tbuckley/cabot-search huggingface dataset:
Abstract MP31: Incident Type 2 Diabetes Onset Age and Duration, Mortality Risk, and Loss in Life Expectancy
Authors: Yin Zhang, Mingyang Song, Molin Wang, Ellen Hertzmark, Kana Wu, A. Heather Eliassen, Lorelei Mucci, Qi Sun, Meir Stampfer, Walter Willett, Frank Hu, Edward Giovannucci
Journal: Circulation (2024)

Introduction: Evidence on the relationship between type 2 diabetes onset age, duration, and mortality risk has been influenced by limited follow-up, inadequate control for confounding, and inability to cover the full range of onset age, duration, and the full spectrum of major causes of death. Moreover, there are scarce data dissecting how type 2 diabetes onset age and duration shape life expectancy. Hypothesis We assessed the hypothesis that early onset of type 2 diabetes and longer disease duration may be associated with higher risk of all-cause and cause-specific mortality and greater loss in life expectancy. Methods: We prospectively followed 270,075 eligible participants in the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study longitudinal cohorts for up to 40 years. The exposures include type 2 diabetes onset age (&lt;40, ≥40 to &lt;50, ≥50 to &lt;60, ≥60 to &lt;70, ≥70 to &lt;80, and ≥80 years) and duration (&lt;10, ≥10 to &lt;20, ≥20 to &lt;30, and ≥30 years). Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for age and a wide spectrum of potential confounders. Results: We documented 73,076 deaths during 8,166,216 person-years of follow-up. In fully-adjusted analyses, incident early-onset type 2 diabetes (diagnosed &lt;40 years of age) was associated with significantly higher mortality from all-causes (HR, 95% CI was 3.16, 2.64-3.79; vs. individuals without type 2 diabetes), cardiovascular disease (6.56, 4.27-10.1), respiratory disease (3.43, 1.38-8.51), neurodegenerative disease (5.13, 2.09-12.6), kidney disease (8.55, 1.98-36.9), and suggestively increased mortality from diabetes-related cancer (1.63, 0.94-2.83) and obesity-related cancer (1.63, 0.92-2.88). The relative risk elevations declined dramatically with each higher decade of age at type 2 diabetes diagnosis for deaths from most of these causes, though the absolute risk difference increased continuously. A substantially higher cumulative incidence of mortality and a greater loss in life expectancy were associated with younger age at type 2 diabetes diagnosis. Comparing individuals with early-onset type 2 diabetes to those without type 2 diabetes, their estimated multivariable-adjusted cumulative incidence of all-cause mortality at age 80 was 0.43 vs. 0.20, and the estimated life expectancy loss at age 40 was 2.5 years. Longer disease duration was associated with generally higher relative and absolute risk of mortality. Conclusions: Early onset of type 2 diabetes and longer disease duration are associated with substantially increased risk of all-cause and cause-specific mortality and greater loss in life expectancy. The effect of early-onset type 2 diabetes on mortality risk is stronger than that of later-onset type 2 diabetes.
