Lipoatrophy and lipohypertrophy are independently associated with hypertension: the effect of lipoatrophy but not lipohypertrophy on hypertension is independent.

Slides:



Advertisements
Similar presentations
Risk Factors for Early Syphilis Among Men Who Have Sex With Men Seen in an STD Clinic – San Francisco, STD Prevention Conference: March 10, 2004.
Advertisements

JNC 8 Guidelines….
Associations between Obesity and Depression by Race/Ethnicity and Education among Women: Results from the National Health and Nutrition Examination Survey,
The association between blood pressure, body composition and birth weight of rural South African children: Ellisras longitudinal study Makinta MJ 1, Monyeki.
Delay from Testing HIV Positive until First HIV Care for Drug Users: Adverse Consequences and Possible Solutions Barbara J Turner MD, MSEd* John Fleishman.
1 Lauren E. Finn, 2 Seth Sheffler-Collins, MPH, 2 Marcelo Fernandez-Viña, MPH, 2 Claire Newbern, PhD, 1 Dr. Alison Evans, ScD., 1 Drexel University School.
Journal Club Alcohol, Other Drugs, and Health: Current Evidence January–February 2009.
HIV Disease in Older Patients Donna M. Gallagher, ANP The International AIDS Society–USA DM Gallagher, ANP. Presented at IAS–USA/RWCA Clinical Conference,
Noreen Clark, PhD Molly Gong, MD Melissa Valerio, MPH Sijian Wang, BS Xihong Lin, PhD William Bria, MD Timothy Johnson, MD University of Michigan School.
RACIAL DISPARITIES IN PRESCRIPTION DRUG UTILIZATION AN ANALYSIS OF BETA-BLOCKER AND STATIN USE FOLLOWING HOSPITALIZATION FOR ACUTE MYOCARDIAL INFARCTION.
Ambulatory Blood Pressure Profiles in Adolescents with Type 1 Diabetes Andrew J. Ellis 1,2, B.A.; David M. Maahs 2, M.D. Ph.D.; Franziska K. Bishop 2,
Patients in routine HIV clinical care at-risk for potentially transmitting HIV in the “test and treat” era of HIV prevention Crane, HM, Mimiaga, M, Feldman,
The Association between Antenatal Depression and Adverse Birth Outcomes among Women Receiving Medicaid in Washington State Amelia R. Gavin, PhD School.
® Introduction Mental Health Predictors of Pain and Function in Patients with Chronic Low Back Pain Olivia D. Lara, K. Ashok Kumar MD FRCS Sandra Burge,
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND PANCREATIC CANCER RISK: A NESTED CASE-CONTROL STUDY Marie Bradley, Carmel Hughes, Marie Cantwell and Liam Murray.
Introduction DCDOH supports HIV test and treat activities - increased number of HIV tests performed, emphasis on earlier linkage to care. Limited data.
1FHI 360 Nigeria. 2USAID Nigeria
Patient Empowerment Impacts Medication Adherence among HIV-Positive Patients in the Veteran’s Health Administration Tan Pham 1,2,3, Kristin Mattocks 1,2,
THE RELATIONSHIP BETWEEN BMI AND SUICIDALITY IN YOUNG ADULT WOMEN Alexis E. Duncan, Pamela A.F. Madden, and Andrew C. Heath Washington University Department.
Metabolic Syndrome, Diabetes, and Cognitive Impairment in the Era of Combination Antiretroviral Therapy Allen McCutchan 1, Jennifer Marquie-Beck 1, Scott.
Low level of high density lipoprotein cholesterol in children of patients with premature coronary heart disease. Relation to own and parental characteristics.
The effects of initial and subsequent adiposity status on diabetes mellitus Speaker: Qingtao Meng. MD West China hospital, Chendu, China.
Quality of Life and Depression as Determinants of Treatment Adherence in Hypertensive Leonelo E. Bautista 1 ; Paul Smith 2 ; Cynthia Colombo 2 ; Dennis.
Association between Systolic Blood Pressure and Congestive Heart Failure in Hypertensive Patients Mrs. Sutheera Intajarurnsan Doctor of Public Health Student.
Early Nutritional Support Influences Body Composition at Four Months Corrected Age in Very Low Birth Weight Preterm Infants Ellen C Christiansen, MD 1,
Skull Base Chordoma and Chondrosarcoma: Changes in National Radiotherapy Patterns and Survival Outcomes Henry S. Park, MD, MPH; Kenneth B. Roberts, MD;
Evidence-Based Medicine 3 More Knowledge and Skills for Critical Reading Karen E. Schetzina, MD, MPH.
