tbuckley/cabot-search huggingface dataset:
Abstract P2162: Contributions of life-course socioeconomic position to later-life MRI measures of vascular brain injury: Results from SOL-INCA-MRI
Authors: Paola Filigrana, Jee-young Moon, Linda Gallo, Hector Gonzalez, Richard Lipton, Wassim Tarraf, Jianwen Cai, Martha Daviglus, Robert Kaplan, Maria Marquine, Krista Perreira, Ariana Stickel, Fernando Testai, Charles DeCarli, Carmen Isasi
Journal: Circulation (2025)

Introduction: Cardiovascular and brain health are closely related. Increasing research has shown that cumulative exposure to low socioeconomic position (SEP) over the life-course increases the burden of poor cardiovascular and brain health. However, the influence of life-course SEP in later-life measures of vascular brain injury has rarely been evaluated Hypothesis: Life-course SEP is associated with white matter hyperintensity volume-WMHV and brain infarcts, two magnetic resonance imaging-MRI derived measures of vascular brain injury Methods: We used data from adults aged 50-85 years (n=2400) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL-INCA-MRI), a population-based cohort study in the U.S. Participants' self-reports of their parental educational attainment was used as a proxy for childhood SEP (&lt;high school-HS and ≥HS). Indexes combining participant’s education, household income, employment, and house ownership were used as proxy for adult SEP (lower and higher SEP) at visit 1 (2008-2011) and visit 2 (2014-2017). Using childhood and adult SEP at visit 1, we classified participants into four socioeconomic mobility categories (stable low or high SEP, upward or downward mobility). WMHV and brain infarcts were quantified (2018-2022) using 3T MRI scans. We used inverse probability weighting and marginal structural models accounting for the complex sampling design, demographic, behavioral, and clinical covariates to quantify the association between life-course SEP and log-WMHV and brain infarcts (Yes or No) Results: Hispanic/Latinos with higher adult SEP at visit 2 had -0.25 (-0.46, -0.04) log-WMHV relative to those with lower SEP. Similarly, adults with upward socioeconomic mobility had -0.24 (-0.47, -0.02) log-WMHV relative to those with stable low SEP. We did not find associations between childhood or adult SEP at visit 1, downward or stable high SEP with log-WMHV. No associations were found between measures of life-course SEP and brain infarcts, except for upward socioeconomic mobility (OR: 0.52 [0.27, 1.00]) Conclusion: This study shows that, among U.S. Hispanic/Latinos, higher adult SEP at visit 2 and upward socioeconomic mobility have a positive influence on WMHV or brain infarcts, highlighting the benefits of an advantageous life-course SEP on measures of vascular brain injury. This study also suggests that vascular brain injury is mostly influenced by stressors in later adulthood rather than in early life
Abstract P1070: Predictors of Non-Arrival at Initial Study Screening Visits among Black Adults: Data from the GoFresh Trials
Authors: Ben Grobman, Christian Rivera, Ruth-Alma Turkson-Ocran, Jingyi Cao, Hannah Col, Md Marufuzzaman Khan, Mingyu Zhang, Manfred Mate-Kole, Timothy Plante, Stephen Juraschek
Journal: Circulation (2025)

Introduction: Trial recruitment is a major determinant of study success and participants’ non-arrival at screening visits represents a significant barrier to timely and representative study completion. However, little is known about the participant and study process characteristics associated with non-arrival at study visits. Objective: To investigate factors associated with non-arrival at initial in-person screening visits in two ongoing randomized controlled trials. Methods: The Groceries For Black Residents of Boston to Stop Hypertension trials (GoFresh and GoFreshRx) study whether home-delivered DASH-patterned groceries can reduce blood pressure among Black adults in communities characterized by lower median income. In this analysis, we examined sociodemographic and study-related factors potentially associated with participant non-arrival at their initial study visit (defined as rescheduling or not showing up at all). Associations were determined using logistic regression with adjustment for age, sex, and hypertension treatment status. Results: Among 1152 participants, the non-arrival rate was 37%. Older participants, those with smaller families, less socially vulnerable participants (participants in the 2 nd and 3 rd quartiles of the Social Vulnerability Index), participants informed via mailed brochures, and participants with a shorter time between initial contact and first scheduled visit were more likely to arrive at their initial visits ( Table 1 ). Participant method of contacting the study (e.g. filling out a survey, calling a study-affiliated number, emailing a study-affiliated email address), visit time (Thursday vs. Friday; AM vs. PM), and season of visit were not associated with visit non-arrival. Conclusion: In this large trial recruitment drive, we identified several participant and study process characteristics associated with non-arrival at screening visits. These factors represent potential targets for future intervention studies that either accommodate patient factors or intervene upon study process barriers to achieve timely and representative recruitment goals.
Abstract P1132: The long-term risk of knee and hip joint replacements attributable to overweight and obesity in the community: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yejin Mok, Pamela Lutsey, Priya Palta, Chiadi Ndumele, Michael Blaha, Matthew Best, Kunihiro Matsushita
Journal: Circulation (2025)

