tbuckley/cabot-search huggingface dataset:
Abstract P3048: Relationships of Body Roundness Index and Triglyceride–glucose Index with 5-year All-cause Mortality in Patients with Diabetes and Comorbid Hypertension: Evidence from Two Prospective Cohort Studies
Authors: Yilu Liu, Hongzhao You, Jiansong Yuan, Shijie You, Yuntao Wu, Shouling Wu, Weixian Yang
Journal: Circulation (2025)

Aims: We aimed to characterise the complex relationships of body roundness index (BRI) and triglyceride-glucose index (TyG) with 5-year all-cause mortality in patients with diabetes and comorbid hypertension. Methods: 5,728 patients from the 1999–2014 US National Health and Nutrition Examination Survey (NHANES) cycles and 3,456 from the 2005–2010 China Kailuan cycles were included. BRI was calculated as 364.2−365.5×√(1−(waist circumference in centimeters/2π) 2 ÷(0.5×height in centimeters) 2 ). TyG was calculated as the logarithmic product of the fasting triglyceride and glucose concentrations. The cut-off values of BRI and TyG were based on median values. Results: The prevalence of 5-year all-cause mortality was 8.4% in the NHANES database and 9.2% in the Kailuan cohort. Multivariable Cox regression demonstrated that a BRI of &gt;6.2 (HR: 2.53, 95% CI: 1.71–2.96) and TyG of &gt;9.5 (HR: 1.64, 95% CI: 1.39–2.72) were independent predictors of 5-year all-cause mortality in diabetic patients with hypertension after adjusting forage, gender, marital status, education level, smoking status, history of myocardial infarction, stroke, urinary protein and CKD-EPI eGFR. These results were reconfirmed in the Kailuan cohort for BRI (HR: 2.91, 95% CI: 1.93–3.57) and TyG (HR: 2.13, 95% CI: 1.86–3.02). TyG was found to mediate the association between BRI and all-cause mortality, being responsible for 24.1% (16.8%-28.5%) in the NHANES database and 27.5% (22.7%-30.1%) in the Kailuan cohort. No significant additive interactions were found between BRI and TyG on 5-year all-cause mortality. Significant multiplicative effects were identified between TyG and BRI in the NHANES database alone (Additive: RERI = 0.05, 95% CI – 3.21–1.97; Multiplicative, HR = 1.27, 95% CI 1.13–1.95 in the NHANES database; Additive: RERI = 0.27, 95% CI – 2.17–5.29; Multiplicative, HR = 1.02, 95% CI 0.85–2.21 in the Kailuan cohort). Conclusions: BRI and TyG were independent risk factors for 5-year all-cause mortality in patients with diabetes and comorbid hypertension. TyG was found to mediate a considerable proportion of the effect of BRI on all-cause mortality in cohorts from both the United States and China. Interventions aimed at improving obesity and abnormal fat distribution might reduce the all-cause mortality risk associated with insulin resistance.
Abstract P3039: A New Biomarker of Aging Derived From Electrocardiogram Improves Risk Prediction of Incident Myocardial Infarction and Stroke.
