tbuckley/cabot-search huggingface dataset:
Abstract P2165: Association of neighborhood environment chracteristics and suboptimal cardiovascular health based on Life’s Essential 8 among young adults in Puerto Rico
Authors: Cynthia Perez, Katherine Tucker, Catarina Kiefe, Sharina PERSON, Polaris Torres, Claudia Boneu, Miredys Sanchez, Jose Rodriguez, Milagros Rosal
Journal: Circulation (2025)

Background: Cardiovascular health (CVH) among young adults in Puerto Rico (PR) is below optimal levels, underscoring the vulnerability of this understudied population. Understanding the influence of neighborhood environment on CVH is crucial for designing public health interventions that promote and sustain CVH. We assessed the association between neighborhood environment characteristics and CVH among young adults living in PR. Methods: This study analyzed data from 2,179 adults aged 18–29 years (mean age: 22.6 y; 60.8% women) participating in the PR-OUTLOOK study. CVH was measured using the AHA's Life’s Essential 8 metric score (range 0-100), with suboptimal CVH defined as a score below 80. The neighborhood environment was evaluated using the Mujahid Neighborhood Health Questionnaire, which assesses neighborhood violence, safety, aesthetic quality, walkability, access to healthy foods, social cohesion, and interaction with neighbors. Responses were recorded on a 5-point Likert scale (1=strongly disagree to 5=strongly agree), except for the violence and neighbor interaction scales, which ranged from 1=often to 4=never. Separate logistic regression models examined the association between each neighborhood environment characteristic and suboptimal CVH, adjusting for age, sex at birth, education, and subjective social status. Results: Mean scores (±SD) for neighborhood environment characteristics were as follows: violence (3.7±0.5), safety (3.4±1.1), aesthetic quality (2.8±0.5), walkability (3.1±0.8), availability of healthy foods (2.4±1.0), social cohesion (3.3±0.7), and activities with neighbors (1.3±0.8). Approximately 72.5% of participants had suboptimal CVH. In adjusted models, young adults who perceived their neighborhoods as having higher aesthetic quality (OR = 0.70, 95% CI: 0.57–0.85), greater walkability (OR = 0.84, 95% CI: 0.75–0.94), and better availability of healthy foods (OR = 0.89, 95% CI: 0.81–0.98) had lower odds of suboptimal CVH compared to their counterparts. Conclusions: Young adults in PR residing in neighborhoods with better aesthetics, walkability, and access to healthy foods have lower odds of suboptimal CVH. Further research is necessary to explore the long-term effects of these neighborhood characteristics on CVH, which could inform the design of targeted interventions to improve cardiovascular outcomes in this population.
Abstract P1113: Periconceptional DASH Diet and Adverse Pregnancy Outcomes:
Authors: McKenzie Jancsura, William Grobman, Jiqiang Wu, Michael Wirth, David Haas, Hy Simhan, Robert Silver, George Saade, Lynn Yee, kartik venkatesh
Journal: Circulation (2025)

Background: A DASH (Dietary Approaches to Stop Hypertension) diet is associated with improved cardiovascular health (CVH) outcomes in non-pregnant individuals, but its association with CVH-related pregnancy outcomes is not clear. We examined whether a periconceptional DASH diet was associated with adverse pregnancy outcomes (APOs), which are associated with CVH-risk. Methods: This is a secondary analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be (nuMoM2b) cohort. We calculated DASH diet scores from Block food-frequency questionnaires administered in the first trimester. DASH diet scores were categorized in tertiles from Tertile 1 (T1, least adherent) to Tertile 3 (T3, most adherent). APOs were evaluated individually and included small-for-gestational-age neonate [&lt;10 th percentile, SGA], large-for-gestational-age [ &gt; 90 th percentile, LGA]), hypertensive disorder of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm birth (PTB) &lt;37 weeks. Individuals with hypertension or diabetes prior to pregnancy were excluded. Modified Poisson regression models were adjusted for age, income, education, and health insurance, but not cardiometabolic risk factors deemed to be on the causal pathway (i.e., BMI). Secondarily, we assessed whether the above associations varied by adequate neighborhood food access, determined at the census tract level using the USDA Food Atlas . Results: Among 7,981 nulliparous individuals with dietary and outcome data, the frequency of SGA, HDP, GDM, and PTB were lower with higher adherence to a DASH diet (p&lt;0.05 for all). In adjusted analyses, nulliparous individuals who reported the highest adherence to a DASH diet (i.e., T3) had a lower risk of developing HDP compared with those who had the least adherence (i.e., T1) (11.6% vs 14.7%; adjusted risk ratio, aRR 0.84, 95% CI 0.71-0.99). Those in T2 compared with the T1 were at lower risk of developing GDM (3.5% vs 4.7%; aRR 0.69, 95% CI 0.52-0.92). Adherence to a DASH diet was not associated with SGA, LGA, or PTB (TABLE). The above associations between a DASH diet and HDP and GDM did not vary by neighborhood food access (interaction p-value=0.82 for HDP; 0.37 for GDM). Conclusions: DASH diet in early pregnancy was associated with lower risk of developing HDP and GDM in nulliparous individuals. Further interventional research is needed to understand whether promotion of a DASH diet in early pregnancy can reduce the risk of these APOs.
Abstract P1087: Impact of Allostatic Load on Prevalent and Incident Pre-Heart Failure in the Echocardiographic Study of Latinos (ECHO-SOL)
Authors: Eric Hirsch, Ayana April-Sanders, Priscilla Duran Luciano, Yawen Yuan, Carmen Isasi, Linda Gallo, Barry Hurwitz, Martha Daviglus, Bonnie Shook-Sa, Mayank Kansal, Gregory Talavera, krista perreira, Carlos Rodriguez
Journal: Circulation (2025)

