bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P377: Association Between Area Deprivation and Premature Cardiovascular Mortality in South Korea
Authors: Kim Hyeon Chang , Kim Eunji , Lee Hokyou , Lloyd-Jones Donald M , Ko Young Gyu , Kim Byoung Gwon
Published: May 2024

Background:
The underlying factors for regional disparities in cardiovascular disease (CVD) have yet to be fully understood. There is limited research on the effect of regional-level socioeconomic conditions on CVD mortality. This ecological study aims to investigate the association between area deprivation and premature death from CVD.

Methods:
The deprivation index was formulated with 10 socioeconomic indicators across all the 250 municipalities in Korea. Mortality rates from total CVD, ischemic heart disease, and cerebrovascular disease in adults <65 years were directly standardized for sex and age using the total population structure. Municipalities are stratified by urbanicity, and the number of hospitals and the size of an area were adjusted in log-linear regression models.

Results:
The most deprived municipalities showed 41.6% excess mortality for total CVD, 30.3% for ischemic heart disease, and 36.9% for cerebrovascular disease, compared to the least deprived ones. Even after adjusting for the number of hospitals per unit area, the association of area deprivation was more significant in metropolitan areas than in other provinces. As one increment of the deprivation index increased, the adjusted rate ratios for total CVD were 1.031 (1.020-1.043) in metropolitans and 1.009 (1.000-1.019) in other provinces. Additional multilevel analyses showed consistent findings of higher risks in deprived areas.

Conclusions:
This study highlights a higher risk of premature cardiovascular death in socioeconomically disadvantaged areas. The CVD prevention strategies should reflect regional characteristics, with a particular focus on reducing the burden in deprived metropolitan areas.
Abstract P406: Screen Time and Behavioral Cardiovascular Health in Youth by Age: The Young Hearts Study
Authors: Phillips Darci , Lloyd-Jones Donald M , De Ferranti Sarah D , Labarthe Darwin R , Davis Matthew , Marma Amanda P , Petito Lucia , Daniels Stephen R , Chopra Aashima , Wang Yaojie , Rosenman Marc , Narayan Rashmi , Gooding Holly , Pletcher Mark J , Alenghat Francis , Gandhi Rupali , Lefaiver Cheryl , Luff Amanda , Khan Huma , Rios Ileah , Zmora Rachel , Yu Amy , Allen Norrina B
Published: May 2024

Background:
Research suggests that screen time is associated with negative health outcomes, including cardiovascular health (CVH) factors (BP, lipids, glucose, BMI) but seldom include CVH behaviors (diet, physical activity, nicotine exposure, and sleep).

Methods:
Young Hearts is an observational study of CVH trajectories in youth aged 0-20. This analysis includes 1749 participants aged 6-18 with complete baseline surveys. Parents (for 6-17 year olds) and adolescents aged 12+ (for themselves) completed surveys on CVH behaviors, medical history, and social context. Participants (stratified by age groups: 6-9, 10-14, and 15-18) reported hours spent on screens during a typical weekday and weekend day, excluding schoolwork and video calls. For 12-17-year-olds, we calculated the average reported screen time. We calculated CVH using the 4 health behaviors in the AHA’s Life’s Essential 8. Each behavior was assigned a score of 0 to 100 and averaged to create the behavioral CVH score. Linear regression assessed the association between screen time (continuous) and CVH score, adjusting for age, sex, race, ethnicity, income, parental education, chronic disease, insurance type, and depressive symptoms.

Results:
The mean age of 1749 participants was 12, 47% were female, 46% non-Hispanic White, 26% Hispanic, 20% non-Hispanic Black, and 9% identified as other. For participants aged 10-14, a 1-hour screen time increase was associated with a -0.9 CVH score (95% CI -1.4, -0.4). Inverse associations between screen time and sleep score were observed among youth aged 10-14 and 15-18 (-1.4; 95% CI -2.6, -0.2). Screen time was inversely related to diet across age groups. Among children aged 6-9, screen time was positively associated with physical activity (1.2; 95% CI 0.2 - 2.1). The findings were consistent by race/ethnicity.

Conclusion:
Higher screen time was associated with less favorable CVH scores due to sleep and diet scores. Future research is needed to better understand the relationship between screen time and physical activity among youth.
Abstract P410: Prevalence and Short Term Follow Up Rates Across the Childhood and Adolescent Obesity Population in a Community Hospital
Authors: Thanneeru Priya , Desai Shivani , Lall Daisy
Published: May 2024

Background:
Obesity is a global pandemic, which is 20.7% prevalent among 6-11 yr old and 22.2% prevalent among 12-19 year old(CDC). Aim is to understand the prevalence across different age groups in a community hospital setting. Secondary aim is to assess the variance of follow up rates across childhood and adolescence as follow up is crucial for the success of any physician intervention.

Methods:
We considered pediatric patients between 5 to 20 years old visiting primary care clinics within a 3-month period with a diagnosis of obesity for our study. We determined the follow up rate for 3 month scheduled weight checks for obese patients relative to the age groups.

