tbuckley/cabot-search huggingface dataset:
Abstract 41: Independent Prediction of Mortality From Opportunistic Screening of Aortic Calcification
Authors: Steven R Horbal, Brian A Derstine, Aleda Leis, Brian E Ross, Edward Brown, Stewart C Wang, Sven A Holcombe
Journal: Circulation (2024)

Introduction: Abdominal aortic calcifications (AAC), often discovered during diagnostic medical imaging, have recently gained traction as valuable indicators of cardiovascular health. The morphomic aortic calcification score (MAC) uses dynamic thresholding and machine learning algorithms to automatically segment, process, and grade AAC from medical imaging. This study’s purpose was to evaluate AAC and mortality in patients over the age of 65 with previous diagnostic imaging. Methods: A novel community sample of 6655 participants had received an abdominal CT scan between 1999-2022 at Michigan Medicine. Participants were 65 years or older and without diagnosed cardiovascular disease at scan time. MAC threshold of 4.21% abdominal aortic wall coverage at the L3 level was used to prioritize sensitivity. Cox models were used to evaluate the associations between MAC and mortality. Model 1 was unadjusted; model 2 controlled for diabetes, subcutaneous-visceral fat ratio, and biological sex; model 3 added age. Effect modification was evaluated between MAC and age, as well as MAC and sex. Results: Mean follow up time was 3,916 (sd 1661) days. From the initial scan, 1306 deaths were observed at 10 years (19.62%), and 2277 deaths overall (34.21%). The proportional hazard assumption held. Models indicated significant hazard ratios for MAC and mortality: model 1 (unadjusted) HR 1.36 (95% CI 1.23, 1.50); model 2 (adjusted) HR 1.28 (1.14, 1.44); model 3 (model 2 + age) HR 1.15 (95% CI 1.03, 1.31). No effect modification was observed between MAC and age or sex. Discussion: MAC, a novel measure of abdominal aortic calcification, was independently associated with mortality in a hospital-based community sample of patients over the age of 65. Interestingly, the addition of age attenuated the MAC-mortality relationship, but significance remained. This work highlights the independent effects of abdominal aortic calcification and potential utility as a factor of future mortality in opportunistic screening of asymptomatic populations.
Abstract 28: Social Dimensions of Sleep: An Exploration of Midlife Working-Class Women’s Experiences in Mexico
Authors: Astrid N Zamora, Elizabeth Roberts, Martha Tellez-Rojo, Karen Peterson, Libni Torres Olascoaga, Alejandra Cantoral, Erica C Jansen
Journal: Circulation (2024)

Sleep, one of Life’s Essential 8, is vital to midlife women’s cardiovascular health (CVH). However, achieving healthy sleep is complex. As a first step, it is important to understand the barriers and facilitators to achieve adequate and high-quality sleep among midlife women in a context-specific manner. To comprehensively address this issue, we employed a mixed-methods approach to provide a nuanced understanding of the ecologies and experiences surrounding sleep health among working-class midlife women from Mexico City. First, we utilized existing epidemiologic data on participants to describe sleep and its correlates in a study population (n=120) of women enrolled in a cohort study via objective and subjective standard sleep measures. Then, we used thematic analysis to analyze in-depth ethnographic interview data (n=30) to characterize self-described barriers and facilitators of sleep. Our findings revealed that a substantial proportion of midlife women experienced poor sleep quality, with 53% reporting short sleep duration and 43% experiencing insomnia-related difficulties over seven days. Epidemiologic data suggested poor sleep outcomes were driven by age, type of work/occupation, food insecurity, mental health issues, and diabetes status. Our ethnographic interviews demonstrated that study participants perceived their familial relationships and responsibilities as the prominent barrier to quality sleep, encompassing challenges such as insufficient sleep due to family obligations and sleep disturbances triggered by family-related stressors. Combining these methodological approaches underscored the strong social dimension of sleep, where good sleep hinged on completing household tasks and attending to family needs. In response to sleep deficits, women frequently turned to caffeine consumption and occasional napping as coping mechanisms and described using sleep facilitators, including remedies like teas or other “natural” products. This study highlights the intricate social drivers of sleep, termed the “Sociality of Sleep,” among Mexican midlife women and may demonstrate how sleep recommendations and hygiene principles are likely inadequate in relation to the complex social dynamics of sleep. These insights provide evidence for considering the social context when tailoring recommendations that promote healthy sleep within this demographic. Furthermore, the combined methodology employed in this research may serve as a model for future sleep health studies.
Abstract 69: Trajectory of Cardiovascular Health Across Childhood and Adolescence in Project Viva
Authors: Izzuddin Aris, Sheryl Rifas-Shiman, Wei Perng, Sarah de Ferranti, Marie-France Hivert, Emily Oken
Journal: Circulation (2024)

