tbuckley/cabot-search huggingface dataset:
Abstract MP18: Association of Sleep Duration with Cardiac Structure and Function in African Caribbeans: a preliminary report from the Tobago Heart Study
Authors: Adrianna Acevedo-Fontanez, Rain Katz, CLIFFORD THOMAS, Deepak Gupta, Ravinder Mallugari, Victor Wheeler, Sanjay Patel, Iva Miljkovic, Allison Kuipers
Journal: Circulation (2025)

Emerging evidence suggests a potential relationship between sleep and cardiac abnormalities, even in the absence of apnea. Therefore, we aimed to test the association of sleep duration and cardiac structure and function as assessed by echocardiography in African Caribbeans aged 50-80 years from the Tobago Heart Study (THS). Between 2021-2024, participants without history of heart failure underwent clinical examinations, 4 to 7-day actigraphy-based sleep assessment, and transthoracic echocardiography (preliminary analysis of 401 participants with all measures). Echocardiograms were analyzed by a central core lab with measures including left ventricular ejection fraction (EF), diastolic function, and left ventricular hypertrophy (LVH), among other indices. Statistical analyses tested the association of 24-hour sleep duration or nighttime sleep (between 8PM-8AM) with echocardiographic parameters adjusted for age, sex, BMI, systolic blood pressure, diabetes, smoking, snoring frequency, and heart rate using linear or logistic regression, as appropriate. The cohort was middle-aged (mean 60 years), predominantly female (89%), hypertensive (73%), and obese (median BMI 31 kg/m 2 ). Mean 24-hr sleep duration was 5.8 hours (range=2-9 hours, median=5.5 hours), with a mean nighttime sleep duration of 5.5 hours. In adjusted models, longer nighttime sleep duration was not associated with echocardiography indices. However, when limited to just individuals who slept at least 5 hours at night, a 1-hour greater nighttime sleep duration was associated with ~5% lower left atrial volume index and ~5% lower pulmonary vascular resistance (P=0.01 for both). In contrast, nighttime sleep duration was not associated with left ventricular EF (b = -0.03 (-0.73 to 0.67), P=0.93). Results were similar when testing 24-hour sleep duration. Overall, among African Caribbean adults who sleep more than 5 hours per night, greater sleep duration may be associated with less risk of atrial fibrillation or pulmonary hypertension. This may be particularly relevant given that the African Caribbean population is at high risk for both hypertensive-related cardiac abnormalities and short sleep duration.
Abstract P2059: Clinical Engagement Trajectories and Patient Factors Associated with Optimal Blood Pressure Management Patterns among Patients with Incident Diagnosis of Hypertension
Authors: Kristen Azar, Lucia Pacca, Mark Pletcher, Stephen Shiboski, Alice Pressman, Maria Glymour, Zijun Shen, Anusha Vable
Journal: Circulation (2025)

Introduction: The established paradigm of “awareness (i.e. diagnosis), treatment and control” as a central strategy to achieve blood pressure control is well accepted as the optimal approach to hypertension (HTN) management, but few studies have explored real-world patterns of healthcare engagement, treatment and blood pressure control within the first two years of diagnosis of HTN, and how they may differ for different sociodemographic patient groups. Methods: We analyzed electronic health records from a large integrated healthcare system in Northern California to characterize trajectories of clinical engagement, blood pressure treatment and control after incident HTN diagnosis. The cohort included 40,469 primary care patients between 2012-2019, with incident HTN. Each month for 24 months after diagnosis, patients were assigned to one of 8 mutually exclusive states for HTN treatment with medications (Y/N), blood pressure control (Y/N), and visit status (up to date Y/N). We applied sequence and cluster analysis to identify common types of BP management trajectories. Using multinomial logistic regression, we estimated associations between patients’ race and ethnicity and these trajectories. We hypothesized that more optimal engagement trajectories are less common among non-Hispanic Black (NHB) individuals, given well documented disparities in BP control among this patient subgroup. Results: We observed 20,564 distinct care management trajectories among individuals that were classified into four clusters representing “Control without medications” (36.4%), “Control with medications” (16.7%), “Medications without control” (10.7%), and “Minimal engagement” (36.2%). The first two of these were classified as optimal care management (OCM), representing 52.6% of individuals. By 24 months only 50% of patients were up to date with their visits, and more than one-third of patients (36.2%) exhibited virtually no follow-up visit after the initial index visit. Comparing OCM with medication to the minimal engagement, those who self-identify as NHB had significantly lower odds (OR [95%CI] 0.75 [0.6, 0.9]) of belonging to the OCM cluster compared to non-Hispanic white (NHW) counterparts. Conclusion: Patients who self-identify as NHB experienced lower odds of OCM compared to NHW. Future studies are needed to identify predictors of clinical engagement trajectories resulting in lack of clinical engagement post-diagnosis, and interventions to encourage better engagement.
Abstract P2135: Nicorandil improves health status outcomes in patients with angina pectoris: a prospective, multicenter, cohort study (GREAT)
Authors: Yong Zeng, xiliang zhao, Xin Du, Yaodong Ding, Changsheng Ma
Journal: Circulation (2025)

