tbuckley/cabot-search huggingface dataset:
Abstract P270: Higher Long-Term Fasting Glucose Variability From Childhood is Associated With Poorer Cognitive Function in Midlife: The Bogalusa Heart Study
Authors: Soo Jung Kang, Ileana De Anda-Duran, Camilo Fernandez Alonso, XUANYI JIN, Owen Carmichael, Lydia A Bazzano
Journal: Circulation (2024)

Background: Elevated fasting blood glucose(FBG) levels have been associated with poorer cognitive function. High FBG variability has also been associated with accelerated cognitive decline in late life. However, the impact of long term FBG variability from childhood on midlife cognitive function (CF) remains understudied. Hypothesis: We hypothesized that there would be an association of higher long-term FBG variability from childhood with poorer midlife CF measures. Aim: We aimed to identify the influence of higher long term FBG variability on midlife CF. Methods: We studied 1,005 midlife Bogalusa Heart Study participants (age at baseline: mean 9.4 years +/- SD 3.5 years; age at neuropsychological(NP) exam: mean 47.9 years+/- SD 5.2 years; 60.4% women(607 of 1005); 33.5 % Black(337 of 1005)) with ≥3 FBG measurements across follow up. Participants having type 2 diabetes mellitus(T2DM) were excluded. T2DM was defined as FBG ≥126 mg/dL or taking diabetes medication. Long-term visit-to visit FBG variability was measured as deviation from age predicted values (DEV) and residual SD (RSD). Using ≥3 FBG measurements, DEV and RSD were obtained from individual growth curves created by fitting random-effects models stratified by race and sex. Participants’ midlife CF was first measured with 10 NP tests, then were classified into 3 distinct NP profiles (optimal, average, and mixed-low) using cluster analysis. Multinomial logistic regression models were used to analyze the associations between long-term FBG variability parameters and NP profiles, adjusting for education status and mean of FBG measures from childhood to midlife . DEV and RSD were standardized to z-scores by race and sex before regression analysis. Tests for interaction according to race and sex were conducted. Results: After adjusting for the mean FBG level and education status, for a 1 SD increase in DEV, the odds of having a mixed-low CF increased by 57.3% (95% CI 1.244, 1.990) and the odds of an average CF increased by 36.9% (95% CI 1.144, 1.640) respectively, compared to optimal CF. After adjusting for the mean FBG level and education status, for a 1 SD increase in RSD, the odds of having a mixed-low CF increased by 56% (95% CI 1.232, 1.974) and the odds of an average CF increased by 37.7% (95% CI 1.147, 1.653), respectively, compared to optimal CF. No significant interactions between long-term FBG variability parameters and race and sex were found. Conclusions: Higher long-term FBG variability was associated with poorer midlife CF. Further studies are needed to identify the role of long-term FBG variability in the association of cardiometabolic risk factors and midlife CF.
