tbuckley/cabot-search huggingface dataset:
Abstract 03: LDL-C Genetic Risk Score Predicts Hyperlipidemia and Modifies Lipid Trajectory Over the Life Course: The Bogalusa Heart Study
Authors: Alexander C Razavi, Mengyao Shi, Lydia A Bazzano, Jiang He, Jovia L Nierenberg, Xiao Sun, Wei Chen, Changwei Li, Camilo Fernandez, Marie A Krousel-Wood, Seamus P Whelton, Tanika N Kelly
Journal: Circulation (2020)

Introduction: Variability in lipid levels is decreased in childhood compared to adulthood. However, few studies have assessed whether genetic information may help to predict hyperlipidemia beyond measured lipid values at this critical developmental stage. Hypothesis: We hypothesized that a low-density lipoprotein cholesterol (LDL-C) genetic risk score (GRS) would predict hyperlipidemia and LDL-C over the life course, even after adjustment for childhood measures. Methods: The analysis included 651 Bogalusa Heart Study participants (63% women, 31% African American, baseline age=9.8 + 3.1 years, median follow-up=40 years) with genome-wide association study (GWAS) data and at least one childhood and one adulthood measure of LDL-C. A weighted LDL-C GRS was constructed using loci from previous GWAS meta-analyses. Hyperlipidemia was defined as an LDL-C &gt; 130 mg/dL or statin use. Cox proportional hazards regression models examined the associations between GRS and hyperlipidemia. Linear and mixed linear regression models were employed to examine the associations of GRS with adulthood LDL-C and life-course LDL-C trajectory, respectively. All models adjusted for age, sex, and childhood LDL-C. Results: Among participants of European ancestry, increasing GRS tertile conferred strong, dose-response increases in the hazards of hyperlipidemia ( Figure ). Similarly, the highest GRS tertile was associated with a 20 mg/dl increased LDL-C level in middle-aged adults compared to the lowest tertile (P&lt;0.0001). Each tertile increase in GRS was also associated with 5.5 mg/dL larger 10-year increase in LDL-C (interaction-P=0.04). No associations were observed among participants of African ancestry. Conclusions: A LDL-C GRS was associated with adulthood LDL-C phenotypes independently of childhood LDL-C values in participants of European but not African ancestry. These findings highlight a need for increased genomics research in diverse populations and suggest a predictive utility of genetic information in childhood.
Abstract P372: U.S. National Estimates of Prescription Nonsteroidal Anti-inflammatory Drugs Among Patients With Cardiovascular Disease
Authors: Andrew Y Hwang, Steven M Smith
Journal: Circulation (2020)

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, fever, and inflammation, but their ubiquitous use has led to concerns over increased risk of adverse cardiovascular (CV) events, particularly in patients with established CV disease (CVD). In 2005, the FDA revised labels for all NSAIDs to include a boxed warning highlighting the potential for increased CV risk. However, little is known regarding real-world prescribing of NSAIDs among patients with CVD. Our objective was to characterize the use of prescription NSAIDs among patients with CVD from 1988-2016 in the U.S. Methods: Using cross-sectional National Health and Nutrition Examination Survey (NHANES) data from 1988-1994 and 1999-2016, we included participants aged ≥18 years with hypertension (defined by self-report, mean blood pressure ≥140/90, or use of an antihypertensive medication), or aged ≥20 years with ≥1 of the following self-reported heart disease conditions: congestive heart failure (CHF), coronary heart disease (CHD), angina, myocardial infarction (MI), or stroke. Survey-weighted data were analyzed to assess prevalence and trends of prescription NSAID use within each CVD population in 6-year examination periods. Results: Overall, prescription NSAID use declined among all U.S. CVD populations over the study period. Prevalence of prescription NSAID use was highest during the 1999-2004 examination years, but thereafter, declined during the 2005-2010 examination years for those with hypertension (13.9% to 8.8%), CHF (14.6% to 8.5%), CHD (16.3% to 7.0%), angina (17.6% to 9.73%), MI (16.1% to 8.2%), and stroke (15.7% to 8.8%). Use of prescription NSAIDs since the 2005-2010 examination years has remained consistent in all CVD populations. These decreases were driven in part by reduced use of COX-2-selective NSAIDs, whereas non-selective NSAID use among all CVD populations was relatively steady from 1999 to 2016. Conclusions: Prescription NSAID use among patients with CVD appears to have declined from 1988 to 2016, primarily because of less COX-2 NSAID use following removal of 2 approved agents. Otherwise, the prevalence of prescription NSAIDs has remained somewhat stable and relatively high among these high-risk CV populations. Our results suggest additional efforts may be needed to limit the use of NSAIDs among patients with CVD, given that these agents are known to be associated with adverse CVD outcomes.
Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys
Authors: Emma Slaymaker, Rachel H Scott, Melissa J Palmer, Luigi Palla, Milly Marston, Lianne Gonsalves, Lale Say, Kaye Wellings
Journal: The Lancet Global Health (2020)

