tbuckley/cabot-search huggingface dataset:
Abstract 057: Associations between Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Risk Factors in Midlife: A Mediation analysis in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study
Authors: Jaclyn Borrowman, Xiaoning Huang, Lucia Petito, Amanda Perak, Denise Scholtens, William Lowe, Donald Lloyd-Jones, William Grobman, Sadiya Khan
Journal: Circulation (2025)

Introduction: Cardiovascular disease (CVD) is the leading cause of death in females globally. Sex-specific CVD risk factors such as adverse pregnancy outcomes (APOs) are on the rise. Pre-pregnancy obesity is a key modifiable risk factor for both APOs and CVD. However, whether APOs mediate the relationship between body mass index (BMI) and midlife CVD risk factors is unclear. Purpose: Determine the extent to which the associations between pre-pregnancy BMI and CVD risk factors 10-14 years after delivery are mediated by APOs. Methods: Participants ≥ 18 years enrolled at 28 weeks’ gestation (range: 24-32 weeks) in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study without pre-pregnancy hypertension or diabetes were included in analyses. Counterfactual causal mediation analysis assessed whether gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) mediated associations between self-reported pre-pregnancy BMI and CVD risk factors 10-14 years after delivery. Missing baseline data were computed using multiple imputation by chained equations to create 10 imputed datasets. The results from each imputed dataset were combined using Rubin rules. Covariates included maternal and gestational age, parity, field center, alcohol and smoking status in pregnancy, and fetal sex. Results: Participants (N = 4,269) were 30.0±5.6 years and 10.6% had a BMI≥30.0 kg/m2. During the HAPO pregnancy, GDM complicated 13.8% and HDP 10.7% of pregnancies. Compared to those with a pre-pregnancy of BMI of 18.5-24.9 kg/m2, those with a BMI ≥30.0 kg/m2 had a greater mean arterial pressure (7.1 mmHg; 95% CI: 6.0 - 8.1), triglyceride (28.5 mg/dL; 95% CI; 21.9 – 35.1), glucose (7.4 mg/dL; 95% CI: 4.9 – 9.8), and hemoglobin A1c (0.3%; 95% CI: 0.2 – 0.4) levels at midlife. Among indivdiuals with a pre-pregnancy BMI≥30.0 kg/m2, GDM mediated a statistically significant portion of associations with fasting glucose levels and hemoglobin A1c whereas HDP mediated the association with mean arterial pressure only ( Table ). Conclusions: In a multinational cohort of pregnant individuals, these findings suggest that APOs do not mediate a majority of the association between obesity and CVD risk factors in mid-life. Prioritizing weight management earlier in the life course before pregnancy may support maternal and future cardiovascular health.
Abstract 017: Investigating 24-hour Activity Profiles and Incident CVD and CVD Mortality in Older Women
Authors: Kelsie Full, Hui Shi, Steve Nguyen, Michael LaMonte, Andrea LaCroix
Journal: Circulation (2025)

Background: Activities throughout the 24-hour day, including sleep, physical activity, and sedentary time, are independently linked with cardiovascular health. However, these behaviors are dynamic and interrelated, and few studies have collectively examined their relations with cardiovascular disease (CVD). Our objective was to examine associations between waist-worn accelerometer-measured 24-hour activity and incident CVD and CVD mortality in a multiethnic cohort of older women. Methods: Women (n=3,897; mean age: 78.5 years, 33% African American, 17% Hispanic/Latino) enrolled in the Women’s Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study wore an Actigraph GT3X+ accelerometer for 7 days in 2012-2014 and were followed through February 2024 for physician-adjudicated incident CVD (non-fatal or fatal myocardial infarction, non-fatal or fatal stroke, or death attributable to any CVD) and CVD mortality. Estimates of sleep duration, wake after sleep onset (WASO), light physical activity, moderate to vigorous physical activity, and sedentary time were scaled to 24-hours and treated as proportions of the 24-hour day. Mixture model-based clustering identified clusters of 24-hour activity behaviors. Bayesian information criterion was used to select the optimal cluster number (1–9). Women with prevalent CVD were excluded from analyses (n=348). We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) relating 24-hour activity profile clusters with CVD and CVD mortality. Models were adjusted for demographics, multimorbidity, and CVD risk factors. Results: Over a median follow-up of 9.8 years, 774 incident CVD cases occurred, including 515 CVD deaths. Clustering analyses identified five 24-hour activity profiles ( Figure 1A ). In models adjusted for demographics, 24-hour activity profiles characterized by longer sleep, less physical activity, and greater sedentary time were associated with increased risk of CVD (Profile 2: HR: 2.02; 95% CI: 1.27, 3.21) and CVD mortality ( Figure 1B ). After adjustment for multimorbidity and CVD risk factors, the HR (95% CI) was 1.59 (1.00, 2.54) for CVD and 2.30 (1.28, 4.15) for CVD mortality. Conclusions: In older women, 24-hour activity profiles that include poor sleep, low physical activity, and high sedentary time increase risk of CVD and CVD mortality. Results from novel 24-hour analyses may highlight new lifestyle strategies for CVD prevention.
Abstract P3010: Association of sedentary behavior with cardiovascular risk biomarkers in a population with overweight or obesity: the PREDIMED-Plus trial
Authors: Linzi Li, Dora Romaguera, Angel M Alonso-Gomez, Estefania Toledo, Miguel Martinez-Gonzalez, Montserrat Fito, Alvaro Alonso
Journal: Circulation (2025)

