tbuckley/cabot-search huggingface dataset:
Abstract P530: Thoracic Aorta and Coronary Artery Calcification and Atherosclerotic Cardiovascular Disease Risk in South Asian Americans
Authors: Rachel S Chang, Feng Lin, Shreya Swaminathan, Matthew J Budoff, Nilay S Shah, Alka M Kanaya
Journal: Circulation (2024)

Background: South Asian populations have a high risk of atherosclerotic cardiovascular disease (ASCVD). Subclinical atherosclerosis measures, including thoracic aortic calcification (TAC) and coronary artery calcification (CAC), are associated with ASCVD events, and TAC is a stronger predictor in women than men. However, no prior studies have investigated TAC in South Asians. Methods: We examined data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study from 2015-2018. TAC and CAC were measured from computerized tomography scans using the Agatston method, and scores were categorized as 0, 1-99, and 100 or greater. Ten-year ASCVD risk was calculated using the 2013 pooled cohort equations, categorized as low, intermediate, or high risk. We determined associations of traditional risk factors with TAC and CAC and used multivariable ordinal logistic regression to examine associations between TAC and CAC with ASCVD risk in stepwise models. Results: Of 958 participants, 30% had TAC scores between 1-99 and 24% had TAC ≥100. TAC and CAC were modestly correlated (r = 0.30). There was a graded prevalence of TAC and CAC scores with levels of ASCVD risk (Figure). Both TAC and CAC were associated with several traditional risk factors; however, only CAC was associated with current smoking, HDL-cholesterol, triglycerides, and diastolic blood pressure. After adjusting for age, gender, and these four additional risk factors, only TAC ≥100 remained associated with ASCVD risk (OR 3.29, 95% CI 1.86 - 2.23), while CAC and TAC &lt;100 were not. The association between TAC and ASCVD risk was stronger for women than men (p-for-interaction &lt;0.001). Conclusion: Though TAC and CAC are associated with traditional risk factors, high TAC levels were independently associated with ASCVD risk, especially among women. Further study is needed to determine whether high TAC scores may be predictive of ASCVD events in South Asian populations.
Abstract P380: Fatherhood and Cardiovascular Health: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: John James Parker, Craig F Garfield, Clarissa D Simon, Laura A Colangelo, Michael P Bancks, Jamal S Rana, Kelley P Gabriel, Norrina B Allen
Journal: Circulation (2024)

Introduction: Emerging literature links fatherhood to men’s health but lacks comprehensive investigation of associations with cardiovascular health (CVH). Hypothesis: Fatherhood will be associated with total CVH and individual CVH metrics. Methods: We included men from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort study which enrolled Black and White individuals aged 18-30 years at baseline (1985-86). CVH was defined using the American Heart Association's Life’s Essential 8 (LE8) scores (0-100) and was calculated at the year 20 follow-up examination to most accurately classify men’s fatherhood status. Multivariable linear regression tested for difference in total CVH and CVH metrics by fatherhood status (father vs non-father vs stepfather &amp; living with children vs not) and age at transition to fatherhood; models adjusted for age, race, marital status, education, having a primary care clinician, income, current alcohol consumption &amp; CESD depression score. Results: In this sample of 1026 men, mean age at LE8 assessment was 45.4 (SD=3.5) years, 720 (70.2%) were fathers, 243 (23.6%) were non-fathers, 63 (6.1%) were stepfathers, and 384 (37.4%) self-identified as Black. The mean age men became fathers was 29.2 years. In adjusted models, there was evidence of interaction between the age at fatherhood and race on total CVH score ( p =0.07). For white men, becoming a father at &lt;20 years was associated with lower total CVH, compared with 30-34 ( p &lt;.01) and ≥35 years ( p =0.02); this association was not found for Black fathers (Figure 1). In adjusted models, stepfathers had worse BMI scores than non-fathers (least squares mean 51.1 vs 64.3, p&lt;0.01), but otherwise there was no difference in total CVH or CVH metrics between non-fathers, fathers, stepfathers, or men living with or without children. Conclusion: Fatherhood is a social determinant of health and understanding its influence may provide opportunities to improve men’s health, particularly among men who become fathers at young ages.
Abstract P511: Trajectories of Modifiable Risk Factors, Cardiac Function and Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Cohort
Authors: Ngoc Quynh H Nguyen, Ruosha Li, Patricia Chang, Amil M Shah, Bing Yu
Journal: Circulation (2024)

