tbuckley/cabot-search huggingface dataset:
Abstract P285: Relationship Between Body Mass Index, Waist Measurement, Six-Minute Walk Performance and Whole-Body Strength in Adults With Cardiovascular Disease: Findings From the Lifestyle Heart Health Study
Authors: Belinda J Parmenter, Kelly McLeod, Xiaoqi Feng
Journal: Circulation (2024)

Introduction: Cardiovascular disease (CVD) is the leading cause of death, killing 17.9 million people annually worldwide. Key risk factors include physical inactivity, overweight/obesity, high blood pressure, high cholesterol which worsen with age, and smoking and excessive alcohol intake. Six-minute walk (6MW) performance and whole-body muscle strength are both related to cardiovascular mortality and also worsen with age, particularly in the absence of physical activity. The aims of this study were to understand levels of cardiovascular risk and compliance to usual medical treatment (medication, lifestyle modifications) in a high socioeconomic Australian population, and to identify relationships between key risk factors, 6MW and muscle strength. A secondary aim was to help inform development of the Lifestyle Heart Health Education Program. Methods: This was a cross-sectional study of 473 people with CVD in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, whole-body muscle strength and 6MW measurements were assessed. Simple linear and stepwise regressions were used to assess potential relationships. Results: Mean age of the cohort was 66.8±11.6; range 21-94 yrs; 68.5% female; socioeconomic index was deemed high. All participants had CVD, of which 25% were on aspirin. Hypertension was prevalent in 65% (38% on anti-hypertensives); 65% had dyslipidaemia (40% on a statin); 91% had a BMI over 26.0; and 85% of males and 80% of females had a waist measurement over gender-specific heart health recommendations. Less than 3% of the cohort smoked, and less than 10% consumed alcohol at a level deemed high-risk. Almost 20% of the cohort were at risk of CV mortality according to 6MW performance with scores less than 350 metres. Waist measurement, BMI, and blood pressure were the greatest risk factors across the cohort. Muscle strength (r=-0.34; r 2 =0.17; p&lt;0.001) and 6MW performance (r=-0.37; r 2 =0.17; p&lt;0.001) both decreased with age. BMI and age were the most significant predictors of 6MW (r=-0.45; r 2 =0.20; p=0.004) and whole-body strength (r=0.49; r 2 =0.24; p&lt;0.001) in females; waist and age were the most significant predictors of 6MW (r=-0.38; r 2 =0.14; p=0.11) and whole-body strength (r=0.41; r 2 =0.17; p=0.04) in males. Conclusion: Whilst alcohol and smoking campaigns are working to reduce consumption of these harmful substances, low cardiorespiratory and muscular fitness and overweight/obesity remain highly prevalent. Population-level interventions such as the Lifestyle Heart Health Program that aim to reduce weight and waist and improve physical activity, walking ability and muscle strength are urgently needed to reduce cardiovascular risk and mortality.
Abstract P276: De Novo Exposomic Geospatial Assembly of the Stroke Belt With Machine Learning and Network Analysis
Authors: Andrew Deonarine, Ayushi Batwara, Roy Wada, Shoba Nair, Puneet Sharma, Joseph Loscalzo, Bisola Ojikutu, Kathryn Hall
Journal: Circulation (2024)

Introduction: Geographical chronic disease patterns, such as the high stroke rates in the southeast United States that characterize the Stroke Belt, are known to vary with chronic disease rates and changes in the social determinants of health (SDOH). However, the role of regional variations in the exposome (quantified by pollution measures) is less clear. Hypothesis: We investigated the hypothesis that there is a geographical relationship between high-dimensional pollution indicators and stroke, and examined if this relationship could be identified using a novel machine-learning pipeline called aPEER (algorithm for Projection of Exposome and Epidemiological Relationships). Methods: aPEER assembles geographical regions from pollution and chronic disease data at the county and census-tract level using machine-learning, and validates findings with network analysis (Figure 1A). Multiple rounds of aPEER analyses were completed with different pollution datasets to iteratively identify the most important set of pollution measures that best predict the geographical distribution of the Stroke Belt and high stroke mortality regions (Figure 1B). Results: Using aPEER, the pollutants formaldehyde, methanol, acetaldehyde, benzene and carbon tetrachloride predicted high stroke mortality regions including the Stroke Belt with superior accuracy (area under the curve (AUC)=0.8417-0.9931) compared to SDOH (AUC=0.6853-0.8860) and chronic disease (AUC=0.8367-0.9731) indicators. Conclusion: In conclusion, we identified five pollutants associated with stroke geography using a combination of machine-learning methods comprising the aPEER pipeline. These pollutants showed superior predictive power compared to conventional SDOH and chronic disease risk factors, highlighting the potential role of the exposome in stroke pathogenesis.
