tbuckley/cabot-search huggingface dataset:
Abstract P241: Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease
Authors: Jeffery Osei, Viola Vaccarino, Maggie Wang, Anish Shah, Rachel J Lampert, Yi-An Ko, Brad Pearce, Michael Kutner, Ernest V Garcia, Marina Piccinelli, Paolo Raggi, James Bremner, Arshed A Quyyumi, Yan Sun, George Haddad, Louis Li, Luis Correia, Tatum E Roberts, Lewam Stefanos, Hashir Ahmed, Amit J Shah
Journal: Circulation (2024)

Background: Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease (CAD), but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by lower heart rate variability (HRV) in response to stress, and MSIMI in patients with stable CAD. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI. Methods: In 735 participants with stable CAD, we measured high frequency (HF) and low frequency (LF) HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. MSIMI was evaluated with single-photon emission computed tomography myocardial perfusion imaging. HRV at rest and stress were categorized into low (lowest quartile) versus high (upper three quartiles) categories; low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI. Results: The mean age was 58 (SD ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high stress HRV, low stress HRV (both HF and LF) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors. LF HRV at rest was also significantly associated with MSIMI with slightly reduced effect estimates. Conclusions: In individuals with CAD, mental stress-induced autonomic dysfunction may be an independent mechanism in the pathogenesis of MSIMI.
Abstract P129: Risk of COVID-19 Hospitalization or Death by the AHA's Life’s Essential 8: The Collaborative Cohort of Cohorts for COVID-19 Research (C4R)
Authors: Timothy B Plante, Stephen P Juraschek, Pallavi Balte, Akshaya Krishnaswamy, Yejin Mok, Norrina B Allen, Kelley P Gabriel, Vanessa Xanthakis, Arnita Norwood, Yuan-I Min, Sara Gonzalez, Daniela Sotres-Alvarez, Gregory A Talavera, Martha L Daviglus, Sameer Talegawkar, Yichen Jin, Donald M Lloyd-Jones, Mitchell S Elkind, Tatjana Rundek, Jose Gutierrez, Emily B Levitan, Mary Cushman, Suzanne E Judd, Henry E Wang, Neil A Zakai, Virginia J Howard, Nathalie Pamir, Monika M Safford, Debora Kamin Mukaz, Amanda M Fretts, Elizabeth Oelsner
Journal: Circulation (2024)

Background: It is unknown how cardiovascular health (CVH) relates to severe Covid-19 illness in adults without clinical cardiovascular disease (CVD). We hypothesized that more optimal Life’s Essential 8 (LE8)-quantified CVH is associated with lower risk of severe Covid-19 among US adults without clinical CVD. Methods: C4R is ascertaining Covid-19 events in 14 NIH cohorts via questionnaires, serosurvey, and medical record adjudication. We included cohorts with pre-pandemic LE8 measures of body mass index (BMI), blood pressure (BP), lipids, diet, glucose, physical activity, smoking, and sleep in participants without clinical CVD. Covid-19 was defined as severe (hospitalization, death) or non-severe (all other events). Fine-Gray sub-distribution hazard models compared incident Covid-19 by LE8 quartiles, with non-severe and severe Covid-19 as competing risks. Models were censored at first event, stratified by cohort, and adjusted for sociodemographics and vaccinations at time of Covid-19. Results: Among 21,300 participants in 7 cohorts (mean [SD] age 67 years [14], 61% female, 2% American Indian, 4% Asian, 16% Black, 33% White, 43% Hispanic), mean (SD) LE8 was 65 (14). In 3/2020-9/2022, there were 3,034 non-severe and 488 severe Covid-19 cases. The best CVH quartile (Q) 4 had more non-severe and fewer severe Covid-19 events. The Q4 vs. Q1 aHR was 1.08 (95% CI 0.98, 1.20) for non-severe Covid-19 and 0.59 (0.45, 0.77) for severe Covid-19. Examining LE8 components separately, better status on 5 LE8 components (BMI, BP, glucose, physical activity, smoking) was associated with significantly lower risk of severe Covid-19, whereas 3 were not associated (cholesterol, diet, sleep; data not shown). Conclusions: Better LE8-quantified CVH was associated with 41% lower risk of severe Covid-19 events in adults without clinical CVD. Further research is needed to elucidate mechanisms of Covid-19 resilience and the role of CVH-directed interventions to reduce risks of severe Covid-19.
Abstract P218: Moderate to Vigorous Physical Activity to Improve Cardiovascular and Mental Health in Sedentary Middle-Aged Adults
Authors: Elizabeth A Moxley, Desale Habtezgi, Kris Varothai, Shaine Henert, Rachel Kowal, Barrie Bode, Sara Budwhani
Journal: Circulation (2024)

