tbuckley/cabot-search huggingface dataset:
Abstract P217: Directionality of Associations Between Daily Physical Activity and Cognition Among Older Adults in the Baltimore Longitudinal Study of Aging
Authors: Francesca R Marino, Jennifer A Deal, Qu Tian, Eleanor M Simonsick, Susan M Resnick, Alden L Gross, Amal A Wanigatunga, Jennifer A Schrack
Journal: Circulation (2024)

Physical activity is a modifiable risk factor for dementia. Associations between physical activity and cognition are likely bidirectional, as cognitive functions are required to initiate and perform activities. Understanding the directionality of these associations has potential implications for both dementia prevention and physical activity engagement. Yet, the directionality between cognitive function and free-living physical activity patterns is unclear. This study included 237 cognitively unimpaired older adults in the BLSA with cognitive test performance and ≥ 3 valid days of wrist accelerometry measured at 2 visits over an average of 1.8 (0.9-4.0) years. Cognitive domain factor scores were derived using confirmatory factor analysis. Accelerometry data were used to calculate daily physical activity patterns: 1) total activity counts (TAC), 2) time spent active, 3) time spent non-active, 4) active-to-sedentary-transition probability (ASTP), 5) mean active bout length, 6) sedentary-to-active transition probability (SATP), 7) mean non-active bout length. Bivariate latent change score models estimated directionality of associations between changes in cognitive factor scores and changes in daily physical activity patterns. Models were adjusted for age, sex, race, education, and number of comorbidities. Participants were on average 77 (60-96) years, 48% women, and 22% Black. After covariate adjustment, one SD higher in baseline TAC was associated with less memory decline (estimate = 0.089, SE = 0.045). One SD higher in baseline time spent non-active was associated with greater declines in language (estimate = -0.068, SE = 0.035), visuospatial processing (estimate = -0.079 SE = 0.034), and global cognition (estimate = -0.058, SE = 0.024). One SD higher in baseline ASTP was associated with greater declines in memory (estimate = -0.114, SE = 0.047) and visuospatial processing (estimate = -0.074, SE = 0.034), whereas mean active bout length was associated with less decline in these domains (memory: estimate = 0.121, SE = 0.046; visuospatial processing: estimate = 0.081, SE = 0.033). There were no associations with time spent active, SATP, or mean non-active bout length and changes in any cognitive factor score. Cognitive factor scores were not associated with changes in any activity pattern. Patterns relating to amount of daily activity, time spent sedentary, and probability of transitioning from active-to-sedentary states were primarily associated with changes in memory and visuospatial processing. This suggests increasing free-living movement or decreasing sedentary behavior might be related to short-term changes in cognition among older adults. Future studies are needed to determine causality of these associations and to evaluate directionality over longer periods of time.
Abstract P324: Training and Technical Assistance to Improve Hypertension Control in Community Health Centers
Authors: Eduardo Sanchez, Celicia Cardoso, Sondi Fiegel, Nekeisha Harrison, David Pena, Jan Pillai, Sonia Ramirez, Alison Smith, Ashley Wagner
Journal: Circulation (2024)

Introduction: About 47% of adults in the U.S. have high blood pressure (BP), a contributing factor to major adverse health conditions including heart attack, heart failure, and stroke. Hypertension has also been linked to worse outcomes from COVID-19 infection, resulting in higher rates of hospitalization and death. In 2021, the AHA launched the National Hypertension Control Initiative (NHCI) in 350 community health centers (CHCs). The 3-year initiative aimed to improve BP control and COVID-19 outcomes through training and technical assistance (T/TA) in CHCs with systematic, multi-sector, culturally sensitive and evidence-based interventions, including self-measured blood pressure (SMBP) monitoring. We hypothesize that T/TA with guideline-directed and evidence-based systematic processes can improve BP control in