Papers by Varant Kupelian
The Journal …, 2011
From the New England Research Institutes, Watertown, Massachusetts (VK, GRC, RCR), Loyola Univers... more From the New England Research Institutes, Watertown, Massachusetts (VK, GRC, RCR), Loyola University Medical Center, Maywood, Illinois (MPF), Cornell University, Weill Medical College, New York, New York (SAK), and Ferring International Pharmascience Center, ...
The Journal of Urology, 2009
Purpose-The objectives of this study were to: 1) investigate the association between lower urinar... more Purpose-The objectives of this study were to: 1) investigate the association between lower urinary tract symptoms (LUTS) and chronic illnesses such as heart disease, diabetes, hypertension, and depression in men and women, and 2) to determine whether a dose-response relationship exists in the association between the severity and duration of urologic symptoms and major chronic illnesses. Materials and Methods-The Boston Area Community Health (BACH) Survey used a multistage stratified design to recruit a random sample of 5,503 adults age 30-79. Urologic symptoms comprising the American Urological Association symptom index were included in the analysis. Results-Statistically significant associations, consistent by gender, were observed between depression and all urologic symptoms. Nocturia of any degree of severity or duration was associated with heart disease among men and with diabetes among women. Among men, a dose-response relationship was observed in the association of symptom severity and/or duration of urinary intermittency and frequency with heart disease, and in the association of urinary urgency with diabetes. Among women, a history of heart disease was associated with weak stream and straining, while a history of hypertension was associated with urgency and weak stream. Conclusions-Results indicate a dose-response relationship in the association of both severity and duration of urologic symptoms with major chronic illnesses. An association between urinary symptoms and depression was observed in both men and women. In contrast, the association between LUTS and heart disease, diabetes, or hypertension varied by gender, suggesting different mechanisms of association in men and women.
Annals of Epidemiology, 2011
PURPOSE-Statins may ameliorate lower urinary tract symptoms (LUTS) through antiinflammatory or ot... more PURPOSE-Statins may ameliorate lower urinary tract symptoms (LUTS) through antiinflammatory or other pathways. We investigated the association between statin use and storage, voiding, and overall LUTS symptoms. METHODS-The Boston Area Community Health Survey is an epidemiologic study of Boston, MA residents (2301 men; 3202 women) aged 30-79. LUTS, voiding and storage symptoms were ascertained through an interviewer-administered questionnaire and defined as scores of ≥8, ≥5, and ≥4, respectively, on relevant components of the American Urologic Association Symptom Index. Participants were included if they had a history of provider-diagnosed high cholesterol or recently used statin medications (N=1,346). Associations were estimated using odds ratios (ORs) and 95% confidence intervals from multivariate logistic regression. RESULTS-In multivariate models, statin use had no association with LUTS (OR=1.03, 95% CI: 0.70, 1.51) among women. No associations were observed for any LUTS among younger (<60) men, but among older (60+) men, we observed significant inverse associations for voiding (OR=0.23, 95% CI: 0.08, 0.66), storage (OR=0.24, 95% CI: 0.11, 0.56) and overall LUTS (OR=0.15, 95% CI: 0.05, 0.44). CONCLUSIONS-Our results suggest that use of statins is associated with a lower prevalence of urologic symptoms among older men but not among women or younger men.
The Journal of Urology, 2007
Erectile dysfunction affects more than 150 million men and is strongly associated with cardiovasc... more Erectile dysfunction affects more than 150 million men and is strongly associated with cardiovascular disease. A 1992 National Institutes of Health consensus development panel identified erectile dysfunction progression and spontaneous remission as priorities for investigation, but there are few data describing the natural course of the disorder following its initial presentation. This analysis estimates the frequency of erectile dysfunction progression and remission among aging men, and assesses the relation of progression/remission to demographics, socioeconomic factors, comorbidities and modifiable lifestyle characteristics. Materials and Methods: Data from the Massachusetts Male Aging Study, a longitudinal study of men (401) 40 to 70 years old, were analyzed to assess erectile dysfunction severity following initial presentation of symptoms. Logistic regression was used to estimate the odds of erectile dysfunction progression/remission as a function of covariates. Results: A total of 141 subjects (35%) exhibited erectile dysfunction remission (95% CI: 30%, 40%). Of 323 subjects with minimal or moderate baseline erectile dysfunction 107 (33%) exhibited erectile dysfunction progression (95% CI: 28%, 38%). The 78 subjects with complete erectile dysfunction were considered ineligible for progression and 45 (58%) of these exhibited complete erectile dysfunction at followup. Age and body mass index were associated with progression and remission, while smoking and self-assessed health status were associated with progression only. Conclusions: Natural remission and progression occur in a substantial number of men with erectile dysfunction. The association of body mass index with remission and progression, and the association of smoking and health status with progression, offer potential avenues for facilitating remission and delaying progression using nonpharmacological intervention. The benefits of such interventions for overall men's health may be far-reaching.
