tbuckley/cabot-search huggingface dataset:
Abstract P170: Cognitive Function at Midlife by Sexual Orientation and Gender Identity in the CARDIA Cohort
Authors: Allegra Kawles, B. R. Slone, Grace V Avila, Molly A Mather, Ankeet Bhatt, James M Shikany, Cora E Lewis, Pamela Schreiner, Farzaneh A Sorond, Kristine Yaffe, Patrick Janulis, Tamar Gefen, Lauren B Beach
Journal: Circulation (2024)

Introduction: Sexual and gender minority (SGM) individuals have higher prevalence of dementia risk factors compared to non-SGM individuals. However, it is not known if differences in cognitive function appear during midlife, as prior studies lack comprehensive measures for sex, sexual orientation, and gender identity (SSOGI) or standardized cognitive assessments. We utilized Coronary Artery Risk Development in Young Adults (CARDIA) study data to assess midlife cognition by SSOGI. Hypothesis: We hypothesize that middle-aged sexual minority (SM) and transgender and non-binary (TGNB) participants demonstrate worse cognitive test scores compared to non-SM and non-TGNB participants, respectively. Methods: A total of 1,978 CARDIA participants completed cognitive assessments at Y25 and self-reported SSOGI measures at Y35. Participants with a history of brain cancer, kidney failure, or stroke prior to Y25 were excluded. Y25 examination included administration of standardized cognitive assessments of verbal memory (Rey Auditory Verbal Learning Test; RAVLT), processing speed (Digit Symbol Substitution Test; DSST), and executive function (Stroop Test). SSOGI variables are listed in Table 1 . Wilcoxon t-tests were used to compare cognitive test scores between analytic subgroups. Results: Mean age of the overall cohort at Y25 was 45 (SD = 3.6) years and 43% identified as Black. TGNB individuals performed significantly worse on a memory recall portion of the RAVLT ( p &lt;0.001) and DSST ( p &lt;0.05) compared to non-TGNB individuals. There was no significant difference in cognitive test scores between SM and non-SM and gay/lesbian and bisexual individuals. See Table 1 for statistical results. Conclusions: Preliminary findings suggest TGNB individuals may demonstrate lower midlife cognitive performance related to verbal memory and processing speed compared to non-TGNB individuals. Future studies will analyze associations of depression and chronic conditions with cognitive scores and expand to later CARDIA time points.
Abstract MP74: Ambient Temperature and Blood Pressure Are Associated in the Jackson Heart Study
Authors: Annabel X Tan, Andrew Y Chang, Daichi Shimbo, Adam P Bress, Mario Sims, Michelle C Odden
Journal: Circulation (2024)

Extreme temperature events related to climate change may impact blood pressure (BP). Communities of color, especially African-American populations, are disproportionately affected by temperature extremes due to structural inequities. We assessed the association between ambient outdoor temperature and BP among participants in the Jackson Heart Study (JHS), a cohort of African American adults residing in the tri-county area of Jackson, Mississippi. We hypothesized that higher outdoor ambient temperatures would be associated with lower BP. The exposure was average outdoor ambient temperature in degrees Fahrenheit, obtained from Daymet Daily Surface Weather dataset for North America accurate to 1km of Jackson, MS. The two outcomes were systolic and diastolic blood pressure (SBP and DBP). A total of 5309 participants were included across 3 visits: Visit 1 (2000-2004), Visit 2 (2005- 2008), Visit 3 (2009-2013). We used a linear mixed effects model to determine the relationship between ambient temperature and SBP/DBP at three visits. Cardiovascular disease, diabetes, BP medication and visit number were included as adjustment variables. Age, sex, socioeconomic status (captured by level of education, income, and occupation), physical activity, history of cardiovascular disease, BP medications and perceived stress were conceptualized as effect modifiers. To account for non-temperature related seasonal variation in BP, we added season specific coefficients to SBP and DBP readings. The average temperature at each visit was 63.8°F (range: 24.5, 85.6), 64.3°F (range: 30.5, 87.8), 66.3°F (range: 21.9, 90.0), respectively. The average age at baseline was 55.3 years and 63% of the study population was female. For every 10 degrees higher temperature in Fahrenheit, SBP was 0.87 mm Hg (standard error: 0.097, p&lt;0.001) and 0.83 mm Hg (standard error: 0.104, p&lt;0.001) lower in unadjusted and adjusted models respectively. DBP was 0.49 mm Hg (standard error: 0.054, p&lt;0.001) and 0.46 mm Hg (SE: 0.058, p&lt;0.001) lower for every 10 degrees Fahrenheit higher temperature, in unadjusted and adjusted models, respectively. We did not find any significant interactions between the effect modifiers listed and ambient temperature. In conclusion, there was an association between higher ambient temperature and lower blood pressure, independent of season. This study is crucial in understanding how ambient temperature affects BP among African American adults. Greater temperature extremes could lead to greater fluctuation in BP levels with uncertain short and long-term health effects.
Abstract P516: Vascular Risk Assessment in Youth With Familial Hypercholesterolemia and Combined Dyslipidemia of Obesity
Authors: Andrew H Tran, Kan N Hor, Omar Khalid, Ami Garg, Elaine M Urbina
Journal: Circulation (2024)

