tbuckley/cabot-search huggingface dataset:
Abstract 67: Childhood Adversity and Young Adult Cardiovascular Health: Future of Families and Child Wellbeing Study (FFCWS)
Authors: Havisha Pedamallu, Hongyan Ning, John T Wilkins, Noreen Goldman, Daniel A Notterman, Lifang Hou, Yinan Zheng, Amanda M Marma, Linda Van Horn, James H Stein, Claudia E Korcarz, Kristin Hansen, Colter Mitchell, Nia Heard-Garris, Donald M Lloyd-Jones, Norrina B Allen
Journal: Circulation (2024)

Introduction: Adversity during childhood, usually measured as retrospectively, is associated with long-term health. We examined associations of prospectively assessed childhood adversity with young-adult (YA) cardiovascular health (CVH). Methods: We included 1155 YAs with adversity measures from baseline Y0 (birth), Y1, Y3, Y5, Y9, and who completed a CVH exam at Y22 in the FFCWS. An adversity score (AS) (range: 0-7) represented the number of adverse childhood exposures experienced by age 9 out of 7 categories - emotional abuse and neglect; physical abuse and neglect; parental incarceration, parental substance use, and interpersonal violence. CVH was estimated using the Life’s Essential 8 (LE8) score (range: 0-100 points) overall and for each component, excluding sleep due to data unavailability. Linear regression models were adjusted for age and sex. Results: By age 9, 38% of YAs had experiences from 0-2 categories, 30% experienced 3, 21% experienced 4, and 11% experienced 5-7. People with higher AS were more likely to self-identify as Black compared to White, Hispanic, or other. In addition, higher AS correlated with lower BMI and higher nicotine use. Compared to individuals with 0-2 AS, an AS of 4 was associated with a 3.6-point (CI: -6.5 to -0.7) lower (less favorable) LE8 score and an AS of 5-7 was associated with a 4.9-point (CI: -8.5 to -1.3) lower LE8 score. Among individual LE8 components, smoking and physical activity scores varied significantly by AS. Compared with an AS of 0-2, a score of 5-7 was associated with a 13.0-point (CI: -22.9 to -3.1) lower smoking score. For physical activity an AS of 4 and 5-7 were associated with a 12.1-point (CI: -21.8 to -2.3) and a 14.4-point (CI: -26.3 to -2.4) lower PA score, respectively. Conclusions: Higher level of childhood adversity was prospectively associated with lower LE8 scores and worse CVH in young adulthood. Understanding the prospective associations between childhood adversity and CVH can help identify higher risk populations and guide treatment recommendations.
Abstract 48: Racial and Ethnic Disparities in Cardiovascular Multimorbidity Progression Among Older United States Adults
Authors: Michael D Green, Robert J Mentz, Stephen J Greene, Bradley G Hammill, Utibe R Essien, Ying Xian, Erin D Michos, Roland J Thorpe, Matthew E Dupre, Emily C O'Brien, Jay B Lusk
Journal: Circulation (2024)

Introduction: There is a knowledge gap in the potential unequal burden and progression of cardiovascular multimorbidity. Understanding the progression of cardiovascular multimorbidity and recognizing racial and ethnic disparities are needed to develop effective strategies to achieve health equity. Our objective is to investigate racial and ethnic disparities in the development and progression of cardiovascular multimorbidity among older adults in the United States and estimate relative life expectancies among patients with severe multimorbidity. Hypothesis: We hypothesized that life expectancy among older adults with severe cardiovascular multimorbidity is inversely related to the number of comorbid conditions and varies by race and ethnicity. Methods: Repeated cross-sectional cohort study of inpatient, outpatient, and carrier claims for a 5% nationwide Medicare sample. We included Medicare beneficiaries aged 65 or older enrolled in Medicare Fee-For-Service program from 2010 to 2020 and living in the continental United States. Multistate life table models were employed to estimate cardiovascular disease (CVD) progression and total life expectancies from ages 65 to 85 years. Progression probabilities and life expectancies were adjusted for age, non-cardiovascular comorbidities, and Medicaid dual eligibility. A microsimulation approach was