tbuckley/cabot-search huggingface dataset:
Abstract P2138: Childhood Parental Incarceration and Adverse Pregnancy Outcomes
Authors: Nicole Fields, Jaclyn Borrowman, Natalie Cameron, Sadiya Khan, Mercedes Carnethon, Amanda Perak, Kiarri Kershaw, Donald Lloyd-Jones, Nia Heard-Garris
Journal: Circulation (2025)

Background: Adverse childhood experiences (ACEs) are associated with adverse pregnancy outcomes (APOs). However, the association between specific ACEs, such as parental incarceration, with APOs is not well understood. We examined whether: (1) childhood parental incarceration and its duration are associated with APOs and (2) if the association differed by race and ethnicity. Methods: Parous participants ≥ 18 years without: (1) history of CVD or diabetes and (2) did not have a pregnancy prior to age 18 in Wave V (2016-2018) of the US National Longitudinal Survey of Adolescent to Adult Health were analyzed. Childhood parental incarceration was defined as incarceration of the respondent’s parent/parental figure before age 18. Duration of parental incarceration was calculated by taking the difference of the age of respondents when the parent started and ended incarceration. Our outcome was defined as the self-reported occurrence of any APO (gestational diabetes, hypertensive disorder of pregnancy, small for gestational age, and pre-term birth). Multivariable logistic regression models assessed associations between parental incarceration and APOs. Covariates included age, difficulty paying bills, marital status, and smoking status during pregnancy. Models were stratified to assess interaction by race and ethnicity. Results: Among 2,088 participants, 234 (11.2%) reported a history of parental incarceration. Women with a history of parental incarceration were younger at first pregnancy, disproportionately Black, more likely to struggle paying bills, and had a higher prevalence of APOs. In unadjusted models, women who experienced childhood parental incarceration had 45% increased odds of experiencing an APO (OR 1.45; 95% CI: 1.10-1.92) but was nonsignificant after adjustment (OR 1.16; 95% CI: 0.83-1.62). Duration of incarceration was not associated with occurrence of APOs though the association differed by race such that a one-year increase in duration of parental incarceration was associated with 6% increased odds of having an APO among Black women (OR 1.06; 95% CI: 1.001-1.12). Conclusions: Longer duration of childhood parental incarceration was associated with higher odds of APOs for Black women. Future research should examine biological pathways by which parental incarceration contributes to deleterious health outcomes, particularly in minoritized communities.
Abstract 061: Joint Associations of Objectively Measured Physical Activity and Cardiovascular-Kidney-Metabolic Syndrome with All-Cause Mortality in US Adults
Authors: Joseph Sartini, Mary Rooney, Jennifer Schrack, John McEvoy, Chiadi Ndumele, Scott Zeger, Elizabeth Selvin, Michael Fang
Journal: Circulation (2025)

Introduction: Physical activity is recommended for slowing the progression of Cardiovascular-Kidney-Metabolic (CKM) syndrome. Guidelines suggest lifestyle modification may be most beneficial for those with advanced CKM (stages 3-4), but few studies have compared the impact of physical activity across the CKM spectrum. Objective: We examined associations between physical activity (PA) patterns and risk of all-cause mortality across CKM stages. Methods: We conducted a weighted, prospective cohort analysis of the 2003-2006 National Health and Nutritional Examination Survey (NHANES), with follow-up until December 31, 2019. We restricted analyses to those adults who were ≥ 20 years old, not pregnant, and able to walk. We classified participants according to CKM stage. We calculated average daily moderate-to-vigorous physical activity (MVPA) using up to 7 days of actigraphy data and the standard cut-point of 2000 activity counts per minute. We visualized the MVPA distributions by CKM stage and calculated the proportion of adults meeting the recommended MVPA target of ≥ 150 minutes a week (≥ 21.4 minutes per day). We fit Cox regression models to estimate relative and absolute mortality risk using a polynomial B-spline of log-MVPA with a single knot at the midpoint. We stratified all analyses by CKM stage and adjusted models for demographics. Results: We included 7,246 adults (weighted mean age 47.6 yrs, 51.5% female). Over a median follow up of 14.4 years, there were 1676 deaths. The percentage of US adults achieving the AHA-recommended MVPA target ranged from 7.3% (CKM stage 3) to 43.1% (CKM stage 0 to 1) ( Fig. 1A ). Greater MVPA was associated with lower hazard of mortality across CKM stages. Hazard ratios of reaching the AHA recommendation, as opposed to being sedentary, ranged from 0.93 (CKM stage 0/1) to 0.52 (CKM stage 4). The minimum MVPA associated with lower mortality ranged from 4.1 minutes per day (CKM stage 3) to 19.9 minutes/day (CKM stage 0/1) ( Fig. 1B ). The associations between greater MVPA and lower absolute mortality risk were more pronounced in later stage CKM ( Fig. 1C ). Conclusion: MVPA is associated with lower mortality along the full spectrum of CKM syndrome. The benefits of MVPA appeared largest in advanced CKM (stages 3-4), where even modest activity potentially confers cardioprotection.
Abstract P1011: Home Blood Pressure Monitoring and Risk of Falls in Older Adults with Hypertension: the AMBROSIA-HOME Cohort Study
Authors: Bharat Poudel, Daichi Shimbo, Joseph Schwartz, Kristi Reynolds, Zhixin Wang, Teresa Harrison, Kimberly Cannavale, Rong Wei, Paul Muntner, Barrett Bowling, Emily Levitan
Journal: Circulation (2025)

