tbuckley/cabot-search huggingface dataset:
Abstract P264: HDL-C Variability and Peripheral Artery Disease
Authors: Pao Hsien H Chu, Ying-Chang Tung
Journal: Circulation (2024)

Background: Growing evidence has recognized the clinical implications of lipid variability in relation to cardiovascular disease and adverse outcomes. However, data on the association between lipid variability and the risk of incident peripheral artery disease (PAD) remain scarce compared to other manifestations like coronary artery disease and stroke. Methods: We conducted a study using data from the Chang Gung Research Database in Taiwan. A total of 93,948 patients diagnosed with hyperlipidemia between 2007 and 2013 who had at least one lipid measurement annually for four consecutive years were included in this study. Lipid levels, including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides, as well as their visit-to-visit variability (average real variability, ARV), were calculated over the four-year period. Patients were followed up until December 31, 2019, for the development of incident PAD. Results: During a mean follow-up of 5.9 years, 2,735 (2.5%) of the patients had incident PAD. The mean levels of the four lipids were all significantly associated with the development of incident PAD. However, only HDL-C ARV showed a significant association with an increased risk of incident PAD, independent of traditional risk factors for atherosclerosis and lipid-lowering therapy (adjusted hazard ratio: 1.13; 95% confidence interval: 1.004-1.27 for the comparison between patients in the highest and lowest quartile of HDL-C ARV; P for trend = 0.002). A sensitivity analysis using the variability independent of the mean as the HDL-C variability index confirmed this association. The study result was consistent across all subgroups analyzed. Conclusions: In this multi-institutional database analysis, visit-to-visit variability in HDL-C was significantly associated with the risk of incident PAD, independent of traditional risk factors for atherosclerosis, mean lipid levels, and the use of lipid-lowering therapy. Absolute levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were all significantly associated with the development of incident PAD. Visit-to-visit variability in HDL-C was significantly linked to the risk of incident PAD, irrespective of traditional atherosclerosis risk factors, mean lipid levels, and lipid-lowering therapy use.
Abstract P160: Prevalence of Genetic Dilated Cardiomyopathy: A Systematic Literature Review
Authors: Mir Sohail Fazeli, Michael Myers, Yue Zhong, Sonomi Maruyama, Cindy Bueno, Arnaud Bastien, Boris Breznen, Negar Golchin
Journal: Circulation (2024)

Background: Dilated cardiomyopathy (DCM) is a leading cause of heart failure and cardiac transplantation worldwide. Many cases of DCM are due to genetic or idiopathic etiology. Two prominent contributors to genetic DCM (gDCM) are the TTN and MYH7 genes, which encode proteins associated with DCM etiology. Purpose: This study aimed to synthesize the published literature on the global prevalence of adult and pediatric gDCM within the clinical DCM population and the general population. Methods: A systematic review was conducted by searching MEDLINE® and Embase from database inception to 09/19/2022. We included observational studies reporting the prevalence of gDCM within any population; prevalence of TTN and MYH7 mutations were also extracted. Excluded were studies using family history as a proxy for gDCM. Median with interquartile range (IQR) or mean with standard deviation (SD) weighted by sample size (in cases of calculations with &lt;10 studies) were used to summarize the data. Results: Of 2,720 identified abstracts, 57 studies were included in the review. Among the adult or mixed (adults and children) DCM population in any country, median prevalence was 21.0% for overall DCM-related genetic mutations, 11.4% for TTN mutations, and 3.2% for MYH7 mutations ( Table ). The prevalence of pediatric gDCM within the DCM population was similar (weighted mean: 21.3%). Data on prevalence of gDCM within the general population were scarce. Conclusion: This study highlights the variable prevalence of gDCM reported across different populations and settings. The current evidence may underestimate the genetic causes due to technical limitations in genetic testing and limited screening. Accurately determining the prevalence of gDCM is critical for identifying high-risk populations, developing targeted prevention strategies for disease complications, and improving outcomes; epidemiological studies using long-read sequencing techniques and large cohort datasets with genotype-phenotype correlation analyses are needed.
Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama
Authors: Lindsay R Pool, Peter Durda, Suzanne E Judd, Ramachandran Vasan
Journal: Circulation (2024)

