tbuckley/cabot-search huggingface dataset:
Abstract MP36: Evaluation of Race and Ethnicity and Pharmacy Dispensing of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists in Patients With Type 2 Diabetes
Authors: Luis A Rodriguez, Holly Finertie, Romain S Neugebauer, Bennett Gosiker, Tainayah W Thomas, Andy J Karter, Lisa K Gilliam, Caryn Oshiro, Jaejin An, Gregg Simonson, Andrea E Cassidy-Bushrow, Sarah K Dombrowski, Margaret B Nolan, Patrick J O'connor, Julie Schmittdiel
Journal: Circulation (2024)

Objectives: To evaluate pharmacy dispensing of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) among patients with type 2 diabetes (T2D) over time and by race and ethnicity. Methods: This was a retrospective cohort study of patients (≥18 years) with T2D using 2014-2022 electronic health record data from 6 large US care delivery systems. Cohort entry was at earliest pharmacy dispensing of any T2D medication. We used logistic regression to evaluate the association between pharmacy dispensing of SGLT2i and GLP1-RA and race and ethnicity, adjusting for cardiovascular risk factors, clinical and demographic characteristics at baseline. Results: Our cohort included 681,823 patients (median [IQR] age 60 [51,69]; 46.4% female; 16.6% Asian, 10.5% Black or African American, 1.4% Hawaiian or Pacific Islander (HPI), 31% Hispanic, 3.8% Multi-racial or Other/Unknown, 0.3% American Indian or Alaska Native (AI/AN), and 36.4% White). Patients were followed for a median [IQR] of 6 years [3,9]. The age, sex, and site adjusted rate of annual pharmacy dispensing of SGLT2i increased from 0.1% to 12.2% between 2014 and 2022 (Figure 1A) and increased from 0.3% to 3.8% for GLP1-RA (Figure 1B). In the fully adjusted models, SGLT2i dispensing was lower for AI/AN (OR 0.80, 95% CI 0.67-0.93), Black or African American (OR 0.89, 0.86-0.92) and Hispanic (OR 0.87, 0.85-0.89) compared to White adults. GLP1-RA dispensing was lower for AI/AN (OR 0.79, 0.63-0.97), Asian (OR 0.50, 0.48-0.52), Black or African American (OR 0.86, 0.83-0.90), HPI (OR 0.51, 0.46-0.57), Hispanic (OR 0.69, 0.66-0.71), and Multi-racial or Other/Unknown (OR 0.78, 0.73-0.83) compared to White adults. Conclusions: Pharmacy dispensing of SGLT2i, and GLP1-RA medications was lower in patients with T2D from minority groups compared to White adults in 6 US large care delivery systems. This suggests the need for equitable interventions to narrow the race and ethnicity gap in the use of these drugs for cardiovascular outcomes in the US.
Abstract P303: Investigating the Relationship Between Cardiovascular Diseases and Major Depressive Disorder Among Asians and Pacific Islanders
Authors: Sophia Gibbs, Adrian Bacong, Lily Amaturo, Timothy Frankland, Ana Rosales, Jiang Li, Yihe Daida, Stephen P Fortmann, Latha Palaniappan
Journal: Circulation (2024)

Background: Poorer mental health is associated with greater cardiovascular disease (CVD) morbidity, recovery, and mortality. Experiencing CVD is also associated with poorer mental health after a CVD event. What has been less examined, is how these associations differ among disaggregated Asian and Pacific Islander (API) groups who have a lower burden of both CVD and poor mental health relative to other racial groups. Objective: To examine the association between CVD diagnosis and experiencing major depressive disorder (MDD) among API people and how it differs between racial groups. Methods: We used survey data (n=5,229) from a study of API patients in Hawai’i and California with a linked electronic health record (EHR) data. Race, sex, body mass index (BMI) and CHD, Stroke, and PVD diagnosis were obtained from EHR while MI and CAD diagnoses were from the survey. Data on health behaviors and social determinants were obtained from the survey. Multivariate logistic regression models were used to determine the association between CVD and MDD. Results: Overall prevalence of MDD was 9.2%. Non-Hispanic White people (6.1%) had the lowest prevalence while “Pacific Islander and White” people had the highest prevalence (12.8%). In the fully adjusted models (Table), people who had a stroke (OR = 1.34, p &lt; .001), CHD (OR = 1.32, p = .01), CAD (OR = 1.35, p = .016) or PVD (OR = 1.49, p &lt; .001) had increased odds of MDD. There was a significant interaction between CAD and increased MDD that differed for Filipino, Asian Indian, “Pacific Islander and Asian”, “Asian and White”, and “Pacific Islander and White” groups compared to Non-Hispanic White people. Conclusion: Diagnosis of certain CVDs could increase the risk of experiencing MDD with potential race group differences for CAD. Further efforts should be made to protect the mental health of patients that have experienced a diagnosis of CVD as MDD can further harm their health outcomes. Moreover, research and treatment should consider potential racial differences in the experience of depression and CVD.
Abstract P506: Multifactorial Risk Control in Atherosclerotic Cardiovascular Disease Among Patients With Type 2 Diabetes Mellitus: Findings From the UK Biobank
Authors: Wenjun Fan, Luohua Jiang, Shaista Malik, Nathan D Wong
Journal: Circulation (2024)

