tbuckley/cabot-search huggingface dataset:
Abstract P2105: Polygenic risk scores for obstructive sleep apnea relying separately on BMI- adjusted and -unadjusted genetic associations reveal separate pathways of cardiovascular disease risk
Authors: Tamar Sofer, Nuzulul Kurniansyah, Satu Strausz, Anne Justice, Yana Hrytsenko, Brian Cade, Matthew Moll, Bernard Haring, Su Yon Jung, Laura Raffield, Jerome Rotter, Stephen Rich, Sina Gharib, Traci Bartz, Peter Liu, Han Chen, Lifang Hou, Daniel Levy, Alanna Morrison, Heather Ochs-Balcom, PETER WILSON, Allan Pack, Hanna Ollila, Susan Redline, Daniel Gottlieb
Journal: Circulation (2025)

Background: OSA is a heterogeneous disease, with obesity a significant risk factor in many but not all cases of OSA, via increased airway collapsibility, reduced lung volumes, and possibly body fat distribution. Research question: We sought to develop PRSs that summarize the genetic liability to OSA that include and exclude obesity related pathways, and to study the associations of these PRSs with OSA comorbid cardiometabolic and CVD outcomes. Approach: Using 1.2 million race/ethnic diverse samples from the Million Veteran Program, FinnGen, TOPMed, All of Us (AoU), Geisinger’s MyCode, MGB Biobank, and the Human Phenotype Project (HPP), we developed, selected, and assessed PRSs for OSA, relying on genome wide association studies both adjusted and unadjusted for BMI: BMIadjOSA and BMIunadjOSA PRS. We tested their associations with cardiometabolic and CVD outcomes in AoU. Results: In association with OSA, adjusted odds ratios (ORs) per 1 standard deviation of the PRSs ranged from 1.38 to 2.75, all statistically significant (Figure). The associations of BMIadjOSA and BMIunadjOSA PRSs with CVD outcomes in AoU shared both common and distinct patterns. For example, BMIunadjOSA PRS was associated with type 2 diabetes, heart failure, and coronary artery disease, but the associations of BMIadjOSA PRS with these outcomes were statistically insignificant with estimated OR close to 1. In contrast, both BMIadjOSA and BMIunadjOSA PRSs were associated with hypertension and stroke. Sex stratified analyses revealed that BMIadjOSA PRS association with hypertension was driven by data from females: females had OR=1.1, p-value=0.002, but males OR=1.01 and statistically insignificant. OSA PRSs were also associated with dual-energy X-ray absorptiometry (DXA) body fat measures. In BMI adjusted analysis, BMIadjOSA PRS was associated with higher visceral adipose tissue (VAT) proportion of total body fat mass (TFM), with lower proportion of gynoid fat mass out of TFM, higher proportion of android fat mass out of TFM, and lower gynoid to android fat mass. In females only, the PRS was associated with higher VAT to SAT ratio (Figure). Conclusions: Distinct components of OSA genetic risk are related to obesity and body fat distribution, and may influence clinical outcomes. These may explain differing OSA risk and associations with cardiometabolic and CVD morbidities between sex groups.
Abstract P1069: Health Care Professional Perspectives on IMPLEMENT-HF: A Qualitative Study Examining Successes, Facilitators, and Barriers in a Quality Improvement Program for Patients with Heart Failure
Authors: Nicole Gonzalez, Sruthi Cherkur, Jalisa Powell, Larry Allen, Javed Butler, Lee Goldberg, Michelle Kittleson, Joann Lindenfeld, Sara Paul, Ileana Pina, Nancy Sweitzer, Lynn Serdynski
Journal: Circulation (2025)

