding in patients with atrial fibrillation. Whether these biomarkers are independently associated with bleeding in the general population is unknown. Methods and Results We used Cox proportional hazards models to examine the association of hs‐cTnT and NT‐proBNP with incident bleeding (defined by International Classification of Diseases, Ninth Revision [ICD‐9] codes) among 9550 middle‐aged men and women without a history of cardiovascular disease or bleeding. There were 847 hospitalizations with bleeding (92% from gastrointestinal bleeding) during a median follow‐up of 9.0 years. Serum levels of hs‐cTnT were associated with bleeding in a graded fashion, with a hazard ratio of 1.28 (95% CI, 1.06–1.59) for 6 to <9 ng/L, 1.52 (1.21–1.91) for 9 to <14, and 2.05 (1.56–2.69) for ≥14 versus <3 ng/L. For NT‐proBNP, the highest category (≥264 versus <42 pg/mL) showed a hazard ratio of 2.00 (1.59–2.61), and the remaining 3 categories had hazard ratios ranging from 1.2 to 1.3. Individuals in the highest category of both hs‐cTnT and NT‐proBNP had a hazard ratio of 3.03 (1.97–4.68) compared with those in the lowest categories. Conclusions In a community‐based population, elevated hs‐cTnT and NT‐proBNP were associated with bleeding‐related hospitalizations. These biomarkers may have a high utility in identifying people at high risk for bleeding. There is a need for research on the underlying mechanisms linking subclinical cardiac abnormalities and bleeding.
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Affiliation(s)
- Lena Mathews
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Division of Cardiology Johns Hopkins School of Medicine Baltimore MD
| | - Junichi Ishigami
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ning Ding
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Ron C Hoogeveen
- Department of Medicine Baylor College of Medicine Houston TX
| | - Anna Kucharska-Newton
- Gillings School of Global Public Health University of North Carolina at Chapel Hill NC.,College of Public Health University of Kentucky Lexington KY
| | | | - Rebecca Gottesman
- Department of Neurology Johns Hopkins School of Medicine Baltimore MD
| | - Elizabeth Selvin
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Kunihiro Matsushita
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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Liu C, Roth DL, Sheehan OC, Blinka MD, Gottesman R. Abstract 92: Stroke Survivors Experience Greater Decline in Life’s Simple 7 Score for Cardiovascular Health Over 10-Year Follow-Up. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.92] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Life’s Simple 7 (LS7) is a measure of cardiovascular health based on seven domains of smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. Due to secondary prevention efforts, stroke survivors may experience improvements in LS7 scores over time compared to those who did not experience a stroke.
Methods:
We included participants over 45 years of age enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who had LS7 data at baseline and 10-year follow-up and did not report a history of stroke at baseline (N=7568). Of these, 361 had an adjudicated ischemic stroke between the LS7 assessments. Scores on each domain of LS7 range from 1-3 for a maximum total score of 21, where a higher score represents better cardiovascular health. A general linear model was used to test the association of having an ischemic stroke on the change in LS7 score. Covariates included the LS7 score at baseline, age, race, gender, cognitive status, and education.
Results:
Findings indicated that those who were younger, African American, and had lower levels of education, experienced significant decline in LS7 scores from baseline to follow-up (Table 1). Those who had a stroke also experienced, on average, 0.25 points more decline in total LS7 scores than those who did not have a stroke (p=0.048).
Conclusions:
Stroke survivors did not experience improvements in cardiovascular health due to secondary prevention after an ischemic stroke. On the contrary, they experienced significantly greater decline, indicating the need for greater efforts in lifestyle modification and secondary prevention after a stroke.
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Affiliation(s)
- Chelsea Liu
- Epidemiology, Johns Hopkins Univ, Baltimore, MD
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Bahouth MN, Gottesman R. Abstract WP372: Hydration Status and Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp372] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Impaired hydration measured by elevated blood urea nitrogen (BUN) to creatinine ratio has been associated with worsened outcome after acute ischemic stroke. Whether hydration status is relevant for patients with acute ischemic stroke treated with mechanical thrombectomy remains unknown.
Materials and Methods:
We conducted a retrospective review of consecutive acute ischemic stroke patients who underwent endovascular procedures for anterior circulation large artery occlusion at Johns Hopkins Comprehensive Stroke Centers between 2012 and 2017. A volume contracted state (VCS), was determined based on surrogate lab markers and defined as blood urea nitrogen (BUN) to creatinine ratio greater than 15. Endpoints were achievement of successful revascularization (TICI 2b or 3), early re-occlusion, and short term clinical outcomes including development of early neurological worsening and functional outcome at 3 months.
Results:
Of the 158 patients who underwent an endovascular procedure, 102 patients had a final diagnosis of anterior circulation large vessel occlusion and met the inclusion criteria for analysis. Volume contracted state was present in 62/102 (61%) of patients. Successful revascularization was achieved in 75/102 (74%) of the cohort. There was no relationship between VCS and successful revascularization, but there was a 1.13 increased adjusted odds (95% CI 1.01, 1.27) of re-occlusion within 24 hours for every point higher BUN/creatinine ratio in the subset of patients who underwent radiological testing for pre-procedure planning (n=57). There was no relationship between VCS and clinical outcomes including early neurological worsening and 3 month outcome.
Conclusions:
Patients with VCS and large vessel anterior circulation stroke may have a higher odds of early re-occlusion after mechanical thrombectomy than their non-VCS counterparts, but no differences in successful revascularization nor clinical outcomes were present in this cohort. These results may suggest an opportunity for the exploration of pre-procedure hydration to improve outcomes.
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de Havenon AH, Yeatts S, Gottesman R, Turan T, Rost N, Prabhakaran S. Abstract TMP99: White Matter Hyperintensity Progression and Subsequent Incident Stroke: A Secondary Analysis of the ACCORD Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tmp99] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Studies have shown that the volume of white matter hyperintensity (WMH) is a risk factor for stroke, but there are scarce data exploring the relationship between WMH progression on serial MRIs and subsequent risk of stroke.
Hypothesis:
We hypothesize that WMH progression in the ACCORD trial increases the risk of subsequent incident stroke.
