tbuckley/cabot-search huggingface dataset:
Abstract P2061: Depressive Symptoms and Food Security in the Addressing Blood Pressure Control through Dietary Approaches (ABCD) Study in Jamaica: A cross-sectional study
Authors: Nadia Bennett, Vivien Wambugu, Trevor Ferguson, Deron Galusha, Marshall Tulloch-Reid, Mayur Desai, Marlene Brewster, Colette Cunningham-Myrie, Carol Oladele, Cavel Lawrence
Journal: Circulation (2025)

Introduction: Globally approximately 280 million people have depression which accounts for 7.5% YLD and is the single largest contributor to non-fatal health loss. Persons with limited or uncertain access to adequate food (food insecurity-FI) are at increased risk of CVD including hypertension making it a critical public health issue. In some populations it has been suggested that FI might be a stronger predictor of depressive symptoms than some of the traditional CVD risk factors. However, the nature of this association is unclear. The aim was to evaluate the prevalence of depressive symptoms and the association between depressive symptoms and food insecurity among persons with hypertension in Jamaica. Hypothesis: Depressive symptoms are directly related to food insecurity. Methods: Cross-sectional study of patients with hypertension attending 2 clinics (1 primary care, 1 specialist hypertension) recruited by sequential sampling. An interviewer administered questionnaire collected socio-demographic (age, sex, marital status, education, employment and comorbidities), depression and food security information. Depressive symptoms were scored using the Patient Health Questionnaire-2 (PHQ-2) based on 2 questions and scored on a scale of 0-6. Questions asked whether, in the last two weeks, participants had a) little pleasure in doing things or b) feeling down or depressed. A score of ≥3 suggested major depressive disorder is likely. A modified 9 item questionnaire based on The Latin America and Caribbean Food Security Scale (ELSCA) classified FI into mild, moderate and severe. Logistic regression was used to assess the association between depressive symptoms and food security. Results: Data of 247 hypertensive participants 29% male with a mean [SD] age of 65.3 ± 12.2 years were analysed. The prevalence of depressive symptoms was 10.2% (n=26) increased with age (p =0.002) and among those with mild 5.8%, moderate 15.7%, and severe 19.4% of food insecurity, but was not statistically significant. In final model adjusted for age and sex the odds of depressive symptoms were not significantly associated with food insecurity. Conclusion: One in ten patients with hypertension in these clinics screen positive for depression using the PHQ2 questionnaire. While depressive symptoms were higher among persons with higher levels of food insecurity the association was not statistically significant. These associations should be further explored in larger studies.
Abstract P2079: The prevalence and LDL cholesterol levels of familial hypercholesterolemia in an African ancestry cohort.
Authors: Matthew Oetjens, Alexandra Winters, Alexander Berry, Melissa Kelly, Dylan Cawley, Sam Gidding
Journal: Circulation (2025)

Background: Familial hypercholesterolemia (FH) is an inherited disorder characterized by lifelong elevated low density lipoprotein cholesterol (LDL-C). Recently, a large systematic review estimated the prevalence of FH to be 1 in 311 individuals. This estimate was largely derived from populations of European ancestry among high income nations. There is a lack of data on FH from large regions in the world and few studies exist on individuals of African ancestry. To address this gap, we examined the prevalence and phenotype of FH among over 70,000 individuals of African ancestry. We hypothesized that the prevalence and phenotype of FH is the same between African and European ancestry groups. Methods: All of Us and Geisinger’s MyCode are US-based healthcare cohorts with linked genomic sequence data and electronic health record data on over 450,000 participants. Genetic variants were collected from canonical FH genes: LDLR , APOB , and PCSK9 . Variants meeting criteria provided by the ClinGen Variant Curation Expert Panel FH guidelines were classified as pathogenic/likely pathogenic (P/LP) or variants of unknown significance (VUS). Participants were assigned into one of four ancestry groups (AFR, ASN, EUR and unclassified) using Rye. Results: We identified 211 individuals in the AFR group with a P/LP variant and 203 with a VUS. Among EUR individuals, 1,435 had a P/LP variant and 762 had a VUS. The prevalence of a P/LP variant was significantly lower in the AFR group (1 in 342) compared to the EUR group (1 in 273) (p=0.003); however, the prevalence of VUS variants was significantly higher with 1 in 356 in the AFR group compared to 1 in 515 in the EUR group (p=2.8 x10 -6 ). The AFR group was more likely to have a P/LP variant in LDLR compared to the EUR group. In All of Us, AFR individuals with a P/LP variant had pretreatment LDL-C levels of 223.0 mg/dL, versus 122.8 mg/dL without a variant. In MyCode, levels were 242.7 mg/dL with a variant and 125.6 mg/dL without. Notably, pretreatment LDL-C was significantly higher in AFR individuals with a P/LP variant (35.8 mg/dL, p=0.001) compared to EUR individuals. Conclusions: The prevalence of P/LP FH variants is lower in AFR than in EUR individuals, but the LDL-C phenotype is more severe, likely due to a higher prevalence of LDLR variants. VUS variants are more common in AFR, possibly reflecting a lack of clinical data in genetic databases. These findings highlight the need for more diversity in FH studies.
Abstract P3166: Fatherhood is associated with biological aging among men in the Coronary Artery Risk Development in Young Adults (CARDIA) study
Authors: John James Parker, Abigail Gauen, Yinan Zheng, Brian Joyce, Craig Garfield, Clarissa Simon, Michael Bancks, Jamal Rana, Kelley Gabriel, Lifang Hou, Donald Lloyd-Jones, Norrina Allen
Journal: Circulation (2025)

