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3. Alcohol Consumption and Risk of Coronary Artery Disease (from the Million Veteran Program)

Author

Song, Rebecca J, Nguyen, Xuan-Mai T, Quaden, Rachel, Ho, Yuk-Lam, Justice, Amy C, Gagnon, David R, Cho, Kelly, O'Donnell, Christopher J, Concato, John, Gaziano, J Michael, Djoussé, Luc, Program, VA Million Veteran, Halasz, Ildiko, Federman, Daniel, Beckham, Jean, Sherman, Scott E, Sriram, Peruvemba, Tsao, Philip S, Boyko, Edward J, Xu, Junzhe, Lederle, Frank, Dellitalia, Louis J, McArdle, Rachel, Kaminsky, Laurence, Swann, Alan C, Hamner, Mark B, Florez, Hermes J, Pandya, Prashant, Villarreal, Gerardo, Wilson, Peter, Morgan, Timothy R, Davis, Lori, Hurley, Robin A, Meyer, Laurence, Ahuja, Sunil K, Konicki, Eric P, Cohen, David, Lichy, Jack, Whittle, Jeffrey, Haddock, Kathlyn Sue, Straub, Karl D, Callaghan, John T, Aguayo, Samuel M, Gupta, Samir, Washburn, Ronald G, Oehlert, Mary E, Hung, Adriana M, Wallbom, Agnes, Keith, Robert, Sonel, Elif, Schifman, Ronald B, Childress, Richard D, Godschalk, Michael F, Shuldiner, Alan R, Rastogi, Padmashri, Gutierrez, Salvador, Fernando, Ronald, Iruvanti, Pran R, Jhala, Darshana, Rosado-Rodriguez, Carlos, Mastorides, Stephen M, Harley, John B, Mattocks, Kristin, Robey, Brooks, Striker, Robert T, Rauchman, Michael, Wells, John, Ballas, Zuhair K, Woods, Susan S, Yeh, Shing Shing, Ratcliffe, Nora R, Klein, Jon B, Golden, Adam G, Ginzburg, Harold M, Sharma, Satish, Oursler, Kris Ann K, Whooley, Mary A, Gibson, Gretchen, and Heinz

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Substance Misuse, Brain Disorders, Heart Disease - Coronary Heart Disease, Alcoholism, Alcohol Use and Health, Heart Disease, Cardiovascular, Clinical Research, Atherosclerosis, Stroke, Oral and gastrointestinal, Good Health and Well Being, Aged, Alcohol Drinking, Alcoholic Beverages, Alcoholism, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Protective Factors, Risk Factors, Self Report, United States, Veterans, VA Million Veteran Program, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

Moderate alcohol consumption has been associated with a lower risk of coronary artery disease (CAD) in the general population but has not been well studied in US veterans. We obtained self-reported alcohol consumption from Million Veteran Program participants. Using electronic health records, CAD events were defined as 1 inpatient or 2 outpatient diagnosis codes for CAD, or 1 code for a coronary procedure. We excluded participants with prevalent CAD (n = 69,995) or incomplete alcohol information (n = 8,449). We used a Cox proportional hazards model to estimate hazard ratios and 95% confidence intervals for CAD, adjusting for age, gender, body mass index, race, smoking, education, and exercise. Among 156,728 participants, the mean age was 65.3 years (standard deviation = 12.1) and 91% were men. There were 6,153 CAD events during a mean follow-up of 2.9 years. Adjusted hazard ratios (95% confidence intervals) for CAD were 1.00 (reference), 1.02 (0.92 to 1.13), 0.83 (0.74 to 0.93), 0.77 (0.67 to 0.87), 0.71 (0.62 to 0.81), 0.62 (0.51 to 0.76), 0.58 (0.46 to 0.74), and 0.95 (0.85 to 1.06) for categories of never drinker; former drinker; current drinkers of ≤0.5 drink/day, >0.5 to 1 drink/day, >1 to 2 drinks/day, >2 to 3 drinks/day, and >3 to 4 drinks/day; and heavy drinkers (>4 drinks/day) or alcohol use disorder, respectively. For a fixed amount of ethanol, intake at ≥3 days/week was associated with lower CAD risk compared with ≤1 day/week. Beverage preference (beer, wine, or liquor) did not influence the alcohol-CAD relation. Our data show a lower risk of CAD with light-to-moderate alcohol consumption among US veterans, and drinking frequency may provide a further reduction in risk.