Background: Sedentary behavior is linked to a higher risk of cardiovascular disease (CVD). Examining its association with CVD-related biomarkers can help understand the underlying mechanisms. Methods: We studied 98 participants (55-75 years, BMI 27-40 kg/m2, with metabolic syndrome) in PREDIMED-Plus, a multicenter randomized trial in Spain for the primary prevention of CVD. Accelerometer was used to measure physical activity (PA) at baseline and at least once during follow-up at years 3 and 5. Blood samples were collected at each time point to measure CVD-related biomarkers: propeptide of procollagen type I (PICP, cardiac fibrosis), high-sensitivity (hs) troponin T (hsTnT, myocardial damage), hs C-reactive protein (hsCRP, inflammation), 3-nitrotyrosine (3-NT, oxidative stress), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP, cardiac overload). Sedentary time was assessed as inactive time (&lt; 1.5 METs in waking time). Using isotemporal substitution, we analyzed the impact of replacing 30-min sedentary time per day with low-intensity PA (LPA, 1.5–3 METs), moderate to vigorous PA (MVPA, &gt; 3 METs) and time in bed (time difference between going to bed and leaving) on log-transformed biomarkers cross-sectionally and longitudinally. Results: At baseline, year 3 and 5, 98, 72 and 65 participants had valid data. Participants averaged 65 years old (SD 4.9), BMI 32.2 kg/m2 (SD 3.3), and 40% were female. Cross-sectionally, replacing 30-min sedentary time with LPA, MVPA, or time in bed had no significant effect on biomarkers. After 5 years, reallocating baseline 30-min of sedentary time per day with LPA or MVPA was associated with a lower hs-TnT level compared to baseline (-0.05, 95% CI -0.08, -0.02; -0.01, 95% CI -0.06, 0.04, respectively). Substituting 30-min sedentary time with LPA or MVPA showed nonsignificant reductions in NT-proBNP (-0.04, 95% CI -0.12, 0.04; -0.04, 95% CI -0.16, 0.09, respectively), but not a consistent impact on other biomarkers (Table). Conclusion: In overweight/obese individuals, prolonged sedentary time, when compared to engaging in PA, was associated with unfavorable levels of hs-TnT over 5 years, but not with other CVD risk biomarkers. Further research is warranted to confirm these results in other populations.
Abstract P3116: Household Food Insecurity and Adiposity Changes Among Adolescents: A Longitudinal Study of Gender-Specific Outcomes in the Greater Baton Rouge Area
Authors: Ashley Fenton, Amanda Staiano, Michael Celestin, Tekeda Ferguson, Candice Myers, Tung-Sung Tseng, Stephanie Broyles
Journal: Circulation (2025)

