tbuckley/cabot-search huggingface dataset:
Abstract P343: Diet Behaviors, Income, and Body Composition Among Diverse Adult Populations in the United States
Authors: Fatemeh Choupani
Journal: Circulation (2024)

Background: Dietary behavior and food components contribute to an increased risk of obesity development and other metabolic disorders across racial groups. Those with favorable healthy diet behaviors and higher incomes experience a lower risk of obesity. Little is known about the effects of diet behaviors and income on body composition among Hispanic and non-Hispanic Black men and women. As a step toward developing successful obesity interventions among minority populations, this study aimed to investigate associations and interactions among eating outside of the home, fast foods, and income with multiple measures of obesity. Method: Publicly available data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) for 3942 Hispanic, non-Hispanic White, and Black women and men were analyzed using two-way MANOVA and sample independent t-tests. Diet behaviors included eating foods outside of the home (FOH) and fast food (FF), while obesity measures included body mass index (BMI), percent of body fat (POF), and waist circumference (WC). Results: Adults were 20-80 years old, with a mean BMI of 25.1, SD=6.4 (men, 24.9; women, 25.2), showing healthy weight overall. On average, men were eating more FOH ( M =0.84, 95% CI: 0.59 to 1.08, p &lt;0.001, Cohen’s d =0.1) and FF ( M =0.57, 95% CI: 0.22 to 0.92, P &lt;0.001, Cohen’s d=0.2) than women; Black men were eating more FOH ( M =1.09, 95% CI: 0.61 to 1.58, p &lt;0.001, Cohen’s d =0.3) than Black women; and there were no significant mean differences on eating FF among Black men and Black women. Women with income &lt;$25000/year were eating more FF and had higher BMI (π 2 =0.013) and POF (π 2 =0.013, p &lt;0.05) than men. On average, Hispanic, White, and Black men were more likely to eat more FOH ( p &lt;0.001) than Hispanic, White, and Black women, and Hispanic and Black women with income &lt;$25000/year were eating more FF and FOH and had higher BMI and WC than Hispanic, White, and Black men ( P &lt;0.05). Conclusion: Understanding associations between diet behaviors, income, and obesity across sex differences and ethnic groups is important to address multilevel public health interventions for those in need of obesity treatment. Additionally, it is important for providers and health professionals to understand obesity risks that are unique by racial group when developing tailored intervention and prevention programs. Key Words: Diet, behavior, income, body mass index, Percent of body fat, waist circumference
Abstract P474: Association Between Dietary Patterns and Incident Hypertension in Regards (REasons for Geographic And Regional Differences in Stroke) Participants
Authors: Kara F Morton, Timothy B Plante, Vera A Bittner, Kim A Williams, Stephen Clarkson, Hely Nanavati, Suzanne E Judd
Journal: Circulation (2024)

Background: The lifetime hypertension prevalence in the US is &gt;70%. Dietary patterns may partially explain this overall risk. We sought to explore the association between dietary intake and risk of incident hypertension. Methods: REGARDS participants without hypertension at Visit 1 (2003-2007) were included, excluding those missing dietary data or Visit 2 follow-up (2013-2016). The exposure of interest was quartile of adherence to 5 dietary patterns previously determined among REGARDS participants using food frequency questionnaires and factor analysis: Convenience, Plant-Based, Sweets, Southern, and Alcohol/Salad (descriptions in Table 1). The outcome of interest was incident hypertension, defined as a blood pressure of ≥130/80 mmHg or the use of antihypertensive medication at follow up. Modified Poisson regression estimated risk ratios (RR), adjusting for demographics, socioeconomic factors, health behaviors, and medical conditions. Results: Of the 3,423 (mean [SD] age 61.6 [± 8.4] years, 58.5% women, 17.9% Black race), 42% (1,438) developed hypertension at median follow-up of 9 years. In unadjusted models, there was no clear association between Convenience, Plant-Based, or Sweets dietary patterns and incident hypertension (Table 1). High adherence to a Southern pattern was associated with incident hypertension. This association remained when adjusting for demographics, but not when adjusting for socioeconomic variables, health behaviors, and comorbid conditions. High adherence to the Alcohol/Salad dietary pattern also had no clear association with incident hypertension risk in the unadjusted model. However, in the fully adjusted model, there was greater risk of incident hypertension with greater adherence to the Alcohol/Salad pattern. Conclusions: Certain dietary patterns in REGARDS were associated with greater risk of incident hypertension. Future analyses to examine which food groups may be driving differential associations may help develop dietary strategies to reduce hypertension.
Abstract P459: Data Harmonization Strategies and Results in 5 CVD Cohorts
Authors: Charles B Eaton, Michael J LaMonte, Mary Roberts, Mir Moafi_Mandani, Norrina B Allen
Journal: Circulation (2024)