Abstract P103: Alterations in Sarcopenia Index Are Associated With Inflammation, Gut and Oral Microbiota Among Heart Failure, Left Ventricular Assist Device and Heart Transplant Patients
Authors: Bruno Bohn, Melana Yuzefpolskaya, Annamaria Ladanyi, Alberto Pinsino, Lorenzo Braghieri, Matthew Carey, Kevin Clerkin, Gabriel T Sayer, Farhana Latif, Koji Takeda, Nir Uriel, Renu Nandakumar, Anne-Catrin Uhlemann, Paolo C Colombo, Ryan Demmer
Journal: Circulation (2024)

Introduction: Sarcopenia, characterized by loss of muscle mass and function, is prevalent in heart failure (HF) and associated with poor outcomes. We investigated alterations in sarcopenia index (SI), a surrogate marker of skeletal muscle mass, in HF, left ventricular assist device (LVAD) and heart transplant (HT) and assessed its relationship with inflammation and digestive tract (gut and oral) microbiota. Hypothesis: Sarcopenia will be associated with increased inflammation, dysbiotic microbial signatures, higher HF class, and earlier time post-HT or post LVAD. Methods: We enrolled 460 HF, LVAD and HT patients. Repeated measures pre and post procedures were obtained in a subset of LVAD and HT patients. Sarcopenia index (serum Creatinine/Cystatin C) and inflammatory biomarkers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha) were measured in 271 and 622 blood samples, respectively. Gut and saliva microbiota were assessed via 16S rRNA sequencing among 335 stool and 341 saliva samples. Multivariable regression models were used to assess the relationship between SI and i) New York Heart Association class; ii) pre- vs. post-LVAD or HT; iii) biomarkers of inflammation and microbial diversity. Results: Median (interquartile range) ln-SI was -0.13(-0.32,0.05). Ln-SI decreased across worsening HF class, further declined within the 1-month after LVAD and HT and rebounded over time to the levels of symptomatic HF. Ln-SI demonstrated an inverse correlation with inflammation (r=-0.28, p&lt;0.0001), and a positive correlation with gut (r=0.26, p&lt;0.0001) and oral microbial diversity (r=0.24, p&lt;0.0001). Presence of the gut taxa Roseburia inulinivorans was associated with increased SI. Conclusions: SI levels decreased in symptomatic HF and remained decreased long-term after LVAD and HT. SI levels covaried with inflammation, gut and oral microbiota in a similar fashion.
