tbuckley/cabot-search huggingface dataset:
Abstract P115: Urban Greenspace and All-Cause, Cardiovascular Disease-Specific, and Breast Cancer-Specific Mortality Among Older Women With Breast Cancer in the United States: Regional Variations Within the Surveillance, Epidemiology, and End Results and Medicare Linked Database
Authors: Jean C Bikomeye, Sergey Tarima, Yuhong Zhou, Jamila L Kwarteng, Andreas M Beyer, Tina W Yen, Aaron N Winn, Kirsten M Beyer
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality in the US. Cancer survivors are at increased risk for adverse CVD outcomes due to multiple factors, including cardiotoxicity. Research suggests that greenspace contributes to better health outcomes, including CVD and breast cancer (BC). Objective: To explore relationships between urban greenspace and all-cause (ACM), CVD-specific (CVDSM), and BC-specific (BCSM) mortality and explore regional differences among older women diagnosed with BC in the US SEER-Medicare database. Methods: The 2011 national landcover database was linked to the 2010 census tracts and the 2010-2017 SEER-Medicare BC cohort. Women were included if they were 66+ years at diagnosis, had invasive BC, enrolled in Medicare Part A and Part B for 12 months before diagnosis, and had a census tract match for greenspace. Independent variable ‘greenspace’ was census tract percent tree canopy quartiles. Outcomes were all-cause, CVD, and BC-specific survival. Censoring was determined by the end of the study date, 12/31/2018. Covariates included age and comorbidity at BC diagnosis, race/ethnicity, dual enrollment in both Medicare and Medicaid eligibility, neighborhood social vulnerability, and tumor stage. Results: Regional variations in association between greenspace and BC survival were observed (Table 1). Greenspace is protective for ACM and BCSM in California, Washington, New Jersey, and Michigan, while no significant associations were observed in Georgia or Louisiana. For CVDSM, greenspace is protective in CA, while no significant differences were observed in Washington, Louisiana, and Michigan. An inverse relationship is observed for CVDSM in Georgia and New Jersey. Discussion: Our findings warrant more studies to investigate why greenspace is protective in some areas (i.e., CA, NJ, MI) or hazardous in other areas (i.e., GA). There is a need to identify critical factors and pathways contributing to these greenspace-survival differences.
Abstract P443: Alcohol Use Prevalence Among US Born and Foreign-Born Black Adults in the 2010 to 2018 National Health Interview Survey
Authors: Kimesha Grant, Ruth-Alma N Turkson-Ocran, Oluwabunmi V Ogungbe, Faith Metlock, Yvonne Commodore-Mensah, Diana Baptiste
Journal: Circulation (2024)

Background: Alcohol use is an important risk factor for CVD, but variations among Black adults are not well known. We aimed to examine differences in alcohol use among Black subgroups. Hypothesis: Foreign-born Black adults will exhibit less alcohol use than their native-born peers. Methods: We performed a cross-sectional analysis of pooled data from the 2010 to 2018 National Health Interview Survey. Exposure was Black subethnic categories; African American (AA), African Immigrant (AI), and Afro-Caribbean (AC) adults; with non-Hispanic U.S. born White adults as the reference group. The outcome was self-reported alcohol use, categorized as never, former, or current drinker. Survey-weighted multinomial logistic regression was used to examine the relative risk ratios of alcohol use adjusting for covariates. Results: We included 415,250 White adults and 84,709 Black adults. Of those, 73,893 (87.2%) were AA, 6,739 (8.0%) were AC, and 4,077(4.8%) were AI. After adjusting for age, sex, marital status, education, employment, income, and insurance, the prevalence rates of current drinking were 68.3, 32.5, 48.1, and 57.1 for White, AI, AC, and AA, respectively. The odds of never drinker and former drinker compared to current drinker were higher among all Black groups than White adults. AI. were more likely to be never drinkers (RRR: 9.48; 95% CI: 8.10-11.10) followed by AC (RRR:3.70 95% CI: 3.22-4.24) and AA (RRR: 1.91 95% CI: 1.81-2.01). Conclusion: Black adults are less likely to be current alcohol drinkers when compared to White adults. However, there is significant variation in alcohol usage within the Black population by region of origin. These findings highlight the need for further intra-race evaluation into the underlying causes of alcohol use differences.
Abstract P328: Hepatocyte Growth Factor and Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS)
Authors: Avery J Campbell, Katherine Wilkinson, Timothy B Plante, Nels Olson, Brittney Palermo, Ryan M Irvin, Russell P. Sawyer, Mary Cushman
Journal: Circulation (2024)