Abstract P290: Telephone Lifestyle Coaching - Sex Differences in Referrals and Enrollment During National Implementation
Authors: Melissa Farmer, Kimberly Claire, Catherine Chanfreau, Sophia Hurley, Eric Pear, Michael Goldstein, Jane Kim, Susan Raffa, Alison Hamilton, Bevanne Bean-Mayberry
Journal: Circulation (2024)

Objectives: Telephone Lifestyle Coaching (TLC) is an evidence-based program providing individualized telephone coaching and self-management support to Veterans working on personalized, healthy living SMART goals. Given the flexibility of telephone support, we explored sex differences in TLC referrals and enrollment. We focus on sex to identify potential opportunities with virtual/telephone prevention programs in VA. Methods: Since March 2019, 44 VA sites have implemented TLC nationwide. Under VA’s QUERI rapid response evaluation program, we examined sex differences in referrals and enrollment with logistic regression controlling for demographics, mental and physical health, prior participation in a VA Whole Health Program and VA’s MOVE! Weight Management Program, and site-level clustering. The sample included all Veterans with at least one primary care visit one year prior to starting TLC. Results: As of 12/31/22, a total of 11,719 Veterans had at least one TLC referral, with 9,514 enrolled (82%), totaling 122,233 encounters. For both referrals and enrollment, mean age was 54, with 33% female, 29% Black, 7% Hispanic, and 34% with rural residence. In adjusted models, female Veterans had increased odds of being referred (OR=2.40, CI:1.89-3.05) and enrolling (OR=1.27, CI:1.13-1.42) compared to male Veterans. Odds of referral were higher for younger Veterans (OR=0.98, CI:0.97-0.98), those with depression (OR=1.62, CI:1.46-1.81), PTSD (OR=1.45, CI:1.21-1.73), overweight/obesity (OR=2.38, CI:1.58-3.57), at least one cardiovascular (CV) risk (OR=1.94, CI:1.63-2.30), and prior participation in Whole Health (OR=2.46, CI:1.74-3.51) or MOVE! (OR=6.40; CI:4.02-10.19). Similar associations with enrollment were observed, except Veterans with depression had decreased odds of enrollment (OR=0.84, CI:0.750.93), and effects for PTSD and CV risks were not significant. Conclusions: TLC demonstrated success in reach and engagement of female Veterans at rates above their national proportions in VA care. Referrals targeted weight and CV risk consistent with Veteran clinical needs. Our findings suggest that prior participation with MOVE! and Whole Health may facilitate engagement. Mental health diagnoses were not a barrier to referral, but depression status may reduce patient participation. Impact: TLC and virtual modalities of lifestyle coaching may have broader application for reaching and engaging female Veterans, as well as Veterans with mental health and CV risks who can benefit from health behavior change to optimize care.
Abstract P305: Room for Improved Secondary Prevention of Major Cardiovascular Events Among the Population With New Onset Diabetes: A Longitudinal Latent Class Trajectory Analysis
Authors: Sarah Oconnor, Claudia Blais, Jérémie Sylvain-Morneau, Awa Diop, Miceline Mésidor, Jacinthe Leclerc, Paul Poirier
Journal: Circulation (2024)

Background: After a diagnosis of diabetes, specialist physicians may play a key role in the secondary prevention of major cardiovascular events (MACE). Yet, trajectories of visits to specialists are heterogenous and their efficacy in the prevention of MACE remains unexplored. Goal: To assess whether trajectories of visits to specialists are associated with MACE among new cases of diabetes. Methods: Using the Quebec Integrated Chronic Disease Surveillance System, we identified new cases of diabetes ≥20 years old during fiscal year 2013, who had no prior history of MACE (ischemic cardiopathy, stroke, myocardial infarction or cardiovascular death). Firstly, individual trajectories according to the presence/absence of ≥1 ambulatory visit to a specialist (cardiologist, internist, endocrinologist) were compiled over consecutive 3-month periods up to 2 years following diagnosis. Patients with no visit were compiled in a “primary care only” group, while others were classified in groups using latent class growth analysis. Patients who had a MACE during this period were excluded. Secondly, the risk of MACE occuring after the 2 years following diagnosis up to December 31 st 2019 was compared between groups using a marginal Cox proportional hazards regression model, adjusted with inverse probability weighting and providing adjusted hazard ratio (aHR) with 95% confidence intervals (CI). Results: Among the 24,782 patients included, 5 groups were identified ( Figure 1 ). A total of 2,837 MACE occurred. Compared with the “primary care only group”, those who consulted a specialist were at higher risk of MACE (Regular/frequent visits: aHR: 1.50 [95% CI: 1.26 to 1.66]; Late visits: aHR: 1.41 [1.13 to 1.73]; Regular/sparce visits: 1.38 [1.27 to 1.51]; Early visits: 1.36 [1.19 to 1.54]), while no difference was observed between these groups. Conclusions: Although confounding by indication cannot be totally ruled out, these results may suggest room for improvement in the secondary prevention of MACE after a diabetes diagnosis.
