tbuckley/cabot-search huggingface dataset:
Abstract 4143925: Cigar smoking and better quality of life positively impact cigarette smoking cessation in adults: Findings from the Population Assessment of Tobacco and Health Study, a national longitudinal cohort study
Authors: Ban Majeed, Bekir Kaplan, Justin Ketchem, David Walsh
Journal: Circulation (2024)

The likelihood of smoking cessation success, sustained cigarette abstinence, varies by demographics, e.g. age, and other factors which shape quality of life, like stress and comorbidities. The recent emergence of newer tobacco products, like cigars and electronic nicotine delivery systems and in turn newer patterns of tobacco use, like exclusive smoking, dual, or poly use, complicates the picture of cessation process. To fill this gap and inform treatment, this study aimed to assess the role of patterns of tobacco use and perceived change in quality of life in cessation (abstinence ≥ 3 months) and examine the effect of age on those relationships in younger (18-44 years) and middle aged/older (45+) adults in the United States who smoke cigarettes. Methods: This study included (N=5,669) participants, in a longitudinal cohort study, Population Assessment of Tobacco and Health Study, with self-reported patterns of tobacco use (wave 4) and valid information on cessation at follow-up (wave 5). Patterns of use included exclusive smoking, dual cigarette/cigar, dual cigarette/ENDS, and poly use. Perceived change in quality of life—perception of quality of life now compared with 12 months ago—included worse, about the same, and better. Cessation at follow-up, included sustained abstinence of ≥3m and current smoking/short-term abstinence. Weighted descriptive analyses and logistic regressions were conducted with sustained abstinence as outcome and patterns of use and change in quality of life as predictors, adjusting for sex, race, education, income, BMI, and tobacco dependence. Analyses were stratified by age groups. Results: Overall, 25.7% reported sustained abstinence at follow-up. In both age groups, dual cigarette/cigar compared to exclusive smoking (45+ year adults OR 3.33, 95% CI: 1.26-8.79) and better quality of life (compared to about the same) were associated with higher odds of sustained abstinence. In both groups, lower odds were associated with being black and higher tobacco dependence. Of interest, only in 45+ year adults, worse change quality of life had OR 1.95 (95% CI: 1.02-3.74). Conclusion: Findings indicate that patterns of tobacco use, improved quality of life, race, and tobacco dependence influence likelihood of cessation in all ages, but worse change in life may produce cessation only in older adults. Improving quality of life may hold a great potential to achieve successful smoking cessation.
Abstract 4143943: Minimally-Invasive Intrapericardial Injections under Direct Visualization via Thoracic Cavity Access in Infant and Pediatric-sized Swine
Authors: Ryan O'Hara, Rohan Kumthekar, Justin Opfermann, Bryan Gonzalez, Bradley Clark, Charles Berul
Journal: Circulation (2024)

Background: Intrapericardial delivery of antiarrhythmic drugs and regenerative therapies is a growing field for infants and children who suffer from certain cardiac diseases. Typically, this is performed under fluoroscopic and/or ultrasonic guidance. Pericardial access via thoracoscopy provides direct visualization of the heart, enabling the operator to avoid injuries to critical cardiac structures, and to visualize intrapericardial injections for targeted drug therapies. Objective: To demonstrate the feasibility of minimally-invasive intrapericardial injections under direct visualization using a novel thoracic access port in immature swine. Methods: Minimally-invasive procedures were performed in 12 Sinclair piglets (8 at 1-month old, 4.1 ± 1.5 kg; 4 at 5-months old, 26.3 ± 1.0 kg). A single 1.2 cm incision just to the left of the subxiphoid process allowed for temporary insertion of the thoracic access port. An EndoCAMeleon thoracoscope with active insufflation was used to visualize the thoracic cavity and the heart (pericardium). An 18-gauge needle was used to gain access to the intrapericardial space. Saline or dyed saline was injected through the needle and/or sheath with direct visualization and confirmed on the thoracoscope. Following the procedure, the access tool was removed and the incision was sutured closed. All studies were performed under IACUC approval. Results: Minimally-invasive intrapericardial injections were successfully performed in 8 infant- and 4 child-sized swine with real-time visualization (Figure). The average time between the incision and pericardial needle access was 16.8 ± 5.0 minutes. No adverse events were observed from either the intrapericardial fluid injection or the use of the thoracic access tool. Conclusion: We demonstrated the feasibility and safety of minimally-invasive intrapericardial injections under direct visualization in swine using a novel thoracic access port. Direct targeted pericardial injection of medications or gene therapies can be performed using this technique. This approach holds promise for providing an alternative to cardiac restoration in infant and pediatric patients who are not amenable to traditional therapies.
Abstract 4143872: Mode of Death in Heart Failure with Preserved Ejection across the Kidney Function Spectrum: Pooled Individual-Patient Level Analysis of 5 Trials
Authors: Nicole Bart, Robert Ariss, Brian Claggett, Muthiah Vaduganathan, Brendon Neuen, Iris Beldhuis, Akshay Desai, Pardeep Jhund, Finnian Mc Causland, Marc Pfeffer, Bertram Pitt, Faiez ZANNAD, Michael Zile, John McMurray, Scott Solomon, Jonathan Cunningham
Journal: Circulation (2024)

