Melissa Y Wei

Emory University, Atlanta, GA, United States

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Publications (10)26.23 Total impact

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    ABSTRACT: Although statins have been shown to reduce cardiovascular disease mortality, less than half of U.S. adults achieve their low-density lipoprotein cholesterol goal. In many patients initiated on a statin, adherence rates decrease over time. To characterize current and former statin users, identify reasons for the discontinuation or switching of statins, and identify factors associated with adherence. The USAGE survey is a cross-sectional, self-administered Internet-based survey of 10,138 U.S. adults fielded September to October 2011. The following statin users were identified and compared: adherent nonswitchers, adherent switchers, non-adherent switchers, and discontinuers. Univariate and multivariate models using a priori covariates for adherence and discontinuation were examined. Most participants were current statin users who adhered with their prescribed statin (82.5%, n = 8371). Former statin users or discontinuers (12%, n = 1220) cited muscle pain, a side effect, as the primary reason for discontinuation (60%), followed by cost (16%), and then perceived lack of efficacy (13%). Discontinuers were less satisfied with their physicians' explanation of cholesterol treatment, more likely to use the Internet to research statins, and less likely to undergo frequent cholesterol monitoring. Among adherent statin users, the primary reasons for switching were muscle side effects (33%) and cost (32%). Individuals at risk for non-adherence included those with low household income, those who experienced muscle pain as a side effect while on statin therapy, and those taking medication for cardiovascular disease. Statin-related muscle side effects are common and contribute significantly to rates of discontinuation, switching, and non-adherence. Improved physician patient communication about side effects and benefits of statins are necessary to improve both adherence and outcomes.
    Journal of Clinical Lipidology 05/2013; 7(5):472-483. · 3.59 Impact Factor
  • Melissa Y. Wei, Nurcan Ilksoy, Lesley Miller
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    ABSTRACT: Background: In 2006 the Centers for Disease Control and Prevention recommended that individuals 13 to 64 years of age be screened for HIV regardless of risk factors. This study aimed to increase HIV screening among adults in an urban Atlanta primary care clinic by identifying barriers to HIV screening and implementing changes through an electronic medical record. Methods: A quality improvement (QI) project using the Institute for Healthcare Improvement Model for Improvement was conducted by residents in an academic primary care clinic from August 2011 to January 2012 to identify barriers to HIV screening. Baseline HIV screening rates were collected, and a test of change (TOC) aimed to improve these rates was implemented. The TOC involved adding a built-in phrase prompting HIV screening to each physician's electronic progress note template. Data on screening rates were recollected after implementation of the TOC. Results: Residents identified physician factors as the greatest barrier to HIV screening, including remembering to offer screening and order the antibody test, and time constraints for counseling and obtaining consent from patients. At baseline, 20% (N=29) of patients had been previously screened for HIV. Among remaining individuals, HIV screening was offered and ordered for 7.8% (N=9) of individuals. Following implementation of the TOC, HIV screening increased to 86% (N=102) and included one case of newly diagnosed HIV. Conclusions: At baseline, HIV testing among individuals at a high-risk urban clinic was low. A simple automated reminder added to a physician's electronic note template significantly increased HIV screening rates.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    Melissa Y Wei, Edward L Giovannucci
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    ABSTRACT: Lycopene has been proposed to protect against prostate cancer through various properties including decreased lipid oxidation, inhibition of cancer cell proliferation, and most notably potent antioxidant properties. Epidemiologic studies on the association between lycopene and prostate cancer incidence have yielded mixed results. Detection of an association has been complicated by unique epidemiologic considerations including the measurement of lycopene and its major source in the diet, tomato products, and assessment of prostate cancer incidence and progression. Understanding this association has been further challenging in the prostate-specific antigen (PSA) screening era. PSA screening has increased the detection of prostate cancer, including a variety of relatively indolent cancers. This paper examines the lycopene and prostate cancer association in light of epidemiologic methodologic issues with particular emphasis on the effect of PSA screening on this association.
