tbuckley/cabot-search huggingface dataset:
Abstract P193: Sex Moderates Diet Quality Differences in Integrated Collaborative Care for Comorbid Obesity and Depression: Post-Hoc Analysis of the Research Aimed at Improving Both Mood and Weight Randomized Clinical Trial
Authors: Sydney W Chin, Nan Lv, Zhengxin Tang, Aankika Parikh, Jun Ma
Journal: Circulation (2024)

Background: High-quality diets, such as the Dietary Approaches to Stop Hypertension (DASH), are associated with lower risk for obesity and obesity-related chronic diseases. It is unclear whether diet quality improves aside from reduced calories in evidence-based behavioral weight loss interventions. Objective: Leveraging data from the Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial, the objective of this post hoc analysis is to investigate (1) whether the study intervention was associated with improved diet quality in adults with comorbid obesity and depression, compared to usual care; and (2) whether the associations were modified by sex. Methods: Participants completed 24-hour dietary recalls at baseline, 6, 12, 18, and 24 months. Dietary outcomes included the DASH score as the composite measure of diet quality and its components. Between-group differences in dietary outcomes were examined among 409 participants and by sex, using repeated-measures mixed-effects linear models. Results: Changes in DASH scores did not differ between the intervention and usual care control groups through 24 months in both women and men. Compared with controls, men in the intervention group had significantly decreased nut, seed, and legume intake at 6 (mean difference, -1.1; 95% CI, -1.9, -0.3 servings/day; P=0.01) and 12 months (-1.0; -2.0, -0.0 servings/day; P=0.048). Compared with controls, women in the intervention group had significantly decreased fruit and vegetable intake at 18 (-1.8; -2.9, -0.6 servings/day; P=0.002) and 24 months (-1.1; -2.2, -0.1 servings/day; P=0.03), and whole grain intake at 24 months (-0.5; -0.9, -0.1 servings/day; P=0.03), but increased percent calories from fat at 24 months (3.6; 0.6, 6.5; P=0.02). Conclusions: Diet quality not only did not improve in an effective behavioral weight loss intervention but deteriorated in women, in particular. These post-hoc findings warrant confirmation and may suggest that behavior change techniques targeting diet quality that are tailored to women and men need to be an explicit focus of behavioral weight loss interventions aside from caloric reductions.
Abstract P300: Evaluation of Organizational Behavior in a Rural Cardiology Clinic
Authors: Ghaith Al Tibi, Rakin Islam, Taskin Forkan, Saad Ahmed, Samuel Miller, Nicolas Chronos
Journal: Circulation (2024)

Introduction: In the healthcare industry, organizational behavior plays a pivotal role in patient care and staff well-being. Exploring these dynamics in a rural setting may add the unique factors of community engagement, resource allocation, and staffing limitations. Taking steps to understand how these concepts manifest can improve the effectiveness of healthcare delivery and form positive work environments that benefit both patients and providers. Research Question: How do healthcare staff at a rural cardiology clinic operate in the context of organizational behavior? Goal: The goal is to understand the organizational behavior in a rural clinic to optimize healthcare delivery and tackle operational-related challenges. Methods: Conducted in 2022 during the COVID-19 pandemic, this study employed a mixed-methods approach featuring interviews with staff at the rural Georgia cardiology clinic of Lake Country Medical Group (LCMG) and a five-point Likert scale survey of twenty-three questions developed from qualitative data gathered through the interviews. The survey queried organizational behavior concepts such as job satisfaction, communication, and leadership, with answers being graded on a scale of 1 being “strongly disagree” to 5 being “strongly agree.” Descriptive statistics were used to analyze survey responses. Results: Twenty LCMG staff responded to the survey. Key survey results were analyzed according to organizational behavior categories (Figure 1). Qualitative data from interviews described operational inefficiencies and day-to-day challenges including scheduling issues, billing difficulties, and deficient recordkeeping perpetuated by “siloed” teams at the clinic. Conclusion: LCMG faces some operational challenges that can be ameliorated by organizational behavior approaches. Solutions oriented around enhancing synchronous work, cross-training, and stress-reduction could improve staff well-being and ultimately lead to improved patient care.
Abstract MP15: Developing and Validating VO <sub>2</sub> Prediction From 6-Minute Walk Test (6MWT) and Association With Cardiovascular Health and Risk Scores: Coronary Artery Risk Development in Young Adults (CARDIA)
Authors: Bjoern Hornikel, Erin Dooley, Barrett Bowling, Baojiang Chen, Pablo Martinez-Amezcua, David R Jacobs, Mercedes R Carnethon, Barbara Sternfeld, Cora E Lewis, Stephen Sidney, Priya Palta, Kelley Pettee Gabriel
Journal: Circulation (2024)