BackgroundA quarter of a century ago, two global events—the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing—placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slower than hoped. We used survey data and national-level indicators of social determinants from 74 countries to examine change in satisfaction of contraceptive need from a contextual perspective.MethodsWe searched for individual-level data from repeated nationally representative surveys that included information on sexual and reproductive health, and created a single dataset by harmonising data from each survey to a standard data specification. We described the relative timings of sexual initiation, first union (cohabitation or marriage), and first birth and used logistic regression to show the change in prevalence of sexual activity, demand for contraception, and modern contraceptive use. We used linear regression to examine country-level associations between the gender development index and the expected length of time in education for women and the three outcomes: sexual activity, demand for contraception, and modern contraceptive use. We used principal component analysis to describe countries using a combination of social-structural and behavioural indicators and assessed how well the components explained country-level variation in the proportion of women using contraception with fractional logistic regression.FindingsIn 34 of the 74 countries examined, proportions of all women who were sexually active, not wanting to conceive, and not using a modern contraceptive method decreased over time. Proportions of women who had been sexually active in the past year changed over time in 43 countries, with increases in 30 countries; demand for contraception increased in 42 countries, and use of a modern method of contraception increased in 37 countries. Increases over time in met need for contraception were correlated with increases in gender equality and with women's time in education. Regression analysis on the principal components showed that country-level variation in met contraceptive need was largely explained by a single component that combined behavioural and social-contextual variables.InterpretationProgress towards satisfying demand for contraception should take account of the changing context in which it is practised. To remove the remaining barriers, policy responses—and therefore research priorities—could require a stronger focus on social-structural determinants and broader aspects of sexual health.FundingUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
Abstract MP26: Mediterranean Diet And Brain Magnetic Resonance Imaging Measures In Young And Older Adults
Authors: YIAN GU, Ashley Mensing, Yaakov Stern
Journal: Circulation (2020)

Introduction: Accumulative evidence has suggested that higher adherence to a healthy dietary pattern, such as Mediterranean diet (MeDi), is associated with preservation of brain structure and less cerebrovascular events. Little is known for these associations across lifespan. Hypothesis: We hypothesized that MeDi was associated with brain atrophy or small vessel pathology measured using magnetic resonance imaging (MRI) in a cohort of healthy adults aged 20-80. Methods: This cross-sectional study included 375 healthy, non-demented adults recruited from market mailing within a 50-mile radius of Columbia University Medical Center in New York City. The participants age ranged 20-80 years old (mean 55, SD=16); had on average 16 (SD=2.3) years of education; 210 (56%) were females; 67% were Whites, 20% African-Americans, and 13% others. MeDi score (range 0-9) was calculated based on food consumption information collected through food-frequency questionnaire. Total brain volume (TBV) and white matter hyperintensity (WMH) were derived from high-resolution structural MRI scans. We examined the association of MeDi with TBV (milliliter, adjusted for intracranial volume) and WMH (milliliter, log transformed) using regression models adjusted for age, gender, race, education, and total caloric intake. Stratified analyses were performed among young (20-45), mid-age (46-65), and older (65-80) adults. Results: In multivariable-adjusted linear regression models, one unit increase in MeDi score, indicating consumption of one more food meeting the desirable level, was associated with larger TBV (β=2.79, p=0.027) and of less WMH (β= -0.058, p=0.041), corresponding to roughly 1.8 years and 1.3 years of less aging (β=-1.54 for age on TBV and 0.044 for age on WMH), respectively. Furthermore, we found the association between MeDi and TBV was similar across age groups, while the association between MeDi and WMH was only significant in the young adults (b=-0.189, p=0.002). Conclusions: Higher MeDi adherence was associated with healthier brain, indicated by larger brain volumes and less white matter lesion burden. These findings suggest that following a healthy diet may help maintain brain health across life span. To our knowledge, this is the first study to examine the relation of MeDi adherence to brain measures in healthy adults of all ages. The novel findings, especially the finding of MeDi and WMH in young adults, are worth of further confirmation in larger and longitudinal studies.
Abstract P438: The Impact of a Yearlong Diabetes Prevention Program-based Lifestyle Intervention on Cardiovascular Health Metrics
Authors: Susan Devaraj, Bonny Rockette-Wagner, Vincent Arena, Rachel G Miller, Jenna Napoleone, Molly Conroy, Andrea M Kriska
Journal: Circulation (2020)

