tbuckley/cabot-search huggingface dataset:
Abstract P432: Validation and Optimization of the American Diabetes Association Score for Undiagnosed Type 2 Diabetes Risk in Hispanic or Latino Adults
Authors: Ben T Varghese, Marlene E Girardo, Elena De Filippis, Adrian Vella, Kent R Bailey, Sagar B Dugani
Journal: Circulation (2024)

Background: The prevalence of type 2 diabetes (T2D) is increasing in Hispanic or Latino adults. The American Diabetes Association (ADA) score to identify current risk of T2D was developed with limited Hispanic or Latino representation. Therefore, we sought to validate the ADA score in a cohort of Hispanic or Latino adults. Methods: At enrollment in the Sangre Por Salud Biobank, 3,625 Hispanic or Latino adults from Phoenix, Arizona completed a baseline questionnaire. Current risk of undiagnosed T2D was based on non-laboratory risk factors and ADA score ≥5 (Table). Participants also completed T2D screening (ie, fasting glucose, 2-hour oral glucose tolerance test, and/or hemoglobin A1c). Undiagnosed T2D was based on 'no self-reported T2D but meeting T2D diagnostic’ criteria. Multivariable logistic regression analyzed associations of ADA risk factors and undiagnosed T2D, and model performance was based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: At enrollment, 7.3% of participants had undiagnosed T2D (n=265/3,625). In multivariable analysis, most risk factors described for the ADA score were significantly associated with T2D, except for sex, which showed no association. ADA score ≥5 had sensitivity 50%, specificity 79%, PPV 18%, and NPV 95%. However, ADA score ≥4 had sensitivity 72%, specificity 61%, PPV 14%, and NPV 96%. ADA score ≥4 vs ≥5 identified 22% (n=59) additional cases of undiagnosed T2D. Furthermore, using the revised definition for elevated blood pressure (&gt;120/80 mmHg) vs ≥140/90 mmHg (current ADA score) further improved the ADA score ≥4 (sensitivity 81%; specificity 52%). Other scores had lower performance using both hypertension definitions. Conclusion: In Hispanic or Latino adults, a lower ADA score than currently recommended identified additional cases of undiagnosed T2D. The ADA score requires validation and recalibration, including for the updated hypertension guidelines.
Abstract P456: Expanding a Pipeline to Address San Joaquin Valley Health Inequity and Social Justice
Authors: Maha Siddiqui
Journal: Circulation (2024)

Introduction: San Joaquin Valley (SJV) is the most medically underserved California region. For the last 50 years, SJV continues to face health inequity with not enough physicians for growing communities. With a diverse community of low income and minority groups, the lack of physicians do not represent the workforce of SJV. Many of the talented high school and community college students who aspire to be physicians from SJV leave to bigger cities rather than coming back to enrich their vulnerable communities. Objectives: I created and expanded no cost pipeline medical programs (summer programs and online class) for SJV high school students and community college students to increase diversity in the medical profession, encourage underrepresented in medicine (URM) students to pursue medicine and come back to SJV to practice medicine in an effort to lower the patient provider gap. Methods: I trained and provided mentorship to medically ambitious low-income high school and community college students in the programs to instill a passion in them to come back after their medical education to practice medicine and lower health equity in SJV. Through the program, students learned about SJV health disparities and applied precision medicine to their own health inequity projects in SJV. Findings: -About 76% (106 of 140) of program participants identified as URM -About 63% (88 of 140) of program participants were first generation -About 83% (103 of 140) of program participants feel that the pipeline program has helped them solidify their passion in medicine -About 66% (92 of 140) of program participants aspire to practice medicine in SJV -About 100% (140 of 140) of program participants feel the program gave them guidance in health disparities, precision medicine, and applying design thinking concepts as a future leader in medicine Direct Outcomes: -Students were able to understanding community concerns beyond science and with a health justice perspective -Served as agents of change by directly communicating with physicians and understanding the need for more URM physicians -Students received mentorship and confidence to rise as URM first generation college students and pursue STEM majors -Youth learned the value of service to disadvantaged communities
Abstract P320: Soluble Receptor for Advanced Glycation End Products and Incident Hypertension: REasons for Geographic And Racial Differences in Stroke (REGARDS)
Authors: Sarah Krumholz, Krystal Ramos Barrera, Nels Olson, Leann Long, Suzanne E Judd, Virginia J Howard, Mary Cushman, Tim B Plante
Journal: Circulation (2024)

