tbuckley/cabot-search huggingface dataset:
Abstract P434: Prediabetes and Diabetes Are Associated With Distinct Gut Microbial Composition in the Framingham Heart Study
Authors: Maura E Walker, Huimin Cheng, Daniel Cho, Honghuang Lin, Maria Carlota Dao, Nicole L Spartano
Journal: Circulation (2024)

Little is known about how the gut microbiome may be associated with impaired glucose regulation (prediabetes and type 2 diabetes). Relative to normoglycemic individuals, prediabetes and diabetes will be associated with distinct microbial composition, which will provide incremental value in classifying glycemic status. We included 1265 Framingham Heart Study participants (mean age 55 yr, 56% female) with 16S rRNA gene sequencing performed on stool samples. Glycemic status was characterized as normoglycemia (&lt;100mg/dL glucose or &lt;5.7 HbA1c), prediabetes (100-125mg/dL glucose or 5.7-6.5 HbA1c), diabetes (&gt;=126mg/dL glucose, &gt;=6.5 HbA1c, or self-reported diabetes diagnosis/medication). MANOVA was used to characterize the differential abundance of microbial composition and diversity by glycemic status. Microbial diversity was characterized by α- and β-diversity (Shannon and Bray-Curtis index) and richness. We used elastic net regression and generated c-statistics to determine the utility of gut microbial composition and diversity in classifying glycemic status while adjusting for age, sex, antibiotic use, waist circumference, hypertension/lipid-lowering medication (model 1). The prevalence of prediabetes and diabetes was 368 (29%) and 113 (9%), respectively. Compared to model 1, differential abundance at the family domain was associated with a moderate improvement in classifying participants by glycemic status (c-statistic: 0.78 vs 0.80). We observed a differential abundance of 16 bacteria families between diabetes/normoglycemia, 6 between prediabetes/diabetes, and 3 between normoglycemic/prediabetes, but microbial diversity did not differ. The abundance of Ruminococcacease and Enterobacteriaceae were the top bacterial contributors to glycemic status prediction. Glycemic status was associated with distinct patterns of microbial composition. The presence of diabetes was associated with a lower abundance of butyrate-producing bacteria, which may be linked to glycemic control.
Abstract MP33: Investigating the Link Between Glucose Patterns Assessed by Continuous Glucose Monitoring With Cognitive Impairment in Older Adults With Diabetes
Authors: Emeka Ejimogu, Dan Wang, Jiaqi Hu, Rebecca Gottesman, Beverly Gwen Windham, Josef Coresh, Arielle Valint, Michael Fang, Elizabeth Selvin
Journal: Circulation (2024)

Introduction: There are no studies in older adults with type 2 diabetes that examine the link between day-to-day glucose patterns and cognitive dysfunction. Continuous glucose monitoring (CGM) is a minimally invasive technology that can assess glucose every 1-15 minutes and characterize nuanced patterns in glucose. Hypothesis: CGM can provide a comprehensive picture of glycemic variability in people with cognitive dysfunction. Methods: We conducted a cross-sectional study of participants with diabetes in the Atherosclerosis Risk in Communities (ARIC) Study (Visit 9, 2021-2022). ARIC participants wore a CGM (Abbott Libre Pro) and underwent cognitive testing in three cognitive domains (memory, executive functioning, and language). Scores were standardized and averaged to give a global cognitive z-score. We compared HbA1c and clinically used CGM parameters (mean glucose, coefficient of variation, percent time in glucose range of 70-180 mg/dL, and percent time above 180 mg/dL) across quartiles of cognitive z-scores, adjusting for age and sex. We calculated p-values for trends from linear or quantile regression treating the median of cognitive Z-score in each quartile as a continuous variable. Results: We included 383 participants with diabetes (mean age, 83 years). Across categories of cognitive functioning, participants in the lowest cognitive functioning categories had significantly higher HbA1c, glucose variability, and less percent time spent with glucose in range (70-180 mg/dl) (Figure) . There was no clear trend in CGM mean glucose (p=0.15) (Figure, Panel B) . Conclusions: Cognitive dysfunction was associated with an increased burden of glycemic dysregulation assessed through CGM and HbA1c. Our results suggest CGM may be a useful complement to HbA1c for monitoring glycemic control in this population. Figure: Hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) metrics across quartiles of cognitive Z-scores in older participants with diabetes in the ARIC Study (2021-2022)
Abstract P207: Blood Metabolomic Signatures of 24-hr Urinary Sodium and Potassium Excretion Were Associated With Cardiometabolic Diseases in the Hispanic Community Health Study/Study of Latinos
Authors: Kai Luo, Yasmin Mossavar-Rahmani, Martha L Daviglus, Robert Burk, Daniel L Labovitz, Bing Yu, Eric Boerwinkle, Lifang Hou, Robert Kaplan, Qibin Qi
Journal: Circulation (2024)

