tbuckley/cabot-search huggingface dataset:
Abstract MP09: Number of incident cardiovascular disease events and deaths prevented among Black adults by achieving blood pressure equity with White adults in the US.
Authors: Shakia Hardy, Lei Huang, Lisandro Colantonio, Oluwasegun Akinyelure, Kathryn Foti, Lama Ghazi, Timothy Plante, Monika Safford, Paul Muntner
Journal: Circulation (2025)

Background: There are preventable disparities in blood pressure (BP) levels by race in the US, that contribute to a higher rate of cardiovascular disease (CVD) events and mortality among non-Hispanic Black compared to non-Hispanic White US adults. We estimated the number of CVD events and CVD deaths that could be prevented among non-Hispanic Black adults by achieving the same mean systolic BP (SBP) as non-Hispanic White adults ≥45 years of age. Methods: We calculated the difference in mean SBP between non-Hispanic Black versus White US adults and the number of non-Hispanic Black US adults from the National Health and Nutrition Examination Survey 2015-2020. The 10-year cumulative incidence of CVD, including stroke, coronary heart disease, or heart failure, and CVD mortality for non-Hispanic Black adults was calculated using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. We applied the relative risk reduction for CVD events and CVD mortality with initiation and intensification of antihypertensive medication from the Blood Pressure Lowering Treatment Trialists Collaboration, calibrated to reflect the SBP reduction for non-Hispanic Black adults to have the same SBP as non-Hispanic White adults. Results: Among non-Hispanic Black and White US adults, mean SBP was 130.7 (95%CI 129.0-132.5) and 124.2 (95%CI 123.1-125.3) mmHg for those not taking antihypertensive medication (difference 6.5 mmHg; 95%CI 4.5-8.5), respectively, and 137.8 (95%CI 135.8-139.8) and 131.2 (95%CI 129.7-132.7) mmHg for those taking antihypertensive medication (difference 6.5 mmHg; 95%CI 4.0-9.1), respectively. Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD events over 10 years by 50,434 (95%CI 33,985-71,137) among non-Hispanic Black US adults not taking antihypertensive medication and 122,881 (95%CI 83,220-176,826) among non-Hispanic Black adults taking antihypertensive medication. Equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD deaths over 10 years by 21,702 (95%CI 7,313-40,278) among non-Hispanic Black US adults not taking antihypertensive medication and 55,055 (95%CI 19,823-99,693) among non-Hispanic Black adults taking antihypertensive medication. Conclusions: Achieving SBP equity between non-Hispanic Black and White adults may substantially reduce the number of CVD events and deaths experienced by non-Hispanic Black adults.
Abstract MP48: Null Causal Associations between Circulating Caffeine Levels and its Metabolites with Cardiac Function and Heart Failure
Authors: Guning Liu, Bing Yu, William Perkison
Journal: Circulation (2025)

Introduction: Observational studies have shown that coffee consumption relates to a decreased risk of heart failure (HF). Our recent findings indicate that caffeine metabolism, not caffeine itself, relates to the onset of HF. The causal effect of circulating caffeine levels on HF and cardiac function is largely inconclusive. Hypothesis: We hypothesize that circulating caffeine level is not causally associated with cardiac function and HF. Methods: We extracted the summary results from genome-wide association (GWAS) studies of plasma caffeine, HF, and 15 cardiac structure and function measures for left atrium, left ventricle, and right ventricle from public databases. Genetic instruments of caffeine were selected if the variants were associated with caffeine at p&lt;5×10 -8 . After clumping at r&lt;0.001, two independent lead variants on gene CYP1A2 , rs2472297, and AHR , rs4410790, were included in the analysis. Using the two-sample Mendelian Randomization (MR) approach, we examined the associations between caffeine level, cardiac function measurements, and HF on each selected variant, and pooled estimates were generated using the inverse-variance weighted method. Results: The summary of caffeine, cardiac function, and HF was from GWAS of European descent, consisting of 9,876 participants from six cohorts, up to 29,506 participants from UK Biobank, and 47,309 cases and 93,014 controls from the Heart Failure Molecular Epidemiology for Therapeutic Targets study, respectively. CYP1A2 and AHR were not causally associated with HF individually or jointly (Odds Ratio meta =1.001, 95% CI = 0.999, 1.004). Both genes also yield insignificant results between caffeine levels and measures of the left ventricle, left atrium, and right ventricle, key parameters underlying HF ( Figure ). Conclusion: We observed no causal association between circulating caffeine and the risk of HF, suggesting health-beneficial effects of coffee consumption may relate to the improved molecular pathways instead of circulating caffeine levels.
Abstract P2112: Longitudinal Associations Between the Microbiome and Glucose Homeostasis Over Time in The Microbiome and Insulin Longitudinal Evaluation Study (MILES)
Authors: Lekki Wood, Kristi Hoffman, Alain Bertoni, Stephen Rich, Jerome Rotter, Yii-Der Ida Chen, Mark Goodarzi
Journal: Circulation (2025)