Background: Black US adults experience greater hypertension burden than other groups and have lower levels of serum soluble receptor for advanced glycation end products (sRAGE). Higher sRAGE may dampen inflammation pathway activity. Inflammation is a hypertension risk factor. It is unclear if lower sRAGE is associated with greater risk of incident hypertension overall and among Black adults. Objective: To estimate the risk of incident hypertension by sRAGE level. Methods: REGARDS enrolled 30,239 Black and White adults in the 48 contiguous United States in 2003-07; a second visit occurred 2013-16. ELISAs measured sRAGE in 4,400 REGARDS participants who attended both visits. This analysis included participants with sRAGE levels and no prevalent hypertension. Hypertension was defined as BP ≥140/90 mm Hg or use of antihypertensive medications. Poisson regression estimated relative risk (RR) of incident hypertension by serum sRAGE quartiles in models adjusting for known confounders. Results: Among the 1803 participants (mean (SD] age 62 [8] years, 55% Women, 25% Black race) incident hypertension occurred in 35% (46% Black and 32% White participants). Median (IQR) sRAGE was 1114 pg/ml (206 to 4256) in Black and 1600 pg/ml (380 to 5500) in White adults. Models were stratified by race because of an sRAGE*race interaction on incident hypertension. Higher sRAGE was associated with lower hypertension risk in White participants in all models ( Table ). There was no association between sRAGE and hypertension in Black adults. Conclusions: Higher serum sRAGE was associated with lower hypertension risk in White, but not Black, adults when adjusted for known risk factors. Whether modifying sRAGE affects hypertension risk is unclear.
Abstract P442: Secondhand Smoking Associated With Sleep Apnea Risk Score
Authors: Suzanne B Gorovoy, Freda Patterson, Michael A Grandner, Elizabeth Connick
Journal: Circulation (2024)

Introduction: Approximately 18 million people have obstructive sleep apnea. While many people experience occasional nights of insufficient sleep, chronic sleep disorders are more serious and increase the risk of injury, morbidity, and mortality. While the association between smoking and sleep problems is well established, the relationship between secondhand smoke on sleep disordered breathing risk is less clear. Hypothesis: Sleep apnea risk increases with the presence of a smoker in the household. Methods: Data from N=9,232 adults were leveraged from the NHANES 2017-March 2020 dataset. The outcome/dependent variable of interest was sleep apnea risk score based on modified STOP-BANG criteria combined, as well as the presence/absence of snoring, tiredness, gasping, high blood pressure, BMI &gt; 35, age &gt; 50, and male gender. The exposure/independent variable was smoking status categorized as no smoker at home (reference) compared to whether there was an outside only smoker or someone who smoked indoors. Linear models estimated the association between smoking and overall risk, while logistic regression models estimated the association between smoking and individual risk factors. Results: Compared to no-smoking households, those with only outdoor smokers had a 0.187 point greater sleep apnea risk score ( p = 0.008), while those with an indoor smoker had a 0.211 point greater sleep apnea risk ( p = 0.018). Outdoor smoking was associated with greater likelihood of concurrent tiredness/sleepiness (OR 1.30, p = 0.014), gasping (OR 1.29, p = 0.024), and less likelihood of being over 50 (OR 0.52, p &lt; 0.001). Indoor smoking was associated with greater snoring (OR 1.33, p = 0.027) and tiredness (OR 1.29, p = 0.013). Indoor/outdoor smoking was not associated with high blood pressure, BMI, or male gender. Conclusion: Having a smoker in the home (Indoor and outdoor) wasere associated with greater apnea risk score. Location of smoking varied in association with individual apnea symptoms, but not in any consistent way. Although studies have shown that smoking worsens sleep apnea risk, future work should explore whether smoking cessation can improve health in other family members as well.
Abstract P109: HDL Cholesterol Confers Exceptionally Strong Cardioprotective and Metabolic Effects in Native Hawaiian and Pacific Islander Populations
Authors: Austin Szatrowski, Patrick Sun, Yoonseo Lee, George Lord, Logan Hallee, Jerris Hedges, Bohdan B Khomtchouk
Journal: Circulation (2024)

