L H Kuller

Korea University, Sŏul, Seoul, South Korea

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Publications (1000)6311.31 Total impact

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    ABSTRACT: Aim: To examine whether the inflammatory markers C-reactive protein (CRP) and fibrinogen are associated with biomarkers of atherosclerosis [carotid intima-media thickness (IMT) and coronary artery calcification (CAC)] in the general male population, including Asians.Methods: Population-based samples of 310 Japanese, 293 Japanese-American and 297 white men 40-49 years of age without clinical cardiovascular disease underwent measurement of IMT, CAC and the CRP and fibrinogen levels as well as other conventional risk factors using standardized methods. Statistical associations between the variables were evaluated using multiple linear or logistic regression models.Results: The Japanese group had significantly lower levels of inflammatory markers and subclinical atherosclerosis than the Japanese-American and white groups (P-values all <0.001). The mean level of CRP was 0.66 vs. 1.11 and 1.47 mg/L, while that of fibrinogen was 255.0 vs. 313.0 and 291.5 mg/dl, respectively. In addition, the mean carotid IMT was 0.61 vs. 0.73 and 0.68 mm, while the mean prevalence of CAC was 11.6% vs. 32.1% and 26.3%, respectively. Body mass index (BMI) showed significant positive associations with both the CRP and fibrinogen levels. Although CRP showed a significant positive association with IMT in the Japanese men, this association became non-significant following adjustment for traditional risk factors or BMI. In all three populations, CRP was not found to be significantly associated with the prevalence of CAC. Similarly, fibrinogen did not exhibit a significant association with either IMT or the prevalence of CAC.Conclusions: The associations between inflammatory markers and subclinical atherosclerosis may merely reflect the strong associations between BMI and the levels of inflammatory markers and incidence of subclinical atherosclerosis in both Eastern and Western populations.
    Journal of atherosclerosis and thrombosis. 11/2014;
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    ABSTRACT: At the same level of BMI, white people have less visceral adipose tissue (VAT) and are less susceptible to developing type 2 diabetes than Japanese people. No previous population-based studies have compared insulin resistance and insulin secretion between these two races in a standardised manner that accounts for VAT. We compared HOMA-IR, HOMA of beta cell function (HOMA-β%) and disposition index (DI) in US white men and Japanese men in Japan.
    Diabetologia 10/2014; · 6.49 Impact Factor
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    ABSTRACT: To examine the association between brain structural changes and β-amyloid deposition, and incident dementia in 183 elderly subjects without dementia (mean age 85.5 years) 2 years later.
    Neurology 10/2014; · 8.30 Impact Factor
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    ABSTRACT: Background: The Women's Health Initiative (WHI) low fat (20% kcal) diet modification (DM) trial (1993-2005) demonstrated a non-significant reduction in breast cancer, a nominally significant reduction in ovarian cancer and no effect on other cancers (mean 8.3 years intervention). Consent to non-intervention follow-up was 83% (n=37,858). This analysis was designed to assess post-intervention cancer risk in women randomized to the low-fat diet (40%) versus usual diet comparison (60%). Methods: Randomized, controlled low fat diet intervention for prevention of breast and colorectal cancers conducted in 48,835 postmenopausal U.S. women, aged 50-79 years at 40 U.S. sites. Outcomes included total invasive cancer, breast and colorectal cancer, cancer-specific and overall mortality. Results: There were no intervention effects on invasive breast 1.08 (0.94, 1.24) or colorectal cancer, other cancers, cancer-specific or overall mortality during the post-intervention period or the combined intervention and follow-up periods. For invasive breast cancer, the HRs were 0.92 (0.84, 1.01) during intervention, during the post-intervention period, and 0.97 (0.89, 1.05) during cumulative follow up. A reduced risk for estrogen receptor positive/progesterone receptor negative tumors was demonstrated during follow-up. Women with higher baseline fat intake (quartile), point estimates of breast cancer risk were HR-0.76; 0.62, 0.92 during intervention versus HR-1.11; 0.84, 1.4 during post-intervention follow-up (p-diff=.03). Conclusions: Dietary fat intake rose post-intervention in intervention women; no long-term reduction in cancer risk or mortality was shown in the WHI DM trial. Impact: Dietary advisement to reduce fat for cancer prevention after menopause generally was not supported by the WHI DM trial.