Methods:
The exposure period was from baseline to month 40, during which an MRI was performed at both baseline and month 40. The primary outcome was incident ischemic stroke after the month 40 MRI until study completion. We fit Cox models to the primary outcome and included both the baseline and month 40 WMH volume as covariates, with the hazard ratio for the month 40 WMH volume of primary interest because it represents WMH progression in this model.
Results:
We included 497 patients, of whom 53.3% were male and the mean (SD) age was 62.7 (5.7) years at enrollment. Mean (SD) follow-up after the month 40 MRI was 5.2 (1.8) years. Incident stroke occurred in 17 (3.4%) patients, in whom 2 were recurrent strokes and 15 were first-ever strokes. WMH progression was associated with subsequent stroke in the Cox model (HR 1.27, 95% CI 1.03-1.57, p=0.024) and remained significant after adjusting for patient age, history of prior stroke, and cigarette smoking (HR 1.33, 95% CI 1.07-1.65, p=0.010).
Conclusions:
Although this preliminary analysis is underpowered, WMH progression, independent of absolute WMH burden, may be a risk factor for future stroke in diabetic patients. This novel finding could have translational implications - specifically that interventions which reduce the progression of WMH could, in turn, reduce future risk of stroke.
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Johansen MC, Doria De Vasconcellos H, Gottesman R. Abstract WMP67: Changes in Left Atrial Strain Are Associated With Embolic Appearing Ischemic Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp67] [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] [Indexed: 11/16/2022]
Abstract
Background:
Accruing evidence suggests that changes in cardiac structure and function, irrespective of tachyarrhythmia, are responsible for thrombus formation. Although transthoracic echocardiogram (TTE) is frequently used for cardiovascular evaluation in ischemic stroke patients (IS), many cardiac features that could clarify stroke subtype are poorly characterized without optimal evaluation of the left atrium (LA). 2D speckle tracking echocardiography (STE) allows an accurate, reproducible, and detailed assessment of the LA cycle.
Methods:
IS with clinically indicated TTE provided consent. LA STE was quantified using a post processing wall motion tracking software per standard definitions. Strain/strain rate (Sr) curves for the 3 components of the LA cycle: 1) Reservoir (Global longitudinal Sr (Srmax)) 2) Conductive (Early LA Sr (Sre)) and 3) Contractile (Late LA Sr (Sra)) were evaluated. The association of embolic-appearing stroke (cardioembolic or cryptogenic; ES) with LA STE features (independent variables) was tested using logistic regression (OR (95%CI)) adjusted for covariates.
Results:
Participants (N=136) were 53-70yo, 57% female and 59% black. Incremental increases in Sra (worse LA contraction) were associated with >2 times greater odds of ES (2.47 (1.29-4.72)) and improvement in Smax (LA reservoir) was associated with decreased odds of ES when adjusting for demographics (0.98 (0.96-0.99)), but not in a fully adjusted model. Improvement in the corresponding emptying fractions was significantly associated with decreased odds of ES (aEF 0.93 (0.98-0.97) tEF 0.96 ( 0.93-0.99)).
Conclusions:
In this study the odds of ES was higher in those with worse LA contraction and decreased with improvement in LA reservoir with corresponding decreased odds of ES with improvement in emptying fractions. LA STE is an underutilized technology and may represent a promising tool for characterization of LA performance in patients with otherwise unexplained ES.
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Mascari R, Sen S, Suri F, Wasserman B, Gottesman R, Rosamond W, Moss K, Beck J. Abstract 136: Role of Periodontal Disease on Intracranial Atherosclerosis. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.136] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Periodontal disease (PD) is a chronic inflammatory process that affects gum and teeth. Due to the role of inflammation on atherosclerosis, we assessed the hypothesis that PD is associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk In Communities (ARIC) study.
Methods:
Full-mouth clinical periodontal measurements (7-indices) collected at 6 sites per tooth from 6155 subjects from the Dental Atherosclerosis in Communities Study (DARIC) without prior stroke were used to differentiate seven periodontal profile classes (PPCs). Of this cohort, a stratified subset underwent 3D time-of-flight MR angiogram and 3D high-isotropic resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. In this study, we evaluated the relationship between PD status and severe asymptomatic ICAS, defined as ≥50% stenosis.
Results:
Among dentate subjects who underwent vascular imaging, 1033 (90%) had 0-50% ICAS and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-A), participants with gingivitis (PPC-C) had significantly higher odds of having ≥50% ICAS (Figure 1; Crude OR 2.1, 95% CI 1.2-3.8, p=0.015). This association strengthened after adjusting for the significant confounding variables: age, hypertension, and LDL cholesterol (Adjusted OR 2.4, 95% CI 1.3-4.5, p=0.006).
Conclusion:
We report a significant association between inflammatory PD class and ≥50% asymptomatic ICAS. Because gingivitis is reversible, future studies are needed to determine if treatment of gingivitis can prevent the development and progression of ICAS, thus reducing the risk of stroke.
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Affiliation(s)
| | - Souvik Sen
- Univ of South Carolina Sch of Medicine, Columbia, SC
| | | | | | | | - Wayne Rosamond
- Univ of North Carolina Sch of Public Health, Chapel Hill, NC
| | - Kevin Moss
- Univ of North Carolina Sch of Dentistry, Chapel Hill, NC
| | - James Beck
- Univ of North Carolina Sch of Dentistry, Chapel Hill, NC
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de Havenon AH, Turan T, Yeatts S, Gottesman R, Prabhakaran S, Rost N. Abstract 133: White Matter Hyperintensity and Cardiovascular Disease Outcomes: A Secondary Analysis of the SPRINT MIND Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.133] [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] [Indexed: 11/16/2022]
Abstract
Background:
The Systolic Blood Pressure Intervention Trial (SPRINT) randomized patients to a goal SBP <120 mm Hg vs. <140 mm Hg . A subset of patients enrolled in SPRINT MIND, which performed a baseline MRI and measured white matter hyperintensity volume (WMHv). We evaluated the association between WMHv and cardiovascular events.
Methods:
The primary outcome was a composite of stroke, MI, ACS, decompensated CHF, or CVD death. The secondary outcome was stroke. The WMHv was divided into quartiles. We fit Cox models to the outcomes and report adjusted hazard ratios for the quartiles of WMHv, and stratified by SPRINT treatment arm.
