1
|
Thompson AD, Petry SE, Hauser ER, Boyle SH, Pathak GA, Upchurch J, Press A, Johnson MG, Sims KJ, Williams CD, Gifford EJ. Longitudinal Patterns of Multimorbidity in Gulf War Era Veterans With and Without Gulf War Illness. J Aging Health 2024:8982643241245163. [PMID: 38591766 DOI: 10.1177/08982643241245163] [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] [Indexed: 04/10/2024]
Abstract
Objectives: To examine whether severe Gulf War illness (SGWI) case status was associated with longitudinal multimorbidity patterns. Methods: Participants were users of the Veteran Health Administration Health Care System drawn from the Gulf War Era Cohort and Biorepository (n = 840). Longitudinal measures of multimorbidity were constructed using (1) electronic health records (Charlson Comorbidity Index; Elixhauser; and Veterans Affairs Frailty Index) from 10/1/1999 to 6/30/2023 and (2) self-reported medical conditions (Deficit Accumulation Index) since the war until the survey date. Accelerated failure time models examined SGWI case status as a predictor of time until threshold level of multimorbidity was reached, adjusted for age and sociodemographic and military characteristics. Results: Models, adjusted for covariates, revealed that (1) relative to the SWGI- group, the SGWI+ group was associated with an accelerated time for reaching each threshold and (2) the relationship between SGWI and each threshold was not moderated by age. Discussion: Findings suggest that veterans with SGWI experienced accelerated aging.
Collapse
Affiliation(s)
- Andrew D Thompson
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Sarah E Petry
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
- Duke Molecular Physiology Institute and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Stephen H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Gita A Pathak
- Division of Human Genetics, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Melissa G Johnson
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
| | - Elizabeth J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| |
Collapse
|
2
|
Soares Ferreira Junior A, Pinheiro Maux Lessa M, Boyle SH, Sanborn K, Kuchibhatla M, Onwuemene OA. Paediatric patients with suspected immune thrombotic thrombocytopenic purpura also experience treatment delays. Br J Haematol 2024; 204:1545-1548. [PMID: 38176420 DOI: 10.1111/bjh.19290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Affiliation(s)
| | - Morgana Pinheiro Maux Lessa
- Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São Paulo, São José do Rio Preto, Brazil
| | - Stephen H Boyle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Kate Sanborn
- Duke Biostatistics, Epidemiology and Research Design Core, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
3
|
Boyle SH, Upchurch J, Gifford EJ, Redding TS, Hauser ER, Malhotra D, Press A, Sims KJ, Williams CD. Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder. J Trauma Stress 2024; 37:80-91. [PMID: 37997023 DOI: 10.1002/jts.22994] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 11/25/2023]
Abstract
Gulf War illness (GWI) is a chronic multisymptom disorder of unknown etiology that is believed to be caused by neurotoxicant exposure experienced during deployment to the Gulf War. Posttraumatic stress disorder (PTSD) covaries with GWI and is believed to play a role in GWI symptoms. The present study examined the association between self-reported military exposures and GWI, stratified by PTSD status, in veterans from the Gulf War Era Cohort and Biorepository who were deployed to the Persian Gulf during the war. Participants self-reported current GWI and PTSD symptoms as well as military exposures (e.g., pyridostigmine [PB] pills, pesticides/insecticides, combat, chemical attacks, and oil well fires) experienced during the Gulf War. Deployed veterans' (N = 921) GWI status was ascertained using the Centers for Disease Control and Prevention definition. Individuals who met the GWI criteria were stratified by PTSD status, yielding three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression, adjusted for covariates, was used to examine associations between GWI/PTSD groups and military exposures. Apart from insect bait use, the GWI+/PTSD+ group had higher odds of reporting military exposures than the GWI+/PTSD- group, adjusted odds ratio (aOR) = 2.15, 95% CI [1.30, 3.56]-aOR = 6.91, 95% CI [3.39, 14.08]. Except for PB pills, the GWI+/PTSD- group had a higher likelihood of reporting military exposures than the GWI- group, aOR = 2.03, 95% CI [1.26, 3.26]-aOR = 4.01, 95% CI [1.57, 10.25]. These findings are consistent with roles for both PTSD and military exposures in the etiology of GWI.
Collapse
Affiliation(s)
- Stephen H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Elizabeth J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | | | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| |
Collapse
|
4
|
Soares Ferreira Junior A, Pinheiro Maux Lessa M, Boyle SH, Sanborn K, Kuchibhatla M, Onwuemene OA. In patients with suspected immune TTP, admission source impacts hospital length of stay and time to therapeutic plasma exchange impacts clinical outcomes. Thromb Res 2023; 227:34-39. [PMID: 37210956 DOI: 10.1016/j.thromres.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION When immune thrombotic thrombocytopenic purpura (TTP) is suspected, outcomes are impacted by time to therapeutic plasma exchange (TPE). We evaluated the impact of time to TPE on outcomes in suspected TTP cases admitted through the Emergency Department (ED) vs. transferred from another facility (Transfer). MATERIALS AND METHODS In a retrospective analysis of the National Inpatient Sample, we examined the association between TTP outcomes and admission source (ED vs. Transfer) for the primary outcome of time to TPE. A second stratified analyses within each analytic group examined the association of time to TPE (<1 day, 1 day, 2 days, and >2 days) and outcomes for the composite outcome of mortality, major bleeding and thrombosis. RESULTS Of 1195 cases, 793 (66 %) were admitted through the ED and 402 (34 %) were transferred. Compared to ED cases, Transfers had a longer hospital length of stay (14.69 vs. 16.65 days, p = 0.0060). For ED cases, TPE after >2 days was associated with higher odds of the composite outcome (OR = 1.68 95 % CI: 1.11-2.54; p = 0.0150) and mortality (OR = 3.01 95 % CI: 1.38-6.57; p = 0.0056). For Transfers, TPE on day 2 was associated with higher odds of the composite outcome (OR = 3.00 95 % CI: 1.31-6.89; p = 0.0096) and mortality (OR = 4.95 95 % CI: 1.12-21.88; p = 0.0350). CONCLUSIONS In suspected TTP admitted through the ED or transferred, there was no significant difference in time to TPE. A longer time to TPE was associated with worse outcomes. Future studies should evaluate strategies to decrease initial time to TPE.
Collapse
Affiliation(s)
| | - Morgana Pinheiro Maux Lessa
- Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | | | - Kate Sanborn
- Duke Biostatistics, Epidemiology and Research Design Core, Duke University School of Medicine, Durham, NC, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
5
|
Malhotra D, Boyle SH, Gifford EJ, Sullivan BA, Nguyen Wenker TH, Abs ND, Ahmed ST, Upchurch J, Vahey J, Stafford C, Efird JT, Hunt SC, Bradford A, Sims KJ, Hauser ER, Helmer DA, Williams CD. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterol Motil 2023; 35:e14548. [PMID: 36942766 DOI: 10.1111/nmo.14548] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans. METHODS Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). KEY RESULTS The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aORIBS = 3.12, 95% CI: 1.93-5.05; aORGERD = 2.04, 95% CI: 1.44-2.90; aORCP = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aORIBS = 4.38, 95% CI: 1.55-12.36; aORGERD = 2.51 95% CI: 1.63-3.87; aORCP = 2.57, 95% CI: 1.53-4.32). CONCLUSIONS & INFERENCES GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.
Collapse
Affiliation(s)
- D Malhotra
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - S H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - B A Sullivan
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - T H Nguyen Wenker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Nono-Djotsa Abs
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, Washington, USA
| | - S T Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - J Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J Vahey
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Stafford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J T Efird
- VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA
- Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - S C Hunt
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - A Bradford
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - K J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | - D A Helmer
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - C D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| |
Collapse
|
6
|
Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Onwuemene OA. Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange. J Clin Apher 2022; 37:340-347. [PMID: 35191546 DOI: 10.1002/jca.21975] [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: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND For inpatients undergoing therapeutic plasma exchange (TPE) in the United States, the primary mode of venous access is the central venous catheter (CVC). To evaluate the impact of CVC on thrombosis outcomes of patients undergoing TPE, we analyzed the National Inpatient Sample (NIS) database. STUDY DESIGN AND METHODS In a cross-sectional analysis of the NIS, we identified hospital discharges of adult patients treated with TPE. Cases were classified into two groups based on CVC status. The primary outcome was thrombosis. Secondary outcomes were major bleeding, packed red blood cell (PRBC) transfusion, in-hospital mortality, hospital length of stay (LOS), and charges. RESULTS Among 9863 TPE-treated discharges, CVC was used in 5988 (60%). These numbers correspond to weighted national estimates of 49 315 and 29 940, respectively. There was a positive and significant association between CVC and thrombosis (OR = 1.23, 95% 1.04-1.46, P = 0.0174), PRBC transfusion (OR = 1.15, 95% 1.03-1.29, P = 0.0121), in-hospital mortality (OR = 1.36, 95% 1.10-1.68, P = 0.0043), hospital LOS (15.63 vs 12.45 days, P < 0.0001) and hospital charges ($166 387 vs. $132 655, P < 0.0001). CONCLUSION In hospitalized patients undergoing TPE, CVC use is associated with increased rates of thrombosis. Future studies are needed to investigate strategies to decrease CVC use and/or prevent CVC-associated complications in TPE-treated inpatients.
Collapse
Affiliation(s)
| | - Stephen H Boyle
- Duke University School of Medicine, Durham, North Carolina, USA.,Durham Veterans Administration Medical Center, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
7
|
Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Onwuemene OA. Bleeding outcomes of inpatients receiving therapeutic plasma exchange: A propensity-matched analysis of the National Inpatient Sample. Transfusion 2021; 62:386-395. [PMID: 34907537 DOI: 10.1111/trf.16769] [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: 07/07/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although therapeutic plasma exchange (TPE) is associated with hemostatic abnormalities, its impact on bleeding outcomes is unknown. Therefore, the main study objective was to determine bleeding outcomes of inpatients treated with TPE. STUDY DESIGN AND METHODS In a cross-sectional analysis of the National Inpatient Sample (NIS), discharges were identified with 10 common TPE-treated conditions. A 1:3 propensity-matched analysis of TPE- to non-TPE-treated discharges was performed. The primary outcome was major bleeding and secondary outcomes were packed red blood cell (PRBC) transfusion, mortality, disposition, hospital length of stay (LOS), and charges. Multivariable regression analyses were used to examine the association between TPE and study outcomes. RESULTS The study population was 15,964 discharges, of which 3991 were TPE- treated. The prevalence of major bleeding was low (5.4%). When compared to non-TPE discharges, TPE had a significant and positive association with major bleeding (OR = 1.37, 95% CI: 1.16-1.63, p = .0003). TPE was also associated with PRBC transfusion (OR = 1.66, 95% CI: 1.42-1.94, p < .0001), in-hospital mortality (OR = 1.45, 95% CI: 1.10-1.90, p = .0008), hospital length of stay (12.45 [95% CI: 11.95-12.97] vs. 7.38 [95% CI: 7.12-7.65] days, p < .0001) and total charges, ($125,123 [95% CI: $119,220-$131,317] vs. $61,953 [95% CI: $59,391-$64,625], p < .0001), and disposition to non-self-care (OR = 1.29, 95% CI: 1.19-1.39, p < .0001). DISCUSSION The use of TPE in the inpatient setting is positively associated with bleeding; however, with low prevalence. Future studies should address risk factors that predispose patients to TPE-associated bleeding.