Abstract P148: Prevalence and Correlates of Overweight and Obesity Among Adults in an Urban HIV Clinic in Uganda
Authors: Redeat L Assefa, Jim Aizire, Sara Nsibirwa, Ponsiano Ocama, Gregory Kirk
Journal: Circulation (2024)

Background: Obesity has become a major comorbidity faced by people living with HIV (PLH). This study aimed to estimate the prevalence and correlates of overweight and obesity among PLH in Uganda. Methods: From June 2016 and February 2020, we conducted a cross-sectional analysis among PLH receiving comprehensive HIV care in a large urban clinic in Kampala, Uganda. We collected data on socio-demographic and behavioral anthropometry, and included variables such as age, marital status, occupation (farmer/other), migration history (rural to urban, urban to rural, consistently rural, consistently urban), contraceptive use history (pills, injections, implants), previous pregnancies (categorized as 0-2, 3-5, ≥6), and socioeconomic status (SES) index variable developed for Ugandan settings. Standardized weight and height assessments were performed with BMI categorization into normal, overweight and obese categories. We performed sex-stratified analysis employing multinomial logistic regression (Stata 18.0) to estimate adjusted relative risk ratios (aRRR) and 95% confidence intervals (CIs) for overweight and obesity compared to under or normal weight., focusing on correlates of overweight in males due to the limited number of obese male participants (n=15). Results: Of 1939 participants aged 18-80 years, 60.2% were female and the median age (IQR) was 43 (35-50) years for females and 47.5 (40-54) years for males. Median body mass index (BMI) was 24.27(21.09-27.99) kg/m2 for females and 21.63 (19.69-24.11) kg/m2 for males. 27.1% and 17.2% were overweight and 16.7% and 2% were obese among females and males, respectively. In adjusted analysis among females, factors positively associated with being overweight were older age (36-50 years: aRRR=1.84; 95% CI:1.26-2.68, &gt;50 years: aRRR=2.16; 95% CI:1.34-2.46), being married (aRRR=2.00; 95% CI:1.46-2.73), middle SES (aRRR=1.47; 95% CI:1.01-2.13), upper SES (aRRR=2.05; 95% CI:1.44-2.90), and rural-to-urban migration (aRRR=1.52; 95% CI:1.05-2.22). Being a farmer was negatively associated with overweight (aRRR=0.42; 95% CI:0.22-0.77). Similar associations were observed with obesity, with ever use of contraception and having had &gt;2pregnancies also significantly associated with increased risk of obesity. For males, being older (36-50 years: aRRR=2.09; 95% CI:1.06-4.11, &gt;50 years: aRRR=2.04; 95% CI:1.01-4.08) and having high SES (aRRR=2.38; 95% CI:1.53-3.70) were positively associated with overweight, while being a farmer was inversely associated (aRRR=0.43; 95% CI:0.20-0.93). Conclusions: High prevalence of overweight and obesity were observed among PLH in Uganda, notably among females. Migration, SES, and reproductive factors were strongly associated with higher BMI. Identified sociodemographic risk factors can guide targeted interventions in this region.
Abstract P365: Systematic Review of Self-Management Interventions for Black Women With Cardiovascular Risk Factors
Authors: Emma Church, Erika Kelley, Taylor Maniglia, Rhea Kohli, Martha Sajatovic, Jennifer B Levin
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) is the leading cause of death among Black women, and when compared to their non-Hispanic White counterparts, they are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review assessed the efficacy of self-management interventions for Black women with CVD risk factors. Hypothesis: Self-management interventions that target more than one health practice, when administered to Black women with CVD risk factors, will decrease CVD risk and improve clinical outcomes. Methods: Searches were run on PubMed, Cochrane, CINAHL, and PsycINFO databases based on the following inclusion criteria: papers written from September 22, 2018; English language; US studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices (individual or group, in-person or remotely delivered, or person-person synchronous); primary prevention; comorbid conditions without a cardiovascular event; at least one patient level outcome (self-reported or biological); Black women at least 18 years of age only. Data extraction included participant demographics; intervention characteristics; self-management/health behavior domains; research design; and study outcomes. Results: Of the 1041 abstracts screened (262 duplicates removed), 87 full-text articles were screened, and 11 papers from 10 unique trials (N= 1,635) were chosen for inclusion. Intervention durations ranged from 5-weeks to 12-months, with a frequency of intervention dose ranging from daily contact to bi-weekly meetings. Of the 10 unique trials, the majority targeted physical activity (n=8), nutrition (n=5), weight loss (n=3), health knowledge (n=2), and BP control (n=2). Interventions were mostly offered in groups (n=9), and some included individual components (n=2). Nine of the eleven papers reported statistically significant improvements in CVD risk factors including weight loss (n=6), physical activity (n=2), BP control (n=2), waist circumference (n=1), and depression (n=1). Few papers (N=1) addressed mental health, and none addressed other social determinants of health. Conclusions: Evidence to date indicates that self-management interventions are not only feasible but also appear to improve CVD risk factors and clinical outcomes in Black women with CVD risk. Future research should assess best practices for the implementation of culturally informed CVD risk prevention programs in underserved populations. Further intervention development should focus on the influence that social determinants of health such as discrimination, stress, and mental health may have on self-management and CVD risk in this population.