Published
2018

4. DASH Score and Subsequent Risk of Coronary Artery Disease: The Findings From Million Veteran Program

Author

Djoussé, Luc, Ho, Yuk‐Lam, Nguyen, Xuan‐Mai T, Gagnon, David R, Wilson, Peter WF, Cho, Kelly, Gaziano, J Michael, Program, the VA Million Veteran, Halasz, Ildiko, Federman, Daniel, Beckham, Jean, Sherman, Scott E, Sriram, Peruvemba, Tsao, Philip S, Boyko, Edward J, Xu, Junzhe, Lederle, Frank, Dellitalia, Louis J, McArdle, Rachel, Kaminsky, Laurence, Swann, Alan C, Hamner, Mark B, Florez, Hermes J, Pandya, Prashant, Villarreal, Gerardo, Wilson, Peter, Morgan, Timothy R, Davis, Lori, Hurley, Robin A, Meyer, Laurence, Ahuja, Sunil K, Konicki, Eric P, Cohen, David, Lichy, Jack, Whittle, Jeffrey, Haddock, Kathlyn Sue, Straub, Karl D, Callaghan, John T, Aguayo, Samuel M, Gupta, Samir, Washburn, Ronald G, Oehlert, Mary E, Hung, Adriana M, Wallbom, Agnes, Keith, Robert, Sonel, Elif, Schifman, Ronald B, Childress, Richard D, Godschalk, Michael F, Shuldiner, Alan R, Rastogi, Padmashri, Gutierrez, Salvador, Fernando, Ronald, Iruvanti, Pran R, Jhala, Darshana, Rosado‐Rodriguez, Carlos, Mastorides, Stephen M, Harley, John B, Mattocks, Kristin, Striker, Robert T, Rauchman, Michael, Wells, John, Ballas, Zuhair K, Woods, Susan S, Yeh, Shing, Ratcliffe, Nora R, Klein, Jon B, Golden, Adam G, Ginzburg, Harold M, Sharma, Satish, Oursler, Kris Ann K, Whooley, Mary A, and Gibson, Gretchen

Subjects
Biomedical and Clinical Sciences, Nutrition and Dietetics, Nutrition, Hypertension, Atherosclerosis, Clinical Research, Cardiovascular, Prevention, Good Health and Well Being, Aged, Coronary Artery Disease, Diet, Healthy, Dietary Approaches To Stop Hypertension, Female, Humans, Incidence, Male, Middle Aged, Patient Compliance, Prognosis, Prospective Studies, Protective Factors, Risk Assessment, Risk Factors, Risk Reduction Behavior, Time Factors, United States, Veterans Health, VA Million Veteran Program, coronary artery disease, epidemiology, nutrition, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Abstract