utilized to derive life tables, and bootstrapping was used to estimate variability. The primary outcome was the development and progression of cardiovascular multimorbidity, defined by the number of major cardiovascular conditions (atrial fibrillation, acute myocardial infarction, heart failure, stroke, and chronic ischemic heart disease). Comorbidities were assessed using validated algorithms based on diagnostic codes billed over a 1-year lookback period, and beneficiaries were followed forward from their index date. Results: Of 2,189,633 beneficiaries, the median age was 69, median follow-up duration was 6 years. The cohort mainly consisted of individuals who are Non-Hispanic White (84.4%, n=1,848,410), followed by individuals who are Non-Hispanic Black (8.2%, n=179,694) and individuals from other racial or ethnic groups (7.4%, n=161,529. Non-Hispanic Black beneficiaries had higher odds of multimorbidity progression compared to Non-Hispanic White beneficiaries. Specifically, those initially with one CVD had elevated odds of developing multiple severe CVDs (OR range: 1.02-1.09). Furthermore, they generally had higher odds of progressing to a greater burden of CVD multimorbidity (OR range: 1.00-1.25). Conclusions: These findings suggest persistent racial and ethnic disparities in cardiovascular multimorbidity progression, identifying a potentially important target for the promotion of health equity.
Abstract 46: Midlife and Late-Life Population Attributable Fractions of Dementia Risk Factors in the United States: A Cohort Study From the Dementia Risk Pooling Project
Authors: Joanne M Li, Abigail M Gauen, Rachel Zmora, John Stephen, Sanaz Sedaghat, Denise Scholtens, Maxwell Mansolf, Ciaran N Kohli-Lynch, Elizabeth Peterson, Alden Gross, Archana Singh-Manoux, Mohammad A Ikram, Christophe Tzourio, Claudia L Satizabal, Deborah A Levine, Donald M Lloyd-Jones, Emily M Briceno, Farzaneh Sorond, Frank Wolters, Jayandra Himali, Lenore J Launer, Lihui Zhao, Oscar L Lopez, Stephanie Debette, Sudha Seshadri, Suzanne E Judd, Timothy M Hughes, Vilmundur Gudnason, Aicha Soumare, Allison Aiello, Sarah Forrester, Norrina B Allen
Journal: Circulation (2024)

Introduction: Dementia cases in the US are projected to nearly double from 5.3 million in 2019 to 10.5 million by 2050. Research has suggested that 41% of US dementia cases may be prevented by eliminating several specific modifiable risk factors. Still, few studies examine risk factor variation between midlife and late-life. Previous studies have also been limited by sample diversity and size. The Dementia Risk Pooling Project (DRPP) is a consortium of longitudinal cohorts including several underrepresented racial/ethnic groups pooled at the individual level. Methods: We estimated individual and combined population attributable fractions (PAF) for seven modifiable risk factors in midlife (aged 45-64) and late-life (aged 65+), using data from six US cohorts in DRPP. We also used potential impact fractions (PIF) to estimate dementia cases that could be prevented due to risk factor reduction in midlife and late-life based upon the National Alzheimer’s Advisory Council goal of a 15% reduction in dementia risk factors by 2030. Results: In a sample of 41,432 unique participants (ppts), risk factor exposure was measured in midlife for 29,983 ppts (60% female, 77% white) and in late-life for 30,633 ppts (56% female, 70% white). During follow-up, 4,186 midlife ppts and 4,893 late-life ppts developed dementia. We found that eliminating midlife risk factors could prevent a greater proportion of dementia cases [PAF 41.3%, 27.9%-54.6%] compared to late-life risk factors [23.1%, 12.4%-33.7%]. Midlife physical inactivity [18.8%, 15.1%-22.4%] appeared to be the greatest contributor. Late-life hypertension and depression appeared to contribute to 9.8% [5.5%-13.9%] and 4.2% [3.5%-5.0%] of cases, respectively. Given the US prevalence of dementia in 2020, we estimate that a 15% reduction in physical inactivity alone could prevent 148,339 dementia cases. Conclusion: The importance of modifiable risk factors for dementia may vary with age. These estimates could inform the timing of public health interventions for dementia prevention.