Abstract P182: Ratio of Cholesterol to Triglycerides Within High-Density Lipoprotein (HDL) as a Novel Marker of Risk for Myocardial Infarction (MI)
Authors: Yuka Koyama, Christy L Avery, Kristin Young, Sarah Koenigsberg, Carolina G Downie, Michelle Meyer, Daniel I Chasman, Kathryn M Rexrode, Kari E North, Ming Ding
Journal: Circulation (2024)

Background: HDL cholesterol, together with LDL-c and triglycerides, are biomarkers widely used to assess risk of myocardial infarction (MI). Thereafter, apoA1 and HDL particle number (HDL-P) were identified as biomarkers inversely associated with risk of MI. State-of-the-art nuclear magnetic resonance spectroscopy allows for profiling of lipidomic markers within HDL, providing an unprecedented opportunity to identify novel biomarkers of MI. Methods: We examined associations between HDL lipid components and risk of MI in the UK Biobank. We leveraged the most up to date lipidomic data measured by NMR. A total of 8229 MI incidents were documented among 249,140 participants over a median 17.7 years of follow-up. Results: Independent of existing risk factors including LDL-c, triglycerides, apo-A1, HDL-P, the percentage of cholesterol over total lipids in HDL was inversely associated with the risk of MI with Hazard Ratio (HR) of 0.85 (0.76, 0.95), when comparing the highest quintile to the lowest. The percentage of triglycerides in HDL was positively associated with 1.13 (1.01, 1.26). We created the ratio of cholesterol to triglyceride within HDL and found it to be inversely associated with risk of MI (HR=0.89 [0.79, 0.99]). This finding is robust and consistently supported across subclasses of HDL. Conclusions: The ratio of cholesterol to triglycerides within HDL particles may be a new marker of risk for MI, independent of existing biomarkers. Table 1 . Hazard Ratios for Myocardial Infarction (MI) across Percentages of Lipids in HDL. Model 1: Cox model adjusted for conventional covariates: Age, Sex, Race, Body Mass Index, Hypertension status, Statin Use, Type 2 Diabetes status, Smoking, Education, Alcohol intake, and Townsend Deprivation Index, LDL-C, and TriglyceridesModel 2: Cox model adjusted for Model 1 covariates plus Apolipoprotein A1 and HDL particle number.
Abstract P485: Exercise Influences Metabolic Parameters and Expression of Markers of Endoplasmic Reticulum Stress in a Diet-Dependent Manner
Authors: McClain Vail, Austin Le Vey, Thuy-Linh Nguyen, Aaron Rodriguez, Nathaniel Spears, Jeffrey L Jasperse, Jeffrey Houghton, Joseph Gigliotti
Journal: Circulation (2024)

The relationship between diet, exercise, and metabolic dysfunction is widely established; however the mechanisms responsible remain unclear. Endoplasmic reticulum stress (ERS) has been shown to play a significant role in metabolic homeostasis and disease processes; however it is unclear how diet and exercise interact to influence ERS. Therefore, the objective of this project was to determine how diet and exercise influence metabolic markers and mRNA expression of ERS-related genes. Weanling C57Bl/6 mice were randomly assigned to receive ad libitum access to standard laboratory chow, AIN93 diet, and our novel “Americanized” diet (AD) for 4-weeks. After 2-weeks, mice from each diet group were randomly assigned to exercise (n=7) or sedentary control groups (n=3). The exercise condition consisted of access to an exercise wheel, three times per week, for 16 hours per day. Wheel utilization was recorded using a bicycle computer/sensor. Insulin sensitivity was determined using standardized insulin-tolerance test. Mice were fasted, euthanized, and blood and liver tissues were collected. Circulating glucose and lipid levels were quantified and hepatic mRNA expression of genes related to ERS ( Ddit3 , Hspa5 , and Erdj4 ) were determined. Data were analyzed using