Introduction: Cardiorespiratory fitness (CRF) is a valuable diagnostic and prognostic measure. Yet, assessing VO 2 max (indicator of CRF) in population-based studies can be challenging due to requiring sophisticated equipment and trained personnel. Thus, we built and validated a model to estimate VO 2 max from a 6MWT, which is less burdensome for participants (submaximal effort). We tested the hypothesis that our model provides valid estimates of VO 2 max that are associated with cardiovascular health - AHA’s Life’s Simple 7 (LS7) and ASCVD scores. Methods: Data are from 576 CARDIA participants [60% female; 40% Black; mean ± SD age = 61.5 ± 3.6; BMI = 28.6 ± 5.7 kg/m 2 ] who attended the Year 35 follow-up exam (2020-22) and completed VO 2 max and 6MWT tests. The study sample was split randomly into a training (2/3) or test (1/3) set. The prediction equation was developed using stepwise multiple linear regression models in the training set. We evaluated accuracy of the model using student's t-test and Pearson correlation coefficients (r) by examining the difference between the observed and predicted VO 2 max in the test dataset. Linear regression models adjusted for age, and sex were used to examine associations of VO 2 max estimates with cardiovascular health and risk indices. Results: The prediction equation included 6MWT distance, sex, age, BMI, physical activity status, and smoking status (R 2 adj = 0.55, RMSE = 4.84). No significant difference was observed between predicted and measured VO 2 max (26.2 ± 5.4 vs 26.0 ± 7.5 mL/kg/min; p =0.76) and the measures were strongly correlated (r=0.80, p &lt;.001) with Bland-Altman plot is presented (Figure). Predicted VO 2 max explained more variance in LS7 score (R 2 adj = 0.55) compared to measured (R 2 adj = 0.37), while explaining similar variance in ASCVD risk (R 2 adj = 0.40 vs 0.38). Conclusions: This prediction equation provides a convenient and useful estimate of CRF estimate of CRF from 6MWT and may provide utility in clinical practice to screen and monitor CRF when direct measurement is not feasible.
Abstract P298: Cross-Sectional and Longitudinal Associations Between Fast Food Outlet Access and Inflammatory Markers in the US-Based Nurses’ Health Study II
Authors: Noreen Siddiqui, Joline Beulens, Jaime Hart, Jochem Klompmaker, Joreintje Mackenbach, Maria Gabriela Pinho, Eric Rimm, Peter James
Journal: Circulation (2024)

Background: Access to fast food outlets (FFO) has increased in recent years and may decrease diet quality and increase cardiovascular disease risk. Inflammation is a well-established cardiovascular disease risk factor, but it remains unclear whether inflammation is one of the pathways explaining associations between the food environment and inflammatory markers. Methods: We included 6,609 participants from the US-based Nurses’ Health Study II (NHS-II), a prospective cohort of registered female nurses. Counts of FFO were obtained from the Infogroup US Historical Business Data within 1500-meter circular buffers and assigned to participants’ residential addresses from 1998 to 2011. Biomarkers included C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor α receptor 2 (TNFαR2, in a subset), and adiponectin. We evaluated cross-sectional associations between counts of FFO (1998) and inflammatory markers (1999) in linear regression models and evaluated longitudinal associations by the change in counts of FFO between 1998 and 2010 and the change in inflammatory markers between 1999 and 2011 using linear mixed models. Models were adjusted for age, race/ethnicity, partners’ education level, smoking, neighborhood socioeconomic status, and population density. Interaction terms were included to explore effect modification by baseline neighborhood socioeconomic status and population density. Results: Our study comprised women with a mean age of 45.3 (+/- 4.4) years at 1998. A one-unit higher count of FFO within a 1500m buffer was not cross-sectionally associated with CRP (β: 0.004, 95%CI: -0.004, 0.010), IL-6 (β: 0.001, 95%CI: -0.001, 0.004), TNFR2 (β: 0.051, 95%CI: -1.495, 1.597), or adiponectin (β: -6.054, 95%CI: -14.576, 2.468). No associations were found in longitudinal models (CRP (β: 0.000, 95%CI: -0.007, 0.008), IL-6 (β: 0.001, 95%CI: -0.002, 0.003), or adiponectin (β: -1.127, 95%CI: -11.889, 14.3152)). No significant effect modification was found between count of FFO and neighborhood socioeconomic status, or population density (P-for-interaction &gt;0.1). Conclusions: While several previous studies have found an association between frequency of consumption of food at fast food restaurants and biomarkers of cardiovascular risk, at the community level, we did not find associations between the count of FFO and several inflammatory markers in a population of US female nurses.
Abstract P116: Exploring The Cardioprotective Potential Of Roflumilast (pde-4 Inhibitor) Against Experimental Epirubicin-induced Cardiotoxicity.
Authors: Akashdeep Singh, Gurfateh Singh, Ramica Sharma
Journal: Circulation (2024)