Abstract P382: Epigenetic Regulation of the NF-kB Pathway by the Neural-Hematopoietic-Inflammatory Axis as a Potential Link Between Psychosocial Stress and Cardiovascular Risk: Data From the Washington DC Cardiovascular Health and Needs Assessment
Authors: Sonal Sharda, Manuel A Cintron, Yvonne Baumer, Joshua A Jacobs, Alina P Pang, Lola R Ortiz-Whittingham, Kameswari A Potharaju, Andrew S Baez, Abhinav Saurabh, Cristhian A Gutierrez Huerta, Erika Ortiz Chaparro, Billy S Collins, Valerie M Mitchell, Michael J Corley, Tiffany M Powell-Wiley
Journal: Circulation (2024)

Introduction: Chronic psychosocial stress (cPSS) is associated with cardiovascular disease (CVD) risk, caused in part by dysregulation of the neural-hematopoietic-inflammatory axis and epigenetic changes. cPSS may also affect NF-kB dependent pathways, suggesting a potential link to accelerated CVD risk and health inequities for populations most impacted by adverse social determinants. Hypothesis: We propose cPSS associates with greater amygdala activity (AmygA), a stress marker, and splenic activity (SpleenA), a hematopoietic activation measure. This relates to higher pro-inflammatory cytokine levels, partially due to less DNA methylation of NF-kB pathway-related genes. Methods: 60 African American adults (93.3% female, mean age 61) with CVD risk, living in the Washington, D.C. area underwent 18 FDG PET/CT to evaluate AmygA and SpleenA. DNA methylation analysis assessed epigenetic associations of the NF- κ B1/2 gene in PBMCs and ELISA- measured serum IL-1β and TNFα. Multivariable regression analysis adjusted for atherosclerotic CVD 10-year risk score and BMI was used to examine associations. Results: Greater AmygA and SpleenA were significantly associated with one another (β=0.26; p=0.003) and both were associated with greater pro-inflammatory cytokines IL1-β (AmygA:β =0.36, SpleenA:β=0.72, p&lt;0.05) and TNF-α (AmygA:β=0.31, SpleenA:β=0.58, p&lt;0.05). Further, we identified 2 significant methylation sites out of 81 on the NF- κ B1/2 gene. Notably, AmygA and SpleenA were inversely associated with the NF-κB1 cg01983105 and cg07955720 methylation sites (Table). Conclusions: We highlight a possible link between AmygA and SpleenA with decreased DNA methylation of the NF- κB gene. Our findings demonstrate a potential relationship between chronic stress-related neural activity and CVD risk through immune function and epigenetic alterations. These results should be examined in larger, diverse population-based cohorts with longitudinal data to identify intervention targets for reducing health inequities.
Abstract P444: Pre-Pregnancy Substance Use and First Trimester Cardiovascular Health Among Nulliparous Pregnant People: The nuMoM2b Study
Authors: Elly M Marshall, Ruchi Bhandari, Robert M Silver, Janet Catov, David M Haas, Amna Umer, Bethany Barone Gibbs
Journal: Circulation (2024)

Introduction: Pre-pregnancy health, including substance use and cardiovascular risk factors, have been associated with higher risks of maternal-fetal morbidity and mortality. The objective of this study was to determine if pre-pregnancy substance use is associated with early pregnancy cardiovascular health (CVH). Hypothesis: Pre-pregnancy use of alcohol, tobacco, marijuana, or illicit substances are associated with worse CVH as early as the first trimester of pregnancy. Methods: This is a secondary analysis using data collected in the first trimester of pregnancy in the nuMoM2b cohort (n=9,895). Pre-pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through standardized questionnaires. Latent class analysis categorized participants into four subgroups based on their reported pre-pregnancy substance use characteristics: [1] Illicit substances, marijuana, and alcohol use (n=1,234); [2] marijuana and alcohol use (n=2,066); [3] tobacco and alcohol use (n=636); and [4] alcohol use (n=3,194). Non-users were referent (n=2,765). CVH score was assessed using the American Heart Association Life’s Essential 8 (LE8) framework and included scoring of measured height, weight, resting blood pressure, blood glucose, and non-HDL cholesterol as well as self-reported diet, sleep, and exercise from 0 (least healthy) to 100 (most healthy). Multiple linear regression evaluated the relationship between pre-pregnancy substance use subgroups and LE8 score (overall and specific components). Results: Mean LE8 score varied by pre-pregnancy substance use subgroup: non-users Mean 65, SD ± 1.3, illicit substances, marijuana, and alcohol use 68 ± 1.3, marijuana and alcohol use 67 ± 1.3, tobacco and alcohol use 62 ± 1.4, and alcohol use 67 ± 1.3 (p&lt;.0001). In adjusted models and compared to non-users, those who used tobacco and alcohol had a lower LE8 score (-2.8, p&lt;.0001), other pre-pregnancy substance use classes had slightly higher scores ranging from 1.8-2.5 points (p&lt;.0001). Similar patterns were observed for individual components of the LE8 score. Conclusion: Individuals who used tobacco and alcohol prior to pregnancy, as opposed to other substance use subgroups, begin pregnancy with worse cardiovascular risk and may benefit from CVH promotion efforts.
