tbuckley/cabot-search huggingface dataset:
Abstract 4137922: Cardiovascular Prognosis of Statin Users Developing Diabetes in Secondary Prevention: <i>A Prospective Multicenter Study</i>
Authors: Yiwen Zhang, Pengfei Li, Hongwei Ji
Journal: Circulation (2024)

Background: In primary prevention, statin use with new-onset diabetes mellitus (DM) was associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. In high-risk and secondary prevention settings, the cardiovascular prognosis of statin users progressing to new-onset DM remains unclear. Methods: We collected data from inpatients with or without baseline ASCVD from four medical centers affiliated to Qingdao University. Patients were categorized into 4 phenotypes: (1) statin non-users without diabetes; (2) statin users with incident diabetes; (3) statin users with pre-existing diabetes; and (4) statin users without diabetes. The primary outcome was ASCVD events. The stratified Cox proportional hazard model was used to investigate the association between the four distinct phenotypes and the risk of ASCVD. Results: Among 12,800 high-risk patients, over a median follow-up of 118 days (interquartile range, 48-379 days), 1447 ASCVD events were documented. Compared with statin non-users without diabetes, statin users without diabetes (hazard ratio [95% confidence interval], 0.77 [0.65, 0.91], P=0.001) and statin users with pre-existing diabetes (0.80 [0.66, 0.99], P=0.035) were associated with lower risk of ASCVD, whereas statin users with new-onset diabetes were not (0.91 [0.70, 1.19], P=0.50), overall P for trend =0.013.( Figure 1 ) In patients with baseline ASCVD (i.e., secondary prevention settings), we observed similar findings ( Figure 2 ) Conclusions: In high-risk patients with pre-existing ASCVD, new-onset diabetes after statin use was likely associated with compromised cardiovascular benefits of statins.
Abstract 4134272: Association of depression symptoms with cardiovascular health stratified by military status: Insights from 2013-2020 National Health and Nutrition Examination Survey
Authors: Arum Lim, Chitchanok Benjasirisan, Marian Botchway, Ashwag Alhabodal, Diana Baptiste, Binu Koirala
Journal: Circulation (2024)

Introduction: Emerging evidence supports the mind-heart-body connection, yet less attention has been given to examining the relationship in specific populations. Veterans have a higher risk for mental and cardiovascular problems and have unique social determinants of health (SDoH), such as healthcare access, than civilians. This study aims to examine how depression and SDoH are associated with cardiovascular health (CVH) and if associations differ by military status. Hypotheses: 1) Depression symptoms and SDoH will be associated with CVH. 2) The associations will differ between people who served in the US military and those who did not. Methods: A cross-sectional analysis was conducted using data from the 2013 to 2020 National Health and Nutrition Examination Survey. Individuals were aged ≥ 20 years without cardiovascular disease and current pregnancy. Patient Health Questionnaire-9 was used to assess depression symptoms and dichotomized into no symptoms (&lt;5) and mild-to-severe symptoms (≥5). The Life's Essential 8 quantified CVH, with scores from 0-100. SDoH included age, gender, race/ethnicity, marital status, education, employment, financial status, health insurance, and healthcare access. Sample weights were applied in multiple linear regression analyses. Results: Among 6498 participants, 92% were civilians (mean age: 45 years; 51% female), and 8% were veterans (mean age: 56 years; 10% female). In both groups, 23% had depression symptoms. The mean CVH was 72 in civilians and 69 in veterans. In adjusted models, individuals with depression symptoms had 4 points lower CVH scores than those without (95% CI: -5.11, -2.84). This trend was similar in civilians but insignificant in veterans. Lower CVH was significantly associated with age, being non-Hispanic Black and other races people, lower education, and lower financial status. The associations were preserved after being stratified by military status. Conclusions: Depression symptoms and SDoH were associated with lower CVH. However, there was no significant evidence that military status moderated the associations of depression and SDoH with CVH. Examining the intersection between depressive symptoms and SDoH may be useful when assessing CVH.
Abstract 4137895: Serum High-density Lipoprotein-Associated Paraoxonase-1 Levels Predict Recurrent Cardiovascular Events after Stent Implantation in Patients with Stable Angina Pectoris
Authors: Yumi Kashima, Masashi Nakagawa, Yusuke Kure, Masanori Matsuo, Yuya Sakamoto, Kenji Shimeno, Yoshiki Matsumura, Ryo Matsumoto, Yukio Abe, Takahiko Naruko
Journal: Circulation (2024)