Neuro- …
The Central Brain Tumor Registry of the United States (CBTRUS) obtained 5 years of incidence data... more The Central Brain Tumor Registry of the United States (CBTRUS) obtained 5 years of incidence data (1990–1994)—including reports on all primary brain and CNS tumors—from 11 collaborating state cancer reg- istries. Data were available for 20,765 tumors located in the brain, ...
European Urology, 2007
Introduction-Although previous studies report an association between erectile dysfunction (ED) an... more Introduction-Although previous studies report an association between erectile dysfunction (ED) and smoking, few have examined the impact of passive smoke exposure on ED. This analysis examines the association of active and passive smoking and ED and investigates a dose-response effect of smoking. Methods-The Boston Area Community Heath (BACH) survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men, aged 30-79 yr, from the city of Boston. ED was assessed using the five-item International Index of Erectile Function. Smoking and passive smoking were assessed by self-report. Analyses adjusted for sociodemographic and lifestyle factors and important chronic illnesses. Results-An association between smoking and ED was observed with a significant trend in increased risk of ED with cumulative pack-years of smoking (adjusted odds ratio [OR] = 1.68; 95% confidence interval [CI], 1.03, 2.30 for ≥ 20 pack-years). Compared to never smokers not exposed to passive smoking, men who never smoked but were exposed to passive smoking had a moderate, statistically nonsignificant, increase in risk of ED (adjusted OR = 1.33; 95%CI: 0.69, 2.55) comparable to the OR observed for a cumulative exposure of 10-19 pack-years of active smoking (adjusted OR = 1.25; 95%CI, 0.68, 2.30). Conclusions-Results indicate a dose-response association between smoking and ED with a statistically significant effect observed with ≥ 20 pack-years of exposure. Passive smoking is associated with a small, statistically nonsignificant increase in risk of ED comparable to approximately 10-19 pack-years of active smoking.
The Journal of Urology, 2012
Purpose-Lower Urinary Tract Symptoms (LUTS) are highly prevalent and reduce quality of life. Life... more Purpose-Lower Urinary Tract Symptoms (LUTS) are highly prevalent and reduce quality of life. Lifestyle behaviors and LUTS development are largely unexamined. The objective of this study was to investigate physical activity, smoking, and alcohol drinking and LUTS development in men and women. Materials and Methods-Data were from a longitudinal observational study, the Boston Area Community Health Survey. Baseline (2002-2005) in-person interviews assessed activity, smoking and alcohol. Five-year follow-up interviews (2006-2010, N=4,145) assessed new reports of moderate-to-severe LUTS, defined by the American Urological Association Symptom Index (AUASI). Analysis used multivariable logistic regression. Results-LUTS developed among 7.7% and 12.7% of at-risk men and women, respectively. Women were 68% less likely to develop LUTS (OR=0.32, 95% CI: 0.17-0.60, P<0.001) if they had high vs. low physically activity. Although the association was similar among men, it was not statistically significant upon adjustment for medical or sociodemographic characteristics in the multivariable model. Women smokers were twice as likely to develop LUTS, particularly storage symptoms (OR=2.15, 95% CI: 1.30-3.56, P=0.003), compared to never-smokers. Among men, smoking was not associated with LUTS. Results for alcohol intake were inconsistent by intake level and symptom subtype. Conclusions-Low physical activity was associated with 2-3 times higher likelihood of LUTS development. Smoking may contribute to LUTS development in women, but not men. Clinicians
Neuro- …, 2001
Prevalence rates are used to supplement descriptions of disease and are unavailable for all prima... more Prevalence rates are used to supplement descriptions of disease and are unavailable for all primary brain tumors in the United States. Data from two population-based tumor registries were obtained from the Central Brain Tumor Registry of the United States and used to compute age-speci c incidence rates (1985-1994) and survival curves for further use in a statistical model to estimate prevalence rates. Prevalence rates were then used to estimate the number of individuals living with a brain tumor diagnosis in the U.S. population for the year 2000. The overall incidence rate in these regions is 13.8 per 100,000 with 2-, 5-, and 10-year survival rates of 58%, 49%, and 38%, respectively. The prevalence rate for all primary brain tumors is 130.8 per 100,000 with approximately 350,000 individuals estimated to be living with this diagnosis in the United States in 2000. The prevalence rate for malignant tumors, 29.5 per 100,000, is similar to previous reports. The prevalence rate for benign tumors, 97.5 per 100,000, is new. Unlike incidence data, the proportion (and expected number) of existing benign tumors (75%, 267,000) is considerably greater than that for malignant tumors (23%, 81,000), re ecting the better prognosis of benign tumors diagnosed in individuals younger than 60 years old. These data underscore the impact of primary brain tumors in the U.S. health care system and emphasize the need for quality-of-life considerations, particularly for those long-term survivors of benign tumors. Neuro-Oncology 3, 152-158, 2001
