tbuckley/cabot-search huggingface dataset:
Abstract MP35: Long-Term Trajectories of Self-Rated Health Are Similar Following Incident Diabetic Foot Disease and Acute Myocardial Infarction Among Adults With Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Katherine M McDermott, Dan Wang, Michael Fang, Pamela L Lutsey, B Gwen Windham, Elizabeth Selvin, Caitlin W Hicks
Journal: Circulation (2024)

Introduction: Incident diabetic foot disease is associated with significant morbidity and mortality. However, data are lacking on long-term patient-reported outcomes. We aimed to evaluate trajectories of self-rated health among adults with diabetes before and after incident foot disease compared to incident acute myocardial infarction (MI), another major diabetes complication. Methods: We conducted a longitudinal analysis of participants in the ARIC Study with diabetes and incident diabetic foot disease (N=749 hospitalizations, N=73 outpatient encounters) or incident MI (N=703). Diagnosis and procedure codes from active hospitalization surveillance and Medicare claims were used to identify events; only MI events were adjudicated. Self-rated health was collected during annual telephone calls and rated from 1 (poor) to 4 (excellent); a score of 0 was assigned to deaths. We used linear regression to examine changes in self-rated health from 1 year pre-event (baseline). Relative effects of index event type over time were estimated by repeated-measures ANOVA. Results: Self-rated health was similar between groups at baseline ( Figure ). Participants with MI had sharper declines from baseline at 1 year post-event than those with diabetic foot disease (-0.93 vs -0.50 points, P&lt;0.01), largely due to higher mortality (29.4% after MI vs 15.9% after diabetic foot disease). Self-rated health stabilized in the outpatient diabetic foot group after 2 years post-event, whereas it continued to decline over 10 years following both MI and inpatient diabetic foot disease ( Figure ). Conclusions: Our findings suggest outpatient diabetic foot disease is primarily associated with a short-term drop in self-rated health, but inpatient diabetic foot disease is associated with long-term declines in self-rated health similar to those experienced after MI. These results reinforce the importance of early diagnosis and treatment of foot disease and of including patient-reported outcomes to measure sequelae of diabetes complications.
Abstract P445: Associations of Homeownership and Overcrowding Conditions With Cardiovascular Health Among Diverse U.S. Children and Adults
Authors: Liliana Aguayo, Nicole Fields
Journal: Circulation (2024)

Background: We hypothesized that children and adults living in rented and overcrowded houses have lower cardiovascular health (CVH), as measured by Life Essential 8 (LE8), a powerful predictor of CVD. We evaluated if this association varied by race/ethnicity. Methods: This cross-sectional study used pooled data from the National Health and Nutrition Examination Survey 2013-2018 (NHANES). LE8 scores (range 0-100) were estimated following age-specific criteria with all metrics available for each age group. Overcrowding was defined as two or more persons per room, per Census Bureau’s criteria. Multivariable linear regressions estimated the association of overcrowding and homeownership (v. rental status) with CVH, for children (aged 2-19) and adults separately. Racial/ethnic differences were examined using interaction terms. Weighted models adjusted for the complex survey design and the following covariates: age, sex, race/ethnicity, insurance status, country of birth, and self or parental education and marital status. Results: Homeownership was associated with a 1-point higher CVH among children ( p =0.02), except for Black children, who had higher CVH when they lived in rented homes (86.51 for renters vs. 85.46 for homeowners). Among adults, homeownership was associated with 2.4 points higher CVH (p=0.008). An interaction showed that for Black and Latinx adults, homeownership was associated with lower CVH than renters (MD=-3.30, p= 0.004 for Black and -2.91, p = 0.006 for Latinx). Overcrowding was not associated with child CVH ( p =0.57). Among adults, and interaction showed that living in overcrowded houses was associated with lower CVH for Black (MD= -2.47, p=0.006) and Latinx adults (MD= -3.53, p &lt;0.001). Conclusions: Overcrowded housing and homeownership are associated with CVH in children and adults, but relationships vary by race/ethnicity. Findings underscore the need to better understand how housing conditions influence CVH disparities and advocate for affordable housing for all.
Abstract P457: Sociodemographic Differences in Cardiac Device Implantation in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Vaia Sigounas, Jason M Collins, Kurtis Anthony, Sophie Buchheit, James Stewart, Wayne D Rosamond, Eric A Whitsel, Eric A Whitsel
Journal: Circulation (2024)