Introduction: Modifiable risk factors are known to associate with incident heart failure (HF), however, their longitudinal impacts have not been fully understood. Independent trajectory clusters of risk factors can help provide insights to the development of HF. Hypothesis: We hypothesize that unfavorable trajectory clusters are associated with increasing risk of HF. Methods: Clinical risk factors, including body mass index (BMI), systolic blood pressure (SBP), low-density lipoprotein (LDL), heart rate, total cholesterol (TCH), and high-density lipoprotein (HDL) were measured in Atherosclerosis Risk in Communities (ARIC) study at 5 consecutive visits (1987-2013). Trajectories were built for each clinical risk factor in participants with at least 3 time points using group-based trajectory modeling approach. Controlling for clinical risk factors, trajectory groups and their associations with post visit 5 incident HF were assessed via Cox proportional regression. Sex stratified analyses were conducted to assess effect modification. Results: Among 4,548 participants (mean age 75, 18.1% Blacks), 390 developed HF after visit 5 (median follow = 8.4 years). Five distinct clusters were identified for SBP, LDL, TCH, heart rate, and three clusters for BMI and HDL. Compared to the lowest cluster, normal-fast rising SBP cluster (HR = 1.7, 95% CI 1.2, 2.5), severely obese BMI cluster (HR = 1.9, 95%CI 1.4, 2.6), and normal-fast rising heart rate cluster (HR = 1.7, 95%CI 1.1, 2.5) had higher risk of developing HF. Interestingly, suboptimal-stable LDL cluster (HR = 0.6, 95%CI 0.4, 0.8) was associated with lower risk of HF compared to the optimal-stable LDL cluster. When stratified by sex (female =59.1%, male = 40.9%), the identified trajectories shared similar patterns with the parent trajectories. The effects on HF were consistent between sex groups; however, most significant associations were diminished in males. Conclusion: We identified distinct trajectories that capture long-term effects of risk factors. Unfavorable clusters significantly associated with increased risk of HF, except LDL, suggesting further investigation on lipids control for HF prevention.
Abstract P402: Association of an Overall Healthy Lifestyle With Different Types of Metabolic Dysfunction-Associated Fatty Liver Disease
Authors: Caimei Yuan, Geng Zong, Chengwu Feng
Journal: Circulation (2024)

Background &amp; Aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects up to one-third of the global population and increases the risk of cardiometabolic disease. Since no approved pharmacotherapy for MAFLD is available, lifestyle modification remains the cornerstone of clinical care. Our study aims to evaluate the association of an overall healthy lifestyle with different types of MAFLD. Methods: We conducted a prospective analysis of 15,721 participants from UK biobank. An overall healthy lifestyle including six evidence-based lifestyles (diet, alcohol consumption, physical activity, sedentary behavior, sleep, and smoking) was assessed by questionnaires. MALFD and its typing were diagnosed by blood biochemistry, ICD codes, and medication information from touchscreen and verbal interview. The risk ratios (RRs) were estimated by Poisson regression models with robust variance. Results: During a median follow-up of 4.4 years, 5,522 participants had MAFLD diagnosed. Compared with those with zero to two healthy lifestyles, the RRs (95% CIs) of those with six healthy lifestyles were 0.41 (0.36 to 0.47) for MAFLD; 0.41 (0.35 to 0.46) for MAFLD-overweight/obesity (MAFLD-O), 0.27 (0.12 to 0.60) for MAFLD-lean/normal weight and metabolic dysfunction (MAFLD-L), 0.17 (0.11 to 0.26) for MAFLD-type 2 diabetes mellitus(MAFLD-T2D) (P-value for heterogeneity &lt; 0.001); and the RRs (95% CIs) of those with five healthy lifestyles were 0.53 (0.49 to 0.58) for single etiology MAFLD (MAFLD-single) and 0.23 (0.10 to 0.55) for dual (or more) etiology fatty liver disease (MAFLD-dual) (P-value for heterogeneity = 0.08). For one additional point in the overall healthy lifestyle, the RR (95% CI) was 0.83 (0.81 to 0.85) for MAFLD, and 0.83 (0.81 to 0.85) for MAFLD-O, 0.71 (0.62 to 0.81) for MAFLD-L, and 0.68 (0.64 to 0.72) for MAFLD-T2D (P-value for heterogeneity &lt; 0.001); and 0.83 (0.81 to 0.85) for MAFLD-dual and 0.70 (0.58 to 0.85) for MAFLD-single (P-value for heterogeneity = 0.08). Meanwhile, significant differences in the correlations of individual lifestyles with subtypes of MAFLD were discovered for sufficient physical activity, low sedentary time, adequate sleep, and never smoking, and with different etiology MAFLD were discovered for low sedentary time. Conclusions: An overall healthy lifestyle that includes six evidence-based factors were strongly associated with lower MAFLD risk, especially MAFLD-L and MAFLD-dual. Our findings support the potential benefits of an integrated healthy lifestyle for MAFLD management and suggest differences in the impact of lifestyle on different types of MAFLD but warrant confirmation by well-designed prospective studies and clinical trials.
Abstract MP23: Cardiovascular Diseases and Risk of Dementia in the General Population: Observational and Genetic Studies
Authors: Jiao Luo, Ida Juul Rasmussen, Borge G Nordestgaard, Anne Tybjaerg-Hansen, Jesper Qvist Thomassen, Ruth Frikke-Schmidt
Journal: Circulation (2024)