Introduction: The American Heart Association recently put forth the Life’s Essential 8 (LE8) algorithm to assess cardiovascular health (CVH) status based on 8 health and behavioral factors. Few studies, however, have characterized the natural history of CVH status across development or identified sociodemographic determinants of CVH trajectories in children. We sought to address this research gap using data from Project Viva, a pre-birth cohort in eastern Massachusetts. Methods: We applied the LE8 algorithm to derive CVH score (range 0-100 points) in early childhood (median age 3.2y), mid-childhood (7.7y), early adolescence (13y), and late adolescence (17.5y). We used segmented mixed-effect models to characterize sex-specific CVH trajectories across these life stages and estimate three subject-specific trajectory parameters: timing of inflection point when CVH score declines; slope before and after the inflection point. We used linear regression models to assess the association of child race and ethnicity, mother’s education level, and annual household income with each trajectory parameter. Results: Among 1,523 children included, 48.7% were female, 3.5% Asian, 15.2% Black, 4.8% Hispanic, 11.5% Other, and 65.0% White. The mean (SD) CVH score was 82.6 (8.6) points in early childhood, 84.1 (8.3) points in mid-childhood, 82.0 (9.8) points in early adolescence, and 73.8 (11.5) points in late adolescence. Females (vs. males) exhibited slower rate of CVH score gain before the inflection point (0.3 vs. 1.0 points/y), later timing of inflection point when CVH score started declining (10.1 vs. 9.6y), and slower rate of CVH score decline after the inflection point (-1.3 vs. -1.5 points/y). Children of Black (β 0.48y; 95% CI 0.28, 0.68) or Other (β 0.28y; 95% CI 0.08, 0.49) race had a later timing of inflection point compared with White children. Children whose mothers were college-educated (vs. non-college educated) had higher CVH score throughout childhood, and exhibited faster rate of CVH score gain before the inflection point (β 0.19 points/y; 95% CI 0.03, 0.34), earlier timing of inflection point (β -0.37y; 95% CI -0.53, -0.22), and faster rate of CVH score decline after the inflection point (β -0.24 points/y; 95% CI -0.38, -0.10). No associations were observed for household income. Conclusions: This cohort study identified a key timepoint between mid-childhood and early adolescence where CVH trajectory declines over time, as well as sociodemographic differences in CVH trajectory parameters. Future studies are warranted to assess other determinants and consequences of these trajectory parameters.
Abstract 54: Circulating Biomarkers and Anticoagulation Breakthrough Stroke Risk in Atrial Fibrillation: The REGARDS Study
Authors: Samuel Short, Katherine Wilkinson, Erin Hald, George Howard, Virginia J Howard, Suzanne E Judd, Elasayed Soliman, Brett Kissela, David Robinson, Robert J Stanton, Mary Cushman
Journal: Circulation (2024)