Background: Cognitive impairment is a major public health burden in the U.S., and Black adults experience a disproportionate burden of cognitive impairment, including dementia. Hepatocyte growth factor (HGF) is a tyrosine kinase receptor MET agonist with neuroprotective properties, including peptide synthesis, neuronal regeneration, and inflammation reduction. Recombinant HGF aids endothelial repair and combats tissue fibrosis in mice. A positive HGF/MET pathway modulator (fosgonimeton) is in Phase 2 clinical trials for mild to moderate Alzheimer’s disease. We investigated the link between circulating HGF and incident cognitive impairment (ICI) in a national cohort study. Methods: REGARDS enrolled a cohort of 30,239 Black and White adults aged ≥45 in 2003-2007. ICI was identified using a 3-test battery administered every 2 years. Excluding participants with baseline cognitive impairment or stroke, with a mean follow-up of 3.5 years, 432 ICI cases and 520 controls were identified and HGF was measured in their baseline blood samples. Logistic regression estimated odds ratios (OR) of ICI by continuous HGF and also per quartile of HGF, controlling for known confounders. We assessed sex*HGF and race*HGF interactions on ICI. Restricted Cubic (RC) splines illustrated potential non-linear relationships. Results: Higher HGF was not associated with greater ICI risk in any model ( Figure ). There was no observed significant sex*HGF (P=0.58) or race*HGF interactions (P=0.19). RC splines visualized a possible non-linear relationship between lower HGF and higher risk of ICI relative to the median HGF level. Conclusions: In a prospective study of HGF in adults free from stroke or cognitive impairment, there was no clear association between higher HGF and ICI, though possible nonlinear associations might exist at low levels. This suggests that pharmaceuticals augmenting HGF pathways may benefit in primary prevention of ICI. Confirmatory studies are needed.
Abstract P508: Comparisons of Cardiovascular Health in US Adults by Chronic Disease Status: National Health and Nutrition Examination Survey (NHANES), 2013-2018
Authors: James W Guo, Hongyan Ning, Donald M Lloyd-Jones
Journal: Circulation (2024)

Introduction: Cardiovascular health (CVH) assessment is typically applied to younger, healthy individuals in the setting of primordial prevention, but the concept may have important benefits for those with chronic diseases of aging (CDAs) at increased risk for incident cardiovascular disease (CVD). No studies have assessed CVH in adults with CDAs vs. healthy adults without CDAs using the new Life’s Essential 8 (LE8) metrics. Methods: We used NHANES data from 2013-2018 to identify presence of 15 CDAs by participant self-report of diagnosis. We included adults ages 20 to 79. CVH was defined by AHA’s LE8 metrics. Overall mean LE8 (range 0-100, higher = better CVH) and individual LE8 metric scores were calculated according to disease status for all participants and stratified by self-identified sex and race/ethnicity. Results: There were 12,296 adults, with mean age 46 years; 51% self-identified as female, 65% as White, 16% Hispanic, 11% Black, 5% Asian, 4% multiracial. Significantly, and often substantially, lower CVH scores were noted for adults with CDA (12 of 15 CDAs) vs. healthy adults, including all subtypes of CVD and lung diseases, liver disease, arthritis, cognitive decline, and depression. Greatest mean LE8 differences were detected for COPD, emphysema, and congestive heart failure. For example, mean overall LE8 score was 14.0 points lower in those with vs. without COPD (51.0 vs. 65.0, P&lt;0.0001) with smoking and physical activity having the largest absolute differences in individual metric scores (36.4 and 23.6, respectively). There were no significant differences in LE8 scores for participants with vs. without cancer, HIV, or osteoporosis. Males and Black adults consistently had lower LE8 scores. Conclusions: CVH is significantly poorer in adults with many of the CDAs compared to healthy adults. These data establish the utility of the LE8 CVH score to identify groups for targeted optimization of CVH to enhance primary and secondary prevention efforts for CVD and potentially for other concomitant CDAs.
Abstract P301: Nativity Explains Disparities in Provider Experience Scores Among Asian and Pacific Islander Patients With and Without Cardiovascular Disease
Authors: Lily Amaturo, Adrian M Bacong, Sophia Gibbs, Ana G Rosales, Timothy B Frankland, Jiang Li, Yihe Daida, Stephen P Fortmann, Latha Palaniappan
Journal: Circulation (2024)