GLM procedures in SPSS. Despite having no influence on body weight, diet (P=0.04) significantly influenced liver weight, with mice fed AD having greater (P = 0.01) liver weight compared to mice fed chow. Exercise tended to increase liver weight compared to the control (P=0.095), while reducing liver lipid content in mice fed chow and AD. AD fed mice had the highest circulating glucose values compared to mice fed chow (P=0.013) and also tended to be greater than mice fed AIN (P=0.056). Exercise significantly increased circulating triglycerides (P=0.03) and tended to reduce circulating glucose levels (P=0.07). Diet significantly influenced insulin sensitivity (P = 0.003), with mice fed AD having less insulin sensitivity as compared to mice fed chow (P&lt;0.001) and also tended to be lower than mice fed AIN (P=0.06). While non-significant (P=0.15), exercising mice tended to have less insulin sensitivity than controls. Exercise caused an increase in Erdj4 mRNA expression (P=0.02), most notably in mice fed AD, which had a greater ER-stress response with exercise than other diet groups (P=0.04). Our data suggests that the physiological responses to acute exercise is dependent upon the quality of diet consumed, and these effects are associated with changes of markers of ERS. Additional studies are needed to further elucidate the mechanisms by which diet, exercise, and ERS interact to influence metabolic health.
Abstract MP32: Associations of Metabolites With Glycemic Outcomes Among Bogalusa Heart Study and Atherosclerosis Risk in Communities Study Participants
Authors: Jenilee Cueto, Tanika N Kelly, Jiang He, Changwei Li, Jovia L Nierenberg, Xiaoying Gu, Eric Boerwinkle, Joe Coresh, Elizabeth Selvin, Bing Yu, Lydia A Bazzano, Casey Rebholz, Kirsten Dorans
Journal: Circulation (2024)

Background: Metabolomics may identify novel biomarkers for predicting, detecting, and managing diabetes. We evaluated the association of novel metabolites with diabetes, prediabetes, and continuous glycemic outcomes (fasting plasma glucose (FPG); hemoglobin A1c (HbA1c)) using data from the Bogalusa Heart Study (BHS) and Atherosclerosis Risk in Communities Study (ARIC). Methods: Untargeted ultrahigh-performance liquid chromatography-tandem mass spectroscopy was used to detect and quantify 1466 serum metabolites in 1194 BHS participants (2013-2016) with and without diabetes (defined as FPG ≥126 mg/dL or use of diabetes medication; prediabetes as FPG of 100 to &lt;126 mg/dL). We assessed cross-sectional associations between all metabolites with FPG and HbA1c (linear regression) and with prediabetes and diabetes (multinomial logistic regression). Significant and novel metabolite associations in BHS were tested for replication (determined by statistical significance and consistent effect direction) among 1528 participants from ARIC (1990-1992). All analyses used Bonferroni-corrected alpha thresholds. Results: In BHS (mean age 48.1 y, 60% female), 16% of persons had diabetes and 32% had prediabetes. Mean FPG and HbA1c were 106.5 mg/dL and 5.9%, respectively. Among 163 novel glycemic-metabolite associations in BHS, 21 metabolites were tested for replication in ARIC (measured on a different platform): Six metabolites for diabetes, 9 for glucose, 12 for HbA1c, and 3 for prediabetes. Among metabolites tested, replication results for All (Black and White) and Black participants across ARIC subgroups identified glycylvaline as statistically significant for novel association replicated with HbA1c (Table). Conclusions: A significant novel metabolite association of glycylvaline, part of the dipeptide subpathway, with HbA1c was identified in BHS and replicated in ARIC. This dipeptide subpathway should be further explored as a potential subpathway to target for detection or management of hyperglycemia.
