tbuckley/cabot-search huggingface dataset:
Imputed State-Level Prevalence of Achieving Goals To Prevent Complications of Diabetes in Adults with Self-Reported Diabetes — United States, 2017–2018
Authors: Yu Chen, Deborah Rolka, Hui Xie, Sharon Saydah
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Diabetes increases the risk for developing cardiovascular, neurologic, kidney, eye, and other complications. Diabetes and related complications also pose a huge economic cost to society: in 2017, the estimated total economic cost of diagnosed diabetes was $327 billion in the United States (1). Diabetes complications can be prevented or delayed through the management of blood glucose (measured by hemoglobin A1C), blood pressure (BP), and non-high-density lipoprotein cholesterol (non-HDL-C) levels, and by avoiding smoking; these are collectively known as the ABCS goals (hemoglobin A1C, Blood pressure, Cholesterol, Smoking) (2-5). Assessments of achieving ABCS goals among adults with diabetes are available at the national level (4,6); however, studies that assess state-level prevalence of meeting ABCS goals have been lacking. This report provides imputed state-level proportions of adults with self-reported diabetes meeting ABCS goals in each of the 50 U.S. states and the District of Columbia (DC). State-level estimates were created by raking and multiple imputation methods (7,8) using data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES), 2017-2018 American Community Survey (ACS), and 2017-2018 Behavioral Risk Factor Surveillance System (BRFSS). Among U.S. adults with diabetes, an estimated 26.4% met combined ABCS goals, and 75.4%, 70.4%, 55.8%, and 86.0% met A1C <8%, BP <140/90 mmHg, non-HDL-C <130 mg/dL and nonsmoking goals, respectively. Public health departments could use these data in their planning efforts to achieve ABCS goal levels and reduce diabetes-related complications at the state level.
Efficacy and safety of abatacept in active primary Sjögren’s syndrome: results of a phase III, randomised, placebo-controlled trial
Authors: Alan N Baer, Jacques-Eric Gottenberg, E William St Clair, Takayuki Sumida, Tsutomu Takeuchi, Raphaèle Seror, Gary Foulks, Marleen Nys, Sumanta Mukherjee, Robert Wong, Neelanjana Ray, Hendrika Bootsma
Journal: Annals of the Rheumatic Diseases (2020)