Introduction: Progression of cardiac arrhythmia or heart failure often leads to treatment with a cardiovascular implantable electronic device (CIED) such as a pacemaker or pacemaker combined with an implantable cardioverter-defibrillator (ICD). Although small, hospital-based studies suggest that CIED implantation differs by sociodemographic factors, few community-based, cohort studies have prospectively evaluated it by sex, race, age, or health insurance status. Methods: We therefore examined incident CIED implantation in the Atherosclerosis Risk in Communities study (ARIC) among 15,527 eligible participants from four U.S. communities (mean age 54.2 years; 55% female; 27% Black; 90% insured) who self-identified as either Black or white and had a resting, standard twelve-lead electrocardiogram (ECG), but no ECG evidence of a pacemaker or ICD at baseline. We identified incident CIED implantation, defined as the initial device placement per participant, using International Classification of Disease (ICD)-9, ICD-10, and Current Procedural Terminology (CPT) codes during follow-up, right-censored at the time of CIED implantation, death, or end of cohort surveillance (December 31, 2020), whichever came first. We computed follow-up times and person-time denominators, then estimated the corresponding incident implantation rates overall, by sociodemographic factors, and device type. Results: Over a mean [standard deviation] follow-up of 24.0 [9.0] years, we identified 1,068 incident CIED (75% pacemaker; 25% ICD) implantations. Incident CIED implantation rates were higher among male, white, older, and insured participants (38, 30, 38, and 29 per 10,000 person-years) than among female, Black, younger, and uninsured participants (21, 23, 20, and 21 per 10,000 person-years). Relative to their counterparts, CIED incidence rates were lower among female, Black, younger, and uninsured participants: incidence rate ratio (95% confidence interval) = 0.55 (0.49-0.62), 0.77 (0.66-0.89), 0.53 (0.47-0.60), and 0.72 (0.56-0.92), respectively. When analyzed separately, patterns of incident implantation were similar for both pacemakers and ICDs. Conclusion: The sociodemographic patterning of incident CIED implantation is manifest and consistent across device type in this U.S. community-based cohort. Although the clinical, behavioral, and sociocultural reasons for the relative infrequency of implantation among female, Black, younger, and uninsured participants remain unclear, ongoing analyses are examining these differences.
Abstract MP43: Disparities in Cardiovascular Health in Childhood: The Young Hearts Study
Authors: Norrina B Allen, Amanda M Marma, Sarah D De Ferranti, Darwin R Labarthe, Matthew Davis, Lucia Petito, Stephen R Daniels, Aashima Chopra, Darci Phillips, Yaojie Wang, Marc Rosenman, Rashmi Narayan, Holly Gooding, Mark J Pletcher, Francis Alenghat, Rupali Gandhi, Cheryl Lefaiver, Amanda Luff, Huma Khan, Ileah Rios, Rachel Zmora, Amy Yu, Donald M Lloyd-Jones
Journal: Circulation (2024)

