tbuckley/cabot-search huggingface dataset:
Abstract P040: The Effect Of Weight Loss And Aerobic Exercise Training On The American Heart Association’s Life’s Simple 7
Authors: Joshua E McGee, Anna C Huff, Marie C Clunan, Nicole R Gniewek, Emily E Grammer, Briceida Osborne, Laura E Matarese, Robert A Carels, Walter J Pories, Joseph A Houmard, Damon L Swift
Journal: Circulation (2021)

There is limited evidence on the impact of weight loss via caloric restriction and aerobic exercise on Life’s Simple 7 (LS7), a health assessment tool used by the American Heart Association to promote and track cardiovascular health (CVH) via modifiable risk factors and health behaviors. Individuals with obesity have a greater prevalence of traditional and non-traditional cardiometabolic risk factors than lean individuals. Objective: Examine the effect of a weight loss intervention on LS7 and assess predictors of change in adults with obesity. Methods: Twenty-six adults (44.9 ± 9.7 years; weight: 93.9 ± 11.1 kg; body mass index: 34.1 ± 3.4 kg/m 2 ) participated in a 10-week medical weight loss program (OPTIFAST) and supervised exercise training program (50-75% VO 2 max) to achieve clinically significant weight loss (≥7% body weight). Poor, intermediate, and ideal CVH categories were defined as scores 0 to 4, 5 to 9, and 10 to 14, respectively. Baseline and post-weight loss LS7 scores were calculated via participant demographics, smoking status, anthropometry, physical activity level, diet intake, and blood lab reports. Paired samples t-test and Pearson’s correlations were used. Results: Mean weight loss was significant (-9.2 ± 3.6 kg, p &lt; 0.001). Mean LS7 score significantly increased from baseline to weight loss (7.3 ± 1.5 vs. 9.6 ± 1.2, respectively, p &lt; 0.001) and 57.7% of participants (15 of 26) improved to ideal CVH following weight loss. A significant inverse association was observed between change in LS7 and systolic blood pressure ( r = -0.41, p &lt; 0.05), total cholesterol ( r = -0.45, p &lt; 0.05), and glucose ( r = -0.41, p &lt; 0.05). There were no further significant relationships with LS7 (i.e. change in weight, body mass index, physical activity, diastolic blood pressure). Discussion: A combined caloric restriction and aerobic exercise training intervention improved a multitude of cardiovascular disease risk factors. Previous epidemiological studies indicate meeting the ideal LS7 metrics is associated with 78% and 49% reduced risk of cardiovascular disease morbidity and mortality, respectively. Thus, the long-term modification of health behaviors and cardiometabolic risk factors to achieve ideal cardiovascular health may reduce risks of cardiovascular morbidity and mortality in individuals with obesity.
Abstract P210: The Social Distribution Of Ideal Cardiovascular Health: A Global Systematic Review
Authors: Farah Qureshi, Kelb Bousquet-Santos, Sakurako Shiba, Scott Delaney, Anne-Josee Guimond, Julia K Boehm, Laura D Kubzansky
Journal: Circulation (2021)