Abstract 07: Spatial Modeling of Social Determinants of Hypertension Within the RESTORE Network
Authors: Biruk Teshome, Karan Parikh, Folahan A Ibukun, Katherine Wheeler-Martin, Cheryl R Dennison Himmelfarb, Lisa A Cooper, Yvonne Commodore-Mensah, Oluwabunmi V Ogungbe
Journal: Circulation (2024)

Introduction: Multiple environmental and neighborhood factors impact hypertension (HTN) prevalence. Applying spatial methods to explore drivers of HTN risks can reveal complex social and ecologic drivers. Objectives: To examine ecological associations between social determinants of health (SDoH), space, and HTN across the American Heart Association-funded RESTORE (Add RE ssing S ocial D eterminants TO p R event Hypertension) Network. Methods: We used City Health Dashboard data, which contains city and county-level aggregate 2019 data for over 950 US cities. We included populated census tracts and counties in RESTORE Network states (Alabama, Maryland, Massachusetts, Michigan, and New York). Primary outcome was HTN prevalence: proportion of adults ≥18 years with diagnosed HTN. Covariates were indicators of clinical care, health behaviors, health outcomes, and physical environment. Using Bayesian hierarchical Besag-York-Mollié (BYM) models with Gaussian distribution by integrated nested Laplace approximation, we estimated associations between social determinants and HTN, accounting for spatial autocorrelation. Results: Of the 5 states assessed, 4828 tracts were in New York, 2745 tracts in Michigan, 1175 tracts in Alabama, 1463 tracts in Massachusetts and 1388 tracts in Maryland, totaling 11,599 census tracts. The observed spatial variation in the model was 91% in New York, 83% in Michigan, 78% in Alabama, 79% in Massachusetts, and 74% in Maryland. After adjusting for known HTN risk factors at the tract level, results showed a moderate-high spatial random effect, i.e., residual HTN prevalence remained in several tracts in the 5 states. Patterns of variation of this spatial random effect also differed between states ( Figure ). Conclusions: These findings can be used to identify areas that have higher rates of HTN after accounting for other SDoH. Targeted local health policies may reduce the burden of HTN across the 5 states and advance cardiovascular health equity.
Abstract 14: Post-Traumatic Stress Disorder Symptoms and Physical Activity Behavior After Hospitalization for Suspected Acute Coronary Syndromes
Authors: Chang Xu, Joseph Schwartz, Gabriel Sanchez, Margaret Murdock, Gaspar Cruz, Ammie Jurado, Andrea Duran, Benjamin Boudreaux, Donald Edmondson, Keith Diaz
Journal: Circulation (2024)

Background: An acute coronary syndrome (ACS) related event can induce post-traumatic stress disorder (PTSD), and post-ACS PTSD is associated with a greater risk for secondary clinical outcomes among ACS survivors. While moderate-vigorous physical activity (MVPA) has been shown to reduce the risk of adverse outcomes after ACS, its impact on PTSD symptoms remains largely unknown. There is a notable absence of empirical evidence, especially from large-scale observational cohort studies with device-based measures of physical activity, on this topic. Aim: To investigate the relationship between physical activity behaviors over the first month post-discharge with PTSD symptoms at one month among patients with suspected ACS. Methods: Patients (n = 434, 48.6% female, 62.6±12.4yrs) evaluated for ACS in the emergency department were fitted with a GENEActiv wrist accelerometer in-hospital and wore the device on their non-dominant wrist for 30 days post-discharge to measure MVPA. Presence and severity of PTSD symptoms were assessed at 1-month follow-up using the PCL-5. Multilevel structural equation modeling was used to simultaneously 1) fit a linear growth curve (GC) model to patients’ 30-day trajectories of MVPA and 2) predict total PTSD symptoms from