tbuckley/cabot-search huggingface dataset:
Abstract P3172: Type A Behavior Pattern and Incident Stroke: REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Jake Ayisi, Rhea Puthumana, Suzanne Judd, Virginia Howard, Timothy Plante
Journal: Circulation (2025)

Introduction: Stroke is a leading cause of adult disability and the 5th leading cause of death in the United States. Both women and Black Americans have a higher lifetime risk of stroke. With stroke playing an important role in morbidity and mortality, there is a need for investigation of risk factors to aid in prevention. Type A behavior pattern (TABP) is characterized by certain behavioral tendencies and is categorized by time urgency/impatience (TUI) and achievement striving/competitiveness (ASC) components. Hypertension is a stroke risk factor and TABP is a risk factor for hypertension. Whether TABP is also a risk factor for stroke is unclear. Objective and Hypothesis: We sought to estimate the risk of incident stroke among adults without prior stroke by the level of TABP. We hypothesized that TABP will be associated with greater stroke risk. Methods: REGARDS enrolled 30,239 White and non-Hispanic Black participants aged ≥45 years in 2003-2007. Participants were contacted every 6 months through structured phone calls, medical records were obtained, and possible stroke events were adjudicated by experts. TUI and ASC (TABP components) were assessed with the Framingham Type A scale at baseline. Those with prior strokes or missing TABP were excluded. Cox proportional hazard models estimated the adjusted relative hazard of stroke by level of TUI and ASC scores separately. Because of significant TUI*race and TUI*sex interactions on incident stroke, TUI was stratified by race and sex. There were no significant ASC*race or ASC*race interactions on incident stroke, so ASC was not stratified. Results: There were 16,982 participants with TUI responses and 16,606 participants with ASC responses; baseline demographics, follow-up, and stroke incidence were similar in both TUI and ASC groups (mean [SD] 64 [10] years old, 65% women, 60% White race, median follow-up 11 years; 5.1 strokes/1000 person-years). As shown in Figure , higher levels of TUI for Black participants and men were associated with greater adjusted stroke risk. Higher ASC levels were associated with greater adjusted stroke risk overall. Conclusions: Higher scores in the TUI component of TABP in Black participants and men and the ASC component of TABP in all were associated with greater stroke risk. Screening and aggressive management of stroke risk factors like hypertension that are also associated with TABP might attenuate some of the excess burden of stroke among persons with greater TABP.
Abstract P3057: Interactions Between Coffee Consumption and Genetic Pathways Uncover Biological Mechanisms Related to Type 2 Diabetes Risk Reduction
Authors: Magdalena Sevilla-Gonzalez, Zhendong Mei, Xingyan Wang, Sarah Hsu, Huan Yun, Jie Hu, Miriam Udler, JoAnn Manson, Jun Li
Journal: Circulation (2025)

Introduction: Higher coffee consumption has been consistently associated with lower type 2 diabetes (T2D) risk but the underlying mechanisms are largely unknown. Our prior study showed higher coffee intake was associated with improved post-load glucose clarence and insulin sensitivity, and lower visceral adiposity. Hypothesis: We hypothesized that coffee consumption was associated with decreased T2D risk, by lowering genetic susceptibility of T2D in pathophysiological pathways related to insulin sensitivity, insulin production, and central adiposity. Methods: We analyzed data from 333,053 UK Biobank participants who were free of baseline chronic diseases. Coffee intake was assessed by a dietary questionnaire at baseline. We calculated seven partitioned polygenic scores (pPS) denoting 7 distinct physiological mechanisms underlying hyperinsulinemia, ranging from proinsulin, insulin secretion, to visceral adiposity. We examined the association of coffee intake, the pPS, and their interactions, with incident T2D, using Cox regression model. Results: We identified 10,707 incident T2D cases during 13.3 years of follow-up. Higher coffee intake, as expected, was associated with lower risk of T2D; compared to participants who did not regularly drink coffee, those consuming 4-5 cups/day had a 21% lower risk of incident T2D (95% confidence interval, 0.74-0.85) after adjusting for known risk factors including BMI. Of all pPS, 5 significantly predicted T2D risk ( P &lt;0.05/7) but 2 pPS related to proinsulin and insulin secretion, did not ( P &gt;0.05). In multivariable adjusted analyses, we identified a significant multiplicative interaction between coffee intake and proinsulin pPS; this pPS, which was in a genetic cluster linked to lower visceral fat and higher post-load insulin response (Fig. A), was associated with lower T2D risk only among participants who were high coffee consumers ( P interaction = 0.004; Fig. B). Furthermore, the positive associations between pPS for adiposity and pPS for visceral adiposity with T2D risk were attenuated among participants who consumed coffee daily vs. who did not ( P interaction = 0.088 and 0.093, respectively). Conclusions: Our data, coupled with our prior study, suggest that coffee consumption may be associated with lower T2D risk through its interactions with genetic pathways related to insulin secretion, post-load insulin sensitivity, and visceral adiposity. These results may inform tailored dietary recommendations to enhance T2D prevention.
Abstract MP40: Title: Investigating the link between hypoglycemia assessed by continuous glucose monitoring with cerebral small vessel disease
Authors: Emeka Ejimogu, Michael Fang, Natalie Daya Malek, Justin Echouffo, Priya Palta, Keenan Walker, B Gwen Windham, Timothy Hughes, James Pike, Joe Coresh, Rebecca Gottesman, Elizabeth Selvin
Journal: Circulation (2025)