    09/2014;
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    ABSTRACT: Cerebral white matter lesions (WMLs) are considered a reflection of cerebral and systemic small vessel disease (SVD), and are associated with reductions in brain volume. Like the brain, the kidney is also sensitive to factors that affect vasculature. Glomerular dysfunction due to renal vascular damage can be measured with different biochemical parameters, such as creatinine or cystatin C, although cystatin C is considered to be more accurate than creatinine in the elderly. The purpose of the study was to determine whether manifestations of SVD in the kidney can predict SVD-based damage to the brain. We examined the relationship between glomerular dysfunction as a measure of SVD on WMLs, gray matter (GM) volume, and cognition in 735 cognitively normal participants from the Cardiovascular Health Study Cognition Study. The multivariate analyses controlled for demographic characteristics, hypertension, heart disease, diabetes, Apolipoprotein 4 allele, C reactive protein, lipids, physical activity, smoking, and body mass index (BMI). Elevated cystatin C levels were associated with lower neuropsychological test scores, the presence of MRI-identified brain infarcts, the severity of WMLs, and GM atrophy five years later. In adjusted models, GM volume was significantly associated with cystatin-C only until BMI and severity of WMLs were added to the model, meaning that the effect of SVD on GM volume is mediated by these two variables. These findings suggest that age-related SVD is a process that leads to altered brain structure, and creates a vulnerability state for cognitive decline.
    Journal of Alzheimer's disease: JAD 09/2014; · 4.17 Impact Factor
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    ABSTRACT: The purpose of this study was to use a novel imaging biomarker to assess associations between physical activity (PA), body mass index (BMI), and brain structure in normal aging, mild cognitive impairment, and Alzheimer's dementia. We studied 963 participants (mean age: 74.1 ± 4.4 years) from the multisite Cardiovascular Health Study including healthy controls (n = 724), Alzheimer's dementia patients (n = 104), and people with mild cognitive impairment (n = 135). Volumetric brain images were processed using tensor-based morphometry to analyze regional brain volumes. We regressed the local brain tissue volume on reported PA and computed BMI, and performed conjunction analyses using both variables. Covariates included age, sex, and study site. PA was independently associated with greater whole brain and regional brain volumes and reduced ventricular dilation. People with higher BMI had lower whole brain and regional brain volumes. A PA-BMI conjunction analysis showed brain preservation with PA and volume loss with increased BMI in overlapping brain regions. In one of the largest voxel-based cross-sectional studies to date, PA and lower BMI may be beneficial to the brain across the spectrum of aging and neurodegeneration.
    Neurobiology of Aging 08/2014; · 6.17 Impact Factor
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    ABSTRACT: Background/Objectives:Higher volumes of ectopic cardiovascular fat (ECF) are associated with greater risk of coronary heart disease (CHD). Identifying factors that are associated with ECF volumes may lead to new preventive efforts to reduce risk of CHD. Significant racial/ethnic differences exist for overall and central adiposity measures which are known to be associated with ECF volumes. Whether racial/ethnic differences also exist for ECF volumes and their associations with these adiposity measures remain unclear.Subjects/Methods:Body-mass index (BMI), CT-measured ECF volumes (epicardial, pericardial and their summation), and visceral adipose tissue (VAT) were examined in a community-based sample of 1,199 middle-aged men (24.2% Caucasians, 7.0% African-Americans, 23.6% Japanese-Americans, 22.0% Japanese, 23.2% Koreans).Results:Significant racial/ethnic differences existed in ECF volumes and their relationships with BMI and VAT. ECF volumes were highest among Japanese-Americans and lowest among African-Americans. The associations of BMI and VAT with ECF differed by racial/ethnic groups. Compared to Caucasians, for each 1-unit increase in BMI, African-Americans had lower whereas Koreans had higher increases in ECF volumes (P-values<0.05 for both). Meanwhile, compared to Caucasians, for each 1-unit increase in log-transformed-VAT, African-Americans, Japanese-Americans and Japanese had similar increases, whereas Koreans had a lower increase in ECF volumes (P-value<0.05).Conclusions:Racial/ethnic groups differed in their propensity to accumulate ECF at increasing level of overall and central adiposity. Future studies should evaluate whether reducing central adiposity or overall-weight will decrease ECF volumes more in certain racial/ethnic groups. Evaluating these questions might help in designing race-specific prevention strategy of CHD risk associated with higher ECF.International Journal of Obesity accepted article preview online, 11 August 2014; doi:10.1038/ijo.2014.154.
    International journal of obesity (2005) 08/2014; · 5.22 Impact Factor
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    ABSTRACT: To determine whether low vitamin D concentrations are associated with an increased risk of incident all-cause dementia and Alzheimer disease.