a) mean daily MVPA, b) average daily change in MVPA (GC slope), and c) covariates (age, biological sex, education, and Charlson Comorbidity Index). Results: Patients engaged in an average of 20.8 (95% CI: 18.4, 23.3, p &lt; 0.001) minutes of MVPA per day. MVPA levels increased at an average rate of 0.11 mins/day (95% CI: 0.05, 0.16, p &lt; 0.001) over the 30 days post-discharge. There was substantial between-patient variability in both average MVPA minutes (SD = 26.0) and daily rate of change in MVPA minutes (SD = 0.38). The daily rate of change in MVPA was significantly associated with 1-month PTSD symptoms (β per 0.5 mins/day difference in daily rate of change in MVPA minutes = -4.5 points on the PCL-5; 95% CI: -6.5, -2.5, p &lt; 0.001), controlling for the above-mentioned covariates. The association between average MVPA minutes and PCL-5 score was small and not statistically significant (β = 0.02; 95% CI: -0.04, 0.07, p = 0.60). Conclusion: PTSD symptoms appear to be mitigated in patients whose MVPA minutes increased over the 30 days post-discharge, whereas no evident association was observed between PTSD symptoms and average daily MVPA minutes. These findings suggest that progressively increasing MVPA by as little as .5 mins/day (i.e., ~1 SD above the mean rate of increase) within the immediate first month post-discharge, as opposed to maintaining a consistent daily average of MVPA, may impede the development of PTSD symptoms in ACS survivors.
Abstract 57: Gut Microbiota, Blood Metabolites and Left Ventricular Diastolic Dysfunction in US Hispanics/Latinos
Authors: Kai Luo, Alkis Taryn, Eun Hye Moon, Brandilyn Peters-Samuelson, Scott Solomon, Martha L Daviglus, Mayank M Kansal, Bharat Thyagarajan, Marc Gellman, Jianwen Cai, Robert Burk, Rob Knight, Robert Kaplan, Susan Cheng, Carlos J. Rodriguez, Qibin Qi, Bing Yu
Journal: Circulation (2024)

Background: Left ventricular diastolic dysfunction (LVDD) is a precursor of heart failure (HF), but its relationship with gut dysbiosis and microbial-related metabolites remains unclear. Hypothesis: Alerted gut microbiota composition is associated with LVDD and blood metabolites, which can be used as indicators of gut dysbiosis. Methods: This study included up to 1996 adults (mean age: 59.4 years; 67.1% female; 45.9% with prevalent LVDD) from the Hispanic Community Health Study / Study of Latinos with echocardiography assessments, gut microbiota (512 bacteria species), and blood metabolome (669 metabolites) data. Cross-sectional associations of gut bacteria with prevalent LVDD and metabolites, and prospective associations of microbial-associated metabolites with incident LVDD were assessed. Results: Seven bacterial species were associated with LVDD (FDR-q &lt;0.1), with inverse associations found for Intestinimonas_massiliensis , Clostridium_phoceensis, and Bacteroide_coprocola , and positive associations for Gardnerella_vaginali , Acidaminococcus_fermentans, Pseudomonas_aeruginosa and Necropsobacter_massiliensis . A total of 220 metabolites were found to be associated with identified bacteria (FDR-q &lt;0.1), with 46 associated with prevalent LVDD (FDR-q &lt;0.1). Of note, 21 metabolites were associated with incident LVDD over a median 4.3 years of follow-up, including many known microbial metabolites (e.g., indolepropionate, 3b-hydroxy-5-cholenoic acid and glycohyocholate). The use of these metabolites significantly improved the prediction of incident LVDD, outperforming models only with traditional risk factors (AUC=0.73 vs. 0.70, p=0.001). Metabolite-based proxy association analyses revealed potential prospective associations between 3 gut bacteria species (e.g., I.massilliensis and C.phoceensis ) and incident LVDD. Conclusion: Our study found gut bacteria and bacteria-associated metabolites linked to LVDD, suggesting their potential roles in this preclinical HF entity.