Introduction: Fatherhood is associated with deteriorations in health behaviors, but fatherhood’s influence on biological aging is unknown. Objective: Test the associations between fatherhood and epigenetic aging. Methods: We included men from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort study which enrolled Black and White individuals aged 18 to 30 years at baseline (1985-86). Biological aging was measured by two DNA methylation-based cellular aging estimators, GrimAge2 and DunedinPACE, which have been shown to be associated with multiple age-related health outcomes and were calculated at CARDIA exam year 15 (Y15), 20, 25, and 30. Generalized estimating equations (GEE) assessed difference in GrimAge2 acceleration (GAA) and DunedinPACE between (a) fathers vs nonfathers and (b) age at fatherhood onset (father’s age at the birth of their oldest child). Models were adjusted for (1) sociodemographic characteristics (Y15 age, race, marital status, education, field center) and subsequentially for (2) sociodemographic characteristics plus cardiovascular health (CVH) metric scores as measured by the AHA’s Life’s Essential 8 (diet, physical activity, sleep, smoking, body-mass index, blood glucose, blood lipids and blood pressure) at Y15. Results: In this sample of 1098 men, mean age at Y15 was 40.4 (SD=3.5) years, 799 (72.8%) were current fathers and 449 (40.9%) self-identified as Black. Fathers had a faster rate of GAA compared to nonfathers in both sociodemographic ( b =1.07 years; 95% CI= 0.55, 1.59) and sociodemographic-CVH adjusted GEE models ( b= 0.69; 95% CI= 0.24, 1.14) (Figure 1). Among fathers, becoming a father at age &lt;25 was associated with faster GAA ( b =1.39 years; 95% CI= 0.88, 1.89) compared with men who became fathers age ≥30, but this association was attenuated after adjusting for CVH metrics (Figure 1). Men who became fathers age &lt;25 had higher DunedinPACE levels in sociodemographic ( b =0.029 years per chronologic year; 95% CI=0.017, 0.041) and CVH adjusted models ( b =0.015; 95% CI=0.002, 0.027), than men who became fathers at age ≥30. Conclusion: Fathers have faster biological aging than nonfathers, especially men who father their first child at a young age (&lt;25 years). These associations are attenuated after adjustment for modifiable CVH behaviors and factors. Understanding the relationship between CVH, fatherhood, and biological aging may provide opportunities to improve men’s health.
Abstract P3062: Active Screening in Black, Hispanic/LatinX, Asian/Pacific Islander, and Native American Individuals Reduces Racial Disparities in Abdominal Aortic Aneurysm Diagnosis
Authors: Grace Miner, Usha Govindarajulu, Christopher Smolock, Peter Faries, Michael Marin
Journal: Circulation (2025)