Background: Poor clinical outcomes for patients undergoing hemodialysis (HD) after drug-eluting stent (DES) implantation have been reported. High-density lipoprotein (HDL) cholesterol is well-established as a negative risk factor for coronary artery disease, and its anti-oxidant property has been attributed mainly to the HDL-bound enzyme paraoxonase-1 (PON-1). Myeloperoxidase (MPO), a pro-oxidant enzyme released from activated neutrophils, has been shown to alter the atheroprotective function of HDL to a dysfunctional form. The aim of this study was to investigate the relationship between plasma MPO and serum PON-1 levels after implantation of DES in patients with stable angina pectoris (SAP) with and without HD. Methods: Serum PON-1 concentrations and PON-arylesterase activity were measured in 183 patients with SAP after DES implantation (HD group, n=37; non-HD group, n=146) with a sandwich ELISA method. Cardiovascular events were defined as sudden cardiac death, fatal or non-fatal myocardial infarction, cerebral infarction and other non-fatal events including unstable angina pectoris or coronary revascularization. Results: Serum PON-1 concentrations and PON-arylesterase activity were significantly lower in the HD group than in the non-HD group (PON-1 concentrations, P&lt;0.0001; PON-arylesterase activity, P&lt;0.0001). In addition, plasma MPO in patients undergoing HD were significantly higher than in patients not undergoing HD (P&lt;0.0001). Moreover, plasma MPO showed a significant inverse correlation with serum PON-1 concentrations and PON-arylesterase activity (concentration: R= -0.24, P=0.0013; arylesterase-activity: R=-0.24, P=0.0014). Cardiovascular event rates were significantly higher in the HD group than in the non-HD group (67.6% vs. 43.8%, P&lt;0.01). Kaplan-Meier survival analysis showed that the low-PON-1 group (&lt;58.0 mg/mL, median) had a significantly worse outcome than the high-PON-1 group ( P =0.013). Multivariate analysis showed that a low serum PON-1 concentration was the only independent predictor of cardiovascular events (odds ratio, 1.93; 95% confidence interval, 1.10 to 3.40, P =0.024). Conclusions: These findings demonstrate that plasma MPO have a significant inverse correlation with PON-1 in patients undergoing HD and suggest that an imbalance between pro-oxidants and anti-oxidants may contribute to the progression and destabilization of human coronary atherosclerotic lesions in patients with SAP who undergo HD following DES implantation.
Abstract 4134079: Neighborhood-Level Indices of Social Disadvantage and Cardiovascular-Kidney-Metabolic Health
Authors: Vaishnavi Krishnan, Xiaoning Huang, Cyanna McGowan, Nilay Shah, Kiarri Kershaw, Alexa Freedman, Gregory Miller, Donald Lloyd-Jones, Sadiya Khan
Journal: Circulation (2024)

Background: Several area-level indices exist that integrate a variety of social drivers of health. However, whether certain indices better capture neighborhood-level variability in cardiovascular-kidney-metabolic (CKM) outcomes is not well known. Aims: We sought to examine the associations of census tract-level indices of social disadvantage with CKM outcomes. Methods: Exposures for the analysis included seven indices of social disadvantage (ADI, COI, EJI, NDI, SDI, SREI, SVI) based on census tract-level data from the 2010-2019 American Community Survey (ACS) and census tract-level median household income from the 2015-2019 ACS data. Outcomes included the census tract-level prevalence of CKM outcomes (obesity, hypertension, diabetes, hyperlipidemia, chronic kidney disease, coronary heart disease [CHD], and stroke) from the 2019 Behavioral Risk Factor Surveillance System. All indices and median income were standardized, and we used linear regression to examine the associations between each census tract-level social measure and CKM outcomes, adjusted for population size and median age. Next, we calculated the △r 2 in adjusted models for the association of median income with each CKM outcome when each index was added. Results: Among 65,476 US census tracts, median (IQR) population size was 4068 (2969, 5374), age was 39 years (35, 44), and household income was $58,870 (44276, 79802). Median income as well as each index was significantly associated with census tract-level prevalence of each CKM outcome assessed (p &lt; 0.05). The r 2 (Panel A) and △r 2 values (Panel B) varied for each of the social measures and CKM outcomes, with higher r 2 values when each index was individually added to median income compared with income alone. For example, for CHD, the r 2 ranged between 0.39 to 0.67 and △r 2 ranged from 0.01 to 0.10. Conclusions: Neighborhood-level measures of social disadvantage are differentially associated with CKM outcomes, with a large proportion of the variability explained by median income. Identifying the advantages and disadvantages of each index and comparison with median income can inform the prioritization of measures for specific outcomes.
Abstract 4132968: CCR5 modulation enhances M-MDSCs functionality in early atherosclerosis
Authors: Komal Sagar, Shamima Akhtar, Ambuj Roy, Milind Hote, Alpana Sharma
Journal: Circulation (2024)