Results:
We identified a total of 264 patients with obesity diagnosis (>95th percentile BMI) visiting outpatient clinics within a three month period. In our sample, the prevalence of obesity in childhood years (5-11) was 58.7%(155 of 264) and prevalence of obesity in the adolescent age group(12-20) was 41.2% (109 of 264). We recorded 30.3%(108 of 155) follow up in childhood years and 33.9%(72 of 109) follow up in the adolescent age group. The calculated p value was >0.05, hence the follow up rates across different age groups are not statistically significant.

Conclusions:
Focused intervention on the childhood age group will decrease the prevalence rates of obesity in a community hospital setting. This study emphasizes the need to formulate a plan to increase the follow up rates in the pediatric obesity population given its high prevalence in community hospital settings. No statistical significance has been found with follow up rates across various age groups. Further research controlling the confounding factors like environmental and socioeconomic factors help us understand the factors hindering follow ups across various age groups.
Abstract P431: Heparin-Warfarin Administered for Pulmonary Vein Thrombi Partially Dissolves Thrombi and Ameliorates Mild to Moderate Type 2 Diabetes Mellitus
Authors: Takeuchi Hidekazu
Published: May 2024

Background:
Pulmonary infection generates arterial thrombi, an important component of which are neutrophil extracellular traps, to defend the host. Pulmonary vein thrombi (PVTs) are underrated compared to arterial thrombi. In 2014, we reported that at least 61% (35 of 57) of elderly patients with chest pain had PVTs, as estimated using cardiac computed tomography (CT), and in 2022, we reported that 98.6% (215 of 218) of senior patients with age-related diseases such as hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM) had PVTs, as evaluated using cardiac CT and transesophageal echocardiography. T2DM is a common disease that can cause atherosclerosis, leading to ischemic stroke and acute myocardial infarction. It is important to better understand the mechanisms of T2DM and how to treat T2DM patients. The relationships between PVTs and T2DM are still unclear. Additionally, the relationships between heparin-warfarin therapy and T2DM are unknown.

Methods:
We identified PVTs in 15 T2DM patients (73.5 ± 9.9 y.o., range 50 y.o. to 88 y.o.; 10 males and 5 females) using both cardiac CT and transesophageal echocardiography. Among the 15 patients, two did not take DM medications; one took one DM medication; one took two DM medications; five took three DM medications; four took 4 DM medications; one took 5 DM medications; and one was treated with insulin.

Results:
The PVTs were partially dissolved by standard doses of heparin and warfarin given at the same time for one month. During the treatment, blood glucose levels were examined 30 minutes before breakfast, lunch, dinner and sleep. Between one and two weeks, the blood glucose levels of 10 patients decreased, especially before lunch, and some patients showed symptoms of hypoglycemia; therefore, the number of administered DM medications was decreased to zero for 6 patients and to one for 4 patients. After one month, the patients’ HbA1c levels had decreased slightly. We treated 10 patients with warfarin for the next several months, none of whom needed to resume DM medications, although their blood glucose tended to increase slightly. Three patients with comparatively severe T2DM showed no change in blood glucose following therapy.

Conclusions:
Heparin-warfarin therapy partially dissolved PVTs and decreased DM medications in patients with mild to moderate T2DM.
Abstract P436: Pre-Diabetes With and Without Cardiac Dysfunction and the Risk of Heart Failure in Older Adults
Authors: Yoshida Yilin , Chen Zhipeng , Fonseca Vivian A
Published: May 2024

Background:
Whether pre-diabetes (pre-DM) is independently associated with the risk of heart failure (HF) in the elderly remains inconclusive.

Objective:
To examine the prevalence of cardiac dysfunction in pre-DM and the prognostic differences of HF in pre-DM with and without cardiac dysfunction in a diverse elderly population.

Methods:
We included HF-free individuals with euglycemia (n=770) or pre-DM (n=2157) who underwent echocardiography at the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 (baseline). A composite cardiac dysfunction measure included ≥2 echocardiographic abnormalities (Left ventricular hypertrophy [LV mass index ≥115 g/m
2
in men or≥95 g/m
2
in women], left atrial enlargement [LA volume index ≥34 mL/m
2
], diastolic dysfunction [E/e’ >13, E/A>2, or E-wave deceleration time >240 ms], and systolic dysfunction [ejection fraction<45%]) and high NT pro-BNP (>125 pg/mL in obese or >100 in non-obese). Our outcome was a new diagnosis of definite or probable acute decompensated HF. We assessed the prevalence of the composite cardiac dysfunction in pre-DM (fasting glucose 100-125 mg/dL or HbA1c 5.7-6.4%) and the association between pre-DM and incident HF with and without cardiac dysfunction at baseline adjusting for age, sex, race, center, education, smoking, BMI, systolic blood pressure, total cholesterol, hypertensive medication, lipid-lowering medication, and eGFR (CKD-EPI) in the Cox regression models.

Results:
9.5% of elderly individuals with pre-DM had cardiac dysfunction. In a median follow-up of 7 years, compared to euglycemia without cardiac abnormalities, we found a significant risk of HF in pre-DM with cardiac dysfunction (HR 2.6, 95% CI 1.6-4.5) but not in pre-DM without cardiac dysfunction (0.8, 0.5-1.2). The finding was consistent in sex and race groups and sensitivity analyses excluding those with a history of hypertension or obesity.