Introduction: Patients with comorbid heart failure (HF) and chronic kidney disease (CKD) face excess risks of mortality, but limited data are available examining specific modes of death across the spectrum of kidney function. Methods: We leveraged individual patient level data from 5 trials of HF with mildly reduced or preserved ejection (CHARM-Preserved, I Preserve, TOPCAT [Americas region], PARAGON-HF, and DELIVER). Causes of death (sudden, heart failure, other CV, and non-CV) were adjudicated by clinical events committees in each respective trial. Results: Among 17,947 patients across the 5 trials with available eGFR data, mean age was 71.6 ± 9.0 years, 51% were women, median NT-proBNP was 840 [25-75 th percentile 424, 1566] pg/ml. Overall, 2084 (12%) had eGFR ≥90 mL/min/1.73m 2 , 7977 (44%) had eGFR 60 - &lt; 90, 4701 (26%) had eGFR 45-60, 3185 (18%) had eGFR &lt;45. During a mean of 2.9 years of follow-up, 3,140 patients died. All-cause death rate was greater in the lower eGFR groups, driven by greater rates of HF and non-CV death. Rates of CV and non-CV death were 5.7/100 patient years (py) and 4.4/100py in patients with eGFR &lt;45 and 2.7/100py and 1.3/100py in patients with eGFR &gt;90 (Table and Figure). HF-related death rate was markedly greater in participants with eGFR &lt;45 (2.0/100py) compared to patients with eGFR&gt;90 (0.3/100py) Conclusions: Among nearly 18,000 patients across contemporary HFmrEF/HFpEF clinical trials, mortality was markedly higher at lower ranges of kidney function, driven mostly by higher non-CV death and HF-related death.
Abstract 4143871: Effect of Continuous Estrogen on Peripheral Microvascular Function in Women of Trans Experience
Authors: Maria Jaramillo-Torres, Emily O'Connell, Gopika SenthilKumar, Matthew Durand, Julie Freed
Journal: Circulation (2024)

We have previously shown that chronic exposure to 17β-estradiol promotes microvascular endothelial dysfunction in isolated human arterioles from healthy adult individuals assigned male at birth (IAMB). Microvascular dysfunction is a strong predictor of future cardiac events and women of transgender experience have a higher risk of cardiovascular death, however the effects of continuous gender affirming hormone therapy on in vivo microvascular function remain unknown. We hypothesized that in vivo endothelial-derived, nitric oxide (NO)-mediated vasodilation is impaired within the peripheral microvasculature in IAMB who have been exposed to continuous gender affirming hormone therapy compared to age-matched controls. Inclusion criteria for this prospective, cross-sectional study included healthy IAMB, age 18-60 years, no past medical history of cardiovascular disease, and a minimum 1-year exposure to gender affirming hormone therapy (estrogen; E2). Peripheral microvascular function was assessed using Laser Doppler Flowmetry with microdialysis (LDF-MD). Two microdialysis fibers were placed in the ventral forearm of eleven subjects (3 IAMB, 8 IAMB+E2) with sites randomized to serve as 1) control (lactated Ringer’s) and 2) infusion with the nitric oxide synthase inhibitor L-NAME. After baseline measurement, vehicle and L-NAME were administered followed by infusion of two doses of acetylcholine (Ach; 1mM, 10mM). Following a rest period, a local heating protocol was then implemented to assess NO-mediated dilation and maximal vasodilation (39°C and 42°C + sodium nitroprusside, respectively). Compared to controls, a reduced trend in dilation to Ach was observed in IAMB+E2 (1mM Ach max dilation (%): 57.2±13.0 vs 80.2±8.7, p =0.33; 10mM Ach max dilation (%): 70.4±7.0 vs 93.7±3.1, p =0.08, IAMB+E2 and IAMB, respectively). A reduced trend in dilation was also observed in IAMB+E2 compared to controls in response to local heating (32.9±8.9 % vs 60.7±6.2 %, respectively, p =0.10). The degree to which dilation was inhibited in the presence of L-NAME was higher with the local heating protocol for the control group (46.6%) vs the estrogen group (22.2%). Together, this pilot study suggests that in vivo microvascular function may be impaired by chronic estrogen therapy in women of trans experience.
Abstract 4143856: Aging Alone: Impact of Social Networks on Older Adults with Advanced Heart Failure
Authors: Sarah Godfrey, Anas Jawaid, Mansi Maini, Jingwen Zhang, Manasa Dutta, Christopher Wrobel, Jennifer Thibodeau, Justin Grodin, Robert Morlend, Mark Drazner, Maryjane Farr
Journal: Circulation (2024)