Introduction: The AHA created “Life’s Simple Seven” metrics to measure progress toward the goal of improving the cardiovascular (CV) health of all Americans, classifying each metric as “ideal”, “intermediate,” or “poor”. Few studies have examined the impact of behavioral lifestyle interventions on CV health metrics. We evaluated changes in CV health metrics during the course of a CDC recognized Diabetes Prevention Program-based lifestyle intervention known as Group Lifestyle Balance (DPP-GLB). Hypothesis: DPP-GLB will be associated with improvements in CV health metrics after 6 months of intervention and maintenance of these improvements at 12 months post-baseline. Methods: We used combined data from two similar intervention trials (occurring 6 years apart) offering a 12 month DPP-GLB program in the community setting to overweight/obese individuals with prediabetes and/or metabolic syndrome. Changes in individual CV health metrics (BMI, blood pressure, total cholesterol, fasting blood glucose, physical activity; measures of smoking and diet were not available) and total metric score (sum of metric profile where ideal=2, intermediate=1 and poor=0 for each metric, possible “total “range of 0-10) were considered after 6 and 12 months of intervention. Results: Among 222 participants (76%) with complete data for all 5 metrics at intervention baseline, 6 and 12 month follow up, there was a significant beneficial shift from baseline to 6 and 12 months in the proportion of participants within CV health metric categories for BMI, physical activity and blood pressure (Figure 1). Total metric score also improved significantly (p&lt;0.01, signed-rank test) at 6 [median (IQR) change: +1.0 (0-1.0)] and 12 months [median (IQR) change: 0.0 (0-1.0)]. Significant improvement was also seen in the median number of ideal metrics at 6 and 12 months (p&lt;0.01 for both). Conclusions: The DPP-GLB intervention was successful in improving CV health metrics at both 6 and 12 months, demonstrating the potential of this program to decrease CVD risk.
Variations in incidence of venous thromboembolism in low-, middle-, and high-income countries
Authors: Deborah M Siegal, John W Eikelboom, Shun Fu Lee, Sumathy Rangarajan, Jackie Bosch, Jun Zhu, Salim Yusuf
Journal: Cardiovascular Research (2020)