Authors: Tom Wilsgaard, Wayne Rosamond, Henrik Schirmer, Haakon Lindekleiv, Zachi Attia, Francisco Lopez-Jimenez, David Leon, Olena Iakunchykova
Journal: Circulation (2025)

Introduction: Deep neural networks are increasingly used to generate diagnostic algorithms in cardiovascular medicine. A biomarker of cardiovascular aging, derived from a deep-learning algorithm applied to digitized 12-lead electrocardiograms (ECGs), has recently been introduced. This biomarker, delta age (δ-age), is defined as the difference between predicted ECG age and chronological age. Hypthesis: We hypothesized that δ-age will improve the prediction of incident fatal and non-fatal myocardial infarction (MI) and stroke on top of what contemporary CVD prediction tools would do. Methods: In this cohort study, we included 7,111 men and women from the Norwegian Tromsø Study conducted in 2015-16, with follow-up through 2021 for incident fatal and non-fatal myocardial infarction (MI) and hemorrhagic or cerebral stroke. We used Cox proportional hazards regression models to assess the independent effect of δ-age on MI and stroke. Discrimination was evaluated using Harrell’s concordance statistic (C-index) and the net reclassification improvement (NRI). Results: During a median follow-up of 5.9 years, we observed 155 incident cases of MI, 141 cases stroke and 290 cases with either MI or stroke. δ-age was observed with a mean of 0 and standard deviation of 6.2 years. In men and women combined, hazard ratios (HRs) per standard deviation increase in δ-age, after adjustment for traditional risk factors, were 1.24 (95% confidence interval (CI) 1.09, 1.41) for the combined outcome, 1.26 (1.06, 1.49) for MI and 1.25 (1.03, 1.50) for stroke. In men, the corresponding HRs were 1.27 (1.09, 1.49), 1.46 (1.18, 1.79) and 1.02 (0.80, 1.31), respectively, and in women, 1.20 (0.97, 1.49), 0.87 (0.64, 1.20) and 1.58 (1.19, 2.11), respectively. The C-index increased modestly when δ-age was added to a model with traditional risk factors. The 95% CI for the C-index increase excluded zero for the combined outcome overall, and for MI in men and for stroke in women. The NRI was 26.0% (13.3%, 38.1%) for the combined outcome, 17.5% (0.6%, 33.5%) for MI and 37.2% (20.1%, 53.0%) for stroke. Conclusions: Incorporating δ-age into primary prevention risk prediction models significantly improved performance beyond traditional cardiovascular risk factors for the combined outcome and separately for MI and stroke.
Abstract P1091: Association of NSAIDs Use, Pain Interference, and Incident Heart Failure among REGARDS Participants with Diabetes.
Authors: Yulia Khodneva, Orysya Soroka, Parag Goyal, Andrea Cherrington, Ro-Jay Reid, Megan Nordberg, Monika Safford, Emily Levitan
Journal: Circulation (2025)

Background: Diabetes mellitus (DM) is a risk factor for heart failure (HF). People with DM frequently have chronic pain, often treated with non-steroidal anti-inflammatory drugs (NSAID). Past research suggests that NSAID use among people with DM may be associated with cardiomyopathy. Therefore, we examined the association of NSAID use with incident HF hospitalization overall and by HF subtype among adults with DM. Methods: Incident HF hospitalizations and HF deaths were expert-adjudicated in the REasons for Geographic and Racial Differences in Stroke (REGARDS) biracial cohort (age ≥ 45 years), recruited in 2003-07 from the continental US. Baseline DM was defined by fasting or random serum glucose, anti-diabetic medication use, and/or self-report. Baseline NSAIDs use came from medication bottle review at an in-home visit and baseline pain interference was self-reported using the SF-12 scale. Propensity for NSAIDs use was computed using 54 baseline participant characteristics. Cox proportional hazards regression, adjusted for propensity score for NSAID use, examined risk for HF overall, by pain interference, and by opioid use. Results: We studied 5483 HF-free REGARDS participants with DM, aged 64 years; 53% female, 56% Black, 15% on NSAIDs, and 27% reporting pain interference in the past week. Over median 15-year follow up, there were 584 incident HF events. We observed no statistically significant associations between NSAID use and incident HF overall (TABLE). However, among those with high pain interference, NSAID use was associated with 1.5-fold increased risk of incident HF compared to similar NSAID nonusers, without differences by HF subtype. NSAID use was associated with 2-fold higher risk of incident HF among prescription opioid users compared to nonusers. Conclusions: Among adults with DM, NSAID use was associated with increased risk of incident HF among those with higher pain interference or concurrent opioid intake. NSAIDs should be used in people with DM with caution.