Importance: Cardiovascular diseases are associated with increased risk of subtypes of dementia. The causal nature is however unclear. Objective: To assess observational and genetic associations between a range of cardiovascular disease and risk of all-cause dementia and its major subtypes. Design, Settings, and Participants: We performed time-dependent Cox regression analyses in three prospective cohorts, the Copenhagen City Heart Study (N=10,373), the Copenhagen General Population Study (N=101,582), and the UK Biobank (N=377,706); median follow-up times were 15, 9, and 13 years, respectively. Estimates from each cohort were pooled in meta-analyses using fixed-effects models. Subsequently, we investigated genetic susceptibility for cardiovascular diseases and risk of all-cause dementia, Alzheimer’s disease, and vascular dementia, using individual-level data from the UK Biobank and summary statistics from the FinnGen study. Exposures: Ischemic heart disease, myocardial infarction, peripheral arterial disease, hypertensive heart disease, stroke, ischemic stroke, atrial fibrillation, heart failure, and the combination of all. Main Outcomes and Measures: Outcomes include all-cause dementia, Alzheimer’s disease, and vascular dementia. Measures are hazard ratios (HRs) and 95% confidence intervals (CIs) in observational studies and odds ratios (ORs) and 95% CIs in genetic studies. Results: Observationally, cardiovascular diseases were associated with high future risk of incident all-cause dementia, Alzheimer’s disease, and vascular dementia in meta-analyses, with HRs up to 7.49 (95% CI: 6.63, 8.46). Genetically, using individual level data from the UK Biobank, predisposition to ischemic stroke was associated with high risk of all-cause dementia, Alzheimer’s disease, and vascular dementia, with ORs of 1.64 (1.35, 1.98), 1.44 (1.10, 1.89), and 2.06 (1.41, 3.01), respectively, with similar estimates for ischemic stroke; genetic predisposition to ischemic heart disease was associated with high risk of vascular dementia, with an OR of 1.24 (1.03, 1.50). Genetic summary-level data from the FinnGen study confirmed the estimates for stroke and ischemic stroke. Conclusion and Relevance: Our study provides novel evidence that the association between stroke and all-cause dementia and its major subtypes may be of a causal nature. Further, we observe that genetic susceptibility for ischemic heart disease is associated with incident vascular dementia. These findings underscore the importance of integrating cardiovascular disease prevention into interventions to reduce dementia risk.
Abstract P339: Waist Circumference During Young Adulthood and Risk For Diabetes in Middle Adulthood Differ by Baseline Weight Status: The CARDIA Study
Authors: Robert Booker, Mandy Wong, Michael P Bancks, Ankeet S Bhatt, Mercedes R Carnethon, Lisa S Chow, Cora E Lewis, Pamela J Schreiner, Jennifer Zink, Shaina J Alexandria
Journal: Circulation (2024)