    Neurology 08/2014; · 8.30 Impact Factor
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    ABSTRACT: Brain health may be affected by modifiable lifestyle factors; consuming fish and antioxidative omega-3 fatty acids may reduce brain structural abnormality risk.
    American journal of preventive medicine. 07/2014;
  • Lewis H Kuller, Timothy C Wong
    Nature Reviews Cardiology 07/2014; · 10.40 Impact Factor
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    ABSTRACT: Background: HIV is associated with end-organ diseases of aging via unclear mechanisms. Longitudinally assessing how HIV infection and ART initiation affect biomarkers of end organ function/disease could clarify these mechanisms. We investigated longitudinal changes in clinical biomarkers following 1) HIV infection and 2) ART initiation with evidence of viral suppression. Methods: Cohort: Veterans Aging Cohort Study Virtual Cohort (VACS VC). VACS VC is a longitudinal cohort of HIV infected (HIV+) and race-ethnicity, sex, age, and clinical site-matched uninfected Veterans enrolled in the same calendar year. Inclusion criteria: a negative and successively positive (>six months) HIV antibody test. We used Wilcoxon signedrank tests to analyze 1) the effect of HIV infection on lipids, renal, hepatic and hematologic/cardiovascular biomarkers and 2)whether ART initiation with HIV-1 RNA<500 cpm reverts any changes back to pre-HIV levels. Results: 422 Veterans had at least 1 biomarker measurement available prior to HIV infection and prior to ART initiation. 297 had at least 1 biomarker measurement available prior to HIV infection and after ART initiation with evidence of viral suppression. Mean age prior to HIV infection was 43 years. HIV infection was associated with reduction in total cholesterol, HDL cholesterol, LDL cholesterol, serum albumin, ALT, platelet count, hemoglobin and elevation of FIB-4 score and triglycerides. These changes occurred without significant changes in BMI. ART initiation (with HIV-1 RNA<500cpm) did not reverse alteration in triglycerides, LDL cholesterol, hemoglobin, or FIB-4 to pre-HIV infection levels. Conclusions: HIV infection is associated with longitudinal changes in serum levels of several biomarkers of end-organ function/disease and mortality. Multiple biomarkers (triglycerides, LDL cholesterol, hemoglobin, and FIB-4 ) remain altered from levels prior to HIV infection levels even following inititiation of ART and evidence of viral suppression. These results give insights into underlying mechanisms of increased risk for aging-related chronic diseases in the context of HIV infection.
    Current HIV Research 07/2014; 12(1):50-9. · 2.03 Impact Factor
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    ABSTRACT: The high prevalence, incidence and mortality rates of prostate cancer in Tobago would appear to strongly indicate that screening of this population would be justified and could positively impact on mortality. We consider our approach to be consonant with the recommendations of the EAU (Heidenreich A et al, 2013) and the findings of Hugosson et al, 2014)
    BJU International 07/2014; · 3.05 Impact Factor
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    ABSTRACT: Physical activity influences inflammation, and both affect brain structure and Alzheimer's disease (AD) risk. We hypothesized that older adults with greater reported physical activity intensity and lower serum levels of the inflammatory marker tumor necrosis factor α (TNFα) would have larger regional brain volumes on subsequent magnetic resonance imaging (MRI) scans. In 43 cognitively intact older adults (79.3 ± 4.8 years) and 39 patients with AD (81.9 ± 5.1 years at the time of MRI) participating in the Cardiovascular Health Study, we examined year-1 reported physical activity intensity, year-5 blood serum TNFα measures, and year-9 volumetric brain MRI scans. We examined how prior physical activity intensity and TNFα related to subsequent total and regional brain volumes. Physical activity intensity was measured using the modified Minnesota Leisure Time Physical Activities questionnaire at year 1 of the study, when all subjects included here were cognitively intact. Stability of measures was established for exercise intensity over 9 years and TNFα over 3 years in a subset of subjects who had these measurements at multiple time points. When considered together, more intense physical activity intensity and lower serum TNFα were both associated with greater total brain volume on follow-up MRI scans. TNFα, but not physical activity, was associated with regional volumes of the inferior parietal lobule, a region previously associated with inflammation in AD patients. Physical activity and TNFα may independently influence brain structure in older adults.
    Neuroscience 05/2014; · 3.12 Impact Factor
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    Arthritis & Rheumatology. 05/2014; 66(5).