To examine the rates of venous thromboembolism (VTE) in high-income, upper middle-income, and lower middle/low-income countries (World Bank Classification).We examined the rates of VTE in high-income, upper middle-income, and lower middle/low-income countries (World Bank Classification) in a cohort derived from four prospective international studies (PURE, HOPE-3, ORIGIN, and COMPASS). The primary outcome was a composite of pulmonary embolism, deep vein thrombosis, and thrombophlebitis. We calculated age- and sex-standardized incidence rates (per 1000 person-years) and used a Cox frailty model adjusted for covariates to examine associations between the incidence of VTE and country income level. A total of 215 307 individuals (1.5 million person-years of follow-up) from high-income (n = 60 403), upper middle-income (n = 42 066), and lower middle/low-income (n = 112 838) countries were included. The age- and sex-standardized incidence rates of VTE per 1000 person-years in high-, upper middle-, and lower middle/low-income countries were 0.87, 0.25, and 0.06, respectively. After adjusting for age, body mass index (BMI), smoking, antiplatelet therapy, anticoagulant therapy, education level, ethnicity, and incident cancer diagnosis or hospitalization, individuals from high-income and upper middle-income countries had a significantly higher risk of VTE than those from lower middle/low-income countries [hazard ratio (HR) 3.57, 95% confidence interval (CI) 2.40-5.30 and HR 2.27, 95% CI 1.59-3.23, respectively]. The effect of country income level on VTE risk was markedly stronger in people with a lower BMI, hypertension, diabetes, non-White ethnicity, and higher education.The rates of VTE are substantially higher in high-income than in low-income countries. The factors underlying the increased VTE risk in higher-income countries remain unknown.
Abstract P458: Genetically Determined Reproductive Aging and Cardiovascular Risk Factors and Coronary Heart Disease Risk: A Two-sample Mendelian Randomization Study
Authors: N. Charlotte Onland-Moret, Veerle Dam, Yvonne T van der Schouw
Journal: Circulation (2020)

Introduction: Accelerated reproductive aging, in women indicated by early natural menopause, is associated with an increased risk of coronary heart disease (CHD) in observational studies. Conversely, an adverse CHD risk factor profile has been suggested to accelerate menopause. We conducted a bidirectional Mendelian randomisation (MR) study to investigate the direction and evidence for a causal nature of the relationship between reproductive aging and (non-)fatal CHD and CHD risk factors. Genomic variants for age at natural menopause (ANM) have been implicated in genome stability, immune function and mitochondrial biogenesis, which are not sex-specific processes. We used ANM variants as a measure for genetically determined reproductive aging in women and also in men, since genome-wide association studies (GWAS) for reproductive aging traits in men are lacking. Hypothesis: Reproductive ageing is causally related to CHD in both women and men. Methods: We conducted a bidirectional two-sample Mendelian Randomization, using both cohort data as well as summary statistics, with four methods: simple median-based, weighted median-based, standard inverse-variance weighted (IVW) regression, and MR-Egger regression. Exposures: Genetically determined reproductive aging, CHD and CHD risk factors. Main outcomes: CHD, CHD risk factors and age at natural menopause. Results: Summary statistics were pooled from three studies with together 417,579 participants from European descent, including 49,150 CHD cases. Publicly available GWAS and EPIC-CVD were pooled for total cholesterol, high density lipoprotein cholesterol, triglycerides, HbA1c, and glucose. Across different MR methods genetically determined reproductive aging was not causally related to CHD risk in women (Relative Risk Estimate (RRE) IVW =0.99, 95% confidence interval (CI): 0.97;1.01), or any of the CHD risk factors. Also, no associations were found in men. Furthermore, CHD was not causally related to reproductive ageing. Conclusions: Reproductive aging is not causally related to CHD risk or CHD risk factors in women, nor in men. We found no evidence for a reverse association. The associations between early menopause and CHD risk in observational studies might be the result of residual confounding, reverse causation, or reflect a shared etiology that results in both earlier menopause and higher CHD risk.
Abstract P417: Relationship Between Blood Pressure Variability and Sleep Architecture
Authors: Xiaoyue Liu, Jeongok G Logan, Younghoon Kwon, Jennifer Lobo, Hyojung Kang, Soyoun Kim, Min-Woong Sohn
Journal: Circulation (2020)