Collapse
Affiliation(s)
| | - Stephen H Boyle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
8
|
Vahey J, Gifford EJ, Sims KJ, Chesnut B, Boyle SH, Stafford C, Upchurch J, Stone A, Pyarajan S, Efird JT, Williams CD, Hauser ER. Gene-Toxicant Interactions in Gulf War Illness: Differential Effects of the PON1 Genotype. Brain Sci 2021; 11:1558. [PMID: 34942860 PMCID: PMC8699623 DOI: 10.3390/brainsci11121558] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
About 25-35% of United States veterans who fought in the 1990-1991 Gulf War report several moderate or severe chronic systemic symptoms, defined as Gulf War illness (GWI). Thirty years later, there is little consensus on the causes or biological underpinnings of GWI. The Gulf War Era Cohort and Biorepository (GWECB) was designed to investigate genetic and environmental associations with GWI and consists of 1343 veterans. We investigate candidate gene-toxicant interactions that may be associated with GWI based on prior associations found in human and animal model studies, focusing on SNPs in or near ACHE, BCHE, and PON1 genes to replicate results from prior studies. SOD1 was also considered as a candidate gene. CDC Severe GWI, the primary outcome, was observed in 26% of the 810 deployed veterans included in this study. The interaction between the candidate SNP rs662 and pyridostigmine bromide (PB) pills was found to be associated with CDC Severe GWI. Interactions between PB pill exposure and rs3917545, rs3917550, and rs2299255, all in high linkage disequilibrium in PON1, were also associated with respiratory symptoms. These SNPs could point toward biological pathways through which GWI may develop, which could lead to biomarkers to detect GWI or to better treatment options for veterans with GWI.
Collapse
Affiliation(s)
- Jacqueline Vahey
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
- Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, NC 27705, USA
| | - Elizabeth J. Gifford
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, NC 27708, USA
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Blair Chesnut
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Stephen H. Boyle
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Crystal Stafford
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Annjanette Stone
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA;
| | - Saiju Pyarajan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA;
| | - Jimmy T. Efird
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; (J.V.); (E.J.G.); (K.J.S.); (B.C.); (S.H.B.); (C.S.); (J.U.); (J.T.E.); (C.D.W.)
- Duke Molecular Physiology Institute, Department of Biostatistics and Bioinformatics, Duke University Medical Center Durham, NC 27701, USA
| |
Collapse
|
9
|
Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Onwuemene OA. Bleeding is associated with intravenous immunoglobulin and therapeutic plasma exchange use in heparin‐induced thrombocytopenia: A propensity matched analysis. eJHaem 2021; 2:466-470. [PMID: 35844687 PMCID: PMC9175867 DOI: 10.1002/jha2.211] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 01/19/2023]
Abstract
Intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE) are used in select cases with heparin‐induced thrombocytopenia (HIT). In a cross‐sectional analysis, a propensity matched sample was generated by IVIG or TPE treatment status to assess the primary outcome of mortality. In 500 HIT cases, IVIG or TPE was not associated with increased mortality (OR = 1.46; 95% CI: 0.81–2.63, p = 0.2052) but was associated with a higher likelihood of major bleeding (OR = 1.75; 95% CI: 1.03–2.96, p = 0.0376). The use of IVIG or TPE in HIT cases with bleeding contraindications to standard therapies should be further investigated.
Collapse
Affiliation(s)
- Alexandre Soares Ferreira Júnior
- School of Medicine Barretos School of Health Sciences Dr. Paulo Prata Barretos São Paulo Brazil
- Department of Medicine Faculdade de Medicina de São José do Rio Preto (FAMERP) São José do Rio Preto São Paulo Brazil
| | | | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA
| | - Oluwatoyosi A. Onwuemene
- Division of Hematology Department of Medicine Duke University School of Medicine Durham North Carolina USA
| |
Collapse
|
10
|
Reavis ZW, Mirjankar N, Sarangi S, Boyle SH, Kuhn CM, Matson WR, Babyak MA, Matson SA, Siegler IC, Kaddurah-Daouk R, Suarez EC, Williams RB, Grichnik K, Stafford-Smith M, Georgiades A. Correction to: Sex and race differences of cerebrospinal fluid metabolites in healthy individuals. Metabolomics 2021; 17:56. [PMID: 34106337 DOI: 10.1007/s11306-021-01809-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Zackery W Reavis
- Department of Pharmacology & Cancer Biology, School of Medicine, Duke University, Durham, NC, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | | | | | - Stephen H Boyle
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Cynthia M Kuhn
- Department of Pharmacology & Cancer Biology, School of Medicine, Duke University, Durham, NC, USA
| | | | - Michael A Babyak
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | | | - Ilene C Siegler
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Rima Kaddurah-Daouk
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Edward C Suarez
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Redford B Williams
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | | | - Mark Stafford-Smith
- Department of Anesthesiology, School of Medicine, Duke University, Durham, NC, USA
| | - Anastasia Georgiades
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Box 3454 DUMC, Durham, NC, 27710, USA.
| |
Collapse
|
11
|
Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Akinyemiju T, Onwuemene OA. Use of therapeutic plasma exchange in heparin-induced thrombocytopenia: A population-based study. J Clin Apher 2021; 36:398-407. [PMID: 33453132 DOI: 10.13039/100005881] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is characterized by anti-heparin/platelet factor 4 immune complexes, which are removed by therapeutic plasma exchange (TPE). Our main objective was to study TPE outcomes in HIT using a large administrative claims database. STUDY DESIGN AND METHODS We used the National Inpatient Sample (NIS) to identify hospital discharges of adult patients (≥18) with a primary or secondary diagnosis of HIT. Cases were classified into two groups based on TPE use. The primary outcome was in-hospital mortality. Secondary outcomes were thrombotic events, major bleeding, hospital length of stay (LOS), and charges. Multivariable regression analysis, controlling for age and medical comorbidities, was used to examine the association of TPE with study outcomes. RESULTS A HIT diagnosis was made in 22 165 discharges, of which 90 (0.4%) received TPE. Corresponding national estimates are 106 435 and 439, respectively. TPE was not associated with decreased in-hospital mortality (OR = 1.72; 95%CI: 0.93-3.17, P = .085). However, TPE was associated with a higher likelihood of major bleeding (OR = 2.35; 95%CI: 1.40-3.68, P = .0009), primarily driven by gastrointestinal bleeding (OR = 2.21; 95%CI: 1.17-4.17, P = .015). TPE was also associated with higher hospital LOS (20.5 vs 10 day, P < .0001) and charges (USD 211181 vs USD 81654, P < .0001). CONCLUSION TPE's association with increased bleeding and a prolonged hospital course indicates that it is being used in HIT cases with a severe clinical phenotype. Future studies are needed to better characterize the HIT phenotype that will most benefit from TPE.
Collapse
Affiliation(s)
| | - Stephen H Boyle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
12
|
Reavis ZW, Mirjankar N, Sarangi S, Boyle SH, Kuhn CM, Matson WR, Babyak MA, Matson SA, Siegler IC, Kaddurah-Daouk R, Suarez EC, Williams RB, Grichnik K, Stafford-Smith M, Georgiades A. Sex and race differences of cerebrospinal fluid metabolites in healthy individuals. Metabolomics 2021; 17:13. [PMID: 33462762 PMCID: PMC8041469 DOI: 10.1007/s11306-020-01757-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Analyses of cerebrospinal fluid (CSF) metabolites in large, healthy samples have been limited and potential demographic moderators of brain metabolism are largely unknown. OBJECTIVE Our objective in this study was to examine sex and race differences in 33 CSF metabolites within a sample of 129 healthy individuals (37 African American women, 29 white women, 38 African American men, and 25 white men). METHODS CSF metabolites were measured with a targeted electrochemistry-based metabolomics platform. Sex and race differences were quantified with both univariate and multivariate analyses. Type I error was controlled for by using a Bonferroni adjustment (0.05/33 = .0015). RESULTS Multivariate Canonical Variate Analysis (CVA) of the 33 metabolites showed correct classification of sex at an average rate of 80.6% and correct classification of race at an average rate of 88.4%. Univariate analyses revealed that men had significantly higher concentrations of cysteine (p < 0.0001), uric acid (p < 0.0001), and N-acetylserotonin (p = 0.049), while women had significantly higher concentrations of 5-hydroxyindoleacetic acid (5-HIAA) (p = 0.001). African American participants had significantly higher concentrations of 3-hydroxykynurenine (p = 0.018), while white participants had significantly higher concentrations of kynurenine (p < 0.0001), indoleacetic acid (p < 0.0001), xanthine (p = 0.001), alpha-tocopherol (p = 0.007), cysteine (p = 0.029), melatonin (p = 0.036), and 7-methylxanthine (p = 0.037). After the Bonferroni adjustment, the effects for cysteine, uric acid, and 5-HIAA were still significant from the analysis of sex differences and kynurenine and indoleacetic acid were still significant from the analysis of race differences. CONCLUSION Several of the metabolites assayed in this study have been associated with mental health disorders and neurological diseases. Our data provide some novel information regarding normal variations by sex and race in CSF metabolite levels within the tryptophan, tyrosine and purine pathways, which may help to enhance our understanding of mechanisms underlying sex and race differences and potentially prove useful in the future treatment of disease.
