tbuckley/cabot-search huggingface dataset:
Abstract P3096: Barriers Associated with The Use of Smart Blood Pressure Monitors Among Minority Older Adults
Authors: Jany Sun, Yanjun Dong, Jimmie Boliboun, Katherine Koo, Valeria Vazquez-Trejo, Michael Cui, Victoria Rizzo, Jeannine Rowe
Journal: Circulation (2025)

Background: Smart blood pressure monitors (SBPMs) are increasingly used among older adults to monitor hypertension, improve health and independence, and decrease hospitalization cost. However, low usage of SBPMs among African American and Latinx is concerning. Beyond sociodemographic factors, reasons for SBPMs use and non-use among minority older patients are not well understood. This study aims to identify barriers associated to the use of SBPMs through conducting an exploratory interview study. Methods: An interview study was conducted with 20 English speaking minority older patients (age 60+) who have hypertension and were prescribed a SBPM. The digital literacy framework as well as Andersen’s expanded model, which identifies psychosocial, enabling, and need factors as mutable factors in health service utilization, were used to guide the study. Data were analyzed using content analysis and mapped to Andersen’s model. Results: The average age of participants was 70.7 (M = 70.7, SD = 10.3). The majority were African American (n = 19; 95%) and female (n = 11; 55%). By applying Andersen’s expanded model, we identified barriers related to the mutable factors. The findings revealed that 18 (90%) participants experienced device malfunctions and other technical problems, such as issues with device accuracy and using wrong sized cuff. 12 (60%) participants indicated gaps in knowledge, expressing that they had never heard of smart health devices before. Also, 7 (35%) participants experienced accessibility challenges, such as missing reminder messages. 6 (30%) participants were concerned about affordability of the SBPMs and would only continue using SBPMs if it remained financially accessible. Lastly, 4 (20%) participants experienced psychological barriers, such as stress and mental load associated with regularly monitoring their health. Conclusion: This study highlights the barriers minority older adults have experienced when using SBPMS to monitor their health. Although SBPMs empower minority older adults to take proactive roles to monitor their own health, these barriers could hinder their willingness to use SBPMs as intended. Identifying these barriers provides a starting point for clinicians to implement strategies and collaborate with other health professions to enhance utilization of SBPMs among minority older adults, ensuring equitable access.
Abstract P3083: Characterization of the Course of Heart Disease using Multimorbidity-adjusted Life Year (MALY): A Multi-state Non-Markov Framework
Authors: Ming Ding, Feng-Chang Lin, Michelle Meyer
Journal: Circulation (2025)

Background: In cardiovascular epidemiology, heart disease has been largely investigated by focusing on a single (or composite) endpoint. A few studies examined the disease course using multi-state Markov models, assuming the current disease state is independent of past states. Markov models are unsuitable to heart disease due to three reasons: First, risk factors interplay and affect future disease risk; second, Markov assumption does not allow for multimorbidity, a common condition for heart disease; and third, the estimated transition probabilities are time-specific and indirect for public health use. Methods: We have developed a multi-state non-Markov framework that splits disease state into substates by conditioning on past states (Ding et al. BMC Medical Research Methodology. 2024. In revision. doi: https://doi.org/10.1101/2024.09.18.24313882). As the substates track history of past states, transition rates between substates can be synthesized into a summary estimate, multimorbidity-adjusted life year (MALY) that represents the adjusted life year in full health. The derivation of MALY can be found in our second paper (Ding et al. medRxiv. 2024.doi: https://doi.org/10.1101/2024.09.18.24313882). In this study, we applied our framework to characterize the course of heart disease among participants enrolled in the Atherosclerosis Risk in Communities Study (ARIC). ARIC data was obtained from NHLBI BioLINCC. Results: We modeled the course of heart disease in five states: healthy, at metabolic risk, coronary heart disease (CHD), heart failure, and mortality ( Figure 1 ). The disability weights assigned to each disease state is shown in Figure 2 . In this mid- to old-age population, the estimated MALY was 24.13 (95% CI: 16.55, 32.06) years ( Figure 3 ). The multimorbidity-adjusted life expectancy was higher among women (79.29 [95% CI: 77.42, 81.57] years) than men (77.07 [95% CI: 74.37, 80.05] years), and was higher among Whites (79.04 [95% CI: 77.05, 81.31] years) than Blacks (75.49 [95% CI: 73.19, 79.30] years). Impact: MALY summarizes the course of heart disease into one estimate and can be used in comparative effectiveness of disease intervention in the near future.
