tbuckley/cabot-search huggingface dataset:
Abstract 13195: Race, Body Mass Index, and the Risk of Atrial Fibrillation: The Multi-Ethnic Study of Atheroclerosis
Authors: Matthew J Singleton, Charles German, Mercedes R Carnethon, Elsayed Z Soliman, Alain G Bertoni, Joseph Yeboah
Journal: Circulation (2020)

Introduction: Higher body mass index (BMI) is associated with an increased risk of incident atrial fibrillation (AF), but it is not known if this relationship varies based on race/ethnicity. Hypothesis: The relationship between BMI and incident AF will vary by race/ethnicity. Methods: Eligible MESA participants had no AF at baseline. The risk of incident AF as a function of baseline BMI was modelled using Cox proportional hazards. Formal tests of interaction by race/ethnicity were performed. Restricted cubic splines models were used to explore non-linear relationships. Results: Among 6,739 participants, 0.8% were underweight, 27.8% had normal BMI, 39.0% were overweight, 21.1% had grade I obesity, 7.6% had grade II obesity, and 3.7% had grade III obesity. Over 79,860 person-years of follow-up (median 13.8), 991 participants (14.7%) had new-onset AF. With BMI modeled as a categorical variable, only those with grade II and grade III obesity had an increased risk of AF (HR 1.48, 95% CI 1.13 - 1.94, p = 0.005 for grade II obesity and HR 2.21, 95% CI 1.11 - 4.40, p = 0.02 for grade III obesity ). The relationship between BMI and AF risk was non-linear, best characterized as J-shaped. However, the risk of AF as a function of BMI varied substantially by race/ethnicity (p-value for interaction = 0.02), with Chinese-American participants having a much higher risk of AF with higher BMI and African-American participants having minimal increased risk of AF with higher BMI (Figure 1). Conclusions: Obesity is associated with an increased risk of incident AF. The relationship between BMI and the risk of AF is J-shaped and this relationship differs by race/ethnicity, such that Chinese-Americans have a more pronounced increased risk of AF with higher BMI, while African-Americans have minimal increased risk. Further exploration of the differential effects of BMI by race/ethnicity on cardiovascular outcomes is needed.
Abstract 17425: Prevalence of Heart Failure in Polyarteritis Nodosa. A Descriptive Analysis From the National Inpatient Sample
Authors: Akshaya Gopalakrishnan, Aman M Amanullah, Janani Rangaswami, Sarath Reddy, Viswanath Vasudevan
Journal: Circulation (2020)

Introduction: Polyarteritis Nodosa (PAN) is a systemic necrotizing vasculitis of medium sized arteries. Congestive heart failure (CHF) in PAN could be due to coronary artery disease, coronary artery aneurysm or renal artery vasculitis. We utilized a national database to study the prevalence of CHF in patients with PAN. Hypothesis: We hypothesized that patients with PAN might have increased prevalence of CHF. Methods: All inpatients more than 18 years of age from the National Inpatient Sample (NIS) between 2009-10 with a diagnosis of PAN were extracted using 9th revision of International Classification of Diseases (ICD-9) code 446.0. Prevalence of CHF and other cardiac risk factors were identified using ICD-9 codes. Logistic regression analysis was performed to examine the association between PAN and CHF. Results: PAN was prevalent in 0.01% (n=3,944) of all inpatient hospitalizations. Patients with PAN were slightly older, more commonly females and had higher rates of CHF (11.3% vs 6.4%; p&lt;0.0001) when compared to the general population. Diabetes mellitus, hypertension, atrial fibrillation, chronic renal insufficiency and chronic lung disease were more prevalent in patients with PAN (p&lt;0.0001 for all). PAN independently predicted CHF both in unadjusted [OR 1.88 (1.49-2.38); p&lt;0.001] and multivariable model adjusted for demographics and other risk factors for CHF [OR 1.36 (1.05-1.78); p=0.02. Conclusions: PAN was associated with increased prevalence and independent predictor of CHF. Further studies are recommended to validate this finding and consider it as a part of routine work up.
Abstract 15710: Myocardial Ischaemia in Cardiac Amyloidosis, Changing Perspectives
Authors: Liza Chacko, Tushar Kotecha, Ana Martinez-Naharro, James Brown, Tamer Rezk, Kristopher Knott, Daniel Knight, Niket Patel, James C Moon, Arantxa Gonzalez, Claudio Rapezzi, Janet Gilbertson, Ornella Leone, Hui Xue, Philip Hawkins, Julian D Gillmore, Peter Kellman, Marianna Fontana
Journal: Circulation (2020)

