tbuckley/cabot-search huggingface dataset:
Abstract P1059: Afterschool Rx: A Feasibility Study of a Community-Based Prescription for Reducing Cardiovascular Risk
Authors: Lauren von Klinggraeff, Hannah Parker, Isha Patel, Michal Smith, Steven Coughlin, Catherine Davis, Paul Estabrooks, Ryan Harris, Marlo Vernon, Michael Beets, Abbi Lane, Sudha Garimella, Bridget Armstrong
Journal: Circulation (2025)

Background: Engagement in afterschool programing (ASP) is associated with improved health behaviors and cardiorespiratory fitness, therefore increasing access to existing ASP may hold promise as an intervention for reducing CV risk in children. Research Question: Is existing community-based ASP a feasible intervention for reducing childhood CV risk? Goals/Aims: Our aim was to assess the feasibility of recruiting children with elevated CV risk, providing free ASP as an intervention, and collecting measures related to CV risk onsite during the programs. Methods: In a metropolitan area of the Southeastern US, potentially eligible children were invited by mailed flyer to participate in Afterschool Rx, a single-group feasibility study. Children were eligible if CV risk factors were identified via EMR (January-June 2023;overweight/obesity [OWOB], and/or elevated systolic and diastolic BP). Children had to attend an elementary school providing transportation to a participating ASP. Participants were provided with 17-weeks of free ASP in Spring 2024. Height, weight, body composition (BIA), and carotid femoral PWV were measured onsite at the beginning and end of the program. Descriptive feasibility data is presented. Results: From EMR records, 7,265 children were eligible. Of those, 2,239 lived in a zip code with a participating ASP and 1,787 were randomly selected to receive mailed recruitment flyers. Flyer QR codes were scanned 222 times (10% engagement), 74 families consented to participate (33% conversion), of which 32 children attended schools with participating ASP. Across 5 ASPs, 22 spots were initially available, though 5 families dropped out of the study prior to registration and 5 were unable to register due to capacity limitations at ASPs. At baseline, the 12 enrolled children had a mean age of 10 (SD 1.24; range 8-13), 58% (n=7) were female, and 42% (n=5) were non-Hispanic Black. Six children had OWOB with normal BP, one had normal weight and elevated BP, 5 had OWOB and elevated BP. Height, weight, body composition, and BP measures were taken for 92% (n=11) at pre and post, while PWV was captured for 10 (83%). Conclusion: Afterschool Rx was successful in recruiting children with elevated CV risk, providing free ASP, and collecting measures onsite at ASP. Difficulties with ASP enrollment was identified an intervention transition point that could be improved. Overall community-based prescription for ASPs is feasible and well-suited for additional development and testing.
Abstract P1037: Promoting Sustained Behavior Change and Nutrition Security in Medicaid-Enrolled Individuals with Stage 2 Cardiovascular Kidney Metabolic Syndrome (CKMS): protocol and early recruitment success of the SUSTAIN study
Authors: Colleen Spees, Daniel Walker, Amaris Williams, Jade Smith, Erin Frey, Guy Brock, Jillian Tatro, Amy Headings, Jenelle Hoseus, Joshua Joseph
Journal: Circulation (2025)

Introduction: Medicaid-enrolled populations are disproportionately impacted by suboptimal nutrition leading to lower Life’s Essential 8 (LE8) cardiovascular health (CVH) scores and greater prevalence of Stage 2 cardiovascular-kidney-metabolic syndrome (CKMS) as defined by the American Heart Association (AHA). With support from the AHA Health Care by Food TM Initiative and leveraging existing academic-community-government-industry partnerships, our team is assessing the feasibility, engagement, and preliminary efficacy of SUSTAIN , a novel Food is Medicine (FIM) intervention in Medicaid-enrolled individuals with Stage 2 CKMS. Hypothesis: Our overall hypothesis is that a comprehensive FIM intervention including culturally appropriate and home-delivered groceries, intensive and tailored behavioral nutrition counseling, and social care coordination will improve nutrition security and CVH compared to individuals receiving home-delivered groceries only. Methods: Informed by the socioecological model and human-centered design, SUSTAIN is a 24-week randomized controlled trial (RCT) of Medicaid-enrolled individuals (n=100) with Stage 2 CKMS to: Aim 1 : Determine the feasibility and engagement of participants in the SUSTAIN intervention compared to enhanced usual care over 24 weeks through mixed-methods measurement of participant enrollment, adherence, retention, and engagement (counseling, screenings, referrals, and uptake); Aim 2 : Determine the preliminary efficacy of the SUSTAIN intervention compared to enhanced usual care in improving behavior change as measured by nutrition security, LE8 measures, biometrics, and purchasing behaviors over 24 weeks to determine effect estimates to robustly power a future RCT. Results: Initial recruitment efforts have enrolled 46 individuals; 148 failed to meet eligibility criteria. Primary reasons for ineligibility were other diagnoses (e.g., heart failure) (n=107) and non-English speaking (n=31). A minority of participants were ineligible due to unwillingness to use mobile phone-based technology (n=2) or lack of backup form of payment for grocery vendor (n=3). Conclusions: Innovative FIM solutions are urgently needed. SUSTAIN will explicate the feasibility, engagement, and preliminary efficacy of SUSTAIN, leading to a scalable FIM nutrition-security-based model to improve CVH in Stage 2 CKMS. SUSTAIN has the potential to drive a paradigm shift in healthcare, fostering healthier, nutrition-secure and resilient communities.
Abstract P2027: Associations Between Paraben Exposure and Cardiometabolic Outcomes in Pediatric Populations: A Systematic Review
Authors: Deanna Chinerman, Ana Lungu, Melanie Henderson, Andraea Van Hulst, Jonathan Chevrier, Tibor Schuster, Tracie Barnett
Journal: Circulation (2025)

Introduction: Parabens are antimicrobial chemicals frequently used as preservatives in consumer products. Due to their chemical structure, exposure to parabens may impact cardiometabolic health by disrupting specific biological pathways. Objective: To synthesize the literature on the associations between paraben exposure and cardiometabolic outcomes in pediatric populations. Methods: Scopus, PubMed, Web of Science, and Embase databases were systematically searched for studies published before July 2024. Inclusion criteria were: at least one paraben exposure measure, at least one reported cardiometabolic outcome (excluding adiposity), and published in English or French. Data extraction included: demographic and methodological details and estimated associations between parabens and cardiometabolic outcomes. Quality was assessed using the Quality Assessment Tool for Quantitative Studies which was developed by the Effective Public Health Practice Project. Results: Of the 9595 records identified: 935 were duplicates, 14 were retained in full-text, and five were included in the review. Excluded were: non-human studies, populations outside the age range of interest (3-19 years), or missing relevant exposure or outcome measures. All five studies were cross-sectional, including 4 of moderate and 1 of weak quality. Exposures studied included methyl (n=5), ethyl (n=5), propyl (n=5), butyl (n=4), and the sum of parabens (n=2), Outcomes studied included blood pressure (n=3), blood lipids (n=3), and measures of glucose and insulin indices (n=3). Confounders adjusted for in most studies included age, sex, socioeconomic status, physical activity, ethnicity, and smoking. Statistical methods included: linear regression models (n=3), Wilcoxon and Chi-squared tests (n=1) and Bayesian machine kernel regression (n=1). Study heterogeneity limited synthesis of study results. One study reported negative associations between ethyl paraben exposure and measures of blood pressure in children 4-6. One study reported a positive association between parabens (in a chemical mixture) and triglyceride/HDL ratios in adolescents. The remaining studies reported no meaningful associations. Conclusion: Research on this topic is limited and heterogeneous making findings inconsistent and difficult to interpret. There is a need for longitudinal studies on parabens and cardiometabolic health, and for a greater understanding of the relationship between lifestyle and exposure patterns in youth.