Type 2 diabetes (T2D) is associated with both relative, and absolute, changes in the microbes colonizing the digestive tract (the gut microbiome). However, T2D-related pathogenesis predates diagnosis by up to decade, and few studies have examined whether gut microbiome differences also relate to the various components of insulin and glucose homeostasis that contribute to onset. The goal of this study was to conduct such an investigation using repeated stool samples from 114 non-Hispanic White and 44 African American individuals without T2D participating in MILES (mean age 60, 67% female), leveraging MILES’ longitudinal design to minimize the influence of temporary microbiome fluctuations. Participants underwent three oral glucose tolerance test, spaced ~ one year apart, from which fasting glucose (FG) and insulin, and C-peptide were derived, and insulin sensitivity, insulin secretion, and disposition index (DI) calculated. Microbes with a prevalence &gt;= 30% were included in multi-level linear models which examined associations of overall composition (diversity, evenness and richness), as well as the relative abundance of individual species, with each of the six glucose measures. Models used centered log-ratio transformed data, included a correction for bias due to compositional effects, and controled for sequencing depth, batch, demographics, and medication useage. P-values equivalent to a&lt;.05 after an FDR correction for the number of microbes (N=130) were considered significant. FG was associated with lower (Shannon index; b=-0.19(0.08),P=.03) and evenness (Inverse Simpson; b=-0.02(0.01),P=.02), with a similar trend inverse association seen for DI (diversity: b=-0.19(0.08),P=.03; evenness: b=0.02(0.01),P=.02). These two indices were also associated with the relative abundance of seven microbes; both FG (logFC=0.46,P=9.9*10-4) and DI (logFC=-0.54,P=1.1*10-4) were associated with Ruthenibacterium lactatiformans, FG only with Anaerotruncus colihominis (logFC=1.31,P=1.22*10-4) and Flavonifractor plautii (logFC=0.68,P=8.3*10-4), and DI only with Adlercreutzia equolifaciens (logFC =-0.55, P=4.6*10-5 ), Asaccharobacter celatus (logFC=-0.38,P=6.6*10-4), Enterorhabdus caecimuris (lofFG=-0.82,P=8.1*10-4), Gordonibacter pamelaeae (logFC=-0.49,P=5.9*10-4), and Limnochorda Pilosa (logFC=-0.40,P=1.2*10-3). The roles of these microbes in lactate, equol, butyrate, and tryptophan production point to the gut microbiome as a mediator of diet-T2D associations.
Abstract MP01: Butter and Plant-Based Oils Intakes and Mortality in Three Large Prospective Cohorts of US Women and Men
Authors: Yu Zhang, Katia Chadaideh, Yanping Li, Yuhan Li, Xiao Gu, Yuxi Liu, Marta Guasch, Eric Rimm, Frank Hu, Walter Willett, Meir Stampfer, Dong Wang
Journal: Circulation (2025)