Background: CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes. Methods: The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose&gt;200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates. Results: In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p&lt;0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control. Conclusion: There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.
Abstract P153: Disruptions to Diabetes and Hypertension Care During the COVID-19 Pandemic and Recovery Approaches in the Latin America and Caribbean Region
Authors: Oluwabunmi V Ogungbe, Samira Jabakhanji, ROOPA MEHTA, John McCaffrey, David Byrne, Sinead Hurley, Rosman Lori, Eyram Bansah, Folahan Ibukun, Irene A Quarshie, Katherine Lord, Lu Yidan, Yunzhi Wang, Asma Rayani, Hairong Liu, Ann M Joseph, Alejandro Escobosa, Ivy Nyamuame, Jieun Lee, Ning Meng, Ibrahim Jehanzeb, Temitope Akinyemi, Shoichiro Nohara, Cecília Sousa, Juliana Farhat, Renato Bandeira de Mello, Yvette Yeboah-Kordieh, Tara Taeed, Lawrence J Appel, Sonia Y Angell, Edward Gregg, Kunihiro Matsushita
Journal: Circulation (2024)

Background: The COVID-19 pandemic disrupted healthcare services in Latin America and the Caribbean (LAC). However, few studies provided comprehensive and quantitative data on the magnitude of this disruption. Objectives: To synthesize evidence on the extent of disruptions to diabetes and hypertension care in LAC during the COVID-19 pandemic and interventions to recover. Methods: We conducted a scoping review of published papers in English, Spanish, and Portuguese. We adopted the Primary Health Care Performance Initiative (PHCPI) Framework to identify healthcare services susceptible to disruptions during the COVID-19 pandemic, specific to diabetes and hypertension, including recovery approaches. We synthesized study findings narratively to represent the diversity of findings geographically and health system. Results: Our search yielded 33,510 abstracts after de-duplication; following title/abstract screening and full-text review, 330 articles (218 on disruptions; 112 on interventions) were included in the synthesis. Although there was high heterogeneity, similarities in landscape of disruptions to primary care services across LAC exist. Of the PHCPI Framework domains, disruptions to workforce, medications and supplies, and patient-related outcomes were most recurrent. Intervention studies focused telehealth using digital strategies for diverse care areas and counseling support for health behaviors and mental health. There were data gaps within LAC regarding health system readiness and digital health effectiveness, adoption, efficiency, reach, and sustainability ( Figure ). Conclusions: This scoping review identified priorities for action within LAC: 1) establish and fund high-quality research and surveillance systems for hypertension and diabetes; 2) Optimally integrate digital health into hypertension and diabetes care; 3) implement mental health promotion strategies among healthcare workers; 4) establish optimal governance, leadership, and financing of healthcare systems.
Abstract P267: Associations of Urinary Zinc With Incident Peripheral Arterial Disease and Amputation in the Strong Heart Study
Authors: Claire Howlett, Filippo Ravalli, Kishan Bhatt, Irene Martinez-Morata, Richard Fabsitz, Maria Tellez-Plaza, Jason G Umans, Walter Goessler, Maria Grau-Perez, Richard B Devereux, Ana Navas-Acien
Journal: Circulation (2024)

Background: Urinary zinc has been associated with cardiometabolic endpoints including diabetes and peripheral artery disease (PAD), but evidence from prospective studies is limited. Objective: Our goal was to evaluate the prospective association between urinary zinc levels and incident PAD and amputation events in a large population-based cohort of American Indian adults in the US, the Strong Heart Study (SHS) cohort. Methods: A total of 2,049 PAD-free and 2,184 amputation-free participants at the baseline examination (1989-91) were included (mean 56 years, 61% female). The median (IQR) urinary zinc levels were 538 (388, 765) μg/g creatinine among PAD-free participants and 547 (396, 784) μg/g creatinine among amputation-free participants. PAD (defined as ankle brachial index &lt;0.9 or &gt;1.4) and amputation events were collected through the second (1993-1995) and third (1997-1999) SHS examination visits. We used logistic regression models to evaluate the progressively adjusted odds ratios (ORs) of PAD and amputation by increasing quantile of urinary zinc. Results: Over the two prospective study visits, 345 participants developed PAD and 23 underwent amputation. After adjustment for CVD risk factors including age, sex, location, body mass index, smoking and alcohol use status, cholesterol levels, estimated glomerular filtration rate, hypertension and diabetes, the ORs per IQR change in urine zinc levels were 1.16 (95% CI: 0.98, 1.38) for PAD, and 1.74 (95% CI: 1.04, 2.92) for amputation. Further adjusting the models for plasma fasting glucose reduced the magnitude of the association between high urinary zinc levels on PAD (OR: 1.09, 95% CI: 0.91, 1.31) and amputation (OR: 1.32, 95% CI: 0.72, 2.44). Conclusions: High urinary zinc levels were prospectively associated with PAD and amputation events, an association that appears to be partly related to lack of glycemic control. Further research is needed to better understand the complex relationship between urinary zinc, glycemic control and CVD.
Abstract P144: 1,5-Anhydroglucitol as a Marker of Hyperglycemic Excursions Defined by Continuous Glucose Monitoring in Older Adults
Authors: Natalie D Malek, Michael Fang, Jung-Im Shin, Joe Coresh, Jim S Pankow, Pamela L Lutsey, Arielle Valint, Justin B Echouffo, Elizabeth Selvin
Journal: Circulation (2024)