CHCs. Methods: The initiative included complementary components: patient and public education, community outreach and integration, health care professional and organization training, and project management and evaluation. Year one focused on laying a foundation of BP control fundamentals to strengthen knowledge and skills with webinars, office hours, tools, and resources. Years two and three reinforced key concepts, introduced new resources, and provided 1:1 support to CHCs, informed by ongoing evaluation. The adoption of systematic processes with evidence-based and guideline-directed practices were encouraged in CHCs. Recognizing potential differences across CHCs, several T/TA methods were deployed during phases of the initiative in anticipation of evolving CHC needs and readiness. The methods for T/TA include providing a core educational curriculum, developing and distributing customized CHC reports with individualized data, using new and existing resources, including a BP measurement policy and procedure and a BP treatment algorithm, and evaluating methods and practice findings. Early Results: Based on UDS data, overall, BP control rates increased in NHCI CHCs from 51.3% to 57.6% (as defined by the performance measure &lt;140/90 mm Hg), demonstrating a 6.3% absolute increase and a 12.3% relative increase from 2020 to 2022. This is compared to all HRSA CHCs, where BP control rates increased from 58.0% to 63.4%, demonstrating a 5.4% absolute increase and a 9.3% relative increase from 2020 to 2022. While all NHCI CHCs started with BP control rates less than 58.9%, some health centers have demonstrated control rates higher than 70%. Discussion: T/TA with guideline-directed and evidence-based systematic processes may have contributed to increased BP control rates in CHCs. The degree of CHC progress may have been influenced by challenges and limitations, such as the impact of the COVID-19 pandemic on participation, clinical leadership engagement, CHC team staffing turnover, and technology interoperability.
Abstract MP64: Cardiovascular Responses to Occupational Physical Activity Are Exaggerated by Work-Related Stress and Low Fitness
Authors: Tyler D Quinn, Timothy Bruehwiler, Paul D Chantler, Bethany Barone Gibbs
Journal: Circulation (2024)

Introduction: Proposed mechanisms explaining the link between high occupational physical activity (OPA) and cardiovascular disease hypothesize that high work-related stress and low worker fitness may exacerbate cardiovascular responses to OPA. Hypothesis: Direct associations between OPA and acute cardiovascular responses will be stronger under high work-related stress and in workers with lower fitness. Methods: 19 male workers (age=46.6±7.9, 68.4% White) with high OPA jobs were observed for seven days. Steps, light (LPA), and moderate-to-vigorous physical activity (MVPA) during work were measured using a thigh-worn activPAL3 micro, hip-worn Actigraph GT3X-BT, and time-use diary. Heart rate (HR) was measured continuously with a Polar chest strap. 24-hour blood pressure (BP) was measured using an ambulatory BP monitor on one workday. Rate-pressure product (RPP), an indirect measure of cardiac workload, was calculated as systolic BP x HR. Daily work-related stress was measured with the Stress in General Scale (scores=-3-21 where higher scores indicate more stress). Worker fitness was estimated as VO 2 max (ml·kg -1 ·min -1 ) using a submaximal treadmill test. Effect modification by stress and fitness on the associations between OPA and RPP was examined using mixed effects models with interaction terms. Results: Work-related stress was directly associated with 24-hour RPP (β=94.10 mmHg*bpm/stress point, p=0.024) while worker fitness was not (β=-33.0 mmHg*bpm/VO 2 max, p=0.561). Direct association between RPP and occupational MVPA were stronger with higher work-related stress and lower fitness (Table 1, p-for-interaction&lt;0.05 for all). Lower intensity OPA (steps and LPA) were also associated with exacerbated RPP responses outside of work with higher work-related stress (Table 1, p-for-interaction&lt;0.001 for all). Conclusions: OPA performed under high stress or by workers with low fitness may exaggerate cardiovascular responses and contribute to OPA's paradoxical cardiovascular health associations.