Abstract P477: Motivations and Barriers to Consuming a Plant-Based Diet: The EAT Plants 1 Study
Authors: Casey M Rebholz, Jiaqi Yang, Audrey Ting, Lauren Bernard, Valerie K Sullivan
Journal: Circulation (2024)

Introduction: Consuming a plant-based diet is associated with a lower risk of cardiometabolic disorders and lower greenhouse gas emissions. Furthermore, a vegetarian diet is considered a healthy dietary pattern according to the U.S. Dietary Guidelines for Americans and strongly aligns with the 2021 AHA Dietary Guidance. Yet, little is known about current barriers to adhering to this dietary pattern. Methods: Adults who were either currently consuming or interested in consuming a plant-based diet were eligible to participate in an interview to assess behavioral, normative, and control beliefs related to consuming a plant-based diet. Participants were recruited using flyers distributed via social media (Facebook), an e-newsletter, a farmer’s market, and on the Johns Hopkins University campus, and by word of mouth. Interviews were conducted in person or via videoconference in July and August 2023 with a semi-structured guide, audio recorded, transcribed, and coded using NVivo software. Results: The study sample consisted of 12 participants who ranged in age from 21 to 62 years, 58% were women, 75% were white, and 17% were Asian American. Participants self-identified as vegan, vegetarian, or consumers of other types of plant-based diets, and had been following this dietary pattern for a long duration, ranging from 2 to 38 years. Reasons for consuming a plant-based diet were related to ethics (animal rights), the environment (desire to reduce environmental impact of their diet), health (prevent or manage disease and to lose or maintain weight), and culture (being raised in a vegetarian community). Many participants mentioned being influenced by books they read to consume a plant-based diet. Participants were largely surrounded by supportive friends, family, and partners who prepared and consumed plant-based meals with them. Barriers to consuming plant-based diet were related to accessibility particularly when traveling and when eating out (restaurants, work events) and taste of certain plant-based foods. Meat and dairy alternatives were common components of plant-based diets. Conclusion: The factors that influence adherence to a plant-based diet are informative for promoting a heart healthy and environmentally low-impact dietary pattern, consistent with current dietary guidance.
Abstract P265: Housing Instability and Cardiometabolic Health in the Rural South: Findings From Alabama Subcohort of the Rural Study
Authors: Nicole D Fields, Mahasin S Mujahid, Jesse Hsu, Alex C Watts, Peter Durda, Margaret E King, Stephanie Broyles, Ramachandran Vasan, Suzanne E Judd, Viola Vaccarino, Tene T Lewis
Journal: Circulation (2024)

Introduction: Housing instability may be an important determinant contributing to cardiometabolic health. However, studies have focused largely on urban contexts. Further, there may be race- and sex-related differences in housing instability, which may help explain racial and sex disparities in cardiometabolic health. We examined the association between housing instability and cardiometabolic health among rural adults and analyzed potential race and sex differences. Methods: Data are from the Risk Underlying Rural Areas Longitudinal subcohort (mean [SD] age, 48.8 [11.0] years; 70.1% women; 79.8% Black) sampled in two rural Counties in Alabama (n=903). Housing stability (range: 0-10) was defined using the Rollins Index with higher scores indicating greater housing instability. We examined multiple measures of cardiometabolic health including BMI, HDL and LDL cholesterol, triglycerides, current smoking status (yes/no), and coronary artery calcification (CAC &gt; 0). Multivariable linear and logistic regression models adjusted for age, education, and income were used to examine continuous and categorical measures of cardiometabolic health, respectively. We further examined differences by self-reported race and sex in the association between housing instability and cardiometabolic health. Results: In the overall sample, mean (SD) housing instability was 1.1 (1.6). The prevalence of housing instability (Rollins Index ≥ 1) was higher for Black participants compared to White participants (60.5% vs. 27.4%, p&lt;.0001). Housing instability did not differ by sex (52.9% women vs. 57.4% men, p=0.187). In multivariable-adjusted models, greater housing instability was associated with presence of CAC among Black participants (OR 1.12; 95% CI: 1.00, 1.26) but with lower prevalence of CAC among White participants (OR 0.49; 95% CI: 0.25, 0.90). Housing instability was also associated with higher HDL cholesterol levels (b=1.04; 95% CI: 0.08, 2.01) among Black participants and higher triglyceride levels among White participants (b=29.40; 95% CI: 0.49, 58.31). Housing instability was not associated with BMI in either group and was associated with higher prevalence of current smoking among Black participants only (OR 1.20; 95% CI: 1.07, 1.34). We did not observe statistically significant associations between housing instability and cardiometabolic health in sex-stratified analyses. Conclusion: Housing instability may be a social determinant of cardiometabolic health; however, findings were mixed and appear to vary for Black adults compared to White adults. Future research should utilize a longitudinal design to assess how changes in housing stability may affect cardiometabolic health over time.