Background: Food insecurity has been consistently linked with obesity in adults, but research findings have been less conclusive among adolescents. Previous studies have suggested that food insecurity places adolescents at a higher risk for adverse health outcomes, with obesity being a significant concern. Objective: To examine the relationship between baseline household food insecurity and adiposity changes over two years among Louisiana adolescents aged 10 to 16 in the Baton Rouge, Louisiana metropolitan area. Methods: Multilevel longitudinal data were collected from June 2016 to August 2018 during baseline and follow-up assessments conducted within the Translational Investigation of Growth and Everyday Routines in Kids study. Adolescent adiposity and body composition data were obtained using body imaging (i.e., dual-energy X-ray absorptiometry and abdominal magnetic resonance imaging) and anthropometric measures at baseline and follow-up. Multivariable multilevel linear regression models, adjusted for demographic and physiological variables, assessed the relationship between baseline household food security status and changes in adiposity outcomes. Results: The analytic sample consisted of 216 adolescents with a mean age of 12.9±1.9; 47.7% were male, 40.7% identified as African American or Hispanic, and 38.4% had obesity at baseline. Twenty-two percent of the sample reported food insecurity at baseline. Compared to food-secure adolescents, food-insecure adolescents experienced significantly larger increases in all adiposity measures between baseline and follow-up (percentage of the 95th BMI percentile: b=7.3, p&lt;0.01; waist circumference: b=3.9, p&lt;0.05; total body fat percentage: b=3.2, p&lt;0.01; and abdominal visceral adipose tissue: b=0.2, p&lt;0.01). Similar results were found among girls; however, among boys, only change in abdominal visceral adipose tissue was higher in food insecure vs food secure boys (b=0.2, p&lt;0.05). Conclusion: This study provides support for the longitudinal association between household food insecurity and increased adiposity in adolescents, with notable gender differences. The main findings show household food insecurity is associated with greater changes in adiposity among girls than boys. These findings underscore the importance of addressing food insecurity as part of comprehensive obesity prevention strategies. Moreover, they highlight the need for gender-specific approaches in tackling this complex public health issue.
Abstract 059: Longitudinal associations of accelerometer-determined sedentary and physical activity behaviors with heart failure biomarkers during the midlife transition: Coronary Artery Risk Development in Young Adults (CARDIA)
Authors: Kelley Gabriel, Bjoern Hornikel, Erin Dooley, Baojiang Chen, Sylvia Badon, Ankeet Bhatt, Mercedes Carnethon, David Jacobs, Sadiya Khan, Joao AC Lima, Jared Reis, Pamela Schreiner, James Shikany, Stephen Sidney, Kara Whitaker, Cora Lewis, Barbara Sternfeld
Journal: Circulation (2025)

Introduction: Few studies have examined the longitudinal associations of accelerometry-based measures of sedentary and physical activity behaviors with subclinical heart failure (HF) in midlife. This is a key gap given an improved understanding of modifiable factors associated with HF risk may better inform prevention strategies. Hypothesis: More time in light intensity physical activity and/or moderate or vigorous intensity physical activity and less sedentary time will be related to lower levels of clinical HF biomarkers (NT-proBNP and hscTnT) across midlife . Methods: Data are from 2,844 CARDIA participants [57.9% women, 45.0% Black persons, aged 45.3 ± 3.6 years at the Year 20 exam (baseline for this analysis; 2005-06)] with at least one available timepoint of valid accelerometer (ActiGraph) wear (≥4 of 7 days with ≥10 hours per day of wear) and HF biomarkers at baseline and 10- and/or 15-years later. Linear mixed effects models, adjusted simultaneously for time spent sedentary and in light- or moderate or vigorous- intensity physical activity (partition model), sex, race, age, center, education, difficulty paying for basics, alcohol and tobacco use, obesity, diabetes, hypertension and hypercholesterolemia, were used to estimate the associations. Results: From baseline to 15-year follow-up, mean (± SD) time spent sedentary increased (488.1 ± 104.3 to 537.5 ± 112.0 min/d) and time spent in light intensity physical activity and moderate or vigorous intensity physical activity decreased (360.1 ± 86.7 to 312.1 ± 87.2 min/d and 37.3 ± 51.7 to 22.1 ± 22.4 min/d, respectively). Over this same period, mean (± SD) HF biomarkers increased (NT-proBNP: 61.6 ± 91.8 to 145.8 ± 1,111.9 pg/mL and hscTnT: 7.8 ± 4.7 to 11.0 ± 28.7 ng/L)). After adjustment, every 5-minute higher moderate or vigorous intensity physical activity was associated with lower NT-proBNP and hscTnT over 15 years ( Table ). Conclusions: Findings highlight the importance of moderate or vigorous intensity physical activity during the midlife transition for subclinical HF prevention, demonstrating this association before the onset of overt signs or symptoms.
Abstract MP71: Smoking and Biological Aging Acceleration Measured by Midlife Proteomic Aging Clocks: Insights from the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Jeffrey Misialek, Shuo Wang, Anna Prizment, Sanaz Sedaghat, Weihua Guan, Peter Ganz, Rajat Deo, Ruth Dubin, Yongmei Liu, Pamela Lutsey, Jim Pankow
Journal: Circulation (2025)

