tbuckley/cabot-search huggingface dataset:
Abstract 4139977: Aggressive LDL cholesterol lowering post ACS with triple combination therapy: Insights from the multicentric LAI-REACT study
Authors: Raman Puri, Kunal Mahajan, Rajeev Agarwala, Ashu Gupta, Aditya Batra, Aziz Khan, Vinod Vijan, Jai Bharat Sharma, Surender Himral
Journal: Circulation (2024)

Background: Patients with acute coronary syndrome (ACS) face a high risk of recurrent events in the early post ACS period. Rapid reduction of low-density lipoprotein cholesterol (LDL-C) is crucial, but high-intensity statins (HIS) alone often fall short of goals. Research Hypothesis: Early use of triple combination therapy of HIS with non-statin drugs: ezetimibe and bempedoic acid (BA) is likely to help achieving the target goals rapidly. Aim: The LAI-REACT (Lipid Association of India Recommended Early and aggressive lipid lowering in ACS with triple Combination Therapy) study evaluated the LDL-C lowering efficacy of a novel triple combination REB (40 mg rosuvastatin, 10 mg ezetimibe, and 180 mg bempedoic acid daily), in patients with ACS. Methods: The multicentric LAI-REACT study enrolled 369 statin-naïve ACS patients across five Indian centers. All received the triple REB combination upon admission. Lipid profiles were assessed at baseline and weeks 1, 2, 4, and 6. Results: The mean age of the study population was 56.3 ± 11.3 years. The mean LDL-C at admission was 119.2 ± 37.1 mg/dL, which significantly decreased to 49.4 ± 19.3 mg/dL at week 1, 44.7 ± 17.4 mg/dL at week 2, 44.6 ± 16.6 mg/dL at week 4, and 46.7 ± 18.3 mg/dL at week 6. The percentage reductions in LDL-C at weeks 1, 2, 4, and 6 were 58.6%, 62.5%, 62.6%, and 60.8% respectively (repeated measures ANOVA, p&lt;0.001). Similarly, non-HDL cholesterol levels demonstrated significant reductions of 53.1%, 54.7%, 54.6%, and 54.9% at weeks 1, 2, 4, and 6 respectively (repeated measures ANOVA, p&lt;0.001). Mean apo-B levels decreased from 92.3 ± 23.6 mg/dL at admission to 65.2 ± 24.1 mg/dL at week 4 (29.4% reduction). Target LDL-C &lt; 70 mg/dL was achieved in 87.3%, 92.1%, 93.2%, and 90.5% of patients at weeks 1,2,4 and 6 weeks respectively. Similarly, target LDL-C &lt; 50 mg/dL was achieved in 55.2%, 70.6%, 69.6% and 64.6% of patients at 1,2,4 and 6 weeks respectively. Conclusion: The LAI-REACT study demonstrates the rapid and sustained efficacy of triple REB therapy in achieving LDL-C goals after ACS. Significant reductions in LDL-C were observed as early as the first week and were maintained up to the sixth week of follow-up. This affordable regimen provides an alternative to more expensive inhibitors of proprotein convertase subtilisin/kexin type 9, potentially improving access to effective lipid-lowering therapy in India.
Abstract 4140064: Income and Mobility Loss in Peripheral Artery Disease
Authors: Mary Whipple, Shujun Xu, Dongxue Zhang, Lu Tian, Lihui Zhao, Mary McDermott
Journal: Circulation (2024)

Introduction: Lower income is associated with a higher prevalence of peripheral artery disease (PAD). However, whether lower income is associated with faster rates of mobility loss among people with PAD is unknown. This study describes associations of income with mobility loss in people with PAD. Methods: Data from four longitudinal studies of participants with PAD conducted in Chicago were combined (the Walking and Leg Circulation Study [WALCS] I, II, and III and the Biomarker Risk Assessment in Vulnerable Outpatients [BRAVO] study). Participants with an ankle brachial index (ABI) &lt;0.90 were categorized at baseline into quartiles of median income derived from their residence zip code. Mobility loss was assessed via participant report and a 6-minute walk test at baseline and annually. Among participants able to walk up one flight of stairs or walk ¼ mile without assistance at baseline, self-reported mobility loss was defined as becoming newly unable to climb one flight of stairs or walk ¼ mile without assistance. Objectively measured mobility loss was defined as becoming unable to complete the 6-minute walk without stopping among participants who completed the 6-minute walk without rest at baseline. Cox regression was used to evaluate relationships between income and mobility loss, adjusting for age, sex, race, cohort, BMI, smoking, and comorbidities. Results: A total of 1133 participants (n=451 [40%] women, n=288 [25%] Black, mean [SD] ABI 0.65 [0.15]) were included. Mean follow-up was 4.5 years. Rates of becoming unable to walk for 6 minutes without stopping were significantly higher among people with lower income, defined by zip code (P trend = 0.001). Conclusions: Among people with PAD, lower income defined by zip code of residence was associated with a significantly higher rate of mobility loss. Future studies should identify the factors that explain the associations reported here and identify interventions to overcome them.
Abstract 4139560: Lipoprotein(a) [Lp(a)]-Enriched Plasma Undergoes More Rapid Oxidation than Small Dense LDL-Enriched Plasma that is Inhibited by Eicosapentaenoic Acid (EPA)
Authors: Samuel Sherratt, Peter Libby, Deepak Bhatt, Preston Mason
Journal: Circulation (2024)