Introduction: Research has shown that Asian patients rate their patient-provider experience lower than Non-Hispanic White (NHW) patients. Few studies have examined whether experience scores differ by cardiovascular disease presence and disaggregated Asian race subgroups. Hypotheses: 1) NHW patients will have the highest healthcare experience scores, followed by multiracial Asian and Pacific Islander (API) patients, and then single race API patients; 2) patients with CVD will have lower scores than patients without CVD; and 3) longer duration in the U.S. will be associated with higher scores. Methods: We examined 5,234 participants, aged 40+ surveyed in two health systems in Hawai'i and California. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey quantified patient experience (range: 5-20). We dichotomized CAHPS to compare patients who scored low (&lt; 18) to high (18+). For immigrants, length of residence determined nativity. Multivariable logistic regression compared the association of race and low CAHPS, adjusting for age, sex, ethnic affiliation strength, education, nativity, and CVD diagnosis. Results: There were no significant differences in CAHPS score by CVD (Table). Chinese and Filipino patients had significantly higher odds of low CAHPS than NHW patients with adjustment for age and sex. These differences were fully attenuated when adjusting for nativity. Compared to U.S.-born people, immigrants who have lived in the U.S. between 0-19 years were more likely to have low CAHPS (OR = 2.13, 95% CI = 1.47, 3.10). Even immigrants who have lived in the U.S. for 20+ years had increased odds of low CAHPS (OR = 1.45, 95% CI = 1.16, 1.81). Conclusion: Although most people have positive provider experiences, differences remain by race. Nativity and duration in the U.S. explained racial variations in CAHPS among API individuals in our study. Research should continue disaggregating racial data by nativity status to improve the quality of care and health outcomes for immigrant populations.
Abstract P481: Diet Significantly Influences the Gastrointestinal Microbial Content in Male Mice Fed a Commercially Available Probiotic Supplement
Authors: Shreya C Singh, Brian Kagel, Jonathan D Westlake, Nathan Lichti, Jeffrey Houghton, Joseph Gigliotti
Journal: Circulation (2024)

The gut microbiome is a growing topic of discussion due to its varying effects on the gut brain barrier, infections, obesity, allergies, and mental health. With a newfound public desire to ameliorate gut health, there has been an increase in probiotic consumption and dietary changes; however more research is needed to understand the mechanisms responsible for the observed phenotypes. In the current study, we set out to determine how different diets and administration of a commercially available probiotic influence the gastrointestinal microbiome in mice. Weanling, male C57Bl/6 mice were purchased and given a week to acclimate to a solid diet and group housing. Mice were then randomly assigned to receive one of three diets ad libitum : chow, the American Institute of Nutrition 93-formulation (AIN93), and our novel Americanized diet (AD). Mice from each diet were then administered a control solution (distilled water) or 30 uL of a commercially available probiotic mixture, orally five days a week for two weeks. After 8-weeks, mice were euthanized and the cecal content was collected and stored in RNAlater solution. Total DNA was isolated from the cecal samples using a commercially available assay, and the presence of microbial species was determined by 16S rRNA sequencing and RT-PCR analysis of Firmicutes, Bifidobacterium, Lactobacillus , and Bacteroides specifically. Data were analyzed using General Linear Models in SPSS with significant difference identified as P&lt;0.05. Diet significantly impacted Bifidobacterium (P=0.015) , Lactobacillus (P=0.001), and Bacteroides (P&lt;0.001) levels, with mice fed the AIN diet having the greatest Bifidobacterium levels but lower Lactobacillus and Bacteroides . Mice fed the AD had the highest Lactobacillus and Bacteroides . Probiotics significantly decreased Bifidobacterium and Firmicutes , with a decrease in Firmicutes being associated with improved physiological phenotypes in other studies. This preliminary study highlights that dietary changes, even within “normal” ranges, significantly influence the gut microbiome. Furthermore, our data supports the claim that commercially available probiotics modulate GI microbial flora and that this effect is modified by the diet consumed. More research is needed to understand the mechanisms underlying this change to maximize its potential benefits and improve gut and overall health.
Abstract P310: Preference for Home Blood Pressure Monitoring versus Ambulatory Blood Pressure Monitoring for Measuring Sleep Blood Pressure: The BetterBP Study
Authors: Chibuike J Alanaeme, Ying Wen, Ligong Chen, Lama Ghazi, Kellen Lenz, Chloe Fang, Bharat Poudel, Maria Cepeda, Michael Lam, Shakia T Hardy, Joseph E Schwartz, Emily B Levitan, Paul Muntner, Daichi Shimbo
Journal: Circulation (2024)