Background: Biological age may provide unique health insights beyond chronological age. Proteomic aging clocks (PACs) assess a person’s biological age, and a positive deviation of biological age from chronological age is known as age acceleration. Smoking has been associated with greater risk of age-related diseases and conditions. It is also associated with age acceleration in previous studies that assessed biological age using DNA methylation-based epigenetic clocks; however, this association has not been investigated using PACs. Methods: A total of 5,762 participants free of CVD from the Multi-Ethnic Study of Atherosclerosis (MESA) had over 7,000 plasma proteins measured using an aptamer-based proteomic profiling platform at exam 1 (2000-2002). Two previously published midlife PACs (ARIC and Lehallier) were calculated from available proteins in MESA, and we calculated age acceleration for each PAC as residuals after regressing PAC on chronological age. We used linear regression to assess the association of self-reported smoking (status, pack-years, and secondhand smoke exposure) with age acceleration measured using both PACs, adjusting for demographics and other potential confounders. Results: The analytic sample was 52% female with a mean age of 62 years (range 45-84) and a race/ethnicity breakdown of 39% White, 12% Chinese, 26% Black, and 23% Hispanic. For smoking, 13% were current smokers, 49% had a total pack-years &gt; 0, and 37% of never smokers had exposure to secondhand smoke. The age acceleration median was -0.15 years using the ARIC midlife PAC and -0.13 years using the Lehallier midlife PAC ( Table ). Smoking status and secondhand smoke exposure in non-smokers were not associated with age acceleration measured by either PAC. Pack-years in ever smokers was positively associated with age acceleration after adjustment for demographics only (model 1). Additional adjustment slightly attenuated the association between pack-years and age acceleration (model 2). Conclusion: Further research is needed to examine the effect of smoking on age acceleration measured by other PACs and determine how these associations compare to those between smoking and epigenetic aging clocks.
Abstract 056: Exposure to artificial light at night in relation to weight gain and cardiovascular risk among women cancer survivors
Authors: Yong-Moon Park, Chandra Jackson, Hazel Nichols, Yong Zhu, Michael Fradley, Katie OBrien, Benjamin Amick, Clarice Weinberg, Dale Sandler
Journal: Circulation (2025)

Background: Cancer survivors are at high risk for weight gain and cardiovascular disease (CVD) after treatment. Artificial light at night (ALAN) may contribute to elevate risks by disrupting circadian rhythm, affecting hormonal regulation and metabolism. This relationship has not been evaluated in women cancer survivors. Methods: After excluding women with daytime sleep schedules and those with prevalent CVD, 2,401 women (aged 35-74 years) who reported a history of cancer other than non-melanoma skin cancer when they enrolled in the Sister Study (2003-2009) were followed through September 2021 (mean follow-up: 11.8 years). Self-reported indoor ALAN exposure during sleep was categorized as: no light (reference group), small nightlight in the room, light outside the room, and television/light on in the room. Generalized Poisson regression models with a log link and robust standard errors were used to estimate multivariable relative risks (RRs) for weight gain ≥5 kg and a BMI increase ≥10% over follow-up. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD, including myocardial infarction, angina, heart failure, heart bypass surgery, angioplasty, transient ischemic attack, or stroke. Results: At cohort entry, the median time since cancer diagnosis was 9.8 years and 28.6% of participants were obese (BMI ≥30). Any ALAN was associated with weight gain (RR 1.51, 95% CI 1.12-2.03) and BMI increase (RR 1.46, 95% CI 1.02-2.09). Sleeping with a television or light on was positively associated with weight gain (RR 1.83, 95% CI 1.27-2.65, P trend =0.0002), particularly in long-term survivors (&gt;10 years, RR 2.99, 95% CI 1.71-5.23, P trend &lt;0.0001), and with BMI increase (RR 1.89, 95% CI 1.21-2.94, P trend =0.003) over follow-up. These associations persisted after adjusting for sleep duration and quality, dietary patterns, and physical activity. Sleeping with a television or light on was also associated with increased CVD risk (HR 1.61, 95% CI 1.05-2.46, P trend =0.03), with a stronger association among survivors with pre-existing CVD risk factors (diabetes, hypertension, or dyslipidemia) at enrollment (HR 1.90, 95% CI 1.13-3.17, P trend =0.0008). Conclusions: ALAN may contribute to weight gain, higher BMI, and elevated CVD incidence in cancer survivors who are women. ALAN may be a modifiable risk factor for obesity and CVD in this high-risk population. Future studies should include an assessment of daytime light exposure.
Abstract P2136: Prognostic Value of the Six-Minute Walk Test in Patients with Hypertrophic Cardiomyopathy
Authors: Yu Zhang, Leqi Wang, lei song
Journal: Circulation (2025)