Objectives To evaluate efficacy and safety of abatacept in adults with active primary Sjögren’s syndrome (pSS) in a phase III, randomised, double-blind, placebo-controlled trial. Methods Eligible patients (moderate-to-severe pSS [2016 ACR/European League Against Rheumatism (EULAR) criteria], EULAR Sjögren’s Syndrome Disease Activity Index [ESSDAI] ≥5, anti-SS-related antigen A/anti-Ro antibody positive) received weekly subcutaneous abatacept 125 mg or placebo for 169 days followed by an open-label extension to day 365. Primary endpoint was mean change from baseline in ESSDAI at day 169. Key secondary endpoints were mean change from baseline in EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and stimulated whole salivary flow (SWSF) at day 169. Other secondary clinical endpoints included glandular functions and patient-reported outcomes. Selected biomarkers and immune cell phenotypes were examined. Safety was monitored. Results Of 187 patients randomised, 168 completed double-blind period and 165 continued into open-label period. Mean (SD) baseline ESSDAI and ESSPRI total scores were 9.4 (4.3) and 6.5 (2.0), respectively. Statistical significance was not reached for primary (ESSDAI −3.2 abatacept vs −3.7 placebo, p=0.442) or key secondary endpoints (ESSPRI, p=0.337; SWSF, p=0.584). No clinical benefit of abatacept over placebo at day 169 was seen with other clinical and PRO endpoints. Relative to baseline, abatacept was associated with significant differences vs placebo in some disease-relevant biomarkers (including IgG, IgA, IgM-rheumatoid factor) and pathogenic cell subpopulations (post hoc analyses). No new safety signals were identified. Conclusions Abatacept treatment did not result in significant clinical efficacy compared with placebo in patients with moderate-to-severe pSS, despite evidence of biological activity.
Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study
Authors: Scott R. Bauer, Benjamin N. Breyer, Meir J. Stampfer, Eric B. Rimm, Edward L. Giovannucci, Stacey A. Kenfield
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Erectile dysfunction, especially in younger men, is an early sign of cardiovascular disease and may decrease quality of life. Men may be motivated to adopt a healthy dietary pattern if it lowers their risk of erectile dysfunction. <h3>Objective</h3> To assess the association between adherence to a diet quality index based on healthy dietary patterns and erectile dysfunction in men. <h3>Design, Setting, and Participants</h3> This population-based prospective cohort study included men from the Health Professionals Follow-up Study with follow-up from January 1, 1998, through January 1, 2014. Participants included US male health professionals aged 40 to 75 years at enrollment. Men with erectile dysfunction or a diagnosis of myocardial infarction, diabetes, stroke, or genitourinary cancer at baseline were excluded. Analyses were completed in February 2020. <h3>Exposures</h3> A food frequency questionnaire was used to determine nutrient and food intake every 4 years. <h3>Main Outcomes and Measures</h3> Diet quality was assessed by Mediterranean Diet score and the Alternative Healthy Eating Index 2010 score, with higher scores indicating healthier diet. Dietary index scores were cumulatively updated from 1986 until men developed erectile dysfunction, cardiovascular disease, died, or were lost to follow-up. Incident erectile dysfunction was assessed with questionnaires in 2000, 2004, 2008, and 2012. Hazard ratios (HRs) by prespecified categories or quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses stratified by age. <h3>Results</h3> Among 21 469 men included in analysis, mean (SD) age at baseline was 62 (8.4) years. During a mean (SD) follow-up of 10.8 (5.4) years and 232 522 person-years, there were 968 incident erectile dysfunction cases among men younger than 60 years, 3703 cases among men aged 60 to less than 70 years, and 4793 cases among men aged 70 years or older. Men younger than 60 years and in the highest category of the Mediterranean Diet score had the lowest relative risk of incident erectile dysfunction compared with men in the lowest category (HR, 0.78; 95% CI, 0.66-0.92). Higher Mediterranean diet scores were also inversely associated with incident erectile dysfunction among older men (age 60 to &lt;70 years: HR, 0.82; 95% CI, 0.76-0.89; age ≥70 years: HR, 0.93; 95% CI, 0.86-1.00). Men scoring in the highest quintile of the Alternative Healthy Eating Index 2010 also had a lower risk of incident erectile dysfunction, particularly among men age younger than 60 years (quintile 5 vs quintile 1: HR, 0.78; 95% CI, 0.63-0.97). <h3>Conclusions and Relevance</h3> This cohort study found that adherence to healthy dietary patterns was associated with a lower risk for erectile dysfunction, suggesting that a healthy dietary pattern may play a role in maintaining erectile health.
Abstract 17279: Elevated Interleukin-6 Levels in COVID-19-Infected Patients Are Associated With Major Adverse Cardiac Events and/or Mortality
Authors: Nicholas Nguyen, Hao Nguyen, Chirag Patel, Farukh Ikram, Priyanka Acharya, Anmol Dhillion, Manavjot S Sidhu
Journal: Circulation (2020)

Introduction: Interleukin-6 (IL-6) is an inflammatory cytokine marker produced in response to infection and tissue injury. As the COVID-19 pandemic continues to thrive, uncertainties remain regarding COVID-19-related cardiovascular outcomes, specifically major adverse cardiovascular events (MACE). High IL-6 levels correlate with disease severity in COVID-19 patients; however, studies have not shown an association between elevated IL-6 levels and MACE and/or mortality. Methods: Two hundred twenty-five patients tested positive for COVID-19 at a major Southwest quaternary United States hospital between March 2020 and May 2020. Chart review of these patients was used to identify cases of MACE/ mortality and their respective IL-6 levels. This data was extracted for clinical analysis to identify any correlation between IL-6 levels and incidence of MACE and/or death. MACE was defined as a composite of myocardial infarction, stroke, deep venous thrombosis/ pulmonary embolism, or shock requiring vasopressor support. Results: Of the 225 patients with COVID-19, 112 patients had an IL-6 level drawn. Patients with elevated IL-6 levels had a higher incidence of MACE compared to patients with normal IL-6 levels (81.8% vs. 48.5%, p=0.0004, OR=4.77, 95% CI=1.81-13.50). There was a significant difference between the percentage of patients with elevated IL-6 levels who expired and patients with elevated IL-6 levels who did not expire (90.4% vs. 53.9%, p=0.0023, OR=8.11, 95% CI=1.76-74.86). IL-6 levels were significantly higher in patients who developed MACE and expired compared to levels in patients that did not (81.6% vs. 46%, p=0.0001, OR=5.21, 95% CI=2.03-14.13). Conclusions: MACE and/or death in COVID-19 patients were associated with elevated IL-6 levels. It is advisable to obtain IL-6 levels in all COVID-19 infected patients to help risk stratify these patients and treat IL-6 positive patients more aggressively.
Abstract 17249: Culprit-Only versus Complete Multivessel Percutaneous Coronary Intervention in Patients with ST-elevation Myocardial Infarction: An Updated Meta-Analysis
Authors: Waqas Ullah, Salman Zahid, Smitha Narayana Gowda, Samavia Munir, yasar sattar, Houmam Moussa Pacha, Ali Ghani, M. Chadi Alraies, David L Fischman
Journal: Circulation (2020)

