Browsing by Author "Wu, Wen-Chih"

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    Association of Kidney Comorbidities and Acute Kidney Failure With Unfavorable Outcomes After COVID-19 in Individuals With the Sickle Cell Trait
    (American Medical Association, 2022) Verma, Anurag; Huffman, Jennifer E.; Gao, Lina; Minnier, Jessica; Wu, Wen-Chih; Cho, Kelly; Ho, Yuk-Lam; Gorman, Bryan R.; Pyarajan, Saiju; Rajeevan, Nallakkandi; Garcon, Helene; Joseph, Jacob; McGeary, John E.; Suzuki, Ayako; Reaven, Peter D.; Wan, Emily S.; Lynch, Julie A.; Petersen, Jeffrey M.; Meigs, James B.; Freiberg, Matthew S.; Gatsby, Elise; Lynch, Kristine E.; Zekavat, Seyedeh Maryam; Natarajan, Pradeep; Dalal, Sharvari; Jhala, Darshana N.; Arjomandi, Mehrdad; Bonomo, Robert A.; Thompson, Trevor K.; Pathak, Gita A.; Zhou, Jin J.; Donskey, Curtis J.; Madduri, Ravi K.; Wells, Quinn S.; Gelernter, Joel; Huang, Rose D. L.; Polimanti, Renato; Chang, Kyong-Mi; Liao, Katherine P.; Tsao, Philip S.; Sun, Yan V.; Wilson, Peter W. F.; O'Donnell, Christopher J.; Hung, Adriana M.; Gaziano, J. Michael; Hauger, Richard L.; Iyengar, Sudha K.; Luoh, Shiuh-Wen; VA Million Veteran Program COVID-19 Science Initiative; Medicine, School of Medicine
    Importance: Sickle cell trait (SCT), defined as the presence of 1 hemoglobin beta sickle allele (rs334-T) and 1 normal beta allele, is prevalent in millions of people in the US, particularly in individuals of African and Hispanic ancestry. However, the association of SCT with COVID-19 is unclear. Objective: To assess the association of SCT with the prepandemic health conditions in participants of the Million Veteran Program (MVP) and to assess the severity and sequelae of COVID-19. Design, setting, and participants: COVID-19 clinical data include 2729 persons with SCT, of whom 353 had COVID-19, and 129 848 SCT-negative individuals, of whom 13 488 had COVID-19. Associations between SCT and COVID-19 outcomes were examined using firth regression. Analyses were performed by ancestry and adjusted for sex, age, age squared, and ancestral principal components to account for population stratification. Data for the study were collected between March 2020 and February 2021. Exposures: The hemoglobin beta S (HbS) allele (rs334-T). Main outcomes and measures: This study evaluated 4 COVID-19 outcomes derived from the World Health Organization severity scale and phenotypes derived from International Classification of Diseases codes in the electronic health records. Results: Of the 132 577 MVP participants with COVID-19 data, mean (SD) age at the index date was 64.8 (13.1) years. Sickle cell trait was present in 7.8% of individuals of African ancestry and associated with a history of chronic kidney disease, diabetic kidney disease, hypertensive kidney disease, pulmonary embolism, and cerebrovascular disease. Among the 4 clinical outcomes of COVID-19, SCT was associated with an increased COVID-19 mortality in individuals of African ancestry (n = 3749; odds ratio, 1.77; 95% CI, 1.13 to 2.77; P = .01). In the 60 days following COVID-19, SCT was associated with an increased incidence of acute kidney failure. A counterfactual mediation framework estimated that on average, 20.7% (95% CI, -3.8% to 56.0%) of the total effect of SCT on COVID-19 fatalities was due to acute kidney failure. Conclusions and relevance: In this genetic association study, SCT was associated with preexisting kidney comorbidities, increased COVID-19 mortality, and kidney morbidity.