Abstract P2051: Community-academic partnership to optimize retention in a hypertension prevention trial in Black Men
Authors: Tanisha Green, Nayelis Garcia, Milla Arabadjian, JOSEPH RAVENELL
Journal: Circulation (2025)

Background: Black adults, particularly Black men are underrepresented in cardiovascular research studies, limiting interpretation and generalization of findings, adversely impacting health equity. Analyses of enrollment strategies often focus on recruitment. Retention strategies to optimize study participation among Black adults, specifically Black men are underexplored. Objectives: To describe retention strategies for Black male participants of a community-engaged hypertension prevention trial. Methods: Community-to-Clinic Linkage Implementation Program (CLIP) is a cluster-randomized barbershop-based implementation study of hypertension prevention for Black men. Eligible participants (age 18-85 years, blood pressure (BP) &lt;130/80 mmHg), were recruited from 22 Black-owned barbershops in Staten Island, New York City. Recruitment was managed by Community Health Workers (CHWs) from a local service organization. Enrolled participants receive navigation to medical care, social services, and lifestyle coaching. Data collection includes questionnaire completion and BP measurement at time of enrollment, 6, 12, and 18 months. BP change at 12 months is the primary outcome. Results: We enrolled 425 participants. All 425 participants have reached the 6-month mark since enrollment and baseline data collection. 293 participants completed a 6-month follow-up visit. 12 and 18-month follow-up periods are ongoing with 206 participants completing the 12-month follow-up, and 71 participants completing the 18-month follow-up to date. After experiencing challenges with re-engaging participants for follow-up visits, new retention strategies were informed by input from CHWs, and the community advisory council (CAC) comprised of local leaders and collaborative community partners. Novel strategies included co-management of retention by CHWs and research staff, hiring a retention specialist, outreach to barbershops, evening and weekend appointments, and availability of mobile vans to meet participants at their choice of location. Conclusions: Retention is a vital component of community-engaged trials and requires creative thinking, flexibility, and cooperation between community and academic partners to optimize outcomes. We offer our experience as an example of real-world strategies for improving retention in a community-engaged trial.
Abstract P3117: Association of Body Roundness Index (BRI) with Left Ventricular Mass and Geometry: The Framingham Heart Study
Authors: Philimon Gona, Saadia Qazi, Carol Salton, Christopher Odonnell, Warren Manning, Michael Chuang
Journal: Circulation (2025)

Introduction: Body roundness index (BRI) is a metric of body shape incorporating both girth (waist circumference, WC) and height (HT), where BRI=364.2 – 365.5*SQRT(1- (WC/(π*HT)) 2 ). In contrast to body mass index (BMI) which does not account for body shape, BRI may be better able to identify adiposity. Increased left ventricular mass (LVM) indexed to body size predicts excess cardiovascular morbidity and mortality, but it is not clear whether indexation to HT or powers of HT, or to body surface area (BSA) are optimal. We sought to determine whether there is association between BRI and various methods of LVM indexation. Methods: 1764 members (944 women) of the Framingham Offspring cohort underwent cardiac magnetic resonance (CMR). Participants were divided into sex-specific tertiles of BRI, then a “referent group” without prevalent CVD, wall-motion abnormalities on CMR, or any history of hypertension was identified. We used sex-specific ANCOVA to test for linear trend across BRI tertiles for LVM and LVM indexed to HT, HT 2.7 , BSA, and total body weight (WT). We further investigated two measures of concentricity (“LV geometry”), as high concentricity is associated with excess morbidity. Relative wall thickness (RWT) was LV wall thickness/chamber diameter, Mass-volume ratio (MVR) was LVM/ end-diastolic volume. Results: The proportion of Offspring meeting Referent criteria (N=775, 57% women) decreased with greater BRI for each sex; Table 1. Table 2 shows that LVM and LVM indexed to HT or HT 2.7 increased with greater BRI, significantly for all except LVM in men. LVM/BSA was not different across tertiles of BRI among women, and decreased minimally (by &lt;3g/m 2 ) in men (p=0.049). LVM/WT decreased markedly with higher BRI in both sexes. RWT did not differ across BRI tertiles in men, but increased among women. MVR increased with greater BRI in both sexes (Table 3). Conclusions: LVM indexed to BSA is largely indifferent to BRI, but HT-indexed LVM increases, and LVM/WT decreases with greater BRI category. These results may suggest that HT indexation, which does not account for WT, may be “under adjustment”. However, simply indexing to WT may also be inappropriate, if the allometric relationship between LVM and body mass is dependent on the type of mass (i.e. fat vs non-fat mass). It remains to be determined which method of LVM indexation is best predictive of incident cardiovascular and overall morbidity and mortality.