Introduction: Allostatic load (AL) is multi-system index that physiologically quantifies the effects of chronic stress. The relationship of AL to pre-heart failure (HF), a precursor of clinical HF, has not been defined. Methods We studied 1,643 Hispanic/Latino adults who were free of clinical HF. An AL score was calculated using multiple physiologic parameters: (1) body mass index and waist hip ratio; (2) white blood cell count; (3) triglycerides, high-density lipoproteins, and low-density lipoproteins; (4) systolic blood pressure, pulse pressure and heart rate; and (5) serum glucose, insulin resistance, and glycosylated hemoglobin. For each parameter, points were assigned for values that fell outside normal ranges (Table 1). Echocardiographic measures of pre-HF were obtained across three domains: 1. systolic function (left ventricular ejection fraction [LVEF], global longitudinal strain [GLS]); 2. diastolic function (mitral inflow velocity [E], mitral annular early diastolic velocity [e’], E/e’); and 3. cardiac remodeling (left ventricular mass index [LVMI], relative wall thickness [RWT], and left atrial volume index [LAVI]). Measurements were obtained at baseline and at follow-up after an average of 4.3 years. Incident pre-HF was defined among those without pre-HF at baseline. Survey-weighted linear and logistic regression analyses were employed. Results The mean age of the study population was 56.4 years (SE = 0.395) and 58.5% were female. AL scores ranged from 0.5 - 10 with a mean of 5.15 (SE = 0.062). Greater AL burden was associated with worsened cardiac parameters (lower baseline LVEF, GLS, and e’; higher baseline LVMI, RWT, and E/e’), more prevalent systolic/diastolic dysfunction and structural remodeling, and increased odds of prevalent pre-HF after age and sex adjustment. Incident pre-HF risk also increased with a higher baseline AL burden (Table 2). Conclusion: Increasing AL was associated with prevalent cardiac abnormalities, prevalent pre-HF, and incident pre-HF. The use of AL as a predictive tool for pre-HF warrants further study.
Abstract P3143: The Association of Psychosocial Factors with Diet Quality in a Puerto Rican Adults
Authors: Anna Porter, Martha Tamez, Donna Spiegelman, Josiemer Mattei
Journal: Circulation (2025)