Introduction: As part of IPD data analysis of racial/ethnic disparities in Heart Failure we sought to harmonize sociodemographic, lifestyle, physiologic, biomarkers, and co-morbid covariates and HF outcomes. This report shares our data harmonizing strategies, matching characteristics, common formats and compares for diabetes, the cohort specific (unmatched) prevalence and prospective association with heart failure and compares them to the harmonized variable (common format). Methods: Nine cohorts (ARIC, JHS, WHI, Health ABC, MESA, FOHS, CARDIA, REGARDS, CHS) data is being harmonized for 128 covariates and HF outcomes of HF, HFrEF, HFmrEF, HFpEF. Twelve baseline variables ( age, sex, cigarette smoking, systolic blood pressure, diastolic blood pressure, pulse, height, weight, BMI, waist circumference, glucose, ECG, used identical formats and were completely matched. Seventy nine baseline variables (race, ethnicity, education, income, sleep, alcohol, CHD, DM, PAD, atrial fibrillation, etc) partially matched and a common format allowed for harmonization. Seventeen covariates (diet and physical activity) that measured the same construct but the questionnaires used differed enough that equipercentile equating was used to harmonize data. Results: In 64,114 participants from 5 cohorts, age range 20-95, mean age 62.7, the prevalence of diabetes mellitus was 10.5% using the common format, and 13.5% using cohort specific definitions. Prevalence varied by cohort from 7.9% to 23.4%. The harmonized prevalence differed by race and sex. The age, sex and race adjusted odds ratio for the prospective association with heart failure was OR=2.8, 95% CI 2.6,3.0. Sex and race specfic odds ratios differed by sex with females having a higher odds ratio, but were similar by race. Conclusion: Risk factors for heart failure are harmonizable in NIH CVD cohorts. Most variables are partially matched and require re-coding using a common format. Prevalence of DM varies by race and sex but association with HF only differs by sex.
Abstract P272: Association of Depression and Handgrip Strength With Morbidity and Mortality in Patients With Heart Failure: A Secondary Analysis From a Randomized Controlled Trial
Authors: Matthew E Lapa, Scott D Rothenberger, Kwonho Jeong, Matthew F Muldoon, Bea Belnap, Bruce L Rollman
Journal: Circulation (2024)

Introduction: Depression is associated with increased morbidity and mortality in patients with heart failure (HF). Handgrip strength (HGS) is a measure of sarcopenia and lower HGS has been associated with adverse HF outcomes. We hypothesized that relationships between HGS and morbidity and mortality would be moderated by depression in HF patients. Methods: We conducted a secondary analysis of patients hospitalized with HF categorized by depression status. We calculated HGS adjusted for body weight and categorized the values into tertiles, from lowest to highest. We fitted Cox proportional hazards models to estimate hazard ratios (HRs) comparing HGS tertiles in relation to 5-year mortality and 1-year readmissions among depressed and non-depressed and tested whether relationships differ by depression status. Models included HGS tertile, depression status, tertile-by-depression interaction, age, sex, race, medical comorbidities, educational attainment, employment, and HF severity. Results: A total of 494 patients were included in the analysis (mean age 63.4 ± 13.4 years, 44% female, 26% non-white race). A total of 83% of patients had depression and the mean LVEF (SD) was 27.8% (9.2). At 12-months following the index hospitalization the readmission rate was 56% (275 of 494), and the 5-year mortality rate was 41% (204 of 494). Individuals with higher HGS (tertile 2) were less likely to be readmitted compared to tertile 1 (46% vs. 63%; P=0.013). Depression status significantly moderated the relationship between HGS and readmission such that strong handgrip strength predicted readmission among depressed (adjusted HR of 0.35 (95% CI; 0.16, 0.81) comparing tertile 2 to tertile 1) but not among non-depressed patients (0.77 (0.55, 1.06)). However, the HGS-mortality relationship was not moderated by depression. Conclusion: HGS is a predictor of hospital readmission among HFrEF patients, and depression is a moderator of the HGS-readmission relationship. We recommend routinely assessing hospitalized HFrEF patients’ HGS and mood symptoms prior to discharge home, and further research is needed to assess the effects of depression on sarcopenia in its relation to clinical outcomes in HF patients.
Abstract 65: Association Between Life’s Essential 8 and Incident Cardiovascular Disease in Women With a History of Adverse Pregnancy Outcomes
Authors: Frank Qian, Haozhang Chen, An Pan, Gang Liu
Journal: Circulation (2024)