Background: Home blood pressure (BP) monitoring (HBPM) devices have been adapted as an alternative to ambulatory BP monitoring devices (ABPM) for measuring sleep BP. We evaluated participants' preference for using HBPM versus ABPM to monitor sleep BP in the BetterBP study. Methods: Participants in the BetterBP study (N=591) completed one night of HBPM (3 measurements total) and 24 hours of ABPM (measurements every 30 minutes) in random order. After completing both procedures, participants were asked about the side effects experienced, willingness to again perform HBPM for one night versus ABPM for 24 hours to monitor sleep BP, and overall preference for HBPM versus ABPM for monitoring BP. We used McNemar’s test to evaluate differences between devices. Results: Among all 591 participants, the mean age was 39 years old, and 63% were women. Additionally, 49% were non-Hispanic, White; 21% were non-Hispanic, Black; 15% were non-Hispanic, Asian; and 7% were Hispanic. Interference of normal sleeping pattern was less common for HBPM compared with ABPM (46% versus 57%; p&lt;0.001). Overall, 7% and 6% of participants reported removing the HBPM and ABPM device, respectively, due to disturbance while sleeping (p=0.88). Also, 27% of participants reported pain while undergoing HBPM for one night compared to 47% for ABPM (p&lt;0.001); 43% had irritation while undergoing HBPM for one night compared to 68% for ABPM (p&lt;0.001); and 12% had bruising while undergoing HBPM compared to 23% for ABPM (p&lt;0.001). For the willingness to perform one night of HBPM versus ABPM to monitor sleep BP, 80% were very or completely willing to use HBPM compared to 60% who were very or completely willing to use ABPM ( Table , p&lt;0.001). For overall preference, 71% of participants preferred HBPM, 24% preferred ABPM, and 5% did not prefer either HPBM or ABPM. Conclusion: Participants reported fewer side effects and greater tolerability with HBPM than ABPM and preferred one night of HBPM over 24 hours of ABPM to monitor sleep BP.
Abstract P426: County-Level Structural Racism and Diabetes Prevalence Among White and Black US Adults
Authors: Krystal Ramos Barrera, Sarah Krumholz, Lorraine T. Dean, Charlie H Nguyên, Geoff B Dougherty, Alden L Gross, Suzanne Judd, Anika L Hines, Timothy B Plante
Journal: Circulation (2024)

Background: Diabetes Mellitus affects 12.7% non-Hispanic Black adults as opposed to 7% non-Hispanic White Adults. We hypothesized that higher structural racism (SR) is associated with greater diabetes prevalence among Black and White adults. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30,239 US Black and White adults from 48 contiguous US states in 2003-2007. We linked a novel county-level structural racism (CSR) metric reflecting domains of housing dissimilarity, school dissimilarity, high school graduation, incarceration, poverty, primary care access, and ambulatory care access. CSR was determined linked to REGARDS participants’ county location at time of recruitment. Diabetes was defined as fasting blood glucose ≥126 mg/dL or random blood glucose ≥200 mg/dL or use of diabetes medications. We excluded those missing CSR score and diabetes status. Poisson regression estimated relative risk (RR) of prevalent diabetes by higher (more adverse) CSR. Results: Among the 28,329 included participants (mean [SD] age 65 years, [9.43], 55% female participants, 42% Black participants). There was a greater proportion of Black adults in areas with higher CSR. As is shown in Table 1 , higher CSR was associated with higher RR of prevalent diabetes overall. However, higher CSR was associated with lower RR in race stratified models. Conclusions: Adverse levels of CSR were associated with lower diabetes prevalence in Black adults. It is unclear if this observation reflects operationalization of CSR, omitted variable bias, survival bias, or a true structural racism-diabetes association. Table 1 - Relative risk (RR) of Diabetes Prevalence age and sex adjusted per 1-point higher CSR*
Abstract P529: Ideal Cardiovascular Health May Mitigate Age-Related Increases in Subclinical Myocardial Damage in US Adults
Authors: Ebenezer K Aryee, Sui Zhang, Justin B Echouffo, John W McEvoy, Joe Coresh, Robert H Christenson, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2024)