Abstract P3045: Symptoms of Hypoglycemia in Older Adults With and Without Diabetes
Authors: Natalie Daya Malek, Michael Fang, Dan Wang, B Gwen Windham, Arielle Valint, Justin Echouffo, Elizabeth Selvin
Journal: Circulation (2025)

Background: The ability of the body to maintain glucose homeostasis decreases with age, and symptoms of non-life-threatening hypoglycemia are non-specific (e.g. hunger, lack of concentration), which may put older adults at risk of hypoglycemia. The prevalence and correlates of symptoms of hypoglycemia in persons without diabetes are poorly understood. Objective: To examine the prevalence and correlates of symptoms of hypoglycemia among older adults with and without diabetes. Methods: Participants in the Atherosclerosis Risk in Communities (ARIC) Study (2021-22) with or without diabetes who were administered the 17-item Hypoglycemia Symptom Rating Questionnaire (HypSRQ) to assess symptoms of hypoglycemia experienced over the past 2 weeks. We quantified the burden of self-reported symptoms of hypoglycemia according to diabetes and high-risk diabetes medication status and evaluated the associations of symptoms with comorbidities including poor physical functioning (short physical performance summary battery score&lt;7) and depression (CES-Depression scale score9). Results: Among 1,085 participants (mean age 83, 60% female), 20.6% had diabetes (not on insulin/sulfonylurea (SU)) and 9% had diabetes (on insulin/SU). Overall, the number of symptoms reported were similar among those without diabetes (1.18 1.9 SD) and those with diabetes not taking insulin/SU (1.18 2.2) and higher among those with diabetes taking insulin/SU (1.41 2.0). Persons with diabetes (on insulin/SU) were more likely to report at least one symptom of hypoglycemia compared to persons with diabetes (not on insulin/SU) or without diabetes. Persons not on insulin/SU most commonly reported feelings of fatigue while persons on insulin/SU reported headaches, sudden temperature changes, feeling unsteady and faint ( Figure ). Irrespective of diabetes status, among those with 1 symptom (vs. none), 18% (vs. 14%) had poor physical functioning, 31% (vs. 23%) had obesity, and 6.5% (vs. 2.5%) had depression. Conclusion: The burden of symptoms of hypoglycemia among very old adults is highest among those with type 2 diabetes and on high-risk diabetes medication. The most prevalent symptom reported differed by high-risk diabetes medication status. Hypoglycemic symptoms are non-specific in older adults who are often experiencing a high burden of comorbidities; therefore, it may be useful to screen for hypoglycemia in older, high-risk patients.
Abstract P3160: The Effect of Early-Life Area-Level Socioeconomic Deprivation on Cognitive Function in Middle-Aged Adults: Findings from the Bogalusa Heart Study
Authors: Eunsun Gill, Dohyeong Kim, Katherine Theall, David Libon, Camilo Fernández Alonso, Lydia Bazzano, Jeanette Gustat, Emily Harville
Journal: Circulation (2025)

Background: Area-level socioeconomic deprivation is linked to cognitive impairment in older adults, but its impact from middle age is unclear. Evidence on the early-life deprivation effect on midlife cognitive function (CF) is limited. Objective: To investigate the effect of early-life Area Deprivation Index (ADI), on CF in middle-aged adults Methods: We assessed the association between early-life ADI and midlife CF in 1,099 subjects from the Bogalusa Heart Study (58.0% Whites, 42.0% Blacks, mean age at ADI: 12.6±5.9, mean age at CF: 48.7±5.0). Census data for 17 block-group variables were collected, including education, poverty, income, employment, and housing. Home ownership was excluded due to a factor loading below 0.3, leaving 16 variables for ADI calculation through factor analysis. The ADI was divided into quintiles, with the 1st quintile as the least deprived and 5th as most. CF was assessed through tests measuring episodic memory, working memory, attention, graphomotor information processing speed (GIPS), and global CF. Associations between ADI and CF were evaluated using a generalized estimation equation, adjusting for age at first exam, sex, race, year, and education. Interaction terms of race and education with ADI quintiles were tested. Results: The independent t-test showed Blacks had a higher ADI than Whites, indicating greater deprivation (0.81±0.58 vs. –0.60±0.80, p &lt;0.001). Global CF decreased in the 5th ADI quintile compared to the 1st (β=–0.002 standardized unit [SE: 0.001], p =0.001), with a downward trend across quintiles ( p =0.002). Episodic memory, working memory, attention, and GIPS also decreased as the quintile of