Background: Social health, including social isolation and kinlessness, has important implications for older adults. Social isolation and lack of traditional kin networks has been associated with adverse health outcomes including long-term facility placement, healthcare utilization, and all-cause mortality. Prior studies report 6-10% of older adults in the US are kinless. However, little is known about the prevalence and impact of kinlessness on older patients with advanced heart failure (HF), particularly given the psychosocial requirements for advanced therapies. Aim To describe the social support structures and their association with clinical outcomes in older adults with advanced HF at a large academic advanced HF center. Methods: We abstracted data from the electronic medical records of adults &gt;70 referred for management of advanced HF from 2012-2022. Patients were excluded if they did not have clinical HF or were not seen by an advanced HF physician. Results: 834 older adults were referred for management of advanced HF. Median age was 75 years (IQR 7), 68% were male, and 71% were white. Mean ejection fraction was 35 (SD 17.4), and most were NYHA class III-IV (62%) at time of referral. In terms of social support, 574 (69%) were married and 734 (88%) had living children, whereas only 28 (3.3%) had no documented living 1 st degree relatives. One hundred twenty (14%) lived alone. Overall, 35 (4.2%) received a left ventricular assist device (LVAD) and 23 (2.8%) received a heart transplant (HT). LVAD recipients were more likely to be married (89%, p&lt;0.001) and have living children (83%, p&lt;0.001). All HT recipients had living children (100%, p=0.03), and they were more likely to be married (70%, p=0.01). No patients without a spouse or living child received an advanced therapy. Overall, 298 (36%) of patients died during the study period. While mortality did not vary by kin status, married adults were more likely to die on hospice (49% vs. 39%), and those with children were less likely to die in the hospital or ICU (38% vs. 43%). Conclusion: Very few (3.3%) older adults referred to an academic advanced HF center lack a living spouse or child, suggesting that kinless older adults are under-referred. Having a living spouse or child was associated with greater rates of LVAD and HT, as well as rates of hospice and out-of-hospital death. These data may identify important disparities in advanced therapies and end-of-life care for older adults with advanced HF who are kinless.
Abstract 4144014: Stress-related genetic factors modify the effect of lower socioeconomic status on cardiovascular disease risk through autonomic and immune mechanisms.
Authors: Krystel AbiKaram, Shady Abohashem, Hui Chong Lau, Maria Khalil, Wesam Aldosoky, Iqra Qamar, Giovanni Civieri, Erin Hanlon, Alula Assefa, Karmel Choi, Jordan Smoller, Antonia Seligowski, Ahmed Tawakol, Michael Osborne
Journal: Circulation (2024)