Introduction: Numerous studies have examined the social determinants of ideal cardiovascular health (ICVH) around the world, but no work has summarized evidence to date. This study aimed to systematically review findings on the social distribution of ICVH globally, and to compare trends in high-income countries (HICs) vs. low/middle-income countries (LMICs). Methods: In November 2019, we systematically searched PubMed, Embase, and LILACS for observational studies published after the American Heart Association (AHA) defined ICVH as a combination of health factors and behaviors in 2010. Search terms included ICVH/Life’s Simple 7 and a pre-defined set of social determinants of health (i.e., education, income/wealth, socioeconomic status (SES), employment, occupation, and race/ethnicity). Each abstract was reviewed by two independent researchers. Studies were included if associations between a composite measure of ICVH and a social determinant of health was quantified using statistical methods. We evaluated risk of bias using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. Overall findings and comparisons between HICs and LMICs (defined by World Bank guidelines) were summarized narratively. Results: A total of 33 studies met inclusion criteria. Only 8 studies were from LMICs (n=4 from China), while 25 were from HICs (n=19 from the US). The most commonly assessed social determinants were education (n=18) and income/wealth (n=17). In both HICs and LMICs, few studies examined occupation or area-level measures, like rurality/urbanicity. Most studies were cross-sectional (n=27). Two thirds of studies and had a moderate (n=14, 43%) or high (n=8, 24%) risk of bias, but no systematic differences were noted by country setting. Nearly half of studies used composite ICVH measures that were of moderate or poor quality (i.e., based on only self-reported data and/or unvalidated instruments), and only 15% of studies (n=5) assessed each ICVH component using the exact criteria defined by the AHA. Despite substantial heterogeneity in how ICVH measures were derived and analyzed (e.g., as a binary, categorical, or count variable), fairly consistent associations were observed between higher levels of ICVH and higher social status (higher education, income/wealth, racial/ethnic majority status) across both HICs and LMICs. Studies of occupation (n=6, all from HICs) and area-level measures (n=4, 3 from LMICs) were less conclusive. Conclusion: Associations between higher social status and ICVH were noted in both HICs and LMICs, but most evidence was based on correlational data from cross-sectional studies in the US, primarily in relation to education and income. Important gaps in the literature include studies from LMICs, longitudinal designs to improve causal inference, and investigations of occupation, rurality/urbanicity, and race/ethnicity in non-US settings.
Interleukin-6 Signaling and Anti-Interleukin-6 Therapeutics in Cardiovascular Disease
Authors: Paul M. Ridker, Manas Rane
Journal: Circulation Research (2021)

IL (interleukin)-6 is a pivotal cytokine of innate immunity, which enacts a broad set of physiological functions traditionally associated with host defense, immune cell regulation, proliferation, and differentiation. Following recognition of innate immune pathways leading from the NLRP3 (NOD-, LRR-, and pyrin domain-containing protein 3) inflammasome to IL-1 to IL-6 and on to the hepatically derived clinical biomarker CRP (C-reactive protein), an expanding literature has led to understanding of the proatherogenic role for IL-6 in cardiovascular disease and thus the potential for IL-6 inhibition as a novel method for vascular protection. In this review, we provide an overview of the mechanisms by which IL-6 signaling occurs and how that impacts upon pharmacological inhibition; describe murine models of IL-6 and atherogenesis; summarize human epidemiological data outlining the utility of IL-6 as a biomarker of vascular risk; outline genetic data suggesting a causal role for IL-6 in systemic atherothrombosis and aneurysm formation; and then detail the potential role of IL-6 inhibition in stable coronary disease, acute coronary syndromes, heart failure, and the atherothrombotic complications associated with chronic kidney disease and end-stage renal failure. Finally, we review anti-inflammatory and antithrombotic findings for ziltivekimab, a novel IL-6 ligand inhibitor being developed specifically for use in atherosclerotic disease and poised to be tested formally in a large-scale cardiovascular outcomes trial focused on individuals with chronic kidney disease and elevated levels of CRP, a population at high residual atherothrombotic risk, high residual inflammatory risk, and considerable unmet clinical need.
Predation landscapes influence migratory prey ecology and evolution
Authors: Megan C. Sabal, Mark S. Boyce, Corie L. Charpentier, Nathan B. Furey, Thomas M. Luhring, Hans W. Martin, Michael C. Melnychuk, Robert B. Srygley, C. Michael Wagner, Aaron J. Wirsing, Ronald C. Ydenberg, Eric P. Palkovacs
Journal: Trends in Ecology & Evolution (2021)
Abstract P078: Gender And Racial Disparities In Aspirin Use For Primary Prevention: Temporal Trends From The National Health And Nutrition Examination Surveys, 2011-2018
Authors: Osama Dasa, Inyoung Jun, Ruba Sajdeya, Mohamad B Taha, Omar Sajdeya, Thomas A Pearson
Journal: Circulation (2021)