Introduction: Anticoagulation reduces ischemic stroke risk in atrial fibrillation (AF), but “breakthrough” stroke occurs. Blood biomarkers might help identify patients at risk for anticoagulation breakthrough stroke, but existing studies are limited by examining few biomarkers in select populations. Hypotheses: Established biomarkers of ischemic stroke risk will also be associated with ischemic stroke risk in people with AF on anticoagulation sampled from the general population. Methods: REGARDS is a prospective cohort of 30,239 Black or White adults aged ≥45 on enrollment in 2003-7 monitored for stroke. Nine established blood biomarkers of ischemic stroke risk were measured at baseline in participants with AF and with no prior stroke who were taking oral anticoagulation at baseline. Hazard ratios of ischemic stroke were estimated by Cox models adjusted for demographics and stroke risk factors. Results: Among 713 participants with AF on anticoagulation (median age 76, 36% female, 17% Black, all taking vitamin K antagonists), 67 (9%) developed a first-time ischemic stroke over 12 years. In models adjusted for demographics, there were positive associations of all biomarkers with stroke risk except for galectin-3, lipoprotein(a), and cystatin C which had inverse or null associations (Figure). Adjustment for risk factors minimally impacted interpretation of results. The greatest associations were with higher N-terminal pro-B type natriuretic peptide, factor VIII, D-dimer, and growth differentiation factor 15; associations for D-dimer and growth differentiation factor 15 were not statistically significant. Hazards for galectin-3, gamma glutamyl transferase, interleukin 6, and lipoprotein (a) were modest and not statistically significant. Conclusion: Biomarkers of cardiac strain (specifically atriopathy), coagulation, and inflammation were associated with higher ischemic stroke risk in people with AF on anticoagulation at baseline. Findings highlight new avenues for reducing stroke risk in AF.
Abstract 59: Sugar-Sweetened Beverages, Gut Microbiota, Circulating Metabolites, and Risks of Cardiometabolic Diseases: The Hispanic Community Health Study / Study of Latinos (HCHS/SOL)
Authors: Yanbo Zhang, Kai Luo, Brandilyn Peters-Samuelson, Yasmin Mossavar-Rahmani, Jee-Young Moon, Martha L Daviglus, Linda Van Horn, Amanda C McClain, Christina Cordero, Neil Schneiderman, James S Floyd, Bing Yu, Robert Burk, Robert Kaplan, Qibin Qi
Journal: Circulation (2024)

Introduction: Sugar-sweetened beverages (SSBs) remain the top contributor to added sugar intake and contribute to significant cardiometabolic disease burdens. However, associations of SSB intake with gut microbiota and blood metabolites, a potential pathway linking SSB intake to cardiometabolic risks, are unclear. Hypothesis: Higher SSB intake alters gut microbial composition and blood metabolites which contribute to higher cardiometabolic risks. Methods: We assessed associations of SSB intake with gut microbiome (metagenomics, n=2970) and 653 serum metabolites (untargeted metabolomics, n=6115) among US Hispanic/Latino adults. We examined cross-sectional associations of gut microbiota with cardiometabolic traits and metabolites, and prospective associations of metabolites with risks of cardiovascular disease (i.e., myocardial infarction, stroke, and heart failure) and diabetes over median follow-ups of 7.6 and 10.5 years, respectively. Results: Higher SSB intake (median=0.9 servings/d) was related to the enrichment of 2 microbial species and depletion of 7 species with multivariable adjustment ( Fig. 1 ). A gut microbiota score, calculated based on the 9 SSB-related species, was related to poorer glycemic, triglyceride, and renal traits ( Fig. 1 ). Among 64 metabolites related to both SSB intake and gut microbiota score ( Fig. 1 ), 7 metabolites (e.g., 5-aminovaleric acid betaine) were associated with cardiovascular disease risk, and 30 metabolites were associated with diabetes risk, including those in the branch-chained amino acid metabolism (e.g., 2-hydroxyisovaleric acid), tryptophan metabolism (indole-3-propionic acid), and ursodeoxycholic acid, which were reported to closely relate to gut microbiota. Conclusion: Among US Hispanics/Latinos, higher SSB intake was associated with unfavorable gut microbiota and circulating metabolites for cardiometabolic risks, suggesting a potential role of gut microbiota and related metabolites in the link of SSB intake with cardiometabolic diseases.
Abstract 64: Risk Factors for Carotid Artery Lipid Deposition Measured by Gray Scale Median of the Intima-Media in Children and Young Adults Over the Life Course
Authors: Fangqi Guo, Xinci Chen, Yanjie Li, Mingzhu Yan, Howard N Hodis, Shohreh Farzan
Journal: Circulation (2024)