Introduction: Heart failure (HF) leads to over 1 million hospitalizations and 450,000 related deaths annually, yet there are substantial quality gaps in care. In 2021, the American Heart Association launched IMPLEMENT-HF (I-HF), a 3-year national Quality Improvement (QI) initiative, to improve care and outcomes for patients with HF. Several QI strategies were used and evaluated over the course of this initiative. Purpose: Focus groups were conducted to gather health care professional (HCP) perspectives on I-HF implementation. Results will assist in determining overall program impact and to identify successes, barriers, and facilitators to inform implementation of future QI programs. Methods: This study involved virtual focus groups (n=8) with HCPs (n=25) recruited from the 111 sites enrolled in I-HF. A semi-structured focus group guide was developed to facilitate the 60-minute sessions. Focus groups were recorded and transcribed, and inductive and deductive thematic analyses conducted in NVivo identified key high-level themes and subthemes. Results: HCPs felt I-HF improved their care team’s knowledge of HF treatment options and their confidence in treating patients with HF. They reported improvements in prescribing guideline-directed medical therapy (GDMT), medication adherence, and follow-up appointment attendance during the program period. HCPs appreciated the flexibility and variety of I-HF’s educational offerings, opportunities to learn from other HCPs, and the benefits of the Get With The Guidelines® program on patient care. Commonly cited implementation barriers included high staff turnover, clinical roles taking precedence, and a lack of leadership and organization within their sites, which hindered full engagement with I-HF. The cost of and lack of insurance coverage for GDMT was frequently cited as a major burden for patients and a barrier to uptake. Conclusions: QI programs like I-HF can improve care and outcomes for patients with HF and increase HCP knowledge and confidence in providing appropriate treatments. Several cited implementation facilitators, such as flexible educational offerings, can be replicated in future programs. Some reported barriers, such as limited staff capacity, will be challenging to address. However, future initiatives can offer additional guidance on program implementation and recommend assigning a point person at each site to enhance internal organization and support more comprehensive adoption of program activities.
Abstract 067: Long-term Cardiovascular Outcomes After COVID-19 Hospitalization in the Omicron Era: Retrospective Cohort Study
Authors: Sergio Renato da Rosa Decker, Yang Song, Issa Dahabreh, Robert Yeh, Dhruv Kazi
Journal: Circulation (2025)

Introduction: Hospitalization for COVID-19 in the Pre-Omicron era was associated with an increased risk of major adverse cardiovascular events (MACE), but data from the Omicron era are sparse. Hypothesis: We investigated the hypothesis that the risk of MACE among older adults hospitalized for COVID-19 during the Omicron era is lower than in the Pre-Omicron era, and is similar to that in a historical influenza cohort. Methods: Retrospective cohort study using 100% of Medicare fee-for-service claims, including beneficiaries aged ≥ 65 years hospitalized for COVID-19 in the Omicron era (11/26/21–09/30/2022), for COVID-19 in the Pre-Omicron era (03/01/20 –11/25/21), or for influenza in the pre-COVID-19 era (03/01/16 – 09/30/18). Outcomes were measured at 1 year of follow-up after the index hospital admission date. The primary endpoint was the cumulative incidence proportion (risk) of MACE (composite of all-cause death, myocardial infarction, ischemic stroke/ transient ischemic attack, pulmonary embolism, deep vein thrombosis, heart failure hospitalization, and cardiac arrest). Secondary outcomes included individual components of MACE and hospitalization for atrial fibrillation. We used inverse probability weighting to allow comparisons to a common standard (Omicron cohort), the Kaplan-Meier method to estimate the cumulative incidence of outcomes including death, and the Aalen-Johansen method for outcomes that did not include death. Results The analysis included 363,719 patients in the Omicron cohort (mean age 79 years; 51% women; 18% dual enrollees), 724,657 in the Pre-Omicron cohort, and 149,572 in the influenza cohort. The risk of MACE at 1 year was lower in the Omicron than in the pre-Omicron cohort (48.6% vs. 49.3%, risk difference after standardization [RD], -0.7%; 95% CI -0.9% to -0.5%) but higher than in the influenza cohort (48.6% vs. 30.3%; RD, 18.3%; 18.1% – 18.6%). Compared with the pre-Omicron cohort, the Omicron cohort had a significantly lower risk of death at 1 year (34.2% vs. 40.1%, RD, -5.9%; -6.1% to -5.7%) but a higher risk of hospitalizations for myocardial infarction, stroke, heart failure, and atrial fibrillation (figure). Conclusions Among older adults, the risk of MACE within 1 year after COVID-19 hospitalization in the Omicron era has declined since the Pre-Omicron era, driven by all-cause death, but it remains elevated. Notably, during the Omicron period the risk of MACE is still higher than that observed in a historical influenza cohort.
Abstract P2015: Perceptions of Health Coaching for Weight Loss Maintenance in Primary Care: Results from the MAINTAIN PRIME Trial
Authors: Kayla Jordanova, Elizabeth Rudd, Jorie Butler, Maribel Cedillo, Jesell Zepeda, Polina Kukhareva, Bernadette Kiraly, Michael Flynn, Kensaku Kawamoto, Molly Conroy
Journal: Circulation (2025)