Abstract P515: Multimorbidity in Rural Alabama: Rural Heart and Lung Study
Authors: Mayra Tisminetzky, Sara Platz, Matheus Montenario, Ritika Revoori, Paula Anzenberg, Ziyue Wang, Nakesha Agyapong, Apurv Soni, Edwin van den Heuvel, Joseph Tejan, Suzanne E Judd, Ramachandran Vasan, David D McManus
Journal: Circulation (2024)

Background: Multimorbidity, defined as the co-occurrence of two or more chronic conditions, is highly prevalent and associated with adverse clinical outcomes. Yet, there are limited data on the most prevalent chronic conditions and overall multimorbidity in the rural Southern in US. We described the prevalence of chronic conditions, risk factors, and overall burden of multimorbidity by race and sex in participants of the Risk Underlying Rural Areas Longitudinal (RURAL) Study. Methods: Our sample included 942 RURAL study participants from two counties in Alabama. Questionnaires were administered at the mobile examination unit and through a smartphone-based application to collect information on eight chronic conditions and three risk factors at baseline. Differences in the prevalence of chronic conditions by self-reported race and sex were examined. Results: The mean age of the RURAL Study sub-cohort was 49 years, 70% were women, 80% were Black individuals and 46% had a high school education or more. Overall, the most common chronic conditions among Black participants were hypertension, diabetes, and asthma (82%, 29%, and 17%, respectively). Alcohol and marijuana use (78% and 24%, respectively) were the most common risk factors. Similar patterns of chronic conditions and risk factors were found in White people and, in men vs. women. Overall, multimorbidity was present in 47% of the participants, while a higher proportion of Black individuals had multimorbidity (50%) as compared to White people (38%). Furthermore, in regression analyses adjusting for age, Black participants had twice the odds of presenting with multimorbidity as compared to their White counterparts. Conclusions: Multimorbidity was highly prevalent in RURAL Study participants in Alabama, especially in Black individuals. Our findings emphasize the challenge of caring for underserved populations residing in rural areas and highlight the importance of implementing strategies to reduce barriers that impede access to healthcare, especially in the rural Southeast.