Results:
Among 719 included patients, the mean WMHv in the quartiles was 0.34, 1.09, 2.61, and 10.8 mL. The primary outcome occurred in 51/719 (7.1%) and the secondary outcome in 10/719 (1.4%). The WMHv was associated with both outcomes (Table 1, Figure 1). After stratifying by treatment arm, we found the association persisted in the standard, but not intensive, treatment arm (Table 2). However, the interaction term between WMHv and treatment arm was not significant.
Conclusions:
We observed that degree of WMH was associated with CVD and stroke risk in SPRINT MIND. The risk may be attenuated in patients randomized to intensive BP lowering. Trials are needed to determine if intensive BP lowering can prospectively reduce the high cardiovascular risk in patients with WMH.
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de Havenon AH, Turan T, Gottesman R, Yeatts S, Prabhakaran S, Rost N. Abstract WMP14: Association of Systolic Blood Pressure, LDL Cholesterol, and Hgb A1c With White Matter Hyperintensity on MRI in the ACCORDION MIND Study. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp14] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
While retrospective studies have shown that poor control of vascular risk factors is associated with progression of white matter hyperintensity (WMH), it has not been studied prospectively.
Hypothesis:
We hypothesize that higher systolic blood pressure (SBP) mean, LDL cholesterol, and Hgb A1c will be correlated with WMH progression in diabetics.
Methods:
This is a secondary analysis of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes Follow-on Study (ACCORDION). The primary outcome was WMH progression, evaluated by fitting linear regression models to the WMH volume on the month 80 MRI and adjusting for the WMH volume on the baseline MRI. The primary predictors were the mean values of SBP, LDL, and A1c from baseline to month 80. We defined a good vascular risk factor profile as mean SBP <120 mm Hg
and
mean LDL <120 mg/dL.
Results:
We included 292 patients, with a mean (SD) age of 62.6 (5.3) years and 55.8% male. The mean number of SBP, LDL, and A1c measurements per patient was 17, 5, and 12. We identified 86 (29.4%) patients with good vascular risk factor profile. In the linear regression models, mean SBP and LDL were associated with WMH progression and in a second fully adjusted model they both remained associated with WMH progression (Table). Those with a good vascular risk factor profile had less WMH progression (β Coefficient -0.80, 95% CI -1.42, -0.18, p=0.012).
Conclusions:
Our data reinforce prior research showing that higher SBP and LDL is associated with progression of WMH in diabetics, likely secondary to chronic microvascular ischemia, and suggest that control of these factors may have protective effects. This study has unique strengths, including prospective serial measurement of the exposures, validated algorithmic measurement methodology for WMH, and rigorous adjudication of study data. Clinical trials are needed to investigate the effect of vascular risk factor reduction on WMH progression.
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Moazzami K, Shao IY, Chen LY, Lutsey PL, Jack CR, Mosley T, Joyner DA, Gottesman R, Alonso A. Atrial Fibrillation, Brain Volumes, and Subclinical Cerebrovascular Disease (from the Atherosclerosis Risk in Communities Neurocognitive Study [ARIC-NCS]). Am J Cardiol 2020; 125:222-228. [PMID: 31771759 PMCID: PMC6942172 DOI: 10.1016/j.amjcard.2019.10.010] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 01/24/2023]
Abstract
The aim of the present study was to investigate the association between atrial fibrillation (AF) and total and regional brain volumes among participants in the community-based Atherosclerosis Risk in Communities Neurocognitive study (ARIC-NCS). A total of 1,930 participants (130 with AF) with a mean age of 76.3 ± 5.2, who underwent 3T brain MRI scans in 2011 to 2013 were included. Prevalent AF was ascertained from study ECGs and hospital discharge codes. Brain volumes were measured using FreeSurfer image analysis software. Markers of subclinical cerebrovascular disease included lobar microhemorrhages, subcortical microhemorrhages, cortical infarcts, subcortical infarcts, lacunar infarcts, and volume of white matter hyperintensities. Linear regression models were used to assess the associations between AF status and brain volumes. In adjusted analyses, AF was not associated with markers of subclinical cerebrovascular disease. However, AF was associated with smaller regional brain volumes (including temporal, occipital, and parietal lobes; deep gray matter; Alzheimer disease signature region; and hippocampus [all p <0.05]) after controlling for demographics, cardiovascular risk factors, prevalent cardiovascular disease, and markers of subclinical cerebrovascular disease. Subgroup analysis revealed a significant interaction between AF and total brain volume with respect to age (p = 0.02), with associations between AF and smaller brain volumes being stronger for older individuals. In conclusion, AF was associated with smaller brain volumes, and the association was stronger among older individuals. This finding may be related to the longer exposure period of the older population to AF or the possibility that older people are more susceptible to the effects of AF on brain volume.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Iris Yuefan Shao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi
| | - David A Joyner
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Sullivan KJ, Griswold M, Hughes T, Hugenschmidt CE, Lockhart S, Mosley T, Gottesman R, Windham G. NEUROPATHOLOGY AND GAIT SPEED DECLINE IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY. Innov Aging 2019. [PMCID: PMC6846235 DOI: 10.1093/geroni/igz038.3377] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neuropathological markers including amyloid-beta (Aβ) have been implicated in mobility decline in older adults, but no studies have examined the relationship between these markers and longitudinal change in gait speed in a racially diverse community-based sample. In the multi-site prospective ARIC study, a subsample of participants (n=1,978, mean age=76.3, 28.5% black) underwent brain MRI at Visit 5 (2011-13). Of these, 343 participants (mean age=75.9, 42.6% black) completed PET scans using the tracer florbetapir to estimate global brain Aβ. We investigated the relationship between four neuropathological markers [white matter hyperintensities (WMH; log2cm3), infarcts (present/absent), brain atrophy (log2cm3), and global Aβ (log2SUVR)] with cross-sectional usual pace gait speed (cm/s) over 4 meters, and change in gait speed through Visits 6 (2016-17) and 7 (2018-19). Linear regression models were adjusted for age, site, sex, education, BMI, intracranial volume, and all race interactions. Cross-sectionally, slower gait was associated with higher WMH volume (β=-2.16, 95%CI: -2.92, -1.39), infarcts (β=-5.81, 95%CI: -7.86, -3.76), and brain atrophy (β=-16.39, 95%CI: -21.07, -11.71). Longitudinally, only higher WMH volume was statistically associated with gait speed decline (β=-0.14, 95%CI: -0.28, -0.01). Global Aβ was not statistically associated with gait speed cross-sectionally (β=-.269, 95%CI: -8.11, 7.57) or longitudinally (β=-1.16, 95%CI: -2.94, 0.62). There were no significant interactions with race. Detrimental relations of cerebral small vessel disease to mobility and mobility decline were observed across race in this diverse sample. The magnitude of the Aβ association with gait speed decline was high, although not statistically significant in the smaller PET subsample.