Introduction: Body mass index (BMI) and waist circumference (WC) capture related but distinct measures of adiposity (overall vs central adiposity). It is unclear if changes in WC are associated with incident diabetes mellitus (DM) and whether the relation is similar between BMI groups. Methods: We included 3,234 CARDIA participants (61% Black, 63% females, mean age 24.7 [3.7] years at baseline) without prevalent DM from baseline (1985-1986) through exam Year 20 (Y20; 2005-2006). Incident DM after Y20 was defined as fasting blood glucose ≥126 mg·dl -1 , post-load blood glucose ≥200 mg·dl -1 , HbA1c ≥6.5%, or use of antidiabetic medication through exam Year 35 (2022-2023). WC (cm) and BMI (kg·m -2 ) were measured at baseline and Y20. WC change was calculated as the difference between Y20 and baseline examinations. We categorized participants into three WC 20-year change groups: no change (±≤6 cm), decrease (&gt;6cm loss), and increase (&gt;6cm gain). We used Cox proportional hazards regression to estimate HR (95% CIs) for incident DM over 15 years. The model was adjusted for baseline age, sex, race, field center, education, smoking status, alcohol intake, diet score, physical activity, HDL, LDL, and BMI status ( Table footnote). We assessed interactions of WC change with BMI status and sex, respectively. Results: The 15-year incidence of DM was 30% (973 cases, 40,037 person-years). Compared with no change in WC, WC decrease was not associated with incident DM (0.84 [0.66, 1.06]) (see Table) , but WC increase was associated with a greater 15-year risk of DM (1.21 [1.02, 1.44]). Interactions of WC change with sex ( p =0.35) and BMI status ( p =0.68) were null. Associations between 20-year WC change and subsequent DM risk were consistent between 20-year BMI status change groups. Conclusion: An increase in central adiposity during young and middle adulthood portends subsequent DM risk. Investigation of more accurate physiological measures of total adiposity and its distribution may help inform adipose tissue-specific pathways underlying DM risk.
Abstract P209: Accelerometer-Measured Sedentary Behaviors and Venous Thromboembolism Risk Among Older Women
Authors: Laura B Harrington, Kara L Cushing-Haugen, Steven Nguyen, Michael J LaMonte, Marcia L Stefanick, Matthew A Allison, Robert B Wallace, JoAnn E Manson, Majken K Jensen, Christopher Kabrhel, Gregory A Wellenius, I-Min Lee, John Bellettiere, Kenneth J Mukamal, Andrea Z LaCroix
Journal: Circulation (2024)

Introduction: Venous insufficiency, which can occur with prolonged sedentary behavior, is associated with venous thromboembolism (VTE) risk. Whether accelerometer-measured sedentary behaviors are associated with VTE risk is unknown. Hypothesis: Longer total sitting times, mean sitting bout durations, and time spent in prolonged sitting bouts are associated with a greater risk of incident VTE. Methods: We studied participants of the Women’s Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health (OPACH) study without prior VTE, with adherent accelerometer wear, and with sedentary behavior data (n=5,591). Between May 2012-April 2014, participants wore the ActiGraph GT3X+ triaxial accelerometer at the hip for 7 days. Three sedentary behavior measures were classified using the Convolutional Neural Network Hip Accelerometer Posture algorithm: total sitting time, mean sitting bout duration, and time spent in prolonged (≥30 minutes) sitting bouts. VTE events were centrally adjudicated. Multivariable-adjusted (Table) Cox models estimated HRs and 95% CIs for each sedentary behavior in relation to VTE risk. Women were censored at death, loss to follow-up, or end of follow-up (February 2023). Mediation by BMI was evaluated for behaviors associated with VTE. Results: On average, participants were 79 years old. Over a mean follow-up of 8.2 years, 229 women experienced a VTE. In primary confounder-adjusted models, longer mean sitting bout durations were associated with greater incident VTE risk (HR per 5-minute increase=1.15; 95% CI: 1.04, 1.28) (Table). BMI mediated approximately 30% of this association (p&lt;0.01). We found no significant evidence that total sitting time nor time spent in prolonged sitting bouts were associated with VTE. Conclusions: Longer mean sitting bout duration was associated with greater VTE risk, with substantial mediation by BMI. Our results suggest that reducing sedentary bout length in older women may reduce VTE risk.
Abstract P517: Age-Stratified Prevalence of Cardiovascular Risk Factors Among Asian American Subgroups
Authors: Prasantha L Vemu, Tali Elfassy, Eugene Yang
Journal: Circulation (2024)