Abstract P145: Randomized Trial of an Integrated Care Intervention Among Latino Adults: Sustained Effects on Diabetes Management
Authors: Heidy Mendez-Rodriguez, Carlos E Rosas, Gregory A Talavera, Scott C Roesch, Fatima Muñoz, Sheila F Castañeda, Paulina M Mendoza, Linda Gallo
Journal: Circulation (2024)

Purpose: Adequate diabetes management is challenging to sustain. In healthcare practices serving under-resourced communities, the development of cost-efficient interventions with a sustainable impact are crucial. We examined the 12-month maintenance effects of a previously successful integrated model of diabetes care at improving glycemic management and psychological well-being among Latino adults with type 2 diabetes (T2D). Methods: A randomized controlled trial (2015-2019) compared an Integrated Care Intervention (ICI) with Usual Care (UC) among 456 adults with T2D. The ICI included integrated medical and behavioral care and health education over 6 months. Assessments were completed at baseline, 3-, 6-, 9-, and 12-months. Results: Most participants were female (63.7%), with a mean age of 55.7 years. In multi-level models, significant group x time (quadratic) interaction effects were found for HbA1c ( ß = .10, 95% CI .02,.17, p &lt; .01) and anxiety ( ß = .20, 95% CI .05,.35, p &lt; .009), but not depression symptoms ( ß = .15, 95% CI -.01,.31, p &lt; .07). Analyses of instantaneous rate of change in the ICI group showed significant decreases at 3- and 6-months for HbAc1 ( ß = -.31 at 3-months; ß = -.12 at 6-months) and anxiety symptoms ( ß = -.92 at 3-months; ß = -.46 at 6-months), and no significant changes at 9- or 12-months, suggesting that initial improvements were largely maintained. The UC group showed a small decrease in anxiety symptoms at 6 months ( ß = -.17), but no other significant changes (all ps &gt; .05). (See Figure 1). Conclusions: This culturally tailored integrated care model that included both medical and behavioral care and health education programs, shows potential in producing and sustaining positive effects on clinical and psychological outcomes above standard care. Findings have implications for practice and policies that facilitate implementing these models in healthcare organizations.
Abstract P455: Effects of COVID-19 Pandemic on Racial Disparities in Coronary Artery Disease Mortality: Has the Existing Gap Worsened?
Authors: Alexander V Sergeev
Journal: Circulation (2024)

Background: Previous studies have indicated that the novel coronavirus SARS-CoV-2 (COVID-19) pandemic resulted in an increase of coronary artery disease (CAD) mortality across various population groups. However, it remains unknown whether the pandemic changed the dynamic of earlier documented existing racial disparities in CAD mortality. Study Objective: To investigate racial disparities in the magnitude of changes in CAD mortality rates from the pre-pandemic to COVID-19 pandemic era. Methods: Using the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying causes of death in the U.S., we analyzed CAD mortality rates in relation to race, adjusting for age and gender. CAD deaths were identified using the ICD-10 codes I20-I25 for the first three years of the pandemic (from March 2020 through February 2023; COVID-era CAD mortality) and for the three years immediately preceding the pandemic (2017-2019; pre-COVID CAD mortality). General linear modeling (GLM) analysis was conducted using SAS (version 9.4). Results: During the first three years of the pandemic, the overall crude CAD mortality rates increased from 160.619/100,000 in pre-COVID era to 164.773/100,000 (p&lt;0.001). Age-adjusted analyses demonstrated that African Americans and Asians experienced a more pronounced increase in age-adjusted CAD mortality rates than whites, when comparing the change in CAD mortality rates from the pre-COVID to COVID era. While age-adjusted CAD mortality rates increased from the pre-COVID to COVID era both in African Americans, Asians and whites, the magnitude of the change (the mortality rate increase) in African Americans was 19.538/100,000 greater than the magnitude of the mortality rate change in whites (p=0.08). Asians experienced a similar gap: the magnitude of the pre-COVID/COVID-era increase in their age-adjusted CAD mortality rate was 19.560/100,000 greater than the magnitude of the pre-COVID/COVID-era increase experienced by whites (p=0.09). Conclusions: While the magnitude of the change in racial CAD mortality disparities in relation to COVID-19 pandemic has not reached the conventional statistical significance level, the worsening of gap is alarming and warrants further investigation.