Introduction: Cardiotoxicity is an important side effect of the treatment of a malignant tumour with Anthracyclines. The anthracycline family drug epirubicin (EPI) is one of the most potent chemotherapeutic agents for treating a range of solid and hematologic malignant tumours. However, its anti-tumor efficacy is dose-dependent, and the development of cardiac-toxicities limits its clinical use. In various Pharmacological Studies Roflumilast (ROF), a PDE-4 Inhibitor has been shown a Neuroprotective and Cardioprotective response but its role in EPI-induced cardiotoxicity and the underlying mechanisms has never been Evaluated. Hypothesis: The Study hypothesized that Roflumilast exerts cardioprotection against EPI-induced cardiotoxicity through attenuating cardiac mitochondrial dysfunction and inflammatory markers. Methods: Wistar rats of either sex were employed into 4 groups 3 groups comprised 7 animals while the control group had 5 animals, EPI-treated rats were intraperitoneally injected with 10 mg/kg for 1 day, while control rats were on normal diet. EPI+ROF (Low Dose) treated rats were intraperitoneally injected with 10 mg/kg of EPI for 1 day and 1mg/kg of ROF via oral gavage for 7 days. While in the higher dose of EPI+ROF treated rats were intraperitoneally injected with 10 mg/kg of EPI for 1 day and 2mg/kg of ROF via oral gavage for 7 days. The rat hearts were rapidly removed to determine cardiac mitochondrial functions and various cardiac biomarkers. Results: EPI induced significantly excessive mitochondrial Oxidative Stress, increased tissue TBARS and decreased levels of SOD and GSH. Conversely, a 7-day treatment with ROF (1mg/kg/day , p.o .) and ROF (2mg/kg/day, p.o .) significantly reduced TBARS levels while increasing SOD and GSH concentrations. The levels of TNF-α, CK-MB AST, ALT, and LDH were noted to be markedly increased in EPI-induced rats. While treatment with ROF (1mg/kg/day, p.o., 7 days ) and ROF (2mg/kg/day, p.o., 7 days) showed significantly decreased levels of TNF-α, CK-MB AST, ALT, LDH. Conclusion: In the current investigation, it can be concluded that administration of EPI leads to Oxidative Stress, Inflammation and Cardiotoxicity. Treatment with the ROF 2mg/kg showed cardioprotective potential by significantly decreasing inflammatory markers, oxidative stress parameters and cardiotoxic parameters. Our findings suggest that ROF protects the heart from EPI-induced cardiotoxicity, and it may serve as a guide for future cardioprotective research strategies.
Abstract P294: Age-Sex Differences in the Global Burden of Deaths and Disability Due to Cardiovascular Disease Attributable to Environmental Risk Factors and Its Trend From 1990-2019 in G20 Countries: A Benchmarking Analysis
Authors: Hardik Dineshbhai D Desai, Khush Dadhania, Anjani Kumar Thota, Vinay Kumar Gadamidi, Priyatha VEMPARALA, Anusha Parisapogu, Nmair Alziadin, Juhi PATEL, Krupa MADHU
Journal: Circulation (2024)