Abstract P3018: Spanish Language Preference is not associated with Prediabetes Risk among Hispanic Adolescents with Overweight or Obesity in an Integrated Healthcare System
Authors: Veronica Njuguna, Joan Lo, Jeanne Darbinian, Nirmala Ramalingam, Steven Nash, Luis Rodriguez
Journal: Circulation (2025)

Introduction: Nationally, up to 1 in 5 Hispanic adolescents have prediabetes. While obesity and other metabolic risk factors contribute to their disproportionate metabolic risk, fewer studies have examined the role of sociodemographic factors such as language proficiency. In this study, we examined whether primary language preference is associated with differences in prediabetes prevalence among Hispanic youth with overweight or obesity. Methods: This retrospective study was conducted using data from Kaiser Permanente Northern California. The cohort included 37,578 Hispanic youth aged 10-17y with body mass index (BMI)≥85 th percentile at exam visits in 2013-2019 and hemoglobin A1c measured within 1 year of the visit. Youth with diabetes or A1c ≥6.5% were excluded. Prediabetes (outcome) was defined by A1c ≥5.7%-6.4%. We also examined A1c ≥6% (secondary outcome). Family/self-reported English vs Spanish language preference was obtained from health records. BMI was classified as overweight (85th to &lt;95th percentile) and obesity (≥95th percentile). A neighborhood deprivation index (NDI) was calculated using area of residence and US Census data. Modified Poisson regression was used to examine the association of language preference with prediabetes, reporting relative risks (RR) and 95% confidence intervals [CI]. Results: The cohort included 37,578 Hispanic youth (mean age 13.1±2.3y), of whom 26,910 (71.6%) reported English and 10,668 (28.4%) reported Spanish as their preferred language. Prediabetes prevalence was 19.3% for both English and Spanish language groups and was similar among those with overweight (13.3% vs 14.3%) and obesity (21.4% vs 21.0%). Adjusting for age, sex, NDI quartile, and BMI (percent of 95 th percentile), the risk of prediabetes for those with Spanish language preference remained similar to those with English language preference (RR 0.99 [0.95-1.04]. There were no differences within overweight or obesity subgroups, when A1c ≥6.0% was used as the outcome, and when analyses were restricted to older or younger age subsets. Conclusion: Prediabetes prevalence was similar among Hispanic youth with elevated BMI who had Spanish compared to English language preference. While differences in dietary and lifestyle factors were not examined, these findings point to similar metabolic risk profiles among Hispanic youth regardless of language preference, when examined in a healthcare system focused on preventive health and uniform access to language services.