Objectives: To determine the association of simultaneous composite clinical and behavioral risk factor control with incident ASCVD among T2DM patients in the UK. Methods: We studied diagnosed T2DM patients without baseline ASCVD in the UK Biobank database. AHA Life Essential 8 (LE8) metrics included BMI, non-HDL-C, HbA1c, BP, physical activity, nicotine exposure, sleep health, and diet patterns. Each factor was measured at baseline and was assigned a score ranging from 0 to 100 (poor to ideal), with the unweighted average of all factors constituting a composite CV health (CVH) score. Incident ASCVD was defined as the composite outcome of MI, ischemic stroke and CV death. The follow-up period was between baseline enrollment at 2006-2010 and year 2021. Cox proportional hazard models were built to determine the association of each factor, CVH score, as well as the number of ideal control factors, and incident ASCVD adjusted for demographic characteristics. Results: A total of 13,787 T2DM patients were included, 36.4% (5022/13,787) female, 89.1% (12,284/13,787) White, mean age of 60.1 ± 6.8 years, followed up for 11.5 ± 2.9 years. Only 2.2% were at ideal composite control of all factors. ASCVD incidence was significantly lower among those with ideal (&gt;=80) vs. poor (&lt;50) CVH score (adjusted HR=0.30, 95%CI: 0.18-0.51, p&lt;0.0001). Those with ideal simultaneous control for 6 or more LE8 factors had 84% lower ASCVD risks compared to those without any ideal control (adjusted HR=0.16, 95%CI: 0.05-0.51, p&lt;0.01). Conclusion: The composite control of multiple risk factors remains poor among T2DM patients in the UK. Having optimal levels of LE8 metrics simultaneously results in significant ASCVD risk reduction in this population.
Abstract P314: Blood Pressure Control Across the State of Alabama
Authors: Stephen Clarkson, Andrea Cherrington, Elizabeth A Jackson, Larry Hearld, Trudi Horton, Demetria M Hubbard, Kimberly Smith, Joshua Richman
Journal: Circulation (2024)

Introduction: Alabama has the highest rate of death from cardiovascular disease among all 50 states. Along with common risk factors, hypertension remains one of the leading risk factors for development of CVD. The Alabama Cardiovascular Cooperative (ALCC) is a 3-year funded initiative to promote the coordination of Alabama-wide efforts to improve cardiovascular risk and reduce disparities through initiatives like the Heart Health Improvement Project (HHIP). Methods: The purpose of this analysis was to understand and establish baseline rates of HTN among adults living in Alabama who receive care in a clinic enrolled in the HHIP. Fifty primary care sites, a mix of federally qualified health centers (FQHC) and non-FQHCs were enrolled. At goal blood pressure was defined as mean SBP&lt;140mmHg and DPB&lt;90mmHg. Rates were estimated and differences tested using logistic regression with sites as random effects. Results: Among HHIP practices, 42 practices provided BP data from 39,368 patients (Table 1). Black patients with HTN were younger and had higher systolic and diastolic blood pressures. Overall, 57.7% of patients had blood pressure at goal, 64.6% among Whites vs. 51.2% among Blacks (p&lt;0.01). Conclusions: More than half of patients with a diagnosis of hypertension seen in clinics enrolled in the HHIP had blood pressure that was adequately controlled, but Black adults with hypertension had significantly lower total rates of controlled blood pressure when compared to White adults. Initiatives like the HHIP are needed to address the disparate outcomes faced by adults with hypertension living in Alabama.
Abstract P235: Subjective Well-Being as Compared With Traditional Risk Factors in Relation to Incident Cardiovascular Diseases
Authors: Minghao Kou, Xiang Li, Hao Ma, Xuan Wang, Yoriko Heianza, JoAnn E Manson, Lu Qi
Journal: Circulation (2024)