Introduction: Abdominal aortic aneurysm (AAA) screening and diagnosis in Black, Hispanic/LatinX, Asian/Pacific Islander and Native American people is challenging given the asymptomatic clinical presentation necessitating access to and utilization of the healthcare system. While previous studies report higher AAA risk in patients who identify as White, institutionalized racism and mistrust of the healthcare system limits representation of non-White individuals biasing AAA risk assessments. Large scale analysis of diverse patient cohorts is essential to understand the true incidence of AAA. Objective: To evaluate the impact of race on diagnosis rates for AAA in a diverse patient population. Methods: Patients over the age of 65 seen at the Mount Sinai Healthcare System were retrospectively reviewed from 2002 to 2024 to assess diagnosis rates in patients eligible for screening by U.S. Preventative Services Task Force (USPSTF) guidelines and those with aortic ultrasound screening. Multivariate logistic regression with interaction factors between patient reported race/ethnicity, screening eligibility, and aortic ultrasound (US) screening were included to assess the impact of US screening and race on AAA diagnosis. Results: A total of 1,070,367 patients were evaluated during the study period of which 54.6% self-identified as female, 11.4% Black, 42.9% White, 10.4% Hispanic/LatinX, 4.6% Asian, 0.08% Native American, 0.54 Pacific Islander, and 9.5% as Other Race. The diagnosis rate in men over 65 who smoked was slightly higher than the diagnosis rate for individuals who did not meet USPSTF guidelines (OR=3.087, 97.5% CI = 0.8-10.36, p=.075). Overall, after adjusting for race/ethnicity, eligibility, and US screening, diagnosis was significantly impacted by race (p&lt;.05), screening (p=0.001), and the interaction effect between race and US screening (p=.008). Contrary to the results of previously studies, the significance of race and screening on diagnosis was driven by ~20% higher odds of a positive AAA diagnosis from screening Black or Hispanic/LatinX patients compared to White patients. Conclusion: AAA incidence in people who identify as Black, Hispanic/LatinX, Asian/Pacific Islanders, and Native Americans is likely much higher than previously reported. With the historic barriers to healthcare access and under representation, active AAA screening programs in these communities could drastically increase diagnosis rates leading to decreased mortality due to ruptured AAA.
Abstract P1094: Patient-Specific Barriers to Establishing Outpatient Heart Failure Care Following Hospitalization
Authors: Megan Nordberg, Sarah Bowman, Stephen Clarkson, Jessica Williams, Andrea Cherrington
Journal: Circulation (2025)

Background: Heart failure (HF) is a complex chronic disease that requires long-term outpatient care. Patients with a high burden of adverse social determinants of health have fewer opportunities for this care. When these patients attend an inter-professional HF clinic specifically designed to care for underserved patients they experience fewer hospital readmissions, however, about 30% of patients will be unable to present to clinic. Methods: Through qualitative interviews guided by the Health Belief Model, we sought to identify patient-specific barriers to successful linkage in outpatient care. We asked patients to describe perceived seriousness of HF, importance of their involvement in their care, barriers to attending appointments, and ways to mitigate barriers. Results: We interviewed 10 patients newly referred to the UAB HF clinic during an inpatient HF hospitalization at UAB Hospital. Participants were 53 years old, white, male, and residing in Jefferson County, AL ( Table ). Patients viewed HF as a serious condition due to the necessity of heart function. They valued information received from doctors, but most emphasized the importance of their involvement in their care, stressing patient responsibility to implement the doctor’s guidance. Barriers to attending appointments were transportation and monetary concerns. Patients reported that rides to and from their appointments would be helpful in addressing their reported barriers. Patients noted the importance of a welcoming environment while hospitalized to encourage appointment attendance following hospital discharge. Conclusion: Patients with HF perceive HF as serious and recognize the importance of their involvement in their care. Inadequate transportation and monetary concerns were reasons they might not attend outpatient appointments, highlighting potential barriers to be addressed. In addition to rides, experiencing a welcoming environment while hospitalized would most help them to attend appointments post-discharge.
Abstract P3163: Social Determinants of Health Among Rural Underserved Patients with Uncontrolled Hypertension
Authors: Javier Jurado Velez, Navneet Baidwan, Tapan Mehta
Journal: Circulation (2025)