Healthy dietary patterns are important for cardiometabolic health. Psychosocial factors are also associated with health outcomes, with studies suggesting that poor psychosocial health is associated with low diet quality. Few studies have examined these associations in adults living in Puerto Rico. This study examines the cross-sectional association of psychosocial factors (depression, loneliness, stress, and social support) with diet quality. This is a secondary analysis of a randomized pilot trial, the Puerto Rican Optimized Mediterranean-like Diet (PROMED), that examined the effect of a culturally appropriate Mediterranean-like diet on cardiometabolic health in a sample of adults with at least two cardiometabolic conditions living in Puerto Rico. Participants were randomized to an intervention or control group and completed 3 visits. Interviewer-administered questionnaires assessed perceived stress, depression, loneliness, and social support as well as a brief diet quality index. Responses were summarized into scores and examined as continuous variables. Diet quality score was log-transformed to aid interpretation of model coefficients. Mixed effects models were used to estimate the association of each psychosocial factor with diet quality. A backwards stepwise method was applied to assess the contribution of each psychosocial factor within a single model; likelihood ratio tests evaluated model fit. Multivariable models controlled for age, gender, education, marital status, and study group. Among 44 participants (94 observations, average 2 visits each), the mean age was 50.6 years (SD=9.5) and 80% were female (Table 1). Distribution of diet quality and psychosocial variables is shown in Figure 1. For every 1-unit increase in social support, diet quality increased by 0.35% (95% CI 0.02, 0.67), while every 1-unit increase in stress was associated with a 0.31% decrease in diet quality (95% CI -0.05, -0.56). Depression (-0.17%; 95% CI -0.35, 0.01) and loneliness (-1.34; 95% CI -2.78, 2.31) were also associated with decreases in diet quality, but these associations were not statistically significant (p&gt;0.05). Backwards stepwise analysis identified stress as the main contributor to diet quality. Stress and social support are key factors affecting diet quality among adults living in Puerto Rico. Interventions aimed at improving diet and cardiometabolic health should consider how psychosocial factors impact dietary behaviors and overall health outcomes.
Abstract P1085: Heart Failure Incidence Among Disaggregated Asian American, Native Hawaiian, and Pacific Islander Subgroups: Insights from the PANACHE Study
Authors: Andrew Ambrosy, Yihe Daida, Rishi Parikh, Thida Tan, Connor Howick, Stacey Alexeeff, Joan Lo, Alan Go
Journal: Circulation (2025)

Background: Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) persons comprise ~10% of the U.S. population—24 million people—yet a significant gap exists in contemporary data on incident heart failure (HF). Methods: We identified adults ≥30 years without cardiovascular disease (CVD) within Kaiser Permanente Northern California and Hawaii from 2012-2022. Incident HF was defined as a hospitalization, &gt;3 clinic visits, or death due to HF, based on validated diagnostic codes and death certificates. We reported age-sex-adjusted incidence per 1,000 person-years by AANHPI subgroup with [95% confidence intervals] and calculated adjusted hazard ratios for incident HF in each subgroup compared to non-Hispanic Whites. Results: Among 2,653,007 million adults without CVD, mean age was 49±15 years and 53% were women. CVD risk factor prevalence was high, including hypertension (22%), dyslipidemia (26%), diabetes (7%), and overweight/obesity (56%). The cohort's self-reported racial/ethnic breakdown and rates of incident HF were: 6.8% Chinese (2.64 [2.55-2.73]), 7.3% Filipino (5.07 [4.93-5.22]), 2.4% Native Hawaiian/other Pacific Islander (8.75 [8.31-9.21]), 1.7% Japanese (3.07 [2.91-3.24]), 0.8% Korean (2.44 [2.15-2.74]), 3.5% South Asian (5.46 [5.1-5.84]), 1.9% Vietnamese (3.05 [2.74-3.37]), 1.0% other Southeast Asian (4.71 [4.1-5.36]), and 74.5% Non-Hispanic White (4.52 [4.49-4.56]). Adjusting for age, sex, and CVD risk factors, Chinese, Filipino, Japanese, Korean, and Vietnamese adults had lower risk of incident HF, while Native Hawaiian/other Pacific Islander and South Asian adults had higher risk compared to non-Hispanic White adults ( Figure ). Conclusions: Most AANHPI subgroups had lower adjusted risk of incident HF compared to non-Hispanic White adults, with Native Hawaiian/Pacific Islander and South Asian adults being notable exceptions. Our findings underscore the importance of disaggregating race and ethnicity to better understand risk profiles and mediators of incident HF.
Abstract P1112: Improving School Food: A Novel Tool to Identify Priorities for Effective Policy Change in Nepal School Environments
Authors: Megan Henry, Namuna Shrestha, Priza Pradhananga, Nicole Ide, Christine Curtis, Ashley Lederer, Archana Shrestha, Sara Benjamin-Neelon
Journal: Circulation (2025)