ADI increased ( p &lt;0.001). Interaction terms with education showed significant negative effect on CF among high school graduates (1 st vs. 4 th quintile: β=–0.004 [SE: 0.002]), and those with education beyond high school (1 st vs. 5 th quintile: β=–0.004 [SE: 0.002]), but not among less than high school (1 st vs. 5 th quintile: β=–0.003 [SE: 0.001]; p for interaction: 0.011). Interactions between ADI quintiles and race were not significant. Conclusion: Higher early-life ADI was associated with lower midlife CF, with a decline observed in CF in the most deprived quintile, although effect sizes were modest. The strongest negative impact was observed among those with high school education or higher. Keywords area deprivation index; cognition; middle-aged adults
Abstract P3046: Association of Epigenetic Age Acceleration with Diabetes and Glucose Metabolism Markers Among Hispanic/Latino Adults in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
Authors: Jorge Gonzalez-Mejia, Sheroi Johnson, Robert Kaplan, Jainwen Cai, Carmen Isasi, krista perreira, Christina Cordero, Linda Gallo, Humberto Parada, Andrea Baccarelli, Christian Dye, Karen Conneely, Shakira Suglia
Journal: Circulation (2025)

Background: Epigenetic age acceleration (AA) has been associated with diabetes, but associations differ across DNA methylation (DNAm) based epigenetic clocks and populations. We examined whether epigenetic age acceleration (EAA) estimated from several epigenetic clocks was associated with the prevalence of diabetes and glucose metabolism markers among Hispanic/Latino adults in the United States. Methods: Genome-wide DNAm was profiled in a random sample of 1,000 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and was used to estimate EAA derived from four well-known epigenetic clocks (Horvath, Hannum, PhenoAge, GrimAge). Using a cross-sectional study design, we investigated the associations between each EAA measure and diabetes status at baseline, as well as their associations with glucose metabolism markers [fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), 2-h post-prandial blood glucose (2hBG), and homeostatic model assessment of insulin resistance (HOMA-IR)]. Survey-weighted Poisson regression models with robust variance were used to estimate prevalence ratios (PRs) for the associations between each EAA measure and diabetes status, adjusting for sex, education, age, smoking status, alcohol use, physical activity, diet, sleep duration, and cell type proportions. Survey-weighted multivariate linear regression models were used to estimate associations between each EAA measure and log-transformed glucose metabolism marker. Results: Five-year increases in EAA were associated with higher prevalence of diabetes for PhenoAA [PR: 1.37 (1.19, 1.57)] and GrimAA [PR: 1.43 (1.06, 1.91)]. Estimates also indicated a higher prevalence of diabetes for HannumAA [PR: 1.22 (0.99, 1.50)] and HovarthAA [PR: 1.13 (0.94, 1.35)]; however, these associations were not statistically significant. In linear regression models, increases in EAA were associated with higher glucose metabolism markers. For example, 5- year increases in PhenoAA were associated with higher levels of FBG [β: 0.02 (0.01, 0.03)] and HbA1c [β: 0.02 (0.01, 0.03)]. Increases in HannumAA, PhenoAA, and GrimAA were associated with higher HOMA-IR (p &lt;0.05). Conclusion: Among a population-based sample of Hispanic/Latino adults, EAA was associated with a higher prevalence of diabetes and higher glucose metabolism markers. Further research on the longitudinal association EAA and diabetes is needed to identify individuals at greater risk for developing diabetes.
Abstract P2078: Extreme Lipoprotein(a) Levels and the Hazard of Acute Myocardial Infarction Among Standard Modifiable Cardiovascular Risk Factors in the United States
Authors: Joana Tome, Monica Silver, Maria Weck, Cory Pack, Maryam Ajose, Natalia Coenen, Elizabeth Marchlewicz, Janna Manjelievskaia
Journal: Circulation (2025)