Introduction: ST-segment elevation myocardial infarction (STEMI) in patients with concomitant multivessel coronary artery disease (CAD) is associated with poor prognosis. Hypothesis: We sought to determine the merits of percutaneous coronary intervention (PCI) of the culprit-only compared with a complete revascularization approach. Methods: The MEDLINE (PubMed, Ovid), Embase, Clinicaltrials.org and Cochrane databases were queried with various combinations of medical subject headings (MeSH) to identify articles comparing complete and culprit-only revascularization. Data were compared using a random-effect model to calculate unadjusted odds ratio. Results: A total of 26 studies consisting of 26,892 patients, 18,377 in the culprit-only and 8,515 in the complete revascularization group were included. The mean age of patients included in the study was 63 years, comprising 72% of male patients. Baseline characteristics of the two treatment groups were comparable. On a median follow-up of 1-year, culprit-only revascularization was associated with a significantly higher odds of major adverse cardiovascular events (MACE) (OR 1.36, 95% CI 1.10-1.69, p=0.005) (figure), angina (OR 2.28, 95% CI 1.83-2.85, p=&lt;0.00001) and revascularization (OR 1.71, 95% CI 1.18- 2.49, p=0.005) compared to complete revascularization group. The all-cause mortality (OR 1.17, 95% CI 0.89-1.54, p=0.25),, cardiovascular mortality (OR 1.20, 95% CI 0.90-1.61, p=0.22), rate of heart failure (OR 1.17, 95% CI 0.86-1.59, p=0.31), CABG (OR 1.47, 95% CI 0.82-2.64, p=0.19), repeat MI (OR 1.23, 95% CI 0.92-1.63, p=0.17) and stroke (OR 1.27 95% CI 0.68-2.34, p=0.45%) were similar between the two groups. Conclusions: In contrast to the culprit-only approach, complete revascularization in patients with the acute coronary syndrome is associated with a significant reduction in MACE, angina and need for revascularization.
Abstract 14443: Aortic Root Rotational Position Associates With Aortic Valve Incompetence and Aortic Dilation After Arterial Switch Operation for Transposition of the Great Arteries
Authors: Stephanie Y Tseng, Justin Tretter, Zhiqian Gao, Nicholas Ollberding, Sean Lang
Journal: Circulation (2020)

Introduction: Variation in aortic root (AoR) rotational position affects flow dynamics in normal patients. Complications of arterial switch operation (ASO) for transposition of the great arteries (TGA) include aortic dilation and neo-aortic regurgitation (AR). We sought to assess the association of neo-AoR rotational position with neo-AoR and ascending aorta (AA) dilation and neo-AR in TGA after ASO. Methods: Patients after ASO for TGA who underwent cardiac magnetic resonance (CMR) from 2005-2020 were retrospectively reviewed. Neo-AoR rotational angle, indexed (to height) neo-AoR and AA dimensions, indexed left ventricular end diastolic volume (LVEDVi), and neo-aortic regurgitant fraction (RF) were obtained from CMR. Multivariable regression analysis for neo-AoR and AA dilation, RF, and LVEDVi were performed. Results: A total of 36 patients (78% male) were included. Median age at ASO was 5 days (3, 7) and at CMR was 17.1 years (12.3, 21.9). Rotational angle was 25% counterclockwise (&lt;-9°), 25% central (-9 to +14°), and 50% clockwise (&gt;+15°). There was no material association of neo-AoR and AA size with sex, age, and coronary artery anatomy. A quadratic term for neo-AoR rotational angle - increasing extremes of counterclockwise and clockwise angles - was significantly associated with neo-AoR dilation (p=0.03), AA dilation (p&lt;0.02), and LVEDVi (p&lt;0.01) (Figure 1) and remained significant in multivariable model of neo-AoR dilation (p&lt;0.02), AA dilation (p&lt;0.01), and LVEDVi (p&lt;0.02). Rotational angle was negatively associated with neo-aortic RF (p&lt;0.05) and remained significant in multivariable model (p&lt;0.02). Conclusions: In conclusion, both clockwise and counterclockwise neo-AoR rotational position in TGA after ASO are associated with neo-AoR and AA dilation and LVEDVi. Counterclockwise rotational angle was associated with RF. Neo-AoR rotational position likely affects valve function and hemodynamics, leading to risk of neo-AR and aortic dilation.
Abstract 13299: Myocardial Injury in Adults Hospitalized With Covid-19
Authors: Nathaniel R Smilowitz, Neil Jethani, Ji Chen, Yindalon Aphinyanaphongs, Ruina Zhang, Siddhant Dogra, Carlos Alviar, Norma M Keller, Louai Razzouk, Adriana Quinones-Camacho, Albert S Jung, Glenn I Fishman, Judith S Hochman, Jeffrey S Berger
Journal: Circulation (2020)