Objective: To investigate associations of butter and plant-based oil intakes with risk of total and cause-specific mortality. Participants: 221,054 women and men from the Nurses’ Health Study (1990-2018), Nurses’ Health Study II (1991-2018), and Health Professionals Follow-up Study (1990-2018) were included, all of whom were free of cancer, cardiovascular disease (CVD), diabetes, or neurodegenerative disease at baseline. Exposure: We assessed dietary intake repeatedly using validated semiquantitative food frequency questionnaires every 4 years. Primary exposures included total butter (butter added at the table and from baking and frying) and plant-based oil intake (safflower, soybean, corn, canola, and olive oil). Main Outcome: We identified deaths through the National Death Index and other sources. A physician classified the cause of death based on all available records. Total mortality was the primary outcome, and mortality due to cancer and CVD were secondary outcomes. Results: During up to 28 years of follow-up, we documented 41,618 deaths, including 11,380 from cancer and 9,114 from CVD. After adjusting for confounding factors, the highest butter intake was associated with an 18% higher risk of total mortality compared to the lowest intake (HR: 1.18; 95% CI: 1.10-1.25; P trend &lt;0.001). Conversely, the highest plant-based oil intake was linked to an 18% lower risk of total mortality (HR: 0.82; 95% CI: 0.76-0.89; P trend &lt;0.001). Higher olive, soybean, and canola oil intakes were also significantly associated with lower total mortality (all P trend &lt;0.001). For every 10 g/day increase in plant-based oil intake, cancer mortality risk decreased by 11% (HR: 0.89; 95% CI: 0.85-0.94; P trend &lt;0.001), and CVD mortality risk by 6% (HR: 0.94; 95% CI: 0.89-0.99; P trend = 0.03). Higher butter intake was associated with increased cancer mortality (HRper10g/day: 1.12; 95% CI: 1.04-1.20; P trend &lt;0.001), but not with CVD mortality ( P trend =0.61). Replacing 10 g/day of butter with plant-based oils was associated with a 19% reduction in total mortality (HR: 0.81; 95% CI: 0.77-0.85; P trend &lt;0.001) and a 20% reduction in cancer mortality (HR: 0.80; 95% CI: 0.74-0.88; P trend &lt;0.001). Conclusion: A higher intake of butter is associated with higher mortality, while a higher intake of plant-based oil is associated with lower mortality. Substituting butter with plant-based oils may confer substantial benefits for preventing premature deaths.
Abstract P3095: Disparities can be exacerbated by new technology for tracking physical activity
Authors: Chanam Shin, Kyungeh An, Kyung Mi Oh
Journal: Circulation (2025)

Introduction: Health disparities persist and may be exacerbated by new technology, such as wearable devices tracking health behaviors. In particular, this digital division continues to bring poor health outcomes in racial/ethnic underrepresented groups. Hypotheses: We assessed the hypotheses that (1) the use of wearable devices would be associated with the level of physical activity, and (2) there would be differences in the use of wearable devices by demographic and sociocultural factors. Methods: A cross-sectional, community-based survey study was conducted in 525 Korean American adults residing in New Jersey, Ohio State, Georgia, and Texas. Data were analyzed using descriptive statistics, chi-square tests, and multiple regressions with statistical significance set at p &lt;.05. Results: Most of the study sample (75%) did not use wearable devices to track their physical activity although 54% were diagnosed with more than one chronic condition. Almost half of them (49%) did not meet the current guidelines by engaging in moderate physical activity less than 150 min per week. Individuals who were younger than 60 years, college educated, income of $50,000 and more, full-time workers, proficient in English tended to use wearable devices than their counterparts, which in turn, were more likely to engage in physical activity. Conclusion: In conclusion, it is critical to address the significant disparities in the use of wearable device for tracking physical activity among Korean Americans. This indicates an opportunity to reduce health disparities by promoting physical activity using wearable devices. More specifically, provision of affordable wearable devices equipped with user-friendly features in conjunction of community education and support would be one way to promote physical activity. Also, particular attention should be given to the individuals who are older than 60 years, less educated, having low income, part-time workers or unemployed, or limited English proficiency. Further research using qualitative or mixed method design need to explore the underlying factors of low uses of wearable devices in Korean American adults.
Abstract P2019: Alcohol Use and Cardiovascular Health: A Target Trial Emulation
Authors: Sinclair Carr, Miguel Martinez-Gonzalez, Kenneth Mukamal, Eric Rimm, Goodarz Danaei
Journal: Circulation (2025)

