tbuckley/cabot-search huggingface dataset:
Abstract 12706: The Impact of Social Determinants of Health and Lifestyle Factors on the Association of Lipoprotein(a) With Cardiovascular Outcomes in Two US Cohorts
Authors: Eric J Brandt, Matthias Kirch, Chaitanya Chennareddy, Nimai Patel
Journal: Circulation (2023)

Introduction: In European cohorts, a higher Mediterranean diet or Life’s Simple 7 (LS7) score abolished or attenuated the risk associated with increasing Lipoprotein(a) [Lp(a)] on cardiovascular (CV) outcomes. This is unstudied in US cohorts. Further, the impact of social determinants of health (SDOH) on the association of Lp(a) with CV outcomes is unstudied. Hypothesis: We hypothesized that SDOH and LS7 scores would attenuate the association of Lp(a) with CV outcomes in US cohorts. Methods: We used data from the Atherosclerosis Risk in Communities (ARIC) and the Multi-Ethnic Study of Atherosclerosis (MESA) studies. Outcomes were time until first fatal or nonfatal myocardial infarction (MI) or stroke. We performed multivariable cox proportional hazard analyses with covariates of age, gender, race and ethnicity, SDOH score, and LS7 score. We identified five SDOH in ARIC and 11 in MESA. The Lp(a) protein-mass from ARIC was tripled to be similar to the Lp(a) total-mass measurement in MESA. Results: ARIC included 15,072 individuals (median Lp(a) = 17.3 mg/dL (IQR 7.5, 40.6)) with 16.2 years average follow up. MESA included 6,822 individuals (Median Lp(a) = 18.3 (IQR 6.9, 43.8)) with 12.3 year average follow up. In age, gender, and race and ethnicity adjusted analyses Lp(a) was associated with MI in ARIC (HR 1.10, p&lt;0.001) and MESA (HR 1.09, p&lt;0.001). Lp(a) was also associated with stroke in ARIC (HR 1.08, p&lt;0.001) but not MESA (HR 0.97, p=0.50). With SDOH and LS7 added to the model, association of Lp(a) with CV outcomes remained similar in ARIC and MESA. SDOH correlated positively and LS7 correlated negatively with MI and stroke. In MESA there was an interaction between LS7 score and Lp(a) for MI. Conclusions: Lp(a) remained similarly associated with CV outcomes in US cohorts after accounting for social and lifestyle factors, although LS7 score may have a small modifying effect on the association between Lp(a) and MI. SDOH and LS7 are strong predictors for CV outcomes.
Abstract 15214: The Benefits of Wearable Physical Activity Tracking Devices and Wellness Initiatives
Authors: Kristen Davis
Journal: Circulation (2023)

Introduction: The recommended amount of physical activity (PA) for adults is 150 minutes of moderate or 75 minutes of vigorous activity(1). 33% of the adults meet the appropriate amount of weekly PA (2). The health benefits of regular PA include a reduced risk of cardiovascular disease, type 2 diabetes, certain cancers, depression, and early death. The healthcare expenses of physical inactivity are nearly 79 billion annually in the United States. Wearable PA tracking devices can motivate people to be active and improve their overall wellness. Wearable devices like Fitbit, Garmin, and smartwatches can track activity progress and participation in wellness initiatives. Hypothesis: Increasing PA among employees and members within the Health Plan by implementing incentivized challenges that promote PA tracking, provide behavior change techniques, and grow the number of connected wearable devices. Methods: Through our proprietary database, data was collected from the UPMC Health Plan Health Risk Assessment questionnaire showing members (average n=52,165) participating in PA year over year compared to the national average from 2015-2021 and connected devices from 2015-2021. Results: The questionnaire revealed 150+ minutes of aerobic PA percent from year to year for 2015 (35%), 2016 (35%), 2017(37%), 2018 (32%), 2019 (36%), 2020 (38%), and 2021 (33%); all the years were above the national average percent except 2018 by offering accessible physical activity challenges. The number of connected devices increased from 3,729 in 2015 to 15,473 in 2021, which was a 296% increase year over year by providing convenient ways to connect devices. Conclusions: Wearable tracking devices in conjunction with wellness initiatives that incorporate incentives, influence behavior change and increase minutes of PA. Continuing to offer PA wellness programs will support the goals of our evaluation of member behavior and participation. Future directions include enhancing wellness initiatives and wearable devices providing a high-value strategy for sustained PA behavior change.
Abstract 16613: Study of Modified HEART Score and HEART Pathway as Predictor of Major Adverse Cardiac Events (MACE) in Patients Presenting With Non ST Elevation- Acute Coronary Syndrome (NST-ACS)
Authors: Roopali Dahiya
Journal: Circulation (2023)