Introduction: Pulse wave analysis (PWA) assesses vascular health by estimating arterial wave reflections noninvasively and is associated with cardiovascular (CV) events in adults in recent studies. However, data in youth are lacking. Individuals with CV risk factors such as familial hypercholesterolemia (FH) or combined dyslipidemia of obesity (CDO) have increased risk of adult-onset CV disease. Using PWA may help improve risk stratification of young patients with adverse CV risk factors and enhance disease management. Hypothesis: We hypothesized that youth with adverse CV risk factors would have differences in arterial wave reflections compared to controls. Methods: Demographic, anthropometric, and fasting lipid values were obtained in 124 patients aged 9-25 years in a study comparing vascular health among normolipidemic controls (N=47), FH (N=45), and CDO (N=32). PWA was obtained using the SphygmoCor XCEL device, and wave separation analyses were performed from brachial artery assessments. Group differences were assessed by chi-square, ANOVA, or Kruskal-Wallis test as appropriate by variable type and distribution normality. Results: There were significant differences between groups in adiposity (CDO with higher BMI, p&lt;0.001) and lipid levels with a more adverse lipid profile (higher TC, LDL, &amp; TG; lower HDL) for the FH and CDO groups versus controls (all p&lt;0.001). The CDO group had higher forward pulse wave amplitude (Pf) versus the control and FH groups (p=0.0002, Figure) and higher backward pulse wave amplitude (Pb) versus controls (p=0.0013). Differences in Pf or Pb between FH and controls did not reach significance. Conclusions: Adolescents and young adults with CDO have altered forward and backward wave reflections compared to normolipidemic controls. It is possible that PWA differences between the FH and control groups may become significant over time. These novel parameters suggest early vascular changes in youth with CDO and may help improve risk stratification in youth with adverse CV risk factors.
Abstract P287: Incorporating Behavioral and Social Determinants of Health Variables Into a Machine Learning Model Predicting Cardiometabolic Disease
Authors: Meg Salvia, Heather Mattie, S. Bryn Austin, Frank B Hu, Josiemer Mattei
Journal: Circulation (2024)