Background: Observational studies on the cardiometabolic effects of alcohol are inconsistent. Long-term randomized trials on alcohol use are currently unavailable, and trials on increasing intake are unlikely. Methods: We emulated a target trial using data from the UK Biobank cohort (502,178 individuals aged 40–69). Eligible participants were all stable current drinkers, irrespective of intake level, who had no myocardial infarction, revascularization procedure, stroke, or liver disease in the past six months, no history of heart failure, cancer (breast, colon, or liver), dementia, or alcohol-related conditions, and were not on antithrombotic drugs or reporting poor health. Alcohol use was assessed at baseline (2006–2010) and again during follow-up (2012–2022). The primary endpoint was time to death or first cardiovascular disease (CVD) event (myocardial infarction, ischemic stroke, angina hospitalization, or coronary revascularization). Secondary endpoints were CVD, type 2 diabetes, and alcohol-related disease or death. We used clone-censor-weighting to estimate risks of endpoints, comparing participants who were moderate drinkers (&gt;0–16g alcohol daily or almost daily) during follow-up with those who were social drinkers (&gt;0–16g on 1–3 days/week or only monthly), adjusting for potential baseline confounders. We chose appendicitis and rheumatoid arthritis (RA) as negative control outcomes to assess unmeasured confounding. Results: Of the 65,594 eligible participants at baseline, 12,470 were moderate drinkers during follow-up and 53,124 were social drinkers, with 1,041 and 4,224 CVD events or deaths, respectively. Moderate drinkers had a 14% lower risk of CVD or death compared to social drinkers (adjusted risk ratio, 0.86; 95% confidence interval, 0.76–0.97). Negative control outcome results indicated similar relative risks for appendicitis (0.87; 0.70–1.08) and RA (0.80; 0.67–0.97) comparing moderate to social drinkers, indicating strong potential for unmeasured confounding. Relative risks for CVD, type 2 diabetes, and alcohol-related disease or death did not differ between the groups. Conclusions: Our analyses suggest that moderate alcohol use was associated with a lower risk of CVD or death compared to social drinking. However, even after comprehensively accounting for potential biases, unmeasured confounding may explain this lower risk, highlighting the need for trials to assess the health impacts of reducing intake. (ClinicalTrials.gov: NCT06583161).
Abstract P2085: Variation in Incident Atherosclerotic Cardiovascular Disease Across Asian American, Native Hawaiian and other Pacific Islander Subgroups: The PANACHE Study
Authors: Alan Go, Rishi Parikh, Andrew Ambrosy, Thida Tan, Stacey Alexeeff, Connor Howick, Joan Lo, Yihe Daida
Journal: Circulation (2025)

Introduction: Atherosclerotic cardiovascular disease (ASCVD) risk varies substantially across racial and ethnic groups, yet few data exist among disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) subgroups. Methods: We identified 2,653,007 members of Kaiser Permanente Northern California and Kaiser Permanente Hawaii integrated healthcare delivery systems from 2012-2022 who were aged ≥30 years with no evidence of prior cardiovascular disease. ASCVD events (acute myocardial infarction and stroke) were identified through December 2023 using validated discharge codes and death certificates. We calculated age- and sex-adjusted rates of incident ASCVD by racial/ethnic subgroup. We then examined the multivariable association between AANHPI subgroup with incident ASCVD compared to non-Hispanic White, after adjustment for age, sex, diabetes, hypertension, dyslipidemia, chronic kidney disease, body mass index, and tobacco use. Results: Between 2012-2022, we identified 182,776 Chinese, 193,327 Filipino, 64,488 Native Hawaiian/other Pacific Islander, 45,502 Japanese, 21,989 Korean, 92,738 South Asian, 50,141 Vietnamese, 26,602 other Southeast Asian, and 1,975,444 non-Hispanic White eligible adults. Mean (SD) age was 49 (15) years overall, ranging from 41 (12) years in South Asian to 55 (16) years in Japanese, with 53% women and higher proportions of women in AANHPI subgroups compared to non-Hispanic Whites. Age- and sex-adjusted rates (per 1000 person-years) of incident ASCVD vs. non-Hispanic Whites (3.61) from highest to lowest in AANHPI subgroups were: Native Hawaiian/other Pacific Islander (6.97), other Southeast Asian (5.37), South Asian (4.85), Filipino (4.23), Vietnamese (3.28), Japanese (3.20), and Chinese (2.50). After adjustment for traditional mediators of cardiovascular risk, compared to non-Hispanic Whites, incident ASCVD was higher for Native Hawaiian/other Pacific Islanders, South Asians, and other Southeast Asians; lower for Chinese, Japanese and Korean; and not significantly different for Filipino and Vietnamese ( Figure ). Conclusions: In a large, contemporary population in California and Hawaii, notable variation existed in the risk of incident ASCVD across AANHPI subgroups that was only partially explained by differences in demographic characteristics and clinical ASCVD risk factors. Delineating AANHPI-specific factors will help to reduce disparities in ASCVD in these growing populations within the U.S.
Abstract P2087: Sex Disparities in Acute Myocardial Infarction Identification and Treatment.
Authors: Mary Imboden, Renee Swanson, Adrienne Jones, Jane Bryant, Lori Tam, Kevin Woolf
Journal: Circulation (2025)