Background: Elevated Lp(a) levels are associated with increased cardiovascular (CV) risk, along with small dense LDL (sdLDL). Lp(a) contains oxidized phospholipid that may “seed” lipid oxidation reactions compared to other lipoproteins. The omega-3 fatty acid EPA delivered as icosapent ethyl (4 g/d) reduced CV events in high-risk patients, including those with elevated Lp(a) (REDUCE-IT). EPA has conjugated double bonds that trap lipid free radicals. We compared rates of oxidation for Lp(a)-enriched and sdLDL-enriched LDL with potential inhibition by EPA at a pharmacologic concentration. Methods: Lp(a) and sdLDL were enriched to 66% of total ApoB-containing particles from patients with elevated levels following isopycnic centrifugation. Lp(a), sdLDL and LDL were matched for total protein (50 µg/mL) and incubated at 37°C for 30 min with EPA (50 µM). Samples then underwent copper sulfate-induced oxidation (20 µM) monitored by formation of malondialdehyde (MDA) for 3 h. We normalized rates of oxidation to total available lipid in the samples. Results: After 0.5 h, Lp(a)-enriched plasma underwent the most rapid oxidation – 60% of total lipid oxidation ( p &lt;0.001 vs other fractions) – followed by sdLDL-enriched plasma (30% of total oxidation) then pure LDL (17% of total oxidation). All samples underwent complete oxidation by 2 h. Initially (t = 0 h), Lp(a) enriched plasma contained more oxidized lipid than all other fractions ( p &lt;0.05). The relative antioxidant activity of EPA was greatest in the Lp(a) enriched samples; EPA inhibited oxidation of Lp(a)-enriched, sdLDL-enriched, and pure LDL by 50%, 46% and 47% ( p &lt;0.001), respectively, at 2 h. The antioxidant activity of EPA in samples persisted at all time points. Conclusions: Lp(a)-enriched plasma underwent rapid oxidation attributed to oxidized phospholipid content and followed by sdLDL and LDL. Oxidation was disproportionately inhibited by EPA in Lp(a) enriched plasma due to free radical scavenging mechanism associated with its multiple conjugated double bonds. The high lipid oxidation rates for Lp(a) inhibited by EPA may contribute to the benefit observed in REDUCE-IT, including in subjects with elevated Lp(a) levels.
Abstract 4139421: Rates Of Atherosclerosis Progression In The Absence Of Cardiovascular Events And Cardiovascular Medications On Cardiac Computed Tomography.
Authors: Jairo Aldana, April Kinninger, Srikanth Krishnan, Venkat Sanjay Manubolu, Ayesha Ghoto, Keishi Ichikawa, Mostafa Mohamed, Lauren Anderson, Juan Ramos, Noah Ramirez, Matthew Budoff, Ronald Karlsberg
Journal: Circulation (2024)