While adherence to healthful dietary patterns has been associated with a lower risk of coronary artery disease (CAD) in the general population, limited data are available among US veterans. We tested the hypothesis that adherence to Dietary Approach to Stop Hypertension (DASH) food pattern is associated with a lower risk of developing CAD among veterans. We analyzed data on 153 802 participants of the Million Veteran Program enrolled between 2011 and 2016. Information on dietary habits was obtained using a food frequency questionnaire at enrollment. We used electronic health records to assess the development of CAD during follow-up. Of the 153 802 veterans who provided information on diet and were free of CAD at baseline, the mean age was 64.0 (SD=11.8) years and 90.4% were men. During a mean follow-up of 2.8 years, 5451 CAD cases occurred. The crude incidence rate of CAD was 14.0, 13.1, 12.6, 12.3, and 11.1 cases per 1000 person-years across consecutive quintiles of Dietary Approach to Stop Hypertension score. Hazard ratios (95% confidence interval) for CAD were 1.0 (ref), 0.91 (0.84-0.99), 0.87 (0.80-0.95), 0.86 (0.79-0.94), and 0.80 (0.73-0.87) from the lowest to highest quintile of Dietary Approach to Stop Hypertension score controlling for age, sex, body mass index, race, smoking, exercise, alcohol intake, and statin use (P linear trend,

Published
2018

5. Post-traumatic stress disorder: the role of the amygdala and potential therapeutic interventions -- a review.

Author

Davis, Lori L. and Hamner, Mark B.

Subjects
POST-traumatic stress disorder, AMYGDALOID body, EVIDENCE-based psychotherapy, NEURAL circuitry, ION channels
Abstract

Introduction: Post-traumatic stress disorder (PTSD) is a psychiatric disorder triggered by exposure to a life-threatening or sexually violent traumatic event, and is characterized by symptoms involving intrusive re-experiencing, persistent avoidance of associated stimuli, emotional and cognitive disturbances, and hyperarousal for long periods after the trauma has occurred. These debilitating symptoms induce occupational and social impairments that contribute to a significant clinical burden for PTSD patients, and substantial socioeconomic costs, reaching approximately $20,000 dollars per individual with PTSD each year in the US. Despite increased translational research focus in the field of PTSD, the development of novel, effective pharmacotherapies for its treatment remains an important unmet clinical need. Observations: In this review, we summarize the evidence implicating dysfunctional activity of the amygdala in the pathophysiology of PTSD. We identify the transient receptor potential canonical (TRPC) ion channels as promising drug targets given their distribution in the amygdala, and evidence from animal studies demonstrating their role in fear response modulation. We discuss the evidence-based pharmacotherapy and psychotherapy treatment approaches for PTSD. Discussion: In view of the prevalence and economic burden associated with PTSD, further investigation is warranted into novel treatment approaches based on our knowledge of the involvement of brain circuitry and the role of the amygdala in PTSD, as well as the potential added value of combined pharmacotherapy and psychotherapy to better manage PTSD symptoms. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Alcohol Consumption and Risk of Coronary Artery Disease (from the Million Veteran Program)

Author

Halasz, Ildiko, Federman, Daniel, Beckham, Jean, Sherman, Scott E., Sriram, Peruvemba, Tsao, Philip S., Boyko, Edward J., Xu, Junzhe, Lederle, Frank, Dellitalia, Louis J., McArdle, Rachel, Kaminsky, Laurence, Swann, Alan C., Hamner, Mark B., Florez, Hermes J., Pandya, Prashant, Villarreal, Gerardo, Wilson, Peter, Morgan, Timothy R., Davis, Lori, Hurley, Robin A., Meyer, Laurence, Ahuja, Sunil K., Konicki, Eric P., Cohen, David, Lichy, Jack, Whittle, Jeffrey, Haddock, Kathlyn Sue, Straub, Karl D., Callaghan, John T., Aguayo, Samuel M., Gupta, Samir, Washburn, Ronald G., Oehlert, Mary E., Hung, Adriana M., Wallbom, Agnes, Keith, Robert, Sonel, Elif, Schifman, Ronald B., Childress, Richard D., Godschalk, Michael F., Shuldiner, Alan R., Rastogi, Padmashri, Gutierrez, Salvador, Fernando, Ronald, Iruvanti, Pran R., Jhala, Darshana, Rosado-Rodriguez, Carlos, Mastorides, Stephen M., Harley, John B., Mattocks, Kristin, Robey, Brooks, Striker, Robert T., Rauchman, Michael, Wells, John, Ballas, Zuhair K., Woods, Susan S., Yeh, Shing Shing, Ratcliffe, Nora R., Klein, Jon B., Golden, Adam G., Ginzburg, Harold M., Sharma, Satish, Oursler, Kris Ann K., Whooley, Mary A., Gibson, Gretchen, Heinz, Song, Rebecca J., Nguyen, Xuan-Mai T., Quaden, Rachel, Ho, Yuk-Lam, Justice, Amy C., Gagnon, David R., Cho, Kelly, O'Donnell, Christopher J., Concato, John, Gaziano, J. Michael, and Djoussé, Luc

