tbuckley/cabot-search huggingface dataset:
Abstract P536: The Association of Adipokines With Cardiac Structure and Function Among Older Adults Without Clinical Cardiovascular Disease
Authors: Andreas Kyrvasilis, Bige Ozkan, Justin B Echouffo-Tcheugui, Vijay Nambi, Erin D Michos, Wendy S Post, Gary Gerstenblith, Roger S Blumenthal, Ron C Hoogeveen, Christie M Ballantyne, Amil M Shah, Elizabeth Selvin, Josef Coresh, Chiadi E Ndumele
Journal: Circulation (2024)

Background: Heart failure (HF) is a growing public health concern. While dysfunctional adipose tissue is a key driver of HF risk in the population, the role of altered adipokine production by adipose tissue in the development of cardiac dysfunction is unknown. Methods: We conducted a cross-sectional analysis of ARIC Visit 5 (2011-13) participants free of coronary heart disease and HF. Using linear regression, we assessed the adjusted associations between the adipokines adiponectin, leptin, apelin, and resistin (per 1-SD) and echocardiographic parameters indicative of cardiac structure and function. Results: We included 3244 participants (mean age 75±5 years, 61% female, 16% Black, 31% with obesity). After adjusting for sociodemographic/lifestyle factors and eGFR, 1-SD higher adiponectin was associated with lower (worse) LV ejection fraction (LVEF), but a more negative (better) longitudinal strain (LS). Higher adiponectin was also associated with higher lateral and medial e’ and lower E/e’, reflecting better diastolic function. Conversely, higher leptin was associated with worse systolic and diastolic function, indicated by a less negative LS, lower lateral and medial e’, and higher E/e’. Higher leptin/adiponectin ratio was associated with better LVEF (β: 1.73, 95% CI: 0.04, 3.41), but worse LS (β: 1.87, 95% CI: 1.17, 2.57), as well as uniformly worse diastolic function (lateral e’ [β: -2.39, 95% CI: -2.99, -1.79], medial e’ [β: -1.43, 95% CI: -1.86, -0.99], E/e’ [β: 2.61, 95% CI: 1.56, 3.67]). Adjustment for clinical variables and BMI attenuated some associations, but resulted in associations of adiponectin with greater LV mass index, and leptin with lower LV mass index. Apelin and resistin had weak associations with cardiac function. Conclusion: Adiponectin and leptin are differentially associated with systolic and diastolic function. Further investigation of the adipokines’ opposing roles in the development of cardiac dysfunction may help elucidate the effect of dysfunctional adipose tissue on myocardium.
Abstract P172: Potential Contribution of Social Factors in Reducing Population Disparities in Cardioprotective Health Behavior Between Bisexual, Gay/Lesbian, and Straight Adults
Authors: Adovich Rivera, Chun Chao, Rulin Hechter
Journal: Circulation (2024)

Background: Studies have demonstrated disparities in cardioprotective behavior by sexual orientation. Social factors have been associated with individual outcomes, but their impact on population disparities is unclear. We assessed if hypothetically intervening on social factors may reduce health behavior disparities by sexual orientation. Methods: We analyzed the intake survey data from the 2015-2023 Kaiser Permanente Research Bank. We compared unadjusted and demographics-standardized prevalence of selected health behaviors by sexual orientation (gay/lesbian or bisexual (LGB) vs straight adults (reference)). We then assessed the potential impact of hypothetically intervening on a single social factor (neighborhood safety, discrimination, education, income) on population disparities using a gap-closing estimand approach (i.e., modified inverse propensity weighting with g-computation). Results: We included 166,479 adults (mean age = 59 years), with 4.5% (7,476) gay/lesbian and 3% (4,936) bisexual. A higher proportion of LGB adults had documented current smoking, binge drinking, and low fruit intake compared to straight adults. Also, a higher proportion of bisexual adults had a high fast-food diet and inadequate sleep. Standardized prevalence of smoking, binge drinking, and inadequate sleep (bi only) remained higher in LGB adults. In gap-closing analysis, no change in gay/lesbian-straight disparities were observed. Reduction in bi-straight disparities in smoking (-2.5%, 95%CI: -3.5, -1.7) and sleep (-2.4%, 95%CI: -3.6, -1.1) may occur with higher college education rates. The sleep disparity (-2.4, 95%CI: -4.0, -0.93) may also decrease by reducing discrimination rates. None of the factors reduced the binge drinking disparity. (Table) Conclusion: LGB adults had higher prevalence of smoking, drinking, and inadequate sleep (bi only). Addressing single factors could reduce some LGB health behavior disparities but multi-factor interventions may be necessary to attain equity across orientations.
Abstract P342: Gut Microbiota and Microbial Metabolites Are Associated With DXA Measured Overall Fat and Trunk Fat in 5-year-old Children
Authors: Yingan Chen, Noel T Mueller, Curtis Tilves, Myriam Doyon, Luigi Bouchard, Patrice Perron, Renee Guerin, Eric Masse, Marie-France Hivert
Journal: Circulation (2024)