Factors associated with Mortality in the Study of Fat Redistribution and Metabolic Change in HIV infection Leslie Modrich 1, Rebecca Scherzer 1,2, Andrew.
Background There is uncertainty regarding the frequency, predictors, and outcomes of IRIS events Prior studies on IRIS have been limited to convenience.
HS499 Bachelor’s Capstone Week 6 Seminar Research Analysis on Community Health.
The Cost Savings and Enhancements of a District’s Wellness Program A Case Study from Broward Presented by: Kay Blake, Training Supervisor Tina Severance-Fonte,
Obtaining housing associated with achieving abstinence after detoxification in adults with addiction Tae Woo Park, Christine Maynié-François, Richard Saitz.
Clinical Characteristic of Patients with Uncontrolled, Potentially Under-treated and Apparent Treatment Resistant Hypertension: NHANES 1988  Brent.
Morbidity and Mortality in Contemporary CAD Patients With Hypertension Treated With Either a Verapamil/Trandolapril or Beta-Blocker/Diuretic Strategy (INVEST):
#735 KA Lichtenstein 1, C Armon 2, K Buchacz 3, AC Moorman 3, KC Wood 2, JT Brooks 3, and the HOPS Investigators 1 University of Colorado Health Sciences.
Life expectancy of patients treated with ART in the UK: UK CHIC Study Margaret May University of Bristol, Department of Social Medicine, Bristol.
Utilization Of Lipid-lowering Therapy In Hypertensive Patients In The United States Simon S.K. Tang, MPH* Sean Candrilli, MS** Lizheng Shi, PhD* *Department.
Generously supported by the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Veteran Affairs, and National Institutes of Health,
Neurocognitive Impairment in HIV-Infected Subjects on HAART: Prevalence and Associations Kevin Robertson *1, Kunling Wu 2, Thomas Parsons 1, Ron Ellis.
High Blood Pressure Increases Mortality Among HIV Seropositive Individuals Without AIDS in Western Kenya Gerald S. Bloomfield 1, Joseph W. Hogan 2, Alfred.
Association between Systolic Blood Pressure and Congestive Heart Failure Complication among Hypertensive and Diabetic Hypertensive Patients Mrs. Sutheera.
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: DISCLOSURES.
Orawan KAEWBOONCHOO, Sumlee SALEEKUL, Mattana TOMPUDSA.
Obesity, Medication Use and Expenditures among Nonelderly Adults with Asthma Eric M. Sarpong AHRQ Conference September 10, 2012.
Association of C-Reactive Protein and Acute Myocardial Infarction in HIV-Infected Patients Virginia A. Triant, MD, MPH, James B. Meigs, MD, MPH, and Steven.
Background Objectives Results Methods Within State Geographic Variation in Antipsychotic Medication Treatment for Medicaid-insured Children and Adolescents.
Association between Systolic Blood Pressure and Congestive Heart Failure in Hypertensive Patients Mrs. Sutheera Intajarurnsan Doctor of Public Health Student.
Socio-economic factors and late diagnosis of HIV in in the Royal Free cohort Socio-economic factors and late diagnosis of HIV in in.
Probability and odds Suppose we a frequency distribution for the variable “TB status” The probability of an individual having TB is frequencyRelative.
Housing Status and HIV Risk Behaviors Among Homeless and Housed Persons with HIV in the United States The findings and conclusions in this presentation.
Weekly Alendronate Safe and Effective at Increasing Bone Mineral Density in HIV-Infected Persons on Antiretroviral Therapy Slideset on: McComsey GA, Kendall.
Vitamin D: A New Frontier in Diabetes Management Contact Information: Background Acknowledgement Methods.
Factors associated with maternal smoking during early pregnancy: relationship to low-birth-weight infants and maternal attitude toward their pregnancy.
1 Subclinical thyroid dysfunction and blood pressure: a community-based study John P. Walsh, Alexandra P. Bremner, Max K. Bulsara‡, Peter O’Leary, Peter.
The short term effects of metabolic syndrome and its components on all-cause-cause mortality-the Taipei Elderly Health Examination Cohort Wen-Liang Liu.
Powered by Infomedica Infomedica Conference Coverage* of 26 th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13,
Screening for hypertension and diabetes at the time of HIV testing in Umlazi Township, Durban, South Africa Ingrid V. Bassett, Ting Hong, Paul Drain, Sabina.