Background: Women with a history of adverse pregnancy outcomes (APOs) are at increased risk of developing cardiovascular disease (CVD). Whether maintaining higher cardiovascular health is associated with a lower risk of CVD in this population is not known. Aims: To evaluate the association between Life’s Essential 8 (LE8) and incident CVD in women with a history of APOs. Methods: We included 2,263 participants with a prior diagnosis of APOs (including hypertensive disorders of pregnancy, gestational diabetes, placental abruption, small for gestational age, or preterm birth) and 107,260 parous participants without a history of APOs from the UK Biobank, all of whom were free of CVD at baseline. LE8 was calculated at baseline (range 0-100). Multivariable-adjusted Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) between LE8 score and incident total and subtypes of CVD. We also examined the interaction between LE8 score and incident CVD among individuals with and without a history of APOs. Results: Over a mean 13.5 years of follow-up, 197 incident CVD events were documented in women with a history of APOs. Compared to women in the bottom tertile of LE8 score (&lt;67), those in the top tertile (&gt;76) had a lower incidence of total CVD, HR (95% CI) of 0.43 (0.29, 0.65), CHD [0.31 (0.17, 0.56)] and AF [0.46 (0.23, 0.91)]. We observed a significant interaction between history of APOs, LE8 score, and incident CVD ( Table 1 ). Women with a history of APO who maintained high LE8 score were at similar risk as those without APO with a high LE8 score, 0.95 (0.63-1.43), whereas there was an excess risk observed for those with an intermediate (HR with vs. without APO: 1.73 vs 1.25) and low LE8 scores (HR with vs. without APO: 2.48 vs 1.81). Conclusion: Among women with a history of APOs, better cardiovascular health as assessed using the LE8 score was associated with a significantly lower incidence of incident CVD. Additionally, women with a history of APOs who maintained high LE8 scores had similar risk of CVD as women without a history of APOs.
Abstract P499: Patterns of Sodium Glucose Cotransporter-2 Inhibitor Prescription by Indication in Patients With and Without Diabetes in the US Health System
Authors: Jung-Im Shin, Yunwen Xu, Alexander R Chang, juan jesus carrero, Amrita Mukhopadhyay, Lesley Inker, Saul Blecker, Leora Horwitz, Morgan Grams
Journal: Circulation (2024)