Collapse
Affiliation(s)
- Zackery W Reavis
- Department of Pharmacology & Cancer Biology, School of Medicine, Duke University, Durham, NC, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | | | | | - Stephen H Boyle
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Cynthia M Kuhn
- Department of Pharmacology & Cancer Biology, School of Medicine, Duke University, Durham, NC, USA
| | | | - Michael A Babyak
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | | | - Ilene C Siegler
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Rima Kaddurah-Daouk
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Edward C Suarez
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Redford B Williams
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | | | - Mark Stafford-Smith
- Department of Anesthesiology, School of Medicine, Duke University, Durham, NC, USA
| | - Anastasia Georgiades
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Box 3454 DUMC, Durham, NC, 27710, USA.
| |
Collapse
|
13
|
Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Akinyemiju T, Onwuemene OA. Use of therapeutic plasma exchange in heparin-induced thrombocytopenia: A population-based study. J Clin Apher 2021; 36:398-407. [PMID: 33453132 DOI: 10.1002/jca.21876] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is characterized by anti-heparin/platelet factor 4 immune complexes, which are removed by therapeutic plasma exchange (TPE). Our main objective was to study TPE outcomes in HIT using a large administrative claims database. STUDY DESIGN AND METHODS We used the National Inpatient Sample (NIS) to identify hospital discharges of adult patients (≥18) with a primary or secondary diagnosis of HIT. Cases were classified into two groups based on TPE use. The primary outcome was in-hospital mortality. Secondary outcomes were thrombotic events, major bleeding, hospital length of stay (LOS), and charges. Multivariable regression analysis, controlling for age and medical comorbidities, was used to examine the association of TPE with study outcomes. RESULTS A HIT diagnosis was made in 22 165 discharges, of which 90 (0.4%) received TPE. Corresponding national estimates are 106 435 and 439, respectively. TPE was not associated with decreased in-hospital mortality (OR = 1.72; 95%CI: 0.93-3.17, P = .085). However, TPE was associated with a higher likelihood of major bleeding (OR = 2.35; 95%CI: 1.40-3.68, P = .0009), primarily driven by gastrointestinal bleeding (OR = 2.21; 95%CI: 1.17-4.17, P = .015). TPE was also associated with higher hospital LOS (20.5 vs 10 day, P < .0001) and charges (USD 211181 vs USD 81654, P < .0001). CONCLUSION TPE's association with increased bleeding and a prolonged hospital course indicates that it is being used in HIT cases with a severe clinical phenotype. Future studies are needed to better characterize the HIT phenotype that will most benefit from TPE.
Collapse
Affiliation(s)
| | - Stephen H Boyle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
14
|
Brummett BH, Boyle SH, Siegler IC, Kuhn CM, Ashley-Koch A, Jonassaint CR, Züchner S, Collins A, Suarez EC, Williams RB. Correction to: Effects of Environmental Stress and Gender on Associations among Symptoms of Depression and the Serotonin Transporter Gene Linked Polymorphic Region (5-HTTLPR). Behav Genet 2020; 51:162. [PMID: 33346869 DOI: 10.1007/s10519-020-10029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA.
| | - Stephen H Boyle
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Ilene C Siegler
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Cynthia M Kuhn
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Stephan Züchner
- Miami Institute of Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ann Collins
- Center for Human Genetics, Duke University Medical Center, Durham, NC, USA
| | - Edward C Suarez
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Redford B Williams
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| |
Collapse
|
15
|
Brummett BH, Muller CL, Collins AL, Boyle SH, Kuhn CM, Siegler IC, Williams RB, Suarez EC, Ashley-Koch A. Correction to: 5-HTTLPR and Gender Moderate Changes in Negative Affect Responses to Tryptophan Infusion. Behav Genet 2020; 51:163. [PMID: 33326061 DOI: 10.1007/s10519-020-10030-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA.
| | - Christopher L Muller
- Center for Human Genetics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Ann L Collins
- Center for Human Genetics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Stephen H Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Cynthia M Kuhn
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Ilene C Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Redford B Williams
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Edward C Suarez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC, 27710, USA
| | - Allison Ashley-Koch
- Center for Human Genetics, Duke University Medical Center, Durham, NC, 27710, USA
| |
Collapse
|
16
|
Jiang W, Whellan DJ, Adams KF, Babyak MA, Boyle SH, Wilson JL, Patel CB, Rogers JG, Harris WS, O’Connor CM. Long-Chain Omega-3 Fatty Acid Supplements in Depressed Heart Failure Patients. JACC: Heart Failure 2018; 6:833-843. [DOI: 10.1016/j.jchf.2018.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/21/2022]
|
17
|
Sun JL, Boyle SH, Samad Z, Babyak MA, Wilson JL, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O’Connor CM, Velazquez EJ, Jiang W. Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients. Eur J Prev Cardiol 2017; 24:591-599. [PMID: 28067532 PMCID: PMC6093615 DOI: 10.1177/2047487316686435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of patients with clinically stable ischemic heart disease and is associated with increased risk of adverse prognosis. We aimed to examine the prognostic value of indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a population of ischemic heart disease patients that was not confined by having a recent positive physical stress test. Methods and results The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study enrolled 310 subjects who underwent mental and exercise stress testing and were followed annually for a median of four years. Study endpoints included time to first and total rate of major adverse cardiovascular events, defined as all-cause mortality and hospitalizations for cardiovascular causes. Cox and negative binomial regression adjusting for age, sex, resting left ventricular ejection fraction, and heart failure status were used to examine associations of indices of MSIMI and ESIMI with study endpoints. The continuous variable of mental stress-induced left ventricular ejection fraction change was significantly associated with both endpoints (all p values < 0.05). For every reduction of 5% in left ventricular ejection fraction induced by mental stress, patients had a 5% increase in the probability of a major adverse cardiovascular event at the median follow-up time and a 20% increase in the number of major adverse cardiovascular events endured over the follow-up period of six years. Indices of ESIMI did not predict endpoints ( ps > 0.05). Conclusion In patients with stable ischemic heart disease, mental, but not exercise, stress-induced left ventricular ejection fraction change significantly predicts risk of future adverse cardiovascular events.
Collapse
Affiliation(s)
- Julia L Sun
- Department of Medicine, University of Chicago Medical Center, USA
| | - Stephen H Boyle
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Zainab Samad
- Departments of Medicine, Duke University Medical Center, USA
| | - Michael A Babyak
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Jennifer L Wilson
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Cynthia Kuhn
- Pharmacology and Cancer Biology, Duke University Medical Center, USA
| | - Richard C Becker
- Department of Medicine, University of Cincinnati Medical Center, USA
| | - Thomas L Ortel
- Departments of Medicine, Duke University Medical Center, USA
| | | | - Joseph G Rogers
- Departments of Medicine, Duke University Medical Center, USA
- Duke Clinical Research Institute, USA
| | - Christopher M O’Connor
- Departments of Medicine, Duke University Medical Center, USA
- Duke Clinical Research Institute, USA
| | - Eric J Velazquez
- Departments of Medicine, Duke University Medical Center, USA
- Duke Clinical Research Institute, USA
| | - Wei Jiang
- Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
- Departments of Medicine, Duke University Medical Center, USA
| |
Collapse
|
18
|
Feigal JP, Boyle SH, Samad Z, Velazquez EJ, Wilson JL, Becker RC, Williams RB, Kuhn CM, Ortel TL, Rogers JG, O'Connor CM, Jiang W. Associations between positive emotional well-being and stress-induced myocardial ischemia: Well-being scores predict exercise-induced ischemia. J Psychosom Res 2017; 93:14-18. [PMID: 28107887 PMCID: PMC6044283 DOI: 10.1016/j.jpsychores.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/15/2016] [Accepted: 11/27/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depressive symptoms have been associated with myocardial ischemia induced by mental (MSIMI) and exercise (ESIMI) stress in clinically stable ischemic heart disease (IHD) patients, but the association between positive emotions and inducible ischemia is less well characterized. The objective of this study was to examine the associations between ratings of well-being and stress-induced ischemia. METHODS Subjects were adult patients with documented IHD underwent mental and exercise stress testing for the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) trial. The General Well-Being Schedule (GWBS), with higher scores reflecting greater subjective well-being, and the Center for Epidemiologic Studies Depression Scale (CES-D) were obtained from the REMIT participants. Echocardiography was used to measure ischemic responses to mental stress and Bruce protocol treadmill exercise testing. Data were analyzed using logistic regression adjusting for age, sex, resting left-ventricular ejection fraction (LVEF), and resting wall motion score index, as well as health-related behaviors. RESULTS GWBS scores were obtained for 210 individuals, with MSIMI present in 92 (43.8%) and ESIMI present in 64 (30.5%). There was a significant inverse correlation between GWBS-PE (Positive Emotion subscale) scores and probability of ESIMI (OR=0.55 (95%CI 0.36-0.83), p=0.005). This association persisted after additional control for CESD subscales measuring negative and positive emotions and for variables reflecting health-related behaviors. A similar inverse correlation between GWBS-PE and MSIMI was observed, but did not reach statistical significance (OR=0.81 (95%CI 0.54-1.20), p=0.28). CONCLUSION This is, to our knowledge, the first study demonstrating that greater levels of self-reported positive emotions are associated with a lower likelihood of ESIMI among patients with known IHD. Our results highlight the important interface functions of the central nervous and cardiovascular systems and underscore areas for future investigation.
Collapse
Affiliation(s)
- Jacob P Feigal
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Stephen H Boyle
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Zainab Samad
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Jennifer L Wilson
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Richard C Becker
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Redford B Williams
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Cynthia M Kuhn
- Department of Pharmacology & Cancer Biology, Duke University, Durham, NC, United States
| | - Thomas L Ortel
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Joseph G Rogers
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | | | - Wei Jiang
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Department of Medicine, Duke University Medical Center, Durham, NC, United States.
| |
Collapse
|
19
|
Boyle SH, Georgiades A, Brummett BH, Barefoot JC, Siegler IC, Matson WR, Kuhn CM, Grichnik K, Stafford-Smith M, Williams RB, Kaddurah-Daouk R, Surwit RS. Associations between central nervous system serotonin, fasting glucose, and hostility in African American females. Ann Behav Med 2015; 49:49-57. [PMID: 24806470 DOI: 10.1007/s12160-014-9626-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous research has shown an association between hostility and fasting glucose in African American women. Central nervous system serotonin activity is implicated both in metabolic processes and in hostility related traits. PURPOSE The purpose of this study is to determine whether central nervous system serotonin influences the association between hostility and fasting glucose in African American women. METHODS The study consisted of 119 healthy volunteers (36 African American women, 27 White women, 21 White males, and 35 African American males, mean age 34 ± 8.5 years). Serotonin related compounds were measured in cerebrospinal fluid. Hostility was measured by the Cook-Medley Hostility Scale. RESULTS Hostility was associated with fasting glucose and central nervous system serotonin related compounds in African American women only. Controlling for the serotonin related compounds significantly reduced the association of hostility to glucose. CONCLUSIONS The positive correlation between hostility and fasting glucose in African American women can partly be explained by central nervous system serotonin function.