Abstract P439: Atherosclerotic Cardiovascular Risk Factor Burden Among Marijuana Users in the US Population
Authors: Anas Abed, Adam Koraym, Giovanna Zampierollo-Jaramillo, Amir Forati, Matthew C Tattersall
Journal: Circulation (2024)

Background: The prevalence of marijuana use in the US is increasing. Marijuana use has been associated with increased atherosclerotic cardiovascular disease (ASCVD) events. The ASCVD risk factor burden among marijuana users compared with non-users and tobacco users has not been defined. We sought to define ASCVD risk factor burden among marijuana users in a nationally representative sample of the US population. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from the 2017-2018 cycle including 4991 participants aged 18-59 representing 223 million US adults. Participants were placed in 4 groups: marijuana and cigarette user (MS), exclusive marijuana user (M), exclusive cigarette user (S), and non-users (NS). ASCVD risk factors were assessed and compared using chi-squared and ANOVA with Tukey’s adjustment for multiple hypothesis testing. Results: The N=4991 participants representing 223 million US adults were a mean 51 years old, 54.82% female and BMI of 32.53. The N=1691 M-users were compared to the N=2552 NS, N=2439 S-users, and N=1020 MS users (Table 1). The M-users were younger, mean age (38.8 years) with a higher BMI (32.9 kg/m 2 ) compared to exclusive smokers, dual-users and non-users. Prevalent coronary heart disease differed by use-group (p &lt; 0.05). Conclusion: Exclusive M-users and dual users had higher prevalent CHD. ASCVD risk factor burden differed slightly between the groups.
Abstract P266: Burden and Trends of Cardiovascular Disease and Its Attributable Risk Factor in Pakistan From 1990-2019: A Benchmarking Analysis
Authors: Khawaja Mushammar Hassan, Khawaja Momal Hassan, Khawaja Muthammir Hassan, Fiza Farrukh, Ameer Farrukh, Mohsin Nazir, Muhammad umer, Aamna Ijaz, Vinay Kumar Gadamidi, Anjani Kumar Thota, Khush Dadhania, Nmair Alziadin, Hardik D DESAI
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) remains the primary cause for death and disability in Pakistan, yet consistent data estimating its impact is limited. Method: Utilizing the Global Burden of Disease tool, we analyzed CVD metrics like prevalence, incidence, DALYs, mortality, and associated risk factors spanning from 1990-2019, categorized by age, gender, year, and region. Results are shown in both absolute numbers and age-standardized rates (ASR) per 100,000 person-years. Results: From 1990-2019, the annual percentage change (APC) witnessed a rise in prevalence by 106% (from 4.1 to 8.6 million), deaths by 98% (from 172,525 to 341,108), and DALYs by 119% (from 4.5 to 9.8 million). When assessed through age-standardized rates (ASR), incidence rates grew by 8% (from 852 to 918), deaths by 9% (from 329 to 357), and DALYs by 9% (from 7326 to 7988). In 2019, ischemic heart disease dominated as the top cause of CVD deaths, constituting 53.76% (183,409 out of 341,108). Over the past 30 years, Balochistan emerged as the most adversely affected state. The age bracket of 70-74 saw the maximum CVD fatalities at 41,848, while the 60-64 age group recorded the highest incidence at 135,376. Men experienced a more pronounced CVD impact than women over these three decades. High blood pressure stood out as the primary cause of CVD-related deaths in Pakistan, trailed by elevated LDL cholesterol levels. Conclusion: CVD accounted for 22.74% deaths amongst all cause of deaths in Pakistan in 2019. From a clinician's perspective, the escalating prevalence and incidence of CVD emphasize the need for early detection, intervention, and tailored treatments, especially in high-risk demographics like older males. From a public health standpoint, these findings underscore the urgency to implement broad-based preventive strategies, focusing on modifiable risk factors such as high blood pressure and LDL cholesterol, and to bolster healthcare infrastructure, particularly in severely affected regions like Balochistan.