Conclusion:
Pre-DM is associated with an increased risk of HF in elderly people, but the risk was only significant among those with cardiac dysfunction.
Abstract P439: Atherosclerotic Cardiovascular Risk Factor Burden Among Marijuana Users in the US Population
Authors: Abed Anas , Koraym Adam , Zampierollo-Jaramillo Giovanna , Forati Amir , Tattersall Matthew C
Published: May 2024

Background:
The prevalence of marijuana use in the US is increasing. Marijuana use has been associated with increased atherosclerotic cardiovascular disease (ASCVD) events. The ASCVD risk factor burden among marijuana users compared with non-users and tobacco users has not been defined. We sought to define ASCVD risk factor burden among marijuana users in a nationally representative sample of the US population.

Methods:
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from the 2017-2018 cycle including 4991 participants aged 18-59 representing 223 million US adults. Participants were placed in 4 groups: marijuana and cigarette user (MS), exclusive marijuana user (M), exclusive cigarette user (S), and non-users (NS). ASCVD risk factors were assessed and compared using chi-squared and ANOVA with Tukey’s adjustment for multiple hypothesis testing.

Results:
The N=4991 participants representing 223 million US adults were a mean 51 years old, 54.82% female and BMI of 32.53. The N=1691 M-users were compared to the N=2552 NS, N=2439 S-users, and N=1020 MS users (Table 1). The M-users were younger, mean age (38.8 years) with a higher BMI (32.9 kg/m
2
) compared to exclusive smokers, dual-users and non-users. Prevalent coronary heart disease differed by use-group (p < 0.05).

Conclusion:
Exclusive M-users and dual users had higher prevalent CHD. ASCVD risk factor burden differed slightly between the groups.
Abstract P443: Alcohol Use Prevalence Among US Born and Foreign-Born Black Adults in the 2010 to 2018 National Health Interview Survey
Authors: Grant Kimesha , Turkson-Ocran Ruth-Alma N , Ogungbe Oluwabunmi V , Metlock Faith , Commodore-Mensah Yvonne , Baptiste Diana
Published: May 2024

Background:
Alcohol use is an important risk factor for CVD, but variations among Black adults are not well known. We aimed to examine differences in alcohol use among Black subgroups.

Hypothesis:
Foreign-born Black adults will exhibit less alcohol use than their native-born peers.

Methods:
We performed a cross-sectional analysis of pooled data from the 2010 to 2018 National Health Interview Survey. Exposure was Black subethnic categories; African American (AA), African Immigrant (AI), and Afro-Caribbean (AC) adults; with non-Hispanic U.S. born White adults as the reference group. The outcome was self-reported alcohol use, categorized as never, former, or current drinker. Survey-weighted multinomial logistic regression was used to examine the relative risk ratios of alcohol use adjusting for covariates.

Results:
We included 415,250 White adults and 84,709 Black adults. Of those, 73,893 (87.2%) were AA, 6,739 (8.0%) were AC, and 4,077(4.8%) were AI. After adjusting for age, sex, marital status, education, employment, income, and insurance, the prevalence rates of current drinking were 68.3, 32.5, 48.1, and 57.1 for White, AI, AC, and AA, respectively. The odds of never drinker and former drinker compared to current drinker were higher among all Black groups than White adults. AI. were more likely to be never drinkers (RRR: 9.48; 95% CI: 8.10-11.10) followed by AC (RRR:3.70 95% CI: 3.22-4.24) and AA (RRR: 1.91 95% CI: 1.81-2.01).

Conclusion:
Black adults are less likely to be current alcohol drinkers when compared to White adults. However, there is significant variation in alcohol usage within the Black population by region of origin. These findings highlight the need for further intra-race evaluation into the underlying causes of alcohol use differences.
Abstract P457: Sociodemographic Differences in Cardiac Device Implantation in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Sigounas Vaia , Collins Jason M , Anthony Kurtis , Buchheit Sophie , Stewart James , Rosamond Wayne D , Whitsel Eric A , Whitsel Eric A
Published: May 2024

Introduction:
Progression of cardiac arrhythmia or heart failure often leads to treatment with a cardiovascular implantable electronic device (CIED) such as a pacemaker or pacemaker combined with an implantable cardioverter-defibrillator (ICD). Although small, hospital-based studies suggest that CIED implantation differs by sociodemographic factors, few community-based, cohort studies have prospectively evaluated it by sex, race, age, or health insurance status.

Methods:
We therefore examined incident CIED implantation in the Atherosclerosis Risk in Communities study (ARIC) among 15,527 eligible participants from four U.S. communities (mean age 54.2 years; 55% female; 27% Black; 90% insured) who self-identified as either Black or white and had a resting, standard twelve-lead electrocardiogram (ECG), but no ECG evidence of a pacemaker or ICD at baseline. We identified incident CIED implantation, defined as the initial device placement per participant, using International Classification of Disease (ICD)-9, ICD-10, and Current Procedural Terminology (CPT) codes during follow-up, right-censored at the time of CIED implantation, death, or end of cohort surveillance (December 31, 2020), whichever came first. We computed follow-up times and person-time denominators, then estimated the corresponding incident implantation rates overall, by sociodemographic factors, and device type.