Background: Over-intensification of antihypertensive medication may lead to hypotension and excessive blood pressure (BP) variability and thus increase the risk for falls, a major cause of injury-related hospitalization and death among older adults. Monitoring BP at home may allow for better BP management and avoidance of falls. Objective: To evaluate the associations of home BP, white coat effect (difference between clinic and home BP), and day-to-day variability of BP with falls. Methods: The Ambulatory Blood Pressure in Older Adults Home BP Monitoring (HBPM) (AMBROSIA-HOME) study included 541 participants from Kaiser Permanente Southern California aged ≥65 years taking antihypertensive medication. Participants were instructed in proper HBPM technique and asked to take 2 BP readings each morning and each evening for 7 days. We included 499 participants (92.2%) with ≥4 days with 2 morning and 2 evening HBPM readings. For both systolic BP (SBP) and diastolic BP (DBP), the white coat effect was defined as mean clinic BP minus mean BP from HBPM and the standard deviation independent of the mean (SDIM) of morning and evening BP were calculated as measures of day-to-day variability. Participants reported any fall where their body parts hit a surface, including falls that occured on stairs, monthly for 1 year using falls calendars. We used Cox proportional hazards models to estimate hazard ratios of time to first fall across quartiles of each HBPM metric, separately, adjusting for demographic characteristics and chronic conditions. Results: The mean ± SD age of participants was 74.2±6.1 years, and 57.3% were women. The prevalence of prefrailty and frailty were 50.7% and 3.4%, respectively. Participants in the top quartile of mean SBP from HBPM were older, more frequently male, more frequently Black and Hispanic, and had higher prevalence of diabetes, arthritis, and neuropathy than those in the lowest quartile. There were 187 participants who reported falls (376 falls/1,000 person-years). We did not find evidence of associations between mean, white coat effect, or SDIM of SBP ( Figure ) or DBP from HBPM and falls. Conclusion: In this population of older US adults with treated hypertension, BP measured using HBPM was not associated with falls.
Abstract P3009: Biomarkers and Risk of Cognitive Impairment in Atrial Fibrillation: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort
Authors: Vinh Le, Samuel Short, Katherine Wilkinson, Suzanne Judd, Hyacinth Hyacinth, Nels Olson, Melissa Smith, Mary Cushman
Journal: Circulation (2025)