Published
2018
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10. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder

Author

Oslin, David W., Lynch, Kevin G., Shih, Mei-Chiung, Ingram, Erin P., Wray, Laura O., Chapman, Sara R., Kranzler, Henry R., Gelernter, Joel, Pyne, Jeffrey M., Stone, Annjanette, DuVall, Scott L., Lehmann, Lisa Soleymani, Thase, Michael E., Aslam, Muhammad, Batki, Steven L., Bjork, James M., Blow, Frederic C., Brenner, Lisa A., Chen, Peijun, Desai, Shivan, Dieperink, Eric W., Fears, Scott C., Fuller, Matthew A., Goodman, Courtney S., Graham, David P., Haas, Gretchen L., Hamner, Mark B., Helstrom, Amy W., Hurley, Robin A., Icardi, Michael S., Jurjus, George J., Kilbourne, Amy M., Kreyenbuhl, Julie, Lache, Daniel J., Lieske, Steven P., Lynch, Julie A., Meyer, Laurence J., Montalvo, Cristina, Muralidhar, Sumitra, Ostacher, Michael J., Paschall, Gayla Y., Pfeiffer, Paul N., Prieto, Susana, Przygodzki, Ronald M., Ranganathan, Mohini, Rodriguez-Suarez, Mercedes M., Roggenkamp, Hannah, Schichman, Steven A., Schneeweis, John S., Simonetti, Joseph A., Steinhauer, Stuart R., Suppes, Trisha, Umbert, Maria A., Vassy, Jason L., Voora, Deepak, Wiechers, Ilse R., and Wood, Amanda E.

Subjects
Male, Depressive Disorder, Major, Depression, Clinical Decision-Making, Remission Induction, Inappropriate Prescribing, General Medicine, Middle Aged, United States, Antidepressive Agents, Pharmacogenomic Testing, United States Department of Veterans Affairs, Treatment Outcome, Pharmacogenetics, Humans, Drug Interactions, Female, Original Investigation
Abstract

IMPORTANCE: Selecting effective antidepressants for the treatment of major depressive disorder (MDD) is an imprecise practice, with remission rates of about 30% at the initial treatment. OBJECTIVE: To determine whether pharmacogenomic testing affects antidepressant medication selection and whether such testing leads to better clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: A pragmatic, randomized clinical trial that compared treatment guided by pharmacogenomic testing vs usual care. Participants included 676 clinicians and 1944 patients. Participants were enrolled from 22 Department of Veterans Affairs medical centers from July 2017 through February 2021, with follow-up ending November 2021. Eligible patients were those with MDD who were initiating or switching treatment with a single antidepressant. Exclusion criteria included an active substance use disorder, mania, psychosis, or concurrent treatment with a specified list of medications. INTERVENTIONS: Results from a commercial pharmacogenomic test were given to clinicians in the pharmacogenomic-guided group (n = 966). The comparison group received usual care and access to pharmacogenomic results after 24 weeks (n = 978). MAIN OUTCOMES AND MEASURES: The co–primary outcomes were the proportion of prescriptions with a predicted drug-gene interaction written in the 30 days after randomization and remission of depressive symptoms as measured by the Patient Health Questionnaire–9 (PHQ-9) (remission was defined as PHQ-9 ≤ 5). Remission was analyzed as a repeated measure across 24 weeks by blinded raters. RESULTS: Among 1944 patients who were randomized (mean age, 48 years; 491 women [25%]), 1541 (79%) completed the 24-week assessment. The estimated risks for receiving an antidepressant with none, moderate, and substantial drug-gene interactions for the pharmacogenomic-guided group were 59.3%, 30.0%, and 10.7% compared with 25.7%, 54.6%, and 19.7% in the usual care group. The pharmacogenomic-guided group was more likely to receive a medication with a lower potential drug-gene interaction for no drug-gene vs moderate/substantial interaction (odds ratio [OR], 4.32 [95% CI, 3.47 to 5.39]; P