    Journal of Oncology 01/2012; 2012:271063.
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    Melissa Y Wei, Terry A Jacobson
    Current Atherosclerosis Reports 12/2011; · 2.92 Impact Factor
  • Melissa Y Wei, Terry A Jacobson
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    ABSTRACT: Omega-3 fatty acid supplements containing both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been shown to reduce triglycerides but also increase low-density lipoprotein (LDL). Whether EPA or DHA given as monotherapy has differential effects on serum lipoproteins has not been systematically evaluated. We performed a meta-analysis of randomized placebo-controlled trials of monotherapy with EPA (n=10), DHA (n=17), or EPA versus DHA (n=6). Compared with placebo, DHA raised LDL 7.23 mg/dL (95% CI, 3.98–10.5) whereas EPA non-significantly reduced LDL. In direct comparison studies, DHA raised LDL 4.63 mg/dL (95% CI, 2.15–7.10) more than EPA. Both EPA and DHA reduced triglycerides, with a greater reduction by DHA in direct comparison studies. DHA also raised high-density lipoprotein (4.49 mg/dL; 95% CI, 3.50–5.48) compared with placebo, whereas EPA did not. Although EPA and DHA both reduce triglycerides, they have divergent effects on LDL and high-density lipoprotein. Further research is needed to elucidate the mechanisms and significance of these differences.
    Current Atherosclerosis Reports 12/2011; 13(6):474-83. · 2.92 Impact Factor
  • Melissa Y. Wei, Y. Liu, Edward L. Giovannucci
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    ABSTRACT: Background: Prior studies suggest dietary magnesium may be inversely associated with colorectal cancer incidence. Further, this association may be modified by calcium intake, vitamin D status and insulin resistance. Methods: This study prospectively examines a cohort of men enrolled in the Health Professionals Follow-up Study (n = 51,529, aged 40-75 at baseline in 1986) without previous diagnosis of cancer at baseline. Total, dietary and supplemental magnesium intake were assessed using a validated Semiquanititative Food Frequency Questionnaire. Incident site-specific colorectal cancer cases were confirmed through medical records and pathology reports. Age- and multivariate-adjusted models were analyzed based on updated person-time using Cox proportional hazards modeling. Results: After 18 years (768,370 person-years) of follow-up, 1013 incident colorectal cancer cases were documented. The mean quintiles of energy-adjusted total magnesium intake at baseline were 257, 306, 343, 384 and 479 mg/day. Magnesium intake was representative of U.S. adults, of which 80% do not meet the Recommended Dietary Allowance. The hazards ratio (HR) of colorectal cancer for the highest versus lowest quintile of cumulative updated total magnesium intake was 0.768 (95% CI: 0.632-0.932, p-trend = 0.0032). After full multivariate-adjustment this association was no longer statistically significant: HR = 1.048 (95% CI: 0.823-1.334). Conclusions: This study reports no primary association between total, dietary or supplemental magnesium intake with colorectal cancer incidence. Further analyses will include effect modification by calcium intake, vitamin D intake and status, and BMI, and have implications for dietary or supplemental magnesium as a potential public health intervention for colorectal cancer prevention.
    138st APHA Annual Meeting and Exposition 2010; 11/2010
  • Melissa Y Wei, Edward L Giovannucci
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    ABSTRACT: The hypothesis that vitamin D is inversely associated with multiple health outcomes has been studied in the Harvard cohorts, including the Nurses' Health Study I (n=121,700 female nurses aged 37-64 at baseline in 1984), Nurses' Health Study II (n=116,671 female nurses aged 27-44 years at baseline in 1991), Health Professionals Follow-up Study (n=51,529 male health professionals aged 40-75 years at baseline in 1986), and Physicians' Health Study (n=22 071 male physicians aged 40-84 years at baseline in 1982). These studies assessed vitamin D through circulating 25-hydroxyvitamin D, dietary and supplemental intake, predicted 25-hydroxyvitamin D, and vitamin D receptor polymorphisms. This review summarizes studies of vitamin D and various endpoints considered in these cohorts, including risk of cardiovascular disease, hypertension, elevated plasma C-peptide, various cancers, bone fractures, and multiple sclerosis. Based on the multiple observed benefits of vitamin D, this article postulates recommendations for vitamin D intake in the US population for reduced incidence of multiple health outcomes.
    Molecular Nutrition & Food Research 08/2010; 54(8):1114-26. · 4.31 Impact Factor