Introduction: Echogenicity of the carotid arterial wall, measured by gray scale median of the intima-media (GSM-IM), is a unitless measure that reflects lipid deposition in the arterial wall, with lower values indicating greater lipid deposition and atherosclerosis. Due to the relative novelty of GSM-IM, its progression and associated risk factors are incompletely understood. This study investigated the GSM profile in childhood and young adulthood using a longitudinal cohort of individuals followed over time, and conducted a priori analysis on the behavioral, psychosocial, and health risk factors for GSM. Methods: Data were collected as part of the Meta-Air2 follow-up study of participants enrolled in the Southern California Children’s Health Study. A total of 240 study participants underwent a carotid artery ultrasound examination in 2008 (mean age±standard deviation [ SD] : 11.2±0.6 years), and again between 2018 and 2023 (24.2±1.6 years) to assess changes in carotid artery health, including GSM-IM, carotid artery intima-media thickness (CIMT), and carotid artery distensibility. Participants self-reported lifestyle behaviors, psychosocial health, and underwent anthropometric and blood pressure measures at both time points. Mixed effects models were used to predict GSM-IM changes with repeated measurements of lifestyle behaviors, perceived stress, BMI, and blood pressure. Results: Means and SDs of GSM-IM were 110.0±27.4 in childhood, and 75.6±15.8 in adulthood, with an annual change rate of -2.6 per year. Individuals of Hispanic ethnicity, and those with lower parental education levels had significantly lower GSM-IM in both childhood and adulthood. GSM-IM was significantly correlated with other measures of carotid artery atherosclerosis, including CIMT (r=0.28; p &lt;0.001) and carotid artery distensibility (r=0.36; p &lt;0.001). Results of mixed effects models adjusting for covariates, indicated that higher BMI (β=-1.35; 95% confidence interval [CI], -1.70, -0.99; p &lt;0.001) and systolic blood pressure (β=-0.32, 95% CI, -0.55, -0.09; p=0.007) were significantly associated with lower GSM-IM. A significant interaction between BMI and age (β difference=0.14; 95% CI, 0.09, 0.20; p &lt;0.001) suggested that a per-unit change in BMI has a greater effect on GSM-IM among adolescents compared to young adults. Health compromising behaviors, including less sleeping time, smoking, drug use, and higher perceived stress were significantly associated with lower GSM-IM in unadjusted models. However, these associations were attenuated after adjustment for covariates. Conclusion: Our study highlights the influence of BMI, particularly during childhood, blood pressure and lifestyle behaviors on adverse changes in GSM-IM, indicative of greater lipid deposition. These risk factors may be key targets for early prevention for atherosclerosis.
Abstract 02: Contributions of Social Determinants of Health to Premature Cardiovascular Mortality in the US General Population
Authors: Alexander Kimbrough, Ling Tian, Jiang He, Katherine T Mills, Joshua D Bundy
Journal: Circulation (2024)

Introduction: Quantifying the contributions of 8 social determinants of health (SDOH) to US population-level premature cardiovascular disease (CVD) mortality will aid in developing and implementing strategies to reduce the burden of CVD mortality for diverse populations. Hypothesis: Levels of unfavorable SDOH are more common in Black and Hispanic adults in the US and contribute to a higher proportion of US population-level premature CVD mortality compared with White adults. Methods: We included 48170 participants aged 20-74 years from the National Health and Nutrition Examination Survey 1999-2018, linked to the National Death Index for cause-specific mortality follow-up through December 31, 2019. Premature CVD mortality was defined as death before age 75 with underlying ICD-10 codes for heart disease or stroke. SDOH included employment, family income-poverty ratio, food security, education, healthcare access, insurance status, home ownership, and marital status. We estimated average population attributable fractions to quantify the contribution of each SDOH to premature CVD mortality by self-reported race/ethnicity. Models controlled for age, sex, and survey year. Results: Combined SDOH accounted for &gt;50% of US population-level premature CVD mortality among US adults (Figure). Among Black adults, SDOH accounted for 64.2% of premature CVD mortality, which was larger than that for Hispanic (58.4%) and White (55.0%) adults. Unemployment was generally the SDOH most strongly associated with premature CVD mortality, with PAFs (95% confidence intervals) ranging from 14.7% (7.3-22.0%) among White adults to 20.8% (7.7-33.9%) among Black adults. Low family income-poverty ratio contributed an additional 27.3% of premature CVD mortality in Black adults. Conclusion: SDOH account for &gt;50% of premature CVD deaths in US adults but contributions differ by race/ethnicity. Interventions targeting SDOH may simultaneously reduce premature CVD mortality among all adults while addressing associated disparities.
Abstract 20: Dairy Consumption in Young Adulthood and Risk of Coronary Artery Calcification Later in Life
Authors: Ethan Cannon, David R Jacobs, Lyn Steffen, Mark J Pletcher, James M Shikany, Philip Greenland, Felipe Martignoni, Pamela Schreiner, Michael D Miedema
Journal: Circulation (2024)