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    ABSTRACT: Wrist-worn accelerometer devices measure sleep in free-living settings. Few studies, however, have investigated whether these devices can also measure waking movement behavior (e.g., total movement volume, physical activity). The purpose of this study was to investigate the ability of a wrist-worn Actiwatch-2 sleep monitor to rank total movement volume and physical activity levels compared to a waist-worn ActiGraph GT1M accelerometer and self-reported leisure-time physical activity, respectively. Additionally, we compared temporally-matched activity measured via ActiGraph GT1M and Actiwatch-2 over the study week. A subset of women from the Healthy Women Study (n=145; age 73.3±1.7y) wore an Actiwatch-2 on their non-dominant wrist and an ActiGraph GT1M on their dominant hip for 7-consecutive days. Participants recorded their leisure-time physical activity in a 7-day diary and completed the past-year version of the Modifiable Activity Questionnaire. Analyses were conducted for all wake periods, and separately for active periods, when both devices were worn. Spearman rank-order correlation coefficients for total movement volume between Actiwatch-2 and ActiGraph GT1M were significant for wake periods (r=0.47, p<0.001) and to a lesser extent for active periods (r=0.26, p<0.01). However, Actiwatch-2 did not rank participant physical activity levels similarly to self-reported leisure-time physical activity estimates (kappa≤0.05, p>0.05). Multilevel model analyses comparing temporally-matched activity measured via ActiGraph GT1M and Actiwatch-2 suggest that the two devices yielded similar levels of activity during wake periods (B=0.90, SE=0.008, p<0.001) as well as during active periods (B=0.81, SE=0.01, p<0.001). A wrist-worn Actiwatch-2 may be useful for ranking total movement volume and for assessing the pattern of activity over a day in older women. However, our data does not support using a wrist-worn Actiwatch-2 device for measuring physical activity.
    Medicine and science in sports and exercise 04/2014; · 4.48 Impact Factor
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    ABSTRACT: Sleep and physical activity are both important for cognition. However, few cognitive function studies include comprehensive measurement of both sleep and physical activity. The purpose of this study was to examine the independent and interactive associations of sleep and physical activity in relation to cognitive function in older women. A subset of 121 women from the Healthy Women Study, mean age 73.3 ± 1.7 years, wore an actigraphy sleep monitor, physical activity accelerometer, and kept sleep and physical activity diaries for 7 consecutive days. Executive function was measured with the Digit Symbol Substitution Test and the Trail Making Test B. Verbal fluency was assessed with a word generation task. In adjusted models, greater actigraphy-assessed sleep efficiency was associated with more correct responses on the Digit Symbol Substitution Test (β = 0.35, SE = 0.15, p < 0.02). Sleep was not associated with verbal fluency. A significant interaction (p < 0.05) was observed between accelerometer-assessed physical activity and actigraphy-assessed sleep efficiency. Specifically, lower sleep efficiency was associated with poorer performance on both the Digit Symbol Substitution Test and the Trail Making Test B among women with low levels of physical activity but not among women with high levels of physical activity. Our findings suggest that greater levels of physical activity may attenuate the negative impact of poor sleep on executive function in older women, with the clearest effects observed using direct measurements of sleep and physical activity.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 04/2014; · 4.31 Impact Factor
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    ABSTRACT: ABSTRACT Background: The purpose of this study was to describe the longitudinal trajectories and bidirectional relationships of the physical-social and emotional functioning (EF) dimensions of positive aging and to identify their baseline characteristics. Methods: Women age 65 and older who enrolled in one or more Women's Health Initiative clinical trials (WHI CTs) and who had positive aging indicators measured at baseline and years 1, 3, 6, and 9 were included in these analyses (N = 2281). Analytic strategies included latent class growth modeling to identify longitudinal trajectories and multinomial logistic regression to examine the effects of baseline predictors on these trajectories. Results: A five-trajectory model was chosen to best represent the data. For Physical-Social Functioning (PSF), trajectory groups included Low Maintainer (8.3%), Mid-Low Improver (10.4%), Medium Decliner (10.7%), Mid-High Maintainer (31.2%), and High Maintainer (39.4%); for EF, trajectories included Low Maintainer (3%), Mid-Low Improver (9%), Medium Decliner (7.7%), Mid-High Maintainer (22.8%), and High Maintainer (57.5%). Cross-classification of the groups of trajectories demonstrated that the impact of a high and stable EF on PSF might be greater than the reverse. Low depression symptoms, low pain, and high social support were the most consistent predictors of high EF trajectories. Conclusion: Aging women are heterogeneous in terms of positive aging indicators for up to 9 years of follow-up. Interventions aimed at promoting sustainable EF might have diffused effects on other domains of healthy aging.