Abstract P315: Consumption of Potatoes and Risk of Hypertension: A Pooled Analysis of US Cohorts
Authors: Luc Djousse, Howard D Sesso, Xia Zhou, Eunjung Kim, I-min M Lee, Lyn Steffen, Julie Buring, JoAnn E Manson, John M Gaziano
Journal: Circulation (2024)

Background: Limited and inconsistent observational data are available on the association of potato consumption with risk of hypertension. Objective: To test the hypothesis that consumption of total; combined baked, boiled, and mashed; and fried potatoes is associated with incidence of hypertension and that dietary pattern (assessed using the plant-based diet index [PDI]) modifies such association. Methods: We pooled and analyzed harmonized, individual-level data from 5 US cohorts (n=67,146). Frequency of baked, boiled, mashed, and fried potato consumption during the previous year was ascertained using a food frequency questionnaire. We used Cox regression to estimate hazard ratios separately in each cohort adjusting for age, sex, race/ethnicity, education, body mass index, energy intake, physical activity, smoking, alcohol intake, trans fats, and PDI score. We then pooled cohort-specific results using an inverse-variance weighted method to estimate summary relative risks. Results: Mean age ranged from 25 to 72 years and median total potato consumption ranged from 1.2 to 3.2 times per week across the cohorts. During the follow up, 31,546 new cases of hypertension occurred. Total potato consumption was not associated with the risk of hypertension: adjusted HR (95% CI): 1.00 (ref), 1.01(0.96-1.05), 1.01(0.96-1.05), 1.04(1.00-1.08), and 1.04(0.99-1.08) for total potato intake of 0; 1-2; &gt;2 to &lt;3; 3-&lt;5; and 5+ times per week, respectively. HR (95% CI) for combined baked, boiled, and mashed potato consumption were 1.0 (ref), 1.00 (0.97-1.04), 1.02 (0.98-1.05), and 1.02(0.98-1.07) for intake of 0, 1-2; &gt;2 to &lt;3; and 3+ times/week, respectively. In contrast, intake of fried potatoes was positively associated with hypertension risk (figure). There was no significant interaction between PDI score and potato consumption on HTN risk. Conclusions: Our pooled analysis showed a positive association between fried, but not combined baked, boiled, and mashed, potatoes and incidence of hypertension.
Abstract MP27: Use of Multivitamin Supplements and Risks of Total and Cause-Specific Mortality Among U.S. Adults
Authors: Ming Ding, Yu-Han Chiu, André O Markon, Siwen Wang, JoAnn E Manson, Frank B Hu, Walter C Willett, Edward L Giovannucci, Beverly J Wolpert, Jorge E Chavarro
Journal: Circulation (2024)

As the most commonly consumed dietary supplement, how multivitamin use associates with risk of mortality remains inconclusive. Methods: We used data from three cohort studies to examine the association of time-varying multivitamin use with risk of mortality. We also emulated a target trial to estimate the association by applying the parametric g-formula. Results: Of 241,068 eligible participants (mean age at baseline: 50 for NHS, 37 for NHSII, and 53 for HPFS), there were 44,415 deaths over 30-years of follow up. Compared to non-users, the pooled age-adjusted harzard ratio (HR) of mortality was 0.92 (95% CI: 0.89, 0.94) and 0.89 (95% CI: 0.88, 0.91) for users who used &lt;1 and ≥1 pill/day, respectively. These results were attenuated after multivariable adjustment (0.97 [0.95, 1.00] and 0.98 [0.96, 0.99], respectively), and the inverse association was primarily due to lower risk of CVD mortality ( table 1 ). In the emulated target trial, the estimated 30-y all-cause mortality under a multivitamin intervention was slightly lower than no intervention ( table 2 ). Conclusions: Multivitamin use may relate to a small reduction in mortality among middle-aged adults.