Background: 24hr urinary sodium (Na) potassium (K) excretions are considered as accurate measures of sodium and potassium intake, but data are limited in large population-based studies due to the difficulties of 24hr urine sample collection. Hypothesis: 24hr urinary Na and K excretion can be predicated by blood metabolomic signatures, which are associated with the risk of cardiometabolic diseases. Methods: We assessed 24hr urinary Na, K excretion and sodium/potassium ratio (Na/K) in 447 apparently healthy individuals from the SOL-Nutrition &amp; Physical Activity Assessment Study (SOLNAS) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We calculated urinary Na, K excretion, and Na/K metabolite scores by using the Least Absolute Shrinkage and Selection Operator regression on 199 serum metabolites in SOLNAS, and evaluated their associations with incident CVD (heart failure, stroke, myocardial infarction), type 2 diabetes (T2D), and hypertension (HTN) in up to 5738 individuals in HCHS/SOL. Results: There were 41, 22, and 71 metabolites selected to be predictive of urinary Na, K excretion, and Na/K, respectively. Metabolite scores were significantly correlated with measured urinary Na (r=0.35, p &lt; 5e -14 ), K (r=0.58, p&lt; 5e -50 ) excretion and Na/K (r=0.6, p&lt; 5e -50 ). After multivariate adjustment, metabolite scores of urinary Na excretion and Na/K were significantly associated with incident CVD risk (hazard ratio=2.6 for Na and 1.91 for Na/K, per 1 SD increase in score), incident T2D (relative risk [RR]=1.33 for Na and 1.16 for Na/K), and incident HTN (RR=1.53 for Na and 1.35 for Na/K) over a median 7.6 years of follow-up. The metabolite score of urinary K excretion was not associated with CMD risk. Conclusion: In US Hispanics/Latinos, higher levels of 24hr urinary Na excretion and Na/K indicated by blood metabolomics signatures were associated with increased risk of CVD, HTN, and T2D.
Abstract P463: The Role of Information and Communication Technology in Cardiovascular Health: A Global Perspective
Authors: Rohan Bhattaram, Yusairah Basheer, Ryan Reichert
Journal: Circulation (2024)

Introduction: Information and Communication Technology (ICT) has emerged as a potent tool in shaping modern healthcare systems. Its ease of availability and function for patients, providers, and administrators has led to its integration at many levels. Because of its multidimensional use, we aimed to investigate the relationship between ICT usage and cardiovascular outcomes at a global scale. This study aims to find the relationship between ICT usage and cardiovascular mortality in countries in the Organisation for Economic Co-operation and Development (OECD). Methods: OECD Statistics, a freely available online database published by the Organisation for Economic Co-operation and Development, was accessed for data retrieval. ICT use, and cardiovascular death rates (per 100,000) in all 38 OECD countries were acquired. Microsoft Excel was used to store data and perform statistical analysis. A linear regression model was used to find the relationship between ICT use and cardiovascular mortality. Significance was assessed using the p-value, with a threshold set at 0.05. Results: A significant relationship between ICT use and cardiovascular mortality was observed (p = 0.02). Notably, Colombia and Japan were excluded from this analysis as they lacked ICT use data. Figure 1 demonstrates the linear relationship. Discussion: With a significant, negative relationship between ICT use and cardiovascular outcomes at a global scale, it can be inferred that elevating cardiovascular health outcomes can be significantly advanced through strategic investment in health technology. It should be considered that greater ICT use can be a proxy for other social and technological infrastructure available in the country leading to better cardiovascular health outcomes. Nonetheless, the integration of innovative health technologies, such as telemedicine, wearable devices, and data analytics, offers the potential to enhance early disease detection, promote health literacy, and optimize resource allocation. These advancements enable timely interventions, informed decision-making, and precise allocation of healthcare resources.
Abstract P325: Perceptions of Primary Care Quality and Hypertension Control in the Eastern Caribbean
Authors: Vivien Wambugu, Sydney A Steel, Deron Galusha, Marcella Nunez-Smith, Carol R Oladele
Journal: Circulation (2024)