Background: Cardiovascular Disease (CVDs) is the leading cause of deaths amongst G20 countries accounting for 35.44% deaths in the G20 Countries. The G20 countries, being major economies, have a significant impact on global environmental conditions. Method: Using Global Burden of Disease tool, we estimated the deaths and Disability adjusted life years (DALYs) stratified by age, sex, year, and location due to CVD attributable to environmental risk factors across the G20 Countries from 1990-2019. Results: From 1990-2019, the annual percentage change showed a 37% rise in deaths, rising from 2,608,027-3,571,390. During the same period, DALYs surged by 25%, going from 63,297,319-78,964,495. However, when evaluating the age-standardized rates, both deaths and DALYs displayed a decrease from 1990 to 2019. In 2019, Saudi Arabia recorded the highest ASMR rate at 114 (with a range of 92-137) per 100,000. Bulgaria closely followed with a rate of 113 (87-141). In terms of age-standardized DALYs rates, Saudi Arabia again stood out, registering the highest in 1990 with a value of 2573 ( 2069-3145). Evaluating by age groups, 80-84 year old witnessed the most significant death count in 2019 (527,371). Meanwhile, the age group of 65-69 years saw the highest DALYs count in 2019, (10.4 million). Over the last three decades, males consistently experienced higher counts of both deaths and DALYs compared to females. Conclusion: Environmental risk factors contributed to 26.78% of CVD-related deaths and 29% of DALYs, underscoring the critical role of environment in cardiovascular health outcomes in G20 Countries. it's essential to integrate environmental risk assessments into routine check-ups and tailor treatment plans that address specific environmental exposures linked to CVD. There's an urgent need for policy reforms promoting environmental health, coupled with widespread community education about the environmental determinants of cardiovascular diseases.
Abstract P522: Racial Differences in Sleep Health in Middle-Aged Adults
Authors: Kristen L Knutson, Shaina J Alexandria, Kathryn Reid, Sabra Abbott, Swaty Chapagai, Xuan Cai, Diana Chirinos, S. Justin Thomas, Cora E Lewis, Pamela B Schreiner, Mercedes R Carnethon
Journal: Circulation (2024)

Introduction: Sleep health is comprised of many dimensions, including duration, quality and sleep disorders. Prior work found that Black adults have worse sleep health than White adults, but the underlying reasons are unknown. Our goal was to examine possible determinants of racial disparities in sleep health. We hypothesized that sleep health would be worse in Black participants, and this would be partly explained by clinical, psychosocial and lifestyle risk factors. Methods: We used cross-sectional data from the sleep ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) study. Several objective sleep measures were collected, including 7 days of wrist actigraphy and a home sleep test (Nox T3s). Sleep disordered breathing was classified by oxygen desaturation index (ODI)&gt;=10 or apnea-hypopnea index (AHI) &gt;=15. We used a series of regression models to calculate the percent reduction in the coefficient estimate for race in models for each sleep health metric after adjusting for clinical factors, psychosocial factors or lifestyle factors. Results: There were 565 Black and 741 White adults in this analysis (mean (SD) age 61 (3.6) years). Black adults had significantly worse sleep health based on all measures, including shorter sleep duration, lower sleep percentage, greater sleep fragmentation and higher prevalence of sleep disordered breathing compared to White adults. Clinical factors, psychosocial factors and lifestyle factors all explained a proportion of the racial differences in sleep fragmentation and sleep percentage and explained away the racial differences in sleep disordered breathing (Table). Conclusions: Racial disparities in sleep health may be partly explained by clinical factors, such as blood pressure and BMI, psychosocial factors, such as education and depression, and lifestyle factors, such as smoking, alcohol intake, and physical activity. These findings provide several potential intervention targets to improve sleep health, particularly in Black adults.
Abstract MP45: Beyond Pregnancy: Meta-Analysis of Lifestyle Intervention for Prevention of Diabetes Mellitus in Women With Prior Gestational Diabetes Mellitus
Authors: Saher Taj Shiza, Zahoor Ahmed, Kenneth Ong
Journal: Circulation (2024)