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    Associations between air pollution indicators and prevalent and incident diabetes in an African American cohort, the Jackson Heart Study
    (Wolters Kluwer, 2021-04-22) Weaver, Anne M.; Bidulescu, Aurelian; Wellenius, Gregory A.; Hickson, DeMarc A.; Sims, Mario; Vaidyanathan, Ambarish; Wu, Wen-Chih; Correa, Adolfo; Wang, Yi; Environmental Health Science, School of Public Health
    Background: Diabetes is especially prevalent among African Americans. Prior studies suggest that long-term exposure to ambient air pollution may be associated with greater incidence of diabetes, but results remain heterogeneous. Few studies have included large numbers of African Americans. Methods: We assessed diabetes status and concentrations of 1- and 3-year fine particulate matter (PM2.5) and ozone (O3) among African American participants of the Jackson Heart Study at visits 1 (2000-2004, N = 5128) and 2 (2005-2008, N = 2839). We used mixed-effect modified Poisson regression to estimate risk ratios (RRs) and 95% confidence intervals (CIs) of incidence of diabetes by visit 2 and prevalence ratios (PRs) of the association between air pollution exposure and prevalent diabetes at visits 1 and 2. We adjusted for potential confounding by patient characteristics, as well as inverse probability weights of diabetes at visit 2, accounting for clustering by census tract. Results: We observed associations between incident diabetes and interquartile range increase in 1-year O3 (RR 1.34, 95% CI = 1.11, 1.61) and 3-year O3 (RR 0.88, 95% CI = 0.76, 1.02). We observed associations between prevalent diabetes and 1-year PM2.5 (PR 1.08, 95% CI = 1.00, 1.17), 1-year O3 (PR 1.18, 95% CI = 1.10, 1.27), and 3-year O3 (PR 0.95, 95% CI = 0.90, 1.01) at visit 2. Conclusions: Our results provide some evidence of positive associations between indicators of long-term PM2.5 and O3 exposure and diabetes. This study is particularly relevant to African Americans, who have higher prevalence of diabetes but relatively few studies of environmental pollution risk factors.
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    Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
    (AMA, 2015-06-26) Lin, Xiaochen; Zhang, Xi; Guo, Jianjun; Roberts, Christian K.; McKenzie, Steve; Wu, Wen-Chih; Liu, Simin; Song, Yiqing; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    BACKGROUND: Guidelines recommend exercise for cardiovascular health, although evidence from trials linking exercise to cardiovascular health through intermediate biomarkers remains inconsistent. We performed a meta-analysis of randomized controlled trials to quantify the impact of exercise on cardiorespiratory fitness and a variety of conventional and novel cardiometabolic biomarkers in adults without cardiovascular disease. METHODS AND RESULTS: Two researchers selected 160 randomized controlled trials (7487 participants) based on literature searches of Medline, Embase, and Cochrane Central (January 1965 to March 2014). Data were extracted using a standardized protocol. A random-effects meta-analysis and systematic review was conducted to evaluate the effects of exercise interventions on cardiorespiratory fitness and circulating biomarkers. Exercise significantly raised absolute and relative cardiorespiratory fitness. Lipid profiles were improved in exercise groups, with lower levels of triglycerides and higher levels of high-density lipoprotein cholesterol and apolipoprotein A1. Lower levels of fasting insulin, homeostatic model assessment-insulin resistance, and glycosylated hemoglobin A1c were found in exercise groups. Compared with controls, exercise groups had higher levels of interleukin-18 and lower levels of leptin, fibrinogen, and angiotensin II. In addition, we found that the exercise effects were modified by age, sex, and health status such that people aged <50 years, men, and people with type 2 diabetes, hypertension, dyslipidemia, or metabolic syndrome appeared to benefit more. CONCLUSIONS: This meta-analysis showed that exercise significantly improved cardiorespiratory fitness and some cardiometabolic biomarkers. The effects of exercise were modified by age, sex, and health status. Findings from this study have significant implications for future design of targeted lifestyle interventions.
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    Intensive Cardiac Rehabilitation Outcomes in Patients with Heart Failure
    (MDPI, 2023-10-31) Jafri, S. Hammad; Guglin, Maya; Rao, Roopa; Ilonze, Onyedika; Ballut, Kareem; Baloch, Zulfiqar Qutrio; Qintar, Mohammed; Cohn, Joel; Wilcox, Matthew; Freeman, Andrew M.; Kalra, Dinesh K.; Wu, Wen-Chih; Medicine, School of Medicine
    Introduction: Cardiac rehabilitation (CR) has proven to be beneficial for patients with heart failure (HF), potentially reducing morbidity and mortality while improving fitness and psychological outcomes. Intensive cardiac rehabilitation (ICR) represents an emerging form of CR that has demonstrated advantages for patients with various cardiovascular diseases. Nevertheless, the specific outcomes of ICR in patients with HF remain unknown. Objectives: The purpose of this study is to assess the effectiveness of ICR in patients with HF. Methods: This retrospective study involved 12,950 patients who participated in ICR at 46 centers from January 2016 to December 2020. Patients were categorized into two groups: the HF group, comprising 1400 patients (11%), and the non-HF group, consisting of 11,550 patients (89%). The primary endpoints included the ICR completion rate, changes in body mass index (BMI), exercise minutes per week (EMW), and depression scores (CESD). A t-test was employed to compare variables between the two groups. Results: The HF group comprises older patients, with 37% being females (compared to 44% in the non-HF group). The ICR completion rate was higher in the non-HF group. After ICR completion, adjusted analyses revealed that patients without HF demonstrated a greater improvement in BMI. There were no differences in fitness, as measured via EMW, or in depression scores, as measured via CESD, between the two groups. Conclusions: Despite the lower baseline functional status and psychosocial scores of HF patients compared to non-HF patients, patients with HF were able to attain similar or even better functional and psychosocial outcomes after ICR.