Introduction: Cardiovascular disease (CVD) disproportionately affects racial minorities in the US. Aspirin is recommended for primary prevention in persons at high CVD risk. Prior evidence revealed racial and gender disparities in aspirin use for primary prevention. Objectives: To describe recent trends in aspirin use for primary prevention by race and gender to identify factors associated with differences in aspirin use. Methods: Data from the National Health and Nutrition Examination Surveys, 2011-2018, were analyzed. Participants aged 40-79 years, without prior history of CVD were included. Logistic regression was used to assess the association of aspirin use with comorbidities and sociodemographic factors. Results: Among 11212 participants, 47.0% were men; the mean (SD) age was 55.8 (9.79) years; 33.1% were non-Hispanic Whites (W), 23.7% non-Hispanic Blacks (B), and 13.1% Hispanics (H). Aspirin use was more prevalent among W (37.8%) compared to B (26.5%) and H (11.5%) ( P -value &lt;0.001). Trends in aspirin use varied by race and gender over the eight-year follow-up period (Figure 1). Generally, aspirin use was significantly lower in women than men. There was a downward trend in aspirin use in H and B women; H men and women had the lowest prevalence of use across the follow-up duration. Aspirin use was significantly higher at older age, with higher BMI, more comorbidities, non-smokers, and having insurance. Compared to W, H (but not B) had a persistently lower likelihood of aspirin use over time in the unadjusted logistic regression model. After adjustment, race (but not gender) was no longer significantly associated with aspirin use. Conclusions: Aspirin use for primary prevention remains prevalent among W compared to others and among men compared to women. However, after adjusting for several covariates, the effects of race were removed but the gender differences remained. The persistent gender gap in aspirin use for primary prevention requires further explanation, and for those at high risk, intervention.
Conversion of endoscopic ultrasound-guided hepaticogastrostomy to transpapillary drainage by anterograde intervention via dedicated biliary metal stent for benign biliary stenosis
Authors: Antonio Martinez-Ortega, Albert Garcia-Sumalla, Sergio Bazaga, Julio G. Velasquez-Rodriguez, Sandra Maisterra, Joan B. Gornals
Journal: Endoscopy (2021)

An 80-year-old woman with obstructive jaundice caused by distal biliary stenosis secondary to chronic pancreatitis was referred for biliary drainage. After failed endoscopic retrograde cholangiopancreatography, endoscopic ultrasound (EUS)-guided biliary drainage was proposed. Portal cavernomatosis prevented an extrahepatic route and EUS-hepaticogastrostomy (HGS) was considered.
Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review
Authors: Ernesto Sosa, Gail D’Souza, Aamna Akhtar, Melissa Sur, Kyra Love, Jeanette Duffels, Dan J. Raz, Jae Y. Kim, Virginia Sun, Loretta Erhunmwunsee
Journal: CA A Cancer Journal for Clinicians (2021)

Abstract Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race‐based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow‐up care to decrease LCS disparities.
Abstract 17019: Secular Trends in Dilated and Hypertrophic Cardiomyopathy in an Epidemiological Cohort in Olmsted County, Minnesota
Authors: Muhammad Masood, Akil A Sherif, Keerthi Jaliparthy, Christopher Scott, Alanna Chamberlain, Steve R Ommen, Virend K Somers, Bernard Gersh, Grace Lin, Peter A Brady, Anwar A Chahal
Journal: Circulation (2018)