Introduction: Lower socioeconomic status (SES) associates with greater MACE risk in part via stress-related mechanisms. Further, a higher polygenic risk score for neuroticism (nPRS), a marker linked to stress sensitivity and chronic stress conditions, is associated with greater MACE risk. Moreover, individuals with higher nPRS are more susceptible to the cardiovascular impacts of lower SES. Yet, it remains unknown whether individuals with higher nPRS experience greater adverse changes in autonomic and inflammatory intermediaries of stress in the setting of lower SES and whether these changes contribute to MACE risk. Accordingly, we tested the hypotheses that: 1) lower SES links to MACE risk via lower heart rate variability (HRV) and higher C-reactive protein (CRP), and 2) lower SES has a greater impact on HRV and CRP among those with higher nPRS. Methods: Individuals (N=18093; median age 64 years; 54% female) with nPRS and SES data were identified in the Mass General Brigham Biobank. SES was assessed as the median income of an individual’s residential zip code with lower income defined as the lowest tertile. Higher nPRS was defined as values ≥ population median. MACE data was collected for 10 years following enrollment using ICD-10 codes. CRP (N=4117) and HRV (N=4412) data were collected from available clinical lab values and electrocardiograms, respectively, with HRV assessed as the standard deviation of all normal RR intervals. Results: In the full cohort, both HRV and CRP mediated the relationship between lower SES and MACE risk (p&lt;0.05 for both). In subgroup analyses, CRP and HRV mediated the link between lower SES and MACE among those with higher (but not lower) nPRS (p&lt;0.05) (Figure 1A). Moreover, lower SES associated with both lower HRV and higher CRP, most notably among those with higher nPRS, while those relationships were attenuated among individuals with lower nPRS (Figure 1B). Conclusions: Alterations in HRV and CRP appear to be heightened among individuals with higher nPRS and may mediate the association between lower SES and MACE. These findings suggest that the adverse health effects of lower SES are greater among those with genetic risk related to stress sensitivity and stress conditions.
Abstract 4144026: Association of anthropometric measurements and cardiometabolic risk in Mexican American children
Authors: Joyce Samuel, Kyung Hyun Lee, Kari North, Jennifer Below, Miryoung Lee, Joseph B McCormick, Susan Fisher-hoch
Journal: Circulation (2024)

Background: Guidelines recommend that pediatricians screen for cardiometabolic (CM) risk factors at certain thresholds of body mass index (BMI) percentile, with lipid screening after BMI exceeds the 85th%ile for age and sex, and glucose metabolism screening after BMI exceeds the 95%ile. We hypothesize that for Hispanic children, BMI may be an insufficiently sensitive harbinger of CM risk factors. Here we describe the CM profile of children and adolescents from an ethnically homogenous cohort of Mexican Americans with a high risk for CM disease and investigate whether some CM characteristics appear prior to usual BMI thresholds. Methods: We assessed children enrolled in the Cameron County Hispanic Cohort, one of the largest and most comprehensive prospective cohorts of Mexican Americans, with participants recruited from randomly selected households living on the Texas-Mexico border and followed every 2 to 5 years since 2014. Using data from the first visit, we describe the prevalence of individual CM risk factors and their clustering based on age, sex, family history, and obesity category. Results: Of 450 participants under 18 years old, the combined prevalence of overweight and obesity was 48.9%, with median age 12 years (range 8 to 17), 49% male, and 97.7% self-identifying as Hispanic/Latino, and no differences observed in demographic factors across weight status categories. Individual CM risk factors, including high triglycerides, low HDL-C level, abdominal obesity, insulin resistance (IR), or elevated BP, alone or in combination, were present in 59.8% of the sample. IR, the most prevalent risk factor, was present in 40.4% of the children, specifically in 76.0% of obese children, and 39.7% and 19.0% of overweight and normal/underweight children. Clustering of any 3 CM risk factors was more likely to occur with increasing weight status categories and occurred in 1.9% of normal weight, 13.7% of overweight, and 42.3% of obese children. Conclusion: In this cohort, abnormal glucose metabolism and dyslipidemia are present well before BMI percentiles exceed usual thresholds. We observed alarmingly high rates of insulin resistance among children who did not meet BMI criteria for obesity, in 40% of overweight and 19% of normal weight children. Reliance on the BMI as a trigger to screen for CM risk factors may be disadvantageous to some high-risk groups, including Mexican Americans.
Abstract 4144025: Heparin-Induced Thrombocytopenia among patients with Non-ST Myocardial Infarction increases mortality nearly two-and-a-half times
Authors: Robert Rezvani, Mohammad Reza Movhaed, Mehrtash Hashemzadeh, Mehrnoosh Hashemzadeh
Journal: Circulation (2024)