Background: Coronary artery disease (CAD) is a major contributor to cardiovascular mortality, with angina pectoris affecting nearly half of CAD patients. The GREAT study aims to establish a large cohort of Chinese patients with angina pectoris, evaluating the effectiveness of anti-anginal treatments through the Seattle Angina Questionnaire (SAQ). Methods: This multicenter, prospective cohort study included 1556 adult CAD patients with angina pectoris receiving or eligible for oral anti-anginal therapy. Patients were observed over 12 months. All participants were registered on an ePRO system via a WeChat Mini program, allowing them to submit questionnaires and clinic visit data. The primary outcome was the 12-month change in the SAQ summary score (SAQ-SS) from baseline. Secondary outcomes included changes in SAQ-SS at 3, 6, and 9 months. Patients were categorized into two groups: those treated with nicorandil (nicorandil group) and those not receiving it (non-nicorandil group). Propensity score matching (PSM) was used to reduce bias and control for confounding factors. Results: A total of 1528 patients were analyzed (FAS), of which 529 (34.6%) were in the nicorandil group and 999 (65.4%) in the non-nicorandil group. Following PSM, 450 matched pairs were identified. Baseline characteristics were well-balanced. The median age was 60 years in the nicorandil group and 61 years in the non-nicorandil group, and most patients were male (74.2% and 73.3%, respectively). β-blockers were widely used (68.7% and 70.2%, respectively). Both groups showed improvements in mean SAQ-SS across all follow-up points, but the nicorandil group had significantly greater improvements (P&lt;0.05). At 12 months, the nicorandil group had a mean SAQ-SS improvement of 17.6 points, compared to 15.1 points in the non-nicorandil group (P=0.003). Furthermore, nicorandil users had significantly greater improvements in the SAQ quality-of-life (18.9 vs 16.3; P=0.042) and physical limitation (11.7 vs 8.4; P=0.001) domains (Table 1). In terms of clinical benefit, a higher proportion of patients in the nicorandil group experienced large or very large improvements in SAQ-SS at 12 months (24.0% vs 20.7% for 20–29 points; 18.2% vs 12.0% for ≥30 points; P=0.005) (Table 2). Conclusion: This real-world evidence demonstrates that nicorandil-based regimens lead to superior health status improvements in patients with angina pectoris compared to non-nicorandil treatments.
Abstract P1125: Targeted Health Coaching Intervention to Improve Physical Activity and Physical Function Post-Structured Cardiac Rehabilitation Programming Among Older Adults: A Pilot Study
Authors: Katherine Collins-Bennett, Julie Counts, Johanna Johnson, Katie Kennedy, Agustin Saldana, Kim Huffman, William Kraus
Journal: Circulation (2025)