Introduction: The Caribbean region has high rates of uncontrolled hypertension, a condition that is predominantly managed in primary care. Though evidence shows patient perceptions of quality of care are associated with health outcomes, there is a paucity of research in the Caribbean. This study aimed to fill evidence gaps on the relationship between perceived quality of care and hypertension management in the Caribbean. Objective: To understand the role of quality-of-care perceptions in hypertension control in the Eastern Caribbean. Hypothesis: We assessed the hypothesis that individuals with higher perceived quality of primary care are more likely to achieve blood pressure control. Methods: We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECHORN) (N=2961). ECHORN is an ongoing longitudinal study of adults conducted across four island sites. Participants completed a self-reported health survey, clinical examination, and laboratory testing. Participants who were aware of their hypertension status and reported a clinic visit within the past year were included in this study. The main exposure, perceived quality of care (QOC), was measured by asking participants to rate the quality of their healthcare. Likert responses were used and categorized as poor/fair, good, and very good in analyses. The outcome, hypertension control, was defined by JNC-7 guidelines and used as a binary variable. Pearson and Mantel-Haenszel Chi-Square tests were used for analysis. Results: The final analysis included 470 participants. Forty-six percent of participants had controlled hypertension, and 54% did not. Younger persons and those with higher educational attainment were more likely to have controlled hypertension. Twenty-four percent ranked QOC as poor/fair, 47% as good, and 29% as very good. Forty-one percent of those who rated QOC as poor/fair, 44 percent of those who rated QOC as good, and 53 percent of those who rated QOC as very good had their hypertension controlled. Mantel-Haenszel Chi-Square results showed a statistically significant positive linear trend in the relationship between QOC and hypertension control. Conclusion: This study demonstrated a positive relationship between higher perceived QOC and hypertension control in the Eastern Caribbean. Due to the burden of hypertension and the lack of region-specific literature on quality of care, further research is warranted to explore dimensions of QOC that most influence hypertension control.
Abstract P467: Patterns of Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: Preliminary Analysis of the RESILIENT Trial
Authors: Ritika Revoori, Victoria Bothwick, Paul McCabe, Stephen P Juraschek, Yuchen Meng, Camila Johanek, Stephanie Pena, Antoinette Schoenthaler, Antoinette Schoenthaler, Samrachana Adhikari, John A Dodson, Lara Kovell
Journal: Circulation (2024)

Background: Hypertension (HTN) is highly prevalent among older adults. Despite evidence that home blood pressure monitoring (HBPM) improves HTN awareness, treatment, and control, engagement with HBPM remains understudied in older adults with ischemic heart disease. This study sought to explain trends associated with HBPM engagement. Methods: We performed an interim analysis of the ongoing RESILIENT randomized mobile health cardiac rehabilitation (mHealth-CR) trial of patients age ≥65 years with ischemic heart disease. Participants in the RESILIENT mHealth-CR group were instructed to perform at least weekly home BP measurements over 12 weeks as part of the study intervention. Three engagement groups (high engagement, gradual decline, baseline engagement) were determined by latent class analysis. ANOVA or Chi-Squared tests were used to determine trends in HBPM engagement and changes in blood pressure (BP) overall and between engagement groups over the 12-week study. Results: Of the 111 participants, the mean (SD) HBPM engagement was 2.3 (2.3) days of HBPM/week and 31.6 (33.1) measures over 12 weeks ( Table ). Weekly HBPM declined from 74.8% to 50.5% from week 1 to week 12. Frequency of HBPM declined over time in both the gradual decline and baseline engagement groups, though remained consistent in the high engagement group. There were no significant differences in mean BP levels at week 1 and week 12 overall or between groups. However, there was a non-significant trend toward a lower systolic BP in the gradual decline group (106 (SD 20.5) mmHg) compared to the high engagement and baseline engagement groups (130 (SD 11.5) and 126 (SD 15.5) mmHg, respectively, p = 0.14). Conclusion: The majority of RESILIENT trial participants measured BP weekly as instructed. There was an overall downward trend in HBPM engagement over time. Once enrollment of the full RESILIENT sample is complete (target N=300 intervention participants), our next steps will be to investigate patient-level factors associated with differential HBPM engagement.
Abstract P319: Effects of Environment and Noise on Blood Pressure Readings: The (Decibel(s)) Trial
Authors: Junichi Ishigami, Hairong Liu, Ahmed Sabit, Di Zhao, Chathurangi H Pathiravasan, Jeanne Charleston, Edgar R Miller, Kuni Matsushita, Lawrence J Appel, Tammy M Brady
Journal: Circulation (2024)