Introduction: Cardiac involvement determines outcome in systemic amyloidosis, but the relationship between amyloid deposits and outcomes is poorly understood. Many clinical observations are not explained by the simple concept of physical, mechanical replacement of the interstitium by amyloid material. Hypothesis: Preliminary studies in patients with cardiac amyloidosis (CA) support the hypothesis that myocardial ischaemia contributes to cell damage. This study assesses the presence and mechanisms of myocardial ischaemia using CMR with multiparametric mapping and histopathological assessment. Methods: 92 patients with CA (41 AL, 51 ATTR) and 73 without CA (26 with unobstructed coronary arteries; 47 with 3VD) underwent CMR with T1, T2, Extracellular volume (ECV) mapping and adenosine stress with myocardial blood flow (MBF) mapping. 25 cardiac biopsies and 3 explanted hearts with CA were analysed histopathologically. Results: CA patients had severe reductions in stress MBF and myocardial perfusion reserve (MPR)- (1.03ml/g/min±0.50;1.54±0.59 ) compared to patients with unobstructed coronary arteries (2.82 ml/g/min±0.53; 2.94±0.59, p&lt;0.001), and comparable only to 3VD (1.32±0.47ml/g/min, p=0.04;1.49±0.44, p=1.00). Myocardial perfusion abnormalities correlated with amyloid burden, systolic function and blood biomarkers (p&lt;0.001). Biopsies showed evidence of diffuse hypoxia with abnormal VEGF staining in cardiomyocytes and endothelial cells. Amyloid infiltration in intramural arteries was associated with severe lumen reduction in 20% of vessels, with severe reduction in capillary density in areas with and without amyloid deposits. Conclusion: CA is associated with severe myocardial ischaemia demonstrable by histology and CMR perfusion mapping. Histological evaluation indicates a complex pathophysiology, where direct disruption of the vessels by amyloid deposits and reduction in epicardial flow contribute to myocardial ischaemia.
Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate
Authors: Kathryn M. Curtis, Antoinette Nguyen, Jennifer A. Reeves, Elizabeth A. Clark, Suzanne G. Folger, Maura K. Whiteman
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1).During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2).CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA.The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception.Provider-administered DMPA should remain available.Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy.Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.* https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021583s033s034lbl.pdf† https://www.cdc.gov/nchs/products/databriefs/db388.htm§ https://www.cdc.gov/nchs/data/nhsr/nhsr086.pdf¶ "Self-administration" and "self-injection" include injection by the DMPA-SC user or by someone who is not the user's health care provider, such as a family or community member.
Abstract 16851: Lipid Profile Differences Among Premenopausal and Postmenopausal African American Women and Implications for Treatment Per Guideline
Authors: Courtney Bess, Puja K Mehta, Gina P Lundberg
Journal: Circulation (2020)

Introduction: Postmenopausal women have an increased cardiovascular disease (CVD) risk compared to premenopausal women. Though literature demonstrates a relationship between abnormal CVD risk factor patterns, namely lipids, and menopause, less is known about this association in minority racial and ethnic groups. Examining this association in African Americans (AA) is important because they experience disproportionate CVD outcomes. Moreover, recent studies have shown that AA eligible for statin therapy were less likely to receive treatment. Hypothesis: Postmenopausal women are more likely to have a more abnormal lipid profile compared to premenopausal women. Methods: A cohort of 962 women (mean age 50 ± 14 years) from the 10,000 Women Project were categorized into self-declared premenopausal (n = 475, mean age 40 ± 9.8 years) and postmenopausal (n= 487, mean age 61 ± 9.1 years) groups. Data was obtained at community health screening events through self-declared health history surveys. Lipid profiles were obtained through a non-fasting point-of-care cholesterol test. Several CVD risk factors were compared among these groups that include serum total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides (TG), pooled cohort Atherosclerotic Cardiovascular Disease (ASCVD) 10-year risk of heart disease or stroke score, BMI, waist circumference, and blood pressure. Student’s T test was utilized for statistical analysis. Results: Cholesterol testing revealed a significant increase in serum TC (p &lt; 0.0001), LDL (p = 0.0001), and TG (p = 0.001) in the postmenopausal group compared to the premenopausal group. Interestingly, there was also a significant increase in serum HDL in the postmenopausal group (p = 0.0081). Additionally, the ASCVD risk score, which is heavily weighted on age, was significantly higher in the postmenopausal group compared to the premenopausal group (p &lt; 0.0001). Conclusion: Menopause is associated with a more abnormal lipid profile and an elevated ASCVD risk score in AA women which places this group at a higher risk of CVD. Prioritizing lipid management, by adhering to cholesterol treatment guidelines, may assist with CVD risk reduction in this high-risk group.
Abstract 15526: Glucagon-like Peptide-1 Receptor Agonists Reduce Adverse Cardiovascular Disease (CVD) Events in Patients With Type 2 Diabetes: An Assessment of Heterogeneity Among CVD Outcomes and a Meta-regression Analysis
Authors: Simran Grewal, Ninad Zaman, Louis Borgatta, Matthew Nudy, Brandon Peterson
Journal: Circulation (2020)