Introduction: Cardiovascular health (CVH) in childhood is associated with lifetime risk for CVD events. CVH declines with age, and only 50% of US adolescents have 5 of the 7 CVH metrics at ideal levels. Little is known about CVH in young children from diverse backgrounds. The aim of this study is to examine CVH scores by age, gender, race/ethnicity and social determinants of health in a large, diverse cohort of children aged 0-18 years. Methods: The Young Hearts (YH) Study is a pragmatic cohort in which parents and children complete annual surveys on demographics, family and social environment, contextual stress and resilience factors, and behaviors. This survey data will be combined with linked EMR data to provide clinical CVH metrics over time. Behavioral CVH (bCVH) was defined using the AHA’s Life’s Essential 8 (LE8) scoring where individual scores (range 0-100; 80+ is ideal) for each of the 4 health behaviors—diet, physical activity, nicotine exposure, sleep—were assessed using age-specific criteria and then averaged for a composite score. These results represent the first 3,534 participants recruited into the study. Linear regression models examined multivariate predictors of bCVH. Results: Among YH participants (mean age 9.5 years; 53% male, 20% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic Black, 7% other) the mean bCVH score was 72.5 (33% high CVH range, 60% moderate, 7% low). CVH scores were 96.2 for nicotine exposure, 44.3 for diet, 74.4 for sleep, and 74.8 for physical activity. Scores declined with age and were lowest for Non-Hispanic Black children (Figure). In adjusted models, significant predictors of lower bCVH scores included being Non-Hispanic Black, older age, lower family income, and lower parental education. Conclusion: Among this diverse cohort of children, more than half had non-ideal bCVH scores by a mean age of 9 years. Early primordial prevention efforts are critical to avert the reduction in CVH and eliminate disparities that emerge early in childhood and lead to excess burden of CVD across the lifespan.
Abstract P243: Association Between a Brain Care Score and Risk of Cerebrovascular Events in American Women
Authors: Leidys Gutierrez-Martinez, Pamela M Rist, Julie E Buring, Martin Vandenburgh, Christina Kourkoulis, Jonathan Rosand, Christopher Anderson, Nirupama Yechoor
Journal: Circulation (2024)

Background: The McCance Brain Care Score (MBCS) is a novel tool derived through a modified Delphi process to motivate lifestyle changes to reduce the risk of cerebrovascular events (CVE) based on prior studies and expert knowledge. However, few studies to date have determined the association between the MBCS and incident CVE. Studying this potential association is particularly important given the higher risk of stroke among women and the potential for unique risk profiles given physiologic and pharmacologic hormonal changes across the lifespan. Methods: The study population was participants in the Women’s Health study (WHS) who had available risk factor information needed to calculate the modified MBCS 5 years after enrollment and no prior history of CVE. The WHS-adaptation of the MBCS is illustrated in Figure 1; higher scores suggest better brain health. Participants were followed from MBCS assessment until first CVE (Stroke or Transient Ischemic Attack), end of study, loss to follow-up, or death, whichever occurred first. CVE were confirmed by medical record review. Cox proportional hazards models were used to examine the association between the MBCS, modeled as a continuous variable, and incident CVE adjusted for potential confounders. Results: In total, 22,965 women were eligible with a median age of 58.0 (Interquartile Range 54.0-63.9) and median MBCS of 15 (14-17). There were 1,364 (5.9%) incident CVE events during a median follow-up of 22.5 (16.8-23.6) years. A one-point higher baseline MBCS was associated with 11% decreased risk of incident CVE after adjusting for age, postmenopausal status, and use of hormonal replacement therapy (HR=0.89; 95%CI=0.87-0.91). This association remained significant after adjusting for comorbidities, race, educational attainment, and income (HR=0.90; 95%CI=0.88-0.93). Conclusion: Higher baseline MBCS was associated with a decreased risk of incident CVE among women. Future studies are needed to understand how longitudinal changes in the MBCS impact risk of CVE.
Abstract P275: Long-Term Mortality Prediction Model for HIV Patients With Heart Failure: Analysis From a Multi-Center Cohort Database in New York City Health + Hospitals
Authors: Yi-Yun Chen, Pawel Borkowski, Natalia Nazarenko, Matthew Parker, Luca Biavati, Coral Vargas-Pena, Ishmum Chowdhury, Joshua Bock, Robert Faillace, Leonidas Palaiodimos
Journal: Circulation (2024)