Background: Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease, including acute myocardial infarction (AMI). Currently, no Lp(a) targeted pharmaceutical treatments are available in the U.S. While Lp(a) has previously shown prognostic value among patients without standard modifiable risk factors (SMuRFs), data is limited among patients with SMuRFs. This study examined the variation in Lp(a) and AMI association by SMuRFs’ number. Hypothesis: We hypothesized that the association between extremely high Lp(a) (XHI) levels and AMI among U.S. adults would differ by SMuRFs’ number with an increased AMI hazard among those with more SMuRFs. Methods: This retrospective study included U.S. adults with ≥1Lp(a) lab result between 01/01/2016-01/31/2023 identified in the Veradigm Network Electronic Health Records (VNEHR) linked to closed claims. Patients had EHR/claims activity ≥13 months prior to and ≥12 months following the index date (30 days post-first Lp(a) test). Patients were stratified by Lp(a) value into low (LO, &lt;50 th percentile) and XHI (&gt;90 th percentile) cohorts. SMuRFs at baseline were defined as hypertension, dyslipidemia, diabetes, chronic kidney disease, current or former smoker, alcohol use disorder, and BMI &lt;18.5 or ≥25. Descriptive analyses were completed in SQL and SAS. Multivariable analyses are ongoing to examine AMI’s association with XHI Lp(a) by the number of SMuRFs. Results: Among the 17,819 patients meeting the inclusion criteria, 1,776 and 8,999 were assigned to the XHI and LO cohorts. Patients overall were 52.9 years old, 59% female, and 59% white. The XHI cohort had a greater proportion of patients with 3 SMuRFs (23.4% vs. 19.0%) and &gt; 4 SMuRFs (15.7% vs. 11.5%) and a lower proportion with 0 SMuRFs (6.6% vs. 11.0%) vs. the LO cohort (all p&lt;0.001). Baseline dyslipidemia (84.0% vs. 74.2%), hypertension (42.1% vs. 35.3%), and diabetes (19.5% vs. 15.7%) were observed more commonly among XHI vs. LO patients (all p&lt;0.001). During a mean follow-up of 3.9-years, AMI incidence was low (&lt;1.5%) and did not differ between Lp(a) cohorts. Conclusions: Patients in the XHI cohort were more likely to have ≥3 SMuRFs and baseline risk factors vs. the LO cohort. Although few patients had an AMI during the follow-up period, the higher presence of SMuRFs and risk factors within the XHI cohort underscore a pressing public health need. Additionally, a longer follow-up period may help better understand SMuRFs’ contribution to AMI hazard.
Abstract P3040: Associations between Triglyceride-glucose-obesity Indicators with Cardiovascular Disease Across Combination of Body Mass Index and Central Obesity Categories: The China Health and Retirement Longitudinal Study
Authors: Ruolin Zhang, Yaojie Wang, Huiyuan Zhou, Juyuan Li, Junke Zhu, Xiong Ding
Journal: Circulation (2025)

Introduction: The triglyceride glucose-body mass index (TyG-BMI) and triglyceride glucose-waist circumference (TyG-WC) are fast and simple clinical indices with proven reliability in predicting heart diseases and stroke. Considering the obesity paradox, where body mass index (BMI) may fail to accurately predict cardiovascular outcomes in obese patients, assessing the effectiveness of TyG-BMI and TyG-WC across the combination categories of BMI and waist circumference (WC) becomes essential. Methods: We included individuals with complete data on TyG, fasting plasma glucose, BMI, and WC at 2011 wave. Incidence of heart disease and stroke was observed during the follow-up visits. All participants were classified into four groups at baseline: both BMI and WC normal, BMI obesity (BMI ≥ 24 kg/m 2 ) but WC normal, BMI normal but WC obesity (WC, male ≥ 90 cm, female ≥ 80 cm) and both BMI and WC obesity. TyG-BMI and TyG-WC were calculated as BMI * TyG index and WC * TyG index, where TyG index = ln[FPG (mg/dL) * TG (mg/dL)/2]. Multivariate Cox proportional hazards models were employed to assess the association between TyG-BMI and TyG-WC with the risk of incident cardiovascular disease within the four groups, adjusted for demographic characteristics, smoking, drinking, blood urea nitrogen, high-density lipoprotein cholesterol, low-density lipoproteins cholesterol, C-Reactive protein, hemoglobin, uric acid, serum creatinine, cystatin C, hypertension, diabetes and kidney disease. Results: Among 7,405 participants (mean age 57.8, 53.9% women), 479 stroke and 1141 heart disease incidents were recorded with average follow-up years of 6.55 and 6.35. The fully adjusted models in Figure 1 revealed that in the BMI and WC obesity group, every 10-unit increase in TyG-BMI and TyG-WC was associated with 4.2% and 1.3% higher risk of heart disease respectively (HR = 1.04, 95% CI = 1.01, 1.07; HR = 1.01, 95% CI = 1.002, 1.03). Additionally, among individuals with normal BMI but obese WC, each 10-unit rise in TyG-WC was associated with a 4.5% increase in stroke risk (HR = 1.05, 95% CI = 1.01, 1.08). Conclusions: The TyG-BMI and TyG-WC indices exhibit differential predictive capabilities for cardiovascular disease risk across diverse obesity phenotypes, where the applicability could not extend to populations characterized by both normal BMI and WC. Our findings stress the importance of applying TyG indices to tailored populations, enhancing the precision of cardiovascular risk assessment.