Introduction: Recent evidence suggests glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce adverse cardiovascular disease (CVD) events. The objective of this study is to analyze randomized controlled trials (RCTs) testing GLP-1 RA’s effects on CVD among participants with type 2 diabetes (T2DM). Methods: RCTs comparing GLP-1 RA versus placebo among participants with T2DM were identified using PubMed and Cochrane databases. The endpoints of this analysis included major adverse cardiovascular events (MACE; a composite of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke), and the individual components of MACE. The primary analysis calculated risk ratios (RR) and 95% confidence intervals (CI) for each endpoint. Heterogeneity for each endpoint was calculated using Chi 2 and I 2 tests. For any endpoint with significant heterogeneity, a meta-regression was performed using baseline hemoglobin A1C (A1C) in each RCT as the moderator and a R 2 value was calculated. Results: 7 RCTs (N = 56,004) were identified with 174,163 patient years of follow-up. GLP-1 RA reduced MACE [RR 0.89, 95% CI 0.83-0.95], cardiovascular death [RR 0.88, 95% CI 0.81-0.95], and nonfatal stroke [RR 0.85, 95% CI 0.77-0.94]. There was no significant heterogeneity among these RCTs (Figure 1). GLP-1 RA did not reduce nonfatal MI [RR 0.91, 95% CI 0.82-1.02]. However, there was significant heterogeneity among these RCTS (Chi 2 =12.94, p=0.04, I 2 =54%). When accounting for A1C in the regression model, there was no longer significant heterogeneity for this endpoint (p=0.23, I 2 =27%). A relationship between A1C and GLP-1 RA’s effect on nonfatal MI (R 2 =0.64, Figure 1) was observed when performing the meta-regression. Conclusion: GLP-1 RA reduced MACE, cardiovascular death, and nonfatal stroke in patients with T2DM with minimal heterogeneity among RCTs. GLP-1 RA did not reduce nonfatal MI, however there may be an association between A1C and GLP-1 RA’s effect on nonfatal MI.
Wrist pain that should not be missed
Authors: Kunal Kulkarni, Aqua Asif, Joseph Dias
Journal: BMJ (2021)

A man in his 20s presented with generalised wrist pain one day after he tripped while playing football and landed on his outstretched and extended right hand. No deformity was found on examination, but he had mild swelling and generalised tenderness around the wrist, particularly at the anatomical snuffbox and scaphoid tubercle. Wrist movement was painful (particularly ulnar deviation) as was axial loading of the thumb. As a scaphoid fracture was suspected, a series of “scaphoid view” wrist radiographs was requested. These usually consist of posteroanterior without (fig 1) or with ulnar deviation (fig 2), lateral, semi-pronated oblique, and posteroanterior 20o beam (elongated scaphoid) views.1



Fig 1 
Posteroanterior radiograph of …
Drainage via colonic transendoscopic enteral tubing increases our confidence in rescuing endoscopy-associated perforation
Authors: Faming Zhang, Quan Wen, Bota Cui
Journal: Endoscopy (2021)