Background: Myocardial injury is frequently identified in patients with Coronavirus Disease 2019 (COVID-19). The incidence and outcome of myocardial injury at presentation and during the course of hospitalization for COVID-19 are uncertain. Methods: Consecutive adults (age ≥18) with COVID-19 admitted to a health care system with 4 large hospitals in New York between March 1st and April 16th, 2020 were identified. Initial and peak cardiac troponin (cTn) measurements were recorded. Myocardial injury was defined by cTn above the laboratory upper limit of normal. Thrombotic events, critical illness, and in-hospital mortality was determined. Results: Among 3,116 adults with COVID-19 and ≥1 cTn measurement, myocardial injury was present in 606 (19%) patients at hospital admission, with a median cTn of 0.10 ng/mL [range 0.04-91.8 ng/mL]. Patients with myocardial injury were older, more likely male, and more likely to have cardiovascular disease. Thrombotic events (38% vs. 10%, p&lt;0.001; adjusted odds ratio [aOR] 3.54, 95 CI 2.91-4.53), critical illness (58% vs. 32%, p&lt;0.001; aOR 1.55, 95% CI 1.22-1.90) and mortality (41% vs. 17%, p&lt;0.001; aOR 1.67, 95% CI 1.31-2.15), were more frequent in patients with versus without myocardial injury at presentation. Myocardial injury based on the peak cTn during hospitalization was detected in 956 (31%) patients and was also associated with thrombotic events (36% vs. 7%, p&lt;0.001; aOR 6.56, 95% CI 5.09-9.85), critical illness (67% vs. 24%, p&lt;0.001; aOR 6.05, 95% CI 5.05-7.87), and mortality (43% vs. 13%, p&lt;0.001; aOR 3.83, 95% CI 3.15-5.03) versus those without myocardial injury. Patients with the highest cTn had the greatest risk of adverse events (Figure). Conclusions: Myocardial injury was observed in 1 in ~5 patients with COVID-19 at hospital presentation, and 1 in ~3 based on the peak cTn. Initial and peak cTn measurements were markers of adverse outcomes. The optimal management of myocardial injury in COVID-19 requires further study.
Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers
Authors: Eleanor M. Dunican, Brett M. Elicker, Travis Henry, David S. Gierada, Mark L. Schiebler, Wayne Anderson, Igor Barjaktarevic, R. Graham Barr, Eugene R. Bleecker, Richard C. Boucher, Russell Bowler, Stephanie A. Christenson, Alejandro Comellas, Christopher B. Cooper, David Couper, Gerard J. Criner, Mark Dransfield, Claire M. Doerschuk, M. Bradley Drummond, Nadia N. Hansel, MeiLan K. Han, Annette T. Hastie, Eric A. Hoffman, Jerry A. Krishnan, Stephen C. Lazarus, Fernando J. Martinez, Charles E. McCulloch, Wanda K. O’Neal, Victor E. Ortega, Robert Paine, Stephen Peters, Joyce D. Schroeder, Prescott G. Woodruff, John V. Fahy
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

Rationale: The relative roles of mucus plugs and emphysema in mechanisms of airflow limitation and hypoxemia in smokers with chronic obstructive pulmonary disease (COPD) are uncertain.Objectives: To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.Methods: We analyzed computed tomographic (CT) lung images and lung function in participants in the Subpopulations and Intermediate Outcome Measures in COPD Study. Radiologists scored mucus plugs on CT lung images, and imaging software automatically quantified emphysema percentage. Unadjusted and adjusted relationships between mucus plug score, emphysema percentage, and lung function were determined using regression.Measurements and Main Results: Among 400 smokers, 229 (57%) had mucus plugs and 207 (52%) had emphysema, and subgroups could be identified with mucus-dominant and emphysema-dominant disease. Only 33% of smokers with high mucus plug scores had mucus symptoms. Mucus plug score and emphysema percentage were independently associated with lower values for FEV1 and peripheral oxygen saturation (P < 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (P < 0.001). Compared with smokers with low mucus plug scores, those with high scores had worse COPD Assessment Test scores (17.4 ± 7.7 vs. 14.4 ± 13.3), more frequent annual exacerbations (0.75 ± 1.1 vs. 0.43 ± 0.85), and shorter 6-minute-walk distance (329 ± 115 vs. 392 ± 117 m) (P < 0.001).Conclusions: Symptomatically silent mucus plugs are highly prevalent in smokers and independently associate with lung function outcomes. These data provide rationale for targeting patients with mucus-high/emphysema-low COPD in clinical trials of mucoactive treatments.Clinical trial registered with www.clinicaltrials.gov (NCT01969344).
New Statin Use and Mortality in Older Veterans
Authors: Jeff Whittle
Journal: JAMA (2020)