Background: While guidelines emphasize quiet settings for blood pressure (BP) measurement, large-scale hypertension screening is often conducted in noisy, public spaces (e.g., health fairs). However, the influence of noise and environment on BP readings is unknown. Methods: We conducted a randomized crossover trial of community dwelling adults in Baltimore, MD to determine the BP effect of noise and public environment. Participants were randomly assigned to the order of triplicate BPs in 3 spaces: private quiet office (private quiet 1 [reference]); noisy public space (public loud); noisy public space + earplugs (public quiet). To account for intrinsic BP variability, all participants underwent a 4th set of BP measurements in a private quiet office (private quiet 2 ). Between each set of triplicate BPs with a WelchAllyn ProB 2000 device and appropriately sized cuff, participants walked for ≥2 minutes, rested for 5 minutes, and had arm/back/feet supported. We conducted difference in difference analysis, overall and stratified by baseline SBP (≥ vs. &lt; 130mmHg) and age (≥ vs. &lt;60yrs). Results: N=108, mean age 56 (SD 17) yrs (55% ≥60 years), 91% Black race, and 44% female. 45% had SBP≥130mmHg. Mean private quiet 1 and private quiet 2 BP was 129/74 and 127/74 mmHg (SBPΔ -1.6 (SD 7.1)/DBPΔ -0.2 (SD 4.0)). The average noise level in public loud was 74 db and in private quiet was 37 db. Public loud and public quiet BPs were slightly different than private quiet 1 BPs, with difference in differences minimal (Table): [Public loud: SBPΔ 0.97 mmHg (95%CI: -0.61, 2.55)/DBPΔ 1.86 mmHg (95%CI: 0.94, 2.78); Public quiet: SBPΔ 1.72mmHg (95%CI: 0.05, 3.39)/DBPΔ 1.66 mmHg (95%CI: 0.79, 2.54)]. The patterns were generally consistent across subgroups by SBP and age. Conclusion: BP readings in noisy public spaces resulted in small overestimation of BP compared to readings in a quiet private office, but the difference was minimal. Large-scale hypertension screening programs in public loud places may be an acceptable option, especially in low resource settings.
Abstract P302: The Mississippi Rural Community Listening Project
Authors: Christina D Ferrell, Akachi Awuruonye, Kisa K Harris, Sandra Carr-Melvin, Felicia V Caples, Dantwan S Smith, Vasan S Ramachandran, Frances C Henderson, Ervin R Fox
Journal: Circulation (2024)