    International Psychogeriatrics 04/2014; · 2.19 Impact Factor
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    ABSTRACT: To examine the association between 6-min walk test (6 MWT) performance and all-cause mortality, coronary heart disease mortality, and incident coronary heart disease in older adults. We conducted a time-to-event analysis of 1,665 Cardiovascular Health Study participants without prevalent cardiovascular disease with a 6 MWT. During a mean follow-up of 8 years, there were 305 incident coronary heart disease events, and 504 deaths of which 100 were coronary heart disease-related deaths. The 6 MWT performance in the shortest two distance quintiles was associated with increased risk of all-cause mortality (290-338 m: hazard ratio [HR] = 1.7; 95% confidence interval [CI] = [1.2, 2.5]; <290 m: HR = 2.1; 95% CI = [1.4, 3.0]). The adjusted risk of coronary heart disease mortality incident events among those with a 6 MWT < 290 m was not significant. Performance on the 6 MWT is independently associated with all-cause mortality and is of prognostic utility in community-dwelling older adults.
    Journal of Aging and Health 04/2014; · 1.56 Impact Factor
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    ABSTRACT: IMPORTANCE Recent studies show that cerebral β-amyloid (Aβ) deposition is associated with blood pressure and measures of arterial stiffness in nondemented individuals. OBJECTIVE To examine the association between measures of arterial stiffness and change in Aβ deposition over time. DESIGN, SETTING, AND PARTICIPANTS Deposition of Aβ was determined in a longitudinal observational study of aging by positron emission tomography using the Pittsburgh compound B twice 2 years apart in 81 nondemented individuals 83 years and older. Arterial stiffness was measured with a noninvasive and automated waveform analyzer at the time closest to the second positron emission tomography scan. All measures were performed under standardized conditions. Pulse wave velocity (PWV) was measured in the central (carotid-femoral and heart-femoral PWV), peripheral (femoral-ankle PWV), and mixed (brachial-ankle PWV) vascular beds. MAIN OUTCOMES AND MEASURES The change in Aβ deposition over 2 years was calculated from the 81 individuals with repeat Aβ-positron emission tomography. RESULTS The proportion of Aβ-positive individuals increased from 48% at baseline to 75% at follow-up. Brachial-ankle PWV was significantly higher among Aβ-positive participants at baseline and follow-up. Femoral-ankle PWV was only higher among Aβ-positive participants at follow-up. Measures of central stiffness and blood pressure were not associated with Aβ status at baseline or follow-up, but central stiffness was associated with a change in Aβ deposition over time. Each standard deviation increase in central stiffness (carotid-femoral PWV, P = .001; heart-femoral PWV, P = .004) was linked with increases in Aβ deposition over 2 years. CONCLUSIONS AND RELEVANCE This study showed that Aβ deposition increases with age in nondemented individuals and that arterial stiffness is strongly associated with the progressive deposition of Aβ in the brain, especially in this age group. The association between Aβ deposition changes over time and generalized arterial stiffness indicated a relationship between the severity of subclinical vascular disease and progressive cerebral Aβ deposition.
    JAMA neurology. 03/2014;
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    ABSTRACT: The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥7.5%) risk. During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.