Introduction: Gut microbiota (GMB) has been associated with obesity in children, but no studies have examined GMB with direct measures of fat mass and trunk fat in children. In our study we examine GMB and GMB metabolites with overall body fat and trunk fat mass (TFM) measured by dual x-ray absorptiometry (DXA) in 5-year-old children. Hypothesis: GMB composition and GMB metabolites are associated with DXA-measured overall fat and TFM. Methods: We conducted our study in children from the Gen3G cohort, a community-based cohort enrolled prenatally in 2010-2013 in Quebec, Canada. A total of 153 children had data on GMB and 140 had data on plasma metabolites in addition to DXA scan at 5-6.5 years of age. We assessed GMB by 16s rRNA sequencing of stool samples, and measured plasma metabolites using the untargeted approach by Metabolon. We used multivariable-adjusted (see figure for covariates) linear regression to examine associations of DXA measured fat with 67 pre-defined GMB-derived metabolites from the Metabolon database. We used ANCOM-BC to examine 542 GMB amplicon sequence variants (ASVs) with body composition measurements. We used a false discovery rate (FDR) correction for multiple testing and considered an FDR value of &lt; 0.2 as significant. Results: Of the 153 children, 43.1% female, 96.1% self-identified as white. Average BMI z-score was 0.18 ± 0.90, with average TFM 2125 ± 637 g. A total of 7 ASVs were associated with total body fat, 3 ASVs with TFM, and 1 ASV with BMI ( Fig. panel A ). Of 67 metabolites tested, 1 was associated with total body fat, 2 with TFM, and 3 with BMI. The two metabolites associated with TFM in a linear fashion ( Fig. panel B ) were deoxycholic acid and glycoursodeoxycholate, which are know to be involved in secondary bile acid metabolism and the etiology of diabetes. Conclusion: In children, associations of GMB composition and metabolites with DXA-measured overall fat mass, TFM, and BMI were in a similar direction. In particular, GMB metabolites related to bile acid metabolism were related to adipose tissue accumulation.
Abstract P359: Neighborhood Disinvestment and Racial/Ethnic Disparities in Peripartum Cardiomyopathy in California, From 2004-2019
Authors: Curisa M Tucker, Chen Ma, Mahasin S Mujahid, Afshan B Hameed, Elliott Main, Suzan Carmichael
Journal: Circulation (2024)

Introduction: Peripartum cardiomyopathy (PPCM) is a rare life-threatening medical condition presenting as idiopathic heart failure in late pregnancy or during the early postpartum period in otherwise healthy patients. Racial disparities in the rates of morbidity and mortality of PPCM have been extensively documented where higher rates occur in Black patients. There is minimal research examining the relationship between racial/ethnic disparities in PPCM and social determinants of health such as neighborhood social disadvantage. Hypothesis: We hypothesize that neighborhood social disadvantage is associated with PPCM and it contributes to racial/ethnic disparities in PPCM, pre-pregnancy hypertension contributes to disparities, and that the timing of PPCM mostly occurs during the postpartum period. Methods: We used data obtained from the California Department of Health Care Access and Information, which included vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997-2018. We created and standardized the Neighborhood Deprivation Index (NDI) as a proxy measure for neighborhood social disadvantage and categorized it into quartiles, with quartile 1 indicating the least deprivation and quartile 4 indicating the most deprivation. We examined the distribution of population characteristics for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and Hispanic births in the sample by PPCM status. We sequentially adjusted multivariable logistic regression models by maternal and clinical characteristics to estimate the association of NDI and race/ethnicity with PPCM using non-Hispanic White as the reference group. We report odds ratios (OR) and 95% confidence intervals (CI) that reflect the total change in odds of PPCM, and calculated the timing of PPCM diagnosis. Results: Our study included 6,970,681 births and 862 (0.012%) PPCM cases. After adjustment, in the NDI regression models, quartile 2 (Q2) through quartile 4 (Q4) had elevated risk for PPCM (Q2: OR 1.2 (CI 1.0-1.5); Q3: OR 1.7 (CI 1.4-2.1); Q4: OR 1.5 (CI 1.2-1.9)). When adjusting for NDI in the race/ethnicity models, the odds of PPCM slightly decreased for each race/ethnicity. After adjusting for pre-pregnancy hypertension in both the NDI and race/ethnicity models, the odds of PPCM slightly decreased for quartile 3 and 4 and in NH Black births. Most PPCM cases (60.4%) were identified during a postpartum hospital encounter. Conclusions: Our results show that neighborhood deprivation and pre-pregnancy hypertension partially explain the racial/ethnic disparities in PPCM. Future research should examine the impact of specific measures of neighborhood deprivation (e.g., access to care, employment levels etc.) on the racial/ethnic disparity in outcomes such as PPCM.
Abstract P419: Urinary Na:K Excretion and the Risk of Cardiovascular Events in Patients With Chronic Kidney Disease
Authors: Cass G Sunga, Leila R Zelnick, Nisha Bansal
Journal: Circulation (2024)