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Cell Softness Prevents Cytolytic T-cell Killing of Tumor-Repopulating Cells
Authors: Yuying Liu, Tianzhen Zhang, Haizeng Zhang, Jiping Li, Nannan Zhou, Roland Fiskesund, Junwei Chen, Jiadi Lv, Jingwei Ma, Huafeng Zhang, Ke Tang, Feiran Cheng, Yabo Zhou, Xiaohui Zhang, Ning Wang, Bo Huang
Journal: Cancer Research (2020)

Abstract Biomechanics is a fundamental feature of a cell. However, the manner by which actomysin tension affects tumor immune evasion remains unclear. Here we show that although cytotoxic T lymphocytes (CTL) can effectively destroy stiff differentiated tumor cells, they fail to kill soft tumor-repopulating cells (TRC). TRC softness prevented membrane pore formation caused by CTL-released perforin. Perforin interacting with nonmuscle myosin heavy-chain 9 transmitted forces to less F-actins in soft TRC, thus generating an inadequate contractile force for perforin pore formation. Stiffening TRC allowed perforin the ability to drill through the membrane, leading to CTL-mediated killing of TRC. Importantly, overcoming mechanical softness in human TRC also enhanced TRC cell death caused by human CTL, potentiating a mechanics-based immunotherapeutic strategy. These findings reveal a mechanics-mediated tumor immune evasion, thus potentially providing an alternative approach for tumor immunotherapy. Significance: Tumor-repopulating cells evade CD8+ cytolytic T-cell killing through a mechanical softness mechanism, underlying the impediment of perforin pore formation at the immune synapse site.
Abstract 14265: Physical Activity Lowers Cardiovascular Mortality by Mediating Systemic Inflammation: The Strong Heart Study
Authors: Ozan Unlu, Zaid Almarzooq, Amanda M Fretts, Ying Zhang, Julie Stoner, Jason G Umans, Shelley A Cole, Mary J Roman, Richard B Devereux, Parmanand SINGH
Journal: Circulation (2020)

Background: Prior work has shown that fibrinogen, a well-known inflammatory marker, is associated with cardiovascular (CV) events. While it is known that physical activity (PA) imparts CV health benefits, there remains a knowledge gap on the interactions of PA with systemic inflammation on risk of CV death among American Indians. Hypothesis: To investigate the relationship between PA, inflammation, and CV death, we tested the hypotheses that: (i) PA is associated with lower risk of CV death, and (ii) the CV benefit of PA is mediated via an inflammatory pathway. Methods: We examined the association between PA (leisure-time plus occupational as METs[Metabolic Equivalent of Task]-hours per week via a validated questionnaire) and CV death among 3,135 adults (mean age 56 ± 8) without baseline CV disease in Strong Heart Study (1989-1991), a longitudinal study among American Indians. Preacher and Hayes bootstrap method was used for the model assessing mediation by fibrinogen. Results: During 26 years (mean 17.3 ± 8 years) of follow-up, there were 378 CV deaths. Compared to participants with minimal activity, subjects with higher levels of PA had a lower risk of CV death. Odds ratios were 0.91 (95% confidence interval [CI]: 0.65-1.21), 0.69 (95% CI: 0.51-0.92), and 0.56 (95% CI: 0.39-0.71) (p-trend=0.003), for increasing quartile of activity compared to the lowest, after adjustment for age, sex, study site, education, smoking, diabetes, hypertension, BMI, LDL cholesterol, and urine albumin-creatinine ratio. Mediation analysis showed the effect of PA on CV death was fully mediated via fibrinogen level (correlation coefficient: 0.998, 95% CI 0.995-0.999; Sobel test z= -3.11, p=0.03) (Figure). Conclusion: In a population-based study of American Indians, PA compared to inactivity, was associated with lower risk of CV death. This study highlights that PA is associated with improved CV outcomes and this effect is largely driven by inflammation.