Introduction: Attending cardiac rehabilitation (CR) improves fitness and quality of life and decreases the risk of future death from heart disease. Unfortunately, once an individual finishes a CR program, continued participation in physical activity (PA) too often reverts to previous sedentary patterns and is even more prevalent among older adults. Thus, this pilot study tested the feasibility of a health coaching intervention to improve PA and physical function after CR among older adults. Hypothesis: Compared to education alone, we hypothesized that health coaching would maintain or improve PA participation and physical function 3 months after CR completion. Methods: A total of 13 older adults who graduated from CR were randomized to either an education or health coaching group for 3 months. The education group received one 30-minute education session within the first month of randomization. The health coaching group received 6 health coaching sessions across the 3-month study duration. Both groups received a Garmin wrist-worn device and step goal ranging from 5,000-8,000 steps per day based on baseline step count. The Senior Fitness Test assessed physical function at baseline and 3 months. Paired t -tests were used to test within-group differences in mean change of outcomes and independent t -tests were used to test between-group differences in mean change of outcomes. Results: Participants were on average 70.8 + 7.0 years old, white (84.6%), and female (61.5%). Average step count adherence was 110.4% + 26.8% and 102.7% + 18.1% for the health coaching and education groups, respectively. Regardless of group, participants significantly improved their waist circumference (-3.3 + 4.4 cm; p = 0.019), chair stands (2.0 + 2.4; p = 0.015), arm curls (2.0 + 2.0; p = 0.005), and 2-minute steps (4.8 + 7.3; p = 0.043). Participants increased their average daily step count by 1194 + 1641 and 545 + 1762 in the health coaching and education groups, respectively. There were no significant between-group differences in this small sample. Conclusions: This pilot study demonstrates utilizing health coaching and education to maintain or increase PA and physical function 3 months after CR is feasible. Future studies should employ a similar approach among a larger sample size to determine the relative efficacy and effectiveness of health coaching and education on PA and physical function after CR amongst older adult populations.
Abstract MP30: Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Dietary Industrial Trans-fatty Acids in China
Authors: Liping Huang, Leopold Aminde, Kathy Trieu, Zeng Ge, Liz Drummond, Laura Cobb, Jason Wu, J. Lennert Veerman, Matti Marklund
Journal: Circulation (2025)

Objectives: To estimate the potential health benefits, costs, and cost-effectiveness of mandating a limit on industrial trans-fatty acids (iTFA) in all foods, fats, and oils in China. Methods: A multiple cohort proportional multistate life table model was used to project the impact of eliminating dietary iTFA on ischemic heart disease (IHD) burden and costs over different time horizons (5 years, 10 years, and population lifetime). Nationally representative data on iTFA intake were derived from the 2015-2018 China Total Diet Study and China National Health and Nutrition Survey 2011. The health benefits were modelled as averted IHD deaths, events, and health-adjusted life years (HALYs) gained. Net costs were estimated by combining healthcare costs and policy implementation costs, which included government monitoring and industry reformulation costs. Cost-effectiveness was assessed through incremental cost-effectiveness ratios, with both costs and HALYs discounted at 3%. Results: Over 10 years, the mandatory iTFA limit was estimated to prevent approximately 111K IHD deaths (95% uncertainty interval [UI]: 101K-120K), 744K IHD events (95% UI: 678K-807K), 330K HALYs (95% UI: 301K-357K), resulting in a healthcare cost saving of around 2.8 billion USD (95% UI: 2.5-3.0). Over the population lifetime, the intervention was projected to avert 1.9 million (95% UI: 1.7-2.0) IHD deaths, 3.4 million (95% UI: 3.0-3.7) IHD events, and 5.9 million (95% UI: 5.4-6.4) HALYs, saving approximately 5.1 billion USD (95% UI: 4.6-5.7) Policy implementation costs were estimated at 165 million USD (95% UI: 132-198) over the first 10 years and 295 million USD (95% UI: 261-329) over the population lifetime ( Figures 1-2 ). The intervention was estimated to be cost-saving regardless of the time horizon, with robust findings across sensitivity analyses. Conclusions These findings suggest that legislating a mandatory limit on iTFAs could be a cost-saving strategy to prevent a substantial number of IHD events and deaths in China.
Abstract P2001: Sex Differences in Cardiovascular Health Among Syrian Refugees at Zaatari Camp: A Cross-Sectional Study Using the AHA Life's Essential 8
Authors: Abeer Alharthi, Bunmi Ogungbe, Tala Al-Rousan, Cheryl Dennison Himmelfarb, Yvonne Commodore-Mensah
Journal: Circulation (2025)