Introduction: The relationship of dairy with cardiovascular disease (CVD) remains controversial. Meta-analyses have shown a modest, protective association of dairy, and other recent evidence has indicated that whole-fat dairy may not be inferior to low-fat dairy, despite concerns about its saturated fat content. Hypothesis: Intakes of total, whole-fat and low-fat dairy during young adulthood are inversely associated with risk of incident coronary artery calcification (CAC), a subclinical marker of atherosclerosis and predictor of future CVD events. Methods: In 3,110 young adult participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, dairy consumption was assessed via a validated diet history. Intake was averaged between baseline (1985-86) and year 7 exams. The first occurrence of CAC score &gt;0 among years 15, 20 and 25 was identified in 904 participants; the remainder were censored at the last available of these exams. Cox proportional hazards regression was used to estimate associations of CAC incidence with each of total, low-fat, and whole-fat dairy. Results: Median daily consumption of total dairy was 1.2 servings in quartile 1 and 5.4 servings in quartile 4. After adjustment for energy intake and other variables, associations of total and low-fat dairy with CAC were null. However, a monotonic trend was observed across quartiles of whole-fat dairy intake, where individuals in the highest quartile had a lower risk of CAC (hazard ratio: 0.74 (0.60, 0.93)) compared to those in the lowest quartile. Conclusions: Whole-fat dairy showed an inverse association with CAC 15 to 25 years later. Possible explanations for this finding include potentially cardioprotective effects of the unique profile of fatty acids or other fat-soluble constituents found in dairy products, as well as the displacement of foods and beverages in the diet. These results challenge dietary guidelines that recommend replacing whole-fat dairy with low-fat alternatives.
Abstract 15: Associations of Physical Activity and Sedentary Behavior With Clinical Cardiovascular Health 2-7 Year After Pregnancy: The nuMoM2b Heart Health Study (HHS)
Authors: Bethany Barone Gibbs, Sarah Modlin, C Noel N Bairey, David Haas, Sadiya S Khan, Abbi D Lane, Rebecca McNeil, Jasmina Varagic, Ligia Vasquez-Huot, Janet M Catov
Journal: Circulation (2024)

Introduction: The reproductive years are a critical period when clinical cardiovascular health (CVH) often declines. Though lifestyle behaviors such as increasing physical activity (PA) are recommended, limited longitudinal data supports these strategies following delivery. Hypothesis: We posited that higher moderate-vigorous intensity PA (MVPA) and lower sedentary behavior (SB) would be associated with more favorable changes in CVH in the years after delivery. Methods: We conducted a prospective analysis in the nuMoM2b Heart Health Study (HHS). nuMoM2b followed primiparas from 8 clinical centers from the 1 st trimester through delivery. The HHS followed a subset of these participants 2-7 years later. Self-reported leisure MVPA from an adapted Modifiable Activity Questionnaire and leisure SB duration were measured only at the HHS follow-up. Clinical components of ideal CVH (BMI, blood pressure [BP], glucose, and lipids) were assessed in the 1 st trimester and the HHS follow-up. CVH components were scored by Life’s Essential 8, where 0 = poorest and 100 = ideal, to calculate component-specific and an average clinical ideal CVH score. Linear regression evaluated associations of MVPA guideline categories and SB quartiles with changes in ideal CVH scores (from 1st trimester to HHS visit), adjusting for baseline and confounders. Results: Participants (n = 3,985) were 27 ± 6 years old, 36% from a racial/ethnic minority group, with average MVPA of 261 ± 332 min/week and SB of 3.8 ± 3.2 hr/day at follow-up. Clinical ideal CVH score declined from the 1 st trimester (85.6 ± 14.5 pts) to follow-up (81.6 ± 16.3 pts; p&lt;0.001). Both higher MVPA and lower SB were associated with more favorable changes in ideal CVH score and ideal BMI score (see Table). Only lower SB was associated with more favorable changes in ideal BP score; only higher MVPA was associated with more favorable changes in ideal glucose and lipid scores. Conclusion: Higher MVPA and lower SB each contribute to the maintenance of ideal clinical CVH in the years following pregnancy.