Introduction: Anxiety and depression are amongst the most common forms of mental illness, of whom 20-30% experience concomitant cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) improves brain-derived neurotrophic factor (BDNF) potentially improving mental health and resilience. Unique barriers to increasing PA engagement exist in those with mental distress, contributing to CVD risk. Research strategies using guideline-based PA programming and motivation may enhance mental well-being, thereby mitigating CVD risk. Objective: To examine the effects of meeting weekly PA recommendations on levels of depression, anxiety, resilience, and associations with CVD risk factors in sedentary middle-aged adults. Methods: Sedentary adults (n=29, 40-60 years) completed a tailored 4-week MVPA regimen after establishing baseline CRF (VO 2 max) using an Astrand-Rhyming cycle ergometer test. Activity trackers (Mi Smart Band 6; Xiaomi) recorded heart rate (HR), and daily steps, along with motivational messaging. Mental health status was measured by pre- and post - brain-derived neurotrophic factor (BDNF) levels, and depression (BDI-II), and anxiety (BAI) scores. CVD risk factors included resting HR, systolic blood pressure (SBP), HbA1c, waist circumference (WC), body mass index (BMI), percent body fat, and lean body mass. Logistical regression determined if factors related to mental health affected achieving MVPA goal. Nonparametric analysis compared pre- and post-response to MVPA. Results: Percentage change of meeting the PA goal decreased by 29% (p=0.048) when the depression score increased by one point. When anxiety scores increased by one point, the likelihood of meeting PA goals increased by 41% (p=0.057). As the resilience score increased by one point, the percentage change of meeting PA goals increased by 17% (p=0.58). Of 29 participants, 19 (65.5%) exhibited no change depression level, two (6.9%) exhibited increased depression, and eight (27.6%) exhibited a decrease in depression. The BDNF decreased in those meeting PA goals, although platelets harbor significant BDNF content posing a profound confounding variable in measured plasma. Following MVPA average weight, BMI and fat mass decreased by 0.5 pounds, 0.11 kg/m 2 and 0.42 lbs., respectively. HbA1c decreased by 0.05% nearing significance (p=0.056). Significant improvements were observed in SBP by 5.44 mmHg (p=0.026) and resting HR (p=0.001). On average WC, fat free mass and VO 2 max increased by 0.61 cm, 9.44 kg/m 2 and 1.22 ml/kg/min respectively. Conclusions: MVPA consistent with the guidelines in middle-aged adults predicts improved anxiety and depression compared to sedentary behavior, likely improving cardiovascular health. A longer-term study to evaluate body composition and metabolic response to PA, in addition to further investigation of BDNF to assess its value in response to MVPA is currently warranted.
Abstract P289: In Africans With Abnormal Glucose Tolerance the Triglyceride-Glucose Index is a Feasible, Effective Way to Distinguish Between Beta-Cell Failure and Insulin Resistance
Authors: Charlita Worthy, Pramodkumar Aravindakshan, Mariam Sayed, Eliza Huefner, Jamaiica Hurston, Christopher W DuBose, Ram Jagannathan, Anne E Sumner
Journal: Circulation (2024)