Introduction: Hypertension remains one of the most prevalent chronic conditions in the United States, with significant racial and ethnic disparities. Similar disparities are also seen among individuals with lower socioeconomic status and individuals living in rural versus urban locations. Understanding how specific social determinants of health contribute to these gaps could address the growing burden of hypertension among high-risk populations. Hypothesis: To investigate specific social determinants of health associated with uncontrolled hypertension among rural, underserved patients residing in Alabama. Methods: A retrospective review of EHR data of patients from the UAB Selma Family Medicine clinic was conducted. The de-identified data was then entered into the Population Health Assessment Engine (PHATE) to render social characteristics and Community Vital Sign (CVS) scores, a social deprivation index, by census tracts for each patient. We provide descriptive statistics and compare the stated factors between patients with controlled and uncontrolled hypertension using logistic regression models. Results: Among 2129 patients, 375 (17.6%) had uncontrolled hypertension with a mean age of 58.7 ± 14.4 years. Women represented 66.7% (250) and 65.1% (1142) of the uncontrolled and controlled hypertension populations, respectively. The prevalence of uncontrolled hypertension was 19.1% among Black patients and 8.2% in White patients. Patients with uncontrolled hypertension had a CVS of 82.37 ± 7.31 and 81.81 ± 8.40 patients with controlled hypertension. Patients with uncontrolled hypertension lived in areas where an average of 46 ± 11% of the population was not employed, 36 ± 9% lived in rental housing, and 28 ± 1% lived below the federal poverty line (FPL). Adjusting for age, race, and sex, a unit increase in the proportion of people below the FPL was associated with 43% higher odds of uncontrolled versus controlled hypertension (OR = 1.43, 95% CI 0.44, 4.64). A unit increase in the percentage of single-parent households was associated with 78% higher odds (OR = 1.78, 95% CI 0.44, 7.22), but a unit increase in the percentage of people without a high school diploma was associated with 29% lower odds of uncontrolled versus controlled hypertension (OR = 0.71, 95% CI 0.08, 6.68). Conclusions: Rural, underserved patients with hypertension experience multiple adverse social determinants that may be important to address when caring for this population.
Abstract P2060: A pilot study of an intervention for self-management of blood pressure among refugees fleeing war and resettled in the United States
Authors: Rawnaq Behnam, Job Godino, Deisy Celis, Cheryl Anderson, Tala Al-Rousan
Journal: Circulation (2025)

Introduction: Blood Pressure (BP) self-monitoring and medication self-titration can effectively mitigate disparities in hypertension control across populations. Refugees have a higher risk of uncontrolled hypertension, cardiovascular diseases (CVD) and other CVD risk factors. BP self-monitoring and medication self-titration have not been tested in refugees. Methods: We conducted a pilot intervention to assess the feasibility and preliminary efficacy of BP self-management through remote self-monitoring and hypothetical medication self-titration among Middle Eastern and North African (MENA) refugees in San Diego, California. Participants measured their BP at home three times per day, three days per week for four weeks. Data were collected via electronic surveys and electronic health records at baseline and after 4 weeks. We performed Chi-square tests and used Atlas.ti for qualitative thematic analyses. Results: Of 107 enrollees, 23 Syrians and 86 Iraqis, 53 (49%) were female. The mean age was 62 years (SD=9.8), and 66 (61%) had an annual household income of &lt;$15,000. The average stay in the US was 9.7 years (SD=5.8), and 37 (35%) were able to read and write in English. The pilot intervention was successfully completed by 102 enrollees. At baseline, mean systolic blood pressure SBP was 128 mmHg (SD=16) and 36 individuals (34%) had uncontrolled BP (i.e., SBP ≥ 140 mm Hg). During the intervention, 91% of participants utilized the BP monitor &gt;1 time/week, with week 1 having the highest utilization rate (97%) and week 4 having the lowest utilization rate (84%). For the index capturing intervention usability, functionality, and acceptability, participants scores averaged 80.7 (SD=15.8) showing a significant intervention preference. Lastly, (14%) of participants self-titrated BP medication based on SBP readings during the intervention, and (22%) correctly answered the hypothetical medication-titration question indicating the ability to follow the hypothetical medication-titration protocol. Qualitative analyses indicated a preference for provider-instructed medication titration, family support, and hypertension education to assist self-titration decisions. Conclusions: A large proportion of MENA refugees live in poverty and have uncontrolled BP. Self-monitoring is feasible, but medication self-titration remains a barrier in MENA refugees residing in San Diego. Results open doors for refugee-focused CVD health education efforts focused on medication self-titration.
Abstract P3044: Co-occurring immigrant-related sanctuary policies in U.S. and receipt of antidiabetic prescriptions
Authors: Danielle Crookes, Salome Goglichidze, Tarik Benmarhnia, Jennifer Lucas, Miguel Marino, John Heintzman
Journal: Circulation (2025)