Introduction: The risk of death from cardiovascular disease (CVD) is three times higher in patients with chronic kidney disease (CKD). Urine sodium and potassium excretion are altered in CKD and have been identified as CVD risk factors in other populations; therefore, they may represent therapeutic targets in persons with CKD. We aimed to examine the association between the ratio of urine Na-to-K (Na:K) with incident atrial fibrillation (AF), heart failure (HF), and myocardial infarction (MI) in patients with CKD. Methods: 2341 adults with CKD enrolled in the Chronic Renal Insufficiency Cohort free of CVD at study entry. Spot urinary Na:K ratio was measured from 24-hour collections and divided into quartiles. Outcomes included physician-adjudicated hospitalizations for AF, MI and HF (overall, preserved [HFpEF] and reduced ejection fraction [HFrEF]). Incidence rates (with 95% CI) were calculated per 1000 person-years. We performed Cox regression in a series of nested models, adjusting for demographics, habits, baseline comorbidities, kidney function and concurrent medications. Results: 586 participants were in the highest quartile of urinary Na:K excretion (mean age 54.3 (SD 11.7); 46% women (271 out of 586). Mean eGFR was lower in this group [49.5 (SD 19.4)] and 24-hour urine protein was higher [0.27 (IQR 0.08-1.19)] compared to lower quartiles. Rates of incident HF [18 (95% CI 7.5-12.5)] and MI [10 (95% CI 7.5-12.5)] were higher in persons with higher urine Na:K ratio (Fig 1). In adjusted models, the highest quartile (compared with the lowest quartile) of urine Na:K ratio was associated with AF (1.57, 95% CI 1.08-2.3) and HF (1.43, 95% CI 1.15-4.12). In sensitivity analyses, elevated urine Na:K was significantly associated with HFrEF (2.18, 95% CI in 1.15-4.12), but not HFpEF. Conclusions: Urinary Na:K excretion was associated with an increased incidence of atrial fibrillation and heart failure in persons with CKD free of CVD. Sodium and potassium represent possible modifiable risk factors for CVD prevention in patients with CKD.
Abstract P239: Association of Presence of Non-Specific Physical Complaints With Future Development of Cardiovascular Disease in Middle-Aged Japanese Workers: Finding From the Aichi Workers Cohort Study
Authors: Zean Song, Yuanying Li, Yoshihisa Nakano, Young-Jae Hong, Tahmina Akter, Mohammad Hassan Hamrah, Hanson Gabriel Nuamah, Chisato Fukuda, Rina Tajima, Jingyi Lin, Zhiling Shi, Mizuho Hibino, Baruck Tegegn Endale, Yupeng He, Masaaki Matsunaga, Atsuhiko Ota, Koji Tamakoshi, Hiroshi Yatsuya
Journal: Circulation (2024)