Background: With the prevalence of abnormal glucose tolerance (Abnl-GT) soaring in sub-Saharan Africa, there is a growing appreciation that the major etiology of Abnl-GT in Africans may be beta-cell failure rather than insulin resistance (IR). As optimal therapy depends on etiology, distinguishing between beta-cell failure and IR is critical. However, identifying IR with formulas such as the Matsuda Sensitivity Index which requires insulin to be assayed in plasma, is expensive and rarely available in medical clinics in most African countries. Therefore, our goal was to use data from the Matsuda Index as the diagnostic standard, and determine how well the widely available, low-cost Triglyceride-Glucose Index (TyG) performs in distinguishing between beta-cell failure and IR in Africans with Abnl-GT. Methods: OGTTs and fasting triglyceride (TG) levels were obtained in 589 African immigrants living in the Washington DC area (Male: 64%, Age: 39±11, (mean±SD) range 20 -69y; BMI 27.9±4.5 kg/m 2 range 19.5-41.9). Glucose tolerance status was determined by ADA criteria for the OGTT. IR was defined as the lowest quartile of the population distribution of the Matsuda Index (≤2.89). As a primary etiology, beta-cell failure was defined as Abnl-GT in the absence of IR. Insulin secretion was calculated using the insulinogenic index. The formula for TyG was: ln(fasting glucose &amp; fasting TG)/2. IR by TyG was defined by the highest quartile of its distribution across the cohort(≥3.38). Results: Abnl-GT occurred in 39% (228/589) of the enrollees. Among participants with Abnl-GT, the prevalence of beta-cell failure and IR were: 59% (134/228) vs. 41% (94/228), P &lt;0.001, respectively. Compared to Africans with Abnl-GT and IR, Africans with Abnl-GT and beta-cell failure had less IR &amp; lower insulin secretion (both P&lt;0.001). Overall, with data from the Matsuda Index as the diagnostic standard, TyG correctly identified the etiology of Abnl-GT in 90% (205/228) of the participants with Abnl-GT, specifically 93% (125/134) with beta-cell failure and 85% (80/94) of participants with IR. Conclusions: As the TyG correctly identified the etiology of Abnl-GT in 90% of Africans, it may be a feasible, economically viable alternative to the Matsuda Index in determining whether Africans with Abnl-GT have beta-cell failure or IR. With correct information about Abnl-GT etiology, therapy for can be optimized.
Abstract P205: Poor Sleep Quality and Daytime Sleepiness Associated With Lower Quality Diet in an Israeli Cohort
Authors: Kathryn E Kennedy, Rockwell Bortz, Elliot Rosenberg, Michael A Grandner
Journal: Circulation (2024)

Introduction: Sleep health and diet quality are bidirectionally linked. Poor sleep can impair metabolic function and alter eating behavior, while a poor quality diet may negatively impact sleep and daytime function through multiple pathways (i.e. inflammation, obesity, daytime fatigue). Methods: In a 2017 Israeli Bureau of Statistics population-based survey of households, 7,230 Israeli individuals reported habitual sleep and diet quality. Sleep variables included sleep duration (≤5, 6, 7, 8, or ≥9 hours per night), sleep disturbances (0, ≤1, 2-3, or 4+ nights per week), and daytime sleepiness (categorized as either “None”, “Not Much”, “Somewhat”, or “Greatly”). Diet variables were categorized as 0, 1, 2, 3, or 4+ daily servings of vegetables, fruits, and whole grains, and 0, 1, 2, 3, or 4+ weekly servings of legumes, red meat, and fish. Covariates included age, sex, BMI, financial status, and ethnicity. Results: Individuals who slept ≤5 hours were less likely to eat daily vegetables (oOR=0.863, p&lt;0.05). Individuals who slept ≤7 hours were less likely to eat daily fruits (oOR=0.858, p&lt;0.02), and whole grains (oOR=0.0.772, p&lt;0.0005). Individuals who slept ≥9 hours were less likely to eat daily vegetables (oOR=0.803, p=0.038), fruits (oOR=0.783, p=0.025), or wholegrains (oOR=0.783, p=0.027), as well as weekly legumes (oOR=0.788, p=0.025), and fish (oOR=0.779, p=0.028). Those with severe sleep disturbances (4+ per week) were less likely to eat daily vegetables (oOR=0.675, p&lt;0.0005), fruits (oOR=0.765, p&lt;0.0005), and whole grains (oOR=0.840, p=0.011), or weekly legumes (oOR=0.806), p=0.001). Mild daytime sleepiness was associated with fewer daily vegetables (oOR=0.834, p=0.007), while “great” daytime sleepiness was associated with fewer vegetables (oOR=0.558, p&lt;0.0005), fruits (oOR=0.689, p&lt;&gt;0.0005), wholegrains (oOR=0.751, p&lt;0.0005), and legumes (oOR=0.734, p&lt;0.0005). In a stepwise model adjusting for all sleep variables, many measures of poor sleep were independently associated with fewer daily vegetables, fruits, and wholegrains, fewer weekly legumes, and more weekly red meat. Conclusions: While the relationship between sleep and diet is complex, these data suggest that multiple independent pathways link poor sleep with an objectively unhealthier diet. The interaction between diet and daytime function, in particular, warrants further attention. Interventions targeting healthier sleep and diet must consider all aspects of sleep quality, including nocturnal sleep itself and daytime sleepiness.
Abstract P245: Association Between Individual Socioeconomic Status and Discharge Dispositions to Home or Rehabilitation Following Incident Stroke Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ning Li, Erin L Abner, Silvia Koton, Lena M Mathews, Kunihiro Matsushita, Anna Kucharska-Newton
Journal: Circulation (2024)