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the US. The prevalence of CVD risk factors and CVD mortality are heterogeneous among disaggregated Asian American subgroups; but little is known about when in the life course these differences arise. Hypothesis: We hypothesize that there are age-specific differences in the prevalence of CVD risk factors across Asian American subgroups that may predispose some subgroups to developing CVD at younger ages. Methods: We analyzed data from 78,559 Asian American adults enrolled in the National Health Interview Survey (2000-2018). CVD risk factors (hypertension, diabetes, high BMI, nicotine exposure, alcohol consumption, insufficient physical activity, and suboptimal sleep) and age were self-reported. We estimated the age-stratified prevalence of each CVD risk factor among Asian American subgroups (Filipino, Indian, Chinese, and “Other Asian”). Analyses accounted for the complex survey design. Results: The study population included 20.3% Chinese, 23.6% Filipino, 18.4% Indian, and 37.7% Other Asian groups. Filipinos had the highest prevalence of hypertension (6.4%, 95% CI: 5.1, 8.1), obesity (24.8%, 95% CI: 22.1, 27.7), alcohol consumption (67%, 95% CI: 63.7, 70.1), and suboptimal sleep (37.3%, 95% CI: 34.3, 40.4) at younger ages (18 - 34). The highest prevalence of diabetes was found in the Indian subgroup starting at ages 35 - 44 years. The Other Asian subgroup had highest prevalence of nicotine exposure (16.1%, 95% CI: 14.6, 17.7) at younger ages (18 - 34). The Chinese subgroup consistently had the lowest prevalence of CVD risk factors across age strata. Conclusions: Our findings show that Indian, Filipino, and Other Asian subgroups have a higher prevalence of most CVD risk factors at earlier ages compared to Chinese subgroup. This may explain why CVD prevalence among Chinese Americans is lower than other Asian subgroups. Our study demonstrates the importance of targeting CVD risk factors among susceptible Asian subgroups earlier in the life course.
Abstract P355: Identifying Barriers and Facilitators to Home Blood Pressure Monitoring Among Pregnant Women With Hypertension Disorders of Pregnancy-A Qualitative Approach
Authors: Mawulorm Denu, Ritika Revoori, Katherine Sadaniantz, Gérman Chiriboga, Sanjna Iyengar, Brooke Staples, Sarah Forrester, Stephenie C Lemon, Tiffany Moore Simas, Sharina PERSON, David McManus, Kathleen Mazor, Lara Kovell
Journal: Circulation (2024)

Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the US, contributing to over 30% of maternal deaths. Improved diagnosis, treatment, and outcomes of HDP may be achieved through home blood pressure monitoring (HBPM). However, there are many challenges to effective HBPM during pregnancy. We conducted this qualitative study to explore barriers and facilitators to HBPM. Methods: Pregnant or postpartum (within 3 years) women, aged 18-50 years with either hypertension (HTN) or preeclampsia, were recruited from a large academic medical center to participate in virtual focus group meetings (N = 5 groups, 2-6 participants/group). The discussions centered on experiences with HDP, HTN management, and HBPM. Focus group meeting audio recordings were transcribed, and thematic analysis was performed (by MD and RR). Meetings (between MD, RR, and LK) resolved any discrepancies, focusing on responses discussing barriers and facilitators to HBPM. Results: Of the 20 participants, mean age was 33.8 (SD 5.9) years, 35% were Hispanic, and 35% were Black. Facilitators to HBPM shared by participants included external support (e.g., partner, healthcare), free access/decision support, comfort in knowing BP readings outside healthcare setting, and technology support. Barriers to HBPM shared by participants were lack of knowledge/uncertainty about the equipment and process (e.g., technique, monitors, and logging), cost/access, traditional pathways for monitoring, and declining motivation. Conclusion: In this study involving women with HDP from diverse backgrounds, we identified several facilitators and barriers to HBPM. Many of the barriers can be overcome through patient education, technology support, reinforcement, and better access to validated monitors. Given the importance of HBPM in improving outcomes for pregnant women with HDP, it is important for healthcare providers and policy makers to work to reduce barriers and amplify facilitators to HBPM for better adoption.