Abstract 004: Longitudinal Change in Cardiovascular Health by Repeated Measures of Self-Reported Sexual Orientation Discrimination in the CARDIA Study Cohort
Authors: Lauren Beach, Grace Avila, Bridget Slone, Renée Brown, Adovich Rivera, Pamela Schreiner, Mercedes Carnethon, James Shikany, Cora Lewis, Ankeet Bhatt, Diana Chirinos, Kiarri Kershaw, Krista Perreira, Tonia Poteat, Gregory Phillips, Patrick Janulis
Journal: Circulation (2025)

Introduction: Few studies have investigated the association of self-reported discrimination based on sexual orientation with cardiovascular health. Objective: We assessed if repeated self-reported sexual orientation discrimination was associated with longitudinal cardiovascular health among males and females in the CARDIA study. Methods: CARDIA participants completed cardiovascular health assessments and sexual orientation discrimination measures in 1992-1993 (Year 7 Exam), 2015-2016 (Year 30 Exam), and 2020-2022 (Year 35 Exam). For each exam, participants reported if they experienced discrimination attributable to sexual orientation in 6 different contexts (at school, getting a job, at work, at home, getting medical care, and in public settings). The number of reported discrimination contexts was summed at each time point and assigned to one of four levels (0, 1, 2, or 3 or more experiences). Multiple imputation by chained equations was used to estimate missing exposure and outcome variables. Linear mixed models stratified by sex were used to estimate the associations between age, sexual orientation discrimination, and Life’s Simple 7 (LS7). The interaction of age and discrimination was used to estimate differences in change in LS7 over time (i.e., age) by levels of discrimination. Results: Median participant age was 54 years (SD 12.7 years), 55.3% of participants were female, and 49.7% were Black. Combining participant reports of females across all 3 exams, 83.5% reported 0, 4.8% reported 1, 2.6% reported 2, and 4.2% reported 3 or more contexts of sexual orientation discrimination. Among males, these percentages were 84.7%, 4.6%, 2.4%, 4.2%, respectively. The mean LS7 score across all visits for all participants was 7.68 (SD 1.78). Females who reported 3 or more sexual orientation discrimination contexts had significantly lower cardiovascular health than those who reported no sexual orientation discrimination (b = -0.60, p=0.008), but no significant difference in their rate of LS7 change from Year 7 to Year 35 Exam (b=0.02, p=0.15). There was no significant association between sexual orientation discrimination and cardiovascular health in males. Conclusions: Among females, sexual orientation discrimination was inversely associated with cardiovascular health. No significant differences were detected in males. Future studies will investigate if these findings vary by sexual identity and race.