Abstract P223: Long Term Impact of COVID19 Pandemic on Estimated Cardiorespiratory Fitness and Physical Activity Level in South American Adults: Results From the Lown Scholars PAFIT Network Online Survey
Authors: Victor ZUNIGA DOURADO, Goodarz Danaei, Rosana Poggio
Journal: Circulation (2024)

Background: While restriction measures helped to control the further transmission of the SARS-cov2 virus, they also produced undesirable repercussions on physical activity level (PAL) and, potentially, cardiorespiratory fitness (CRF). However, the extent to which CRF has returned to pre-pandemic levels in the current time has yet to be consistently evaluated, especially in South America. Objective: We aimed to assess changes in PAL and estimated CRF (eCRF) from before the COVID-19 pandemic until the current time using an online survey with validated questionnaires and identifying the determinants of the observed changes. Methods: We conducted a cross-sectional online survey using Global Physical Activity Questionnaire (GPAQ) to assess physical activity and sedentary time on a convenience sample of 1934 adults (68.7% women) from Argentina (n = 484), Brazil (n = 405), Chile (n = 279), Colombia (n = 343) and Uruguay (n = 423). We asked participants questions regarding their physical activity, body weight, socioeconomic status, education and cardiovascular risk factors before the start of the pandemic (Feb/Mar 2020) and at the time of the survey (Jul-Sep 2022). We calculated the eCRF before the pandemic and at the current time using a Brazilian equation including age, sex, body mass index, arterial hypertension, hyperlipidemia, current smoking, physical inactivity, and diabetes. To adjust for age, we also calculated eCRF using only the current time age. Results: The participants reported a significant increase in the prevalence of self reported hypertension (12.9% to 16.5%), diabetes (6.8% to 9.8%), dyslipidemia (18.9% to 24%), and obesity (15.4% to 18.2%) comparing pre-COVID-19 period to the time of the survey. In contrast, they reported a significant decrease in PAL at work (median 936.5 to 864.6 METs/min/week; p &lt; 0.032) and within active transportation domains (median 502.6 to 460.3 METs/min/week; p &lt; 0.008). No significant changes were reported in leisure time physical activity. The median sedentary time on weekdays increased by 60 minutes (360 to 420; p &lt; 0.001) post pandemic and eCRF was reduced (mean difference, -1.17 mL/min/kg; p &lt; 0.001). When adjusted for age, the differences remained statistically significant. (-0.50; mL/min/kgmL/min/kg; p 0.001). Conclusion: Social restriction policies aimed at controlling pandemics may lead to reduction in physical activity level and cardiorespiratory fitness in the long term.
Abstract P441: Alcohol Consumption and Incident Heart Failure, Ischemic Heart Disease and Atrial Fibrillation Among Current Drinkers: The All of Us Research Program
Authors: Yakubu Bene-Alhasan, Albert D Osei, Samuel Mensah, Ejaz Mishal, Ted Akhiwu, Yvette Yeboah-Kordieh, Luc Djousse, Ken J Mukamal
Journal: Circulation (2024)

Background: The Alcohol Use Disorders Identification Test (AUDIT-C) is a clinically validated assessment tool with components that quantify last-year frequency of alcohol use, quantity consumed per drinking day and frequency of binge drinking. We determined the associations between AUDIT-C scores, their components and risks of heart failure (HF), ischemic heart disease (IHD) and atrial fibrillation (AF). Methods: In the NIH-sponsored ‘All of Us’ Research Program, we followed participants free of HF, IHD and AF who had consumed alcohol in the past year. We created Cox proportional hazards models for incident HF, IHD and AF that simultaneously adjusted for all 3 components of the AUDIT-C, sociodemographic factors, prevalent diseases and smoking status. We also created restricted cubic splines (RCS) regression models to determine the dose-response relationships between AUDIT-C scores and incident HF, IHD and AF. Results: The final sample size was 133,025 adults with a mean age of 50 years. There were 1,411 HF, 3793 IHD and 1072 AF cases over a median follow-up of 45 months. RCS demonstrated a J-shape association between total AUDIT-C scores and HF, an L-shaped association with IHD and a positive but non-significant association with AF. For AUDIT-C components, frequency of intake was associated with incident HF and IHD. Compared to drinking monthly or less, drinking 2-4 times/month, 2-3 times/week and 4 or more times per week were all associated with lower risk of incident IHD. Drinking 2-4 times/month and 2-3 times/week were negatively associated with incident HF. We observed no comparable associations of drinking quantity or binge drinking with risk of HF, IHD or AF. Conclusion: The AUDIT-C provides a quick, straightforward, and informative assessment of alcohol consumption. Among current drinkers, drinking frequency is associated with lower risk of HF and IHD but not AF. Greater quantity consumed per drinking day and episodes of binge drinking are not associated with lower risk of major cardiac diseases and should be discouraged.