Abstract P465: Linking Electronic Health Record and Wearable Device Data Can Provide Insight Into Expected Changes in Captured Heart Rate Due to Medication Usage
Authors: Keith Feldman, Ray G Duncan, An Nguyen, Galen Cook-Wiens, Joshua M Pevnick
Journal: Circulation (2024)

Introduction: From remote patient monitoring to arrythmia detection, heart rate (HR) data collected by wearable devices is widely utilized across healthcare practice and research. Although accuracy varies across devices, data are generally assumed to be “internally consistent” (i.e., within-person trends are reliable). As a result, individuals’ change from baseline is commonly used as a biomarker for risk models. However, defining a baseline from device data alone is problematic. External influences such as therapeutic use of HR-altering medications (e.g., beta-blockers) may alter patterns derived from HR data, and computational models not accounting for such may become less effective. Hypothesis: Initiation of a HR-altering medication as denoted in an individual’s EHR will correspond to a change in HR data collected by their wearable device. Methods: This study utilized data from 1938 patients at Cedars-Sinai Medical Center who linked Apple Watches to their EHR 4/2015 – 11/2018. It focused on 32 patients with ≥10 days of HR data before and after their 1 st prescription of a HR-altering medication, with no prior orders of these medication over the prior year. Mean daytime (9a-9p) hourly HR were compared before and after medication start (Fig 1) using a linear mixed model, adjusted for hour of the day, measurements per hour, time since medication was started, and time from the start of observation (to account for pre-medication trends) with a patient-level random effect. Results: HR-altering medication produced significant changes in device-measured HR. Post-medication HR averaged 3.2 BPM lower [95% CI, 2.8-3.6, p&lt;.001] than pre-medication periods. Secondary analyses identified decreased hourly HR range (p&lt;.001), and increased wear time (p=.005) in pre/post medication periods that may also impact model efficacy. Conclusion: Linking EHR and wearable data offers a promising route in identifying events that may bias computational tools and indicate a need for model-retraining or use of adjusted relationships.
Abstract P330: The Association Between APOE Genotype and Dementia in the Dementia Risk Pooling Project
Authors: Natalia A Lakomski, Katherine Giorgio, John Stephen, Maxwell Mansolf, Aicha Soumare, Alden Gross, Allison Aiello, Archana Singh-Manoux, Mohammad A Ikram, Catherine Helmer, Christophe Tzourio, Claudia L Satizabal, Deborah A Levine, Donald M Lloyd-Jones, Emily M Briceno, Farzaneh Sorond, Frank Wolters, Jayandra Himali, Lenore J Launer, Lihui Zhao, Oscar L Lopez, Stephanie Debette, Sudha Seshadri, Suzanne E Judd, Timothy M Hughes, Vilmundur Gudnason, Rachel Zmora, Elizabeth Peterson, Denise Scholtens, Norrina B Allen, Sanaz Sedaghat
Journal: Circulation (2024)

Introduction: Apolipoprotein E ( APOE ) is a glycoprotein that mediates and regulates lipid transport and uptake. The APOE e4 allele is associated with increased risk of mortality and Alzheimer’s Disease and related dementias. It has been suggested that the APOE e2 allele is associated with increased survival and serves as a protective factor for cognitive decline and dementia. However, due to the rarity of the e2 allele, this association is not fully understood. Furthermore, the association between APOE genotypes and dementia may differ by race/ethnicity. Methods: Data from six large, community-based, prospective cohort studies from the Dementia Risk Pooling Project (DRPP) were used. Cumulative incidence estimates for dementia and mortality by race and APOE genotype (combining one or two e2 or e4 alleles: 24, 22/23, 33, 34/44 ) were estimated. Cox regression models were used to estimate the APOE genotype ( 22, 23, 33, 34, 44 ) cause-specific hazard ratios (HRs) for dementia and mortality adjusting for age, sex, and cohort. Results: The sample consisted of 43,404 participants (average age 54, 52% female, 16% Black participants). Overall, the 5-year cumulative incidence of dementia was higher in White participants across different genotypes, while mortality rate was higher in Black participants (Figure 1). The 5-year cumulative incidence of dementia was higher among both Black and White participants with one or two e4 alleles. Using the APOE e2/e4 genotype as a reference, the dementia HRs for the e2/e2 and e2/e3 genotypes were 0.73 (95% CI 0.51-1.06) and 0.64 (95% CI 0.53-0.76), respectively. e3/e4 and e4/e4 genotypes were associated with higher HRs of 1.32 (95% CI 1.12-1.56) and 2.68 (95% CI 2.20-3.27), respectively. There was no association between APOE genotypes and mortality. Conclusion: In this large, pooled cohort, the presence of an e2 allele was associated with lower risk of dementia, while the presence of an e4 allele was associated with higher risk in both Black and White adults. APOE genotype was not associated with mortality.