Abstract P3087: Comparison of Self-Reported and Adjudicated Cardiovascular, Stroke and Pulmonary Events in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Sierra Patterson, Jianwen Cai, Jonathan Zhang, Robert Kaplan, Sylvia Wassertheil-Smoller, Matthew Allison, Daniela Sotres-Alvarez, Bharat Thyagarajan, James Floyd, Elina Jerschow, Daniel Labovitz, Martha Daviglus, Amber Pirzada, Larissa Aviles-Santa, Wayne Rosamond
Journal: Circulation (2025)

Introduction: Observational studies often use participants’ self-reported health data to identify clinical endpoints. Information on the accuracy of self-reported cardiovascular and pulmonary events among Hispanic/Latino populations is lacking. Research Question: Are self-reported hospitalizations for cardiovascular and pulmonary events in an observational study of Hispanic/Latino participants consistent with physician adjudication of medical records? Methods: We assessed 526 participants (mean age: 54 years; 64% female) who self-reported hospitalizations during 2008-2016 annual follow-up interviews in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Participants reported all hospitalizations within the past year and the reason for each hospitalization. Medical records for reported hospitalizations were abstracted and reviewed by two physicians to determine event classification. Disagreements between reviewers were adjudicated by a third physician. Reviewers classified each event as myocardial infarction (MI), heart failure (HF), stroke, or chronic lower respiratory disease (CLRD; defined as asthma, chronic obstructive pulmonary disease, chronic bronchitis, or emphysema). We calculated the positive predictive value (PPV) of these self-reported events as the proportion verified by physician review. We examined the PPV by gender and acculturation (measured by language preference: Spanish or English). Results: There were 90 MI, 96 HF, 112 stroke, and 538 CLRD events self-reported during follow-up. Using physician adjudication as the standard criterion, the PPV of self-reported events was 42% for MI, 25% for HF, 54% for stroke, and 18% for CLRD. The PPV of stroke among females was 43% (95% CI: 32%, 56%); the PPV among males was 65% (95% CI: 53%, 76%). The PPV of CLRD among females was 20% (95% CI: 17%, 24%); the PPV among males was 11% (95% CI: 7%, 18%). For CLRD, the PPV among those whose preferred language was Spanish was 16% (95% CI: 12%, 20%); the PPV among those whose preferred language was English was 23% (95% CI: 18%, 29%). Among self-reported MI events not confirmed by physician adjudication, the most common diagnosis was unspecified chest pain. Conclusions: In an observational study of Hispanic/Latino participants, the PPV of self-reported cardiovascular and pulmonary events is low and varies by demographics. Relying solely on self-report to ascertain cause-specific clinical events may contribute substantial bias in observational studies.
Abstract P3075: Diet quality and risk of hypertension in women cancer survivors
Authors: Yong-Moon Park, Nithya Neelakantan, Susan Steck, Hazel Nichols, Katie OBrien, Michael Fradley, Mario Schootman, Benjamin Amick, Dale Sandler
Journal: Circulation (2025)

Background: Higher diet quality has been associated with reduced hypertension risk in the general population. Although women cancer survivors are at elevated risk of hypertension following cancer treatment, it is unclear if diet quality is also associated with risk of hypertension among women cancer survivors. Methods: We analyzed 1,441 women (aged 35 to 74 years) from the Sister Study (2003-2009) who reported a history of cancer other than non-melanoma skin cancer and had no prevalent hypertension at enrollment. Prevalent hypertension was defined as systolic blood pressure (BP) ≥140 mmHg, diastolic BP ≥90 mmHg, or the use of antihypertensive medication at enrollment. Participants diagnosed with cancer within one year of enrollment were excluded. The median time since diagnosis was 11.4 years. Participants were followed through September 2021 (median follow-up: 11.6 years). Dietary quality was assessed using the validated 110-item Block food frequency questionnaire and categorized into quartiles based on the entire Sister Study population for Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI-2015), alternate Mediterranean diet (aMED), and alternative Healthy Eating Index (aHEI-2010). Incident hypertension was self-reported as a new diagnosis or initiation of antihypertensive medication at any time during follow-up. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident hypertension. Results: After adjusting for potential confounders, higher DASH scores were associated with decreased risk of incident hypertension (HR Q4vsQ1 0.63, 95% CI 0.48-0.84, P trend =0.01). Associations were weaker for aMED (HR Q4vsQ1 0.78, 95% CI 0.59-1.03, P trend =0.09) and HEI-2015 (HR Q4vsQ1 0.78, 95% CI 0.60-1.03, P trend =0.12), and no significant association was found for aHEI-2010. A 5-year lag analysis yielded similar results. DASH remained associated with reduced hypertension risk even after adjusting for pre-existing diabetes, dyslipidemia, and cardiovascular disease history. The association between DASH and hypertension risk was not evident in long-term survivors (≥15 years post-diagnosis). A stricter hypertension definition (BP ≥130/80 mmHg) did not materially change the findings. Conclusion: Our findings suggest that higher diet quality, particularly following DASH dietary patterns is associated with reduced risk of hypertension in women cancer survivors.