Introduction: Continuous glucose monitoring (CGM) is a minimally invasive technology that can assess glucose levels every few minutes, allowing for the characterization of nuanced glucose patterns such as subclinical hypoglycemia. However, few studies have examined whether subclinical episodes of hypoglycemia, as assessed by CGMs, are associated with cerebrovascular alterations in older adults with diabetes. Hypothesis: CGM-assessed hypoglycemia is associated with a greater prevalence of lobar microhemorrhage, subcortical infarction, cortical infarction, and increased volume of white matter hyperintensities. Methods: We conducted a cross-sectional study of participants with type 2 diabetes in the Atherosclerosis Risk in Communities (ARIC) Study. Participants wore a CGM (Abbott Libre Pro) sensor for up to two weeks during Visit 9 (2021-2022). A 3 Tesla brain MRI scan was obtained during Visits 8 to 11 (2020-2024). We evaluated the prevalence of any lobar microhemorrhage, subcortical infarction, cortical infarction, and median white matter hyperintensity volume according to the presence of hypoglycemia, defined as any episode of sustained glucose (≥ 30 minutes) below 54 mg/dL (level 2 hypoglycemia) during the two weeks of CGM wear. Prevalence estimates were generated using logistic regression. Median white matter hyperintensity volume was estimated using quantile regression. Estimates were adjusted for age, sex, race, and HbA1c. White matter hyperintensity was additionally adjusted for total intracranial volume. Results: We included 138 participants with diabetes (mean age 82 years, 59% White adults, 51% Male). Among participants, 15%, 20%, and 32% had a cortical infraction, lobar microhemorrhage, and subcortical microhemorrhage, respectively. A total of 40 participants experienced a hypoglycemic episode. The adjusted prevalence of subcortical infarction was significantly higher among persons experiencing one or more hypoglycemic episodes (p=0.021) (Figure). The adjusted prevalences of lobar microhemorrhage, cortical infarction, and white matter hyperintensity volume were also higher among persons experiencing hypoglycemia, but these differences were not significant. Conclusions: CGM-assessed hypoglycemia was associated with an increased burden of cerebrovascular alterations. Our findings indicate that these subclinical hypoglycemic episodes could play a role in linking diabetes to changes in the brain.
Abstract 021: The Effectiveness of a Community Health Worker-Led Intensive Blood Pressure Intervention on Coronary Heart Disease and Heart Failure
Authors: Farah Allouch, Katherine Mills, Guozhe Sun, Ning Ye, Xiaofan Guo, Lixia Qiao, Nanxiang Ouyang, Songyue Liu, Wei Miao, Yangzhi Yin, Ziyi Xie, Jing Chen, Jiang He
Journal: Circulation (2025)