Collapse
Affiliation(s)
- Stephen H Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, BOX 3366, Durham, NC, 27710, USA,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Boyle SH, Matson WR, Velazquez EJ, Samad Z, Williams RB, Sharma S, Thomas B, Wilson JL, O'Connor C, Jiang W. Metabolomics analysis reveals insights into biochemical mechanisms of mental stress-induced left ventricular dysfunction. Metabolomics 2015; 11:571-582. [PMID: 25983674 PMCID: PMC4431771 DOI: 10.1007/s11306-014-0718-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mental stress induced left ventricular dysfunction (LVD) has been associated with a greater risk of adverse events in coronary heart disease (CHD) patients independent of conventional risk indicators. The underlying biochemical mechanisms of this cardiovascular condition are poorly understood. Our objective was to use metabolomics technology to identify biochemical changes that co-occur with mental stress-induced LVD in patients with clinically stable CHD. Participants were adult CHD patients who were recruited for mental stress-induced myocardial ischemia screening. For this study, we randomly selected 30 patients representing the extremes of the mental stress-induced left ventricular ejection fraction (LVEF) change distribution; 15 who showed LVD (i.e. LVEF reduction ≥5) and 15 who showed a normal left ventricular response (NLVR; i.e. a LVEF increase of ≥5) to three mental stressors. An electrochemistry based metabolomics platform was used to profile pre- and post-stress serum samples yielding data for 22 known compounds, primarily within the tyrosine, tryptophan, purine and methionine pathways. There were significant stress-induced changes in several compounds. A comparison between the NLVR and LVD groups showed significant effects for kynurenine (p = .036, N-acetylserotonin (p = .054), uric acid (p = .015), tyrosine (p = .019) and a trend for methionine (p = .065); the NLVR group showed a significantly greater stress-induced reduction in all of those compounds compared to the LVD group. Many of these biochemicals have been implicated in other stress-related phenomena and are plausible candidates for mechanisms underlying LVD in response to mental stress.
Collapse
Affiliation(s)
- Stephen H. Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3366, Durham, NC 27710, USA
| | - Wayne R. Matson
- Department of Systems Biochemistry, Counterpoint Health Solutions Inc, Bedford, MA, USA
| | - Eric J. Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Zainab Samad
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Redford B. Williams
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3366, Durham, NC 27710, USA
| | - Swati Sharma
- Department of Systems Biochemistry, Counterpoint Health Solutions Inc, Bedford, MA, USA
| | - Beena Thomas
- Department of Systems Biochemistry, Counterpoint Health Solutions Inc, Bedford, MA, USA
| | - Jennifer L. Wilson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3366, Durham, NC 27710, USA
| | | | - Wei Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3366, Durham, NC 27710, USA, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
21
|
Jiang W, Boyle SH, Ortel TL, Samad Z, Velazquez EJ, Harrison RW, Wilson J, Kuhn C, Williams RB, O’Connor CM, Becker RC. Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J 2015; 169:496-507.e1. [PMID: 25819856 PMCID: PMC4382806 DOI: 10.1016/j.ahj.2014.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/15/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. METHODS Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. RESULTS Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n=117) met criteria for MSIMI and 18.15% (n=49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10μM (6.95[5.54] vs. -14.23[8.75].; P=0.045), epinephrine 10μM (12.84[4.84] vs. -6.40[7.61].; P=0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P<.001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. CONCLUSIONS These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.
Collapse
|
22
|
Cooper-Dehoff RM, Hou W, Weng L, Baillie RA, Beitelshees AL, Gong Y, Shahin MHA, Turner ST, Chapman A, Gums JG, Boyle SH, Zhu H, Wikoff WR, Boerwinkle E, Fiehn O, Frye RF, Kaddurah-Daouk R, Johnson JA. Is diabetes mellitus-linked amino acid signature associated with β-blocker-induced impaired fasting glucose? ACTA ACUST UNITED AC 2014; 7:199-205. [PMID: 24627569 DOI: 10.1161/circgenetics.113.000421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 5-amino acid (AA) signature, including isoleucine, leucine, valine, tyrosine, and phenylalanine, has been associated with incident diabetes mellitus and insulin resistance. We investigated whether this same AA signature, single-nucleotide polymorphisms in genes in their catabolic pathway, was associated with development of impaired fasting glucose (IFG) after atenolol treatment. METHODS AND RESULTS Among 234 European American participants enrolled in the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) study and treated with atenolol for 9 weeks, we prospectively followed a nested cohort that had both metabolomics profiling and genotype data available for the development of IFG. We assessed the association between baseline circulating levels of isoleucine, leucine, valine, tyrosine, and phenylalanine, as well as single-nucleotide polymorphisms in branched-chain amino-acid transaminase 1 (BCAT1) and phenylalanine hydroxylase (PAH) with development of IFG. All baseline AA levels were strongly associated with IFG development. Each increment in standard deviation of the 5 AAs was associated with the following odds ratio and 95% confidence interval for IFG based on a fully adjusted model: isoleucine 2.29 (1.31-4.01), leucine 1.80 (1.10-2.96), valine 1.77 (1.07-2.92), tyrosine 2.13 (1.20-3.78), and phenylalanine 2.04 (1.16-3.59). The composite P value was 2×10(-5). Those with PAH (rs2245360) AA genotype had the highest incidence of IFG (P for trend=0.0003). CONCLUSIONS Our data provide important insight into the metabolic and genetic mechanisms underlying atenolol-associated adverse metabolic effects. Clinical Trial Registration- http://www.clinicaltrials.gov; Unique Identifier: NCT00246519.
Collapse
|
23
|
Ersbøll M, Al Enezi F, Samad Z, Sedberry B, Boyle SH, O'Connor C, Jiang W, Velazquez EJ. Impaired resting myocardial annular velocities are independently associated with mental stress-induced ischemia in coronary heart disease. JACC Cardiovasc Imaging 2014; 7:351-61. [PMID: 24631512 DOI: 10.1016/j.jcmg.2013.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/10/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between resting myocardial function as assessed by tissue Doppler myocardial velocities and the propensity to develop mental stress-induced ischemia (MSIMI). BACKGROUND Tissue Doppler myocardial velocities detect preclinical cardiac dysfunction and clinical outcomes in a range of conditions. However, little is known about the interrelationship between myocardial velocities and the propensity to develop MSIMI compared with exercise stress-induced myocardial ischemia. METHODS Resting annular myocardial tissue Doppler velocities were obtained in 225 patients with known coronary heart disease who were subjected to both conventional exercise stress testing as well as a battery of 3 mental stress tests. Diastolic early (e') and late (a') as well as systolic (s') velocities were obtained, and the eas index, an integrated measure of myocardial velocities, was calculated as e'/(a' × s'). MSIMI was defined as: 1) the development or worsening of regional wall motion abnormality; 2) a reduction in left ventricular ejection fraction ≥ 8%; and/or 3) ischemic ST-segment changes during 1 or more of the 3 mental stress tests. RESULTS A total of 98 of 225 patients (43.7%) exhibited MSIMI. Patients developing MSIMI had significantly lower s' (7.0 ± 1.7 vs. 7.5 ± 1.2, p = 0.016) and a' (8.9 ± 1.8 vs. 10.0 ± 1.9, p < 0.001) at baseline, whereas e' did not differ (6.5 ± 1.7 vs. 6.5 ± 1.8, p = 0.85). Furthermore, the eas index was significantly higher (0.11 ± 0.04 vs. 0.09 ± 0.03, p < 0.0001). The eas index remained significantly associated with the propensity to develop MSIMI (odds ratio per 0.05-U increase: 1.85; 95% confidence interval: 1.21 to 2.82; p = 0.004) after adjustment for resting left ventricular ejection fraction, resting wall motion index score, sex, and social circumstances of living. There was no association between resting eas index and exercise stress-induced myocardial ischemia. CONCLUSIONS MSIMI but not exercise stress-induced myocardial ischemia is independently associated with resting abnormalities in myocardial systolic and late diastolic velocities as well as the integrated measure of the eas index in patients with known coronary artery disease. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).
Collapse
Affiliation(s)
- Mads Ersbøll
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Fawaz Al Enezi
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Zainab Samad
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Brenda Sedberry
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stephen H Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | | | - Wei Jiang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
24
|
Zhu H, Bogdanov MB, Boyle SH, Matson W, Sharma S, Matson S, Churchill E, Fiehn O, Rush JA, Krishnan RR, Pickering E, Delnomdedieu M, Kaddurah-Daouk R. Pharmacometabolomics of response to sertraline and to placebo in major depressive disorder - possible role for methoxyindole pathway. PLoS One 2013; 8:e68283. [PMID: 23874572 PMCID: PMC3714282 DOI: 10.1371/journal.pone.0068283] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 05/28/2013] [Indexed: 12/05/2022] Open
Abstract
Therapeutic response to selective serotonin (5-HT) reuptake inhibitors in Major Depressive Disorder (MDD) varies considerably among patients, and the onset of antidepressant therapeutic action is delayed until after 2 to 4 weeks of treatment. The objective of this study was to analyze changes within methoxyindole and kynurenine (KYN) branches of tryptophan pathway to determine whether differential regulation within these branches may contribute to mechanism of variation in response to treatment. Metabolomics approach was used to characterize early biochemical changes in tryptophan pathway and correlated biochemical changes with treatment outcome. Outpatients with MDD were randomly assigned to sertraline (n = 35) or placebo (n = 40) in a double-blind 4-week trial; response to treatment was measured using the 17-item Hamilton Rating Scale for Depression (HAMD17). Targeted electrochemistry based metabolomic platform (LCECA) was used to profile serum samples from MDD patients. The response rate was slightly higher for sertraline than for placebo (21/35 [60%] vs. 20/40 [50%], respectively, χ2(1) = 0.75, p = 0.39). Patients showing a good response to sertraline had higher pretreatment levels of 5-methoxytryptamine (5-MTPM), greater reduction in 5-MTPM levels after treatment, an increase in 5-Methoxytryptophol (5-MTPOL) and Melatonin (MEL) levels, and decreases in the (KYN)/MEL and 3-Hydroxykynurenine (3-OHKY)/MEL ratios post-treatment compared to pretreatment. These changes were not seen in the patients showing poor response to sertraline. In the placebo group, more favorable treatment outcome was associated with increases in 5-MTPOL and MEL levels and significant decreases in the KYN/MEL and 3-OHKY/MEL; changes in 5-MTPM levels were not associated with the 4-week response. These results suggest that recovery from a depressed state due to treatment with drug or with placebo could be associated with preferential utilization of serotonin for production of melatonin and 5-MTPOL.