Background: The Appalachia and Mississippi Delta regions have the lowest life expectancy in the United States. In response, Alabama, Mississippi, Kentucky, and Louisiana were selected for The Risks Underlying Rural Areas Longitudinal (RURAL) Study. The RURAL study is an observational population-based study focused on these at-risk communities in the rural south. During the planning phase, investigators identified the need to incorporate insights from the community in the proposal. Therefore, they initiated the “Rural Community Listening Project” in the four states to seek community members’ points of view on outreach research in their communities. The objectives of this research were to hear from members of the communities their concerns and ideas about health research, approaches that would promote their willingness to participate, and their willingness to have blood drawn and x-rays taken as a part of the research process. Method: Mississippi investigators conducted four focus group interviews with 10-12 participants in each focus group. They interviewed a total of 45 men and women between the ages of 35 to 65 in county-specific focus groups. The groups represented four rural Mississippi Counties: LeFlore, Oktibbeha, Panola, and Tishomingo. The investigators digitally recorded the interviews and had them transcribed, then analyzed the transcripts using thematic analysis. Results: Two themes arose: (1) Encouragement to Participate and (2) Barriers to Participation. Encouragement to Participate included (1) having trusted community stakeholders involved, (2) helping the community, (3) promoting one’s health, and (4) receiving feedback on one’s health. Barriers included lack of trust, time, location, and transportation. Overall, the focus group interviewees had not participated in health research but would be willing to do so. Participants had little to no experience in doing health surveys or tracking their health information using mobile or electronic devices but did not raise objections to doing so. Word-of-mouth, social media, newspaper, telephone, cell phone, and mail were recommended as modes of communicating with their communities. “Relevance to the individual” arose as a more prominent encourager than monetary incentives. Focus group interviewees reported trusting doctors, nurses, and health care providers in their respective communities to collect health information. Conclusion: The in-common barriers to participation in research were time, transportation, and location. Across all focus groups, trust emerged as a requisite for research participation. The model of listening to the community’s experiences, concerns, and recommendations can potentially inform future research practices in rural communities and changes to related state and/or local policies.
Abstract P101: The Association Between Residing in a Food Desert and Hypertension in Victims of Sudden Death
Authors: Alleigh Wiggs, Andrew Cesmat, Thibaut Davy-Mendez, Ross J Simpson
Journal: Circulation (2024)

Introduction: Sudden deaths, defined as unexpected deaths not attributable to suicide, trauma or cancer account for over 10% of deaths in adults aged 18-64 years. More evidence is needed to understand how socioeconomic factors interplay with physiological processes such as hypertension to contribute to sudden death. We hypothesized that residing in a food desert would be associated with hypertension and poor blood pressure (BP) control in people who died of sudden death. Methods: We screened Emergency Medical Services (EMS) records from 2013 to 2015 in Wake County, NC, which includes the capital city of Raleigh and &gt;1 million residents, and adjudicated 399 sudden death victims using a standardized protocol. We collected medical history and BP measures from health records and linked geocoded patient addresses to census-tract data from the USDA’s Food Access Research Atlas. Of these, 350 victims had address data available, and of these 196 had blood pressures available. Residing in a food desert was defined as living in a low income and low access area, which is defined as no access to grocery stores within 1 mile in urban areas and 10 miles in rural areas. The ten most recent systolic BP measures prior to death were used to calculate average BP. We calculated unadjusted differences in mean BP by residence in a food desert. We also calculated unadjusted odds ratios (ORs) comparing the probability of having a hypertension diagnosis and of having controlled BP (systolic BP &lt;130 mmHg) by residence in a food desert. Results: We examined 350 sudden decedents who were 33% Black (116 of 350), 64% White (224 of 350), 31% women (109 of 350), and a median age of 55. Of these, seventy-nine (23%) resided in a food desert, and these were more likely to have diabetes mellitus (38.0% vs. 26.6%), (30 of 79 and 72 of 271 respectively). Sudden decedents who resided in a food desert had higher systolic BP with a mean of 140 mmHg compared with 134 mmHg for those who did not reside in a food desert (mean difference 6.15, CI 6.012-6.298). Of those residing in a food desert, 60.8% (48 of 79) had a medical diagnosis of hypertension, and 33.3% (14 of 48) had controlled BP. There was no association between residing in a food desert and a diagnosis of hypertension (OR 1.04, 95% CI 0.62-1.74) or controlled BP (OR 1.73, 95% CI 0.85-3.54). Conclusion: Almost a quarter of sudden decedents resided in a food desert at the time of death. In this case group, residing in a food desert was associated with a small BP increase but not with diagnosed hypertension or controlled BP. Large population studies are necessary to investigate the risk of sudden death and poor blood pressure control associated with residing in a food desert.