Introduction: Rates of progression of atherosclerosis have been derived from populations with established atherosclerotic cardiovascular disease and on plaque modifying therapies. However, the rate of atherosclerosis progression in populations with no history of MACE, risk factors or risk modifying interventions is not known. The aim of this study is to determine the rate of progression in healthy populations on serial CCTA. Aim: To determine whether in this population, the rates of progression can be classified in slow, intermediate, and rapid. Methods: NATURE-CT retrospectively selected 205 participants from two sites in Los Angeles. Subjects underwent at least two CCTA scans, the initial scan showing CAC ≤100, absence of MACE, not placed on lipid modifying therapy in the first and last scan, and at least 2 years apart. Patients with diabetes, familial hypercholesterolemia or chronic kidney disease were excluded. FDA cleared automated software Cleerly Labs (Cleerly.Inc, NY, NY) which quantified percent atheroma volume PAV% from CCTA. Annual change in PAV% is presented by tertile in this lipid-modifying naïve cohort to understand slow, intermediate and rapid plaque progression rates among subjects. Results: There were 205 subjects with a mean age of 54.9±10.2 years and 72% (148) were male. Average time between serial CCTA scans was 4.9±2.2 years. Annual change in PAV% was less than 0.075% in the first tertile (mild progression), between 0.075% and 0.275% with intermediate progression (2nd tertile) and those with greater than 0.275% in a rapid group (3rd tertile). The median and interquartile range [IQR] for annualized change in PAV% for slow progression was 0.03 (0.0, 0.05), intermediate progression was 0.17 (0.12, 0.20) and 0.46 (0.35, 0.67) for rapid progressors. The moderate and rapidly progressing subjects were more likely to be male, have higher BMI, triglyceride levels, and baseline plaque. Rapid progressors were more likely to have LAP present. Conclusions: Rates of atherosclerosis progression can be classified in slow, intermediate, and rapid progressors, based on a population with low plaque burden in the first scan, no lipid-modifying interventions, and no events. The presence of low-attenuation plaque correlates rapid progression of atherosclerosis and may offer a justification for plaque directed treatment if confirmed with further studies.
Abstract 4138167: Comparative Efficacy Of Minimally Invasive Versus Standard Treatments For Intracerebral Hemorrhage: A Meta-Analysis and Systemic Review
Authors: Nouman Shafique, Syed Ali, Usman Akbar, Sheraz Ahmad Tariq, Muhammad Saim Mazhar, Ahmed Muaaz Umer, Fatima Ashfaq, Ali Raza Khan, Fnu Muhibullah, Adeena Shafique, Iqra Shafiq, Haider Hasnain, Muhammad Ramzan, zeeshan nasir, Muhammad Talha, Faizan E Mustafa, Imtiaz Nazam, muhammad khaliq, Muhammad Ayub, Saurabh Sharma
Journal: Circulation (2024)

Background: Intracerebral hemorrhage (ICH) has high morbidity and mortality. Traditional craniotomy causes significant trauma and lacks proven benefits. Minimally invasive techniques (MIT) like CT-guided thrombolysis, endoscopic, and neuronavigation surgeries show promise in reducing secondary neurotoxicity. Our meta-analysis compares MIT with standard treatments for supratentorial spontaneous intracerebral hematomas (SSICHs) to evaluate their effectiveness in improving clinical outcomes. Methods: We comprehensively searched PubMed, EMBASE, and Cochrane Library for studies published before June 1, 2024, comparing MIT versus standard treatment for ICH. Data were analyzed using R (v.4.3). Pooled proportions with 95% confidence intervals (CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% CIs were used for dichotomous and continuous variables. Outcomes included overall survival, functional neurological outcome, hospitalization length, recurrent bleeding, volume reduction, and Glasgow Coma Scale (GCS) score at discharge. Results: We identified six studies, including 1,117 patients. There were 463 patients who underwent MIT and 654 patients who received standard treatment. The MIT group exhibited statistically significant increased odds of survival (OR: 1.98 [1.25, 3.15]; I2=26%; p=0.004) and functional neurological outcome (OR: 1.94 [1.27, 2.96]; I2=25%; p=0.002) compared to the standard treatment group. The MIT group demonstrated statistically significant lower length of hospitalization (MD: -2.89 [-4.49, -1.30]; I2=47%; p=0.0004) and better GCS score at discharge (MD: 1.50 [1.00, 2.00]; I2=0%; p&lt;0.00001) compared to the standard treatment group. The MIT group also showed a trend towards more volume reduction (MD: 12.33 [-11.39, 36.05]; I2=99%; p=0.31) and lesser odds of recurrent bleeding (OR: 0.71 [0.25, 1.99]; I2=15%; p=0.52) compared to the standard treatment group, but these were not statistically significant. Conclusion: MIT show superior outcomes in survival, functional neurological status, hospitalization length, and GCS scores at discharge compared to standard treatments for SSICHs. While trends towards greater volume reduction and lower bleeding recurrence were observed, they were not statistically significant. Further research is needed to optimize MIT and confirm its benefits in larger, randomized trials.
Abstract 4138946: Psychological Stress and Risk of Heart Failure and Its Subtypes in the Women’s Health Initiative
Authors: Emily Gathright, Matthew Allison, Matthew Burg, Bernhard Haring, Longjian Liu, Simin Liu, JoAnn Manson, Lisa Martin, Abu Taiyab Nazmus Saquib, Aladdin Shadyab, Sylvia Wassertheil-Smoller, Julie Weitlauf, gretchen wells, Charles Mouton, Judith Ockene, Elena Salmoirago-Blotcher
Journal: Circulation (2024)