Introduction: Among parous women,1 in 3 have a pregnancy complication, increasing chances of developing Diabetes Mellitus(DM), Hypertension, or heart disease. Lifestyle intervention is recommended to reduce cardiovascular morbidity risk after complicated pregnancies. The effect of lifestyle intervention on the risk of type 2 DM in women with prior Gestational DM (GDM) is not widely studied. Our study highlights the impact of lifestyle intervention on risk of type 2 DM in women with prior GDM. Methods: We ran a systemic literature search of PubMed, EMBASE, Clinical Trials.gov, and Google Scholar from January 2000 to August 2023 for relevant articles comparing lifestyle intervention (diet and physical activity) with standard care in women with prior GDM. The relative risk (RR) of DM with 95% confidence interval (CI) and p-values were extracted with fixed effect model using RevMan v.5.4. Results: Of 3100 articles that were screened, 28 underwent full-text review, and 11 studies met the inclusion criteria. Of 11 studies, 1661 were evaluated in intervention group (IG) and 1671 in control group (CG). The mean age of participants was 26.1-39 years, with a baseline body mass index (BMI) range (R) of 23.4-31.4 kg/m2 and a follow-up duration with R of 4-36 months. On analysis, the incidence of type 2 DM was 7.6% in IG compared to CG (10.35%). IG showed a 27% reduction in DM incidence as compared to CG, RR of 0.73(CI: 0.59-0.91) (p &lt; 0.05) (Figure 1). On meta-regression analysis, duration of lifestyle intervention (R: 4-36 months) significantly impacted the observed reduction in incident type 2 DM (p &lt; 0.05) (positive relation) as compared to baseline BMI (p = 0.21) (Figure 1). Conclusion: Our analysis highlights that lifestyle intervention in women with prior GDM positively reduces risk of type 2 DM, and intervention duration significantly impacts the long-term risk of DM and cardiovascular diseases. Further data is warranted from larger studies for stronger evidence regarding the benefits of lifestyle intervention in prior GDM patients
Abstract P413: Epigenetic Age Acceleration Measures Predict Cardiovascular Outcomes in Diabetic Kidney Disease
Authors: Avi Aronov, Yang Pan, Xiao Sun, Katalin Susztak, James Lash, Tanika N Kelly
Journal: Circulation (2024)

Introduction: Cardiovascular disease (CVD) remains the leading cause of mortality in the US, highlighting the need for novel approaches to its prediction, prevention, and management. Epigenetic age acceleration (EAA), or increased DNA methylation-based age relative to chronological age, is a promising biomarker of disease risk. While previous studies have prospectively linked EAA to CVD, recent work in patients with end-stage kidney disease showed no association between EAA and mortality from CVD, underscoring a need for more research across patient populations. Hypothesis: EAA measures, specifically intrinsic epigenetic age acceleration (IEAA), extrinsic epigenetic age acceleration (EEAA), phenotypic epigenetic age acceleration (PhenoAA), and Grim epigenetic age acceleration (GrimAA), are associated with incident CVD in diabetic kidney disease (DKD). Methods: In a subset of 496 participants from the Chronic Renal Insufficiency Cohort with DKD, selected based on kidney function decline over follow-up (large versus small), we examined four EAA measures: IEAA, EEAA, PhenoAA, and GrimAA. GrimAA is comprised of eight DNA methylation-based biomarkers, including plasminogen activator inhibitor-1 age acceleration (PAI-1 AA ) and tissue inhibitor of matrix metalloproteinase (TIMP-1 AA ), which were also assessed. Primary outcomes were incident CVD, atherosclerotic CVD, and CVD mortality; secondary outcomes included myocardial infarction, congestive heart failure (CHF), cerebrovascular accident, and peripheral artery disease (PAD). Cox proportional models tested associations between the EAA measures and CVD endpoints after adjusting for baseline demographics, clinical center, kidney function decline as a study design feature, lifestyle, and clinical risk factors. Results: Participants were predominantly male (63%), with a median age of 57 years, median eGFR of 44 mL/min/1.73m 2 , and mean hemoglobin A1c of 8.0%. After adjusting for multiple testing, each standard deviation increase in GrimAA was associated with incident CVD (HR=1.27; 95% confidence interval [CI], 1.08-1.50; p=0.012) and PAD (HR=1.65; 95% CI, 1.15-2.37; p=0.006). Likewise, PAI-1 AA was significantly associated with incident CVD (HR=1.24; 95% CI, 1.06-1.44; p=0.006) and PAD (HR=1.46; 95% CI, 1.17-1.81; p=0.001), while TIMP-1 AA was associated with CHF (HR=1.32; 95% CI, 1.09-1.60; p=0.005). Nominally significant associations between IEAA and atherosclerotic CVD were also identified (HR=1.24; 95% CI, 1.00-1.53; p=0.049). Similarly, EEAA was nominally associated with incident CVD (HR 1.22; 95% CI, 1.01-1.47, p=0.039). Conclusion: EAA measures, notably GrimAA, are promising CVD biomarkers in DKD patients. Associations of GrimAA components PAI-1 AA and TIMP-1 AA with incident CVD add to the accumulating evidence of their predictive and therapeutic potential.