Results:
Over a mean [standard deviation] follow-up of 24.0 [9.0] years, we identified 1,068 incident CIED (75% pacemaker; 25% ICD) implantations. Incident CIED implantation rates were higher among male, white, older, and insured participants (38, 30, 38, and 29 per 10,000 person-years) than among female, Black, younger, and uninsured participants (21, 23, 20, and 21 per 10,000 person-years). Relative to their counterparts, CIED incidence rates were lower among female, Black, younger, and uninsured participants: incidence rate ratio (95% confidence interval) = 0.55 (0.49-0.62), 0.77 (0.66-0.89), 0.53 (0.47-0.60), and 0.72 (0.56-0.92), respectively. When analyzed separately, patterns of incident implantation were similar for both pacemakers and ICDs.

Conclusion:
The sociodemographic patterning of incident CIED implantation is manifest and consistent across device type in this U.S. community-based cohort. Although the clinical, behavioral, and sociocultural reasons for the relative infrequency of implantation among female, Black, younger, and uninsured participants remain unclear, ongoing analyses are examining these differences.
Abstract P459: Data Harmonization Strategies and Results in 5 CVD Cohorts
Authors: Eaton Charles B , LaMonte Michael J , Roberts Mary , Moafi_Mandani Mir , Allen Norrina B
Published: May 2024

Introduction:
As part of IPD data analysis of racial/ethnic disparities in Heart Failure we sought to harmonize sociodemographic, lifestyle, physiologic, biomarkers, and co-morbid covariates and HF outcomes. This report shares our data harmonizing strategies, matching characteristics, common formats and compares for diabetes, the cohort specific (unmatched) prevalence and prospective association with heart failure and compares them to the harmonized variable (common format).

Methods:
Nine cohorts (ARIC, JHS, WHI, Health ABC, MESA, FOHS, CARDIA, REGARDS, CHS) data is being harmonized for 128 covariates and HF outcomes of HF, HFrEF, HFmrEF, HFpEF. Twelve baseline variables ( age, sex, cigarette smoking, systolic blood pressure, diastolic blood pressure, pulse, height, weight, BMI, waist circumference, glucose, ECG, used identical formats and were completely matched. Seventy nine baseline variables (race, ethnicity, education, income, sleep, alcohol, CHD, DM, PAD, atrial fibrillation, etc) partially matched and a common format allowed for harmonization. Seventeen covariates (diet and physical activity) that measured the same construct but the questionnaires used differed enough that equipercentile equating was used to harmonize data.

Results:
In 64,114 participants from 5 cohorts, age range 20-95, mean age 62.7, the prevalence of diabetes mellitus was 10.5% using the common format, and 13.5% using cohort specific definitions. Prevalence varied by cohort from 7.9% to 23.4%. The harmonized prevalence differed by race and sex. The age, sex and race adjusted odds ratio for the prospective association with heart failure was OR=2.8, 95% CI 2.6,3.0. Sex and race specfic odds ratios differed by sex with females having a higher odds ratio, but were similar by race.

Conclusion:
Risk factors for heart failure are harmonizable in NIH CVD cohorts. Most variables are partially matched and require re-coding using a common format. Prevalence of DM varies by race and sex but association with HF only differs by sex.
Abstract P477: Motivations and Barriers to Consuming a Plant-Based Diet: The EAT Plants 1 Study
Authors: Rebholz Casey M , Yang Jiaqi , Ting Audrey , Bernard Lauren , Sullivan Valerie K
Published: May 2024

Introduction:
Consuming a plant-based diet is associated with a lower risk of cardiometabolic disorders and lower greenhouse gas emissions. Furthermore, a vegetarian diet is considered a healthy dietary pattern according to the U.S. Dietary Guidelines for Americans and strongly aligns with the 2021 AHA Dietary Guidance. Yet, little is known about current barriers to adhering to this dietary pattern.

Methods:
Adults who were either currently consuming or interested in consuming a plant-based diet were eligible to participate in an interview to assess behavioral, normative, and control beliefs related to consuming a plant-based diet. Participants were recruited using flyers distributed via social media (Facebook), an e-newsletter, a farmer’s market, and on the Johns Hopkins University campus, and by word of mouth. Interviews were conducted in person or via videoconference in July and August 2023 with a semi-structured guide, audio recorded, transcribed, and coded using NVivo software.

Results:
The study sample consisted of 12 participants who ranged in age from 21 to 62 years, 58% were women, 75% were white, and 17% were Asian American. Participants self-identified as vegan, vegetarian, or consumers of other types of plant-based diets, and had been following this dietary pattern for a long duration, ranging from 2 to 38 years. Reasons for consuming a plant-based diet were related to ethics (animal rights), the environment (desire to reduce environmental impact of their diet), health (prevent or manage disease and to lose or maintain weight), and culture (being raised in a vegetarian community). Many participants mentioned being influenced by books they read to consume a plant-based diet. Participants were largely surrounded by supportive friends, family, and partners who prepared and consumed plant-based meals with them. Barriers to consuming plant-based diet were related to accessibility particularly when traveling and when eating out (restaurants, work events) and taste of certain plant-based foods. Meat and dairy alternatives were common components of plant-based diets.