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Affiliation(s)
- Kevin J Sullivan
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | - Michael Griswold
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | - Timothy Hughes
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | | | - Samuel Lockhart
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Thomas Mosley
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | | | - Gwen Windham
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
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Powell D, Kuo PL, Deal JA, Gottesman R, Palta P, Knopman D, Gross AL. THE RELATIONSHIP OF APOE ε4 TO THE RELATIVE TIMES AND HAZARDS OF DEMENTIA. Innov Aging 2019. [PMCID: PMC6841551 DOI: 10.1093/geroni/igz038.2175] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although APOE ε4 is an established risk factor for dementia, it is unclear whether it is associated with elevated risk or earlier symptom onset. Longitudinal study of 10,400 white-race individuals in the ARIC cohort followed from age 60 to incident dementia diagnosis, death, or censoring. All-cause dementia was defined using standardized algorithms incorporating longitudinal cognitive change, proxy report, and hospital or death certificate dementia codes. Death was ascertained via the National Death Index and death certificates. We used a parametric mixture of generalized gamma distributions to simultaneously estimate the distribution of event times and the proportion of individuals who experience each outcome (i.e., dementia and its competing risk, dementia-free death) by APOE ε4 status (≥ 1 allele vs. no alleles). Age-adjustment was through use of age as the time scale. APOE ε4 carrier status was associated with a doubling of the overall frequency of dementia incidence to 25% compared to 13% (p < 0.001) in non- ε4 carriers. The distributions of time to dementia was modified by APOE ε4 status (p=0.007): median time to dementia onset among APOE ε4 carriers was 81.9 years compared to 83.3 years in non-APOE ε4 carriers (p = 0.005). No differences in results were found by sex. APOE ε4 carrier status is associated with both elevated risk and earlier time to dementia onset. These findings clarify the causal role of APOE in dementia etiology, could help better identify at-risk subgroups, and may help facilitate better research recruitment.
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Affiliation(s)
- Danielle Powell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Pei-Lun Kuo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Jennifer A Deal
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | | | - Priya Palta
- Columbia University, New York, New York, United States
| | | | - Alden L Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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Deal JA, Rawlings A, Sharrett AR, Reed N, Betz J, Mosley T, Lin F, Gottesman R. HEARING IMPAIRMENT, COGNITIVE PERFORMANCE, AND BETA-AMYLOID DEPOSITION IN THE ARIC-PET AMYLOID IMAGING STUDY. Innov Aging 2019. [PMCID: PMC6845544 DOI: 10.1093/geroni/igz038.2032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hearing impairment is a risk factor for dementia but the mechanism underlying this association is unknown. We investigated the relationship between hearing and cognitive performance and brain β-amyloid deposition in 252 adults aged 67-88 years (37% black race) without dementia from three U.S. communities. Global cortical standardized uptake value ratios (SUVRs) were calculated from florbetapir-positron emission tomography scans, with elevated SUVR defined as >1.2 (the median value). Air conduction hearing threshold levels for the frequencies of 0.5, 1, 2 and 4 kHz were obtained by pure tone audiometry and averaged for the better-hearing ear to yield a pure tone average (PTA) in decibels hearing level (dB). A composite cognitive score was created from ten neuropsychological tests summarized using latent variable methods. Multivariable-adjusted linear and Poisson regression with robust standard errors were used to estimate the average difference in cognitive scores and prevalence of elevated SUVR, respectively, by hearing impairment status. In analyses adjusted for age, sex, education and APOE ε4 status, hearing was not associated with elevated SUVR [prevalence ratio per 10 db increase (worse hearing) = 0.94 (95% CI: 0.84, 1.04)]. Results did not differ by race. In contrast, each 10 db increase in hearing impairment was associated with 0.08 standard deviation (95% CI: 0.02, 0.15) lower cognitive score, after adjustment for demographic and cardiovascular factors. Poorer hearing is associated with poorer cognitive performance but not with amyloid deposition, suggesting that the mechanism underlying the relationship between hearing and cognition may be independent of Alzheimer’s-related pathologic brain changes.