Introduction: Health coaching can expand the capacity of primary care providers (PCPs) in supporting patient self-management of overweight and obesity. Current platforms for weight management health coaching include in-person meetings, phone calls, and asynchronous online messaging. We seek to understand patient perceptions and facilitators and barriers to engagement with asynchronous, online coaching through the patient portal of the electronic health record (EHR). Hypothesis: Patients will find EHR- and primary care-integrated health coaching acceptable for weight management. Methods: Participants in MAINTAIN PRIME were primary care patients with BMI ≥25 before intentional weight loss of ≥5%, randomized to health coaching with tracking tools (coaching) vs. tracking tools alone. Coaching was performed by trained primary care staff via EHR messaging. We are conducting semi-structured interviews at 24-months with active and inactive participants in the coaching arm (active defined as remaining enrolled in trial and responding to messages within 1 week). An interview guide includes the domains of EHR platform for health coaching, patient-coach relationship, and coaching integration with primary care. We analyzed interviews via thematic analysis. Results: Six of 11 completed interviews have been analyzed. Half of participants (3/6) were active, 66.7% were female (4/6), and average age was 39.6 years. Results to date reveal positive perceptions of the EHR platform for health coaching. Most participants found the platform convenient and liked the integration with other health records. Others stated a preference for separating coaching from medical care. Participants liked engaging with coaches at the time of their choosing. Messages were overall helpful, though sometimes felt impersonal and templated. Participants felt coaches were professional but lacked a personal connection, which could have improved with an initial in-person or video meeting. Lastly, many participants were unaware of coaching integration with their PCP teams other than the initial referral to coaching. Conclusions: Overall, participants had positive perceptions of the coaching experience though noted some areas for improvement such as adding a face-to-face meeting with the health coach and further personalizing messages to promote stronger coaching relationships. Discussions between PCPs and coaching participants regarding weight management could bolster a sense of integration and support.
Abstract P1139: Lower Pre-Pregnancy Cardiovascular Health is Associated with Higher Odds of Hypertensive Disorders of Pregnancy: Coronary Artery Risk Development in Young Adults Study (CARDIA)
Authors: Leah Dodds, Daniel Feaster, Catarina Kiefe, Erica Gunderson, Natalie Bello, Tatjana Rundek, Michael Paidas, Shathiyah Kulandavelu, Tali Elfassy
Journal: Circulation (2025)

Introduction: Hypertensive disorders of pregnancy (HDP) such as gestational hypertension, preeclampsia and eclampsia lead to increased maternal morbidity, mortality, and are associated with cardiovascular disease risk. It remains unknown whether HDP is a result of pathological events associated with pregnancy complications and/or due to pre-existing cardiovascular traits of the mother unmasked by the stressful nature of pregnancy. Objective: To determine whether cardiovascular health prior to pregnancy, assessed by the American Heart Association’s Life’s Essential 8 (LE8) score, is associated with risk of HDP. Methods: CARDIA is a prospective cohort study of 5,115 Black or White US adults aged 18-30 at baseline (1985-86), from four US cities, followed over 30 years across nine study visits. Participants underwent assessments of health behaviors (diet, smoking, physical activity, sleep) and clinical metrics (body mass index, blood pressure, cholesterol, fasting glucose, medication use) used to estimate the LE8 score (range: 0 to 100). Cardiovascular health was categorized as low (LE8 &lt;50), moderate (LE8 50-79) or high (LE8 ≥80). HDP was self-reported as having a post-baseline pregnancy lasting ≥20 weeks gestation complicated by gestational hypertension, preeclampsia or eclampsia. We used generalized mixed models to determine the association between time-updated LE8 and incident HDP accounting for the 2,036 live births nested within 1,227 women. Models were adjusted for baseline education and income, time-updated age and parity, follow-up time, and cumulative live births. Missing values for LE8 computation at an exam were imputed from the most proximal available value. Results: Mean (SD) baseline age was 24.1 years (3.6), 48.7% were Black women; 19.9% reported HDP in ≥1 pregnancy post-baseline. At baseline, the average LE8 score was 79.0 (11.0) and significantly lower among women who developed HDP (77.0 [10.9]) than in women who did not (79.5 [11.0]), p&lt;0.01. From fully adjusted mixed models, compared to women with high pre-pregnancy cardiovascular health, women with moderate (OR: 1.79, 95%CI: 1.14, 2.81) and low cardiovascular health (OR: 4.03, 95%CI: 1.09, 14.95) prior to pregnancy had greater odds of HDP. Conclusions: Women with low or moderate cardiovascular health were at greater risk of developing HDP compared to women with high cardiovascular health. Results suggest that lower pre-pregnancy cardiovascular health is an independent risk factor for HDP.
Abstract P1016: Relationships between Sex and In Hospital Outcomes in Patients with Complete Heart Block.
Authors: Nadhem Abdallah, Mohammed Samra, Meriam Abdallah
Journal: Circulation (2025)