Introduction: Among the various scores studied in literature, the modified HEART score and HEART pathway were found to have high discriminatory power of predicting major adverse cardiac events (MACE) in Non ST elevation acute coronary syndrome (NSTEACS) patients in various international studies. This warrants need for evaluation of these scores for better management of patients in hectic emergency departments of Indian healthcare system. Methods: This prospective observational study was conducted between January 2021 and May 2022 in a tertiary care hospital of New Delhi, India. Modified HEART score was calculated based on history, ECG, age, risk factors and highly sensitive troponin I (hsTrop I) values for 60 patients. Collected serum samples of hsTrop I at 0 and 3 hours were measured using ELISA kits. As per the score, patients in low risk group were discharged safely and intermediate and high risk groups were assessed with the help of stress testing and coronary angiography and managed accordingly. The occurrence of MACE was assessed at 30 days from presentation to healthcare facility. Results: The study showed that proportion of patients with MACE was significantly higher in high risk group (82.14%) as compared to low (0%) and intermediate risk group (20.83%) (p value &lt;0.001). Modified HEART score was the best predictor of MACE at cut off point of &gt;6 with 88.1% chances of correctly predicting MACE. Negative predictive value of HEART pathway was found to be 100% which enabled safe disposition of low risk group patients. Conclusions: Hence, when modified HEART score and HEART pathway were used together, it allowed efficient use of resources and prediction of MACE in NSTEACS. This was the first study done on Indian population where modified HEART score and HEART pathway were used simultaneously to predict the occurence of MACE.
Abstract 15983: Association of Cardiovascular Health With Nonalcoholic Fatty Liver Disease in American Adults
Authors: Pamela L Alebna, Gowtham Grandhi, Naman Shetty, Abdul Mannan Khan M Minhas, Nicholas Chew, Dave L Dixon, Michael J Blaha, Pankaj Arora, Mohammad Siddiqui, Arun Sanyal, Anurag Mehta
Journal: Circulation (2023)

Introduction: Nonalcoholic fatty liver disease (NAFLD) affects 1 in 3 Americans and is associated with an increased cardiovascular disease (CVD) risk, however the association of cardiovascular health (CVH), quantified by the AHA Life’s Essential 8 (LE8) score, and NAFLD is unclear. Hypothesis: CVH has an inverse association with NAFLD quantified using vibration-controlled transient elastography in a nationally representative sample from the NHANES 2017-2020 cycle. Methods: Individuals aged &lt;20 years, with pregnancy, viral, autoimmune, or alcoholic liver disease were excluded. The mean value of the 8 components (each scored from 0 to 100) was calculated to estimate the LE8 score. Ideal, intermediate, and poor CVH were categorized based on LE8 score of ≥80, 50-79, and &lt;50, respectively. A median controlled attenuation parameter of &gt;288 decibels per meter and median liver stiffness of &gt;8.6 kilopascals were used to define hepatic steatosis and fibrosis, respectively. A survey weighted logistic regression model was used to assess the association of CVH with liver steatosis and fibrosis. Results: The final study population included 8,974 participants, corresponding to a weighted sample of 230,700,687 with a mean age of 47.7 years, SE 0.76 and 51.3% women. The mean LE8 score was 68.4, SE 0.46. 35.6% (95% CI 33.4-37.8) participants had hepatic steatosis and 8.4% (95% CI 6.8-10.0) had hepatic fibrosis. Among those with poor CVH, the proportion of individuals with hepatic fibrosis (22.4% vs. 2.0%) and steatosis (67.4% vs. 11.9%) was higher as compared to those with ideal CVH (Figure). Participants with ideal CVH had 94% lower odds of hepatic steatosis and 86% lower odds of hepatic fibrosis as compared to those with poor CVH. Conclusions: CVH is independently associated with prevalent NAFLD among American adults. LE8 score may be considered an index of metabolic liver health and not just cardiovascular health.
Abstract 16782: Depression and Its Relationship With Uncontrolled Hypertension: A Single Urban Center Experience
Authors: Xiarepati Tieliwaerdi, Richard Amoateng, Aaisha Shah, Muhammad Ibraiz Bilal, Kathryn Manalo, Edmund Appiah-Kubi, Alexandra Johnston, Mrudula Gadani
Journal: Circulation (2023)