Relative to the general population, Native Hawaiian and Pacific Islander (NHPI) communities are significantly more prone to obesity, diabetes, and heart disease. Our population-based longitudinal study focuses on HDL cholesterol levels and cardiovascular risk among NHPI and other (comparison) populations. Given the importance of health disparities in cardiovascular disease among the people of Hawai'i, this study holds considerable importance for establishing more diverse, equitable, and inclusive healthcare and precision medicine approaches. Specifically, we communicate a novel data-driven finding, revealed from a statistical and machine learning analysis of epidemiological data from the NIH All of Us Research Program, showing that the cardioprotective effect of high-density lipoprotein (HDL) cholesterol is significantly stronger in NHPI populations relative to other racial/ethnic demographics (including White, Black, and Hispanic/Latinx communities). Our results indicate that: 1) the cardioprotective effect of HDL against coronary artery disease (CAD), acute myocardial infarction (MI), and major adverse cardiovascular events (MACE), is much more powerful in NHPI populations compared to any other racial/ethnic groups currently represented in All of Us . 2) HDL has an exceptionally strong negative relationship with Type II diabetes (T2D) incidence in NHPI populations, which is also significantly stronger than in other ethnicities. In NHPI populations, these results suggest that an additional emphasis ought to be placed on the cardiac and metabolic-protective effect of HDL level as a key biomarker/risk factor in physicians’ assessment of cardiometabolic disease risk. These cardiovascular health equity findings highlight the importance of more and improved diversity, equity, and inclusion efforts to adequately serve growing subpopulations of historically underrepresented groups such as NHPIs within the US healthcare system.
Abstract MP04: Socioeconomic Spatial Social Polarization and Blood Pressure at Three Spatial Levels
Authors: Hoda S Abdel Magid, Samuel Jaros, Gina S Lovasi, Suzanne E Judd, Michelle C Odden
Journal: Circulation (2024)

Spatial social polarization (SSP) indices measure how a population is distributed at extremes of privilege and deprivation. The choice of spatial level for analysis impacts the results of studies of SSP, resulting in a bias known as the Modifiable Areal Unit Problem (MAUP). The objective of this study is to examine the association between participant SSP with systolic and high blood pressure among Black and White adults in the CHS and REGARDS studies across three spatial levels: ZCTA, census tract, and county. We used the Index of Concentration at the Extremes (ICE) to measure SSP across socioeconomic domains including race/ethnicity, income, joint race/ethnicity with income, and home ownership using ZCTA-, census tract-, and county-level data. We computed quintiles for each geographic level, with quintile 1 representing the most deprived area and quintile 5 representing the most privileged for each SSP domain measured. High BP was defined as a treated or untreated blood pressure &gt;140/90 mmHg. Multilevel mixed-effects regression models were adjusted for source study and a priori defined covariates with a random intercept for spatial level. The magnitude of the association between spatial privilege and blood pressure was higher at more local levels. We found that study participants who resided in the most polarized and disadvantaged quintile for race/ethnicity had an odds ratio of 1.01 (95% CI: 0.87, 1.16), 1.20 (95% CI: 1.06, 1.35), and 1.24 (95% CI: 1.09, 1.40) at the county, ZCTA, and tract level respectively for high blood pressure compared to those in the most polarized privileged groups for race/ethnicity. Similar results were found for systolic blood pressure, though results varied by the ICE domain examined. These varying effects as a result of MAUP may be functions of the larger area units not capturing the underlying granular SSP distributions of deprivation and privilege and washing out the total effects of spatial polarization on blood pressure.
Abstract P336: The Association of Coronary Artery Calcium Progression and Cognitive Function in Midlife - The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Masayuki Teramoto, Tina Hoang, Stephen Sidney, James G Terry, Mark J Pletcher, Gregory M Marcus, Thomas Hoffmann, Kristine Yaffe
Journal: Circulation (2024)