In Nepal, four noncommunicable diseases (NCDs) (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) account for over half of total mortality. Diet is a modifiable risk factor for NCDs. 97% of the population in Nepal consumes insufficient fruit and vegetables and ultra-processed food consumption is rising. Nepal’s Multisectoral Action Plan for the Prevention and Control of NCDs (2021–2025) sets a goal of 25% reduction in NCD-related mortality. WHO endorses healthy public food procurement and service (HPFPS) policies to reduce NCDs. In Nepal, a novel tool based on translating WHO nutrition guidance into procurement standards was used to evaluate school eating environments prior to HPFPS policy implementation. To evaluate this natural experiment, data collectors visited all schools subject to HPFPS policy in three municipalities in 2024. The tool was used to conduct one-day structured observations of school food environments. Data was summarized using median and interquartile range (IRQ) for continuous variables and percentages and frequencies for categorical variables. Among 249 schools, 84% were private, 12% were government, and 4% were community. Schools had a median 305 (IQR 100-500) students enrolled. All schools had an onsite kitchen, and 94% served meals and snacks six days per week. 95% prepared and served set meals; children selected an additional snack in 45% of schools. 82% had a planned menu, which was usually set daily or weekly (59% and 12% of all schools). 1% used standard recipes and 4% conducted nutritional analysis. Sugar-sweetened beverage marketing was found in 3% of schools, located on refrigerators. Using a novel tool based on translating WHO nutrition guidance into procurement standards, we found that all schools in the sample prepared meals in a central kitchen, offering a distinct point of intervention. Most schools had a fixed menu, but few used standardized recipes or conducted nutritional analysis, a potential point of policy implementation support. Policies could target set meals and snack options to enhance their nutritional quality. Among the limited number of schools that displayed marketing, all were sugar-sweetened beverages located on refrigerators. Consistent with WHO recommendations on marketing to children, policies should prohibit advertisements and branded equipment. Use of a novel tool within Nepal schools was effective in highlighting priority areas to inform policy development and implementation.
Abstract MP70: The Burden of Protein-Energy Malnutrition Mortality in Older Adults by County, Race, and Ethnicity in the USA,2000-19: A Systematic Analysis of Health Disparities
Authors: Juliana Teruel Camargo, Jessica Otero Machuca, Amanda Hinerman, Erik Rodriquez, Christian Alvarez Privado, Laura Dwyer-Lindgren, Ali Mokdad, George Mensah, Eliseo Perez-Stable
Journal: Circulation (2025)

Importance: Older adults have a higher malnutrition risk due to aging, chronic diseases, and social vulnerabilities. Understanding malnutrition mortality trends across racial/ethnic groups helps guide interventions to reduce health disparities and improve quality of life. Objectives: Estimate malnutrition mortality rates among older adults (ages 65-74 and ≥75) nationally and by county for racial/ethnic groups. Design/Setting: Analysis of National Vital Statistics System death registration (2000-2019), using small-area estimation to adjust for misclassification of race/ethnicity on death certificates. Exposure: Race/ethnicity (American Indian/Alaska Native (AIAN), Asian, Black, Latino, White) and county, mapped to temporally stable geographical units. Main Outcomes and Measures: Deaths due to malnutrition (ICD codes E40-E46.9, E64). Results: In 2019, adults aged ≥75 had the highest malnutrition mortality rate (49.2 per 100,000) compared to those aged 65-74 (4.6 per 100,000). Between 2000-2019, mortality increased for both ≥75 (19.5 to 49.2 per 100,000) and 65-74 (2.2 to 4.6 per 100,000). The Black population consistently had the highest malnutrition mortality rates (2019: ≥75: 60.8 per 100,000; 65-74: 7.7 per 100,000), followed by AIAN, White, Latino, and Asian populations. County-level analysis showed wide mortality variations for those ≥75 (4.9–308.9 per 100,000) and 65-74 (1.5–24.0 per 100,000). The South, particularly for Black individuals, was most affected, with rates of 0.6–27.9 per 100,000 (65-74) and 4.4–208.3 per 100,000 (≥75), with 66.2% of counties located in southern metro areas. For AIAN, mortality ranged from 0.6–34.9 per 100,000 (65-74) and 5.5–254.7 per 100,000 (≥75), with 75% in Rocky Mountains' metro areas. White individuals had rates of 0.4–25.0 per 100,000 (65-74) and 5.2–334.9 per 100,000 (≥75), mainly in nonmetro-Southern counties. Latino mortality ranged from 0.4–13.2 per 100,000 (65-74) and 4.2–173.1 per 100,000 (≥75), mostly in Rocky Mountains’ nonmetro areas, while Asian rates were 0.4–7.3 per 100,000 (65-74) and 4.4–141.5 per 100,000 (≥75), mainly in Rocky Mountains’ metro areas. Conclusions and Relevance Malnutrition mortality among older adults increased over the study period, particularly for those aged ≥75 in Southeastern counties. The variation across geography, age, race, and ethnicity indicates the need for targeted malnutrition screening, treatment, and nutritional interventions and policies for older adults.
Abstract P3137: Psychological Factors and Coronary Atherosclerosis Progression in the Multi-Ethnic Study of Atherosclerosis
Authors: Luis Correia, Laura Ward, Amit Shah, Yinxian Chan, Tene Lewis, Viola Vaccarino, Dayna Johnson
Journal: Circulation (2025)