Collapse
Affiliation(s)
- Hongjie Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Jiang W, Velazquez EJ, Kuchibhatla M, Samad Z, Boyle SH, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O'Connor C. Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial. JAMA 2013; 309:2139-49. [PMID: 23695483 PMCID: PMC4378823 DOI: 10.1001/jama.2013.5566] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Mental stress can induce myocardial ischemia and also has been implicated in triggering cardiac events. However, pharmacological interventions aimed at reducing mental stress-induced myocardial ischemia (MSIMI) have not been well studied. OBJECTIVE To examine the effects of 6 weeks of escitalopram treatment vs placebo on MSIMI and other psychological stress-related biophysiological and emotional parameters. DESIGN, SETTING, AND PARTICIPANTS The REMIT (Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment) study, a randomized, double-blind, placebo-controlled trial of patients with clinically stable coronary heart disease and laboratory-diagnosed MSIMI. Enrollment occurred from July 24, 2007, through August 24, 2011, at a tertiary medical center. INTERVENTIONS Eligible participants were randomized 1:1 to receive escitalopram (dose began at 5 mg/d, with titration to 20 mg/d in 3 weeks) or placebo over 6 weeks. MAIN OUTCOMES AND MEASURES Occurrence of MSIMI, defined as development or worsening of regional wall motion abnormality; left ventricular ejection fraction reduction of 8% or more; and/or horizontal or down-sloping ST-segment depression of 1 mm or more in 2 or more leads, lasting for 3 or more consecutive beats, during 1 or more of 3 mental stressor tasks. RESULTS Of 127 participants randomized to receive escitalopram (n = 64) or placebo (n = 63), 112 (88.2%) completed end point assessments (n = 56 in each group). At the end of 6 weeks, more patients taking escitalopram (34.2% [95% CI, 25.4%-43.0%]) had absence of MSIMI during the 3 mental stressor tasks compared with patients taking placebo (17.5% [95% CI, 10.4%-24.5%]), based on the unadjusted multiple imputation model for intention-to-treat analysis. A significant difference favoring escitalopram was observed (odds ratio, 2.62 [95% CI, 1.06-6.44]). Rates of exercise-induced ischemia were slightly lower at 6 weeks in the escitalopram group (45.8% [95% CI, 36.6%-55.0%]) than in patients receiving placebo (52.5% [95% CI, 43.3%-61.8%]), but this difference was not statistically significant (adjusted odds ratio; 1.24 [95% CI, 0.60-2.58]; P = .56). CONCLUSIONS AND RELEVANCE Among patients with stable coronary heart disease and baseline MSIMI, 6 weeks of escitalopram, compared with placebo, resulted in a lower rate of MSIMI. There was no statistically significant difference in exercise-induced ischemia. Replication of these results in multicenter settings and investigations of other medications for reducing MSIMI are needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00574847.
Collapse
Affiliation(s)
- Wei Jiang
- Department of Medicine, Duke University Medical Center, DUMC Box 3366, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kaddurah-Daouk R, Bogdanov MB, Wikoff WR, Zhu H, Boyle SH, Churchill E, Wang Z, Rush AJ, Krishnan RR, Pickering E, Delnomdedieu M, Fiehn O. Pharmacometabolomic mapping of early biochemical changes induced by sertraline and placebo. Transl Psychiatry 2013; 3:e223. [PMID: 23340506 PMCID: PMC3566722 DOI: 10.1038/tp.2012.142] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this study, we characterized early biochemical changes associated with sertraline and placebo administration and changes associated with a reduction in depressive symptoms in patients with major depressive disorder (MDD). MDD patients received sertraline or placebo in a double-blind 4-week trial; baseline, 1 week, and 4 weeks serum samples were profiled using a gas chromatography time of flight mass spectrometry metabolomics platform. Intermediates of TCA and urea cycles, fatty acids and intermediates of lipid biosynthesis, amino acids, sugars and gut-derived metabolites were changed after 1 and 4 weeks of treatment. Some of the changes were common to the sertraline- and placebo-treated groups. Changes after 4 weeks of treatment in both groups were more extensive. Pathway analysis in the sertraline group suggested an effect of drug on ABC and solute transporters, fatty acid receptors and transporters, G signaling molecules and regulation of lipid metabolism. Correlation between biochemical changes and treatment outcomes in the sertraline group suggested a strong association with changes in levels of branched chain amino acids (BCAAs), lower BCAAs levels correlated with better treatment outcomes; pathway analysis in this group revealed that methionine and tyrosine correlated with BCAAs. Lower levels of lactic acid, higher levels of TCA/urea cycle intermediates, and 3-hydroxybutanoic acid correlated with better treatment outcomes in placebo group. Results of this study indicate that biochemical changes induced by drug continue to evolve over 4 weeks of treatment and that might explain partially delayed response. Response to drug and response to placebo share common pathways but some pathways are more affected by drug treatment. BCAAs seem to be implicated in mechanisms of recovery from a depressed state following sertraline treatment.
Collapse
Affiliation(s)
- R Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Duke University Medical Center, Box 3903, Durham, NC 27710, USA. E-mail: rima.kaddurahdaouk.duke.edu
| | - M B Bogdanov
- Department of Neurology and Neuroscience Weill Cornell Medical College, New York, NY, USA
| | - W R Wikoff
- UC Davis Genome Center, University of California, Davis, NC, USA
| | - H Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - S H Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - E Churchill
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Z Wang
- Department of Statistics and Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - A J Rush
- Duke-NUS Graduate Medical School, Singapore
| | - R R Krishnan
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Duke-NUS Graduate Medical School, Singapore
| | - E Pickering
- Pfizer Global R&D, Clinical Research Statistics, Groton, CT, USA
| | - M Delnomdedieu
- Pfizer Global R&D, Neuroscience Clinical Research, Groton, CT, USA
| | - O Fiehn
- UC Davis Genome Center, University of California, Davis, NC, USA,Metabolomics Research and Core Laboratories UC Davis Genome Center, Room 1314+1315, First Floor, 451 Health Sci Drive Davis, CA 95616, USA
| |
Collapse
|
27
|
Brummett BH, Kuhn CM, Boyle SH, Babyak MA, Siegler IC, Williams RB. Cortisol responses to emotional stress in men: association with a functional polymorphism in the 5HTR2C gene. Biol Psychol 2011; 89:94-8. [PMID: 21967853 DOI: 10.1016/j.biopsycho.2011.09.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/29/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
Abstract
The serotonin 5HTR2C receptor has been shown to mediate HPA axis activation during stress. We hypothesized that a functional polymorphism (rs6318) of the 5HTR2C gene would be associated with HPA axis response to a laboratory stress protocol. The present sample consisted of 41 men (22 African Americans, 19 Caucasians). We found that at rest men with the more active rs6318 Ser23 C allele had similar cortisol values compared to those with the less active Cys23 G allele. During laboratory stress, however, men with the Ser23 C allele exhibited the predicted significantly higher cortisol levels (p<0.001), as well as larger increases in anger (p=0.08) and depressive mood (p=0.006) ratings, compared to the Cys23 G carriers. The increase in cortisol was significantly related to the increases in ratings of anger and depression assessed before and after the emotion induction, and these correlations became nonsignificant when rs6318 genotype was covaried. We conclude that genetic variation in 5HTR2C may be associated with HPA axis activation and stimulated by emotional stress, and also with both psychological and physiological endophenotypes that increase the risk of cardiovascular disease and type-2 diabetes.
Collapse
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry, Duke University Medical Center, Durham, NC, United States.
| | | | | | | | | | | |
Collapse
|
28
|
Han X, Rozen S, Boyle SH, Hellegers C, Cheng H, Burke JR, Welsh-Bohmer KA, Doraiswamy PM, Kaddurah-Daouk R. Metabolomics in early Alzheimer's disease: identification of altered plasma sphingolipidome using shotgun lipidomics. PLoS One 2011; 6:e21643. [PMID: 21779331 PMCID: PMC3136924 DOI: 10.1371/journal.pone.0021643] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/04/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The development of plasma biomarkers could facilitate early detection, risk assessment and therapeutic monitoring in Alzheimer's disease (AD). Alterations in ceramides and sphingomyelins have been postulated to play a role in amyloidogensis and inflammatory stress related neuronal apoptosis; however few studies have conducted a comprehensive analysis of the sphingolipidome in AD plasma using analytical platforms with accuracy, sensitivity and reproducibility. METHODS AND FINDINGS We prospectively analyzed plasma from 26 AD patients (mean MMSE 21) and 26 cognitively normal controls in a non-targeted approach using multi-dimensional mass spectrometry-based shotgun lipidomics to determine the levels of over 800 molecular species of lipids. These data were then correlated with diagnosis, apolipoprotein E4 genotype and cognitive performance. Plasma levels of species of sphingolipids were significantly altered in AD. Of the 33 sphingomyelin species tested, 8 molecular species, particularly those containing long aliphatic chains such as 22 and 24 carbon atoms, were significantly lower (p<0.05) in AD compared to controls. Levels of 2 ceramide species (N16:0 and N21:0) were significantly higher in AD (p<0.05) with a similar, but weaker, trend for 5 other species. Ratios of ceramide to sphingomyelin species containing identical fatty acyl chains differed significantly between AD patients and controls. MMSE scores were correlated with altered mass levels of both N20:2 SM and OH-N25:0 ceramides (p<0.004) though lipid abnormalities were observed in mild and moderate AD. Within AD subjects, there were also genotype specific differences. CONCLUSIONS In this prospective study, we used a sensitive multimodality platform to identify and characterize an essentially uniform but opposite pattern of disruption in sphingomyelin and ceramide mass levels in AD plasma. Given the role of brain sphingolipids in neuronal function, our findings provide new insights into the AD sphingolipidome and the potential use of metabolomic signatures as peripheral biomarkers.