Introduction: Depression and hypertension (HTN) contribute to cardiovascular risks with studies showing that depression increases the risk of developing HTN. However, the impact of depression on blood pressure control in patients with HTN remains unclear. The study aimed to investigate the incidence of depression in patients with uncontrolled HTN. Methods: A matched-pair analysis was conducted on 9,046 patients with diagnosis of HTN at a single-center Internal Medicine clinic between 2019 and 2022. Demographic variables, co-morbidities, blood pressure and PHQ 9 scores were recorded. Uncontrolled HTN was defined as BP ≥140/90 mmHg, and PHQ-9 scores ≥ 4 indicated depression. Age- and gender-matched patients with controlled HTN were included for comparison. Results: Among 9,046 patients with HTN, 1,886 (20.4%) had uncontrolled HTN. Patients with uncontrolled HTN were older (57.43 ±17.02 vs 46.68 ± 18.6, p=0.000) and more likely to be black (34.1 % vs 29.1%, p&lt;0.000) compared to those with controlled HTN. In the matched-pair analysis (3,660 patients), no significant difference in incidence of depression was observed in patients between uncontrolled and controlled HTN (389 vs 377, p=0.626). Patients with uncontrolled HTN had a higher prevalence of congestive heart failure (150 vs 113, p=0.018) and chronic kidney disease (211 vs 167, p=0.017). Conclusions: This single-center matched-pair analysis suggest that depression is not associated with inadequate blood pressure control, despite its role in increasing the risk of developing HTN in prior studies. Optimal blood pressure control plays a crucial role in preventing development of co-morbid conditions as seen in our study. A holistic approach to HTN management and factors beyond depression should be considered. Further research is warranted to gain a deeper understanding of the relationship between depression, HTN, and cardiovascular outcomes, enabling more targeted interventions and improved patient care.
Abstract 17913: Meta-Analysis of Atrial Fibrillation in Cardiac Sarcoidosis
Authors: Carlson Sama, Noah Fongwen, Muchi Ditah Chobufo, Yasmin S Hamirani, James Mills, Melissa Roberts, Mark Greathouse, Irfan Zeb, Brian Kazienko, sudarshan balla
Journal: Circulation (2023)

Introduction: Ventricular arrhythmias, including their association with 18 F-fluorodeoxy-glucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) has been extensively studied in patients with cardiac sarcoidosis (CS), whereas atrial involvement and related arrhythmias have not been thoroughly investigated despite evidence of their occurrence. Research Questions/Aims: We herein sought to assess the prevalence, incidence, and characteristics of atrial fibrillation (AF) in patients with CS. We also examined the predictors of atrial arrythmias as well as its association with atrial inflammation as detected by 18 FDG-PET/CT. Methods: PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I 2 statistics whilst Funnel plots and Egger’s test were used to assess for publication bias. Results: From a total of 8 studies comprising 978 patients with CS, a random effects meta-analysis approximated the pooled summary estimates for the prevalence of AF to be 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10% - 23%) from a total of 5 studies. One study estimated the prevalence of permanent AF at 12.5% (95% CI: 3.5%- 28.9%). In 9 studies involving 545 patients with CS, the cumulative pooled incident rate of AF was estimated at 13%, 25%, and 23% at &lt;2years, 2-4years, and &gt;4years of follow-up respectively. Increased left atrial size and atrial 18 F-FDG uptake were identified as strong independent predictors for the development of atrial arrythmias in patients with CS on qualitative synthesis. Conclusions: The burden of AF and related arrythmias in CS patients is considerable, with a heightened risk for adverse outcomes. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for primary prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.
Abstract 15466: Social Determinants of Health Vulnerabilities Among Patients With Substance Use Disorder and Infective Endocarditis
Authors: Hend Mansoor, Jungjun Bae, Nicholas Anthony, Daniel Harris, Chris Delcher
Journal: Circulation (2023)