The sociopolitical environment can affect healthcare seeking patterns for immigrants. Local-level sanctuary policies, which limit local law enforcement’s involvement with federal immigration law, may facilitate care by reducing exposure to policing, but their effects on immigrants’ healthcare seeking are understudied. For people with diabetes, receiving glucose-lowering medications is a necessary part of care. In prior work, we have not observed associations between antidiabetic prescription rates and a continuous index or high/low classification of county-level sanctuary policy environments. Questions about individual policy effects remain, but sanctuary policies rarely occur in isolation. Thus, we identified plausible groupings of sanctuary policies based on their typology or co-occurrence. We advance this work by examining associations between three policy groupings and receipt of antidiabetic prescriptions. We used the Immigrant Legal Resource Center’s data on seven county-level sanctuary policies in existence in 2017 and linked this with electronic health record data (using patient addresses) for non-pregnant immigrant and non-immigrant adults (18+ years old), diagnosed with diabetes and seen at OCHIN community health centers across the U.S. Exposures were three groups of sanctuary policies: Group (G)1) declines 287(g) and detention contracts and holds other sanctuary policies vs. only declines 287(g)/contracts; G2) 2-policy group of highly correlated policies vs. neither policy; and G3) 4-policy group of moderately correlated co-occuring policies vs. none of those policies. Using multilevel logistic regression, adjusted for individual- and county-level confounders, we quantified associations between policy groups and patients’ receipt of at least one antidiabetic prescription during the study period (2017-2019). Interaction with nativity status was examined. In a sample of 21,151 patients, we observed a moderate effect of the 4-policy group on receiving antidiabetic prescriptions (OR G3 : 1.32 (95%CI: 1.00-1.74)), but did not observe effects of the other groups (OR G1 : 1.02 (95%CI: 0.80-1.31); OR G2 : 1.13 (0.90-1.42)). No interaction between policies and nativity status was observed. Our findings suggest that some combinations of sanctuary policies are more impactful on receipt of antidiabetic prescriptions than others. Future work will examine the effect of these policies on other CVD-related outcomes.
Abstract P2091: Relations Between Plasma and Digitally-Obtained Neuropsychological Biomarkers: Data from the Disparities and Equity in Childhood Cardiovascular Exposures and Alzheimer’s Dementia (DECADE) Study
Authors: Ileana De Anda-Duran, Jessica Woo, Elaine Urbina, Lydia Bazzano, Owen Carmichael, Achala Vagal, Ganesh Baliga, David Libon
Journal: Circulation (2025)

Background: Plasma proteins associated with Alzheimer’s disease (AD) include β-amyloid-42 (Aβ 42 ), phosphorylated -tau at threonine-181 (p-tau 181 ), and neurofilament light chain (NfL). This study assessed the relationship between these biomarkers and digital neuropsychological test performance. Methods: Middle-aged participants in the DECADE study had blood drawn and completed the Rowan Digital Cancellation Test (RDCT) consisting of 64 targets embedded among foils. Within 90 seconds, participants circled as many targets as possible, alternating between letters and symbols. RDCT outcomes included correct targets; ‘think’ time between correct targets; ‘ink’ time to circle correct targets; total pen strokes; commission errors; and total pen stroke distance and were summarized using factor analysis. Their association with AD biomarkers was done using linear regression. Results: The first 77 participants (age=55.3±8.7; 81.6% female) were included, with serum Aβ 42 (mean±SD: 7.8 + 2.7 pg/ml), p-Tau 181 (17.2 + 11.1 pg/ml), and NfL (10.5 + 13.8 pg/ml) assessed. Factor analysis identified 2 factors (Table). Higher scores on Factor 1 (49.2% variance) correspond to fewer correct responses, more think time, commission errors, and pen strokes. Higher scores on Factor 2 (27.9% variance) correspond to more correct responses, fewer commission errors, ink time, and pen strokes. Adjusting for age, sex, education, and both RDCT factor scores, NfL was negatively associated with Factor 2 (R 2 = 0.176, β= -0.445[JW1] , SE=2.57; p&lt; 0.01 ) suggesting worse RDCT test performance with increasing biomarker level. In contrast, Aβ42 was positively associated with Factor 1 (R 2 =0.268, β= 0.503, SE= p&lt; 0.003. Analyses involving p-Tau 181 were not significant. Conclusion: In this community-dwelling, middle-aged sample, plasma levels of AD-related proteins are associated with digital measures of neurocognitive performance. Middle-age assessment of serum AD-related proteins and digital neuropsychological performance have the potential to help identify emergent neurodegenerative illness.