    JAMA The Journal of the American Medical Association 03/2014; 311(12):1225-33. · 29.98 Impact Factor

Publication Stats

41k Citations
6,311.31 Total Impact Points

Institutions

  • 2010–2014
    • Korea University
      • College of Nursing
      Sŏul, Seoul, South Korea
    • Medical University of South Carolina
      Charleston, South Carolina, United States
  • 1975–2014
    • University of Pittsburgh
      • • Department of Epidemiology
      • • School of Medicine
      • • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
  • 2013
    • Wake Forest University
      • Department of Internal Medicine
      Winston-Salem, North Carolina, United States
    • Keio University
      Edo, Tōkyō, Japan
  • 2006–2013
    • Shiga University of Medical Science
      • • Department of Health Science
      • • Department of Medicine
      Ōtu, Shiga, Japan
    • University at Buffalo, The State University of New York
      • Department of Social and Preventive Medicine
      Buffalo, NY, United States
  • 2012
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, MD, United States
  • 2011
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
    • United States Department of Agriculture
      Washington, Washington, D.C., United States
    • Cornell University
      • Department of Medicine
      Ithaca, NY, United States
    • Alpert Medical School - Brown University
      Providence, Rhode Island, United States
  • 2010–2011
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States
  • 2007–2011
    • University of California, Los Angeles
      • • Department of Neurology
      • • Laboratory of Neuro Imaging
      • • Department of Medicine
      • • Department of Epidemiology
      Los Angeles, CA, United States
    • Inje University
      • College of Medicine
      Kimhae, South Gyeongsang, South Korea
    • University of Michigan
      • Department of Internal Medicine
      Ann Arbor, MI, United States
    • Arizona State University
      Phoenix, Arizona, United States
    • Albert Einstein College of Medicine
      • Department of Epidemiology & Population Health
      New York City, NY, United States
  • 1991–2011
    • University of Minnesota Twin Cities
      • • Division of Cardiology
      • • Division of Biostatistics
      Minneapolis, MN, United States
  • 1998–2010
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
    • Maine Medical Center
      Portland, Maine, United States
    • London School of Hygiene and Tropical Medicine
      • Faculty of Epidemiology and Population Health
      Londinium, England, United Kingdom
  • 2009
    • Boston Children's Hospital
      • Department of Radiology
      Boston, MA, United States
    • Beth Israel Medical Center
      New York City, New York, United States
    • National Cerebral and Cardiovascular Center
      Ōsaka, Ōsaka, Japan
  • 2007–2009
    • CHA University
      • Department of Internal Medicine
      Seoul, Seoul, South Korea
  • 2003–2009
    • National Institute on Aging
      • Laboratory of Epidemiology, Demography and Biometry (LEDB)
      Baltimore, MD, United States
    • University of California, San Diego
      San Diego, California, United States
    • San Diego State University
      San Diego, California, United States
    • Philadelphia University
      Philadelphia, Pennsylvania, United States
    • National Institutes of Health
      • Laboratory of Epidemiology, Demography, and Biometry (LEDB)
      Bethesda, MD, United States
  • 1997–2009
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 1996–2009
    • University of Vermont
      • • Department of Pathology
      • • Department of Medicine
      Burlington, VT, United States
  • 2008
    • Johns Hopkins Bloomberg School of Public Health
      Baltimore, Maryland, United States
    • Tufts University
      Georgia, United States
    • George Washington University
      • Department of Medicine
      Washington, D. C., DC, United States
    • Kaiser Permanente
      Oakland, California, United States
  • 2003–2008
    • Beth Israel Deaconess Medical Center
      • • Department of Medicine
      • • Division of General Medicine and Primary Care
      Boston, MA, United States
  • 1999–2007
    • University of Helsinki
      • Department of Psychology
      Helsinki, Province of Southern Finland, Finland
    • North Carolina Department of Health and Human Services
      Raleigh, North Carolina, United States
  • 1990–2007
    • University of California, Davis
      • • Center for Neuroscience
      • • Department of Neurology
      • • School of Medicine
      Davis, CA, United States
  • 2002–2006
    • University of Washington Seattle
      • • Department of Medicine
      • • Department of Biostatistics
      Seattle, WA, United States
  • 2005
    • University of Bristol
      Bristol, England, United Kingdom
    • University of Nevada, Las Vegas
      Las Vegas, Nevada, United States
    • Harvard Medical School
      • Department of Medicine
      Boston, MA, United States
  • 1994–2004
    • Tulane University
      • • Department of Epidemiology
      • • School of Public Health and Tropical Medicine
      New Orleans, LA, United States
    • University of Melbourne
      • Department of Ophthalmology
      Melbourne, Victoria, Australia
  • 1991–2004
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, Maryland, United States
  • 2001
    • Emory University
      • Division of Endocrinology
      Atlanta, GA, United States
  • 2000
    • Slippery Rock University of Pennsylvania
      Slippery Rock, Pennsylvania, United States
    • University of California, San Francisco
      San Francisco, California, United States
  • 1994–1996
    • University of Alabama at Birmingham
      • Department of Medicine
      Birmingham, Alabama, United States
  • 1995
    • University of Benin
      • Department of Community Health
      Benim, Edo, Nigeria
  • 1993
    • University of Tennessee
      Knoxville, Tennessee, United States
  • 1992–1993
    • University of Delaware
      Delaware, United States
    • National Heart, Lung, and Blood Institute
      Maryland, United States
    • Pittsburg State University
      Kansas, United States
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 1991–1992
    • Childrens Hospital of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States
  • 1988
    • Pennsylvania Department of Health
      Harrisburg, Pennsylvania, United States
  • 1986
    • Georgia Health Sciences University
      • Department of Medicine
      Augusta, Georgia, United States