Background: High-sensitivity cardiac troponins (hs-cTn) levels reflect myocardial damage and increase with age. Even minor elevations in hs-cTn are linked to increased cardiovascular risk. Little data exists on how level of cardiovascular health impacts age-related rises in hs-cTn among individuals in the population. Methods: We conducted a cross-sectional analysis of 6,955 adults aged 20 years or older free of self-reported coronary artery disease and heart failure who participated in the 1999-2004 National Health and Nutrition Examination Survey. Hs-cTnT and hs-cTnI were measured from stored samples. Total cardiovascular health was modeled using the AHA’s Life’s Essential 8 metrics (all variables excluding sleep) and categorized as low, moderate, or high. For the distinct participants within each level of cardiovascular health, we compared average levels (geometric means) of hs-cTn across each decade of age. Using multivariable linear regression, we estimated the percent rise in hs-cTn per decade within each cardiovascular health stratum. Results: The mean age was 45 years, with 54% being female and 72% being White adults. There was a stepwise rise in average levels of hs-cTn per decade, however the difference in average hs-cTn in older age vs young adulthood was least for those with high cardiovascular health, and greater for those with lesser cardiovascular health (Figure). In linear regression, those with high cardiovascular health had lesser percent rise in hs-cTnT per decade than those with moderate and low cardiovascular health (13% vs 19% vs 23%, p interaction &lt;0.001). Similar differences per decade between those with high versus moderate and low cardiovascular health were seen for hs-cTnI (17% vs 19% vs 23%, p interaction = 0.04). Conclusion: Level of cardiovascular health may influence the degree of myocardial damage associated with aging. Mitigation of age-related myocardial damage may be one mechanism underlying the cardiovascular benefits of maintaining ideal cardiovascular health.
Abstract P381: Geographic Variation in Financial Strain and Food Insecurity After the COVID-19 Pandemic: Implications for Cardiovascular Health Equity
Authors: Jewel Scott, Ebony Toussaint, Charles Ellis, Gayenell S Magwood
Journal: Circulation (2024)

Reduced food security is associated with higher healthcare expenditures and increased risk of coronary heart disease, angina, heart attacks, and hypertension. State-level responses to the COVID-19 pandemic and support policies may contribute to regional differences in financial strain and food insecurity, which could have implications for cardiovascular outcomes. Hypothesis: We assessed the hypothesis that there is geographic variation in financial strain and food insecurity in the United States three years after the start of the pandemic. Methods: This study utilizes weighted data from the U. S. Census Bureau’s Household Pulse Survey Phase 3.10 conducted from August 23 - September 4, 2023. We organized data responses according to the Department of Health and Human Services regions - Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. Food insecurity was measured using a single survey item about having sufficient food to eat in the last 7 days. Financial strain was defined as difficulty paying expenses in the last seven days. Results: There were 254,966,752 adults in the total sample population, (59%) reported difficulty with expenses due to the COVID-19 pandemic. The Atlanta region reported the most financial strain (13%), while the Denver region reported the least (2%), p-value=0.000. The rate of food insecurity was highest in the Atlanta region at 8% compared with 5% or less in other regions, p-value=0.000. Among the 8 states in the Atlanta region, Black individuals were disproportionately more likely to be food insecure, with the greatest difference for Kentucky, Florida, Tennessee, and South Carolina. All states in the Atlanta region had similar odds of food insecurity, but Mississippi residents were nearly twice as likely to experience food insecurity than residents of other states (OR 1.87, p =0.016). Conclusions: The Atlanta region (i.e., the “Deep South”) consists of the most populous states for non-Hispanic Black people and is experiencing the worst food insecurity and financial strain post-pandemic. The economic toll of the pandemic and post-pandemic inflation may contribute to worsening food insecurity and cardiovascular outcomes in a region that is already burdened by poor cardiovascular health. Multilevel intervention is needed to support full pandemic recovery and avoid exacerbating inequities in cardiovascular disease.