Background: Little is known about the impact of coronary artery calcium (CAC) and its progression on cognitive function in midlife, a time of importance for cognitive aging. Methods: In CARDIA, CAC was measured using computed tomography at years 15 (baseline), 20 and 25. CAC progression was defined as: (1) CAC&gt;0 at follow-up among participants with baseline CAC=0; (2) an annualized change of ≥10 units at follow-up among those with 0&lt;baseline CAC&lt;100; or (3) an annualized percent change (annualized change in CAC score divided by baseline CAC score) ≥10% among those with baseline CAC≥100. Cognitive function was measured with Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), Stroop Interference, Montreal Cognitive Assessment (MoCA) and Verbal Fluency (Letter and Category Fluency) at year 35. We used linear regression to estimate the difference between marginal means with 95% confidence intervals (CIs) of each cognitive test by CAC score (0 vs &gt;0) and CAC progression. Results: Among 2,341 participants (mean age 40.3 ± 3.6 years, 56% female, 43% Black at baseline), higher CAC score and CAC progression were associated with significantly lower cognitive performance in all cognitive tests. After adjustment for demographics, the association remained for CAC progression, compared to no progression, for most test scores: DSST (-2.70 95% CI: -4.05 to -1.36, p &lt; 0.001), MoCA (-0.44 95% CI: -0.74 to -0.13, p = 0.005) and verbal fluency (-0.85 95% CI: -1.57 to -0.12, p = 0.02). Similar associations were observed for higher CAC score (&gt;0 vs 0): DSST (-3.11 95% CI: -5.16 to -1.06, p = 0.003), MoCA (-0.81 95% CI: -1.28 to -0.34, p = 0.001) and RAVLT (-0.67 95% CI: -1.12 to -0.23, p = 0.003). Additional adjustment for physical activity, depressive symptoms, and APOE, and mutually for baseline CAC score and progression did not materially change the association. Conclusions: CAC score and progression were associated with lower cognitive function in midlife. CAC progression may be an independent risk factor for early cognitive aging, independent of baseline CAC score and other risk factors.
Abstract P100: Global Burden of Atrial Fibrillation and Atrial Flutter and Its Trend From 1990-2019 in G20 Countries: Results From the GBD 2019
Authors: Krupa ishan MADHU, Nmair Alziadin, Khush Dadhania, Mallareddy Banala, Vinay Kumar Gadamidi, Anjani Kumar Thota, Priyatha VEMPARALA, Anusha Parisapogu, Juhi PATEL, Hardik Dineshbhai Desai
Journal: Circulation (2024)

Background: Atrial Fibrillation and Atrial Flutter (Afib) ranks 6th in mortality and 7th in disability amongst all cardiovascular disease the G20 nations. Method: We employed 2019 Global Burden of Disease methodology. Afib and Flutter, non-fatal health outcomes, such as incidence and prevalence, were estimated using the Bayesian meta-regression tool (DisMod MR 2.1). Fatal health outcomes were assessed using the Cause of Death Ensemble Model (CODEm), considering factors like age, gender, year, and location throughout the G20 from 1990 to 2019. Results: From 1990 to 2019, prevalence rose from 23.2 million (95%UI: 17.6-29.7) to 48.9 million (37.5-61.6). The annual percentage change (APC) in incidence surged by 102% (1.8-3.8 million), DALYs by 119% (3-6 million), and deaths by 168% (93,864-251,272). Despite these increases, the age-standardized rate per 100,000 person-years declined over the past three decades. In 2019, the U.S. reported the highest age-standardized incidence rate at 109.52 (88.97-131.92) per 100,000, while Sweden had the top mortality rate of 8.63 (4-10.32) per 100,000. The age group 65-69 had the peak incidence count of 700,768 (362,032-1,158,177). Meanwhile, the highest death count was in the 85-89 age bracket with 59,325 (48,618-70,077), and the most DALYs were in the 80-84 age group with 1,083,488 (882,995-1,323,533) in 2019. Males consistently faced a higher burden than females over this period. Conclusion: AFib and AF accounted for 1.88% deaths amongst all cardiovascular casualties in 2019. Clinicians in the G20 countries must prioritize early detection and intervention for Afib and flutter, especially in males and the elderly, given its escalating prevalence and its ranking as a major cause of death and disability. Public health strategies in the G20 nations should focus on targeted awareness and interventions to combat the rising burden of atrial fibrillation, with countries like the United States and Sweden requiring heightened attention due to their notably high incidence and mortality rates.
Abstract P322: Mapping Geographic Variation in Hypertension Prevalence in United States Congressional Districts Using Spatial Modeling
Authors: Oluwabunmi V Ogungbe, Biruk Teshome, Karan Parikh, Folahan A Ibukun, Katherine Wheeler-Martin, Cheryl R Dennison Himmelfarb, Lisa A Cooper, Yvonne Commodore-Mensah
Journal: Circulation (2024)