Category Sex Systolic BP (mmHg) Men (n=58) Women (n=106) P value
- Higher SBP visit-to-visit variability (SBV) has been associated
Higher HDL, better brain
John Weeks1, MD Candidate 2017, Justin Hickman1, MD Candidate 2017
Itamar Grotto, Michael Huerta, Ehud Grossman and Yehonatan Sharabi
Exercise Adherence in Patients with Diabetes: Evaluating the role of psychosocial factors in managing diabetes Natalie N. Young,1, 2 Jennifer P. Friedberg,1,
American Public Health Association Annual Meeting
From ESH 2016 | POS 3C: Luiz Aparecido Bortolotto, MD, PhD
Cognitive Impacts of Ambient Air Pollution in the National Social Health and Aging Project (NSHAP) Cohort Lindsay A. Tallon MSPH1, Vivian C. Pun PhD1,
San Francisco Department of Public Health
Progress and Promise in RAAS Blockade
The Relationship between Recent Alcohol Use and Sexual Behaviors/STDs: Gender Differences among STD Clinic Patients Heidi E. Hutton PhD, Mary E. McCaul.
Melissa Herrin, Jan Tate ScD, MPH & Amy Justice, MD, PhD
Presentation transcript:

Lipoatrophy and lipohypertrophy are independently associated with hypertension: the effect of lipoatrophy but not lipohypertrophy on hypertension is independent of obesity Heidi M. Crane 1, MD, MPH, Carl Grunfeld 2, MD, PhD, Robert D. Harrington 1, MD, and Mari M. Kitahata 1, MD, MPH From the Departments of Medicine, University of Washington 1, Seattle, WA and University of California 2, San Francisco, CA Lipoatrophy and lipohypertrophy are independently associated with hypertension: the effect of lipoatrophy but not lipohypertrophy on hypertension is independent of obesity Heidi M. Crane 1, MD, MPH, Carl Grunfeld 2, MD, PhD, Robert D. Harrington 1, MD, and Mari M. Kitahata 1, MD, MPH From the Departments of Medicine, University of Washington 1, Seattle, WA and University of California 2, San Francisco, CA Background  Lipoatrophy (LA) and lipohypertrophy (LH) are associated with metabolic abnormalities, but little is known about their impact on hypertension  Prior studies have been small, yielded conflicting findings, and did not examine LA and LH separately  We conducted this study to examine the independent association between LA and LH with hypertension among HIV-infected patients Methods  STUDY SETTING: Cross-sectional study of patients in the University of Washington (UW) HIV Cohort, a longitudinal observational cohort of HIV-infected patients  STUDY SUBJECTS: Convenience sample of patients ≥18 years of age who attended the clinic for a routinely scheduled appointment between 9/26/05 and 1/3/07  DATA SOURCE: Patients used tablet PCs with touch screens to complete an assessment with body morphology (based on the Fat Redistribution and Metabolic Change [FRAM] instrument), smoking status, and illicit drug use  Data were also obtained from the UW HIV Information System (UWHIS) which captures comprehensive clinical data for the UW HIV cohort from 1995 to the present. Demographic, clinical, laboratory, medication, and socioeconomic data are obtained from multiple institutional data systems. Clinical patient data such as blood pressure (BP), height, and weight are routinely collected and integrated in the UWHIS  DEFINITION OF HYPERTENSION: We defined hypertension as a clinical diagnosis of hypertension confirmed by treatment with an antihypertensive medication, or a mean systolic BP >140 mmHg or diastolic BP >90 mmHg within the prior 6 months  BODY MORPHOLOGY: FRAM items for individual body regions were coded on a 7-point scale ranging from –3 to +3. No change was scored as 0, mild, moderate, and severe increases were scored as +1, +2, and +3, and mild, moderate, and severe decreases were scored as -1, -2, and -3. An overall LH score was calculated using all positive responses and an overall LA score was calculated using all negative responses totaled. Severity of each of these conditions was defined as none (0 points), mild (1-12 points), and moderate- to-severe (>12 points) Methods cont.  