Abstract P349: Physical Activity Perceptions and Engagement of Patients Prescribed an Anti-Obesity Medication in a Medical Weight Loss Clinic
Authors: Renee J Rogers, Stephen D Herrmann, Mary Hastert, Sarah Stolte, Cathleen Beaver, Joseph E Donnelly, John M Jakicic
Journal: Circulation (2024)

Introduction: Physical activity (PA) may elicit important health benefits when coupled with contemporary anti-obesity medications (AOM). However, currently there is little known about perceptions of PA and associated PA engagement of patients receiving these AOM therapies. Hypothesis: We assessed the hypothesis that PA would differ by perceptions of confidence to engage in PA, current and future importance of PA, and PA amount in patients receiving AOM treatment within the context of a medical weight loss clinic. Methods: An electronic survey was distributed to patients in a clinical research registry who were receiving treatment with an AOM at a university medical center-based weight loss clinic. The survey included questions about their perceived confidence to do structured PA or exercise regularly (PA-CONFIDENCE) and perceived importance of structured PA or exercise for management of their body weight currently (PA-IMPORTANCE) or in the future (PA-FUTURE). Participants also reported their current level of PA. Results: Survey responses were received from 96 patients. For these analyses, data were examined for patients currently prescribed a GLP-1 AOM (83 patients). High PA-CONFIDENCE was reported by 44.6% of participants, with 34.9% and 20.5% reporting moderate and low PA-CONFIDENCE, respectively. PA was 154±117 min/wk, 107±105 min/wk, and 76±77 min/wk for high, moderate, and low PA-CONFIDENCE (p=0.033). Participating in ≥150 min/wk of PA was reported by 54.1% with high, 20.7% with moderate, and 11.8% with low PA-CONFIDENCE (p=0.002). Ratings of PA-IMPORTANCE were 63.9% for high, 28.9% for moderate, and 7.2% for low. Participating in ≥150 min/wk of PA was reported by 48.2% with high, 12.5% with moderate, and 0% with low PA-IMPORTANCE (p=0.002). Ratings of PA-FUTURE were 79.5% for high, 18.1% for moderate, and 2.4% for low. Current participation in ≥150 min/wk of PA was reported by 33.7% with high, 12.5% with moderate, and 0% with low PA-FUTURE (p=0.002). Conclusions: Less than one-half of patients prescribed an AOM report confidence to engage in regular structured PA, and of those with high confidence only approximately one-half achieve current public health recommendations for PA. While more than one-half of patients report that PA is important, less than one-half engage in the recommended amount of PA. Strategies are needed to increase perceived confidence to perform and importance of PA in AOM treated patients, and to increase PA participation.