Background: Low levels (≤6 μg/mL) of serum 1,5-anhydroglucitol (1,5-AG) are thought to reflect periods of hyperglycemia. During periods of hyperglycemia, 1,5-AG competes with glucose for reabsorption in the kidney and is excreted in the urine, resulting in low serum concentrations of 1,5-AG. However, the performance of 1,5-AG to identify hyperglycemic excursions detected by continuous glucose monitoring (CGM) is unknown. Methods: We conducted a cross-sectional analysis of participants with diabetes in the Atherosclerosis Risk in Communities Study who wore a CGM sensor in 2021-2022 for up to 2 weeks. We evaluated the performance of 1,5-AG, modeled continuously and dichotomously (≤6 μg/mL, &gt;6 μg/mL), to identify CGM derived metrics of hyperglycemia. Hyperglycemic excursions were defined as percent time spent with CGM glucose above 140 mg/dL, area under the curve (AUC) &gt;140 mg/dL*minute, peak (maximum) CGM glucose, and the coefficient of variation (CV). Results: Among 322 participants with diabetes (mean age 83, 55% female), 22% had 1,5-AG≤6 μg/mL. The median CGM wear time was 13.9 days. The mean CGM glucose was 125 mg/dL (SD, 28) among those with 1,5-AG&gt;6 μg/mL and 156 mg/dL (SD, 45) among those with 1,5-AG≤6 μg/mL. 1,5-AG was inversely associated with percent of time CGM glucose &gt;140 mg/dL ( Figure ), AUC &gt;140 mg/dL (Pearson correlation, r =-0.25), peak CGM glucose ( r =-0.41) and CV ( r =-0.25). Individuals with 1,5-AG≤6 μg/mL spent 5.5 hours more per day above 140 mg/dL compared to those with 1,5-AG&gt;6 μg/mL. Conclusion: 1,5-AG is correlated with CGM-defined hyperglycemia. Low levels of 1,5-AG identify older adults with diabetes experiencing glycemic excursions.
Abstract P136: Trends in Ultra-Processed Food Consumption Among US Adults With Prediabetes and Diabetes, 2001-2018
Authors: Zijing Guo, Amelia S Wallace, Mary R Rooney, Dan Wang, Casey M Rebholz, Eurídice M Steele, Vanessa Garcia-Larsen, Julia A Wolfson, Mika Matsuzaki, Elizabeth Selvin, Michael Fang
Journal: Circulation (2024)

Background: For individuals with prediabetes and diabetes, the Centers for Disease Control and Prevention recommends consuming more whole foods rather than highly processed foods as part of the everyday diet. Trends in ultra-processed foods (UPFs) consumption among adults with diabetes and prediabetes in the general population are uncharacterized. Methods: We conducted a serial cross-sectional analysis of data in adult participants (aged 20+) in the National Health and Nutrition Examination Survey (NHANES) cycles 2001-2018 (N=76,815). We defined diabetes as either a HbA1C &gt;=6.5% or self-reported diabetes diagnosis and prediabetes as a HbA1C 5.7 – &lt;6.5% and no self-reported diabetes diagnosis. Foods were classified using the NOVA classification system. We characterized the mean percent of total energy intake from UPF and minimally processed foods for adults by diabetes status from 2001-2018, and assessed time trends with linear regression. Results: Approximately 15% of the adults in this sample have prediabetes while 8% of the adults have diabetes. UPF consumption was &gt;50% of total energy intake in all survey cycles. From 2001 to 2018, UPF consumption increased for adults with diabetes (51% to 56%, p=0.001), prediabetes (54% to 57%, p=0.009), and no diabetes (53% to 56%, p=0.027) (Fig, A-C) . Over the same period, minimally processed food consumption decreased for adults with diabetes (37% to 29%, p&lt;0.001), prediabetes (34% to 28%, p&lt;0.001), and no diabetes (32% to 27%, p&lt;0.001) (Fig, D-F) . Conclusion: UPF consumption increased among adults with diabetes, prediabetes, and those without diabetes between 2001-2018. Since consuming UPF is linked with poor health outcomes including diabetes and cardiovascular diseases, there should be strategies and interventions designed to enhance overall diet quality for all persons, particularly those with prediabetes and diabetes.
Abstract P388: Higher Social Vulnerability Was Associated With Less Community-Based Rehabilitation Utilization After Stroke
Authors: Shuqi Zhang, Janet Freburger, Anna M Johnson, Charity Patterson, Sara Jones
Journal: Circulation (2024)