Background: The role of immune suppressive microenvironment, promulgated by the presence of Myeloid Derived Suppressor Cells (MDSC) have been the major focus of research delineating the underlying mechanisms of cardiovascular diseases (CVD). CCR5, a chemokine receptor, has been associated with both immunosuppressive and inflammatory phenotypes, however, the possible role of CCR5 pertaining to MDSCs in the development of atherosclerosis has not been elucidated yet. Therefore, we investigated the therapeutic potential of CCR5 modulation in early atherosclerosis progression. Methods: CCR5 receptor-ligand expression was studied with flow cytometry, real time PCR and immunocytochemistry in 65 individuals (25 Healthy controls, 20 young hypercholesterolemic individuals, and 20 stable [Coronary Artery Disease] CAD patients). To induce atherosclerosis, mice were fed high fat diet (HFD) for 6 weeks following partial ligation of left carotid artery in C57BL6 mice. MDSCs phenotype and functionality were assessed using CCR5 inhibitor in vitro (10 -8 M) and in vivo (i.p 3ng/day for 15 days) . M-MDSCs phenotype switch, atherosclerotic lesion development and plaque phenotype was studied in vivo . Results: We observed CCR5 elevation on Monocytic-MDSCs in the early phase of atherosclerosis. M-MDSCs displayed an intermediate phenotype with expression of both pro and anti-inflammatory mediators in early atherosclerosis, a similar trend was observed in inflammatory cytokines stimulated M-MDSCs ( in vitro ). Notably, DAPTA treatment shifted phenotype of M-MDSCs to anti-inflammatory profile with elevated expression of IL-10 and reduced expression of IFNγ, IL4, and IL22. Further, CCR5 modulation expanded IL10+M-MDSC in vivo . Additionally, DAPTA reduced the migratory potential, reduced cholesterol uptake and improved the functionality (suppression of T cell) of M-MDSCs. Blocking CCR5 with DAPTA led to the formation of stable plaque in HFD-fed mice. Conclusion: Increased expression of CCR5 coupled with inflammatory cytokine secretion by regulatory cells lead to dysfunctional M-MDSCs in CVD risk factor population. Possibly this dysfunctionality contributes to the development and progression of CVD including atherosclerosis. Our findings show targeting of CCR5 with DAPTA reduces atherogenesis, increases plaque stabilization and corrects phenotypic alterations in immune suppressive M-MDSCs. The functionality and phenotype of M-MDSCs in atherosclerosis, may be ameliorated by targeting CCR5.
Abstract 4133161: Variation in Prevalence, Treatment, and Outcomes in Heart Failure with Improved Ejection Fraction by Race and Ethnicity
Authors: Alex Chang, Keane Lee, Rishi Parikh, Andrew Ambrosy, Thida Tan, Steven Hamilton, Maria Pabon Porras, Orly Vardeny, Ivy Ku, Elena Vasti, Alexander Sandhu, Alan Go, Sirtaz Adatya, Ankeet Bhatt
Journal: Circulation (2024)