Abstract P471: Association of Food Insecurity With Premature Mortality and Life Expectancy in the United States
Authors: Hao Ma, Xuan Wang, Xiang Li, Yoriko Heianza, Peter T Katzmarzyk, Oscar Franco, Lu Qi
Journal: Circulation (2024)

Introduction: Food insecurity has been linked to multiple causes of disease and mortality; however, its relationship with life expectancy by sex, and across racial and ethnic groups remains unknown in the US. Hypothesis: Associations of food insecurity with all-cause premature mortality and life expectancy may vary by racial and ethnic, and sex in US adults. Methods: We included 57404 adults who participated in the NHANES 1999-2018, with linkage to the National Death Index through December 31, 2019. Levels of food security were assessed with the US Department of Agriculture Adult Food Security Survey Module (full, marginal, low, and very low). Results: During a median of 9.3 years of follow-up, 4263 premature deaths were documented. Compared with the full food security group, the adjusted Hazard Ratios (HRs) were 1.50 (95% CI, 1.31-1.71), 1.44 (1.24-1.68) and 1.81 (1.56-2.10) across marginal, low, and very low food security groups, respectively ( P -trend &lt; 0.001). The corresponding life expectancy at age 50 in each group was 32.5 (95% CI, 32.4-32.6), 29.9 (28.9-30.9), 30.0 (28.9-31.0), and 28.0 (26.8-29.2) years. Equivalently, adults with marginal, low, or very low food security lived on average 2.6 (95% CI, 1.5-3.7), 2.5 (1.4-3.7), or 4.5 (3.2-5.8) years shorter at age 50 years, respectively, compared with those with full food security. The associations appeared to be stronger in women than in men, and stronger in White adults than in Black and Hispanic adults (All P -interaction&lt;0.05). Conclusions: Although the relation of food security and life expectancy varied across sex, racial and ethnic groups, overall, lower levels of food security are related to a higher risk of premature mortality and a shorter life expectancy.
Abstract P435: Trends and Disparities in Glycemic Control Among Youth and Adults With Type 1 Diabetes in the US Health System: 2008-2022
Authors: Yunwen Xu, Michael Fang, Shoshana Ballew, Joe Coresh, Elizabeth Selvin, Jung-Im Shin
Journal: Circulation (2024)

Introduction: Glycemic control is crucial for type 1 diabetes (T1D) management, yet contemporary data in the US are scarce. This study aims to investigate trends in glycemic control among US youth and adults with T1D from 2008 through 2022. Hypothesis: Glycemic control has improved over time. Methods: We used a well-validated algorithm to identify patients with T1D using de-identified electronic health record data from the Optum Labs Data Warehouse. We characterized trends in hemoglobin A1c (HbA1c) &lt;7% from 2008-2010 to 2020-2022, overall and by age, sex, and race/ethnicity. Results: We included 128,821 patients with T1D (17% youth under age 18 years, mean age 38 years, 48% female, 78% non-Hispanic White). Among youth, mean HbA1c decreased from 8.9% in 2008-2010 to 8.5% in 2020-2022 ( P&lt;.001 ), and the percentage with HbA1c &lt;7% increased from 8% to 16% ( P&lt;.001 ). The percentage with HbA1c &lt;7% did not differ by age or sex, and it was notably higher in Non-Hispanic White youth than racial/ethnic minority youth in 2020-2022 ( Figure A-D ). Among adults, mean HbA1c decreased from 8.2% in 2008-2010 to 8.1% in 2020-2022 ( P&lt;.001 ). Trend in percentage with HbA1c &lt;7% among adults increased significantly from 20% in 2008-2010 to 26% in 2020-2022 ( P&lt;.001 ). Adults who were older and White were more likely to have HbA1c &lt;7% compared to younger and Black or Hispanic adults in all years ( Figure E-F ). Conclusion: There have been marginal improvements in glycemic control among patients with T1D over the last 15 years. Overall, percentage with HbA1c&lt;7% remains low, particularly among youth and racial/ethnic minority patients. There is an urgent need to expand access to care and diabetes technology to enhance management in the population.