Introduction: Heparin is widely used as anticoagulant in hospitals. It is considered a mainstay of therapy in ST-elevation and non-ST elevation myocardial infarction and is included in the ACLS management of these conditions. Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening immune mediated prothrombotic disorder as a consequence of heparin exposure. This is caused by the production of antibody-heparin/PF4 immunocomplex, which causes platelet activation and aggregation. This study aims to determine the effect of HIT on mortality in patients with non-ST elevation myocardial infarction (NSTEMI). Research Questions/Aims: Given the significant morbidity of myocardial infarction, research is needed to identify factors which increase morbidity and mortality. This study aims to determine the mortality of NSTEMI patients with and without HIT. Methods: Data was analyzed from available ICD-10 codes from 2016 to 2020. Patients greater than 18 years with ICD-10 codes for NSTEMI with and without HIT were included. The mortality rates were compared between HIT-positive and HIT-negative NSTEMI patients. Patient demographic, clinical, and hospital characteristics were summarized using means and standard deviations for continuous variables, and proportions with 95% confidence intervals for categorical variables. Logistic regression ascertained the odds of binary clinical outcomes relative to patient and hospital characteristics. Multiple logistic regression was used to ascertain the likelihood of the outcome (Odds Ratios (95% CI)) occurring between the characteristics. Analyses were conducted following the implementation of population discharge weights. All p-values were calculated as 2-sided, with a significance level set at p&lt;0.05. Data analysis was performed using STATA 17 (Stata Corporation, College Station, TX). Result: We found a significant increase in mortality in NSTEMI patients with HIT vs no HIT for years 2016-2020 (odds ratio [OR] = 2.55, 95% confidence interval [CI] = (2.19-2.98), p &lt; 0.05). In addition, cardiogenic shock was associated in NSTEMI patients with HIT vs no hit (OR = 8.66, CI = (8.43-8.90), P &lt; 0.001) Conclusion: This finding suggests that HIT is associated with increased mortality among NSTEMI patients. In the year 2020, COVID-19 infections may have exacerbated the mortality difference observed in years 2016-2019.
Abstract 4143937: Association Between Lipoprotein(a) Levels and Incident Complex Coronary Revascularization Procedures in the FOURIER Trial
Authors: Prakriti Gaba, Michelle O'Donoghue, Robert Giugliano, Andrea Bellavia, Maria Laura Monsalvo, Jose Flores-Arredondo, Julia Kuder, Dan Atar, Anthony Keech, Marc Sabatine, Brian Bergmark
Journal: Circulation (2024)

Background: Elevated Lp(a) levels are associated with a higher risk of major adverse CV events. Whether elevated Lp(a) levels are associated with a higher risk of complex coronary revascularization procedures or modify the benefit of evolocumab remains unknown. Methods: The FOURIER trial randomized 27,564 pts with stable ASCVD on optimized statin therapy to evolocumab vs placebo (median f/u 2.2 yrs). The association between Lp(a) (≥125 nmol/L) and complex coronary revascularization procedures (complex PCI or any CABG) was assessed in pts from the placebo arm with an adjusted Cox regression model. Complex PCI events were identified through blinded review of all revascularization events and defined as ≥1 of: multivessel PCI, ≥3 stents, ≥3 lesions treated, bifurcation PCI, or total stent length &gt;60 mm. Effect modification between Lp(a), evolocumab and the risk of complex revascularization was assessed by including an interaction term in the model. Kaplan-Meier event rates are reported at 3 yrs. Results: In FOURIER, 4048 (32%) pts had a baseline Lp(a) concentration ≥125 nmol/L. A total of 332 complex coronary revascularization procedures occurred. Pts with higher baseline Lp(a) levels were more frequently female (29% vs 23%) and more likely to have multivessel disease (24% vs 21%), diabetes mellitus (38% vs 34%) or prior PCI (66% vs 60%). Higher baseline Lp(a) was associated with a 27% higher risk of complex coronary revascularization (3.7% vs 3.2%; HRadj 1.27, 95% CI: 1.01-1.59; P=0.04) ( Fig 1A ), including a 41% higher risk of complex PCI (2.3% vs 1.7%; HRadj 1.41, 95% CI: 1.05-1.90). Evolocumab significantly reduced the risk of complex coronary revascularization procedures by 22% (HR 0.78, 95%CI [0.63, 0.95]) in pts with Lp(a) &lt;125 nmol/L and by 41% (HR 0.59, 95%CI [0.45, 0.78]) in pts with Lp(a) ≥125 nmol/L ( Fig 1B ). Conclusion and Relevance: Among pts with ASCVD in FOURIER, higher baseline Lp(a) levels helped identify those with an increased risk of complex PCI or CABG. These findings highlight the value of baseline Lp(a) levels in identifying pts at risk for future complex coronary revascularization and the potential for reducing such high-risk and costly procedures with evolocumab. Clinical Trial Registration . NCT01764633