Background: Psychological distress increases the risk of acute cardiac events, but studies are conflicting on whether it causes atherosclerotic progression. In previous longitudinal studies, missing outcome measures across time may have resulted in selection bias. Objective: To estimate the longitudinal association of psychological factors with coronary atherosclerotic burden. Methods: In the Multi-Ethnic Study of Atherosclerosis (MESA), we examined psychological exposures via validated scales (anger trait, anxiety trait, chronic stress, lifetime discrimination, everyday discrimination, and depression) and subclinical atherosclerosis with coronary artery calcium (CAC) at baseline for all participants, who were invited to repeat their CAC scores at four subsequent visits. Linear mixed models tested the association of psychological scales with atherosclerosis progression by the slope of log-transformed CAC score over time, accounting for confounders in the causal model (age, gender, race, income, work status, neighborhood). As a sensitivity analysis to adjust for selection bias, we ran the model after multiple imputations by chain equations of the missing CAC scores at the follow-up visits. Results: The 6,814 MESA participants had a median age of 62 years (IQR53-70), and 47% were males. All participants had a baseline CAC Score measurement: 746 had only the baseline, 2452 participants had two CAC scores, 2831 had three, and 785 had four. The mean time between the baseline and the last CAC score was 6.5 ± 3.5 years. For a standard deviation (SD) increase in each psychological scale, the change in CAC score per visit was estimated to be near zero (Figure 1 shows the 95% confidence intervals of the percent change in CAC Score by SD increment in each scale). The number of missing CAC scores was associated with a more adverse socioeconomic and cardiometabolic risk profile and higher baseline CAC Scores, suggesting selection bias. The analysis performed after imputing missing CAC scores showed consistent associations between higher levels of psychological scales and progression of the CAC scores over time (Figure 1). Conclusion: While no association was found in the analysis of observed outcomes, associations emerged after outcome imputation to account for selection bias due to missing data. Future studies should minimize missing values of the outcome to avoid biased results.
Abstract P3013: Left Ventricular Diastolic to Systolic Wall Stress Ratio and Mortality Following Transcatheter Aortic Valve Replacement
Authors: Audrey White, Ravinder Mallugari, Debra Dixon, Evan Brittain, Kelly Schlendorf, Daniel Clark, Holly Gonzales, Anna Vatterott, Natalie Jackson, Brian Lindman, Deepak Gupta
Journal: Circulation (2025)

Background: Most studies of left ventricular wall stress in patients with aortic stenosis (AS) focus on the end systolic (LVESWS) component with suggestion of an inverse association with adverse outcomes. LV end diastolic wall stress (LVEDWS) is less characterized and LVEDWS to LVESWS ratio, which may provide a combined measure of diastolic and systolic dysfunction and remodeling, has not been previously reported in patients with severe AS undergoing transcatheter aortic valve replacement (TAVR). Hypothesis: Higher LVEDWS to LVESWS ratio assessed by echocardiography prior to TAVR associates with greater risk of post-TAVR death. Methods: From a multicenter registry of patients with severe AS undergoing TAVR, we examined 637 participants (median age 84 years, 43% female, 95% white) who underwent pre-TAVR echocardiogram from which LVEDWS and LVESWS could be calculated from chamber dimensions, wall thicknesses, aortic valve gradient, blood pressure, and E/e’. Multivariable-adjusted Cox regression was used to examine associations between LVEDWS, LVESWS, their ratio, and the risk of post-TAVR mortality. Results: Median LVEDWS, LVESWS, and LVEDWS/LVESWS ratio were 22.1 (IQR: 16.2, 29.7) kdynes/cm2, 64.7 (IQR: 50.0, 90.7) kdynes/cm2, and 0.32 (IQR: 0.24, 0.43), respectively. Correlates of higher LVEDWS/LVESWS included: female gender, non-white race, hypertension medication use, higher natriuretic peptide and LV ejection fraction, and lower systolic and diastolic BP and hemoglobin. Over a median follow-up of 3 years post-TAVR, 262 (41%) individuals died. Higher LVEDWS tended towards greater risk of death (aHR: 1.013; 95% CI 0.999 – 1.027, p=0.071), while higher LVESWS associated with lower mortality risk (aHR: 0.993; 95% CI 0.988-0.998, p=0.008). Higher LVEDWS/LVESWS ratio associated with greater risk of death (aHR: 1.130, 95% CI 1.043-1.224, p=0.003, per 0.1 unit) (Figure), independent of age, comorbidities, LVEF, mass index, natriuretic peptide, and troponin. Conclusion: Among patients with severe aortic stenosis, higher LVEDWS to LVESWS ratio prior to TAVR associated with greater risk of post-TAVR mortality.