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Affiliation(s)
- Jennifer A Deal
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Andreea Rawlings
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States
| | | | - Nicholas Reed
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Joshua Betz
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Thomas Mosley
- University of Mississippi Medical Center MIND Center, Jackson, Mississippi, United States
| | - Frank Lin
- Johns Hopkins University, Baltimore, Maryland, United States
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Ding J, Davis-Plourde KL, Sedaghat S, Tully PJ, Wang W, Phillips C, Pase MP, Himali JJ, Gwen Windham B, Griswold M, Gottesman R, Mosley TH, White L, Guðnason V, Debette S, Beiser AS, Seshadri S, Ikram MA, Meirelles O, Tzourio C, Launer LJ. Antihypertensive medications and risk for incident dementia and Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies. Lancet Neurol 2019; 19:61-70. [PMID: 31706889 DOI: 10.1016/s1474-4422(19)30393-x] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dementia is a major health concern for which prevention and treatment strategies remain elusive. Lowering high blood pressure with specific antihypertensive medications (AHMs) could reduce the burden of disease. We investigated whether specific AHM classes reduced the risk for dementia. METHODS We did a meta-analysis of individual participant data from eligible observational studies published between Jan 1, 1980, and Jan 1, 2019. Cohorts were eligible for inclusion if they prospectively recruited community-dwelling adults; included more than 2000 participants; collected data for dementia events over at least 5 years; had measured blood pressure and verified use of AHMs; included in-person exams, supplemented with additional data, to capture dementia events; and had followed up cases for mortality. We assessed the association of incident dementia and clinical Alzheimer's disease with use of five AHM classes, within strata of baseline high (systolic blood pressure [SBP] ≥140 mm Hg or diastolic blood pressure [DBP] ≥90 mm Hg) and normal (SBP <140 mm Hg and DBP <90 mm Hg) blood pressure. We used a propensity score to control for confounding factors related to the probability of receiving AHM. Study-specific effect estimates were pooled using random-effects meta-analyses. RESULTS Six prospective community-based studies (n=31 090 well phenotyped dementia-free adults older than 55 years) with median follow-ups across cohorts of 7-22 years were eligible for analysis. There were 3728 incident cases of dementia and 1741 incident Alzheimer's disease diagnoses. In the high blood pressure stratum (n=15 537), those using any AHM had a reduced risk for developing dementia (hazard ratio [HR] 0·88, 95% CI 0·79-0·98; p=0·019) and Alzheimer's disease (HR 0·84, 0·73-0·97; p=0·021) compared with those not using AHM. We did not find any significant differences between one drug class versus all others on risk of dementia. In the normal blood pressure stratum (n=15 553), there was no association between AHM use and incident dementia or Alzheimer's disease. INTERPRETATION Over a long period of observation, no evidence was found that a specific AHM drug class was more effective than others in lowering risk of dementia. Among people with hypertensive levels of blood pressure, use of any AHM with efficacy to lower blood pressure might reduce the risk for dementia. These findings suggest future clinical guidelines for hypertension management should also consider the beneficial effect of AHM on the risk for dementia. FUNDING The Alzheimer's Drug Discovery Foundation and the National Institute on Aging Intramural Research Program.
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Affiliation(s)
- Jie Ding
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Kendra L Davis-Plourde
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | - Sanaz Sedaghat
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phillip J Tully
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Wanmei Wang
- University of Mississippi Medical Center, The MIND Center, Jackson, MS, USA
| | - Caroline Phillips
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Matthew P Pase
- The Framingham Heart Study, Framingham, MA, USA; Melbourne Dementia Research Centre, The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Jayandra J Himali
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | - B Gwen Windham
- University of Mississippi Medical Center, The MIND Center, Jackson, MS, USA
| | - Michael Griswold
- University of Mississippi Medical Center, The MIND Center, Jackson, MS, USA
| | | | - Thomas H Mosley
- University of Mississippi Medical Center, The MIND Center, Jackson, MS, USA
| | - Lon White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Vilmundur Guðnason
- Icelandic Heart Association, Kopavogur, Iceland; University of Iceland, Reykjavik, Iceland
| | - Stéphanie Debette
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Alexa S Beiser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; The Framingham Heart Study, Framingham, MA, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Osorio Meirelles
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Christophe Tzourio
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
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Pokharel Y, Mouhanna F, Schneider ALC, Rawlings AM, Knopman DS, Nambi V, Virani SS, Hoogeveen RC, Alonso A, Heiss G, Coresh J, Mosley T, Gottesman R, Selvin E, Ballantyne C, Power MC. High-Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change. J Am Geriatr Soc 2019; 67:2353-2361. [PMID: 31359423 PMCID: PMC6861618 DOI: 10.1111/jgs.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Cardiac troponin T, measured using a high-sensitive assay (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with increased stroke risk and perhaps with cognitive decline. However, few well-designed prospective studies with extended follow-up have been conducted. We aimed to estimate the association of hs-cTnT and NT-proBNP with 15-year cognitive change in the Atherosclerosis Risk in Communities (ARIC) study. DESIGN Prospective cohort study. SETTING Four US communities. PARTICIPANTS A total of 9114 and 9108 participants from the Atherosclerosis Risk in Communities study for analyses of hs-cTnT and NT-proBNP, respectively. MEASUREMENTS We examined association of hs-cTnT and NT-proBNP with 15-year change (1996-1998 to 2011-2013) in three cognitive tests of executive function (Digit Symbol Substitution Test), verbal learning memory (Delayed Word Recall Test), and semantic fluency (Word Fluency Test), and an overall score combining the three tests using multivariable linear mixed effect models. We conducted several sensitivity analyses including multiple imputations to address bias due to missing data and attrition, and we compared associations within groups combining hs-cTnT and NT-proBNP into a three-level categorical variable. RESULTS At baseline (1996-1998), mean age was 63.4 (standard deviation [SD] = 5.7) years; 56.4% were women, and 17.5% were black. The hs-cTnT at baseline was not associated with cognitive change in any measure. Some evidence indicated accelerated decline in verbal learning and memory when comparing those in the highest with the lowest NT-proBNP quintiles; however, this association was not replicated when considering clinically relevant cutoffs or deciles of exposure in survivors. Sensitivity analyses were consistent with our primary analyses. There was little evidence to support effect modification by any considered factors. People with highest levels of both biomarkers had excessive decline in global z scores vs people with lowest levels (-.34; 95% confidence interval = -.63 to -.04). CONCLUSION Markers of myocardial injury and stretch were not associated with cognitive decline following 15 years among survivors, but when combined together they were suggestive in post hoc analysis. Whether this represents targets of intervention should be examined in the future. J Am Geriatr Soc 67:2353-2361, 2019.