Background: Coronary heart disease (CHD) and heart failure are increasing in China and represent significant public health and economic challenges. Although community health worker (CHW)-led interventions have shown effectiveness in blood pressure (BP) control within low-resource environments, their impact on CHD and heart failure is yet to be fully documented. Objectives: This study estimated the effectiveness of a CHW-led intensive BP intervention on risk of myocardial infarction and heart failure. Methods: The China Rural Hypertension Control Project (CRHCP) included 33,995 hypertensive patients from 326 villages in rural China. We randomly assigned 163 villages to a non-physician community healthcare provider-led intervention and 163 villages to usual care. In the intervention group, trained non-physician community healthcare providers (NPCHPs) initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic BP (SBP) goal of &lt;130 mmHg and a diastolic BP (DBP) goal of &lt;80 mmHg, with supervision from primary care physicians. The primary outcomes were myocardial infarction and heart failure, with secondary analyses exploring fatal and nonfatal myocardial infarction. Results: Over 48 months, the net reduction in SBP was 22.0 mmHg (95% CI: 20.6-23.4) and in DBP was 9.3 mmHg (8.7-10.0) in the intervention group compared to usual care. During follow-up, we observed 174 myocardial infarction events (0.26% yearly rate) in intervention compared to 204 (0.32% yearly rate) in usual care participants. The NPCHP-led intervention demonstrated a 19% reduction in myocardial infarction (HR=0.81; 95% CI: 0.67-0.99). Notably, nonfatal myocardial infarction was reduced by 23% (HR=0.77; 0.62-0.96), although no significant reduction was observed for fatal events (HR=0.88; 0.63-1.53). For heart failure, we observed 107 events (0.16% yearly rate) in the intervention group compared to 147 (0.23% yearly rate) in usual care group, corresponding to a 32% reduction in heart failure (HR=0.68; 0.54-0.85). Conclusion: This study provides compelling evidence that intensive BP control, led by NPCHPs, is effective at reducing CHD and heart failure among rural residents in China. This NPCHP-led intervention is both cost-effective and feasible for implementation in low-resource settings. These findings support the scale-up of the CRHCP intervention across low- and middle-income countries to reduce the global burden of CHD and heart failure.
Abstract P2083: Lower Your LDL Cholesterol Now Initiative: Understanding Survivor LDL Awareness and Behaviors
Authors: Meg Yuan, Mary Dunn, Eliana Collins, Jamie Wielgopolan
Journal: Circulation (2025)

Introduction: High cholesterol, and specifically high low-density lipoprotein cholesterol (LDL-C), is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. About 1 in 4 U.S. adults have high LDL-C, which can be caused by lifestyle risk factors or genetics. More investigation is needed to understand the appropriate educational approach on LDL-C with heart attack and stroke survivors. Goals: The American Heart Association (AHA) is implementing a national 3-year initiative called Lower Your LDL Cholesterol Now TM to improve LDL-C understanding, testing and treatment adherence among survivors. We aim to understand survivors’ knowledge, motivators, and barriers to cholesterol testing and treatment to ultimately build an educational approach, supportive of cholesterol self-management skills. Methods: A 15-minute online survey was conducted with The Harris Poll on behalf of the AHA among nationally representative sample of 3,008 U.S. adults aged 18+ and an oversample of 503 U.S. adults aged 18+ who have experienced and survived a heart attack and/or stroke. Results: The survey revealed three out of four survivors (75%) reported having high cholesterol yet nearly half (47%) are unaware of their LDL-C number. Additionally, only about half (49%) prioritize their cholesterol, and 1 in 3 believe high cholesterol poses no or only a small increased risk for heart attack and stroke. However, 98% of survivors are willing to get their cholesterol measured if recommended by their health care professional (HCP). Conclusion: Nearly all survivors are receptive to having their cholesterol checked by their HCP if recommended, therefore, this initiative will focus on educating survivors to 1) know their LDL-C number, 2) understand the connection between high LDL and repeat events and 3) improve treatment adherence.
Abstract P3069: Effect of cocoa extract supplementation on incident hypertension in the COSMOS trial
Authors: Rikuta Hamaya, Sidong Li, Jessica Lau, Pamela Rist, JoAnn Manson, Howard Sesso
Journal: Circulation (2025)