Urology, 2007
Objectives-Since lifestyle factors and comorbidities may influence lower urinary tract symptoms (... more Objectives-Since lifestyle factors and comorbidities may influence lower urinary tract symptoms (LUTS) by gender and race/ethnicity differently, we investigated these associations in the Boston Area Community Health (BACH) Survey. Methods-Using a multi-stage stratified cluster random sample, 5506 adults aged 30-79 were enrolled; 2301 men, 3205 women, 1770 Black, 1877 Hispanic, 1859 White. Adiposity, lifestyle factors, comorbidities (cardiovascular diseases, diabetes, high blood pressure, high cholesterol, depressive symptoms, prior urinary tract infections) were considered in predicting the odds of LUTS (American Urological Association Symptom Index 8+) by gender and race/ethnicity. Results-The prevalence of LUTS was 18.7% with similar rates by gender (men 18.7%, women 18.6%) and race/ethnicity (Black 19.3%, Hispanic 16.2%, White 18.9%); however, prevalence did increase substantially with age. Depressive symptoms were associated with increased odds of LUTS across all gender and racial/ethnic groups; overall odds ratio (95% confidence interval): 2.4 (1.9, 3.2), p < 0.001. Age increased the odds of LUTS among all groups. Physical activity decreased the odds of LUTS, particularly among women: 0.4 (0.2, 0.7), p = 0.003 comparing high to low activity. Cardiovascular diseases and prior urinary tract infections increased the odds of LUTS overall: 1.6 (1.2, 2.1), p = 0.004; 1.9 (1.4, 2.4), p < 0.001, respectively, and for most groups. Conclusions-Lifestyle and clinical factors associated with LUTS are similar by gender and race/ ethnicity.
The Journal of Clinical Endocrinology & Metabolism
Context: Previously we demonstrated, in individuals who have had type 1 diabetes (T1D) for 50 or ... more Context: Previously we demonstrated, in individuals who have had type 1 diabetes (T1D) for 50 or more years (Medalists), that glycemic control was unrelated to diabetic complications, with the exception of cardiovascular disease (CVD), contrary to what has been documented in registrybased studies. Objective: The purpose of this study is to validate these initial findings and identify contributors to mortality on an individual basis in a large cohort.
The Endocrine Society's 93rd Annual Meeting & Expo, June 4–7, 2011 - Boston, 2011
Neuroepidemiology
Introduction: Amyotrophic lateral sclerosis (ALS) is a rare neurological disorder characterized b... more Introduction: Amyotrophic lateral sclerosis (ALS) is a rare neurological disorder characterized by progressive deterioration of motor neurons. Assessment of the size/geographic distribution of the ALS population, including ALS with genetic origin, is needed to understand the burden of the disease and the need for clinical intervention and therapy. Objectives: The main objective of this study was to estimate the number of prevalent and incident ALS cases overall and superoxide dismutase 1 (SOD1) and chromosome 9 open reading frame 72 (C9orf72) ALS in 22 countries across Europe (Belgium, France, Germany, Ireland, Italy, Netherlands, Norway, Russia, Spain, Sweden, and UK), North America (USA and Canada), Latin America (Argentina, Brazil, Colombia, Mexico, and Uruguay), and Asia (China, Japan, South Korea, and Taiwan). Methods: A comprehensive literature search was conducted to identify population-based studies reporting ALS prevalence and/or incidence rates. Pooled prevalence and incid...
Cancer, 1999
Five-year survival estimates in standard cancer reports provide a general description of disease ... more Five-year survival estimates in standard cancer reports provide a general description of disease outcome that is useful for surveillance and comparison purposes. However, for cancer survivors these overall survival rates may be discouraging, and the relevant question regarding an individual is this: Once he or she has survived for a specified period of time, what is the probability of survival over the next period of time?
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Papers by Varant Kupelian