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    ABSTRACT: Vitamin D status is associated inversely with risk of colorectal cancer, but the association with adenoma risk is less clear. This meta-analysis examined the overall relationship between circulating (plasma or serum) 25-hydroxyvitamin D [25(OH)D], vitamin D intake (dietary, supplemental, or total), and colorectal adenoma incidence in published studies. A meta-analysis composed of 17 epidemiologic studies [1 cross-sectional, 9 case-control, and 7 cohort or nested case-control studies; 7 on 25(OH)D and 12 on vitamin D intake] published before December 2007 was done to examine the association between circulating 25(OH)D, vitamin D intake, and colorectal adenomas. Summary Peto odds ratios (OR) were computed for overall and stratified analyses. Circulating 25(OH)D was inversely associated with risk of colorectal adenomas: the OR was 0.70 [95% confidence interval (95% CI), 0.56-0.87] for high versus low circulating 25(OH)D. The highest quintile of vitamin D intake was associated with an 11% marginally decreased risk of colorectal adenomas compared with low vitamin D intake (OR, 0.89; 95% CI, 0.78-1.02). For recurrent adenomas, there was a decreased risk of 12% (95% CI, 0.72-1.07) among individuals with high versus low vitamin D intake. The inverse associations appeared stronger for advanced adenoma [OR, 0.64; 95% CI, 0.45-0.90 for serum 25(OH)D and OR, 0.77; 95% CI, 0.63-0.95 for vitamin D intake], but the number of studies was small. Both circulating 25(OH)D and vitamin D intake were inversely associated with colorectal adenoma incidence and recurrent adenomas. These results further support a role of vitamin D in prevention of colorectal adenoma incidence and recurrence.
    Cancer Epidemiology Biomarkers &amp Prevention 12/2008; 17(11):2958-69. · 4.56 Impact Factor
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    ABSTRACT: Previous studies, such as the Women's Health Initiative, have shown that a low dose of vitamin D did not protect against colorectal cancer, yet a meta-analysis indicates that a higher dose may reduce its incidence. Five studies of serum 25(OH)D in association with colorectal cancer risk were identified using PubMed. The results of all five serum studies were combined using standard methods for pooled analysis. The pooled results were divided into quintiles with median 25(OH)D values of 6, 16, 22, 27, and 37 ng/mL. Odds ratios were calculated by quintile of the pooled data using Peto's Assumption-Free Method, with the lowest quintile of 25(OH)D as the reference group. A dose-response curve was plotted based on the odds for each quintile of the pooled data. Data were abstracted and analyzed in 2006. Odds ratios for the combined serum 25(OH)D studies, from lowest to highest quintile, were 1.00, 0.82, 0.66, 0.59, and 0.46 (p(trend)<0.0001) for colorectal cancer. According to the DerSimonian-Laird test for homogeneity of pooled data, the studies were homogeneous (chi(2)=1.09, df=4, p=0.90. The pooled odds ratio for the highest quintile versus the lowest was 0.49 (p<0.0001, 95% confidence interval, 0.35-0.68). A 50% lower risk of colorectal cancer was associated with a serum 25(OH)D level > or =33 ng/mL, compared to < or =12 ng/mL. The evidence to date suggests that daily intake of 1000-2000 IU/day of vitamin D(3) could reduce the incidence of colorectal with minimal risk.
    American Journal of Preventive Medicine 04/2007; 32(3):210-6. · 3.95 Impact Factor
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    ABSTRACT: Inadequate photosynthesis or oral intake of Vitamin D are associated with high incidence rates of colorectal cancer, but the dose-response relationship has not been adequately studied. Dose-response gradients from observational studies of Vitamin D intake and serum 25-hydroxyvitamin D were plotted as trend lines. The point on each linear trend line corresponding to an odds ratio of 0.50 provided the prediagnostic Vitamin D intake or 25-hydroxyvitamin D concentration associated with 50% lower risk compared to <100IU/day Vitamin D or <13ng/ml serum 25-hydroxyvitamin D. Medians of these values were determined. Overall, individuals with >or=1000IU/day oral Vitamin D (p<0.0001) or >or=33ng/ml (82nmol/l) serum 25-hydroxyvitamin D (p<0.01) had 50% lower incidence of colorectal cancer compared to reference values. Intake of 1000IU/day of Vitamin D, half the safe upper intake established by the National Academy of Sciences, was associated with 50% lower risk. Serum 25-hydroxyvitamin D of 33ng/ml, which is known to be safe, also was associated with 50% lower risk. Prompt public health action is needed to increase intake of Vitamin D(3) to 1000IU/day, and to raise 25-hydroxyvitamin D by encouraging a modest duration of sunlight exposure.
    The Journal of Steroid Biochemistry and Molecular Biology 10/2005; 97(1-2):179-94. · 3.98 Impact Factor

Publication Stats

543 Citations
26.23 Total Impact Points

Institutions

  • 2011–2013
    • Emory University
      • School of Medicine
      Atlanta, GA, United States
  • 2008–2010
    • Oregon Health and Science University
      • Department of Public Health & Preventive Medicine
      Portland, OR, United States
    • Harvard University
      • Department of Nutrition
      Boston, MA, United States
  • 2005–2007
    • Harvard Medical School
      Boston, Massachusetts, United States