Introduction: Machine learning models hold potential for improved cardiometabolic disease prediction and more efficacious prevention and intervention efforts. Current models are limited by use of cross-sectional datasets and variables (features) consisting of diagnostic criteria (such as blood glucose or hemoglobin A1c in type 2 diabetes models) and overlook health behaviors and social determinants of health (HB-SDH). Hypothesis: Machine learning models built with HB-SDH variables will accurately predict type 2 diabetes. Methods: We used data from 2,493 participants without diabetes in the Adolescent to Adult Health study (mean age = 15.5 years at baseline (1994), 40.9% male) who contributed blood samples and anthropometric measures in wave 4 (2008) or 5 (2016-2018). We used an 80/20 split to form separate training and test datasets; the training dataset was used to build random forest and XGBoost models, and performance with respect to classifying diabetes was evaluated in the test dataset. We first built a model using 15 demographic and biomarker features as a comparator for our second model, which included 34 HB-SDH features measured during adulthood but no biomarkers. Results: Five-hundred sixteen participants developed type 2 diabetes. In XGBoost, the comparator model was found to predict diabetes with 92.6% accuracy (95% CI: 89.8%, 94.8%) and area under the curve (AUC) = 0.8165. The HB-SDH model had 88.7% accuracy (95% CI: 85.4, 91.4%) and AUC = 0.7631. Using random forest, the comparator model had 93.0% accuracy (95% CI: 90.3, 95.2%) and AUC = 0.8376, while the HB-SDH model had 89.8% (95% CI: 88.6, 92.4%) accuracy and AUC = 0.7650. The top 10 variables in ascertaining classifications in the random forest model included self-reported general health, waist circumference, self-reported anxiety diagnosis, self-reported hypertension diagnosis, income, BMI, education level, change in weight, financial scarcity, and experienced stigma, while in the XGBoost model these were self-reported general health, experienced stigma, financial scarcity, self-reported anxiety diagnosis, experienced weight stigma, waist circumference, income, self-reported hypertension diagnosis, sugar-sweetened beverage intake, and BMI. Conclusions: Machine learning models built with behavioral and social determinants of health variables perform comparably to models with biomarkers and identify salient features for diabetes risk. The features that factored into classification performance were similar between random forest and XGBoost models. In this population, HB-SDH of relevance included socioeconomic indicators, sugary beverages, anxiety, and experiencing stigma, in addition to adiposity and hypertension. This finding needs to be replicated in diverse cohorts that may experience different HB-SDH.
Abstract P163: Smoking Timing and Hazard of Incident Heart Failure: A Cohort Study in UK Biobank
Authors: Ying Hu, Xiang Li, Rui Tang, Jian Zhou, Minghao Kou, Xuan Wang, Hao Ma, Yoriko Heianza, Zhaoxia Liang, Lu Qi
Journal: Circulation (2024)

Objective: Smoking is an establish risk factor for heart failure (HF); however, little is known about how the timing patterns of smoking is related to HF risk. We prospectively evaluated the association of smoking timing with hazard of incident HF; and examined whether smoking intensity or smoking burden might modify the relationship. Methods: This study included 308490 participants from the UK Biobank who were free of HF at baseline and completed the questionnaire on the time from waking to the first cigarette. We evaluated the association between smoking timing and hazard of incident HF using Cox proportional hazards models. Results: During a median follow-up time of 12 years, a total of 6917 incident cases of HF were documented. Compared to non-smokers, the multivariate hazard ratios [95% confidence interval (CI)] of incident HF were 1.47 (1.11-1.95) for &gt;2 hours, 1.74 (1.34-2.25) for 1-2 hours, 2.21 (1.83-2.66) for 30-60 minutes, 2.24 (1.82-2.76) for 5-15 minutes, and 2.39 (1.79-2.19) for &lt;5 minutes of the time from waking to the first cigarette, respectively, independent of smoking intensity or smoking burden ( P for trend &lt;0.001). The positive associations between shorter time from waking to the first cigarette and hazard of incident HF were more pronounced in female participants than in male participants ( P -interaction=0.001). We found that even among participants with light smoking intensity, those with the shortest time from waking to the first cigarette had a 178% or a 261% higher risk of HF (HR 2.78, 95% CI 1.92-4.03), comparable to that among people with heavy smoking intensity or heavy smoking burden, respectively. Conclusions: Our findings indicate that shorter time from waking to the first cigarette is significantly associated with a higher hazard of incident HF, independent of smoking intensity or smoking burden.
Abstract P224: Rural Hospital Closures Are Associated With Increased Mortality From Ischemic Heart Disease: A County-Level Analysis
Authors: Meghamsh Kanuparthy, Srikur Kanuparthy, Dwight Harris, Mark Broadwin, Christopher Stone, Frank W Sellke
Journal: Circulation (2024)