Introduction: Given the intricate interplay of HIV infection and heart failure (HF), conventional mortality prediction models for general heart failure may prove insufficient for this specific population. Our objective is to assess the fitness of current HF death prediction models and develop a prediction model tailored to the unique challenges of long-term mortality risk in HIV patients with heart failure. Method: The statistical models were developed through New York City Health + Hospitals HIV Heart failure (NYC 4H) retrospective cohort. Demographic and medical factors were obtained through chart reviews, while social adversities were assessed via licensed social workers' psychosocial assessment notes. Patients with baseline cancer, no baseline ejection fraction (EF), or those below 18 years of age were excluded from the study. Multivariable logistic regression models were constructed to predict the risk of overall death. Model 1 was derived from the existing MAGGIC Risk prediction model for general heart failure patients. Model 2 employed backward step-wise selection from NYC 4H cohort for HIV HF biologic factors, functional status, medical and interventional treatment to predict mortality risk. Model 3 further adjusted for single significant social factors and insurance. Model comparison was performed using the area under the ROC curve. Result: The study comprised 597 HIV heart failure patients, averaging 61.1 years in age. Over the 4-year follow-up, 102 deaths (17.1%) were recorded. Model 1 (MAGGIC Risk prediction model) had an AUC of 0.72. Model 2, which included backward-selected variables such as age, race, HIV viral load at baseline and follow-up, CD4 count at baseline, EF at baseline, smoking status, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral arterial disease, chronic kidney disease, activities of daily living, obesity, implantable cardioverter-defibrillator implantation, and the total number of guideline-directed medical therapy, significantly improved the AUC to 0.85. Incorporating social factors such as exposure to any lifetime adversities, specific adversities (lack of family support, polysubstance abuse, and mental illness), and insurance status, model 3 raised the AUC to 0.88. In heart failure with reduced EF (HFrEF) subset (n=502), Model 2 and Model 3 achieved AUCs of 0.88 and 0.90, respectively. Conclusion: HIV heart failure patients exhibit unique mortality prediction factors compared to general heart failure patients without HIV infection. Considering the high burden of social adversities, socioeconomic factors can enhance the predictive yield of models within this specific population.
Abstract P396: Life’s Essential 8 Cardiovascular Health Metrics Are Deteriorating In South Korea: A Nationwide Survey 2007-2021
Authors: Dasom Son, Yeeun Seo, Hyeok-Hee Lee, Hyeon Chang Kim, Hokyou Lee
Journal: Circulation (2024)

Introduction: The American Heart Association (AHA) recently updated the “Life’s Essential 8” (LE8) metrics for quantification of cardiovascular health (CVH). We investigated temporal trends of CVH status by LE8 metrics among Korean adults, using nationwide survey data. Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007-2021, including 93,092 participants aged 20 years or older. The LE8 CVH score was calculated as the average score of 8 metrics: diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure, each scaled 0 to 100 points. The CVH scores of 80 to 100 were categorized as high CVH, 50 to &lt;80 as moderate CVH, and 0 to &lt;50 as low CVH. All statistical analyses accounted for the complex survey design of the KNHANES data. Results: From the 4 th (2007-2009) to 8 th (2019-2021) cycle of the KNHANES, the mean LE8 CVH score declined from 68.9 to 66.6 in the Korean population. The proportion of adults with high CVH decreased from 22.5% to 16.9%, while the proportion of adults with low CVH increased from 8.4% to 10.6% (Figure A). Most adults had already lost ideal CVH by young adulthood; only 25% of adults aged 20-39 attained high CVH, and the proportion was lower at older ages. By individual metrics (Figure B), the score decreased in terms of physical activity (51.2 to 32.8), BMI (77.3 to 74.2), blood lipids (70.1 to 65.9), blood glucose (87.5 to 82.0), and blood pressure (75.9 to 72.3), remained stable in terms of sleep health (80.7 to 80.8), and increased in terms of diet (46.7 to 52.0) and nicotine exposure (63.6 to 73.3). The time-trends were similar across sex and age groups, although CVH scores were generally lower among men and older age. Conclusions: The CVH status of Korean adults has deteriorated over the past 15 years, especially in terms of physical activity, BMI, blood lipids, blood glucose, and blood pressure.
Abstract MP42: Insomnia Symptoms Are Associated With Poor Cardiometabolic Health Among Bhutanese Refugees in the United States
Authors: Rupsha Singh, Jeffrey Cohen, Taku Suzuki, Shambika Raut, Francisco Montiel Ishino, Chandra Jackson
Journal: Circulation (2024)