Introduction: Blood pressure (BP) variability (BPV) is a novel marker for cardiovascular disease (CVD) independent of high BP. Sleep architecture represents the structured pattern of sleep stages consisting of rapid eye movement (REM) and non-rapid eye movement (NREM), and it is an important element in the homeostatic regulation of sleep. Currently, little is known regarding whether BPV is linked to sleep stages. Our study aimed to examine the relationship between sleep architecture and BPV. Methods: We analyzed in-lab polysomnographic studies collected from individuals who underwent diagnostic sleep studies at a university hospital from 2010 to 2017. BP measures obtained during one year prior to the sleep studies were included. BPV was computed using the coefficient of variation for all individuals who had three or more systolic and diastolic BP data. We conducted linear regression analysis to assess the relationship of systolic BPV (SBPV) and diastolic BPV (DBPV) with the sleep stage distribution (REM and NREM sleep time), respectively. Covariates that can potentially confound the relationships were adjusted in the models, including age, sex, race/ethnicity, body mass index, total sleep time, apnea-hypopnea index, mean BP, and history of medication use (antipsychotics, antidepressants, and antihypertensives) during the past two years before the sleep studies. Results: Our sample (N=3,565; male = 1,353) was racially and ethnically diverse, with a mean age 54 ± 15 years and a mean BP of 131/76 ± 13.9/8.4 mmHg. Among the sleep architecture measures examined, SBPV showed an inverse relationship with REM sleep time after controlling for all covariates ( p = .033). We subsequently categorized SBPV into four quartiles and found that the 3 rd quartile (mean SBP SD = 14.9 ± 2.1 mmHg) had 3.3 fewer minutes in REM sleep compared to the 1 st quartile ( p = .02). However, we did not observe any relationship between DBPV and sleep architecture. Conclusion: Greater SBPV was associated with lower REM sleep time. This finding suggests a possible interplay between BPV and sleep architecture. Future investigation is warranted to clarify the directionality, mechanism, and therapeutic implications.
Abstract 49: Consumption of Ultra-processed Foods and Beverages is Associated With Increased Risk of Cardiovascular Mortality in the Moli-sani Study Cohort
Authors: Marialaura Bonaccio, Augusto Filippo Di Castelnuovo, Simona Costanzo, Amalia De Curtis, Mariarosaria Persichillo, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello
Journal: Circulation (2020)

Introduction: Consumption of ultra-processed food and beverages (UPFB) is gaining growing attention due to its possible relation with increased risk of disease/mortality. To date, the possibility of such an association was only addressed in two European and one US population-based cohorts. Hypothesis: We assessed the hypothesis of a positive association between UPFB consumption and mortality risk in a large sample of the Italian population and tested whether some known cardiovascular disease (CVD) risk factors and nutrients could be on the pathway of this relation. We also separately analyzed UPFB presumed to be healthy ( e.g. , breakfast cereals, fruit juices) from nutrient-poor foods ( e.g., cakes, snacks). Methods: Longitudinal analysis on 22,810 men and women (mean age 55±12 y) recruited in the Moli-sani Study cohort between 2005-2010. Food intake was assessed using a semi-quantitative 188-item food frequency questionnaire. UPFB intake was defined by the NOVA classification according to degree of food processing and then categorized as number of servings/d. Hazard ratios with 95% confidence intervals (95% CI) were calculated using multivariable Cox-proportional hazard models. Results: Over a median follow up of 8.3 y, 1,235 deaths were ascertained. As opposed to lower intake (&lt;2 servings/d), individuals reporting high intake of UPFB (&gt;4 servings/d) experienced an increased risk of CVD mortality (HR=1.50; 95%CI 1.18-1.92) and of death for ischemic heart (IHD)/cerebrovascular disease (1.56; 1.13-2.14). An upward trend was found for all-cause mortality too (1.15; 1.00-1.34). Biomarkers of renal function (cystatin C and creatinine) or of lipid metabolisms were likely to be on the pathway between UPFB and CVD mortality. Among selected macronutrients, high content of sugar and saturated fats possibly drove the relation of UPFB with CVD mortality. High intake of ‘healthy’ UPFB was associated with an increased trend of risk comparable to that associated with ‘unhealthy’ UPFB. Conclusions: In a large Mediterranean cohort of Italian adults, high consumption of UPFB was associated with increased risk of CVD death and IHD/cerebrovascular mortality. This association was partly explained by established CVD risk factors and a high dietary content of sugar and saturated fats. UPFB presumed to be healthy appeared similarly linked to higher death risk. National dietary guidelines might consider discourage excessive consumption of ultra-processed food while recommending natural or minimally processed foods.