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally. The Syrian refugee crisis has exacerbated CVD risk due to socioeconomic, biological, and environmental factors. This study aims to assess cardiovascular health (CVH) using the American Heart Association's Life's Essential 8 (LE8) metric among Syrian refugees residing in the Zaatari Camp in Jordan. Methods: A cross-sectional study was conducted at the King Salman Humanitarian Aid and Relief Primary Health Center within the Zaatari refugee camp. Participants included adult Syrian refugees evaluated for their CVH through the LE8 metrics: diet, physical activity, nicotine exposure, sleep health, body weight, blood glucose, blood pressure, and lipid levels. Data was collected in January 2024 using point-of-care testing devices and structured questionnaires. Descriptive and chi-square analyses were used. The total CVH score was derived by averaging eight health metrics, resulting in a composite score from 0 to 100. Scores of 80+ indicate high CVH, 50-79 indicate moderate CVH, and &lt;50 indicate low CVH. Results: Syrian refugee (N=218) participants included males (50.6%) with a mean age of 48 years (+13.5). Most had a high school education or below (68.3%) and a high unemployment rate (68.2%). Almost 46% of individuals earned a household income of $51 - $150 monthly. More than 50% had low diet diversity, 61.8% were classified as hypertensive, and 49% were obese. Sex-stratified analysis showed that males had higher scores in BMI (24.7%) and physical activity (70.3%) compared to females (p&lt;0.0001, p=0.034, respectively). Females had higher scores in sleep (55.4%) and nicotine exposure (84.1%) compared to males (p=0.001, p&lt;0.0001, respectively). The total LE8 score for the participants was 60.6 (±15.8). Conclusion: Although the refugees demonstrated a moderate level of CVH, these findings suggest that without intervention, their CVH is likely to worsen due to high rates of hypertension, obesity, and poor dietary habits. Furthermore, implementing health assessment tools in refugee camps can aid clinicians in the early identification and management of CVD risk factors.
Abstract P3001: Associations of Biomarkers with Epicardial Adipose Tissue Volume and Density in Cardiovascular Risk Assessment: Insights from the PROMISE Trial
Authors: Perisa Ashar, Ibrahim Hadzic, Lydia Kwee, Marcel Langenbach, Pamela Douglas, Svati Shah, Borek Foldyna
Journal: Circulation (2025)

Introduction: Epicardial adipose tissue (EAT) has emerged as a potential biomarker due to its relationship with cardiovascular (CV) events. This study leverages data from the PROMISE trial to investigate relationships between EAT characteristics and biomarkers related to metabolic and CV health. Hypothesis: We hypothesize that specific biomarkers are significantly associated with CTA-derived EAT volume (EATv) indexed by body surface area (EATv/BSA) and EAT density (EATd), even after adjusting for clinical variables. Methods: We analyzed 1,544 individuals (mean age: 60.3 + 8.1 years; 52.9% female) with both CTA and blood samples. Biomarkers included alanine transaminase, beta-2 microglobulin, creatinine, cystatin C, galectin-3, high-sensitivity troponin I, glucose, homocysteine, lipoprotein(a), insulin, NT-proBNP, and uric acid. Univariate models assessed the direct relationship between each biomarker and EATv/BSA and EATd. False Discovery Rate (FDR) correction was applied. Significantly associated biomarkers were tested in multivariate models adjusted for age, sex, race, diabetes, hypertension, statin use, and smoking status. For EATv/BSA, models both with and without BMI were considered, due to EATv’s strong association with BMI. For EATd, the multivariate model adjusted for BMI and EATv. Results: Cystatin C, homocysteine, and uric acid were positively associated with EATv/BSA with statistical significance in both univariate and multivariate models (Table 1). Lipoprotein(a) was significant in both the univariate model and multivariate model excluding BMI, but not in the multivariate model including BMI. Cystatin C and uric acid were negatively associated with EATd, with statistical significance in both univariate and multivariate models (Table 2). Conclusions: This study identifies cystatin C and uric acid as significant biomarkers associated with both EATv and EATd in individuals with suspected CAD. The relationship between EAT and these biomarkers may reflect underlying metabolic disturbances, with obesity potentially contributing to higher excretion of cystatin C and elevated uric acid levels. Understanding these associations can enhance cardiovascular risk prediction models, leading to more targeted and effective interventions.
Abstract 065: Lower Acute Healthcare Utilization Associated with Virtual Cardiometabolic Health Programs
Authors: Susan Devaraj, Jenna Napoleone, Madison Noble, Christina Parrinello, Carolyn Jasik, Sarah Linke
Journal: Circulation (2025)