Introduction: Multiple clinical practice guidelines strongly recommend sodium-glucose cotransporter-2 inhibitors (SGLT2i) for people with diabetes and atherosclerotic cardiovascular disease or chronic kidney disease as well as for people with urine albumin-to-creatinine ≥200 mg/g or heart failure (HF), regardless of diabetes status. We characterized SGLT2i prescription patterns by indication for SGLT2i therapy in patients with and without diabetes in the US in 2022. Hypothesis: The prescription of SGLT2i is low across all indications. Methods: Using deidentified electronic health record data from the Optum Labs Data Warehouse, we included adults with estimated glomerular filtration rate ≥20 ml/min/1.73 m 2 across 31 US health systems. We assessed prevalence of SGLT2i prescription by presence of diabetes and indication, and compared them with renin-angiotensin system inhibitors (RASi), which were background therapies in the landmark trials of SGLT2i. Results: We classified 760,337 patients with diabetes and 2,640,077 patients without diabetes by their indications for SGLT2i therapy (indication present, absent, or unknown due to lack of albuminuria testing). SGLT2i were prescribed in 11.2%, 11.2%, and 7.1% of patients with diabetes and indication present, absent, or unknown, respectively, and 2.5%, 0.1%, and 0.1% of patients without diabetes. In contrast, RASi were prescribed more frequently among patients with indication present (with diabetes: 31-44%; without diabetes: 16-33%). RASi were prescribed to the majority of patients prescribed SGLT2i ( Figure A ). Practice patterns varied across health systems, but &lt;30% of patients with an indication received a SGLT2i prescription in all systems. ( Figure B ). Conclusions: In this large-scale analysis of contemporary US data, prescription of SGLT2i is low, which may deprive patients of needed cardiorenal protection. Future work should investigate whether changes in costs enabled by the 2022 Inflation Reduction Act may stimulate more optimal prescription patterns.
Abstract 17: Associations Between Digital Health App Engagement and Physical Activity Among African American Women With Cardiovascular-Kidney-Metabolic Syndrome: Data From the Step It Up Digital Health-Enabled Physical Activity Intervention
Authors: Manuel A Cintron, James Troendle, Mario Pita, Hannatu Tarfa, Foster Osei Baah, Kameswari Potharaju, Keitra Thompson, Sandy T Reynolds, Shelby R Hicks, Dana Sandler, Ayushi Dave, Sonal Sharda, Jennifer Wills Gallagher, Michael Heist, Billy S Collins, Sarah M Deguzman, Elizabeth M Aquino Peterson, Lola Ortiz-Whittingham, Andrew S Baez, Marcus R Andrews, Marie Marah, Ayanna L Wells, Yvonne Baumer, Tonya Dodge, Tiffany M Powell-Wiley
Journal: Circulation (2024)

Background: Physical activity (PA) improves cardiovascular-kidney-metabolic health (CKMH); however, few digital health tools to increase PA are tailored for populations disproportionately impacted by adverse social determinants, such as African American (AA) women. Less is known about the effects of engagement with digital health applications (apps) on PA among AA women from under-resourced communities. The objective was to examine associations between app engagement and PA over six months in the Step It Up (SIU) digital health PA intervention. Methods: We enrolled women with ≥Stage 1 CKM syndrome (overweight/obesity) from resource-limited Washington, DC areas into SIU. Before the study, we created the SIU app with community-engaged approaches. Participants used the SIU app and a Fitbit Charge 2 PA monitor for the study. After collecting baseline PA data for two weeks, the app provides interactive PA educational modules, motivational and place-tailored messages about PA, and CKMH self-monitoring tools for six months. We examined associations between overall app and specific feature engagement (i.e. ecological momentary stress assessments (EMA) completed when opening the app, goal setting, modules) with PA (in steps/day) using linear mixed modeling. Results: Participants (N=57) had mean age=60±14 years and BMI=37±8 kg/m 2 . Overall app engagement was positively associated with PA, with each unit increase in engagement associated with 148 more steps/day (p&lt;0.001, Table). Of the app features, engagement with the app EMA was significantly associated with higher PA (p&lt;0.001). Engagement with app goal-setting tools and modules were less significantly associated with higher PA (p=.06 and p=.07 respectively). Conclusions: Engagement with community-tailored, digital health tools like the SIU app can increase PA for AA women with CKM syndrome from under-resourced communities. Future studies should identify methods for increasing engagement in digital health interventions to improve PA and CKMH among AA women.
Abstract 34: Social Risks, Glycemic Control and Elevated Blood Pressure Among Patients With Diabetes in the Ascension Health System
Authors: Carrie R Howell, Andrea Cherrington, Courtney Watson, Collin Miller, Ashlin Jones, Thomas Aloia, Erin Rice, Benjamin Conrad, Stacy Garrett-Ray, Richard Fogel, Frederick A Masoudi
Journal: Circulation (2024)