Introduction: Data indicate that the incidence of infective endocarditis (IE) is rising among patients with substance use disorder (SUD) and is linked with increased mortality. However, the social determinants of health (SDOH) vulnerabilities associated with IE in this population has not been well characterized. Aims: To examine the SDOH associated with IE among patients with SUD. Methods: Using our electronic medical records, we identified patients with concurrent diagnosis of IE and SUD from 2017 until May 2023. Socio-demographics and SDOH including unstable housing (identified using diagnosis codes, residential address test, and natural language processing of clinical notes documenting homelessness and shelter referrals) were identified. A multivariable regression model was conducted to identity independent risk factors associated with IE among patients with SUD. Results: Among 26,918 patients admitted with an SUD encounter, 1,422 (5.3%) had an IE encounter. Patients with IE were younger (37 vs 43 years, P&lt;0.001), mostly white (96% vs 87.7%, P&lt;0.001), Medicaid enrollees (84.2% vs 58.6%, P&lt;0.001), and had less than high school education (10.6% vs 8.1%, P=0.005). They were more likely to reside in rural areas (58.1% vs 44.8%) and have unstable housing (28.6% vs 16.3%). Patients with IE had higher prevalence of smoking (83.5% vs 67.3%) as well as cardiac, dental, mental and other health conditions. Certain socio-demographics and SDOH were independently associated with IE on multivariable regression (Figure). Conclusions: Patients with SUD and IE have distinct socio-demographics and SDOH characteristics. Incorporating these factors into future risk prediction tools could better help identifying SUD patients who are at risk to implement targeted techniques which have been proven to lower the risk of infection.
Abstract 14629: Assessing the Contribution of Racial Differences in Elevated Lipoprotein (a) Levels to Disparities in Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Jelani K Grant, Seth S Martin, Sui Zhang, Kuni Matsushita, Salim S Virani, Roger S Blumenthal, Ron C Hoogeveen, Eric Boerwinkle, Christie M Ballantyne, Josef Coresh, Chiadi E Ndumele
Journal: Circulation (2023)

Introduction: Racial differences in Lp(a) distributions are well known, with higher levels in Black adults compared to White adults. It is unclear whether the risk implications of higher Lp(a) levels are the same in Black and White adults. Furthermore, the contribution of racial differences in Lp(a) to disparities in ASCVD in the US has not been well characterized in long-term cohort studies. Objective: We evaluated the relative risk associations for higher Lp(a) and estimated the related population-attributable fraction (PAF) for ASCVD in Black and White adults. Methods: We performed a prospective analysis of 9,519 Black and White participants at ARIC Visit 4 (1996-1999) without baseline ASCVD. Plasma Lp(a) was measured from stored Visit 4 plasma samples using an apo(a) isoform-insensitive assay (Denka Seiken). Lp(a) was categorized as &lt;30, ≥30 to &lt;50, 50≥ to &lt;100 and ≥100 mg/dL. We assessed the association of higher Lp(a) categories with incident coronary heart disease (CHD) and ASCVD (CHD and ischemic stroke) overall and stratified by race, with tests for interaction. We calculated the PAF for ASCVD and CHD associated with Lp(a) ≥30 mg/dL, overall, and for Black and White adults. Results: The mean age was 63±6 years, with 59% women and 23% Black adults. There was a higher prevalence of Lp(a) &gt; 30 mg/dL among Black than White adults (54 vs 24%). During a follow-up of 24 years, there were 2,235 ASCVD and 1,715 CHD events. Higher Lp(a) categories were associated with progressively higher risk, with Lp(a) ≥100 mg/dL associated with hazard ratios of 1.71 (95% CI 1.38-2.12) for ASCVD and 1.67 (1.30-2.13) for CHD, with no significant differences by race (Table). The PAF associated with elevated Lp(a) was two times higher in Black than White adults for ASCVD (10.7 vs 4.7%) and CHD (10.5 vs 4.3%). Conclusion: Differences in Lp(a) distributions likely contribute to racial disparities in ASCVD. Evolving therapies targeting Lp(a) lowering could assist in addressing disparities in ASCVD.
Abstract 18307: Causal Association Between Gut Microbiota Composition and the Risk of Atrial Fibrillation
Authors: Jingyang Wang, Jiangshan Tan, Yanmin Yang
Journal: Circulation (2023)