Conclusion:
The factors that influence adherence to a plant-based diet are informative for promoting a heart healthy and environmentally low-impact dietary pattern, consistent with current dietary guidance.
Abstract P500: Proton Pump Inhibitor Use and Incident Cardiovascular Disease in Postmenopausal Women, Results From the Women’s Health Initiative
Authors: Soliman Ahmed I , Wactawski-Wende Jean , Hovey Kathleen M , Millen Amy E , Eaton Charles B , Gray Shelly L , LaMonte Michael J
Published: May 2024

Introduction:
Evidence from in-vitro and animal studies suggests that proton pump inhibitor (PPI) use is associated with incident cardiovascular disease (CVD). Observational studies in humans have shown conflicting results and didn’t account for relevant confounders such as diet and physical activity or confounding by indication.

Methods:
This study included 148,452 postmenopausal women without history of CVD at enrollment into the Women’s Health Initiative (WHI) observational study and clinical trials in 1993-1998. The primary exposure was PPI use (no, yes) determined by medication inventory conducted at baseline. The main outcome was incident primary CVD defined as a composite endpoint of physician-adjudicated myocardial infarction, coronary revascularization, stroke, and CVD mortality. Follow-up time was to September 2010. Cox proportional hazards regression was used to estimate hazards ratios (HR) and 95% confidence intervals (CI) for the association of PPI use and CVD. All models were adjusted for baseline age and stratified according to WHI study component. Additional models were further adjusted for demographics (education, income), lifestyle (smoking, alcohol, diet quality, physical activity, sleep duration), and major CVD risk factors (body mass index, family history of CVD, treated hypercholesterolemia, treated diabetes, treated hypertension).

Results:
Baseline prevalence of PPI use was 1.91%. After a mean follow-up of 11.3 years, there were 10,944 CVD events. PPI use was associated with a 28% higher risk of CVD compared to non-use in the age adjusted model (HR: 1.28, 95%CI: 1.13-1.45). The association was attenuated but remained significant after adjusting for potential confounders and was materially unchanged when using propensity score adjustment to better address confounding by indication (Table).

Conclusions:
PPI use was associated with higher risk of incident CVD in postmenopausal women. Further investigations are warranted to confirm this finding and identify potential mechanisms.
Abstract P516: Vascular Risk Assessment in Youth With Familial Hypercholesterolemia and Combined Dyslipidemia of Obesity
Authors: Tran Andrew H , Hor Kan N , Khalid Omar , Garg Ami , Urbina Elaine M
Published: May 2024

Introduction:
Pulse wave analysis (PWA) assesses vascular health by estimating arterial wave reflections noninvasively and is associated with cardiovascular (CV) events in adults in recent studies. However, data in youth are lacking. Individuals with CV risk factors such as familial hypercholesterolemia (FH) or combined dyslipidemia of obesity (CDO) have increased risk of adult-onset CV disease. Using PWA may help improve risk stratification of young patients with adverse CV risk factors and enhance disease management.

Hypothesis:
We hypothesized that youth with adverse CV risk factors would have differences in arterial wave reflections compared to controls.

Methods:
Demographic, anthropometric, and fasting lipid values were obtained in 124 patients aged 9-25 years in a study comparing vascular health among normolipidemic controls (N=47), FH (N=45), and CDO (N=32). PWA was obtained using the SphygmoCor XCEL device, and wave separation analyses were performed from brachial artery assessments. Group differences were assessed by chi-square, ANOVA, or Kruskal-Wallis test as appropriate by variable type and distribution normality.

Results:
There were significant differences between groups in adiposity (CDO with higher BMI, p<0.001) and lipid levels with a more adverse lipid profile (higher TC, LDL, & TG; lower HDL) for the FH and CDO groups versus controls (all p<0.001). The CDO group had higher forward pulse wave amplitude (Pf) versus the control and FH groups (p=0.0002, Figure) and higher backward pulse wave amplitude (Pb) versus controls (p=0.0013). Differences in Pf or Pb between FH and controls did not reach significance.

Conclusions:
Adolescents and young adults with CDO have altered forward and backward wave reflections compared to normolipidemic controls. It is possible that PWA differences between the FH and control groups may become significant over time. These novel parameters suggest early vascular changes in youth with CDO and may help improve risk stratification in youth with adverse CV risk factors.
Abstract P526: Association of Hemoglobin A1c With Sleep Duration in Non-Diabetic Population
Authors: Tantisattamo Ekamol , Noree Wanprapit , Rochanaroon Voramol , Chuenchaem Urairat , Wanichwecharungruang Nisha , Kulthamrongsri Narathorn , Tribuddharat Narisara , Srikulmontri Thitiphan , Suenghataiphorn Thanathip , Puchongmart Chanokporn , Thiravetyan Ben , Naunsilp Piengpitch , Vutthikraivit Possawat , Wang Jiayuan , Bao Alan , Ghaffarian Bahaar , Ha Young , Yanez Andrea , Au Michael , Tanariyakul Manasawee , Wattanachayakul Phuuwadith , Rodsom Kamonluk , Jariyayothin Irin
Published: May 2024

Background:
Shorter sleep duration is associated with higher hemoglobin A1c (HbA1c) in patients with type 2 diabetes. We aim to examine the association between HbA1c level and sleep duration in non-diabetic population.

Methods:
A cross-sectional study using 2017-2020 NHANES included self-questionnaires of the presence or absence of diabetes and sleep duration on weekdays and weekends. The association between the quartile (Q) of HbA1c and sleep duration in non-diabetic patients was examined by multiple linear regression.