Background: Early identification and diagnosis are pivotal in the management of patients with acute myocardial infarction (AMI). The American Heart Association / American College of Cardiology (AHA/ACC) guidelines recommend obtaining an electrocardiogram (ECG) for patients who present to the emergency department (ED) with ischemic symptoms within 10 minutes of arrival. This is an important step in ensuring early administration of reperfusion therapy for those with an ST-elevation myocardial infarction (STEMI). A goal of ≤90 min or ≤ 120 min when transfer is involved is recommended for door-to-balloon (DTB) procedure time to reduce the risk of poor outcomes. However, past research has shown that sex disparities exist in ED triage and timely treatment of patients experiencing an AMI. The aim of this study was to assess sex differences in timely identification and treatment of patients presenting to the ED with AMI. Methods: We performed a retrospective cross-sectional analysis of 874 STEMI (234 females and 640 males) and 1,650 Non-STEMI (NSTEMI; 556 females, 1095 males) patients that presented to two urban EDs between January 1, 2022, and March 31, 2024. Sex differences in time to ECG (STEMI and NSTEMI) and DTB (STEMI only) were compared continuously, as well as categorically based on AHA/ACC recommendations (ECG delay: &gt;10 min, DTB delay: &gt;90 min or &gt;120 min with transfer). Continuous variables were compared using a multi-factor analysis of variance and categorical variables were tested using chi-square test of association. Results: Median time to ECG was 4.0 min longer for female compared to male STEMI patients, and 2.5 min longer for female vs male NSTEMI patients (ECG delay: 20.3% of female vs. 11.6% of male STEMI patients and 29.3% female vs. 20.3% of male NSTEMI patients). EMS activation time to ECG was also longer in females (+7.4 min for female STEMI patients and +2.9 min for female NSTEMI patients, compared to male counterparts). Similarly, DTB was 28.0 min longer when no transfer was involved and 15.2 min longer with transfer in female compared to male STEMI patients (DTB delay: 40.6% female vs. 37.0% male STEMI patients). Conclusion: In AMI patients presenting to the ED, female sex was associated with a significantly longer time to ECG. Female STEMI patients also had longer DTB times, which is associated with poorer outcomes. Initiatives are needed to understand these sex disparities and achieve the AHA/ACC guidelines for both time to ECG and DTB.
Abstract MP10: Using Target Trials and Machine Learning to Estimate Heterogeneous Treatment Effects of First-Line Antihypertensive Medications
Authors: Jingzhi Yu, Abel Kho, Lucia Petito, Norrina Allen
Journal: Circulation (2025)

Introduction: Guidelines for hypertension (HTN) treatment make universal recommendations, ignoring prior research demonstrating differences in BP reduction between HTN medication classes in individuals with different clinical presentations. Here, we leveraged causal inference methods to emulate randomized trials to assess heterogeneity in the effectiveness of first-line HTN treatments. Methods: A hypothetical target trial was designed to assess comparative effectiveness of first-line HTN medications in subgroups defined by clinical presentation. For its emulation, patients with new HTN diagnosis (2014-2022) at Northwestern Medicine (NM) who initiated medication treatment (ACEi, ARB, CCB, Diuretics, CCB or Diuretic combination treatment [with ACEi/ARB]) were selected from the NM electronic health records. Eligibility criteria were: no prior prescription of HTN medication, 1+ outpatient visit in the year before diagnosis, and no pregnancy within a year of HTN diagnosis. The primary outcome was achieving a blood pressure of under 140/90 mm Hg after six months. The analysis involved three steps: using g-computation to estimate individual treatment effects (ITE) of antihypertensive medications, employing Causal Forest to identify key clinical variables affecting ITE, and using targeted maximum likelihood estimation with SuperLearner to estimate treatment effects within patient subgroups. Results: Our study included 22,433 eligible patients from NM. We created 16 patient subgroups by using commonly used clinical thresholds of systolic BP, low-density lipid cholesterol, age, and BMI to partition the overall patient population. Statistically significant differences in treatment effects were found in several subgroups – e.g. in subgroup 1, diuretics were found to perform significantly better than all other HTN medications ( Figure ). Conclusions: Personalized HTN treatment strategies have the potential to improve BP control rates in many patient populations.