Background: Psychological stress affects cardiovascular (CV) health via multiple physiological and behavioral pathways. Few studies have assessed whether psychological stress impacts heart failure (HF) incidence. A prior large cohort study identified unique associations between perceived stress and HF subtype, but these associations were confounded by other health risk factors (e.g., prevalent baseline CV disease). No prospective study has evaluated these associations in women free of baseline CV disease. Goal: To evaluate the prospective association of psychological stress with incident HF and HF subtype risk in post-menopausal women. Hypothesis: Psychological stress is prospectively associated with an increased HF hospitalization risk, which may vary by HF type (HFpEF vs. HFrEF). Method: Of 29,703 post-menopausal women enrolled in the Women’s Health Initiative (WHI) free of baseline CV disease and pre-existing HF at first adjudication, psychological stress was assessed via an 11-item scale of stressful life events (SLE) over the past year (WHI screening, 1993-1998) and the 4-item Perceived Stress Scale (PSS; WHI Extension 2, 2010-2015). Incident HF was confirmed via adjudication of self-reported first hospitalization. Cox proportional hazards models adjusting for demographic, medical, and lifestyle factors were used to calculate hazard ratios associating stress quartiles with incident HF, HFpEF, and HFrEF hospitalization. Results: At screening, women were 62±7 years, 49% from underrepresented racial and ethnic populations, and 59% were at least high school graduates. At baseline women reported a mean of 2±.01 SLEs over the past year. Mean PSS scores were 4.16±3.09. Over a median of 15 years, there were 1,624 incident HF events (HFpEF, n=998; HFrEF, n=626). In fully adjusted models neither the number of SLEs or PSS scores were associated with HF risk(Table 1). Conclusions: In this WHI cohort, the number of SLEs and perceived stress were not prospectively associated with risk of HF, HFpEF, or HFrEF hospitalization. Future research is needed to understand whether specific types of stressors, stress measured more proximally to HF onset, or lab-based stress assessments may capture an association of stress with HF risk.
Abstract 4140084: A Case of Transient Cortical Blindness occurring during Percutaneous Transluminal Coronary Angiography for Acute Coronary Syndrome.
Authors: Adeniyi Adelakun, Iyad Farouji, ahmad haddad, Stanley Szwed
Journal: Circulation (2024)

Description of case: A 55 yo man with no PMHx presented with a few hours of intermittent left-sided chest tightness. Serial EKG revealed dynamic ST-T wave changes in lateral leads—Figure 1. His lipid panel was abnormal, and the High-Sensitive Troponin T trended up—table 1. Based on the hemoglobin A1C result of 10.6, he was newly diagnosed with DM. Coronary angiography shows two vessel diseases. The left circumflex artery's first obtuse marginal artery branch (LCX-OM1) received a stent in the first instance. During the planned PTCA for treatment of LAD 48 hours after, he developed sudden bilateral loss of vision while on the table just before stent deployment. In this case, with the emergence of the symptom of vision loss, PTCA was halted to allow the operator to rule out an acute cerebrovascular accident (CVA) through urgent CT head and MRI brain scans. He consented to complete the LAD PTCA the day after, which achieved the intended restenosis without complications. Discussion: Bilateral transient cortical blindness (TCB) is a reversible syndrome of vision loss affecting both eyes in the presence of normal visual pathways due to a brief disturbance in the occipital cortices. TCB is more commonly associated with cerebral angiography but has been rarely reported after coronary angiography. Angiographic contrast toxicity is one of the proposed pathophysiologic mechanisms. During our case, approximately 30 mL of iohexol was used before TCB, while about 120 mL of iodixanol was used for the repeat and conclusive procedure. We are not aware of a previous report in which PTCA was recommenced hours after being halted due to TCB in a patient suffering acute coronary syndrome. The absence of symptom recurrence when the PTCA was recommenced, which underscored the benign nature of TCB, enabled the patient to receive conclusive, definitive treatment for his acute coronary condition.
Abstract 4138926: Results of an Employee Physical Activity Promotion Intervention within a Very Large Academic Health System
Authors: Margaret McCarthy, Yuhe Xia, Sean Heffron
Journal: Circulation (2024)