Backgrounds: Cocoa flavanols have potential blood pressure (BP)-lowering effects in shorter-term, smaller-scale randomized clinical trials (RCTs), but its effect on incident hypertension has not been examined in a large-scale RCT. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) evaluated whether longer-term cocoa extract supplementation had an effect on incident hypertension in older adults. Methods: COSMOS is a 2x2 factorial, double-blind, placebo-controlled RCT testing cocoa extract (including 500 mg/day cocoa flavanols, with 80 mg/day (-)-epicatechin) and a multivitamin among 21,442 women aged ≥65y and men aged ≥60y. In 8,905 COSMOS participants free from baseline self-reported hypertension, we investigated the effect of cocoa extract on incident hypertension using Cox proportional hazards models. Incident hypertension was defined as self-reported first-time physician diagnosis, initiation of anti-hypertensive medications, or self-reported elevated systolic BP (SBP) ≥ 140 mmHg or diastolic BP (DBP) ≥ 90 mmHg. Results: Mean age at baseline was 71.1 years (SD: 6.2) and 58.8% of the participants were women. 48.6% had baseline SBP &lt; 120 mmHg, corresponding to the normal range. Baseline characteristics were balanced between the cocoa extract and placebo groups. Over a median follow-up of 3.4 years, in intention-to-treat analyses cocoa extract supplementation had no significant effect on incident hypertension, with the incidence rates (IRs) of 71.2 and 73.8 per 1000 person-years in cocoa and placebo groups, respectively (hazard ratio [HR]: 0.96 [95% confidence interval: 0.88, 1.05]). A significant interaction was observed between treatment assignment and baseline SBP (p=0.002). Cocoa extract supplementation reduced the incidence of hypertension among participants with baseline SBP &lt; 120 mmHg (IR: 38.2 vs. 50.3 per 1000 person-years; HR: 0.76 [0.64, 0.90]), but not among those with SBP of 120-139 mmHg (IR: 101.4 vs. 96.8 per 1000 person-years; HR: 1.05 [0.93, 1.18]; Figure ). Consistent results were obtained in sensitivity analyses using different definitions of hypertension: physician diagnosis, initiation of anti-hypertensive medications, or elevated BP alone. Per-protocol analysis using inverse probability weighting to account for non-adherence also supported the effect in SBP &lt; 120 mmHg. Conclusion: In older adults, years-long supplementation of cocoa extract may reduce the risk of incident hypertension among those with normal BP levels.
Abstract MP44: Plasma Proteomic Signature Of BMI Reveals Heterogeneous Cardiometabolic Risk Profiles Within And Across Standard BMI Classifications
Authors: Kiani Jacobs, Eric Leszczynski, Jacob Barber, Prashant Rao, Michael Mi, Prasun Dev, Matthew Herzig, SUJOY GHOSH, Clary Clish, Claude Bouchard, Jeremy Robbins, Robert Gerszten, Mark Sarzynski
Journal: Circulation (2025)

Background: The proteome is altered in obesity and proteomic signatures of BMI have been identified. However, few studies have examined differences in clinical profiles between actual and protein-predicted BMI. Hypothesis: Plasma protein-based BMI classification will better capture cardiometabolic risk compared to actual BMI classification. Methods: Data on cardiometabolic phenotypes and plasma proteins (4979 proteins via SomaScan) were available in 645 adults (56% Female, 35% Black, 17-65 yrs) from the HERITAGE Family Study. LASSO regression models with 10-fold-cross-validation were used to create a BMI proteomic signature. Protein-predicted BMI was classified into weight classes and compared to actual BMI classification to create 7 groups (underpredicted, matched, or overpredicted) ( Fig 1A ). General linear models adjusted for age, sex, race, and measured BMI were used to examine differences in cardiometabolic traits across groups. Results: The LASSO model (R 2 =0.82, RMSE=2.2) included 208 proteins. Protein-predicted BMI correlated with actual BMI at r=0.95 (p&lt;0.0001), with a 16% misclassification rate ( Fig 1A ). Participants whose proteins underpredicted BMI class generally had more favorable cardiometabolic profiles than matched groups of the same class, while overpredicted BMI class groups showed worse cardiometabolic profiles than matched groups of the same class ( Fig 1B ). Conclusions: We identified individuals matched for BMI but with opposing proteomic signatures that differed in cardiometabolic risk profiles. Proteomic profiling may identify clinically meaningful heterogeneity in cardiometabolic health not fully captured by BMI that could potentially be used as biomarkers and/or targets of therapeutic responsiveness.
Abstract P3051: Longitudinal trends in glucose and hearing loss in midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Pamela Schreiner, Meredith Adams, Lisa Chow, Donald Lloyd-Jones
Journal: Circulation (2025)