STATISTICAL ANALYSES: We used multivariate logistic regression to examine associations between hypertension, LA, LH, demographic characteristics (age, race, sex, risk factor for HIV transmission), and clinical characteristics (current and nadir CD4 + T cell counts, peak HIV-1 RNA level, current HAART use, smoking, and current illicit drug use)  Final models are adjusted for age, race, sex, current HAART use, current and nadir CD4 + T cell counts Results  347 patients enrolled with a total of 2,278 BP readings (Table 1)  Body morphology: no abnormality in 70 (20%) patients  137 (39%) with mild LH and 25 (7%) with moderate LH  101 (29%) with mild LA and 14 (4%) with moderate LA  Hypertension-125 patients (35%) had hypertension  105 with a clinical diagnosis of hypertension  36 with mean SBP >140 mmHg  27 with mean DBP >90 mmHg  In adjusted analyses, patients reporting any degree of LA were more than twice as likely to have hypertension compared with patients reporting no abnormalities (OR 2.2; p=0.04), as were patients with any degree of LH (OR 2.5; p=0.01)  Additional adjusted analyses were conducted to examine the association with body morphology severity (Table 2)  patients with moderate LH were 4 times as likely to have hypertension (OR 4.3; p<0.01) as patients without abnormalities  patients with moderate LA were 4 times as likely to have hypertension (OR 4.3; p=0.03) as patients without abnormalities  patients with mild LH were twice as likely to have hypertension (OR 2.3; p=0.03) as patients without abnormalities  patients with mild LA were twice as likely to have hypertension, however this difference was not statistically significant  Older age and higher current CD4 + cell count were also associated with increased risk of hypertension (Table 2)  We hypothesized that the impact of LH on hypertension was mediated, in part, through a higher body mass index (BMI). When BMI was added to the adjusted model, BMI was significantly associated with hypertension (OR=1.1; p<0.001 per kg/m 2 ), and the association between LH and hypertension was no longer present. However, the association between moderate LA and hypertension was present after adjusting for BMI (OR=5.1; p=0.02) Conclusions  We found that LA and LH are significantly associated with hypertension among patients in routine HIV care  Our findings suggest that the association between LH and hypertension may be mediated via BMI, but that LA is associated with hypertension independent of BMI  There is a dose response effect with more severe body morphology abnormalities associated with greater risk of hypertension  Self-reported measures of LA and LH are associated with clinical outcomes such as hypertension with potential long-term cardiovascular implications Strengths and limitations  The FRAM measure allowed us to examine the strength of the relationship between hypertension and LA severity separately from LH severity  The observational cross-sectional study design demonstrates a significant association between LA and LH and hypertension but does not provide evidence of causality Table 1. Clinical and demographic characteristics of study patients (N=347) No abnormality N=70 LH N=162 LA N=115 p value N (%) Sex Male61 (87)136 (84)102 (89) Female9 (13)26 (16)13 (11)0.5 Race White48 (69)111 (69)89 (77) Black14 (20)41 (25)18 (16) Other8 (11)10 (6)8 (7)0.2 Age (years) < 3010 (14)4 (3)8 (7) (30)52 (32)18 (16) (40)72 (44)54 (47) ≥ 5011 (16)34 (21)35 (30)0.001 Risk factor for HIV transmission MSM43 (61)95 (59)68 (59) IDU16 (23)36 (22)26 (23) Heterosexual11 (16)30 (19)17 (15) Other01 (1)4 (4)0.4 Current CD4+ T cell count (cells/mm 3 ) (23)23 (14)33 (29) (24)39 (24)28 (24) >35037 (53)100 (62)54 (47)0.045 CD4+ T cell count nadir (cells/mm 3 ) (56)110 (68)83 (72) (29)37 (23)25 (22) >35011 (16)15 (9)7 (6)0.1 Body mass index <18.53 (4)1 (1)10 (9) (51)52 (32)59 (51) (33)61 (38)29 (25) >30.08 (11)48 (30)17 (15)<0.001 Cigarette smoking Never23 (33)45 (28)24 (21) Current28 (40)69 (43)57 (50) Past19 (27)48(30)34 (30)0.4 Currently receiving HAART Yes48 (69)133 (83)90 (78) No22 (31)27 (17)25 (22) Patients with both LA and LH are placed in the more severe category Table 2. Adjusted odds ratios for factors associated with development of hypertension VariableUnadjusted OR (95% CI; p) Adjusted OR (95% CI; p) Body morphology No abnormality1 (ref) Mild LA2.4 ( , 0.02)2.0 ( ; 0.08) Mild LH2.7 ( , 0.005)2.3 ( ; 0.03) Moderate LA5.8 ( , 0.004)4.3 ( ; 0.03) Moderate LH5.6 ( , 0.001)4.3 ( ; 0.006) Age (years) Less than 301 (ref) years5.9 ( , 0.09)4.4 ( ; 0.2) years13.4 ( , 0.01)9.4 ( ; 0.04) Over ( , 0.003)14.9 ( ; 0.01) CD4+ count*1.1 ( , 0.01)1.1 ( ; 0.02) *Modeled per increase of 100 cells/mm 3 current CD4+ count