Abstract P3072: Midlife Depressive Symptoms and Hypertension Status Modify The Association Between Long-Term Systolic Blood Pressure Variability From Childhood and Midlife Cognitive Function: The Bogalusa Heart Study
Authors: Soo Jung Kang, Jeanette Gustat, Wan Tang, Phillip Hwang, Ileana De Anda-Duran, Camilo Fernández Alonso, Lydia Bazzano
Journal: Circulation (2025)

Background: Hypertension (HTN) and depression have been speculated to have a bidirectional relationship, and linked to risk of dementia. Long-term systolic blood pressure (SBP) variability has been associated with HTN in adults. Evidence regarding long-term SBP variability and worse cognitive function in older adults is increasing. Whether depressive symptoms at midlife modifies the association between long-term SBP variability from childhood and midlife cognitive function is unclear. Methods: We examined 1104 midlife participants of the Bogalusa Heart Study (age at enrollment: 9 ± 3 years, follow-up: 39 ± 3 years, age at last exam: 48 ± 5 years, 61% women, 35% Black participants) with ≥3 measurements of SBP across follow-up. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (scores of ≥10 defined as having depressive symptoms). Long-term SBP variability from childhood was measured as the deviation from age predicted value (DEV). DEV is the mean of the difference between each observed SBP value and predicted SBP value for age, which were obtained by fitting repeated SBP measures across follow-up to random effects models. Midlife cognitive function was measured by 8 neuropsychological tests, which were standardized by age, race, and sex, then averaged into a global cognitive score (GCS). Associations between long-term variability of SBP and GCS were analyzed using multivariable linear regression models Stratified analyses by midlife depressive symptom and HTN status were performed. Results: DEV of the study population was 7 ± 3 mmHg. A total of 692 (63%) and 360 (33%) participants had HTN and depressive symptoms at midlife, respectively. Of the 692 participants with HTN, 250 (36%) had depressive symptoms. Higher long-term variability of SBP was linked to poorer midlife cognitive function. Stratified analysis by depressive symptom and HTN status showed higher effect sizes in participants with depressive symptoms and HTN at midlife, compared to those without (Table). Conclusions: Both depressive symptoms and HTN status at midlife may interact with SBP variability and influence midlife cognitive function. Screening for both depressive symptoms in addition to SBP variability in individuals with HTN may be beneficial to preserve midlife cognitive function.
Abstract P3084: Yield of Various Recruitment Approaches for an Observational Cohort of Patients with Heart Failure with Preserved Ejection Fraction: A Single Center Experience from HeartShare
Authors: Ramzi Kibbi, Quan Mai, Laura Seegmiller, Vaishnavi Krishnan, Elizabeth Marquez, Sadiya Khan, Laura Rasmussen-Torvik
Journal: Circulation (2025)

Introduction: The HeartShare Network aims to improve understanding of heart failure with preserved ejection fraction (HFpEF), a condition that disproportionately affects those with adverse social determinants of health. Ensuring diverse recruitment is key to advancing HFpEF research. This study examines response rates of various recruitment approaches across sociodemographic groups at a single HeartShare Clinical Center for an online registry including patients with and without HFpEF. Hypothesis: We hypothesized that electronic health record (EHR) messaging would be more effective in recruiting a diverse group of participants compared to telephone and in-person outreach. Methods: This observational study recruited patients aged 30 years and older between 8/1/2023-8/1/2024 from a tertiary-care academic center (Northwestern Medicine). Participants were contacted via phone calls, EHR portal messages, and in-person outreach. Data on age, race, and ethnicity were collected. Area Deprivation Index (ADI) was calculated using addresses. Statistical analyses, including Fisher’s Exact Test, were conducted using R to assess differences in recruitment rates across demographic groups and recruitment methods. Results: Among 8,080 patients contacted through EHR messaging, 144 (1.8%) enrolled in the online registry. In comparison, among 1,439 participants contacted via phone, 174 (12.1%) enrolled and among 193 approached in-person, 79 (41%) enrolled. Response rates (consenting after contact) varied for each approach by race and ethnicity (p&lt;0.001). White participants had a response rate of 14% (after phone contact), 2% (after EHR contact), and 54% (after in-person contact). Black participants had a response rate of 6% (phone), &lt;1% (EHR), and 49% (in-person). Hispanic participants had response rates of 5% (phone), &lt;1% (EHR), and 38% (in-person). Among the enrolled, participants from the most deprived areas (ADI 5th quintile) were most effectively recruited through in-person methods compared with those from the least deprived quintile who were most successfully recruited via phone. Conclusion: While more individuals were contacted through EHR-based messaging, response rates were lower, especially among Black and Hispanic participants. In-person recruitment was the most successful in engaging minoritized populations or those residing in more deprived areas. Future studies should explore ways to improve response rates among diverse populations using EHR approaches.