Introduction: Hearing loss (HL) is a common condition that often goes undetected until the deficits are pronounced. Diabetes may affect the vasculature and neural system of the inner ear, damaging both the auditory nerve and the vestibular systems, leading to HL. Less is known about how hyperglycemia over prolonged periods of time from young adulthood is associated with HL in midlife. Hypothesis: Young adults who experience early increases in fasting glucose levels will experience greater odds of future HL compared to those whose glucose levels either stay stable or increase later in life. Methods: CARDIA participants had hearing assessed at the Year 35 exam (Y35, 2020-2022, ages 53-70 years) using an automated method for testing auditory sensitivity to obtain pure-tone air-conduction thresholds. HL was defined as a sound detection threshold &gt;25 dB in the better ear at high frequencies (4000-8000 Hz). Fasting serum glucose was measured by standardized methods starting at baseline (1985-1986). Fasting glucose trajectories were created using PROC TRAJ (SAS) for 1921 participants with complete hearing and covariate data. Results: Mean glucose at Y0 was 81.9 mg/dL and 107.7 mg/dL at Y35. The sample was 57.4% women and 44.1% Black; 61.3% had normal hearing, 21.6% had mild HL and more severe HL was rare. Three distinct trajectories were identified: glucose remained low; glucose increased early; and glucose increased later (Figure). Compared to the remained low group, those whose glucose increased in early adulthood had 93% higher odds of high frequency HL. Those whose glucose increased later in adulthood had 14% higher odds of HL that did not reach statistical significance. Odds ratios were unchanged after adjustment for age, race, sex, education, smoking, drinking, physical activity and obesity. Conclusions: Prolonged exposure to elevated glucose was associated with mild high-frequency HL in midlife in a population-based cohort without severe HL, providing additional motivation to manage hyperglycemia.
Abstract 027: Correlates of Cardiac Structure and Function from the First Population-based Study of Echocardiography in the African Caribbean Diaspora: a preliminary report of the Tobago Heart Study
Authors: Allison Kuipers, Rain Katz, Clifford Thomas, Deepak Gupta, Ravinder Mallugari, Victor Wheeler, Iva Miljkovic
Journal: Circulation (2025)

Abnormal cardiac structure and function are associated with increased risk of heart failure and cardiovascular (CV) events. Persons with African ancestry are at high risk for hypertensive-related cardiac abnormalities; yet, there have been no population-based echocardiographic studies in African Caribbeans. Therefore, we aimed to perform echocardiography in men and women aged 50-80 years from Tobago (the Tobago Heart Study: THS). Between 2021-2024, 623 participants (81% female, mean age 60.7 years) underwent clinical examination including brachial-ankle pulse-wave velocity (PWV) and ankle brachial index (ABI, peripheral artery disease, PAD= ABI&lt;0.9), and transthoracic echocardiography. Images were analyzed by a core lab to include left ventricular (LV) ejection fraction (EF), LV mass index (LVMI), diastolic dysfunction, and LV geometry (normal, concentric remodeling, or left ventricular hypertrophy [LVH]). Multivariable linear or logistic regressions were used. Risk factors were common in the THS, with 50% obesity and 78% hypertension yet only 12% BP control. Mean PWV was 1609 cm/s and 4.4% had PAD. Abnormal LV geometry was present in the majority (80%), most being concentric remodeling (68%). LVH was seen in 12% overall and was more prevalent in men than women (29% vs 9%, P&lt;0.01). Mean EF was 64% with EF&lt;50% in 1.4%. Diastolic dysfunction prevalence was 13.6%. In addition to age and sex, CV risk factors associated with echocardiographic indices in multivariable models included SBP, DBP and antihypertensive medication use. BMI, diabetes, statin use, smoking and sedentary behavior were not independent predictors of any echocardiography measure. Though greater alcohol intake (&gt;4/week) was independently associated with greater odds of LVH (OR (95%CI): 4.1 [1.6-10.3]). After adjusting for CV risk factors, PWV was associated with greater odds of concentric remodeling (P=0.03; Table). Also, lower ABI was associated with lower LVEF (P=0.02, Table) and PAD presence was associated with greater odds of EF&lt;50% (OR: 6.8; 95% CI: 1.3-37.6, not shown). The THS presents the first population-based assessment of cardiac structure and function in the African Caribbean diaspora. Cardiac structural remodeling is highly prevalent in the THS and is associated with arterial stiffness and PAD. Thus, these results further highlight the need for blood pressure control in this high-risk population.