Introduction: Atrial fibrillation (AF) is highly prevalent, and its health effects outside of stroke are under intense study. AF increases dementia risk, but underlying mechanisms are unknown. Stroke or cerebrovascular pathophysiology, possibly attenuated with anticoagulation, may be contributory. Hypotheses: We assessed two hypotheses: (1) that higher levels of 9 circulating biomarkers (see Figure) would be associated with greater risk of incident cognitive impairment (ICI) in REGARDS participants with AF, and (2) that associations would be attenuated after adjusting for oral anticoagulant use. Methods: REGARDS enrolled 30,239 persons &gt; 45 years old in 2003-07. AF was defined by self-report or ECG. ICI was defined during follow-up by robust cognitive norms based on the Montreal Cognitive Assessment and Six-Item Screener. Biomarkers were measured at baseline in participants with AF and no prior stroke. HRs of time to ICI by biomarkers were calculated by Cox proportional hazards models, with covariates shown in the Figure. Interaction testing by baseline oral anticoagulant use was also performed. Results: Among 2,261 participants with baseline AF, mean follow-up was 10.6 years (mean age 66.5 years, 51% women, 28.7% Black), and there were 149 ICI cases (7%). Higher NT-proBNP, FVIII, and GDF15 were each associated with ICI (Figure), with the largest association for FVIII (HR adj 2.41 per SD higher FVIII). Added adjustment for anticoagulant use did not attenuate associations, but the association of GDF15 was lower among those on anticoagulation (HR 1.0, 95% CI 0.4-2.6 compared to HR 1.8, 95% CI 1.1-3.0 without anticoagulation; p interaction 0.07). Conclusion: Higher NT-proBNP, FVIII, and GDF15 were associated with ICI in this biracial cohort with AF. Risk associated with GDF15, an inflammation marker, might be reduced with anticoagulation, but further study is needed.
Abstract P2002: Cardiovascular Diseases Risk Assessment in the Adult Population: the Italian Health Examination Survey 2023-2024 - CUORE Project
Authors: Chiara Donfrancesco, Cinzia Lo Noce, Anna Di Lonardo, BENEDETTA MARCOZZI, Serena Vannucchi, MARIA MORELLO, SERGIO BERNARDINI, DANIELA GALEONE, Paolo Bellisario, Luigi Palmieri
Journal: Circulation (2025)

Introduction: The reduction of non-communicable diseases premature mortality is pursued by the WHO; risk conditions targets are recommended as well as population-level monitoring of cardiovascular disease (CVD) risk. The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported periodic CVD risk assessment through national health examination surveys (HESs), technically and financially supported by the Ministry of Health - National Centre for Disease Prevention and Control, and conducted within the CUORE Project. Hypothesis: The aim of assessment is the monitoring of the cardiovascular risk distribution in the Italian general population. Methods: In 2023 a new HES started including the 10-year fatal and non-fatal CVD risk assessment based on the knowledge of sex, age, smoking habit, measured systolic blood pressure and fasting total and HDL serum cholesterol, and presence of diabetes (on measured fasting serum glycemia and/or treatment) and anti-hypertensive therapy. Up to now, data from random samples of residents in 12 Regions (of 20 regions) distributed in North, Centre and South of Italy, aged 35-69 years, without previous CVD, are available (1029 men, 1064 women). Determinations were assayed by a central lab. CUORE Project functions developed on and for the Italian adults were used. Results: Mean values of the CVD risk assessment resulted 6.7% (95% CI: 6.3-7.1) in men and 2.2% (2.1-2.4) in women. For men aged 35-44 years risk was 1.6% (1.5-1.7), for 45-54 years 3.9% (3.6-4.2), for 55-64 years 9.3% (8.7-10.0), for 65-69 years 17.1% (16.1-18.1); for women was 0.4% (0.4-0.5), 1.1% (1.0-1.2), 3.1% (2.8-3.4) and 5.8% (5.4-6.2) respectively. Prevalence of CVD risk less than 5% was 56% (50-62) in men and 88% (85-92) in women, of 5-10% risk were 23% (19-28) of men and 10% (6-13) of women, of 10-15% risk were 4% (2-7) of men and 0% of women, of over 15% risk were 1% (0-2.5) of men and 0% of women. Conclusions: Compared to 2008, these data showed stable mean levels of CVD risk both in men and women at any age-classes and stable prevalence of CVD risk classes. CVD risk perception represents a challenge in primary prevention especially for young age groups and women.
Abstract P1023: Temporal Changes in High-Sensitivity C-Reactive Protein and Risk of Atrial Fibrillation in African Americans: The Jackson Heart Study
Authors: Hiroto Yagasaki, Wondwosen Yimer, Daisuke Kamimura, Nancy Min, James Floyd, Kaustuv Bhattacharya, Susan Heckbert, Michael and Jo Alice Hall, Adolfo Correa, Takeki Suzuki
Journal: Circulation (2025)