Background: Considerable evidence has shown that alterations in gut microbiota composition are associated with atrial fibrillation (AF). However, the causal associations remain largely unresolved. This study aims to reveal the causality between gut microbiota and AF. Method: We incorporated data from the largest genome-wide association studies (GWASs) of gut microbiota composition including a sample of 18,304 individuals and AF compared a total of 60,620 cases and 970,216 controls of European ancestry. A two-sample Mendelian randomization framework was designed to investigate the involvement of gut microbiota in AF. Results: Among all gut microbiota, four microbial taxa, namely Lachnospiraceae FCS020 group (OR: 1.077; 95% CI: 1.011- 1.148; P= 0.021), Rikenellaceae_ RC9_ gut_ group (OR: 1.047; 95% CI: 1.010- 1.086; P= 0.012), Catenibacterium (OR: 1.060; 95% CI: 1.002-1.122; P= 0.043), Victivallis (OR: 1.038; 95% CI: 1.001- 1.077; P= 0.044), and Erysipelatoclostridium (OR: 1.344; 95% CI:1.095-1.649; P= 0.014), were identified to be causally associated with the higher risk of AF. Besides, genetically predicted five microbial taxa, namely Lachnospiraceae NK4A136 group (OR: 0.918; 95% CI: 0.865- 0.973; P= 0.004), Howardella (OR: 0.948; 95% CI: 0.910- 0.989; P= 0.012), Intestinibacter bartlettii (OR: 0.933; 95% CI: 0.879- 0.991; P= 0.024), Alloprevotella (OR: 0.942; 95% CI: 0.896-0.992; P= 0.022), Anaerostipes (OR: 0.922; 95% CI: 0.857-0.992; P= 0.030), Odoribacter (OR: 0.910; 95% CI: 0.831- 0.996; P= 0.041), Ruminococcus (gnavus group) (OR: 0.952; 95% CI: 0.908- 0.999; P= 0.044), and Ruminiclostridium 5 (OR: 0.678; 95% CI: 0.486- 0.947; P= 0.046), can prevent AF. Conclusions: Our study provides evidence of the causal effect of the gut microbiota on AF, highlighting causal microbial taxa. Our results may offer novel insights into gut microbiota-mediated mechanisms and interventions of AF.
Abstract 18940: Can the Religious Observation of Fasting Cause Prinzmetal’s Angina?
Authors: Natasha Qureshi, Kirtivardhan Vashistha, Syed Ali, Yumiko Kanei
Journal: Circulation (2023)

CASE DESCRIPTION: A 73-year-old male with HTN, HLD, CAD/MI status post PCI to the RCA and LAD (2021), and former tobacco use presented with acute, severe, left-sided chest pain with nausea, diaphoresis and dizziness. He started fasting and adjusted his sleep schedule 3 days prior for Ramadan, but did not miss any of his medications including isosorbide and ranolazine. He was chest pain free on arrival, but subsequently developed severe chest pain becoming bradycardic, hypotensive and hypoxic. At that time the EKG (Figure 1) showed ST elevation (STEMI) in leads II, III and aVF with high degree atrioventricular block. He was started on intravenous fluids and a vasopressor but had spontaneous resolution of symptoms within 10 minutes. Emergent coronary angiography revealed stable 70% stenosis of an ostial left circumflex (LCx) artery and non-obstructive CAD of the RCA. Labs revealed normal blood glucose, negative urine toxicology and mild elevation of troponin (trended serially). Echocardiogram was normal with no regional wall motion abnormalities. He was treated as vasospastic angina with addition of a calcium channel blocker without recurrence of his symptoms. DISCUSSION: Vasospastic angina is an important cause of acute coronary syndrome. Our patient had severe vasospastic angina while being treated for CAD for over 10 years. No prior studies have linked fasting to vasospasm. We hypothesize that fasting and a diurnal sleep schedule may contribute to worsened episodes in susceptible individuals due to hormonal changes including glucose shifts and an increase in catecholamines and cortisol. Increased catecholamine levels may induce spasm by stimulation of alpha receptors in the coronary arteries, and cortisol can induce vascular inflammation, potentiating negative effects. We highlight the importance of keeping high clinical suspicion for a diagnosis of vasospasm, as well as the need to further understand the complex pathophysiology to counsel patients in the future.