Introduction: Stress responses to work-related stressors often manifest in non-specific physical complaints, by monitoring it may provide early indications of underlying health issues. Hypothesis: We hypothesized that there is a significant association between non-specific physical complaints and the subsequent incidence of cardiovascular diseases (CVD) in middle-aged Japanese. Methods: A cohort of 4820 Japanese workers (3876 male, 944 female) ages 35 to 65 years were followed from 2007 to 2019 for CVD incidence (stroke and acute coronary artery diseases). Non-specific physical complaints were assessed as a domain of stress response in the 57-item brief job stress questionnaire and consisted of 11 items: felt dizzy; experienced joint pains; experienced headaches; had stiff neck or shoulders; had lower back pain; had eyestrain; had heart palpitations or shortness of breath; had stomach or intestine problems; lost appetite; had diarrhea or constipation; couldn’t sleep well. Each item had four possible responses from never, sometimes, often, to always, corresponding scores of which are 1, 2, 3, and 4, respectively. The presence of non-specific physical complaints was defined as a sum score of 27-44 for males and 30-44 for females according to the recommended standard values. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) of non-specific physical complaints for CVD were estimated and adjusted for age, sex, smoking status, alcohol consumption, regular exercise, sleep duration, body mass index, systolic blood pressure, total cholesterol, and histories of hypertension, hyperlipidemia, and diabetes. Results: During a median of 10.4 years of follow-up, 90 CVD cases were identified. The presence of non-specific physical complaints was significantly associated with the incidence of CVD independent of confounding variables (HR: 2.04, 95% CI: 1.02-4.07). Conclusion: The present study revealed that the presence of non-specific physical complaints was associated with a higher risk of developing CVD.
Abstract P356: Women’s Reproductive Factors Are Associated With Future Risk of Hearing Loss
Authors: Dongshan Zhu, Chunying Fu, Qi Wang
Journal: Circulation (2024)

Introduction: The association between female reproductive factors and risk of hearing loss (HL) has been unclear. Hypothesis: Women’s reproductive factors have been associated with comorbidities such as cardiovascular disease and diabetes, which are all linked to hearing loss (HL). We thus hypothesized that reproductive factors might be associated with the risk of HL. Methods: We used data from the UK Biobank (UKB). Reproductive factors included number of children, age at the first/last birth, age at menarche, age at natural menopause, and reproductive period. HL was ascertained using the International Classification of Diseases 10th revision (ICD-10) codes H90 (conductive and sensorineural hearing loss) and H91 (other hearing loss). Cox proportional hazards models were used to examine the association between reproductive factors and hospital ascertained HL, considering death as a competitive event. In addition, we combined age at menopause with HRT status to see their joint effect on HL. All models were adjusted for age at baseline, ethnicity, education level, income, Townsend deprivation index, BMI, smoking status, drinking status, physical activities, cardiovascular disease, diabetes, and HRT use status. Results: Compared to women who had no child, women who had two, three and four or more children was linked to elevated risk of HL, with HR (95% CI) of 1.14 (1.04-1.25), 1.24 (1.11-1.38), and 1.35 (1.17-1.55), respectively. Compared to women who had first birth before age 25 years, women who had first birth greater than age 26 years had reduced risk of HL (0.84, 0.76-0.93). Women who gave last birth over age 40 years had elevated risk of HL (1.21, 1.01-1.45), compared to those who had last birth before age 35 years. Compared to women who had menopause at age 46-50 years, those who had early menopause less than age 45 years were associated with 24% higher risk of HL (1.24, 1.00-1.54). In addition, women with reproductive period less than 30 years had elevated risk of HL (1.19, 1.07-1.34), compared to women with reproductive period greater than 35 years. Women who had age at menopause greater than 50 years and used HRT had 25%-50% higher risk of HL, compared to their counterpart who did not use HRT. Conclusions: In conclusion, higher number of children, having first birth before age 25 years, having last birth after age 40 years, having menopause before age 45 years, and having reproductive period shorter than 30 years were associated with higher risk of hearing loss. In women with menopause age greater than 50 years, HRT use increased the risk of hearing loss.
Abstract P228: Baseline Characteristics of a Pilot Randomized Controlled Trial of a Self-Management Program for Depressed Black Women at Risk for Hypertension
Authors: Emma Church, Taylor Maniglia, Martha Sajatovic, Farren Basil Shaw Briggs, Erika Kelley, Danette Conklin, Mahboob Rahman, Carla Harwell, Carla Conroy, Jennifer B Levin
Journal: Circulation (2024)