Abstract P2005: Applying a comprehensive cardiometabolic risk prediction model to real-world primary care patient data
Authors: Carrie Howell, Shiori Tanaka, Greer Burkholder, Tapan Mehta, Larry Herald, William Garvey, Andrea Cherrington
Journal: Circulation (2025)

Background: Comprehensive risk prediction models utilized at the point of care have potential to improve screening rates, facilitate prevention referrals, and reduce disparities. However, feasibility of deploying comprehensive models in the clinical workflow are largely unknown. Objective: To assess: (1) feasibility of applying a validated risk prediction model – the cardiometabolic disease staging system (CMDS) - that incorporates metabolic, vascular, and social determinants of health (SDoH) factors to electronic health record (EHR) data from primary care patients and (2) cardiometabolic disease risk for 10-year onset of type 2 diabetes (T2D) and major adverse cardiovascular events (MACE). Method: Data to calculate CMDS [clinical: BMI, glucose, blood pressure, HDL, triglycerides, smoking status; SDoH: income, education, insurance status, stress and neighborhood level social vulnerability] among patients without documented T2D or MACE diagnosis [myocardial infarction, stroke, cardiovascular death] were extracted. CMDS was applied using 3 algorithms: (1) clinical and (2) clinical + SDoH for predicting T2D; and (3) clinical for MACE. Feasibility of model application was determined by calculating the percent of patients with a score out of all eligible primary care patients. We estimated mean scores overall by outcome; quartiled scores to determine risk strata; and assessed mean MACE by diabetes risk quartile. Results: A total 10,398 patients [mean age: 63.7 years (SD 10.6), 63% female, 26% non-Hispanic Black] were identified. Full data were available to apply the clinical model to 73% of patients and the CMDS + SDoH to &lt;1% for T2D outcome; 67% for clinical MACE model. Among patients that had a clinical CMDS calculated there was a mean 17.4% risk of developing T2D; and 10.6% of MACE. Quartiles of risk had natural breaks at &lt;6%, 6-10%, 11-20% and &gt;21% for T2D and &lt;5%, 5-8%, 9-14%, &gt;14% for MACE. Missing SDoH data [99.4% income; 95.4% education; 0% insurance; 94.7% stress; 33.5% neighborhood level social vulnerability; 0.6% marital status] was the limiting factor for CMDS + SDoH model application. Mean MACE risk was 11.0% among those at highest risk for T2D. Conclusion: While the clinical CMDS algorithms could be applied to EHR data, findings highlight the lack of available data to apply risk prediction models with SDoH measures. Future work should examine how to incorporate models into primary care workflow, including efforts to systematically screen social risks.
Abstract 030: The Association of Obesity Measures on the Development and Progression of Coronary Artery Calcium: Insights from the CARDIA Study
Authors: Shanshan Gustafson, Andrew Tai, Rishi Parikh, Erin Wong, Isabella Hanck, Norrina Allen, Sascha Goonewardena, Jamal Rana, John Carr, Donald Lloyd-Jones, Ankeet Bhatt
Journal: Circulation (2025)

Background: Coronary artery calcium (CAC) is a well-established marker of subclinical atherosclerosis and of cardiovascular risk. Identifying modifiable risk factors early in life such as body mass index (BMI) and waist-to-hip ratio (WHR) that predict development and progression of CAC in midlife can guide early intervention to decrease cardiovascular risk. Hypothesis: We hypothesize that higher BMI and WHR in young adulthood is associated with both the presence and progression of CAC 10 years later. Methods: We analyzed participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study with BMI and WHR measured at Y5 (Ages 23 to 35), and CAC measured between Y15-25 (ages 33 to 55). We used logistic regression models to assess the association between BMI/WHR and the presence of CAC (Agatston score &gt;0) at Y15, and a repeated-measures GEE linear model to assess the association between BMI/WHR and progression of CAC (log Agatston score) from Y15 to Y25. We conducted nested models adjusting for demographic variables (age, sex, race) and cardiovascular risk factors (diabetes, hypertension, smoking status, total cholesterol, lipid-lowering pharmacotherapy use). Results: A total of 2,838 participants had full data on obesity measures and CAC. Patients in higher quartiles of both BMI and WHR at Y5 had higher systolic blood pressures and total cholesterol. For each 5 kg/m 2 higher BMI at Y5, there was an associated increase in the prevalence of CAC&gt;0 at Y15 (i.e., 10 years later) by 28% (OR: 1.28, 95% CI: 1.13 to 1.44, P= 0.001), adjusting for age, sex, and race; however, this association was attenuated after full adjustment (OR: 1.12, 95% CI: 0.98 to 1.29). For each 0.1 increase in WHR at Y5, there was an associated increase in the prevalence of CAC&gt;0 at Y15 by 31% (after full adjustment (OR: 1.31, 95% Ci: 1.01, 1.69). There was an association of change in slope of yearly CAC progression between Y15-25 which increased by 18% for every 5 kg/m 2 higher BMI and by 58% for every 0.1 higher WHR assessed in young adulthood ( Figure ). Conclusion: BMI and WHR measured in young adulthood are both associated with the presence and progression of CAC 10-20 years later; however, WHR may be a stronger predictor of CAC and progression of CAC than BMI.