Collapse
Affiliation(s)
- Xianlin Han
- Sanford-Burnham Medical Research Institute, Orlando, Florida, United States of America
| | - Steve Rozen
- Department of Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Stephen H. Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Caroline Hellegers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Hua Cheng
- Sanford-Burnham Medical Research Institute, Orlando, Florida, United States of America
| | - James R. Burke
- Bryan Alzheimer Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kathleen A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Bryan Alzheimer Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Institute of Brain Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| |
Collapse
|
29
|
Barefoot JC, Brummett BH, Williams RB, Siegler IC, Helms MJ, Boyle SH, Clapp-Channing NE, Mark DB. Recovery expectations and long-term prognosis of patients with coronary heart disease. ACTA ACUST UNITED AC 2011; 171:929-35. [PMID: 21357800 DOI: 10.1001/archinternmed.2011.41] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Expectations of patients regarding their prospects for recovery have been shown to predict subsequent physical and social functioning. Evidence regarding the impact of expectations on clinical outcomes is limited. METHODS At the inpatient service of a tertiary care hospital, we evaluated beliefs of patients undergoing coronary angiography about their prognosis as predictors of long-term survival and 1-year functional status. Baseline assessments, including a measure of expectations for recovery, were obtained during hospitalization with mortality follow-up for approximately 15 years. Patients with significant obstructive coronary artery disease were interviewed while in the hospital and enrolled in follow-up. Functional status was assessed at baseline and 1 year later with questionnaires reflecting physical capabilities. Analyses controlled for age, sex, disease severity, comorbidities, treatments, demographics, depressive symptoms, social support, and functional status. There were 1637 total deaths, 885 from cardiovascular causes, in the 2818 patients in these analyses. The outcomes were total mortality, cardiovascular mortality, and 1-year functional status. RESULTS Expectations were positively associated with survival after controlling for background and clinical disease indicators. For a difference equivalent to an interquartile range of expectations, the hazard ratio (HR) for total mortality was 0.76 (95% confidence interval [CI], 0.71-0.82) and 0.76 (95% CI, 0.69-0.83) for cardiovascular mortality. The HRs were 0.83 (95% CI, 0.76-0.91) and 0.79 (95% CI, 0.70-0.89) with further adjustments for demographic and psychosocial covariates. Similar associations (P < .001) were observed for functional status. CONCLUSION Recovery expectations at baseline were positively associated with long-term survival and functioning in patients with coronary artery disease.
Collapse
Affiliation(s)
- John C Barefoot
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Iqbal Kring SI, Barefoot J, Brummett BH, Boyle SH, Siegler IC, Toubro S, Hansen T, Astrup A, Pedersen O, Williams RB, Sørensen TIA. Associations between APOE variants and metabolic traits and the impact of psychological stress. PLoS One 2011; 6:e15745. [PMID: 21283811 PMCID: PMC3023763 DOI: 10.1371/journal.pone.0015745] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/27/2010] [Indexed: 01/29/2023] Open
Abstract
Objective In a previous study, we observed that associations between APOE rs439401 and metabolic traits were moderated by chronic stress. Thus, in a population of stressed and non-stressed Danish men, we examined whether associations between APOE rs439401 and a panel of metabolic quantitative traits, all metabolic traits which may lead to T2D and CVD were moderated by psychological stress. Methods Obese young men (n = 475, BMI≥31.0 kg/m2) and a randomly selected control group (n = 709) identified from a population of 141,800 men were re-examined in two surveys (S-46: mean age 46, S-49: mean age 49 years) where anthropometric and biochemical measures were available. Psychological stress factors were assessed by a self-administered 7-item questionnaire. Each item had the possible response categories “yes” and “no” and assessed familial problems and conflicts. Summing positive responses constituted a stress item score, which was then dichotomized into stressed and non-stressed. Logistic regression analysis, applying a recessive genetic model, was used to assess odds ratios (OR) of the associations between APOE rs439401 genotypes and adverse levels of metabolic traits. Results The APOE rs439401 TT-genotype associated positively with BMI (OR = 1.09 [1.01; 1.17]), waist circumference (OR = 1.09 [1.02; 1.17]) in stressed men at S-46. Positive associations were observed for fasting plasma glucose (OR = 1.42 [1.07; 1.87]), serum triglycerides (OR = 1.41 [1.05; 1.91]) and with fasting plasma insulin (OR = 1.48 [1.05; 2.08]) in stressed men at S-49. Rs439401 TT-genotype also associated positively with surrogate measures of insulin resistance (HOMA-IR; OR = 1.21 [1.03; 1.41]) and inversely with insulin sensitivity (Stumvoll index; OR = 0.90 [0.82; 0.99], BIGTT-SI; OR = 0.60 [0.43; 0.85]) in stressed men. No significant associations were observed in non-stressed men, albeit the estimates showed similar but weaker trends as in stressed men. Conclusion The present results suggest that the APOE rs439401 TT-genotype is associated with an adverse metabolic profile in a population of psychologically stressed Danish men.
Collapse
|
31
|
Flood AM, Boyle SH, Calhoun PS, Dennis MF, Barefoot JC, Moore SD, Beckham JC. Prospective study of externalizing and internalizing subtypes of posttraumatic stress disorder and their relationship to mortality among Vietnam veterans. Compr Psychiatry 2010; 51:236-42. [PMID: 20399332 PMCID: PMC2858053 DOI: 10.1016/j.comppsych.2009.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/31/2009] [Accepted: 08/05/2009] [Indexed: 11/18/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) can be a complex disorder, and some studies have found that samples of individuals with PTSD contain subtypes that may relate to health outcomes. The goals were to replicate previously identified PTSD subtypes and examine how subtype membership relates to mortality. Data from the Vietnam Experience Study and a clinical sample of Vietnam veterans were combined (n = 5248) to address these research questions. Consistent with previous studies, 3 PTSD subtypes emerged: externalizers (n = 317), internalizers (n = 579), and low pathology (n = 280). Posttraumatic stress disorder diagnosis was associated with increased risk of all-cause and behavioral-cause (eg, homicide, suicide) mortality. Both externalizing and internalizing subtypes had higher mortality and were more likely to die from cardiovascular causes than those without PTSD. Externalizers were more likely to die from substance-related causes than those without PTSD. The value of considering possible PTSD subtypes is significant in that it may contribute to identifying more specific targets for treatment and rehabilitation in veterans with PTSD.
Collapse
Affiliation(s)
| | - Stephen H. Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
| | - Michelle F. Dennis
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - John C. Barefoot
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Scott D. Moore
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
| |
Collapse
|
32
|
Jonassaint CR, Boyle SH, Kuhn CM, Siegler IC, Copeland WE, Williams R. Personality and inflammation: the protective effect of openness to experience. Ethn Dis 2010; 20:11-14. [PMID: 20178176 PMCID: PMC2898189] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Prior research found reduced mortality in coronary heart patients with higher scores on the Openness to Experience domain and its facets. Decreased C-reactive protein level (CRP) levels may be one mechanism by which higher Openness to Experience leads to decreased mortality. Thus, the current study aimed to test the association between the Openness to Experience domain and its facets, as assessed by the NEO Personality Inventory-Revised, and CRP in a sample of 165 healthy Black and White, male and female community volunteers. METHODS Blood samples were taken before and after a 40-minute mental stress protocol. BMI and education were significant predictors of CRP and, in addition to age, were included as covariates in all analyses. Race and sex were tested as possible moderating variables. RESULTS In a mixed effects model the main effect of time (pre/post-stress), Openness to Experience (O) and their interaction were not significant predictors of CRP. However, results showed a significant race x O effect on CRP (P=.03). In Blacks, higher Openness to Experience domain (r=-.41, P<.01), aesthetics facet (r=-.30, P=.01), feelings facet (r= -.41, P<.01), and ideas facet (r=-.38, P<.01) scores were associated with lower mean CRP levels. In contrast, among White participants, neither the Openness to Experience domain nor its related facets were associated with CRP. DISCUSSION The Openness to Experience domain and its facets may be associated with markers of the inflammatory process among Blacks but not Whites.
Collapse
Affiliation(s)
- Charles R Jonassaint
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, USA
| | | | | | | | | | | |
Collapse
|
33
|
Brummett BH, Morey MC, Boyle SH, Mark DB. Prospective study of associations among positive emotion and functional status in older patients with coronary artery disease. J Gerontol B Psychol Sci Soc Sci 2009; 64:461-9. [PMID: 19515993 DOI: 10.1093/geronb/gbp041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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] Open
Abstract
We examined associations between positive emotion (PE) and functional status (Duke Activity Status Inventory) in 948 coronary artery disease (CAD) patients (35.1% women; age M = 70.1 years, SD = 6.3). Emotion and function measures were gathered during hospitalization and annually for 3 years. We used random coefficient models to examine PE during hospitalization and follow-up, as a predictor of change in function. Analyses adjusted for baseline functional status, negative emotion, social support, marital status, and disease severity. Sex was examined as a moderator of effects. PE assessed during hospitalization was a significant predictor of change in function such that lower levels of PE were associated with accelerated decline in function. Lower levels of PE during follow-up were also related to increasing decline in function but only in men. Thus, our findings indicate that PE is associated with less decline in functional status following hospitalization for CAD.
Collapse
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC 27710, USA.
| | | | | | | |
Collapse
|
34
|
Brummett BH, Boyle SH, Kuhn CM, Siegler IC, Williams RB. Positive affect is associated with cardiovascular reactivity, norepinephrine level, and morning rise in salivary cortisol. Psychophysiology 2009; 46:862-9. [PMID: 19470128 DOI: 10.1111/j.1469-8986.2009.00829.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Positive affect was examined as a predictor of (1) cardiovascular reactivity during a sadness and an anger recall task and recovery following the protocol, (2) epinephrine (EPI) and norepinephrine (NOREPI) reactivity and level during the recall protocol, and (3) the diurnal pattern of salivary cortisol. Sample was 328 individuals. Negative affect, age, race, sex, smoking status, income, and BMI were adjusted. During sadness recall, positive affect was inversely related to systolic blood pressure (p=.007) and diastolic blood pressure (p=.049) reactivity, and unrelated to heart rate (p=.226). Positive affect was unrelated to reactivity during anger recall (ps>.19), and was unrelated to recovery at the end of the recall protocol. Positive affect was inversely related to the mean level of NOREPI (p=.046), and unrelated to EPI (p=.149). Positive affect was inversely related to the increase in cortisol 30 min post awakening (p=.042), and unrelated to the evening decline in cortisol levels (p=.174). Positive emotions may be relevant to good health.
Collapse
Affiliation(s)
- B H Brummett
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | |
Collapse
|
35
|
Gale CR, Deary IJ, Boyle SH, Barefoot J, Mortensen LH, Batty GD. Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age: the Vietnam experience study. Arch Gen Psychiatry 2008; 65:1410-8. [PMID: 19047528 PMCID: PMC3634571 DOI: 10.1001/archpsyc.65.12.1410] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Lower cognitive ability is a risk factor for some forms of psychopathology, but much of the evidence for risk is based on individuals who required specialist care. It is unclear whether lower ability influences the risk of particular patterns of comorbidity. OBJECTIVE To examine the relation between premorbid cognitive ability in early adulthood and the risk of major depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), alcohol and other drug abuse or dependence, and comorbid forms of these conditions in midlife. DESIGN Prospective cohort study in which cognitive ability was measured on enlistment into military service at a mean age of 20.4 years and psychiatric disorder was assessed by structured diagnostic interview at a mean age of 38.3 years. SETTING The United States. PARTICIPANTS A total of 3258 male veterans, participants in the Vietnam Experience Study. MAIN OUTCOME MEASURES Major depression, GAD, PTSD, and alcohol or other drug abuse or dependence since enlistment and currently, diagnosed according to the DSM-III. RESULTS Lower cognitive ability was associated with an increased risk of depression, GAD, alcohol abuse or dependence, and PTSD and with some patterns of comorbidity. For a 1-SD decrease in cognitive ability, unadjusted odds ratios (95% confidence interval) for having these disorders currently were 1.32 (1.12-1.56) for depression, 1.43 (1.27-1.64) for GAD, 1.20 (1.08-1.35) for alcohol abuse or dependence, 1.39 (1.18-1.67) for PTSD, 2.50 (1.41-4.55) for PTSD plus GAD, 2.17 (1.47-3.22) for PTSD plus GAD plus depression, and 2.77 (1.12-6.66) for all 4 disorders. Most associations remained statistically significant after adjustment for confounders. CONCLUSIONS Lower cognitive ability is a risk factor for several specific psychiatric disorders, including some forms of comorbidity. Understanding the mechanisms whereby ability is linked to individual patterns of psychopathology may inform intervention.