Introduction: Emerging evidence suggests a role of subjective well-being (SWB) in modifying the risk of developing cardiovascular disease (CVD), while supportive data from prospective studies are scarce. Hypothesis: Low SWB is independently associated with higher incidence of CVD, comparable in magnitude to several established traditional risk factors. Methods: The study included a total of 154,217 women and men from the UK Biobank study, free of CVD at baseline and with measurements of SWB based on general happiness, personal health, family relationships, friendships, and financial situation, followed up until May 31, 2021. Cox proportional hazards models were used to estimate associations between SWB and incident CVD. The relative importance of SWB in terms of predicting outcomes was measured by explained R 2 values. Results: During a median follow-up of 11.3 years, there were 11,662 incident CVD events (8,474 coronary heart disease [CHD] cases and 1,804 ischemic strokes). Individuals with low SWB had an approximately 2-fold higher risk of CVD compared to those with high SWB (Hazard Ratio [95% Confidence Interval], 1.99 [1.75-2.27] for CVD, 1.98 [1.71-2.30] for CHD, and 1.90 [1.34-2.69] for ischemic stroke) after adjusting for traditional risk factors. Of 12 factors examined, SWB was ranked as the fourth-strongest CVD risk factor, following hypertension, smoking, and body mass index ( Figure ). SWB was ranked as the sixth- and third-strongest risk factor for CHD and ischemic stroke, respectively. Conclusions: Our study indicates that SWB is robustly associated with the risk of incident CVD, potentially as one of the strongest modifiable risk factors for CVD prediction.
Abstract MP46: Recurrent Hypertensive Disorders of Pregnancy and Subsequent Maternal Coronary Heart Disease and Stroke
Authors: Angela M Malek, Dulaney A Wilson, Julio Mateus, Jessica Pittman, Tanya N Turan, Kelly J Hunt
Journal: Circulation (2024)

Introduction: Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies and lead to maternal morbidity and mortality. Prior HDP increases HDP risk in subsequent pregnancies with little known about coronary heart disease (CHD) and stroke in recurrent HDP. We aimed to assess the relationship between recurrent HDP and subsequent CHD and stroke. Methods: This retrospective cohort study included women aged 12-49 with one or more singleton, live birth in South Carolina from 2004-2016. Deliveries were evaluated for HDP (preeclampsia, eclampsia, gestational hypertension) defined by birth certificate and/or hospitalization/emergency department (ED) visit data. Women were classified as having no, one, or two or more pregnancies with HDP. Hospitalization/ED visit and death certificate data defined incident CHD and stroke. Extended Cox models with time varying covariates were used to evaluate the association of recurrent HDP with CHD and stroke controlling for sociodemographic, behavioral, and clinical characteristics. Results: The 163,598 women (non-Hispanic White (NHW; 57.8%), non-Hispanic Black (NHB; 33.9%), and Hispanic (8.3%) had two or more (3.3%), one (12.0%), or no (84.7%) HDP pregnancies. Women with recurrent HDP were more likely to develop subsequent CHD or stroke after covariable adjustment (Table 1). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of CHD (HR=2.25; 95% CI: 1.97-2.56 and HR=2.98; 95% CI: 2.43-3.67, respectively). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of stroke (HR=2.05; 95% CI: 1.61-2.61 and HR=2.97; 95% CI: 2.04-4.32, respectively). Discussion: Women with recurrent HDP are at higher risk of subsequent CHD and stroke. Higher incident CHD and stroke risk appears to persist into the next pregnancy with accumulated HDP conferring higher risk.
Abstract MP60: A Randomized Placebo-Controlled Trial of Pitavastatin Calcium to Treat Combined Dyslipidemia of Obesity in Adolescents - The Pediatric Heart Network Dyslipidemia of Obesity Intervention in Teens (Do It!) Trial
Authors: Brian W McCrindle, Silva Arslanian, Michele Mietus-Snyder, Elaine M Urbina, Adam Ware, Jessica E Teng, Felicia Trachtenberg, Mark Russell, Amy S Shah, Mark Cartoski, Julie A Brothers, Christine San Giovanni, Justin Zachariah, Sandra Pena, William T Mahle, Amy Peterson, Sheela Magge, Geetha Raghuveer, Binu Sharma, Valiantsina Kazlova, Craig A Sponseller, D'Andrea Freemon, Sarah Deferranti
Journal: Circulation (2024)