Background: Atrial fibrillation (AF) is associated with significant morbidity and mortality. Inflammation plays an important role in AF pathogenesis. The relationship between high-sensitivity C-reactive protein (hs-CRP), a key biomarker of chronic inflammation, and incident AF in African Americans (AAs), remains unclear. This study aimed to examine the association between baseline and serial hs-CRP levels and incident AF in AAs in the Jackson Heart Study (JHS). Methods: Participants of the JHS with hs-CRP assessment and without previous AF at baseline were included in the study. hs-CRP measurement at Visit 1 (baseline) and Visit 2 were used. Elevated hs-CRP was defined as 3 mg/L per guidelines. Incident AF was defined as having 12 lead electrocardiogram evidence at a subsequent follow up, or a documented diagnosis code at the time of hospital discharge from 2000 to 2016. Cox proportional hazards models were used to evaluate the association between baseline hs-CRP as a continuous variable and AF risk (t 0 =Visit 1), and the risk of AF in those with elevated hs-CRP at Visit 1 or 2, compared to those who had never had elevated hs-CRP (t 0 =Visit 2). Results: Of the 4,169 participants followed for a median of 13.7 years, 351 participants developed AF (6.7 cases per 1,000 person-years). 1,089 participants (44.1%) never had elevated hs-CRP, while 1,379 (55.9%) had elevated hs-CRP at Visit 1 or 2. hs-CRP at baseline was significantly associated with incident AF in Model 1 (age and sex-adjusted), but not in Model 2 (further adjusted) (Table). Elevated hs-CRP at Visit 1or 2 was associated with higher risk of AF incidence in both Model 1 (HR 1.81, 95% CI 1.28-2.58, P &lt; 0.005) and Model 2 (HR 1.61, 95% CI 1.11-2.32, p&lt;0.05). Conclusion: In a community AA cohort, baseline hs-CRP was not associated with incident AF. On the other hand, individuals with elevated hs-CRP at Visit 1 or 2 had a higher risk of AF incidence. This might suggest usefulness of serial hs-CRP measurements to identify those with lower AF risk.
Abstract P3026: Prevalence of Cardiac Arrhythmias by Cardiovascular-Kidney-Metabolic Syndrome Stage: The Atherosclerosis Risk in Communities Study
Authors: Amelia Wallace, Sui Zhang, Esther Kim, Elizabeth Selvin, Chiadi Ndumele
Journal: Circulation (2025)

Background: Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder resulting from the complex relationships between obesity, diabetes, kidney disease, and the cardiovascular system. CKM syndrome is associated with atherosclerotic cardiovascular disease, heart failure, sudden cardiac death, and atrial fibrillation (AF), but the prevalence and burden of other major arrythmias have not been characterized in CKM. Methods: We conducted a cross-sectional study of participants in the Atherosclerosis Risk in Communities (ARIC) Study who attended Visit 6 (2016 – 2017) and wore a non-invasive single-lead electrocardiogram patch (Zio XT) for up to 2 weeks. We evaluated the age-adjusted prevalence of 4 major arrhythmias (AF, long pause lasting &gt;3 seconds, non-sustained ventricular tachycardia, and Mobitz type 2 or third-degree atrioventricular block) by CKM stages. CKM stage is defined as: Stage 0/1 – no risk factors or excess/dysfunctional adiposity; Stage 2: metabolic risk factors or moderate- to high-risk chronic kidney disease; Stage 3: subclinical CVD, high predicted CVD risk, or very high-risk chronic kidney disease; and Stage 4: clinical CVD. Results: Our study included 2,616 ARIC participants (mean age 79.2 years; 58% female; 26% Black). Overall, prevalence of advanced CKM syndrome was high (Stage 4: 37.8%, Stage 3: 42.2%, Stage 2: 16.4%, Stage 0/1: 3.3%). Compared to participants with Stage 0/1 CKM, participants with Stage 4 CKM were more likely to be older (mean age 80.2 vs. 76.1 years), male (48% vs. 31%), Black (29% vs. 7%), have &lt;High School education (16.9% vs. 3.4%), smoke cigarettes (8.0% vs 2.4%), and were less likely to drink alcohol (44.0% vs. 60.0%). Age-adjusted prevalence of all major arrhythmias was highest among participants with Stage 4 CKM, including non-sustained ventricular tachycardia (36.8%) and AF (15.6%) ( Figure ). Conclusions: The age-adjusted prevalence of clinically significant arrhythmias is high among older community-dwelling adults with advanced CKM syndrome. Efforts to achieve and maintain more optimal CKM health may help to reduce the odds of developing major arrhythmias.
Abstract P1042: Effects of urban greenspace on time to major adverse cardiovascular events among women with breast cancer: Insights from the Greater Milwaukee Area
Authors: Jean Bikomeye, Sergey Tarima, Yuhong Zhou, Jamila Kwarteng, Andreas Beyer, Tina Yen, Aaron Winn, Kirsten Beyer
Journal: Circulation (2025)