Introduction: The prevalence of insomnia symptoms is higher among refugees globally compared to the general population, and poor sleep is a risk factor for poor cardiometabolic health. The resettled Bhutanese refugee community is the third-largest refugee group in the United States (US) and appears to be-based on a few existing studies-particularly susceptible to sleep disturbances such as insomnia symptoms as well as cardiometabolic conditions such as hypertension, and type 2 diabetes. No prior studies have investigated associations between insomnia symptoms and cardiometabolic conditions in this community. Hypothesis: We hypothesized that participants reporting insomnia symptoms will have a higher prevalence of cardiometabolic conditions. Methods: We used data from the 2021-2022 Bhutanese Community of Central Ohio Health Study (N=495) to examine associations between insomnia symptoms and cardiometabolic health. Insomnia symptoms, measured by self-reports of difficulty falling/staying asleep, were categorized as “not at all,” “sometimes,” and “often/all the time.” A cardiometabolic condition was based on self-reported medical diagnosis/treatment of one or more of the following conditions: hypertension, dyslipidemia, and type 2 diabetes. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of cardiometabolic conditions among participants with insomnia symptoms compared to participants without insomnia symptoms while adjusting for sociodemographic characteristics and body mass index (using criteria for Asians). Results: The sample was mainly aged between 18-44 years (69.8%), 51% were male, and most lived in the US for ≥11 years (60.2%). Insomnia symptoms prevalence was 56.4% for “not at all”, 30.7% for “sometimes,” and 12.9% for “often/all the time.” Overall, 12.9% of participants had at least 1 cardiometabolic condition, 10.8% had at least 2 conditions, and 6.3% had all 3 conditions. Compared to not having insomnia symptoms, having insomnia symptoms sometimes was associated with a higher prevalence of type 2 diabetes [PR=2.15, 95%CI: 1.19-3.87], hypertension [PR=1.86, 95%CI: 1.24-2.79], dyslipidemia [PR=1.73, 95%CI: 1.01-2.96], and 1 or more cardiometabolic conditions [PR=1.67, 95%CI: 1.20-2.32]. Similarly, compared to not having insomnia symptoms, having insomnia symptoms often/all the time was associated with a higher prevalence of type 2 diabetes [PR=2.18, 95%CI: 1.04-4.54], hypertension [PR=1.71, 95%CI: 1.06-2.74], dyslipidemia [PR=3.03, 95%CI: 1.67-5.47], and 1 or more cardiometabolic conditions [PR=1.68, 95%CI: 1.15-2.47]. Conclusions: In conclusion, the burden of both insomnia symptoms and cardiometabolic health conditions were prevalent among the US Bhutanese refugee population, and the insomnia-cardiometabolic health associations were strong.
Abstract P168: Life’s Simple Seven by Sexual Orientation and Sex in the CARDIA Cohort
Authors: Lauren B Beach, B. R. Slone, Grace Avila, Ankeet Bhatt, James M Shikany, Pamela Schreiner, Carl Streed, Billy A Caceres, Gregory Phillips, Tonia Poteat, Krista Perreira, Cora E Lewis, Mercedes R Carnethon, Patrick Janulis
Journal: Circulation (2024)

Introduction: Sexual minorities are impacted by broad-ranging health disparities. Few studies have investigated cardiovascular health by sexual orientation. Objective: We assessed Life’s Simple 7 (LS7) in 2015-16 in the Coronary Artery Risk Development in Young Adults (CARDIA) study by sexual orientation identity, including an interaction term for sex. Methods: CARDIA participants completed sex and sexual orientation identity items in 2020-22 and had complete LS7 data on file from 2015-2016. Poisson and linear regression were used to test for LS7 differences and generated similar results. Linear models are reported to facilitate interaction interpretations. Results: In 2015-16, mean participant age was 55.2 years, 59.7% of participants were female, and 44.3% were Black. Compared to heterosexual male participants, heterosexual female participants had significantly higher LS7 scores (B = 0.950, p &lt; 0.001). No LS7 differences were found between heterosexual male participants and gay, bisexual, or something else/not sure male participants. A significant interaction was detected between sex and identifying as gay/lesbian (B = -1.177, p = 0.003), suggesting the LS7 protective effect of sex for heterosexual female participants was lower for gay/lesbian female participants (Table 1). Conclusions: Future studies will assess LS7 longitudinally by sexual orientation and gender identity in CARDIA. Table 1. Differences in LS7 Score by Sex and Sexual Orientation Identity