Background: Combined dyslipidemia of obesity (CDO) is prevalent in ~20% of youth and characterized by high numbers of atherogenic small LDL (sLDL) particles associated with stiffer arteries. The safety and impact of statin therapy is not known. Methods: A 2-year masked trial of pitavastatin calcium 4 mg/day versus placebo for participants ages 10-19 years with body mass index (BMI) ≥85 th %ile and CDO defined as non-HDL-C ≥120 mg/dL and either low HDL-C or high triglyceride (TG):HDL-C ratio. The primary outcome was change in carotid-femoral pulse wave velocity (PWV) and carotid measures assessed at baseline, 6, 12, 18, and 24 months. Secondary outcomes included safety and lipid measures. Results: Across 18 sites, 59 participants were randomized to pitavastatin and 60 to placebo. Demographic (mean age 13.5±1.2 yrs; 55% males), anthropomorphic (BMI %ile 98±3; waist/height ratio 0.66±0.08), lipid (non-HDL-C 167±29 mg/dL, LDL-C 127±25 mg/dL, HDL-C 37±7 mg/dL, TG/HDL ratio 6.4±4.7, sLDL number 866±419 nmol/L), vascular (PWV 5.0±0.7 m/sec) and safety measures were similar at baseline between groups. There were 28 early terminations (11 pitavastatin, 17 placebo). Significant reductions with pitavastatin versus placebo were noted in non-HDL-C (median -25% vs +3% at 6 months, p&lt;0.001), LDL-C (-29% vs +7%, p&lt;0.001), and apolipoprotein B (-26% vs 0%, p&lt;0.001). An early reduction relative to placebo in sLDL particle number was not sustained (FIGURE A), and there were no significant changes or trends for PWV (FIGURE B) or carotid measures in either group. There was one serious adverse event (placebo), and no significant differences in liver enzymes, muscle toxicity, glucose homeostasis, or somatic growth, including adiposity. Conclusions: Over 2 years, treatment of CDO in adolescents with pitavastatin calcium resulted in significant improvement in dyslipidemia with no safety concerns. No change in PWV in either group may be due to lower-than-expected baseline PWV, insufficient magnitude of impact on CDO, or lack of change in adiposity.
Abstract P450: Assessing Admission Risk in Under-Resourced Neighborhoods: An Analysis by Race
Authors: Deekshita Behara, Floyd W Thoma, Jianhui Zhu, Suresh R Mulukutla, Jared W Magnani, Amber E Johnson
Journal: Circulation (2024)

Introduction: Cardiovascular disease (CVD) disproportionately affects socioeconomically disadvantaged communities and people of racial minority backgrounds. The Area Deprivation Index (ADI) is a validated measure of census-level characteristics based on income, education, employment, housing, and more. Although ADI is often linked to adversity, it is less well known if ADI is associated with racial disparities in CVD admission among cardiac patients living in disadvantaged communities. Hypothesis: We hypothesized that among a cohort of cardiac patients, risk for CVD admissions would be associated with ADI and that risk would vary by race. Methods: We identified ADI among n=27694 patients receiving care in a large health care system. We compared individual’s demographic variables using chi square for categorical variables and t-test for continuous variables. Using, ANOVA we determined differences in ADI by race. We further used ADI to identify neighborhoods with disproportionate rates CVD admissions using linear regression. Results: Figure Panel A shows that the ADI of American Indians, Blacks, and Asians was higher compared with that of Whites. Completion of an ANOVA test provided a p-value &lt;0.05, showing that the average ADI is not equal between race groups. Panel B shows a linear association between higher ADI and increased risk of CVD event. Yet, some block groups were outliers with lower than predicted CVD events, labeled as low utilizers. Conclusion and Implications: Racial minority groups tended to have a higher ADI, yet some groups at high risk for CVD had disproportionately lower CVD events. These findings along with our team’s future work will inform interventions to address neighborhood level social determinants of cardiac health. Interventions that account for the unique social and healthcare contexts and inequities specific to at-risk communities will in turn help address the health challenges unique to these groups.
Abstract P479: Whole Grain and Refined Grain Intake and Associations With Adiposity, Inflammation, and Incident Type 2 Diabetes Among Adults of South Asian Ancestry in the MASALA Cohort
Authors: Caleigh M Sawicki, Alka M Kanaya, Namratha Kandula, Meghana Gadgil, Shilpa N Bhupathiraju
Journal: Circulation (2024)