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Affiliation(s)
- Yashashwi Pokharel
- Saint Luke’s Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Farah Mouhanna
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea L. C. Schneider
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea M. Rawlings
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Vijay Nambi
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Salim S. Virani
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ron C. Hoogeveen
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Josef Coresh
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christie Ballantyne
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
- Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
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de Havenon A, Prabhakaran S, Turan T, Gottesman R, Yeatts S, Rost N. Is There Equipoise Regarding the Optimal Medical Treatment of Patients with Asymptomatic White Matter Hyperintensities? J Stroke Cerebrovasc Dis 2019; 28:104371. [PMID: 31495669 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/14/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND White matter hyperintensity (WMH) is a common manifestation of chronic ischemic microvascular disease that heralds greater risk of functional disability, stroke, and dementia. SPRINT MIND recently reported that intensive blood pressure reduction resulted in lower rates of mild cognitive impairment and WMH progression, suggesting that medical interventions could have a measurable impact on WMH. We conducted an anonymous survey of providers in the NINDS StrokeNet to better understand neurologist attitudes about asymptomatic WMH. METHODS We sent a 7-question survey to the 29 Regional Coordinating Centers of the StrokeNet, whose coordinators disseminated the survey to providers "involved in the care of a patient after their stroke." RESULTS We received 136 responses. For stroke prevention therapies, including aspirin and statin therapy and blood pressure target, there was substantial equipoise, with no single option receiving >50% endorsement and between 15-32% of respondents choosing the option of "not sure." 83% of respondents indicated high or moderate enthusiasm for a trial targeting this patient population. The clinical outcomes of reduction in ischemic stroke, cognitive impairment, or dementia were high importance (>70% endorsement), while the remaining radiographic, safety, and clinical endpoints all failed to reach 50% endorsement. CONCLUSIONS Our survey establishes meaningful neurologist attitudes that can inform future WMH research. There is considerable equipoise regarding optimal medical treatment for patients with asymptomatic WMH and providers in StrokeNet, who would be a vital stakeholder in WMH research in the United States, enthusiastically support a clinical trial to resolve open questions on optimal medical management.
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Affiliation(s)
- Adam de Havenon
- University of Utah, Department of Neurology, Salt Lake City, Utah.
| | - Shyam Prabhakaran
- Department of Neurology, Feinberg School of Medicine, Chicago, Illinois
| | - Tanya Turan
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Sharon Yeatts
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Natalia Rost
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
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Nomura Y, Faegle R, Hori D, Al-Qamari A, Nemeth AJ, Gottesman R, Yenokyan G, Brown C, Hogue CW. Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A Retrospective Cohort Study. Anesth Analg 2019; 127:1314-1322. [PMID: 29677060 PMCID: PMC6533899 DOI: 10.1213/ane.0000000000003384] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.86; P = .014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02-1.475; P = .029), but not moderate-severe large cerebral arterial stenosis (P = .406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21-8.71; P = .019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.
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Affiliation(s)
- Yohei Nomura
- From the Division of Cardiac Surgery, Department of Surgery and
| | - Roland Faegle
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daijiro Hori
- From the Division of Cardiac Surgery, Department of Surgery and
| | | | - Alexander J Nemeth
- Radiology, Division of Neuroradiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Gottesman
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gayane Yenokyan
- The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | - Charles Brown
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Brown CH, Neufeld KJ, Tian J, Probert J, LaFlam A, Max L, Hori D, Nomura Y, Mandal K, Brady K, Hogue CW, Shah A, Zehr K, Cameron D, Conte J, Bienvenu OJ, Gottesman R, Yamaguchi A, Kraut M. Effect of Targeting Mean Arterial Pressure During Cardiopulmonary Bypass by Monitoring Cerebral Autoregulation on Postsurgical Delirium Among Older Patients: A Nested Randomized Clinical Trial. JAMA Surg 2019. [PMID: 31116358 DOI: 10.1001/jamasurg.2019.1163.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Delirium occurs in up to 52% of patients after cardiac surgery and may result from changes in cerebral perfusion. Using intraoperative cerebral autoregulation monitoring to individualize and optimize cerebral perfusion may be a useful strategy to reduce the incidence of delirium after cardiac surgery. Objective To determine whether targeting mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral autoregulation monitoring reduces the incidence of delirium compared with usual care. Design, Setting, and Participants This randomized clinical trial nested within a larger trial enrolled patients older than 55 years who underwent nonemergency cardiac surgery at a single US academic medical center between October 11, 2012, and May 10, 2016, and had a high risk for neurologic complications. Patients, physicians, and outcome assessors were masked to the assigned intervention. A total of 2764 patients were screened, and 199 were eligible for analysis in this study. Intervention In the intervention group, the patient's lower limit of cerebral autoregulation was identified during surgery before CPB. On CPB, the patient's mean arterial pressure was targeted to be greater than that patient's lower limit of autoregulation. In the control group, mean arterial pressure targets were determined according to institutional practice. Main Outcomes and Measures The main outcome was any incidence of delirium on postoperative days 1 through 4, as adjudicated by a consensus expert panel. Results Among the 199 participants in this study, mean (SD) age was 70.3 (7.5) years and 150 (75.4%) were male. One hundred sixty-two (81.4%) were white, 26 (13.1%) were black, and 11 (5.5%) were of other race. Of 103 patients randomized to usual care, 94 were analyzed, and of 102 patients randomized to the intervention 105 were analyzed. Excluding 5 patients with coma, delirium occurred in 48 of the 91 patients (53%) in the usual care group compared with 39 of the 103 patients (38%) in the intervention group (P = .04). The odds of delirium were reduced by 45% in patients randomized to the autoregulation group (odds ratio, 0.55; 95% CI, 0.31-0.97; P = .04). Conclusions and Relevance The results of this study suggest that optimizing mean arterial pressure to be greater than the individual patient's lower limit of cerebral autoregulation during CPB may reduce the incidence of delirium after cardiac surgery, but further study is needed. Trial Registration ClinicalTrials.gov identifier: NCT00981474.