Background: The contribution of socioeconomic status (SES) to discharge destination in stroke survivors is not known. Hypothesis: Discharge to home, as compared to inpatient rehabilitation, will be greater among stroke survivors with low, as compared to high SES. Methods: The study population included ARIC Study participants, enrolled in fee-for-service Medicare, aged 66 years or older, with incident ischemic or hemorrhagic stroke (1992-2017). Black participants from the Minneapolis and Washington County study centers were excluded due to low numbers. Individual SES was estimated from median household income and education. Discharge disposition was ascertained from CMS Medicare inpatient records. Logistic regression models with inverse probability of treatment weighting were used to estimate the effect of exposures, accounting for age, sex, race, study center, comorbidity, and stroke severity. The Elixhauser Comorbidity Index was used to as a measure of comorbidity burden. Stroke severity was estimated from discharge diagnosis and procedure codes obtained from Medicare hospitalization records. Results: Of a total 710 ARIC stroke survivors (mean age at discharge 76 (SD: 6.2) years, 30.1% (214 of 710) Black, 57.5% (408 of 710) women), 50.7% (360 of 710) were discharged home. Compared to high income, low and moderate income was associated with lower adjusted odds of discharge to home among White participants (AOR:0.8, 95% CI: 0.68-0.93) and AOR: 0.63, 95% CI: 0.57-0.69), respectively) and higher odds discharge to home among Black participants (AOR: 1.36, 95% CI: 1.07-1.73 and AOR: 1.43, 95% CI: 1.11-1.83, respectively). Low income was also associated with higher odds of discharge home among women. Adjustment for stroke severity and comorbidity did not attenuate estimates. No significant association between education and discharge disposition was observed. Conclusions: Low and moderate median household income is statistically significantly associated with discharge home among Black and female stroke survivors.
Abstract P284: Effects of a Laughter Program on Cardiovascular Risk Factors in Community-Dwelling Older Adults
Authors: Tetsuya Ohira, Narumi Funakubo, ERI Eguchi, Kokoro Shirai
Journal: Circulation (2024)

Introduction: While there have been several intervention studies on the psychological effects of laughter, few have examined both the psychological and physical effects in community-dwelling older people. This study aimed to examine the effects of a laughter program on body weight, waist circumference, heart rate, blood pressure, grip strength, and health-related quality of life (HRQOL) in community-dwelling older adults using an intervention trial in Japan. Hypothesis: Laughter-based interventions are effective in reducing cardiovascular risk factors and improving quality of life in the community-dwelling elderly population. Methods: In Yao City, Osaka Prefecture, two school districts were selected and participants were recruited for a laughter program for seniors aged 70 and older in each district. One of the two districts was assigned to receive the laughter program first (laughter intervention group), and the other was assigned to receive the laughter program later (control group). A total of 87 people applied to participate (40 in the intervention group, mean age 75 years; 37 in the control group, mean age 75 years), and the intervention group received 10 laughter programs over 12 weeks. The laughter program was composed of an approximately 30-min lecture about laughter and health, or an approximately 30-min appreciation of rakugo by a professional performer of rakugo , a traditional form of Japanese comic storytelling, and an approximately 60-min laughter yoga class by the laughter yoga teachers. Rakugo was regarded as part of the laughter lectures, and three lectures were given. In both groups, participants were measured for weight, waist circumference, blood pressure, grip strength, and HRQOL at baseline and after 12 weeks. The effects of the laughter program on these factors were analyzed using analysis of covariance for change in each measure, adjusted for age, sex, baseline values, and medication use. Results: None of the participants were injured or physically ill from the laughter program. The laughter program significantly improved the mean waist circumference ( p &lt;0.001), heart rate ( p = 0.04), grip strength ( p &lt;0.001), and mental component summary scores of HRQOL ( p = 0.04). A similar tendency occurred for the mean changes in diastolic blood pressure and physical component summary scores of HRQOL. No significant changes were observed for body weight and systolic blood pressure. Conclusion: The comprehensive 12-week laughter intervention program, consisting primarily of laughter yoga, significantly improved physical and psychological functions such as waist circumference, heart rate, grip strength, and HRQOL among community-dwelling older adults.
Abstract P384: Longitudinal Associations of Deprived Neighborhoods With Incident Cardiovascular Disease and Cardiovascular Mortality Among UK Biobank Participants
Authors: Kosuke Tamura, Yangyang Deng, Moniruzzaman Mohammad, Breanna Rogers, Ram Jagannathan, Lu Hu, Veronique L Roger, Leonardo Marino-Ramirez
Journal: Circulation (2024)