Background: The six-minute walk test (6MWT) is a simpler, safer, and more cost-effective measure of functional capacity than cardiopulmonary exercise testing (CPET) and can be used for risk stratification of several cardiovascular diseases. However, there are no data on the prognostic value of the 6MWT in hypertrophic cardiomyopathy (HCM). Objective: To investigate the prognostic value of the 6MWT in HCM and determine whether it can be used as an alternative to CPET. Methods: A total of 534 patients with HCM were prospectively recruited to undergo both 6MWT and CPET. The endpoint of this study was major adverse cardiovascular events (MACE, a composite of cardiovascular death, heart failure, aborted sudden cardiac death, and stroke). The associations of the 6MWT with MACE were investigated using survival analyses, and the ability of 6MWT and CPET parameters to predict MACE were compared. Results: Four hundred and ninety-six patients with HCM who had complete follow-up data available were included. The mean age was 46.8 years, and 69.1% were male. The 6MWT distance correlated significantly with peak VO 2 on CPET (r=0.328, P&lt;0.001). Thirty-eight patients had MACE during a median follow-up of 2.7 years. A shorter 6MWT distance was independently associated with a higher risk of MACE (per 100-m decrease, hazard ratio 1.755, P=0.003) after adjusting for covariables. The association between peak VO 2 and MACE was also determined (per 1 mL/min/kg decrease, hazard ratio 1.102, P=0.044). The ability of the 6MWT distance to predict MACE was not significantly different from that of peak VO 2 (C-statistic, 0.643 vs 0.616). The optimal cutoff value of the 6MWT distance was identified as 423 m. Addition of the 6MWT distance (as a dichotomous variable) to the adjusted Cox model with clinical and demographic covariables significantly improved the ability of the model to predict MACE (C-statistic, 0.791 vs. 0.731, P=0.038), while addition of peak VO 2 did not improve the prediction performance of the model (C-statistic, 0.754 vs. 0.731, P=0.346). Conclusions: Poor performance on the 6MWT was an independent risk factor for MACE in patients with HCM. The 6MWT distance provided additional prognostic discrimination beyond conventional covariables when compared with peak VO 2 . These findings suggest that the 6MWT not only serves as an alternative to CPET but has greater clinical value, highlighting the importance of routine 6MWT to assess functional capacity in patients with HCM.
Abstract P1088: The Association of Kidney Function Trajectories with Atrial Fibrillation, Heart Failure, and Mortality over a 19-Year Follow-up: Results from CRIC study
Authors: XUANYI JIN, L Hamm, Hua He, Chung-shiuan Chen, Siyi Geng, Oygen Suayp, Flor Alvarado, Arnold Alper, Geetika Gorrepati, Lydia Bazzano, Katherine Mills, Adriaan Voors, Jiang He, Jing Chen
Journal: Circulation (2025)

Background: The long-term trajectories of estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD) have not yet been well investigated. Objectives: The current study aims to compare eGFR trajectory patterns over 19-years follow-up, and their association of atrial fibrillation (AF), heart failure (HF), and all-cause mortality. Methods: Using data from the Chronic Renal Insufficiency Cohort (CRIC) where eGFR (creatine-based: CKD-Epi equation) was measured annually, group-base trajectory models were used to identify latent groups. Multivariable Cox proportional hazard models were used to examine the association of eGFR trajectory groups with the incident events of HF and AF based on records of hospitalization, and death from any cause. Results: Three eGFR trajectories were identified among 3,939 subjects (Figure 1). The largest was Group 1 (52.0%) with steeper declines both early and late in follow-up. Group 2 (32.7%) displayed a stable declining pattern, and Group 3 (15.3%) was predominantly stable with minimal decline. Group 1 were more likely to be the black (50.6%,) and have a higher BMI (32.3±7.8), hypertension (95%), diabetes (58.4%), and elevated NTproBNP (median 245.2pg/ml), at the baseline (all p &lt;0.0001). Group 3 were younger (54.1 year) compared to Groups 1 and 2 (59.3 and 60.5 years). Compared to Groups 2 and 3, Group 1 had greater hazard ratio (HR) of incident AF (HR, 3.14 [95% CI: 2.40, 4.11]), HF (HR, 9.13 [95% CI: 6.15, 13.6]), and mortality (HR, 3.95[95% CI: 3.29, 4.74]), adjusted for age, sex, race, BMI, hypertension, diabetes, eGFR, and NTproBNP. Conclusion: This study identified a group of CKD patients with steeper decline in eGFR data over 19-years of follow-up and a significantly higher risk of AF, HF, and all-cause mortality.