Introduction: Black women have the highest prevalence of hypertension (HTN) compared to other racial/ethnic groups. Depression impacts women on a 2:1 ratio and increases cardiovascular risk. Black women are less likely to receive evidence-based care for depression and face barriers to engaging in healthy behaviors. In the current descriptive analysis, we examined baseline data from an ongoing pilot randomized controlled trial aimed to assess the efficacy of a group self-management program to decrease depression and HTN risk. Hypotheses: We assessed the hypothesis that a well-characterized sample of 30 depressed Black women would have high levels of physical and psychosocial risk factors for cardiovascular disease, low levels of treatment engagement, and that depression severity would correlate with experience of discrimination, stress, and perceived lack of social support. Methods: Inclusion criteria were Black women between the age of 18-49 with moderate depression (PHQ-9 of ≥10) and at least one risk factor for HTN. Social determinants of health (SDOH), discrimination, stress, and social support were assessed using validated measures. Results: The sample consisted of 30 Black females; mean age=34.27, SD= 8.60, and mean years of education=13.97, SD=1.79. Mean depression=15.10, SD=3.16, 33.33% endorsed thoughts of self-harm, and 36.67% reported currently receiving treatment for depression. Of those, 72.7% were in therapy and 54.5% were taking medication. Forty percent reported a history of physical abuse and 36.7% reported a history of sexual abuse. Salient cardiovascular risk factors included mean BMI=37.47, SD=5.84 (29/30 met BMI&gt;30 criteria), 26.67% smoker, 6% diabetes, 13% high cholesterol, and 46.67% other chronic health conditions. Mean discrimination score was 27.23, SD=10.96 indicating moderate exposure to discrimination and 75% identified race as the main source of discrimination. Additionally, 26.67% scored above the threshold on violence as measured by a SDOH screener and perceived stress averaged in the moderate range. Depression severity was significantly correlated with discrimination ( r =.43, p &lt;.05), stress, ( r =.55, p &lt;.01) and trended with social support ( r =-.39, p =.076). Conclusion: In conclusion, given the high rates of CVD risk factors, multiple psychosocial stressors, and low rates of treatment engagement, to improve cardiovascular health in Black women, we must be aware of and address a more comprehensive set of socio-emotional risk factors. Self-management interventions that simultaneously provide social support, address mental health needs, and are led by peers are likely to increase engagement and improve health outcomes.
Abstract P404: Food Insecurity Has a Moderation Effect in the Association Between Neighborhood Deprivation and Obesity Among Children
Authors: Titilola Labisi, Margo Sidell, Xia Li, Corinna Koebnick
Journal: Circulation (2024)

Background: Childhood obesity tracks into adulthood and is a risk factor for non-communicable diseases such as cardiovascular diseases and diabetes. The relationships between socioeconomic status (SES) (including food security, financial stability, and living conditions) and obesity among children have been well established. However, there is limited research on the heterogeneity of the role of food insecurity or insufficiency and neighborhood deprivation (ND) on obesity risk in children. We aimed to investigate the moderating effect of food insecurity in the association between ND, health insurance, race/ethnicity, and Body Mass Index (BMI) among children aged 3-11 years old. Methods: For this cross-sectional study of 223,653 children aged 3-11 years who were members of Kaiser Permanente in Southern California, weight and height were collected during routine annual medical visits and extracted from electronic health records. ND index (NDI) was based on patients’ addresses using 2021 regional data. Higher indices represent a higher deprivation. The risk of food insecurity was assessed using the Hunger Vital Sign™ tool on the well-child visit questionnaire. A multivariate linear regression analysis was performed with the absolute distance from the median BMI-for-age and sex based on the 2000 CDC growth charts. Models included age, sex, race/ethnicity, state-subsidized health insurance, self-reported risk food insecurity, and 2-way interaction terms for NDI and state-subsidized health insurance with food insecurity. Results: The cohort included children with a mean age of 7.9 years (SD 2.4), males (51.2%), Hispanics (50.3%), living with obesity (24.1%), resided in neighborhoods above the average deprivation (39.6%), and were enrolled in state-subsidized health insurance (25.6%). The risk of food insecurity and insufficiency were reported at 5.0% and 3.3%, respectively. In adjusted models, a higher NDI quintile, state-subsidized health insurance, race/ethnicity, and food insecurity were all associated with a higher BMI (p&lt;0.0001). Food insecurity also moderated the association between NDI and BMI (p = 0.0244) and between state-subsidized health insurance and BMI (p = 0.0034). The effect of food insecurity was highest among those with the least ND and with private health insurance. In a separate model, food insecurity had no moderating effect in the association between race/ethnicity and BMI (p = 0.1). Conclusion: Food insecurity showed a moderating effect on high BMI risk among children in higher deprived neighborhoods and enrolled in state-subsidized health insurance. This study highlights the possible effects of food insecurity on obesity among children regardless of race/ethnicity. Future studies are recommended to investigate the moderating role of food insecurity in health outcomes, specifically obesity-associated conditions among children with low SES.