Background: Although growing evidence has suggested that whole grain over refined grain consumption is associated with lower measures of adiposity, no studies have examined these relationships in South Asians, who are at higher risk of less favorable adipose tissue distribution and risk of type 2 diabetes (T2D). Objective: We evaluated the associations between whole and refined grain intake with cross-sectional measures of adiposity (waist circumference, visceral, subcutaneous, hepatic, and pericardial adipose tissue), markers of inflammation (CRP, adiponectin), and incident T2D. Methods: We included 891 South Asians who completed the baseline visit in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study for cross-sectional analyses and 715 participants who completed exam 2 (~5 y after baseline). Whole and refined grain intake were determined using data from semi-quantitative food frequency questionnaires. We used multivariable linear and logistic regression models to evaluate associations between whole and refined grain intake with adiposity, inflammation, and incident T2D (among n=542 participants free of diabetes at baseline; n=48 incident cases), adjusting for several demographic, health, and lifestyle factors. Results: At baseline, participants (45% female) were on average 55 ± 9.2 (mean ± SD) years old with a BMI of 25.3 ± 3.9 kg/m 2 . Cross-sectionally, we observed that higher consumption of whole grains was associated lower pericardial fat (Beta ± SE: -2.3 ± 0.81 cm 3 , p-value=0.005) and higher refined grain intake was associated with higher percent difference in CRP (10.2 ± 4.65%, p-value=0.03) even after adjustment for BMI and other dietary factors (legumes, fruits, vegetables, and dairy). Substitution models also showed that replacing 1 serving/d of refined grain with whole grain was associated with lower pericardial fat (-3.2 ± 1.27 cm 3 , p-value=0.01) and CRP (-11.4 ± 5.38 % difference, p-value=0.02) in the fully adjusted models. Whole grain intake was also associated with greater attenuation of hepatic fat (0.71 ± 0.35 HU, p-value=0.04), but this did not remain significant after adjustment for BMI. Neither whole nor refined grain intake was associated with 5-year incident T2D. Conclusions: Higher intake of whole grain was associated with lower pericardial fat, while higher refined grain intake may be associated with higher inflammation. These observations support recommendations to consume whole grains over refined grains, especially among high-risk groups such as South Asians.
Abstract MP65: Multimorbidity Trajectories From Early Adulthood and Current and Subsequent Accelerometer-Measured Sedentary and Physical Activity Behaviors in Midlife: Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Erin E Dooley, C. Barrett Bowling, Baojiang Chen, Bjoern Hornikel, Sylvia E Badon, Pamela J Schreiner, Mercedes Carnethon, Cora E Lewis, Kelley Pettee Gabriel
Journal: Circulation (2024)

Introduction: Multimorbidity, having two or more chronic diseases, can lead to functional limitations. However limited data exist on the associations of multimorbidity during the early life-course with physical activity (PA). We assessed the hypothesis that patterns of multimorbidity accumulation from early to mid- adulthood is associated with differences in 1) concurrent PA and 2) changes in PA during midlife. Methods: We analyzed subsamples of CARDIA participants who wore an accelerometer (ActiGraph GT3X) on the waist ≥4 days with ≥10 hr/day during the Year 30 (2015-16; n = 1425) and again at Year 35 (2020-22; n = 745 of 1425) follow-up exams. Accelerometer estimates included time (min/day) spent in sedentary (SB), light intensity (LPA), or moderate to vigorous intensity PA (MVPA) behaviors. Six identified latent trajectories of early- to mid- life multimorbidity based on age and rate of accumulation included: 1) mid-20s fast; 2) mid-20s slow; 3) late-20s fast; 4) mid-30s fast; 5) mid-40s fast; and 6) early-50s slow [referent]. Linear models were used to estimate differences in 1) behaviors at Year 30 and 2) relative change (%) from Year 30 to Year 35 by multimorbidity trajectory, after adjustment. Results: CARDIA adults (overall: 62% female, 45% Black, mean age = 55 at Year 30) in the early-50s slow group had the highest MVPA (54.5 min/day) and LPA (348 min/day) and least SB (515 min/day) (unadjusted χ 2 : p &lt; 0.01). At Year 30, when compared to early-50s slow, mid-20s slow had lower LPA (β = -17.1, p = 0.003) and late-20s fast had lower MVPA (β = -12.0, p &lt; 0.001) after covariate adjustment. No significant differences in 5-year relative change in any activity were found by multimorbidity trajectory (Figure). Conclusions: In this prospective cohort, adults who accumulated disease later (early-50s) had higher PA at midlife. Changes in midlife PA and SB did not differ by multimorbidity trajectory, however this was a relatively short follow-up. Additional follow-up will provide clarity as CARDIA participants transition into older adulthood.