Background: Calls to address social risks have stimulated interest in integrating screening measures into the electronic medical record (EMR) - particularly, self-reported individual level social risks - to improve care for chronic diseases like diabetes (DM). Objective: Examine associations between individual-level social risks and glycemic control and elevated blood pressure (BP) among patients with DM in the Ascension Health System. Methods: A 10-item EMR-embedded survey [access to care, resources, transportation, employment] was collected in Ascension primary care clinics in 12 U.S. states. Neighborhood-level risk was characterized with the CDC Social Vulnerability index (SVI) by census tract of patients’ residences. Associations between social risk (individual/composite) and uncontrolled DM (HbA1c &gt;9%) and elevated BP (&gt;120/80) adjusting for age, sex, race/ethnicity, SVI, region, and chronic conditions were examined. Results: Among 75,848 patients with DM and social risk data available [median age 62, 53% female, 22% Black, 7.5% Hispanic]. 20% had poor glycemic control; 27% had elevated BP; 20% lived in a high SVI census tract. Patients identifying any social risk were more likely to have poor glycemic or elevated BP. Patients with the highest social risk scores had higher odds of uncontrolled glycemia (OR 1.72, 95% CI 1.60-1.85) and elevated BP (OR 1.18, 95% CI 1.10-1.26). Conclusion: Examination of a large sample of primary care patients in a large multi-region health system determined that individual-level social risks were correlated with glycemic and BP control. These data highlight the need to simultaneously address social risks and medical conditions to impact population health.
Abstract 23: Multidimensional Association of Sleep With Health Behaviors and Cardiometabolic Risk in Adolescents
Authors: Julio Fernandez-Mendoza, Casandra C Nyhuis, Natasha Morales-Ghinaglia, Anthony Rahawi, Pura Ballester-Navarro, Susan Calhoun, Jason Liao, Alexandros Vgontzas, Duanping Liao, Edward O Bixler
Journal: Circulation (2024)

Introduction: Insufficient sleep has been recognized by AHA as part of Life’s Essential 8 in the prevention of cardiovascular disease (CVD). While sleep is a multidimensional phenomenon comprised of duration, efficiency, quality, timing, and regularity, prior epidemiological research in youth has predominantly focused on sleep duration. It is important to disentangle which sleep dimensions most associate with other health behaviors and biomarkers for CVD risk in adolescents. Hypothesis: We hypothesize that specific dimensions of insufficient, disturbed, and misaligned sleep will be differentially associated with nutrition, physical activity, and inflammation. Methods: We analyzed data from 421 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 5-night at-home actigraphy (ACT), 1-night in-lab 9-h polysomnography (PSG), self-reported insomnia symptoms, daytimes sleepiness, sleep schedule, circadian preference, and dietary assessment, as well as fasting blood draw assayed for C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα). Linear regression models tested the independent association of each sleep dimension with caloric intake, ACT-derived sedentary behavior, and blood-based inflammatory biomarkers, while accounting for sex, age, race/ethnicity, and body mass index. Results: Higher ACT-measured night-to-night variability in sleep duration was most strongly associated with increased caloric intake, particularly carbohydrates (B=0.203, p&lt;0.001), while shorter PSG-measured sleep duration was also associated with carbohydrates but to a lesser extent (B=-0.150, p=0.002). Later bedtime on weekdays was most strongly associated with higher bouts of sedentary behavior (B=0.216, p&lt;0.001), while shorter ACT-measured sleep duration was most strongly associated with time spent sedentary (B=-0.226, p&lt;0.001). PSG-measured sleep apnea was most strongly associated with higher CRP (B=0.287, p&lt;0.001) and IL-6 levels (B=0.260, p&lt;0.001), while later bedtime on weekdays (B=0.136, p=0.025) and evening circadian preference (B=-0.124, p=0.017) were also associated with inflammation but to a lesser extent. Conclusions: The association of inadequate sleep with health behaviors and cardiometabolic risk in adolescents is in itself multidimensional. These data support that AHA guidelines should be updated to include insufficient, disturbed, and misaligned sleep as contributors to CVD risk.