Background: Racial and ethnic disparities exist in heart failure with reduced ejection fraction (HFrEF), but little is known about how race and ethnicity relate to patients with HF with improved EF (HFimpEF). Research Question: Do the epidemiology, treatment, and outcomes vary by race and ethnicity in patients with HFimpEF? Aim: To describe the relationship between race and ethnicity and HFimpEF within a large, integrated health care delivery system. Methods: We identified adults aged ≥18 years with incident HFrEF (LVEF≤40%) from 2013-2018 within Kaiser Permanente Northern California. HFimpEF was defined as LVEF&gt;40% within 12 months after incident HFrEF. Self-reported race and ethnicity were classified as non-Hispanic White, non-Hispanic Black, Asian American/Native Hawaiian/Pacific Islander (AANHPI), Hispanic, and other. Incidence rates of worsening HF (WHF) events (i.e., HF hospitalization, ED visit, or urgent outpatient WHF visits) or all-cause death were compared across patients with HFimpEF and persistent HFrEF using Cox proportional hazard models adjusted for age, sex, and LVEF at incident HFrEF, stratified by race and ethnicity. Results: Among 12,639 adults with incident HFrEF, 7,562 (59.8%) were White, 1,481 (11.7%) were AANHPI, 1,385 (11.0%) were Black, and 1,537 (12.2%) identified as Hispanic. Rates of HFimpEF following incident HFrEF was lowest among Black patients (26%), but similar among other race and ethnicities (36%, 34%, 30%, and 30% for AANHPI, White, Hispanic, and other, respectively, chi-squared p&lt;0.01). Medication use was similar across groups at time of HFimpEF, but generally declined thereafter (Panel A) . Among patients with HFimpEF, Black and Hispanic patients had significantly higher crude rates of WHF or death compared to White patients (34 and 30 compared to 23 per 100 person-years, p&lt;0.01 for each). Despite these differences in absolute rates, relative associations between HFimpEF (vs. persistent HFrEF) and WHF or death remained similar across all race and ethnicities (AANHPI: aHR=0.52 [95%CI 0.42-0.65], Black: aHR=0.70 [95%CI 0.56-0.87], Hispanic: aHR=0.60 [95%CI 0.49-0.73], White: aHR=0.53 [95%CI 0.48-0.58], p interaction =0.13) (Panel B) . Conclusions: HFimpEF is common within 12 months after incident HFrEF, and HF medication adherence declines in the years following. HFimpEF is associated with improved clinical outcomes across race and ethnicity, but occurs less frequently in Black patients despite similar HF medical therapy use.
Abstract 4137883: Association of Pre-Donation Blood Pressure with Hypertension in Living Kidney Donors
Authors: Ekamol Tantisattamo, Chutawat Kookanok, Vitchapong Prasitsumrit, Tatchaya Kanthajan, Ariya Mongkolporn, Voramol Rochanaroon, Tulaton Sodsri, Thutpharritchn Phoonakh, Varissara Piyaphinunsuk, Wanprapit Noree, Nopavit Mohpichai, Adivitch Sripusanapan, Natee Deepan, Vichayut Chayapinun, Methavee Poochanasri, Napat Suriyathumrongkul, Nisha Wanichwecharungruang, Natnicha Jakramonpreeya, Urairat Chuenchaem, Smuch Siramongkholkarn, Kamonluk Rodsom, Nicha Wareesawetsuwan, Kanita Mankan, Sorawis Ngaohirunapt, Narathorn Kulthamrongsri, Phuuwadith Wattanachayakul
Journal: Circulation (2024)

Background: Living kidney donors (LKD) are at risk for developing hypertension (HTN); however, the levels of pre-donation blood pressure (BP) that may predict post-donation BP are unknown. Hypothesis: Higher pre-donation BP is associated with a greater risk of developing post-donation HTN. Goals: We aim to examine the association between pre-donation BP and the risk of developing HTN in LKD. Methods: A retrospective cohort study using OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. Systolic and diastolic hypertension (SHTN and DHTN) were defined by SBP ≥130 and DBP ≥80 mmHg, respectively. Multiple Cox regression was utilized to examine the association between decile of pre-donation BP and time-to-event of developing post-donation SHTN and DHTN. Results: Of 174,311 adult LKD, the mean±SD age was 41±12 years and 60% were female. Mean pre- and post-donation SBP and DBP and deciles of BP are shown in Table 1 and Figure 1, respectively. The median time to follow-up for developing SHTN was 13.2 (IQR 6.8, 24.4) and DHTN was 12.2 months (IQR 6.3, 24.1). The incidence rate of developing SHTN and DHTN was 0.020 and 0.03 person-months, respectively. After adjusting for age (&lt;65 vs. ≥65 y/o), gender, race, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, eGFR, urine protein:creatinine ratio, and the interaction term between decile of pre-donation SBP and age, LKD in deciles 5 to 10 (SBP 119–200 mmHg) had significantly graded increased risk for developing SHTN compared to LKD in decile 4 (SBP 115-118 mmHg; HR decile10 4.82, 95%CI 3.37, 6.91), while those in deciles 1 to 3 had a graded decrease in the risk but were non-significant (HR decile1 0.68, 95CI% 0.42, 1.11). In addition, there was a decreased risk of SHTN observed in elderly LKD (≥65 y/o) in deciles 5 and 10 (P interaction 0.041 and 0.009). The pattern of pre-donation DBP decile – DHTN association was similar to the SBP – SHTN association, but only DBP deciles 8-10 (DBP 81–195 mmHg) were significant (HR decile10 2.10, 95%CI 1.31, 3.34); Figur 2. There was no interaction between pre-donation DBP and age. Conclusions: Elevated pre-donation SBP or DBP greater than 118 or 80 mmHg is associated with a graded increase in developing post-donation SHTN or DHTN, respectively especially in the non-elderly (&lt;65 years old) LKD. BP control during the pre-donation period should be achieved to mitigate the risk of post-donation HTN.
Abstract 4137935: Adipogenesis in Bone Marrow Niche under Cardiac Stress Worsens Cardiac Function
Authors: KOHSAKU GOTO, Yukiteru Nakayama, Ichiro Manabe, Issei Komuro, Norihiko Takeda, Katsuhito Fujiu
Journal: Circulation (2024)