Background: Timely rehabilitation care significantly improves function and mobility after stroke, but barriers exist in access and utilization. The impact of neighborhood social determinants of health is not fully understood. Our study aims to estimate the association between Social Vulnerability Index (SVI), a measure of a community's need for support, and post-stroke rehabilitation utilization. Methods: This study is an observational, secondary analysis of the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 41 North Carolina hospitals from 2016-2019. This analysis included 4765 individuals (51.2% female; 74.8% Whites; mean age 69.9) discharged directly home after stroke and linked to administrative claims. Utilization of physical or occupational therapy was obtained from outpatient, carrier file and home health claims. Geocoded participant addresses were linked to 2018 summary SVI percentile ranking and its four sub-domains at the Census tract level. Generalized estimation equations with cluster of Census tract and hospital were used to estimate the association between quintiles of SVIs and incidence proportion of rehabilitation use within 30 days. Covariates included patients’ socio-demographics, clinical characteristics, and comorbidities. Results: The overall proportion of rehabilitation use by 30 days was 38.6%, ranging from 34.6-46.5% across SVI quintiles. In multivariable analysis, quintiles of higher summary SVI were associated with lower rehabilitation use compared with the least vulnerable quintile (RD and 95% CI, Q5 vs Q1: -0.098 [-0.147 to -0.049]; Table). There was a significant decreasing trend across quintiles (P-trend &lt; 0.001). Similar results were observed for SVI sub-domains except for minority status and language. Conclusion: Higher social vulnerability was associated with less post-stroke rehabilitation use. The finding is useful to identify communities for targeted interventions to improve access and utilization to rehabilitation.
Abstract P446: Community-Engaged Strategies for Recruitment of Black Men at Risk for Hypertension: The CLIP Study
Authors: Milla E Arabadjian, Tanisha Green, Antoinette Schoenthaler, Olugbenga Ogedegbe, JOSEPH RAVENELL
Journal: Circulation (2024)

Background: Recruitment of Black participants in research studies is challenging. Mistrust of academic and medical institutions due to historic mistreatment, medical racism, and lack of culturally tailored strategies to engage Black communities as partners, has led to under-representation of Black participants in studies. Black men have higher prevalence of hypertension (HTN) and worse outcomes than other groups. Yet, Black men are underrepresented in HTN clinical trials. The Community-to-Clinic Linkage Program to Prevent Hypertension (CLIP) is a community-engaged cluster randomized trial to test barbershop facilitation to prevent HTN among Black men residing in Staten Island (SI), New York City. Objective: To describe recruitment strategies to engage Black men in CLIP via an academic-community partnership. Methods and Results: Approximately 10% of SI residents identify as Black, of which ~ 90% live in 3 census tracts with the highest prevalence of HTN in the borough. The study team collaborates with Community Health Action of Staten Island (CHASI), a grassroots health organization with &gt; 30 years of community focus on addressing the root causes of health disparities on SI, the Director of Health in SI, a community advisory council (CAC) comprised of local leaders and residents, and the New York American Heart Association providing HTN education materials in an academic-community partnership to implement CLIP. Our recruitment goal is to enroll 84 men across 4-5 Black-owned barbershops over 5 cycles (12 weeks each), total N=418. We did not meet recruitment goals for cycles 1 and 2, (~60% enrolled). In consultation with CHASI and the CAC we adjusted our recruitment strategies to: 1) host bi-monthly community events in or around participating barbershops; 2) offer study incentives at the time of enrollment; 3) leverage existing relationships with faith-based organizations and other stakeholders to promote CLIP; and 4) distribute co-branded promotional flyers with CHASI and other stakeholders to publicize events. Subsequently we exceeded recruitment goals in our last cycle (113% enrolled); current cycle recruitment is ongoing. Several strategies have been successful in improving recruitment of Black men for CLIP: 1) deep community ties of our community health partner; 2) enlisting local community health workers representative of the study population; 3) flexibility and open communication between academic and community staff; 4) trust in the competence of each partner; 5) mutual commitment to the mission of the study. Conclusion: Partnering with engaged and trusted community partners, stakeholders, and local leaders positively impacts recruitment of Black men participants in HTN research studies. Organizations with deep community ties are crucial for establishing trust and identifying flexible solutions to recruitment challenges.