Background: Although healthcare workers may be aware of the risks of physical inactivity, their levels of physical activity (PA) are similar to those of all US adults, with less than half engaging in sufficient PA. The purpose of this health promotion was to encourage daily PA among employees in a large urban healthcare system. We also tested whether individualized progress updates further influenced PA. Methods: This 10-week PA program was available to all employees across all practice locations of NYU Langone Health. Employees could sync their phone or accelerometer (e.g., Fitbit) via app or web browser to count.it, the vendor chosen to monitor and manage step counts. Participants were also asked to voluntarily provide basic information (age, sex, job role, work location) and complete the Physical Activity Vital Sign (minutes/week and intensity of PA) at enrollment and 10 weeks. For 10 weeks, participants were sent a message through their employee ‘MyChart’ portal with a link to information on the benefits of PA, and a reminder of that week’s step-count challenge. Those meeting criteria for weekly challenges were included in gift card raffles. Participants were randomized 1:1 to receive the standard MyChart message +/- additional emails detailing their progress. Comparisons between groups included independent samples t-tests, Wilcoxon signed-rank tests, and chi-squared tests, with linear mixed effect modeling to assess predictors of step counts. Associations between variables were assessed using Cohen’s kappa. Results: 3528 employees registered to participate (8% of all employees) although active users diminished over time (1225 at week 10). Average daily steps remained stable throughout (7319 + 4540 in week 1, 7229 + 5010 in week 10). Although there was no difference in any individual week, receipt of personalized feedback was associated with significantly higher average step counts throughout the 10-wk intervention as a whole (p=0.01). Age and an urban work location were positively associated with steps, while female sex and a clerical job role were negatively associated with steps counts (all p&lt;0.005). Conclusion: Our findings provide important insight for the promotion of population health, and specifically, workplace interventions. They further suggest specific groups that may benefit from targeted efforts.
Abstract 4138187: Right Atrial Pressure/Pulmonary Artery Wedge Pressure Ratio Correlates With Early Outcomes After Pulmonary Thromboendarterectomy
Authors: CZE CI CHAN, Marie Bautista, Jenny Yang, Mona Alotaibi, Timothy Fernandes, Demosthenes Papamatheakis, David Poch, Kim Kerr, Victor Pretorius, Michael Madani, Hyong Kim
Journal: Circulation (2024)

Background: Elevated right atrial pressure/pulmonary artery wedge pressure (RAP/PAWP) ratio has been associated with poor outcomes in pulmonary arterial hypertension (PAH). However, the current risk assessment tools in PAH focus on absolute RAP values and cut-offs over the measured RAP in context of PAWP. This ratio has not been investigated in chronic thromboembolic pulmonary hypertension (CTEPH). The ratio of RAP to PAWP may help with risk assessment prior to pulmonary thromboendarterectomy (PTE). Method: We retrospectively reviewed patients with CTEPH who underwent PTE at the University of California San Diego between January 2021 and December 2023. Baseline characteristics including invasive pulmonary hemodynamics and post-operative outcomes were analyzed. Mean computer generated values were used for both RAP and PAWP. Post-operative outcomes of interest were reperfusion pulmonary edema (RPE), ventilator days, re-intubation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and 30-day mortality. Results: Of 532 CTEPH patients undergoing PTE during this time period, total of 496 patients with baseline hemodynamics meeting analysis criteria were categorized into 2 groups: RAP/PAWP ratio ≥1 ( inverse group, n=133, 26.8%) and RAP/PAWP ratio &lt;1 (control group, n=363, 73.2%). There were no differences in sex, age, body mass index and comorbidities. However, patients in the inverse group had a higher incidence of hemoptysis, worse baseline functional class, worse baseline hemodynamics including lower cardiac index, and higher median N-terminal pro-brain natriuretic peptide. Post PTE, rates of RPE and re-intubation were higher in the inverse group (14% vs. 6%, p =0.005 and 5% vs. 1%, p =0.036, respectively). Ventilator days (3.1±5.1 days vs. 1.9±2.7 days, p =0.009), ICU and hospital LOS (5.7±5.5 vs. 4.2±3.8 days, p = 0.005 and 15.0±7.2 vs. 12.4±7.0 days, p =0.001, respectively) were longer in the inverse group. Additionally, 30-day mortality was higher in the inverse group (4% vs. 1%, p =0.019). Overall 30-day post PTE mortality during this period was 1.6%. Conclusion: CTEPH patients with mean RAP equal or higher than the mean PAWP have higher rates of early complications following PTE surgery. Additional analysis is needed to evaluate if this ratio is an independent risk factor prior to CTEPH intervention.