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    Residential distance to major roadways and cardiac structure in African Americans: cross-sectional results from the Jackson Heart Study
    (BioMed Central, 2017) Weaver, Anne M.; Wellenius, Gregory A.; Wu, Wen-Chih; Hickson, DeMarc A.; Kamalesh, Masoor; Wang, Yi; Department of Environmental Health Sciences, Richard M. Fairbanks School of Public Health
    Heart failure (HF) is a significant source of morbidity and mortality among African Americans. Ambient air pollution, including from traffic, is associated with HF, but the mechanisms remain unknown. The objectives of this study were to estimate the cross-sectional associations between residential distance to major roadways with markers of cardiac structure: left ventricular (LV) mass index, LV end-diastolic diameter, LV end-systolic diameter, and LV hypertrophy among African Americans.
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    Residential Proximity to Major Roadways Is Not Associated with Cardiac Function in African Americans: Results from the Jackson Heart Study
    (MDPI, 2016-06-13) Weaver, Anne M.; Wellenius, Gregory A.; Wu, Wen-Chih; Hickson, DeMarc A.; Kamalesh, Masoor; Wang, Yi; Department of Environmental Health Sciences, FSPH
    Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure. We examined these associations using multivariable linear or logistic regression, adjusting for potential confounders. Of 4866 participants at study enrollment, 106 lived <150 m, 159 lived 150–299 m, 1161 lived 300–999 m, and 3440 lived ≥1000 m from a major roadway. We did not observe any associations between residential distance to major roads and these markers of cardiac function. Results were similar with additional adjustment for diabetes and hypertension, when considering varying definitions of major roadways, or when limiting analyses to those free from cardiovascular disease at baseline. Overall, we observed little evidence that residential proximity to major roads was associated with cardiac function among African Americans.
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    Variation in statin prescription among veterans with HIV and known atherosclerotic cardiovascular disease
    (Elsevier, 2022) Erqou, Sebhat; Papaila, Alexa; Halladay, Christopher; Ge, Augustus; Liu, Michael A.; Jiang, Lan; Lally, Michelle; Menon, Anupama; Shah, Nishant R.; Miech, Edward; Virani, Salim S.; Zullo, Andrew R.; Shireman, Theresa I.; Longenecker, Christopher T.; Ross, David; Sullivan, Jennifer L.; Wu, Wen-Chih; Rudolph, James L.; Emergency Medicine, School of Medicine
    Background: People with HIV have increased atherosclerotic cardiovascular disease (ASCVD) risk, worse outcomes following incident ASCVD, and experience gaps in cardiovascular care, highlighting the need to improve delivery of preventive therapies in this population. Objective: Assess patient-level correlates and inter-facility variations in statin prescription among Veterans with HIV and known ASCVD. Methods: We studied Veterans with HIV and existing ASCVD, ie, coronary artery disease (CAD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD), who received care across 130 VA medical centers for the years 2018-2019. We assessed correlates of statin prescription using two-level hierarchical multivariable logistic regression. Median odds ratios (MORs) were used to quantify inter-facility variation in statin prescription. Results: Nine thousand six hundred eight Veterans with HIV and known ASCVD (mean age 64.3 ± 8.9 years, 97% male, 48% Black) were included. Only 68% of the participants were prescribed any-statin. Substantially higher statin prescription was observed for those with diabetes (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI], 2.0-2.6), history of coronary revascularization (OR = 4.0, CI, 3.2-5.0), and receiving antiretroviral therapy (OR = 3.0, CI, 2.7-3.4). Blacks (OR = 0.7, CI, 0.6-0.9), those with non-coronary ASCVD, ie, ICVD and/or PAD only, (OR 0.53, 95% CI: 0.48-0.57), and those with history of illicit substance use (OR=0.7, CI, 0.6-0.9) were less likely to be prescribed statins. There was significant variation in statin prescription across VA facilities (10th, 90th centile: 55%, 78%), with an estimated 20% higher likelihood of difference in statin prescription practice for two clinically similar individuals treated at two comparable facilities (adjusted MOR = 1.21, CI, 1.18-1.24), and a greater variation observed for Blacks or those with non-coronary ASCVD or history of illicit drug use. Conclusion: In an analysis of large-scale VA data, we found suboptimal statin prescription and significant interfacility variation in statin prescription among Veterans with HIV and known ASCVD, particularly among Blacks and those with a history of non-coronary ASCVD.