Abstract 55: Associations Between Cardiovascular Disease, Cognition, Kidney Function and Polyepigenetic Scores of Atherosclerosis in the Health and Retirement Study
Authors: Farah Ammous, Colter Mitchell, Jessica Faul
Journal: Circulation (2024)

Introduction: Atherosclerosis, characterized by the accumulation of arterial fatty and fibrous materials, underlies various morbidities, particularly cardiovascular disease (CVD). Epigenetic processes, like DNA methylation (DNAm), may function as mediators or biomarkers of atherosclerosis. In this study, we estimated polyepigenetic scores, which are risk-profile scores calculated from the results of an external epigenome-wide association study, for coronary artery calcification (DNAm-CAC) and carotid plaque (DNAm-cPlaque). We assessed the hypothesis that these scores are associated CVD, cognitive function, and renal function. Methods: We utilized data from the Health and Retirement Study, a longitudinal survey of U.S. adults over age 50. DNAm was measured on a representative sample of respondents aged 56 years and older who consented to blood draws in 2016 (N=3,875). We defined CVD based on self-reported physician diagnoses, cognitive function/dementia status using the Langa-Weir classification, and kidney function using serum cystatin C. We used weighted linear regression for modeling associations with cognitive and kidney function, logistic regression for prevalent CVD, and Cox proportional hazards models for incident CVD and dementia over a four-year follow-up period. Results: In 2016, the sample had a mean age of 67.4 years (SD=8.5). Most participants were females (57%), with Whites/Caucasians comprising 75% and Blacks/African Americans 17% of the sample. Both DNAm-CAC and DNAm-cPlaque were higher in smokers, individuals with a history of stroke, and those of Black/African American ancestry, while participants with higher education and greater wealth had lower scores (p&lt;0.05). In unadjusted models, DNAm-CAC was linked to higher CVD (Odds ratio: 1.16, 95% CI: 1.07-1.26, p = 3.7х10 -4 ), worse cognitive function (Beta: -0.50, 95%CI: -0.68 - -0.32, p=8.0х10 -9 for DNAm-CAC and -0.38, 95% CI: -0.56 - -0.20, p=1.1х10 -5 for DNAm-cPlaque), and declining kidney function (1.02 fold-increase, 95% CI: 1.01-1.03, p=0.004). Adjusting for comorbidities/lifestyle factors attenuated CVD and kidney function associations but not cognition (Beta = -0.30, 95% CI: -0.14 - -0.30 for DNAm-CAC; -0.23, 95% CI:-0.05- -0.23 for DNAm-cPlaque). DNAm-cPlaque was associated with dementia/cognitive impairment incidence (hazard ratio: 1.16, 95% CI: 1.01-1.32, p=0.03) after adjusting for comorbidities/lifestyle factors including APOE -E4 genotype. For both cognitive function and dementia/cognitive impairment incidence, adjusting for race/ethnicity, education, and wealth fully attenuated the associations. Conclusions: Our findings highlight the significance of polyepigenetic scores of atherosclerosis as potential biomarkers for associated morbidities in a representative U.S. sample and underscore the role of social factors as a pathway influencing these associations.