Objective: Ischemic heart disease remains the leading cause of death in the United States; yet mortality from heart disease is geographically heterogeneously distributed. From 2011 - 2020, several hospitals across the US have closed. In this study we will investigate the impact of hospital closure on county level disease-specific mortality data. We hypothesize that rural hospital closures will be associated with increased risk of mortality from ischemic heart disease. Methods: The CDC-Wonder database, an online outcomes reporting system was queried for county level, ischemic heart disease specific mortality in Texas - the state with the largest number of hospital closures. Demographic, socioeconomic, and comorbidity information was collated from the County Health Ranking project. Hospital closure data was obtained from the Sheps Center for Health Services Research. Counties were grouped by Health Service Area (HSA) and were considered affected if any county in the HSA was affected by a hospital closure. A difference in difference analysis with unbiased staggered adoption was performed with a multivariate linear model. 4 counties with multiple hospital closures in the time frame were excluded from analysis. Results: Over a 10-years (2011 - 2020) 247,712 deaths were recorded as related to ischemic heart disease in Texas. Difference-in-difference analysis with all counties did not demonstrate a significant treatment effect of hospital closure (ATT = - 0.01, p = 0.71). Restricting comparisons to rural hospitals demonstrated a significant effect of rural hospital closures as compared to other rural counties (ARR = 0.119, p = 0.04). There was so significant effect in comparison of non-rural counties with hospital closures. Conclusions: These results demonstrate the disproportionate impact of hospital closure on rural health outcomes. As compared to patient-level analysis relying on hospital discharge data, this country level analysis captures non-hospital deaths and elucidates the true human cost of hospital closure.
Abstract P292: Lessons Learned From the Implementation of a Peer-to-Peer Cardiology Consultation Program in Federally Qualified Health Centers
Authors: Emily Tolbert, Cassie Walker
Journal: Circulation (2024)

Introduction: Conventional access to specialist care for cardiovascular disease can be expensive, geographically limited, and unavailable to communities that need it most. Health consultations that include cardiovascular considerations can improve life expectancy without extra costs. The Doctors With Heart (DWH) is an initiative from the American Heart Association (AHA) initially developed to decrease gaps in care by using telemedicine as a vehicle for cardiovascular consultations between volunteer cardiologists and primary care providers at Federally Qualified Health Centers (Health Centers). Despite efforts to on-board and train Health Centers on the consultation process and benefits to patient care, consultation utilization remained low. Objective: Identify opportunities to enhance DWH to increase consultation utilization by understanding the need for and barriers to conducting consultations among Health Centers already participating in DWH. Methods: An AHA Program Evaluator and the DWH Program Director co-conducted interviews and focus groups with 31 health care professionals from five Health Centers in the Midwest participating in DWH. Thematic analysis revealed key themes across evaluation objectives. Results: Interviewees had mixed feelings about the need for consultations which was largely driven by the barriers they perceived to conducting them. Many interviewees felt consultations could be an effective way to expedite care for patients who need specialty cardiovascular care. They could also help patients with complex but manageable co-morbidities since the patient can receive cardiovascular care within the primary care setting. However, a few providers felt they already had sufficient access to cardiovascular care for their patients. Interviewees identified three key barriers to conducting consultations: time and administrative burden for providers and staff, providers forgetting the consultations exist, and provider hesitations and concerns. During Health Center on-boarding, DWH should work with Health Centers to integrate consultations into existing clinic workflows, identify a program champion at each site, train multiple clinic staff about the program, and secure buy-in from providers. After Health Center on-boarding, DWH and Health Center program champions should find ways to regularly remind providers about the program and determine whether non-provider staff can help providers identify potential consultation cases. Conclusion: While there was an identified need for cardiology consultations among many Health Centers, more support from DWH and Health Center staff and leadership is needed to establish the program within the clinic setting and ensure on-going consultation utilization. DWH can implement strategies to facilitate consultations during Health Center on-boarding and program implementation.
Abstract P187: Associations of Body Composition, Inflammation, and Lipids: The Multi-Ethnic Study of Atherosclerosis
Authors: Saeid Mirzai, Rishi Rikhi, Parag A Chevli, Mohanad Gabani, Annie Green Howard, Tina E Brinkley, Morgana Mongraw-Chaffin, David M Herrington, Dalane W Kitzman, Matthew A Allison, Michael D Shapiro
Journal: Circulation (2024)