A 25-year-old woman with stricturing Crohn's disease in the transverse colon underwent endoscopic balloon dilation. A colonic transendoscopic enteral tube (outer diameter 2.7 mm, FMT-DT-F-27/1350; FMT Medical, Nanjing, China) with loops was fixed onto the ascending colon wall by endoscopic clips [1] after dilation ([Fig. 1]). The colonic transendoscopic enteral tube was primarily for frequently delivering medications and for transplantation of washed microbiota [2] after endoscopy-associated perforation and bleeding were excluded. However, perforation was identified on X-ray ([Fig. 2]) when she complained of abdominal pain and fever 1 day after endoscopy. The transendoscopic enteral tube was immediately used to drain the air and fluid in the colon using syringe suction ([Fig. 3]). She recovered rapidly and started enteral nutrition 4 days later. Interestingly, she suffered another endoscopic dilation-induced perforation 1 year later and was successfully rescued in time by the same colonic transendoscopic enteral tube technique and antibiotics.
洗浄電極を用いた心外膜アブレーション-病変形成に及ぼす双極vs.単極アブレーションの作用-
Authors: Nagashima Koichi, Watanabe Ichiro, Okumura Yasuo, Sonoda Kazumasa, Kofune Masayoshi, Mano Hiroaki, Ohkubo Kimie, Nakai Toshiko, Kunimoto Satoshi, Kasamaki Yuji, Hirayama Atsushi
Journal: Circulation (2012)
Abstract 16285: Cardiac Troponin I Measured by a Novel Ultra-Sensitivity Assay Provides Incremental Diagnostic Information to Cardiac Exercise Stress Testing
Authors: Sjur Hansen H Tveit, Joanna Cwikiel, Torbjørn Omland, Eivind Berge, Ingebjørg Seljeflot, Arnljot Flaa
Journal: Circulation (2018)

Introduction: This study tested the hypothesis that cardiac troponin I, measured with the novel Singulex Clarity® ultra-sensitivity Single Molecule Counting (SMC™) assay (us-cTnI), would provide di...
Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel — 33 U.S. Sites, January–March 2021
Authors: Tamara Pilishvili, Katherine E. Fleming-Dutra, Jennifer L. Farrar, Ryan Gierke, Nicholas M. Mohr, David A. Talan, Anusha Krishnadasan, Karisa K. Harland, Howard A. Smithline, Peter C. Hou, Lilly C. Lee, Stephen C. Lim, Gregory J. Moran, Elizabeth Krebs, Mark Steele, David G. Beiser, Brett Faine, John P. Haran, Utsav Nandi, Walter A. Schrading, Brian Chinnock, Daniel J. Henning, Frank LoVecchio, Joelle Nadle, Devra Barter, Monica Brackney, Amber Britton, Kaytlynn Marceaux-Galli, Sarah Lim, Erin C. Phipps, Ghinwa Dumyati, Rebecca Pierce, Tiffanie M. Markus, Deverick J. Anderson, Amanda K. Debes, Michael Lin, Jeanmarie Mayer, Hilary M. Babcock, Nasia Safdar, Marc Fischer, Rosalyn Singleton, Nora Chea, Shelley S. Magill, Jennifer Verani, Stephanie Schrag, Anna Yousaf, Yunmi Chung, Jennifer Onukwube, Wei Xing, Bradley Clinansmith, Lisandra Uribe, Kye E. Poronsky, Dean M. Hashimoto, Monica Bahamon, Michelle St. Romain, Efrat Kean, Amy Stubbs, Sara Roy, Gregory Volturo, James Galbraith, James C. Crosby, Megan R. Fuentes, Mary Mulrow, Jane Lee, Helen Johnston, AmberJean Hansen, Scott K. Fridkin, Lucy E. Wilson, Sara Lovett, Melissa Christian, Christopher Myers, Valerie L.S. Ocampo, Keipp Talbot, Jessica Seidelman, Aaron M. Milstone, Mary Hayden, Matthew Samore, Jennie H. Kwon, Daniel Shirley, Denise Dillard, Jennifer Dobson
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

Throughout the COVID-19 pandemic, health care personnel (HCP) have been at high risk for exposure to SARS-CoV-2, the virus that causes COVID-19, through patient interactions and community exposure (1). The Advisory Committee on Immunization Practices recommended prioritization of HCP for COVID-19 vaccination to maintain provision of critical services and reduce spread of infection in health care settings (2). Early distribution of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) to HCP allowed assessment of the effectiveness of these vaccines in a real-world setting. A test-negative case-control study is underway to evaluate mRNA COVID-19 vaccine effectiveness (VE) against symptomatic illness among HCP at 33 U.S. sites across 25 U.S. states. Interim analyses indicated that the VE of a single dose (measured 14 days after the first dose through 6 days after the second dose) was 82% (95% confidence interval [CI] = 74%-87%), adjusted for age, race/ethnicity, and underlying medical conditions. The adjusted VE of 2 doses (measured ≥7 days after the second dose) was 94% (95% CI = 87%-97%). VE of partial (1-dose) and complete (2-dose) vaccination in this population is comparable to that reported from clinical trials and recent observational studies, supporting the effectiveness of mRNA COVID-19 vaccines against symptomatic disease in adults, with strong 2-dose protection.
Abstract 15987: Equitably Identifying Majority and Minority Populations at Risk for Abdominal Aortic Aneurysms
Authors: Deeksha S Bidare, Panagiotis Kougias, Scott A LeMaire, Joseph L Mills, Neal R Barshes
Journal: Circulation (2020)