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Affiliation(s)
- Charles H Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karin J Neufeld
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Andrew LaFlam
- Medical Student, School of Medicine, Tufts University, Medford Massachusetts
| | - Laura Max
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaushik Mandal
- Division of Cardiac Surgery, Department of Surgery, Penn State University Hershey Medical Center, Hershey, Pennsylvania
| | - Ken Brady
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles W Hogue
- Bluhm Cardiovascular Institute, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Ashish Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kenton Zehr
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Duke Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - John Conte
- Division of Cardiac Surgery, Department of Surgery, Penn State University Hershey Medical Center, Hershey, Pennsylvania
| | - O Joseph Bienvenu
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Michael Kraut
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Reed NS, Huddle MG, Betz J, Power MC, Pankow JS, Gottesman R, Richey Sharrett A, Mosley TH, Lin FR, Deal JA. Association of Midlife Hypertension with Late-Life Hearing Loss. Otolaryngol Head Neck Surg 2019; 161:996-1003. [PMID: 31382849 DOI: 10.1177/0194599819868145] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the association of midlife hypertension with late-life hearing impairment. STUDY DESIGN Data from the Atherosclerosis Risk in Communities study, an ongoing prospective longitudinal population-based study (baseline, 1987-1989). SETTING Washington County, Maryland, research field site. SUBJECTS AND METHODS Subjects included 248 community-dwelling men and women aged 67 to 89 years in 2013. Systolic blood pressure (SBP) and diastolic blood pressure were measured at each of 5 study visits from 1987-1989 to 2013. Hypertension was defined by elevated systolic or diastolic blood pressure or antihypertensive medication use. A 4-frequency (0.5-4 kHz) better-hearing ear pure tone average in decibels hearing loss (dB HL) was calculated from pure tone audiometry measured in 2013. A cutoff of 40 dB HL was used to indicate clinically significant moderate to severe hearing impairment. Hearing thresholds at 5 frequencies (0.5-8 kHz) were also considered separately. RESULTS Forty-seven participants (19%) had hypertension at baseline (1987-1989), as opposed to 183 (74%) in 2013. The SBP association with late-life pure tone average differed by the time of measurement, with SBP measured at earlier visits associated with poorer hearing; the difference in pure tone average per 10-mm Hg SBP measured was 1.43 dB HL (95% CI, 0.32-2.53) at baseline versus -0.43 dB HL (95% CI, -1.41 to 0.55) in 2013. Baseline hypertension was associated with higher thresholds (poorer hearing) at 4 frequencies (1, 2, 4, 8 kHz). CONCLUSION Midlife SBP was associated with poorer hearing measured 25 years later. Further analysis into the longitudinal relationship between hypertension and hearing impairment is warranted.
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Affiliation(s)
- Nicholas S Reed
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Cochlear Center on Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew G Huddle
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joshua Betz
- Cochlear Center on Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - James S Pankow
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas H Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Frank R Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Cochlear Center on Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Cochlear Center on Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Qiao Y, Suri FK, Zhang Y, Liu L, Gottesman R, Alonso A, Guallar E, Wasserman BA. Racial Differences in Prevalence and Risk for Intracranial Atherosclerosis in a US Community-Based Population. JAMA Cardiol 2019; 2:1341-1348. [PMID: 29094154 DOI: 10.1001/jamacardio.2017.4041] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 11/14/2022]
Abstract
Importance Intracranial atherosclerotic disease (ICAD) is an important cause of stroke; however, little is known about racial differences in ICAD prevalence and its risk factors. Objective To determine racial differences in ICAD prevalence and the risk factors (both midlife and concurrent) associated with its development in a large, US community-based cohort. Design, Setting, and Participants Analysis of 1752 black and white participants recruited from the Atherosclerosis Risk in Communities (ARIC) cohort study who underwent 3-dimensional intracranial vessel wall magnetic resonance imaging from October 18, 2011 to December 30, 2013; data analysis was performed from October 18, 2011 to May 13, 2015. Exposures Midlife and concurrent cardiovascular risk factors. Main Outcomes and Measures Intracranial plaque presence, size (maximum normalized wall index) and number were assessed by vessel wall magnetic resonance imaging. Midlife and concurrent vascular risk factor associations were determined by Poisson regression (plaque presence), negative binominal regression (plaque number), and linear regression (plaque size), and compared between races. Results Of the 1752 study participants (mean [SD] age, 77.6 [5.3] years; range, 67-90 years), 1023 (58.4%) were women and 518 (29.6%) were black. Black men had the highest prevalence (50.9% vs 35.9% for black women, 35.5% for white men, and 30.2% for white women; P < .001) and the highest frequency (22.4% vs 12.1% for black women, 10.7% for white men, and 8.7% for white women; P < .01) of multiple plaques. Prevalence increased with age, reaching 50% before ages 68, 84, and 88 years in black men, white men, and white women, respectively (ICAD prevalence remained <50% in black women). Midlife hypertension and hyperlipidemia were associated with 29% (prevalence ratio [PR], 1.29; 95% CI, 1.08-1.55) and 18% (PR, 1.18; 95% CI, 0.98-1.42), respectively, increased ICAD prevalence with no significant differences between races. Midlife hypertension was also associated with larger plaques (1.11 higher mean maximum normalized wall index; 95% CI, 0.21-2.01). Midlife smoking and diabetes were associated with increased risk of ICAD in black individuals (102% [PR, 2.02; 95% CI, 1.12-3.63] and 57% [PR, 1.57; 95% CI, 1.13- 2.19], respectively), but not in white participants (P < .05 interaction by race). Conclusions and Relevance The prevalence of ICAD was highest in black men. Midlife smoking and diabetes were strongly associated with late-life ICAD in blacks only, whereas midlife hypertension and hyperlipidemia were associated with late-life ICAD in both races. These associations may help to explain racial differences in US stroke rates and offer insight into preventive risk-factor management strategies.
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Affiliation(s)
- Ye Qiao
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fareed K Suri
- Department of Neurology, CentraCare Clinic, St Cloud, Minnesota
| | - Yiyi Zhang
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Li Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Gottesman
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hu E, Wu A, Dearborn J, Gottesman R, Steffen L, Coresh J, Rebholz C. Adherence to the Healthy Eating Index-2015 (HEI-2015), Cognitive Function, and Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Study (OR32-01-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz052.or32-01-19] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The Healthy Eating Index-2015 (HEI-2015) score was created to measure adherence to the 2015–2020 Dietary Guidelines for Americans. It remains undetermined whether adherence to the newly released guidelines is associated with improved cognitive function or reduced incident dementia.
Methods
We assessed the diet of 13,632 participants from the Atherosclerosis Risk in Communities (ARIC) study who were recruited from 1987–1989 and calculated their HEI-2015 scores (0–100) using responses to food frequency questionnaires. Baseline cognitive function was assessed using the Delayed Word Recall, Digit Symbol Substitution, and Word Fluency Tests. We used linear regression models to assess the cross-sectional association of adherence to HEI-2015 and standardized cognitive test scores. Incident dementia was ascertained through the end of 2017. Dementia status at the ARIC Neurocognitive Study visits (2011–13, 2016–17) was determined by detailed neurocognitive battery, informant interviews, and adjudicated review as well as through dementia screening by phone interview and informant review, or by ICD-9 dementia code for a hospitalization or death. We used Cox proportional hazards regression models adjusted for demographic, lifestyle, genetic, and clinical covariates to estimate the association between HEI-2015 score and risk of incident dementia.