Background: Type 2 diabetes and hypertension are common and costly conditions that increase risk for hospitalization. Lifestyle-focused virtual health programs may offer an effective and accessible self-management solution for these conditions and reduce future high-cost acute care encounters. The purpose of this study was to evaluate the differences in inpatient and emergency room (ER) healthcare utilization between patients enrolled in a virtual health program (VH) for cardiometabolic lifestyle management vs. usual care (UC) controls at 6 and 12 months. Methods: We conducted a real-world, retrospective secondary analysis of healthcare claims incurred between July 2019 and May 2023 from multiple payers. Inclusion criteria included continuous coverage for ≥6 months pre- and post-index, an age range of 18-64 years, and having commercial insurance. Index date was defined as the program enrollment date for VH patients or an outpatient claim with a type 2 diabetes and/or hypertension diagnosis code for UC patients. VH patients were enrolled in Omada for Diabetes (DM; n=317), Hypertension (HTN; n=1,102), or Diabetes&amp;Hypertension (DM+HTN; n=315) program and 1:3 propensity score matched (demographics, clinical characteristics and pre-index costs) to UC controls (n=951, n=3,306, and n=945, respectively). Mean differences in post-index inpatient, ER, and acute (inpatient+ER) encounter counts were compared at 6 and 12 months using t-tests. Results: After matching, the VH and UC groups had no statistically significant differences in pre-index characteristics. VH patients across all programs had fewer inpatient, ER, and acute encounters at 6 and 12 months vs. UC (absolute mean difference range -0.01 to -0.33, relative difference range: -5% to -63%). Specifically, DM VH patients had 63% lower inpatient utilization at 12 months, 46% lower ER utilization at 6 months, and 54% and 52% lower acute utilization at both 6 and 12 months vs. UC (all p&lt;.05). HTN VH patients experienced significant reductions at both 6 and 12 months for ER and acute utilization vs. UC (ER: -56%, -43%; Acute: -51%, -40%; all p&lt;.05). Finally, DM+HTN patients had 43% lower ER utilization at 6 months vs. UC (p=.04). Conclusions: Using a lifestyle-focused virtual health program to support cardiometabolic disease management may lead to meaningful reductions in high-cost acute care encounters, indicating the value of using virtual solutions as an effective and accessible approach to between-visit care.
Abstract P1159: Aortic Arch Calcification Improves Cardiovascular Event Risk Stratification Among Individuals With a History of Cigarette Smoke Exposure
Authors: Robert Trujillo, Salman Ansari, Matthew Budoff, Robyn McClelland, Spencer Hansen, Moyses Szklo
Journal: Circulation (2025)

Cigarette smoking and aortic arch calcification (AAC) are powerful risk factors for incident cardiovascular disease (CVD), but their relationship is yet to be thoroughly investigated. We used data from the Multi-Ethnic Study of Atherosclerosis to examine the development and progression of AAC, and the extent to which AAC can risk stratify for CVD, among individuals with a history of smoking. Our study sample consisted of 2846 men and women in the US aged 53 to 93 years old who were scored for AAC at two exams roughly 5 years apart. We hypothesized that cigarette smoke exposure would be significantly associated with AAC at initial exam, with AAC progression between exams, and that AAC would improve risk prediction accuracy for CVD among smokers. We used linear mixed-effects models to assess AAC development and progression, proportional hazards models to investigate the relationship between AAC and incident CVD among smokers, and the area under the time-dependent receiver-operator characteristic curve (AUC) to characterize model prediction accuracy. All models were adjusted for demographic and cardiovascular risk factors. Relative to participants who never smoked, being a former or current smoker was significantly associated with higher AAC at initial exam (P=0.001), but not AAC progression between exams. Among current or former smokers, a one-unit increase of log-transformed AAC was associated with a 20.6% increased risk of CVD (P&lt;0.001), and a 13.0% increased risk of all-cause mortality (P=0.01). The inclusion of AAC as a risk factor among smokers improved the 8-year AUC for CVD events from 0.731 to 0.778. In conclusion, AAC is a measure of atherosclerotic burden that can improve risk stratification for CVD in smokers.