Introduction: Idiopathic Dilated (DCM) and hypertrophic cardiomyopathies (HCM) are leading causes of sudden cardiac death. The incidence and prevalence of both DCM and HCM were originally estimated in Olmsted County, MN over 1975-1984. Incidence was 6.0 and prevalence was 36.5 per 100,000 person-years, for DCM; with incidence and prevalence rates of 2.5 and 19.7 per 100,000 person-years for HCM. This study aims to determine the incidence and mortality rates of individuals diagnosed with HCM and DCM in Olmsted County, MN from 1984 to 2016. Methods: The Rochester Epidemiology Project is a validated long term medical record linkage system that collects and links medical information for the approximately 145000 residents of Olmsted County, Minnesota. Using this database and the Electronic Health Record systems at Mayo Clinic and Olmsted Medical Center in Rochester, MN, we manually reviewed and validated the medical records of 4440 patients. This cohort includes all patients with any mention of a cardiomyopathy based on ICD and HICDA codes during the period 1984 to 2016. Data were summarized with mean and standard deviation, frequency and percentage and compared between groups using two sample t-test for continuous data and chi-square for proportions. Survival was computed using Kaplan-Meier methods and compared to expected survival based on age and gender. Incidence was computed using Olmsted County population numbers during the time period and adjusted to the US 1980 white population to allow for comparison with the previous study. Results: The calculated crude incidence rate for DCM and HCM are 10.1 and 7.8 per 100,000 respectively. Incidence rates adjusted for comparison to US 1980 white population (age and sex adjusted) are 10.4 (95% CI: 9.3-11.4) and 8.0 (95% CI: 7.1-8.8) per 100,000 person-years, respectively. The observed number of deaths in this cohort (HCM and DCM) was 420 vs 194 expected. Conclusions: Calculated incidence, both crude and adjusted rates are higher than previously estimated rates. The crude incidence rate for HCM is almost 4-fold higher than that for DCM is 2.4 times higher than the original estimate by Codd et al. Individuals with cardiomyopathies were found to have a higher overall mortality rate than the general population with an observed to expected hazard ratio of 1.73 (95% CI 1.49-2.01, p&lt;0.001) for DCM and 1.44 (95% CI 1.21-1.71, p&lt;0.001) for HCM. Our findings suggest that previous studies may have underestimated the true burden of HCM and DCM in the population which has important implications for healthcare provision and cost.
Association of Medicaid Expansion With Cancer Stage and Disparities in Newly Diagnosed Young Adults
Authors: Xu Ji, Sharon M Castellino, Ann C Mertens, Jingxuan Zhao, Leticia Nogueira, Ahmedin Jemal, K Robin Yabroff, Xuesong Han
Journal: JNCI Journal of the National Cancer Institute (2021)

Abstract Background Young adults (YAs) experience higher uninsurance rates and more advanced stage at cancer diagnosis than older counterparts. We examined the association of the Affordable Care Act Medicaid expansion with insurance coverage and stage at diagnosis among YAs newly diagnosed with cancer. Methods Using the National Cancer Database, we identified 309 413 YAs aged 18-39 years who received a first cancer diagnosis in 2011-2016. Outcomes included percentages of YAs without health insurance at diagnosis, with stage I (early-stage) diagnoses, and with stage IV (advanced-stage) diagnoses. We conducted difference-in-difference (DD) analyses to examine outcomes before and after states implemented Medicaid expansion compared with nonexpansion states. All statistical tests were 2-sided. Results The percentage of uninsured YAs decreased more in expansion than nonexpansion states (adjusted DD = −1.0 percentage points [ppt], 95% confidence interval [CI] = −1.4 to −0.7 ppt, P &amp;lt; .001). The overall percentage of stage I diagnoses increased (adjusted DD = 1.4 ppt, 95% CI = 0.6 to 2.2 ppt, P &amp;lt; .001) in expansion compared with nonexpansion states, with greater improvement among YAs in rural areas (adjusted DD = 7.2 ppt, 95% CI = 0.2 to 14.3 ppt, P = .045) than metropolitan areas (adjusted DD = 1.3 ppt, 95% CI = 0.4 to 2.2 ppt, P = .004) and among non-Hispanic Black patients (adjusted DD = 2.2 ppt, 95% CI = −0.03 to 4.4 ppt, P = .05) than non-Hispanic White patients (adjusted DD = 1.4 ppt, 95% CI = 0.4 to 2.3 ppt, P = .008). Despite the non-statistically significant change in stage IV diagnoses overall, the percentage declined more (adjusted DD = −1.2 ppt, 95% CI = −2.2 to −0.2 ppt, P = .02) among melanoma patients in expansion relative to nonexpansion states. Conclusions We provide the first evidence, to our knowledge, on the association of Medicaid expansion with shifts to early-stage cancer at diagnosis and a narrowing of rural-urban and Black-White disparities in YA cancer patients.
Abstract 15245: Cd34+ Progenitor Cells in the Progression of Cardiac Allograft Vasculopathy
Authors: Ilke Ozcan, Takumi Toya, Michel Corban, Ali Ahmad, Darrell Loeffler, Hunter Ostlie, Sudhir Kushwaha, Lilach O Lerman, Amir LERMAN
Journal: Circulation (2020)