Results
Compared to participants in the lowest quintile of HEI-2015 score, participants in the highest quintile scored higher on the Digit Symbol Substitution Test (β: 0.07, 95% CI: 0.03 to 0.11, P for trend < 0.001), Word Fluency Test (β: 0.07, 95% CI: 0.02 to 0.12, P for trend < 0.001) and global cognitive score (β: 0.05, 95% CI: 0.01 to 0.10, P for trend = 0.003) (Table). In total, there were 2354 cases of incident dementia over a median follow-up of 25 years. Compared to participants in the lowest quintile, participants in other quintiles had a lower risk of incident dementia after adjusting for covariates. Participants in the highest quintile had a 19% lower risk of dementia compared to those in the lowest (HR: 0.81, 95% CI: 0.71–0.93, P for trend = 0.01).
Conclusions
Higher adherence to the 2015–2020 Dietary Guidelines for Americans was associated with higher baseline cognitive function and lower risk of incident dementia.
Funding Sources
NHLBI, NIDDK, NIA, NINDS, NIH, HHS.
Supporting Tables, Images and/or Graphs
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Li D, Misialek JR, Jack CR, Mielke MM, Knopman D, Gottesman R, Mosley T, Alonso A. Plasma Metabolites Associated with Brain MRI Measures of Neurodegeneration in Older Adults in the Atherosclerosis Risk in Communities⁻Neurocognitive Study (ARIC-NCS). Int J Mol Sci 2019; 20:ijms20071744. [PMID: 30970556 PMCID: PMC6479561 DOI: 10.3390/ijms20071744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Plasma metabolites are associated with cognitive and physical function in the elderly. Because cerebral small vessel disease (SVD) and neurodegeneration are common causes of cognitive and physical function decline, the primary objective of this study was to investigate the associations of six plasma metabolites (two plasma phosphatidylcholines [PCs]: PC aa C36:5 and PC aa 36:6 and four sphingomyelins [SMs]: SM C26:0, SM [OH] C22:1, SM [OH] C22:2, SM [OH] C24:1) with magnetic resonance imaging (MRI) features of cerebral SVD and neurodegeneration in older adults. Methods: This study included 238 older adults in the Atherosclerosis Risk in Communities study at the fifth exam. Multiple linear regression was used to assess the association of each metabolite (log-transformed) in separate models with MRI measures except lacunar infarcts, for which binary logistic regression was used. Results: Higher concentrations of plasma PC aa C36:5 had adverse associations with MRI features of cerebral SVD (odds ratio of 1.69 [95% confidence interval: 1.01, 2.83] with lacunar infarct, and beta of 0.16 log [cm3] [0.02, 0.30] with log [White Matter Hyperintensities (WMH) volume]) while higher concentrations of 3 plasma SM (OH)s were associated with higher total brain volume (beta of 12.0 cm3 [5.5, 18.6], 11.8 cm3 [5.0, 18.6], and 7.3 cm3 [1.2, 13.5] for SM [OH] C22:1, SM [OH] C22:2, and SM [OH] C24:1, respectively). Conclusions: This study identified associations between certain plasma metabolites and brain MRI measures of SVD and neurodegeneration in older adults, particularly higher SM (OH) concentrations with higher total brain volume.
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Affiliation(s)
- Danni Li
- Department of Lab Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, MMC 609, Minneapolis, MN 55455, USA.
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55906, USA.
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - David Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
| | - Tom Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Hao Q, Qiao Y, Williams N, Johnson B, Wasserman BA, Gottesman R. Abstract TP157: Ethnic Difference in Stroke Recurrence for Patients With Intracranial Atherosclerotic Stenosis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp157] [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] [Indexed: 11/16/2022]
Abstract
Background:
Intracranial atherosclerotic stenosis (ICAS), one of most common stroke subtypes worldwide, carries high risk of stroke recurrence despite maximal medical treatment. ICAS more commonly affects non-white populations including Asian, African-American and Hispanic individuals. It is plausible that non-white stroke patients with ICAS might also have more active disease, and thus higher risks of stroke recurrence. We aim to compare the rate of stroke recurrence in stroke patients with ICAS in white and non-white population. Method: We retrospectively reviewed a consecutive series of patients with ischemic stroke due to ICAS in major vessels (MCA, ACA, PCA, intracranial segment of ICA and VA, BA) with >50% stenosis identified on MRA or CTA. The clinical characteristics, risk factors and rate of stroke recurrence were compared in white and non-white patients, using Chi-square (for categorical variables) test and t-test (for continuous variables).
Results:
A total of 183 patients [66.3% non-white, mean (SD) age, 63 (±14) years] who were hospitalized between January 2005 and December 2010 and satisfied the inclusion criteria were included in the analysis. Compared with white patients, non-white patients had a higher rate of HTN, DM and drug abuse (Table 1), as well a nonsignificantly higher stroke recurrence rate (3 months: OR 1.29, 95% CI 0.59-2.82; long term: OR 1.63, 95% CI 0.84 - 3.18). History of CKD was the only factor associated with 3-month stroke recurrence (OR 3.73, 965 CI 1.13-12.31).
Conclusion:
White and non-white ischemic stroke patients with ICAS have distinct risk factor profiles and possibly distinct stroke recurrence rates. Analysis with a larger sample size is ongoing to verify this finding.
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Affiliation(s)
- Qing Hao
- Icahn Sch of Medicine at Mount Sinai, New York, NY
| | - Ye Qiao
- Johns Hopkins Univ Sch of Medicine, Baltimore, MD
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50
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Trivedi T, Androulakis M, Redd KT, Alonso A, Soliman E, Magnani J, Gottesman R, Rosamond W, Sen S. Abstract 14: Is Low Heart Rate Variability, a Marker of Autonomic Dysfunction, the Missing Link Between Migraine With Visual Aura and Cardioembolic Stroke? Stroke 2019. [DOI: 10.1161/str.50.suppl_1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Souvik Sen
- Neurology, USC Sch of Medicine, Columbia, SC
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