Collapse
Affiliation(s)
- Catharine R Gale
- Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, England.
| | | | | | | | | | | |
Collapse
|
36
|
Brummett BH, Boyle SH, Siegler IC, Kuhn CM, Surwit RS, Garrett ME, Collins A, Ashley-Koch A, Williams RB. HPA axis function in male caregivers: effect of the monoamine oxidase-A gene promoter (MAOA-uVNTR). Biol Psychol 2008; 79:250-5. [PMID: 18639608 DOI: 10.1016/j.biopsycho.2008.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 06/20/2008] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
Abstract
Caregiving stress is associated with negative health outcomes. Neuroendocrine functioning may be a mediator of such outcomes. The MAOA gene regulates activity of neurotransmitters involved with neuroendocrine responses to stress. Differences in polymorphisms of this gene have been shown to influence susceptibility to stress. Therefore, we examined allelic variation in MAOA-uVNTR, a functional polymorphism of MAOA, as a moderator of chronic stress effects on urinary cortisol excretion in 74 males enrolled in a case/control study of caregivers for relatives with dementia. Mixed models analysis of variance were used to examine MAOA-uVNTR genotype (3 repeats vs. 3.5/4 repeats) as a moderator of the impact of stress (caregiver vs. non-caregiver) on the urinary excretion pattern (overnight, daytime, evening) of cortisol. Caregivers with MAOA-uVNTR alleles associated with less transcriptional activity (3-repeats) displayed a pattern of cortisol excretion -- a decrease from overnight to daytime -- that was suggestive of HPA axis blunting, as compared to non-caregivers and those caregivers with the more active alleles (3.5/4 repeats) (cortisol p<.043). Individuals with less active MAOA-uVNTR alleles who are under chronic stress may be at increased risk for exhaustion of the HPA response to such stress.
Collapse
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Batty GD, Shipley MJ, Mortensen LH, Boyle SH, Barefoot J, Grønbaek M, Gale CR, Deary IJ. IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study. J Epidemiol Community Health 2008; 62:522-31. [PMID: 18477751 DOI: 10.1136/jech.2007.064881] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the role of potential mediating factors in explaining the IQ-mortality relation. DESIGN, SETTING AND PARTICIPANTS A total of 4316 male former Vietnam-era US army personnel with IQ test results at entry into the service in late adolescence/early adulthood in the 1960/1970s (mean age at entry 20.4 years) participated in a telephone survey and medical examination in middle age (mean age 38.3 years) in 1985-6. They were then followed up for mortality experience for 15 years. MAIN RESULTS In age-adjusted analyses, higher IQ scores were associated with reduced rates of total mortality (hazard ratio (HR)(per SD increase in IQ) 0.71; 95% CI 0.63 to 0.81). This relation did not appear to be heavily confounded by early socioeconomic position or ethnicity. The impact of adjusting for some potentially mediating risk indices measured in middle age on the IQ-mortality relation (marital status, alcohol consumption, systolic and diastolic blood pressure, pulse rate, blood glucose, body mass index, psychiatric and somatic illness at medical examination) was negligible (<10% attenuation in risk). Controlling for others (cigarette smoking, lung function) had a modest impact (10-17%). Education (0.79; 0.69 to 0.92), occupational prestige (0.77; 0.68 to 0.88) and income (0.86; 0.75 to 0.98) yielded the greatest attenuation in the IQ-mortality gradient (21-52%); after their collective adjustment, the IQ-mortality link was effectively eliminated (0.92; 0.79 to 1.07). CONCLUSIONS In this cohort, socioeconomic position in middle age might lie on the pathway linking earlier IQ with later mortality risk but might also partly act as a surrogate for cognitive ability.
Collapse
Affiliation(s)
- G D Batty
- MRC Social & Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Brummett BH, Boyle SH, Siegler IC, Zuchner S, Ashley-Koch A, Williams RB. Lipid levels are associated with a regulatory polymorphism of the monoamine oxidase-A gene promoter (MAOA-uVNTR). Med Sci Monit 2008; 14:CR57-CR61. [PMID: 18227761 PMCID: PMC2759533] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The monoamine oxidase-A (MAOA) gene plays a vital role in the metabolism of neurotransmitters, e.g, serotonin, norepinephrine, and dopamine. A polymorphism in the promoter region (MAOA-uVNTR) affects transcriptional efficiency. Allelic variation in MAOA-uVNTR has been associated with body mass index (BMI). We extended previous work by examining relations among this polymorphism and serum lipid levels. MATERIAL/METHODS The sample consisted of 74 males enrolled in a study of caregivers for relatives with dementia. Regression models, adjusted for age, race, group status (caregiver/control), and cholesterol lowering medication (yes/no), were used to examine associations between high verses low MAOA-uVNTR activity alleles and total cholesterol, HDL, LDL, VLDL, LDL/HDL ratio, triglycerides, and BMI. RESULTS Higher total cholesterol (p<0.03), LDL/HDL ratio (p<0.01), triglycerides (p<0.02), and VLDL (p<0.02) were associated with low activity MAOA-uVNTR alleles. HDL and LDL were modestly related to MAOA-uVNTR activity, however, they did not reach the conventional significance level (p<0.07 and p<0.10, respectively). BMI (p<0.74) was unrelated to MAOA-uVNTR transcription. CONCLUSIONS The present findings suggest that MAOA-uVNTR may influence lipid levels and individuals with less active alleles are at increased health risk.
Collapse
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
AIMS This study examined the association of hostility to drinking pattern and whether this association mediated the relation of hostility to mortality. PARTICIPANTS AND DESIGN Subjects were 3326 current drinkers from the Vietnam Experience Study cohort who were followed for vital status. SETTING United States. MEASUREMENTS Hostility was measured by an abbreviated version of the Cook-Medley Hostility Scale (ACM). The alcohol variables were total monthly intake of alcohol, drinking frequency, drinks per drinking day and drinking > or = 5 drinks on at least one occasion in the past month (i.e. heavy episodic drinking). FINDINGS Regression analyses showed associations between the ACM and total monthly intake of alcohol (P < 0.0001), drinks per drinking day (P < 0.0001) and heavy episodic drinking (P < 0.0001), but not with frequency of drinking days. Hostility, drinks per drinking day, heavy episodic drinking and total monthly alcohol intake were also associated with all-cause mortality (all Ps < 0.0001). Further analyses showed that drinking pattern, particularly drinks per drinking day, may account partially for the relation of hostility to mortality. CONCLUSIONS High hostility is associated with elevated mortality and a deleterious drinking pattern characterized by relatively high intake per drinking occasion. Drinking pattern could help explain the relationships between hostility and health.
Collapse
Affiliation(s)
- Stephen H Boyle
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, NC, USA.
| | | | | | | |
Collapse
|
40
|
Brummett BH, Boyle SH, Siegler IC, Kuhn CM, Ashley-Koch A, Jonassaint CR, Züchner S, Collins A, Williams RB. Effects of environmental stress and gender on associations among symptoms of depression and the serotonin transporter gene linked polymorphic region (5-HTTLPR). Behav Genet 2007; 38:34-43. [PMID: 17955359 DOI: 10.1007/s10519-007-9172-1] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 09/28/2007] [Indexed: 12/16/2022]
Abstract
The short (s) variant of the serotonin transporter (5-HTT) gene linked functional polymorphic region (5-HTTLPR) is associated with depression. Stressful life events, gender, and race have been shown to moderate this association. We examined the relationship between 5-HTTLPR genotype and symptoms of depression in two samples. Study 1 = 288 participants from a study of caregiver stress; and Study 2 = 142 participants from a study examining psychosocial stressors, genetics, and health. Main effects of 5-HTTLPR on symptoms of depression were examined, along with moderation by stress (caregiving status or low childhood socioeconomic status (SES), gender, and race. The 5-HTTLPR x stress group x gender interaction was significant in both samples (P < 0.003, and P < 0.008, respectively). For females, the s allele, combined with caregiving stress (Study 1) or low childhood SES (Study 2), was associated with higher depression scores as compared to participants in the non-stressor group and those with the long (l) allele; whereas, in males, the l allele, combined with a stressor, was associated with higher depression scores as compared to those in the non-stressor group and those with the s allele. Findings from two independent samples suggest that the association of 5-HTTLPR with depression varies according to gender and stressful life events.
Collapse
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Boyle SH, Surwit RS, Georgiades A, Brummett BH, Helms MJ, Williams RB, Barefoot JC. Depressive symptoms, race, and glucose concentrations: the role of cortisol as mediator. Diabetes Care 2007; 30:2484-8. [PMID: 17630268 DOI: 10.2337/dc07-0258] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the associations of depressive symptoms with glucose concentrations and morning cortisol levels in 665 African-American and 4,216 Caucasian Vietnam-era veterans. RESEARCH DESIGN AND METHODS Glucose level was measured as a three-level variable (diabetes, impaired glucose, and normal). Depressive symptoms were measured by the Obvious Depression Scale (OBD) from the Minnesota Multiphasic Personality Inventory. RESULTS Regression models showed significant race x OBD interactions in relation to glucose concentration (P < 0.0001) and cortisol (P < 0.0001). The OBD was positively associated with glucose concentration and cortisol in both racial groups. However, the magnitude of those associations was larger for African Americans. Further analyses suggested that cortisol partially mediated the race difference in the relation of depressive symptoms to glucose concentrations. CONCLUSIONS These results suggest that enhanced hypothalamic pituitary adrenal activity plays an important role in the relation of depressive symptoms to dysregulated glucose metabolism and may partially explain the differential effects of depressive symptoms on glucose levels in African-American and Caucasian male subjects.