Introduction: Abdominal aortic aneurysm (AAA) screening efforts have had two shortcomings: (1) a high number needed to treat; and (2) persons categorized as black are less frequently identified prior to presenting with a ruptured AAA (rAAA). The goal of this analysis was to identify community-level factors that could be used to identify specific majority and minority populations in Texas that could benefit from directed screening efforts. Methods: The study sample was comprised of all patients who underwent surgical or endovascular treatment for intact AAA (iAAA) and rAAA at all non-federal Texas hospitals from 2006-2014, aggregated by county and by metropolitan statistical area (MSA). These were then combined with demographics and other community-level characteristics in multivariate analyses. Results: In total, 22,455 patients who underwent treatment of iAAA or rAAA were included. 47% of the variance in the rate of AAA or AAA repair among Texas counties was explained by just two variables: proportion elderly (p&lt;0.001) and proportion categorized as white (p&lt;0.001). Within MSAs, the incidence of rAAA was directly and strongly correlated with iAAA incidence (R 2 =0.58, p&lt;0.001). The rAAA:iAAA ratio demonstrated populations in several MSAs that had higher than expected rAAA rates, with the four most extreme high-outliers comprised of black populations (Figure). The incidence rates of AAA ultrasound relative to AAA repair were lower for persons categorized as black than for those categorized as white in 10 MSAs (58%) despite a higher proportion (81 vs 70%, p&lt;0.0001) living within 50 miles of providers of Medicare-reimbursed AAA ultrasound screenings. Conclusion: Readily-accessible, publicly-available data can be used to identify geographic areas and populations that could benefit from more intensive screening efforts. Directing ultrasound screening efforts at persons categorized as black in specific geographic areas may help increase equity in AAA care.
Abstract 041: Cardiovascular Disease, Hypertension, Diabetes And Cystatin C Jointly Predict Covid-19 Mortality Alongside Age, Male Sex And Black Ethnicity
Authors: Joshua Elliott, Barbara Bodinier, Matthew Whitaker, Ioanna Tzoulaki, Paul Elliott, Marc Chadeau-Hyam
Journal: Circulation (2021)

Introduction: Studies of risk factors for severe/fatal COVID-19 to date may not have identified the optimal set of informative predictors. Hypothesis: Use of penalized regression with stability analysis may identify new, sparse sets of risk factors jointly associated with COVID-19 mortality. Methods: We investigated demographic, social, lifestyle, biological (lipids, cystatin C, vitamin D), medical (comorbidities, medications) and air pollution data from UK Biobank (N=473,574) in relation to linked COVID-19 mortality, and compared with non-COVID-19 mortality. We used penalized regression models (LASSO) with stability analysis (80% selection threshold from 1,000 models with 80% subsampling) to identify a sparse set of variables associated with COVID-19 mortality. Results: Among 43 variables considered by LASSO stability selection, cardiovascular disease, hypertension, diabetes, cystatin C, age, male sex and Black ethnicity were jointly predictive of COVID-19 mortality risk at 80% selection threshold (Figure). Of these, Black ethnicity and hypertension contributed to COVID-19 but not non-COVID-19 mortality. Conclusions: Use of LASSO stability selection identified a sparse set of predictors for COVID-19 mortality including cardiovascular disease, hypertension, diabetes and cystatin C, a marker of renal function that has also been implicated in atherogenesis and inflammation. These results indicate the importance of cardiometabolic comorbidities as predisposing factors for COVID-19 mortality. Hypertension was differentially highly selected for risk of COVID-19 mortality, suggesting the need for continued vigilance with good blood pressure control during the pandemic.
Assessment of Primary Care Appointment Times and Appropriate Prescribing of Statins for At-Risk Patients
Authors: Allison J. Hare, Srinath Adusumalli, Saehwan Park, Mitesh S. Patel
Journal: JAMA Network Open (2021)

more likely to face decision fatigue, or the erosion of initiative that results from the cumulative cognitive burden of a long session of decision-making. 4,5is study was limited by its observational design at one health system.Future interventions targeting improvements in statin prescribing should consider the influence of time of day.