Background: We have recently reported that repetitive cardiac decompensation with multimorbidity often experienced by patients with heart failure (HF) is attributed to epigenetic modifications of hematopoietic stem cells (HSCs) in the bone marrow (BM). HF reprogrammed HSCs differentiation and altered tissue macrophage homeostasis. These findings demonstrate that the BM can carry an innate immune memory of cardiac stress that may exacerbate HF and predispose other organs to pathology. Aims: Because the stemness of HSCs is mainly regulated by mesenchymal stromal cells (MSCs) in the BM niche, we investigated phenotypic alterations of MSCs under cardiac stress. Methods&amp;Results: Transcriptome analysis of MSCs showed preferential differentiation toward adipocytes in murine pressure overload models. In vitro assays and histological BM sections also support this finding. Furthermore, single-cell RNA sequencing of MSCs demonstrated that the percentage of adipocyte-primed MSCs increased in proportion to the severity of cardiac dysfunction, and also correlated with the frequency of myeloid-lineage progenitor cells. To investigate the influence of adipo-lineage MSCs on HSCs, we conducted BM transplantation supplemented with MSCs from control or HF mice. Recipient mice transplanted with HF-MSCs showed significant increases in myeloid-biased multipotent progenitors in BM and myeloid cells in peripheral blood. Additionally, the number of proinflammatory cardiac macrophages was significantly increased in the HF-MSCs group, promoting cardiac fibrosis and dysfunction. Conclusions: Our results demonstrated that the BM niche could perceive cardiac stress in the form of adipocytic skewing of MSCs in the setting of HF, which changed the differentiation behavior in HSCs and ultimately led to further deterioration of cardiac function through the impaired differentiation of circulating monocytes into cardiac macrophages. Therefore, suppressing the adipocytic differentiation of MSCs could have a novel therapeutic potential to avoid repeated HF events.
Abstract 4134935: Impact of COVID-19 on Cardiology Fellows and Faculty in the United States: Two Years Later
Authors: Mandana Chitsazan, Jiun-Ruey Hu, Jacqueline Pires, Aleksandar Obradovic, Martha Gulati, Katherine Clark, Yehia Z Ali, Elissa Altin, Jennifer Kwan
Journal: Circulation (2024)

Introduction: Recent data demonstrated that the COVID-19 pandemic adversely affected cardiovascular fellows in training (cFIT) and faculty in terms of educational disruption and search for job prospects, respectively. However, less is known about the pandemic's effect on cFIT and faculty in terms of general well-being, shifts in personal and professional priorities, quantitative measures of stress levels, and research productivity. Methods: A national survey targeting cFIT and faculty was developed to assess the effect of the pandemic two years later on these parameters. Fifty-four participants, including 21 cFIT and 33 faculty, responded to the survey. The survey was distributed between October 2021 and May 2022 to program directors of ACGME-accredited general cardiology fellowship programs in the United States. Results: 30% of cFITs perceived impaired clinical training during the pandemic; 36% of fellows experienced a decline in their clinical skills in the cardiac catheterization lab, while 27% experienced a decrease in their echocardiographic skills. Additionally, a significant percentage of cFIT reported negative interference in their competencies in nuclear cardiology (27%) and electrophysiology (12%). Most participants (76%), including faculty and fellows, reported several health issues such as sleep problems, low energy, changes in appetite, difficulty concentrating, and restlessness due to the pandemic. 43% of the faculty and 61% of cFIT reported high rates of impaired short-term productivity (Figure). Conclusion: In this national survey, we found that two years after the onset of the COVID-19 pandemic, cardiology fellows and faculty continued to experience significant concerns for decreased hands-on training and diminished research productivity. While faculty were not distressed regarding decreased clinical competencies, concerns about short-term and long-term research productivity persisted. Faculty and fellows all experienced increased stress levels and impaired productivity. Although limited by a small sample size, which can introduce bias, these results signal the importance of performing a follow-up study on the impact of COVID-19 on wellness as well as the impact on career.