Background: There is a growing body of data to support the presence of sex disparities in outcomes in cardiovascular related hospitalizations. Despite this, there remains a paucity of data on relationships between sex and in-hospital outcomes in cases of Complete Heart Block (CHB). Methods: We examined the 2016-2020 Nationwide Readmission Database (NRD) to identify patients with a principal diagnosis of CHB. Men were used as our control group, while women comprised our cohort. The primary outcome was in-patient mortality. Secondary outcomes included odds of mechanical ventilation use, all cause 30-day readmission, length of stay (LOS) and total hospitalization charges (THC). Multivariate linear and logistic regression models were used to adjust for confounders. Results: Among the patients with CHB (N = 175,257), 45% were Female. A Female sex was associated with higher odds of in-hospital mortality (adjusted OR [aOR] 1.42, 95% CI 1.3 – 1.55, p&lt;0.001) compared to male patients with CHB. Additionally, female sex was associated with a higher likelihood of mechanical ventilation use (aOR 1.1, 95% CI 1.03 – 1.2, p=0.004), all cause 30-day readmission (aOR 1.08, 95% CI 1.03 – 1.13, p=0.004), longer LOS (4.13 days vs 3.86 days, p&lt;0.001) and lower THC ($89,908 vs. $94,590, p=0.002) compared to male patients with CHB. Conclusion: Among patients with CHB, female sex was associated with higher odds of mortality, non-fatal adverse events, and lower resource utilization compared to male patients.
Abstract P2109: Sex Differences in the Plasma Metabolome Before and After Exercise Training
Authors: Eric Leszczynski, Jacob Barber, Prashant Rao, Kiani Jacobs, Michael Mi, Prasun Dev, Charles Schwartz, SUJOY GHOSH, Claude Bouchard, Clary Clish, Jeremy Robbins, Robert Gerszten, Mark Sarzynski
Journal: Circulation (2025)

Background: Sex differences in metabolites, particularly their changes with exercise training, are largely unknown. We hypothesized that metabolites would not largely differ between males and females at baseline, but that most of the exercised-induced changes in metabolites would be sex-specific. Methods: Plasma metabolites were measured using untargeted LC-MS methods before and after a 20-week exercise intervention in participants from the HERITAGE Family Study (n=671, 56% Female, 35% Black, 17-65 yrs). A total of 810 metabolites were included. Sex differences at baseline were examined using Student t-tests. Paired t-tests were used to examine changes in metabolites with exercise training by sex. Significance was defined as FDR&lt;0.05. Results: At baseline, the levels of 398 plasma metabolites were higher in males, while 155 were higher in females. The most significant sex differences were found for creatine, uric acid, and androsterone 3-glucuronide. Most exercise training changes in the plasma metabolome were sex-specific (74%, Fig 1A ). A majority of the female-specific metabolite changes were in carnitines and LPCs, with the highest individual changes in DG 30:1, CAR 10:2, and ectoine. Most of training changes observed only in males were in TGs, DGs, and PCs, with the greatest individual changes in PE 40:6, adenosine, and TG 54:9 ( Fig 1B ). Conclusions: Most of the plasma metabolites were different between sex groups at baseline, but importantly, a majority of the exercise-induced changes occurred in only males or females. The differential sex response of the plasma metabolome to exercise training observed in this study could represent important sex-specific metabolic pathway responses to an exercise intervention.
Abstract P1014: The associations of financial barriers to dental health care with incident cardiovascular disease and dementia: a longitudinal analysis in the All of Us cohort
Authors: Mabeline Velez, Peter Buto, Kendra Sims, Jennifer Weuve, Jingxuan Wang, Anna Pederson, Maria Glymour
Journal: Circulation (2025)