Results:
Of 7,998 non-diabetic participants ≥18 years old, mean±SD age was 47±19 and 52% were female. Mean HbA1c levels from Q1 to Q4 were 5.0±0.2, 5.4±0.1, 5.7±0.1, and 6.5±0.9%, respectively (Figure 1). Mean sleep durations on the weekdays and weekends were 7.6±1.7 and 8.3±1.8 hours, respectively. Compared to participants with HbA1c in Q1, sleep durations in both weekdays and weekends were lower in Q2 to 4 with the lowest sleep duration in Q3 (β
weekdays_Q3
-0.32; 95%CI -0.43, -0.21; P <0.001 and β
weekends_Q3
-0.43; 95%CI -0.54, -0.31; P <0.001). After adjusting for age, gender, race, SBP, DBP, BMI, serum creatinine, urinary albumin:creatinine ratio, hemoglobin, ferritin and interaction term between HbA1c quartile and race (white vs. non-white), the direction of HbA1c - weekday sleep duration association remains with the lowest sleep duration in Q3 (β
weekdays_Q3
-0.34; 95%CI -0.48, -0.19; P <0.001). Furthermore, race was identified as an effect modifier with an increased weekday sleep duration observed in White with HbA1c in Q3 (β
weekdays_Q3
0.26; 95%CI 0.04, 0.49; P
interaction
0.022). Only HbA1c Q3 was significantly associated with weekend sleep duration (β
weekends_Q3
-0.18; 95%CI -0.34, -0.03; P 0.022).

Conclusions:
In non-diabetic population, HbA1c was inversely associated with sleep duration on both weekdays and weekends and in a U-shaped relationship except for White whose HbA1c was positively related to sleep duration on the weekdays. Glycemic status may be involved in sleep duration or quality.
Abstract P539: Association of Physical Activity With Aortic Stiffness in the Jackson Heart Study
Authors: Patrick Zakary , Heitman Elizabeth , Affuso Olivia , Walker Benjamin , Cooper Leroy L , Reneker Jennifer C
Published: May 2024

Introduction:
Arterial stiffness, defined as high rigidity of the arterial wall, results from vascular aging, and is associated with cardiovascular disease (CVD) later in the lifespan. The reference standard for central aortic stiffening is carotid-femoral pulse wave velocity (CFPWV).

Hypothesis:
Higher levels of physical activity are associated with lower levels of aortic stiffness, as measured by CFPWV, among African Americans.

Methods:
A secondary analysis was conducted on data from 1,226 participants in the Jackson Heart Study (JHS) who underwent arterial tonometry assessment for CFPWV (2011-2016) and had physical activity data available. Physical activity was assessed using a 30-item questionnaire that measured four domains: active living habits, work, home life, and sport/exercise activities. Scores were summed across all domains, with higher scores representing higher physical activity (range = 0-16). Higher CFPWV, measured in meters per second (m/s), indicated increased arterial stiffness. Linear regression models (adjusted for sex and age, and multivariable-adjusted for CVD risk factors) were used to assess the association of physical activity with CFPWV.

Results:
The sample was 60.3% female with a mean age of 59.02 (SD=10.02). The mean physical activity score was 6.16 (2.27) and mean CFPWV value was 10.3m/s (3.84). There was a significant inverse association between physical activity score and CFPWV across both models. With each 1-unit increase in the total physical activity score, CFPWV was -0.14 m/s lower [95% CI -0.22, -0.06] in the model adjusted for age and sex. In the multivariable adjusted model, the magnitude of the association was similar, B = -0.13, 95% CI [-0.20, -0.05].

Conclusions:
In this sample of African Americans, greater physical activity was associated with lower levels of aortic stiffness. Given that aortic stiffness is an independent predictor of CVD, longitudinal investigations of the association between physical activity and CFPWV are needed, including exploring whether physical activity interventions can improve aortic stiffness.
Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall
Authors: Nies Moritz , Watanabe Keita , Kawamura Iwanari , Santos-Gallego Carlos G. , Reddy Vivek Y. , Koruth Jacob S.
Published: May 2024

BACKGROUND:

Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA’s ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue.

METHODS:

A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall.

RESULTS:

(1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions.

CONCLUSIONS:

This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.
Randomized, Multicenter Study to Assess the Effects of Different Doses of Sildenafil on Mortality in Adults With Pulmonary Arterial Hypertension
Authors: Hoeper Marius M. , Ewert Ralf , Jansa Pavel , Sirenko Yuriy , Skride Andris , Balagtas Cecile , Hackley Sarah , Vogt Susanne , Abreu Paula , Haughie Scott , Hassan Tarek , Oudiz Ronald J.
Published: May 2024

BACKGROUND:

Sildenafil, approved for pulmonary arterial hypertension (PAH), has a recommended adult dose of 20 mg TID, with a previously approved 5-mg TID dose by the US Food and Drug Administration. Safety concerns arose because of common off-label use of higher doses, particularly after pediatric data linked higher doses to increased mortality. To assess this, the Food and Drug Administration mandated a study evaluating the effects of various sildenafil doses on mortality in adults with PAH.

METHODS:

This randomized, double-blind study compared sildenafil at doses of 5, 20, or 80 mg TID in adults with PAH. The primary objective was noninferiority of 80 mg of sildenafil versus 5 mg for all-cause mortality. Secondary end points included time to clinical worsening and change in 6-minute walk distance at 6 months. Interim analyses were planned at 50% and 75% of the anticipated mortality events. Safety and tolerability were assessed in the intention-to-treat population.