Abstract 52: Associations of Ideal Cardiovascular Health and Its Change With Cardiovascular-Kidney Outcomes in Young Adults
Authors: Hokyou Lee, Hyeok-Hee Lee, Jong Hyun Jhee, Eun Jin Kim, Hyeon Chang Kim, Donald M Lloyd-Jones
Journal: Circulation (2024)

Introduction: The AHA recently highlighted the linkage of cardiovascular (CVD) and chronic kidney disease (CKD) and the importance of promoting cardiovascular health (CVH) to prevent them. We hypothesized that attaining ideal CVH score or improving it in young adulthood is associated with low risk of cardiovascular-kidney events, but data are scarce. Methods: We studied 3,836,283 participants of the Korean national health screening in 2009-2010 (baseline age 20-39 y) without prior CVD or CKD. Participants were categorized by the number of ideal CVH components met (range 0-6; diet data unavailable). A subgroup of 2,768,705 participants who underwent follow-up health exam in 2011-2014 (median 4.2 y from baseline) were stratified by combination of baseline and follow-up CVH scores. The primary outcome was a composite of CVD events, incident CKD, and death from kidney disease or CVD, until 31 Dec 2021 (Fig, footnote). Results: At baseline, participants had median age 31 y, and 38.2% were female. During a median follow-up of 12.1 y, 172,217 cardiovascular-kidney events occurred. The multivariable-adjusted risk of cardiovascular-kidney event decreased gradually (HR 0.81 per 1 p higher CVH score) with higher CVH scores (Fig, A). A CVH score of 6 was associated with a 65% lower risk of cardiovascular-kidney event than a CVH score of 0. An increase in CVH score from the baseline to follow-up exam was associated with a lower risk of cardiovascular-kidney event (HR 0.87 per +1 p CVH score change). The risk was lowest in participants with high CVH at both baseline and follow-up; having high CVH at baseline, and improving from low to high CVH, were also associated with lower risk than those who maintained low CVH (Fig, B). Findings were similar for CKD and other individual endpoints. Conclusions: Achieving, maintaining, or improving ideal CVH during young adulthood was associated with lower risk of cardiovascular-kidney events, highlighting the importance of promoting early-life CVH for combined prevention of cardiovascular and kidney disease.
Abstract 24: Actigraphy-Measured Sleep Irregularity Increases the Risk of Incident Cardiovascular Disease and Cardiovascular Mortality in Older Women
Authors: Kelsie M Full, Steven Nguyen, Michael J LaMonte, Andrea Z Lacroix
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) is the leading cause of death for U.S. women. Our understanding of how poor sleep health contributes to CVD is limited by reliance on cross-sectional studies, self-reported sleep measures, and predominately non-Hispanic white samples. Our objective was to prospectively investigate actigraphy-measured sleep health and incident CVD and CVD mortality in a cohort of older multiethnic women. Methods: Women (n=3,992; mean age: 78.5 years, 33% African American, 17% Hispanic/Latino) enrolled in the Women’s Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study wore an Actigraph GT3X+ accelerometer for 7 days in May 2012-April 2014 and were followed through February 2022 for physician-adjudicated incident CVD (definition in Table footnote) and CVD mortality. Sleep duration, timing, efficiency, irregularity, and continuity were derived from accelerometers (definition in Table footnote). Women with prior CVD at baseline were excluded from analyses. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Minimally adjusted models included age, race and ethnicity. Models were additionally adjusted for education, smoking, alcohol consumption, comorbid conditions, self-rated health, and CVD risk factors. Results: Over a median of 8.3 years of follow-up, 636 incident CVD cases occurred, including 395 CVD deaths. In minimally adjusted models, longer sleep duration, greater sleep irregularity, and more wake after sleep onset were associated with increased CVD risk (Table 1). In models further adjusted for CVD risk factors, the HR (95% CI) for a 60-minute increase in sleep irregularity was 1.18 (1.01-1.37) for incident CVD and 1.30 (1.07-1.58) for CVD mortality. Conclusions: Greater sleep irregularity was associated with higher risk of incident CVD and CVD mortality in a diverse cohort of older women. These results support the importance of maintaining regular sleep for cardiovascular health.