Collapse
Affiliation(s)
- Stephen H Boyle
- Department of Psychiatry and Behavioral Medicine, Duke University Medical Center, Box 2969, Durham, NC 27745, USA.
| | | | | | | | | | | | | |
Collapse
|
42
|
Boyle SH, Jackson WG, Suarez EC. Hostility, anger, and depression predict increases in C3 over a 10-year period. Brain Behav Immun 2007; 21:816-23. [PMID: 17321106 PMCID: PMC1995457 DOI: 10.1016/j.bbi.2007.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 01/09/2007] [Accepted: 01/12/2007] [Indexed: 01/06/2023] Open
Abstract
We examined the relation of hostility, anger, and depression to 10-year changes in the third (C3), and fourth (C4) complement in 313, apparently healthy male participants enrolled in the Air Force Health Study (AFHS), a 20-year study designed to evaluate the health consequences of dioxin exposure. Hostility, depression, and anger were assessed using subscales from the Minnesota Multiphasic Personality Inventory (MMPI), which was administered in 1985. Given the high intercorrelations among these psychological scales, we used a principal component analysis to generate a composite score representing the linear combination of the hostility, anger, and depression scales. The dependent variables, C3 and C4 levels, were determined from samples collected in 1992, 1997, and 2002. Regression analyses controlling for age, race, alcohol use, body mass index, and cigarette use as well as onset of disease, and use of lipid lowering and blood pressure medications during follow-up revealed a significant timexcomposite score interaction for C3 complement (p<.0003), but not C4. Post-hoc analyses revealed that high composite scores were associated with larger 10-year increases in C3. These observations suggest that men who are hostile and are prone to experience frequent and intense feelings of anger, and depression show activation of the complement system, and specifically increases in C3, that may contribute to the development of coronary heart disease.
Collapse
Affiliation(s)
- Stephen H. Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - Edward C. Suarez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| |
Collapse
|
43
|
Abstract
OBJECTIVE To examine the NEO Personality Inventory (NEO PI) Openness to Experience (O) domain and its facets as predictors of cardiac deaths and all-cause mortality. METHODS The NEO PI was administered to a sample of 977 coronary catheterization patients with significant coronary artery disease. Over an average 15-year follow-up period, 266 cardiac deaths and 463 total deaths occurred. The relationships of O scores to mortality were examined with Cox proportional hazard models. Each model included age, left ventricular ejection fraction, severity of congestive heart failure, and number of diseased vessels as covariates. RESULTS The O domain score was not associated with all-cause mortality and only approached significance for decreased cardiac deaths (p = .055). However, a higher score for Openness to Feelings was associated with a decreased risk of cardiac death (p < .01) and all-cause mortality (p < .01). High Openness to Actions was also associated with decreased cardiac mortality (p < .01) and all-cause mortality (p = .03) risk. Higher Openness to Aesthetics and Ideas were only associated with decreased cardiac death risk (both p values <.04). In contrast, Openness to Fantasy and Values were not associated with longevity. Previous evidence suggested that educational achievement may account for the effects of Openness to Experience on mortality; however, controlling for educational achievement did not change the results. CONCLUSION These findings suggest that greater emotional awareness and high curiosity, as indicated by the NEO PI Feelings and Actions facets, are associated with increased patient longevity independently of other risk factors and educational achievement.
Collapse
|
44
|
Abstract
OBJECTIVE The purpose of the present investigation was to examine the prospective associations of hostility, anger, depression, and anxiety, alone and in combination, to incident coronary heart disease (CHD). METHODS Subjects were 2105 men who participated in the Air Force Health Study, a 20-year study designed to evaluate the effects of herbicide exposure on various health outcomes in Air Force veterans of Operation Ranch Hand. Psychological attributes were assessed in 1985 using scales constructed from the Minnesota Multiphasic Personality Inventory. Participants were followed for an average of 15 years for evidence of ischemic heart disease (International Classification of Diseases codes 410-414, 428.4, or 36). The relation between psychological attributes and CHD was examined with Cox proportional hazard models. RESULTS Adjusting for CHD risk factors, depression, anxiety, hostility, and trait anger were significant predictors of incident CHD. In addition, a factor analytically derived psychological risk factor composite score was the strongest predictor of CHD. CONCLUSIONS These results suggest that the covariation of hostility, anger, depression, and anxiety accounts for the increased risk of CHD associated with each individual factor. The results of this study challenge the conventional approach of examining these psychological attributes in isolation.
Collapse
Affiliation(s)
- Stephen H Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | |
Collapse
|
45
|
Suarez EC, Boyle SH, Lewis JG, Hall RP, Young KH. Increases in stimulated secretion of proinflammatory cytokines by blood monocytes following arousal of negative affect: the role of insulin resistance as moderator. Brain Behav Immun 2006; 20:331-8. [PMID: 16288846 DOI: 10.1016/j.bbi.2005.09.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 09/15/2005] [Accepted: 09/19/2005] [Indexed: 01/04/2023] Open
Abstract
We examined the effect of negative affect on changes in stimulated secretion of cytokines by blood monocytes and determined whether insulin resistance (IR), as indexed by the Homeostasis Model Assessment (HOMA), moderated these associations in 58 healthy men (aged 18-65 years). Blood samples and ratings of negative affect were collected at rest and 15min following subjects' participation in the Anger Recall Interview (ARI). Assessment of lipopolysaccharide (LPS)-stimulated secretion of IL-1beta, IL-6, and TNF-alpha was accomplished by ELISA of supernatant. Regression models controlling for age, body mass index, and race/ethnicity revealed that higher HOMA-IR values were associated with larger stress-induced increases in IL-1beta and TNF-alpha (p<.05). Furthermore, arousal of negative affect during the ARI was differentially associated with stress-induced changes in stimulated secretion of TNF-alpha and IL-6 as a function of HOMA-IR (p<.05). Increases in stimulated cytokine secretion were associated with arousal of negative affect, but only among men with higher HOMA-IR values. Among men with lower HOMA-IR values, arousal of negative affect was associated with diminished cytokine secretion. Collectively, these data suggest that the HOMA-IR moderates the impact that arousal of negative affect has on the ability of blood monocytes to secrete inflammatory cytokines in response to LPS. Stress-induced increases in cytokine secretion among high HOMA-IR men are consistent with the role of inflammation in cardiovascular disease, hypertension, type 2 diabetes as well as the metabolic syndrome and underscore the relevance of negative affect in the etiology of these inflammatory conditions.
Collapse
Affiliation(s)
- Edward C Suarez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | | | | | | | | |
Collapse
|
46
|
Brummett BH, Boyle SH, Siegler IC, Williams RB, Mark DB, Barefoot JC. Ratings of positive and depressive emotion as predictors of mortality in coronary patients. Int J Cardiol 2005; 100:213-6. [PMID: 15823627 DOI: 10.1016/j.ijcard.2004.06.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [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: 03/18/2004] [Accepted: 06/17/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND An extensive body of research has demonstrated an association between negative affective states and health outcomes. Positive emotions may also influence physical health, however, their examination has received far less attention. METHODS Positive and depressive emotion ratings were examined as independent and joint predictors of survival in a sample of 866 cardiac catheterization patients. The mean follow-up was 11.4 years, during which 415 deaths occurred. The mean age of the sample was 60.3 years and 74.3% of the sample were males. RESULTS Both positive and depressive ratings were associated with survival (hazard ratio=0.80, 95% CI=0.66-0.97, p<0.025 and hazard ratio=1.32, 95% CI=1.13-1.54, p<0.001, respectively), adjusted for risk factors. Positive emotion ratings were no longer significantly related to mortality when the two emotion measures were simultaneously included in a survival model. CONCLUSION The current findings are consistent with a theory that suggests that the relation between positive emotion and mortality may be partly mediated by depressive emotion.
Collapse
Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Boyle SH, Williams RB, Mark DB, Brummett BH, Siegler IC, Barefoot JC. Hostility, age, and mortality in a sample of cardiac patients. Am J Cardiol 2005; 96:64-6. [PMID: 15979435 DOI: 10.1016/j.amjcard.2005.02.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [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: 08/19/2004] [Revised: 02/16/2005] [Accepted: 02/16/2005] [Indexed: 11/21/2022]
Abstract
This study examined hostility as a predictor of survival in a sample of 1,328 patients who had documented coronary artery disease. After controlling for disease severity, there was a significant interaction between age and hostility. Hostility was significantly associated with poorer survival but only in younger (<61.2 years) patients.
Collapse
Affiliation(s)
- Stephen H Boyle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
OBJECTIVE This article presents a reanalysis of an earlier study that reported a nonsignificant relation between the 50-item Cook-Medley Hostility Scale (CMHS) and survival in a sample of coronary patients. Since publication of those results, there have been significant developments in the measurement of hostility that suggest that an abbreviated scale may be a better predictor of health outcomes. This study examined the ability of the total CMHS and an abbreviated form of the CMHS (ACM) to predict survival in a sample of patients with documented coronary artery disease (CAD) with increased statistical power. METHODS Nine hundred thirty-six patients (83% were male; mean age = 51.48) with CAD who were followed for an average of 14.9 years. The ACM consisted of the combination of the cynicism, hostile attribution, hostile affect, and aggressive responding subscales that were identified in an earlier study (Barefoot et al. [1989]) by a rational analysis of the item content. The relation between hostility and survival was examined with Cox proportional hazard models (hazard ratios [HRs] based on a two standard deviation difference). RESULTS Controlling for disease severity, the ACM was a significant predictor for both CHD mortality (HR = 1.33, p <.009) and total mortality (HR = 1.28, p <.02). The total CMHS was only a marginally significant predictor of either outcome (p values < 0.06). CONCLUSION The results of this study suggest that hostility is associated with poorer survival in CAD patients, and it may be possible to refine measures of hostility in order to improve prediction of health outcomes.
Collapse
Affiliation(s)
- Stephen H Boyle
- Department of Psychiatry, Duke University Medical Center, Box 2969, Durham, NC, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Everly GS, Boyle SH. Critical incident stress debriefing (CISD): a meta-analysis. Int J Emerg Ment Health 2001; 1:165-8. [PMID: 11232385] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Psychological debriefings represent a genre of group crisis interventions. Critical Incident Stress Debriefing (CISD) represents the oldest standardized variation of this genre. Recent reviews have called into question the effectiveness of CISD. In this study 5 previously published investigations were meta-analyzed revealing a large effect size (Cohen's d = .86) supporting the notion that the CISD model of psychological debriefing is an effective crisis intervention.
Collapse
Affiliation(s)
- G S Everly
- Loyola College, Maryland and Johns Hopkins University, USA
| | | |
Collapse
|
50
|
|