RESULTS:

The study was halted after the first interim analysis, demonstrating noninferiority for 80 mg of sildenafil versus 5 mg. Of 385 patients enrolled across all dose groups, 78 died. The primary analysis showed a hazard ratio of 0.51 (99.7% CI, 0.22–1.21;
P
<0.001 for noninferiority) for overall survival comparing 80 mg of sildenafil with 5 mg. Time to clinical worsening favored 80 mg of sildenafil compared with 5 mg (hazard ratio, 0.44 [99.7% CI, 0.22–0.89];
P
<0.001). Sildenafil at 80 mg improved 6-minute walk distance from baseline at 6 months compared with 5 mg (least square mean change, 18.9 m [95% CI, 2.99–34.86];
P
=0.0201). No significant differences were found between 80 mg of sildenafil and 20 mg in mortality, clinical worsening, and 6-minute walk distance. Adverse event–related drug discontinuations were numerically higher with 80 mg of sildenafil.

CONCLUSIONS:

Sildenafil at 80 mg was noninferior to sildenafil at 5 mg when examining all-cause mortality in adults with PAH. Secondary efficacy end points favored 80 mg of sildenafil over 5 mg. On the basis of these findings, the Food and Drug Administration recently revoked the approval of 5 mg of sildenafil for adults with PAH, reinforced 20 mg TID as the recommended dose, and now allows dose titration up to 80 mg TID, if needed.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02060487.
Career and Performance of the Artillery Officers in the Batteries of the Siege of Cartagena (1873–1874)
Authors: Cameno Mayo Diego
Published: May 2024

The pacification of cantonal Cartagena occurred at a very difficult time for Spain. The republican government had to face several conflicts at the same time, as well as internal disorder and indiscipline in the Army. In these pages, an investigation is proposed, from the field of prosopography, on the artillery officers who were in charge of the cannon batteries and who ended up surrendered in Cartagena. The objective is to know their previous and future trajectories, in addition to the training they received to successfully fulfill their mission.
Nine new species of Horismenus Walker (Hymenoptera: Eulophidae) in Brazil, with an emphasis on the fauna of one of the largest tropical forests on the planet, the Atlantic Forest
Authors: PIKART TIAGO G. , SCHOENINGER KARINE , COSTA VALMIR A. , HANSSON CHRISTER , ZANUNCIO JOSÉ C. , SERRÃO JOSÉ E.
Published: May 2024

Horismenus Walker (Hymenoptera: Eulophidae) is one of the largest genera in Eulophidae, and additional collecting in tropical America will undoubtedly add numerous new species. Here we describe nine new species of Horismenus from material collected in Brazil, mainly in Atlantic Forest remnants: H. amplicavus sp. nov., H. atlanticus sp. nov., H. bilineatus sp. nov., H. crastoensis sp. nov., H. novaiguassuensis sp. nov., H. parvicavus sp. nov., H. pterathrix sp. nov., H. sagittatus sp. nov., and H. saueri sp. nov. In addition, we also provide images, diagnoses, and comments to facilitate the identification of each new species.
Path-following control of 4WIS/4WID autonomous vehicles considering vehicle stability based on phase plane
Authors: Sun Yang , Wang Chao , Wang Haiyang , Tian Bin , Ning Haonan
Published: May 2024

In order to ensure the following accuracy and improve the operational stability of four-wheel independent driving and four-wheel independent steering autonomous vehicles, this paper proposes a path-following control strategy based on the β−[Formula: see text] phase plane. First, based on the kinematic relationship between the vehicle and the reference path, the linear matrix inequality theory is used to design the H∞ controller to obtain the wheel steering angle. Then, the vehicle steering system is subjected to nonlinear analysis according to phase plane theory, and a partition region controller is designed. In the unstable region, the instability degree of the vehicle is predicted by quadratic polynomial extrapolation and the particle swarm optimization PID controller is designed to determine the required yaw moment to restore the vehicle to the stable region. In the stable region, a fuzzy sliding mode controller is adopted to determine the required yaw moment so that the actual state variable of the vehicle follows the ideal state variable. Finally, the optimal tire force distributor is designed such that the required forces are allocated to all four wheels. The simulation results show that the proposed method can obtain excellent path-following performance and stability performance under different driving conditions.
The anatomy of internal interference in public service media: How do journalists interpret whether editorial interference constitutes unacceptable encroachment on their autonomy?
Authors: Urbániková Marína
Published: May 2024