Introduction: In 2019, the global prevalence of cardiovascular disease (CVD) reached 523 million, and CVD resulted in 18.6 million deaths. Despite well-documented associations between social determinants of health and CVD, sparse data exist on the associations between living in deprived neighborhoods and incident CVD and mortality. Hypothesis: Living in deprived neighborhoods increases the risk of CVD incidence and mortality. Methods: We analyzed the UK Biobank prospective cohort, excluding prevalent CVD cases at baseline (n=297,950, mean age=55.5 years, female=53.2%). The primary exposure was the neighborhood deprivation index (NDI), defined as an area-level proximity measure of neighborhood socioeconomic status. A higher score indicates more deprived neighborhoods (expressed in quartiles). The primary outcomes were incident CVD and CVD-related mortality, including 1) overall CVD, 2) ischemic heart disease (IHD), and 3) cerebrovascular disease (CeVD). Cox proportional-hazard regression models were used to examine associations between NDI and CVD outcomes, adjusting for covariates and reported hazard ratios (HRs) with 95% confidence intervals (CIs). Results: During a median follow-up of 14.3 years (4,261,877 person-years), 20,113 incidents and 12,619 deaths were included in the analysis. In comparison to those living in the lowest NDI quartile (least deprived), those in the highest NDI quartile (most deprived) had a 20%, 15%, and 34% greater risk of developing overall CVD, IHD, and CeVD incidence, respectively ( Table ). Moreover, they exhibited a 33%, 34%, and 35% greater risk of mortality for overall CVD, IHD, and CeVD, respectively. Conclusions: Our study demonstrates that living in highly deprived neighborhoods increased the risk for CVD, IHD, and CeVD incidence and mortality in the UK Biobank cohort. Future research should consider analyzing such linkages by sex and race and reducing CVD risk via local efforts to invest in deprived neighborhoods to alleviate the burden of CVD.
Abstract P200: Mediterranean Diet and Metabolic Syndrome in Adolescents: An Analysis From the National Health and Nutrition Examination Survey 2015-2020
Authors: Mary Hastert, Anna GORCZYCA
Journal: Circulation (2024)

Background: The Mediterranean Diet (MD) is an evidence-based dietary approach emphasizing fruits, vegetables, whole grains, seafood, and olive oil. While it’s demonstrated efficacy in enhancing cardiometabolic health in adults, it’s received minimal evaluation in adolescents with metabolic syndrome (MetS). Hypothesis: We hypothesized that higher consumption of MD foods was associated with better metabolic health in a nationally representative sample of U.S. adolescents. Methods: A secondary analysis was conducted using data from the National Health and Nutrition Examination Surveys 2015-2020 (pre-COVID) in adolescents (12-19 years) with ≥ 2 valid 24-hour dietary recalls, complete fasting data for all components of the International Diabetes Foundations definition of MetS risk factors, and no known diabetes. Consumption of MD foods was evaluated using the validated, literature-based MD intake score (Medi-Lite, 0-16 score, excluding alcohol). MetS was evaluated using a continuous MetS score (cMetS) and separated into quartiles [Q1, metabolically unhealthy (cMetS score 1.83 ± 1.64) vs. Q4, metabolically healthy (cMetS score -4.16 ± 0.89)]. Correlation of Medi-Lite scores with cMetS scores and quartile groups controlled for energy intake, age, sex, and BMI were assessed via Pearson correlation and odds ratios, respectively. Results: The primary analyses included 886 adolescents (~15 years, 49% female, 70% non-Hispanic, body mass index ~25 kg/m 2 ) with a mean cMetS score of -1.40 ± 2.39. In the total sample, overall consumption of the MD was low (mean score 6.95 ± 1.83) and cMetS scores were not associated with Medi-Lite scores (r = -0.05, p = 0.21). There was a significant between-group difference for Medi-Lite scores between quartiles (F = 1.69, p = 0.05). In the metabolically healthy group, there was a positive trend towards between cMetS score and Medi-Lite score (r = 0.15, p = 0.06). No correlation was found between cMetS and Medi-Lite scores in the metabolically unhealthy group (r = -0.04, p = 0.59). Metabolically healthy adolescents had higher odds of consuming the MD compared to metabolically unhealthy adolescents (OR 2.012, 95% CI 1.44 to 2.81, p &lt; 0.001). Conclusion: In conclusion, U.S. adolescents had an overall low consumption of MD foods. Metabolically healthy adolescents consumed more MD foods compared to metabolically unhealthy adolescents. Future research should evaluate a MD lifestyle intervention as a treatment option for adolescents with MetS.