Published
2022

11. The role of PTSD in adjudicating violent crimes

Author

Hamner, Mark B.

Subjects
Violent crimes -- Psychological aspects, Post-traumatic stress disorder -- Diagnosis, Criminal psychology -- Ethical aspects, Health, Law, Porter v. McCollum (558 U.S. 30 (2009))
Abstract

Introduction There are a number of considerations, including ethical and clinical or diagnostic factors, in utilizing the diagnosis of posttraumatic stress disorder (PTSD) in criminal proceedings. The reliability and validity [...]

Published
2014

29. The many faces of posttraumatic stress disorder

Author

Hamner, Mark B.

Subjects
Brain -- Injuries, Post-traumatic stress disorder -- Reports, Antiterrorism measures -- Reports, Health, Psychology and mental health, Reports
Abstract

Chronic posttraumatic stress disorder (PTSD) may occur secondary to combat, terrorism, civilian assaults including physical and sexual abuse, or other traumatic experiences. This month's special report includes a series of [...]

Published
2008

30. Long-Term Treatment of Posttraumatic Stress Disorder

Author

Hamner, Mark B.

Subjects
Psychotherapy -- Usage -- Physiological aspects, Clinical psychiatry -- Physiological aspects -- Usage, Post-traumatic stress disorder -- Causes of -- Care and treatment -- Complications and side effects -- Diagnosis -- Risk factors, Psychiatrists -- Practice -- Usage -- Physiological aspects, Health, Psychology and mental health, Practice, Diagnosis, Care and treatment, Complications and side effects, Physiological aspects, Usage, Risk factors, Causes of
Abstract

Byline: Mark B. Hamner, MD Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after severe psychological stress, eg, assault, combat, natural disasters, terrorism, or other stressors. The stressor [...]

Published
2007

32. A Double-Blind, Randomized, Controlled Pilot Trial of N-Acetylcysteine in Veterans With Posttraumatic Stress Disorder and Substance Use Disorders

Author

Back, Sudie E., primary, McCauley, Jenna L., additional, Korte, Kristina J., additional, Gros, Daniel F., additional, Leavitt, Virginia, additional, Gray, Kevin M., additional, Hamner, Mark B., additional, DeSantis, Stacia M., additional, Malcolm, Robert, additional, Brady, Kathleen T., additional, and Kalivas, Peter W., additional

Published
2016
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33. A Multisite Randomized Controlled Trial of Mindfulness‐Based Stress Reduction in the Treatment of Posttraumatic Stress Disorder

Author

Davis, Lori L., Whetsell, Charles, Hamner, Mark B., Carmody, James, Rothbaum, Barbara O., Allen, Rebecca S., Bartolucci, Al, Southwick, Steven M., and Bremner, J. Douglas

Abstract

Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence‐based treatment. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans. Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90‐minute group MBSR or present‐centered group therapy (PCGT) for eight weeks. Follow‐up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16. Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician‐Administered PTSD Scale for DSM‐IV (CAPS‐IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self‐reported PTSD Checklist for DSM‐IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single‐blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women. Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self‐reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS‐IV scale.

Published
2019
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40. Limbic System

Author

Hamner, Mark B., primary, Lorberbaum, Jeffrey P., additional, and George, Mark S., additional

Published
2010
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