Introduction: CD34+ progenitor cells play a role in vascular repair and plaque stability. However, their role in cardiac allograft vasculopathy (CAV), vessel remodeling, and changes in plaque morphology is incompletely understood. Hypothesis: We hypothesized that decreased levels of baseline CD34+ progenitor cells would be associated with Intravascular Ultrasound (IVUS)-defined vulnerable plaque characteristics and CAV progression. Methods: In heart transplant patients undergoing annual IVUS, CD34+ cells were counted in peripheral blood using flow cytometry, on the same day as baseline IVUS. Gray-scale and virtual-histology IVUS were used to evaluate vessel size, plaque burden, and plaque composition (fibrous, fibrofatty, necrotic core, calcific). Positive remodeling was defined as expansion of external elastic membrane area on follow-up. Patients were divided into two groups by the median of the change (Δ) in necrotic core volume over the subsequent 3 years. Results: A total of 55 patients (mean age 52±15 years, 65% males) were included. Median time after transplant was 4.2 years at baseline. Average vessel area at baseline and three years were 15.8±4.6 and 15.3±5.4 mm, respectively (p=0.32). Twenty-four patients (44%) who showed positive remodeling at follow-up, compared to those who did not, had lower levels of baseline CD34+ progenitor cells (absolute count per 100,000 counts, 980 [690, 1460]) vs. 665 [438, 1015], p=0.02) (Fig. 1A). Patients with greater than median (&gt;1.96 mm3) Δnecrotic core volume, as compared to those with below median Δ, also had lower baseline CD34+ cells (705 [483, 998] vs. 1180 [660, 1620] per 100,000 counts, p=0.04) (Fig. 1B). Conclusions: Lower levels of CD34+ progenitor cells are associated with long-term positive coronary vascular remodeling and increased plaque necrotic core volume in patients who underwent allograft heart transplant. This study supports the notion that circulating CD34+ progenitor cells play a role in CAV.
Abstract 13567: Variability in Reported Post-percutaneous Coronary Intervention Mortality Among Physicians Practicing at Multiple Sites in New York State
Authors: Nancy Yang, Peter W Groeneveld, Sameed Ahmed M Khatana, Jay S Giri, Alexander C Fanaroff, Ashwin Nathan
Journal: Circulation (2020)

Introduction: New York State (NYS) publicly reports physician-level post-percutaneous coronary intervention (PCI) mortality at each individual site they practice, to empower patients to make informed decisions. Given that mortality is a rare event and some sites have low case volumes, we hypothesized that the reported data at each site for physicians practicing at multiple sites is highly unstable and thus misleading for patients. In this study, we examined variation in site-specific risk-adjusted mortality rates (RAMR) for physicians practicing at multiple sites in NYS. Methods: This study uses publicly reported 30-day physician-level RAMR for all PCI performed in NYS between 2014 and 2016. We obtained the site-specific RAMR (ssRAMR) at each hospital where the physician performed PCI, and overall mean RAMR (mRAMR) for the physician. We excluded physicians who performed PCI at only one hospital. We identified outliers for mRAMR and maximum ssRAMR if values were greater than the 95 th percentile for each measure and plotted the outliers. Results: Between 2014 and 2016, 142,853 PCI procedures were performed by 373 physicians at 61 hospitals. Among 207 (55.5%) physicians practicing at multiple sites who performed 82,075 PCI (57.5%), the median mRAMR was 1.11% (IQR 0.66-1.60%, range 0-5.33%) and the median ssRAMR was 0.52% (IQR 0-1.53%, range 0-47.69%). Among the 11 physicians classified as ssRAMR outliers, only 3 (27.2%) physicians were also classified as an mRAMR outlier. Conclusion: We found that the individual ssRAMRs reported for a physician practicing at multiple hospitals is highly variable, and that mRAMR and ssRAMR outlier status are not consistent with each other. Thus, we believe public reporting of ssRAMR in NYS does not adequately reflect the quality of care delivered by physicians performing PCI. Figure: mRAMR and ssRAMR among maximum ssRAMR outliers. Each letter (A-K) represents a separate outlier physician.