Introduction: Though poor oral health is linked to elevated risk of later-life cardiovascular disease (CVD) and Alzheimer’s Disease and Related Dementias (ADRD) via systemic inflammation, the impact of financial barriers to oral care on CVD and ADRD incidence remains unquantified. Hypothesis: We hypothesized that older adults reporting financial barriers to oral care -particularly women, people marginalized due to racial/ethnic identity, or with periodontitis - have elevated risk for CVD and ADRD. Methods: We used data from All of Us participants aged at least 55 years (N=65,770, 77.2% Non-Hispanic White, 57.9% women). Our primary exposure was self-reported difficulty accessing oral care due to cost within the past year, defined as yes or no. We identified congestive heart failure (CHF), cerebrovascular accident (CVA), myocardial infarction (MI) and ADRD outcomes in linked electronic health records. Using Cox proportional hazards models, we estimated associations of difficulty accessing dental care with each outcome. We assessed heterogeneity by gender, racial/ethnic identity, and prevalent periodontitis diagnosis. We estimated the population attributable fractions (PAF) of each outcome associated with difficulty accessing oral care using national prevalence estimates. Results: Participants who reported difficulty affording oral care had a higher incidence of CVA (adjusted HR=1.72; 95% CI: 0.72, 3.86) and CHF (HR=1.22; 95% CI: 1.01, 1.47). Estimated effects on MI (HR=1.11; 95% CI: 0.85, 1.44) and ADRD (HR=1.02; 95% CI: 0.61, 1.69) were not robust to adjustment for demographic, health behavioral, and clinical confounders. We did not observe differences in these associations by race/ethnicity, gender, or periodontitis. The estimated PAFs suggest that eliminating financial barriers to oral care could, over three years, prevent 9% of incident stroke, 4% of MI, 6% of CHF, and 4% of ADRD. Conclusion: Addressing financial barriers to needed oral care remains an unrealized policy target for CVD and ADRD prevention.
Abstract P3104: Assessment of Dietary Recall Plausibility Using an Updated Formula that Considers Energy Intake Measured by Doubly-Labeled Water
Authors: Leinys Santos Baez, Michele N. Ravelli, Diana A. Diaz-Rizzolo, Collin Popp, Bin Cheng, Dympna Gallagher, Dale Schoeller, Blandine Laferrere
Journal: Circulation (2025)

Background: Self-reported, free-living energy intake (rEI) by dietary recalls are notoriously inaccurate. Assessment of rEI plausibility have been limited to arbitrary assumptions or validation against measured energy expenditure (mEE) by doubly-labeled water (DLW). We aimed to identify plausible dietary recalls using an updated formula that considers measured energy intake calculated by DLW (mEI) instead. Methods: In a two-week cross-sectional study, up to six rEI by repeated Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool, with body energy store changes (ΔBES) measured by quantitative magnetic resonance (QMR) on days 1 and 14, mEE assessed by DLW, and mEI computed by energy balance equation (mEE + ΔBES). Participants were asked to maintain an eucaloric diet. A rEI:mEI ratio was calculated for each participant, and a group cut-off was calculated using the formula: ±1SD = √(CVrEI 2 )/d)+(CVmEI 2 ). Dietary recall entries within ±1SD of the cutoffs were categorized as plausible (PR), &lt;1SD categorized as under-reported (UR), &gt;1SD categorized as over-reported (OR). Spearman correlations and linear regression performed to evaluate the linear relationships for continuous variables. Results are mean±SD. Significance set at p&lt;0.05. Results: In our cohort (n=39, age: 60.6±6.9 years, BMI: 33.1±6.4 kg/m 2 , 33.3% men), 50%, 26.3%, 23.7% of the dietary recalls were UR, PR and OR, respectively. The rEI:mEI ratio showed a significant negative correlation with body weight (ß=-0.38, p =0.02). Greater mEI predicted higher body weight (ß=26.6, p&lt;0.01) and BMI (ß=51.4, p=0.02). In contrast, no relationships were observed between rEI and body weight (ß=9.3, p=0.09) or BMI (ß=22.5, p=0.28). However, in PR entries alone, rEI predicted greater body weight (ß=19.5, p&lt;0.01) and BMI (ß=44.8, p=0.04). Conclusion: These preliminary results align with past studies supporting higher implausible energy intake in adults with greater body weight, based on self-reported dietary recalls. In contrast to rEI, we found a consistent and significant association between mEI and PR, with body weight and BMI. This supports the notion that higher energy requirements are needed to maintain energy balance in individuals with greater body mass. These findings support this method for identifying plausible reporting (PR) when assessing dietary intake.