Introduction: Using spatial methods to explore drivers of hypertension (HTN) risks, commonalities, and differences across geographical areas can be assessed to inform future public health research and advocacy efforts. Objectives: To examine ecological associations between social determinants of health (SDoH), space, and HTN across congressional districts (CDs) in effect for the 118th US Congress. Methods: We obtained aggregate district-level data from Congressional District Health Dashboard on health behaviors, exposures, and outcomes for US CDs in 2019. Primary outcome was HTN prevalence, defined as proportion of adults who self-reported diagnosed HTN. Exposure variables were SDoH: health outcomes (diabetes, obesity, frequent physical and mental distress), health behaviors (physical activity, binge drinking, smoking), clinical care (routine checkups), and physical environment (air pollution). We fitted a hierarchical Bayesian Besag-York-Mollié model using the integrated nested Laplace approximation (INLA) method, which allowed the estimation of spatial autocorrelation of HTN prevalence at CDs level, accounting for SDoH. Results: Across 421 CDs, we found a variation in the modeled linear proportion of 83% across the CDs in the United States after adjusting for known HTN risk factors at the CDs level. A notable degree of variation in HTN prevalence exists within specific CDs, independent of recognized risk factors ( Figure ). These unmeasured variables act as confounding elements, and districts with darker shading indicate increased HTN attributed to the district, while lighter, red-shaded districts exhibit a reduced district-specific proportion of HTN. Conclusions: Our findings show significant geographic variation of HTN beyond known risk factors which underscores the significance of adopting a spatial perspective to understand HTN prevalence. It emphasizes the necessity for tailored public health interventions that consider the unique geographic context of each CDs.
Abstract P318: Provider Barriers and Facilitators to Treatment Intensification for Patients With Uncontrolled Blood Pressure
Authors: Teresa N Harrison, Janet Mora Marquez, Liang Ni, Angeline L Ong, Jeffrey W Brettler, Greg Wozniak, Brent Egan, Michael Rakotz, Kristi Reynolds, Jaejin An
Journal: Circulation (2024)

Background: Hypertension is the leading cause of cardiovascular disease and premature death worldwide, however, therapeutic inertia, failure to intensify pharmacotherapy when blood pressure (BP) is not at goal, is a key obstacle to hypertension control. We aimed to identify barriers and facilitators to increasing the dose or adding a different antihypertensive medication class for patients with uncontrolled BP. Methods: We conducted a qualitative study of healthcare providers from Kaiser Permanente Southern California (KPSC). Using a stratified purposeful sampling approach, we identified 300 providers across 15 medical centers and specialties and with a mix of treatment intensification rates. In 2 separate waves, we emailed a letter of invitation to 150 eligible providers followed by 2 reminder emails each two weeks apart. We sought to conduct 30 semi-structured interviews about management of patients newly diagnosed with hypertension including use of single-pill combination therapy (SPC) (the recommended first-line therapy within KPSC), barriers to therapeutic intensification and use of home BP monitoring for treatment intensification decision making. We used rapid analysis methods to code responses and develop themes. Results: A total of 11 interviews were completed with providers from family medicine (n=7), internal medicine (n=3) and cardiology (n=1) who had an average of 6 years of practice within KPSC. The majority of providers reported using monotherapy as first-line treatment while SPC therapy was reserved for younger patients and those with baseline systolic BP &gt;160 mm Hg. Monotherapy was often preferred to help providers determine if the first-line medication is causing side effects. Nearly all providers reported maximizing the dose of one medication before adding another medication class. Providers ranked the barriers to intensifying patients’ treatment in order of importance as 1) side effects such as frequent urination, hyperkalemia, and hypotension, 2) nonadherence to the current antihypertensive medication regimen and patient preference/hesitancy, 3) comorbidities (e.g., kidney function), and 4) age-related factors such as memory loss and ability to complete follow-up labs. All providers reported using patients’ home BP readings for treatment decision-making with most recognizing that patients’ out-of-clinic BP may be lower than clinic BP. Conclusion: Providers embraced stepped-care treatment for newly diagnosed patients with hypertension with most preferring monotherapy as first-line treatment. Concerns with side effects, nonadherence to the medication regimen and shared decision-making are key factors in providers’ decisions to intensify therapy for patients with uncontrolled BP. Targeted interventions to address provider barriers to treatment intensification may be needed.