Abstract 007: Associations of Accelerometer Measures of Physical Activity and Sedentary Behavior with Alzheimer’s Disease Related Dementias and Vascular Dementias Classified Using Medicare Claims Data Among Older Black, Hispanic and White Women: The Objective Physical Activity and Cardiovascular Health Study
Authors: Steve Nguyen, Chongzhi Di, Eric Hyde, Charles Eaton, Michael LaMonte, Andrea LaCroix
Journal: Circulation (2025)

Introduction: Higher amounts of physical activity (PA) have been shown to be associated with lower risk of Alzheimer’s disease related dementias (ADRD), however few studies have prospectively examined accelerometer measures of PA and sitting with ADRD and specifically vascular dementias (VD) among older diverse women. Methods: Older postmenopausal women (n=5417; mean age=78 ± 7 years; 33% Black, 17% Hispanic) in the Objective Physical Activity and Cardiovascular Health Study without prior ADRD wore accelerometers for 7 days in May 2012-April 2014 and were followed through December 31, 2021. Incident ADRD was classified using Medicare Claims data, allowing for identification of events among older Black, Hispanic or Latina, and White women. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) for total PA, light PA (LPA), moderate-to-vigorous intensity PA (MVPA), steps/day, total sitting time, and mean sitting bout duration (MSBD) with ADRD and VD adjusting for age, race and ethnicity, education, alcohol, smoking, hypertension, diabetes, physical functioning, and body mass index (BMI). We additionally carried out stratified analysis across covariates. Results: There were 1143 ADRD events, including 187 VD events, during a median follow-up of 8.6 years. The HR (95% CI; P-trend) for ADRD and VD for each 1 standard deviation (SD) increment was 0.83 (0.69-1.00; 0.04) and 0.77 (0.48-1.25; 0.70) for total PA (SD=90 minutes/day), 0.58 (0.48-0.71; &lt;0.001) and 0.61 (0.38-0.99; 0.02) for MVPA (SD=34 minutes/day), 0.53 (0.43-0.65; &lt;0.001) and 0.57 (0.34-0.97; 0.01) for steps/day (SD=2051 steps/day), and 1.15 (0.95-1.38; 0.03) and 0.84 (0.52-1.37; 0.72) total sitting time (SD=102 minutes/day). Associations for steps with ADRD were similar among Black (HR=0.69, 95% CI=0.57-0.85), White (HR=0.70, 95% CI=0.61-0.81) and Hispanic or Latina women (HR=0.80, 95% CI=0.63-1.01, P-interaction=0.32). LPA and MSBD were not associated with ADRD or VD. Conclusions: Higher MVPA and steps/day were associated with lower ADRD and VD risk while higher total sitting time was associated with higher ADRD risk, supporting interventions aimed at increasing PA and reducing SB for ADRD prevention in diverse populations.