This study examines the suspected transmission of political pressure through management to journalists in public service media, where independence is crucial for fulfilling its democratic mission. Such interference is often covert and performed without hard evidence, making it difficult to prove. To provide insight into these practices, this study explores the case of RTVS, the public service broadcaster in Slovakia, during a conflict that arose after the appointment of a new director general in 2017. Using semi-structured interviews with journalists and managers ( N = 16), it introduces an inductively developed classification scheme for internal interference and examines the context and conditions under which the journalists considered it to be politically motivated and as an illegitimate encroachment on their autonomy. The study shows that perceived internal interference by management takes two forms: interference in editorial content at various levels (and through multiple tools and means) and the use of disciplinary mechanisms. When journalists experience internal interference with a possible political background, trust in their superiors and the perception of their motives are crucial factors influencing their reactions and interpretation of the situation. However, for a variety of reasons that the study analyzes in detail, the RTVS journalists distrusted their superiors' moral integrity, professional skills, and political independence, which resulted in the departure of a large part of the TV newsroom. The article concludes with suggestions for methodological implications for further research on perceived interference.
Effectiveness and tolerability of eptinezumab in treating patients with migraine resistant to conventional preventive medications and CGRP (receptor) antibodies: a multicentre retrospective real-world analysis from Germany
Authors: Scheffler Armin , Wenzel Pauline , Bendig Merle , Gendolla Astrid , Basten Jale , Kleinschnitz Christoph , Nsaka Michael , Lindner Diana , Naegel Steffen , Burow Philipp , Fleischmann Robert , Holle Dagny
Published: May 2024

Background

Eptinezumab is a monoclonal antibody that targets calcitonin gene-related peptide (CGRP mAb) and is used for migraine prophylaxis. Efficacy data are mainly from clinical trials, real-world data are hardly available yet. Reimbursement policy in Germany leads to eptinezumab mainly being used in patients having failed pre-treatment with other CGRP mAb. To date, it is unclear whether eptinezumab is efficacious and well tolerated in this population and how the treatment response differs from patients who are naive to CGRP mAbs.

Methods

We analysed clinical routine data of 79 patients (episodic migraine (EM): n = 19; chronic migraine (CM): n = 60) from four different centres in Germany. All patients were treated with eptinezumab (100mg). Differences in monthly headache (MHD), migraine (MMD) and acute medication days (AMD) after three months were analysed. The correlation of response with the number of CGRP mAb failures was evaluated. Significance level has been corrected (alpha = 0.017).

Results

After three months MHD, MMD and AMD were significantly reduced. In EM, the median reduction for MHD was 4.0 days (IQR: -6.5 to -1.0; p = 0.001), for MMD 3.0 days (IQR: -5.5 to -1.5; p < 0.001) and for AMD 2.0 days (IQR: -5.0 to -0.5; p = 0.006). In CM, median reduction of MHD was 4 days (IQR: -8.0 to 0.0; p < 0.001), 3.0 days (IQR: -6.0 to-1.0; p < 0.001) for MMD and 1.0 day (IQR: -5.0 to 0.0; p < 0.001) for AMD. All patients were resistant to conventional preventive therapies and most to CGRP mAbs. Fourteen patients had never received a CGRP mAb and 65 patients had received at least one mAb without sufficient effectiveness and/or intolerability (one: n = 20, two: n = 28, three: n = 17). There was a significant association between the number of prior therapies and the 30% MHD responder rate (none: 78.6%, one: 45.0%, two: 32.1%, three: 23.5%, p = 0.010). Regarding tolerability, 10.4% (8/77) reported mild side effects.

Conclusions

The effectiveness of eptinezumab is significantly reduced in patients who have not previously responded to other CGRP mAbs. However, limitations such as the retrospective nature of the analysis, the small sample size and the short treatment period with only the lower dose of eptinezumab must be considered when interpreting the results.
Blockade of the ADAM8-Fra-1 complex attenuates neuroinflammation by suppressing the Map3k4/MAPKs axis after spinal cord injury
Authors: Qian Zhanyang , Li Rulin , Zhao Tianyu , Xie Kunxin , Li PengFei , Li Guangshen , Shen Na , Gong Jiamin , Hong Xin , Yang Lei , Li Haijun
Published: May 2024

Background

Mechanical spinal cord injury (SCI) is a deteriorative neurological disorder, causing secondary neuroinflammation and neuropathy. ADAM8 is thought to be an extracellular metalloproteinase, which regulates proteolysis and cell adherence, but whether its intracellular region is involved in regulating neuroinflammation in microglia after SCI is unclear.

Methods

Using animal tissue RNA-Seq and clinical blood sample examinations, we found that a specific up-regulation of ADAM8 in microglia was associated with inflammation after SCI. In vitro, microglia stimulated by HMGB1, the tail region of ADAM8, promoted microglial inflammation, migration and proliferation by directly interacting with ERKs and Fra-1 to promote activation, then further activated Map3k4/JNKs/p38. Using SCI mice, we used BK-1361, a specific inhibitor of ADAM8, to treat these mice.

Results

The results showed that administration of BK-1361 attenuated the level of neuroinflammation and reduced microglial activation and recruitment by inhibiting the ADAM8/Fra-1 axis. Furthermore, treatment with BK-1361 alleviated glial scar formation, and also preserved myelin and axonal structures. The locomotor recovery of SCI mice treated with BK-1361 was therefore better than those without treatment.

Conclusions

Taken together, the results showed that ADAM8 was a critical molecule, which positively regulated neuroinflammatory development and secondary pathogenesis by promoting microglial activation and migration. Mechanically, ADAM8 formed a complex with ERK and Fra-1 to further activate the Map3k4/JNK/p38 axis in microglia. Inhibition of ADAM8 by treatment with BK-1361 decreased the levels of neuroinflammation, glial formation, and neurohistological loss, leading to favorable improvement in locomotor functional recovery in SCI mice.

Graphical Abstract