Background: Prior evidence has linked inflammation with myopenic obesity (MO), a high cardiometabolic risk body composition phenotype characterized by low muscle and high fat mass. Inflammation may also alter lipid metabolism. This study aimed to examine the association between MO and lipids and whether inflammation is one potential mediator of their complex relationship. Methods: We conducted a cross-sectional analysis of 1,421 Multi-Ethnic Study of Atherosclerosis participants with abdominal computed tomography body composition, lipid, and inflammatory marker measurements. The ratio of total skeletal muscle area to total adipose tissue area (SM/AT) at L3-4 was used to identify MO (lowest sex-stratified tertiles of &lt;0.52 in men and &lt;0.44 in women). Principal component analysis was used to reduce six inflammatory markers by patterns of covariation. Parallel mediation analysis was conducted to examine whether the inflammatory components mediated the relationship between SM/AT and lipids, acknowledging the limitations of cross-sectional data. Results: The sample’s mean age was 64±10 years, 52.4% were female, and 42.1% were Caucasian. Participants with MO (n=474), compared to those without (n=947), had lower high-density lipoprotein cholesterol (HDL-C; 49±13 vs. 54±16, p&lt;0.001), higher remnant cholesterol (RC; 28±13 vs. 24±13, p&lt;0.001), and similar low-density lipoprotein cholesterol (LDL-C; 110±32 vs. 113±30, p=0.073). All inflammatory markers were higher in MO (p≤0.002). Parallel mediation analysis showed significant direct effects between SM/AT and both HDL-C and RC, which were mediated by component 1 but not component 2. There was no significant direct or indirect effect between SM/AT and LDL-C (Table 1). Conclusion: Participants with MO exhibited elevated levels of inflammation and unfavorable lipid profiles. Two inflammatory components were identified, one of which (IL-6, CRP, fibrinogen, and leptin) partially mediated the relationship of SM/AT with HDL-C and RC.
Abstract P155: Identifying Inpatient and Outpatient Factors That Reduce Heart Failure Exacerbation Readmissions
Authors: Sumeet Aujla, Kutiba Tabbaa, Ziad Affas, Samer Dubaisi, Alan Joseph, Amanda Najor, Erin Onofrey, Ali Hussain, Jelena Arnautovic
Journal: Circulation (2024)

Acute heart failure 30-day readmissions are associated with increased patient morbidity and mortality. Our aim is to identify systemic factors that can reduce heart failure readmissions, including the implementation of a heart failure care coordination team. We assessed the hypothesis that individualized post-discharge education and summary from the heart failure care coordination team will reduce 30-day heart failure readmissions.This retrospective study included 213 patients, 18 years and older admitted with NYHA Class II-IV and ACC/AHA Stage B-D heart failure exacerbations from July 2021- March 2022, at a community hospital. Collected variables included demographics, medical comorbidities, labs, echocardiographic findings, inpatient orders, LACE index score, discharge follow-up, receipt of an after-visit summary, length of stay, and 30-day readmission. Descriptive data was summarized as counts and percentages for categorical data, and mean or median for continuous data. Between-group parametric data means were compared by calculating the t-test for independent variables, or medians using the Mann-Whitney U test for data that were nonparametric. Categorical variables were compared by calculating the chi-square test for association or Fisher’s exact test, as appropriate. The primary study objective was tested using Logistic regression modeling. Throughout this study, a p-value ≤0.05 (two-tail) was considered statistically significant. The medical records of all available reduced treatment plan patients were compared to preserved treatment plan patients in approximately equal numbers. Pair-wise t-tests required the greatest number of subjects. Using the conventional power level of 80%, a two-tailed alpha of 0.05, and assuming a medium effect size, it was estimated that this comparison will require at least 114 subjects. In this study, 189 of 213 patients were reached by the heart failure care coordination team. 49/189 were readmitted in 30 days and 140/189 were not. For the readmission group, the percentage of patients who were CKD Stage 3 or 4 (39.4%, 28 of 71) was higher than those who were not (21.1%, 30 of 142) with a p-value of 0.005. The percentage of patients who had discharge BNP checked (39.1%, 18 of 46) was higher than those who were not (24.1%, 40 of 166) with a p-value of 0.043. A higher LACE index score was associated with readmission as compared to a lower score, with a p-value of &lt; 0.001. In conclusion, presence of CKD stage 3 or 4, discharge BNP, and a higher LACE-index score were associated with 30-day heart failure readmission. Counterintuitively, the heart failure care coordination team did not have an impact on this endpoint, contrary to our hypothesis. Future studies with a larger sample size and focus on the outpatient care team efforts may be helpful in elucidating the team's potential in preventing heart failure readmission.