Abstract P219: Moderated-Mediated Effects of Environmental Barriers and Income Level on Exercise Determinants Among Black Americans With Hypertension
Authors: Donya Nemati, Adrian Noriega de la Colina, Navin Kaushal
Journal: Circulation (2024)

Introduction: Black individuals are disproportionately affected by hypertension and due to racial disparities have fewer opportunities to engage in preventive measures such as exercise compared to their White counterparts. There is a dearth of research employing a theory-driven approach to comprehensively investigate the factors contributing to disparities in exercise participation among racial groups, both at the individual and environmental levels. The I-Change Model is a contemporary health behavior model comprising three primary pillars hypothesized to influence health behavior: Awareness, Motivation, and Action/Planning. What sets this model apart is its unique emphasis on the proximity of the barrier construct to predicting behavior execution, a feature that may contribute to disparities in exercise participation, including racial disparities. Hence, this observational study aimed to apply the ‘I-Change model’ to identify factors that contribute to exercise behaviors among Black and White individuals with Hypertension. Methods: We used the I-Change model, which includes mediating behavioral determinants, along with moderators that include environmental barriers (e.g., access and transportation to a supportive exercise environment), and income (low vs. moderate and above) to gain a better understanding of racial disparities in exercise participation. Individuals with hypertension (n= 370) that comprised of Black (n= 142) and White (n= 228) adults who were recruited via an online recruitment platform and completed a survey that included validated theoretical constructs. Hayes PROCESS 4.0 Macro (model #16) for SPSS was used to construct the theoretical model and analyze the data. The model included race (x), exercise time (y), behavioral determinants (mediators), environmental behaviors, and income (moderators between mediators and exercise time). Results: I-Change determinants (risk of heart disease, planning, exercise knowledge, exercise partner/social support) mediated the relationship between race and exercise time (β= .24, 95% CI .098, .394) in favor of White participants. Moderated-mediation effects were found on barriers that interacted between planning and exercise time (β= .03, 95% CI .0018, .0674), and income which interacted between social support and exercise time, (β= .05, 95% CI .0004, .1056). Conclusion: Intervention work at the community level for low-income Black individuals with hypertension supported by a theoretical framework is needed. Specifically, an exercise promotion program that supports the development of I-Change determinants, which provides an accessible and supportive environment, would be helpful in providing equitable exercise opportunities for Black individuals with hypertension.
Abstract P366: Targeted Facebook Ads Increased Engagement Among Rural Communities During Pre-Recruitment Phases of the Mississippi Core of the Risk Underlying Rural Areas Longitudinal Study
Authors: Kisa K Harris, Abril Grant, Felicia V Caples, Christina D Ferrell, Dantwan S Smith, Eric D Lucas, Kenyatta A Poe, Ramachandran S Vasan, Frances C Henderson, Ervin R Fox
Journal: Circulation (2024)

Background: Data is sparse regarding the utility of social media in engaging southern, rural communities to participate in health research. Community Advisory Board (CAB) members of the Mississippi (MS) Core of the Risk Underlying Rural Areas Longitudinal (RURAL) Study suggested the use of the Facebook social media platform to promote the RURAL Study. During the pre-recruitment phase of engagement (6 months prior to initiation of examinations and 3 months prior to official recruitment), RURAL investigators used Facebook posts to help increase awareness of and interest in the RURAL Study. Objective: To use Facebook metrics to identify the types of posts that garnered the most engagement. Methods: The Principal Investigator of the RURAL Study’s MS Core collaborated with the University of MS Medical Center Social Media Coordinator to implement a Facebook page for the Study. The MS team implemented social media posts to promote the RURAL Study. Data on the number of post reactions, comments, and shares, as well as the reach of organic and paid ads, were collected to identify posts with highest engagement. Findings: In Oktibbeha County, the greatest number of Facebook profile visits occurred October 15-November 7, 2022. Facebook posts had the greatest reach between June 24-27 and September 19-30, 2022. Paid ads (boosted posts) produced greater reach than organic ads. In addition, post reactions positively correlated with the number of people reached. Posts with the greatest number of reactions were related to RURAL-sponsored events (e.g., the County Health Fair and the RURAL Open House event). There was significant Facebook activity around popular community events during which the RURAL Study was promoted (e.g., Fannie Lou Hamer event, the Open House event, and the Black Jack Morning Church Service). Although MS Core of RURAL investigators participated in interviews on local TV media prior to recruitment, organic Facebook ads that included links to videos of these interviews did not receive many reactions on the MS Core of the RURAL Study’s Facebook page. Conclusion: Using social media may be an effective tool for reaching communities during the pre-recruitment phase of engagement. Our findings support that paid ads that targeted specific audiences were more effective than organic ads. Facebook posts that documented RURAL’s participation and engagement in community events were more effective than posts about RURAL’s promotion in broadcast media.