Background: Cardiovascular disease (CVD) remains a significant concern among breast cancer (BC) survivors, particularly following potentially cardiotoxic treatments, such as anthracyclines and anti-HER2 drugs, which increase the risk of major adverse cardiovascular events (MACE). Social determinants of health (SDOH) and environmental factors influence health outcomes, including those related to CVD. Greenspace has been associated with cardiovascular and cancer-related health benefits, yet its specific impact on MACE among BC survivors remains unknown. Objective: This study aims to investigate the association between urban greenspace and time to first MACE incidence among individuals with BC after being treated with cardiotoxic therapies in the greater Milwaukee, WI area. Methods: A retrospective cohort study was conducted using electronic medical records from the Froedtert Health System, linked to the National Death Index. Cox proportional hazards regression models were used to assess the association between percent tree canopy cover and MACE-specific hazards, adjusting for sociodemographic, clinical, and neighborhood-level factors. Results: Among the 849 women included, 44.6% experienced a MACE. Non-Hispanic Black (NHB) women had a higher proportion of MACE incidence. Adjusted models indicated a 18% and 20% lower MACE-specific hazard for women in the second and third quartiles of percent tree canopy cover, as compared to the women in the first (lowest) quartile, respectively. Racial/ethnic disparities in MACE incidence were evident, with the NHB group having a higher proportion of MACE (61.9%) compared to NHW women (41.6%). Discussion: Our findings suggest a protective effect of urban tree canopy on time to incident MACE among BC survivors receiving cardiotoxic treatments. These results underscore the importance of considering environmental factors in Cardio-Oncology care and highlight the benefits of greenspace in mitigating cardiovascular complications among individuals with BC. Future research should delve into environmental factors, behavioral factors, and biological mechanisms that underlie these associations. Additionally, longitudinal studies should be conducted to evaluate greenspace-based interventions for BC survivors, aiming to advance precision Cardio-Oncology interventions. Observed racial/ethnic disparities in MACE incidence underscore the urgent need for equity-focused interventions addressing greenspace access and MACE-related disparities.
Abstract 010: Peripheral Neuropathy is Detected in More than Half of Very Old Adults
Authors: Yuan-Haw Andrew Wu, Jiahuan Helen He, Dan Wang, Katherine McDermott, Michael Fang, B Gwen Windham, Elizabeth Selvin, Caitlin Hicks
Journal: Circulation (2025)

Objectives: Emerging evidence suggests peripheral neuropathy (PN) may be more common in older individuals than previously reported, even in the absence of diabetes. However, most studies define PN by loss of protective sensation alone, a late form of PN. We aimed to quantify the prevalence and risk factors for PN in community-dwelling adults aged 80-100 years using the Michigan Neuropathy Screening Instrument (MNSI), a validated screening tool that includes a questionnaire and physical examination. Methods: We conducted a cross-sectional analysis of participants in the Atherosclerosis Risk in Communities Study (2022–2023) who completed the MNSI. Using age-, sex-, site-adjusted logistic regression, we quantified associations between various risk factors and PN, including education, height, body mass index, Short Physical Performance Battery (SPPB) score, lifestyle habits, and comorbidities. PN was defined by a score &gt; 2 on the physical examination or ≥ 7 on the questionnaire portion of MNSI. Results: Among 993 participants (median age 84 years, 40% male, 18% Black, 30% with diabetes), 44.1% screened positive for PN. Risk factors associated with PN included advanced age (≥ 95 years vs 80-85 years, aOR 2.60), male sex (aOR 1.47), taller height (height quartile 2 and 4 vs quartile 1, aOR 1.69 and 1.54), low physical function score (SPPB 0-6 vs 10-12, aOR 2.12), former alcohol consumption (vs no alcohol drinking history, aOR 1.64), and prevalent cardiovascular disease (aOR 1.47) ( Figure ). Diabetes and prediabetes were not significantly associated with PN based on the MNSI, but diabetes was associated with PN based on monofilament testing for loss of protective sensation (aOR 1.51, 95% CI 1.08-2.13). Conclusions: PN detected by the MNSI is highly prevalent among very old adults, regardless of diabetes status. In contrast, PN in adults with diabetes is associated with loss of protective sensation. Routine screening of older adults using the MNSI may be warranted to facilitate early detection and management.