Background: The number of joint replacements due to osteoarthritis has grown recently, likely reflecting the obesity epidemic, demanding substantial medical expenditure (over $20 billion for knee and hip replacements). However, data on joint-specific replacements attributable to overweight/obesity and their lifetime risk are limited. Methods: In 15,287 ARIC study participants (age 45-64 years) at visit 1 (1987-89), we assessed the association of body mass index (BMI) at mid-life with knee/hip joint replacements due to osteoarthritis based on discharge diagnosis using multivariable Cox models. We calculated a population-attributable fraction for BMI ≥25 kg/m 2 . We also estimated the residual lifetime risk from age 50 through 95 years, accounting for the competing risk of death. Results: Over a median follow-up of 25.4 years, 1,874 participants (12%) underwent osteoarthritis-related knee or hip replacements (1,380 and 699 cases, respectively). In adjusted Cox models, participants with obesity (BMI ≥30.0 kg/m 2 ) and overweight (25.0-29.9 kg/m 2 ) had a 4- and 2-fold higher risk of joint replacements compared to participants with normal weight (&lt;25.0 kg/m 2 ). The association was stronger for knee vs. hip replacements (hazard ratios 4.58 [95% CI 3.85, 5.44] vs. 2.40 [1.87, 3.07] for BMI 30+ kg/m 2 compared to &lt;25 kg/m 2 ). 47% of knee/hip replacements were attributed to overweight and obesity. The residual risk of osteoarthritis-related joint replacements after age of 50 was highest in White women (17%), followed by Black women (12%), White men (11%), and Black men (4%). The residual lifetime risk within the same race and sex varied by ~2-fold according to obesity status (e.g., White women with obesity vs. normal weight: 25% vs. 12%) ( Figure ). Conclusions: Obesity and overweight are attributed to half of knee and hip replacements, and one in five to ten Whites and Blacks with obesity/overweight require joint replacements after age 50. Our findings emphasize the importance of weight management, such as increased physical activity.
Abstract P2018: Re-evaluating the Effect of Pravastatin on Mortality and Cardiovascular Events Using G-methods to Adjust for Adherence in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial – Lipid Lowering Trial
Authors: Rienna Russo, Anna Siefkas, Barry Davis, Eric Rimm, Issa Dahabreh, Miguel Hernan, Goodarz Danaei
Journal: Circulation (2025)

Introduction: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack – Lipid-Lowering Trial (ALLHAT-LLT) was a large-scale, pragmatic clinical trial comparing pravastatin to usual care. In contrast to placebo-controlled statin trials, ALLHAT-LLT did not find an effect on all-cause mortality when data were analyzed under the intention-to-treat (ITT) principle. Objective: We replicated the ITT analysis and estimated the per-protocol effect of pravastatin on the 5-year risk of all-cause mortality and major adverse cardiovascular events (MACE). Methods: To replicate the ITT analysis, we used discrete time methods (pooled logistic regression). To estimate the per-protocol effect, we censored individuals when they deviated from protocol, i.e., in the pravastatin arm when they discontinued the study drug in the absence of adverse events. In the usual care arm, following the trial’s protocol, we considered the initiation of lipid-lowering therapy to be clinically indicated and not a deviation from protocol. We adjusted for baseline and time-varying factors associated with adherence using inverse probability weighting. Our outcomes of interest were all-cause mortality and a composite endpoint of MACE (myocardial infarction, stroke, heart failure, and cardiovascular mortality). Results: Of 10,355 individuals randomized, we included 9,741 individuals who had complete baseline data. This restriction did not result in an imbalance between the randomization groups, nor substantial changes in the distribution of characteristics compared to the original trial. The ITT findings were consistent with the original trial, (hazard ratio 1.00; 95% confidence interval (CI) 0.88, 1.13). Over one-third (35%) of individuals in the pravastatin arm were nonadherent to protocol at year 5. After adjusting for this, we found a 5-year risk difference of -2.99 (-4.94, -1.46) and risk ratio of 0.79 (0.68, 0.89) for all-cause mortality and -3.56 (-7.06, 0.18) and 0.82 (0.66, 1.01) for MACE, comparing pravastatin to usual care. Findings were consistent across sensitivity analyses modifying definitions of adherence and missing data methods. Conclusion: We found that use of pravastatin was protective against all-cause mortality and cardiovascular events after adjusting for adherence to protocol. Results support the use of g-methods to adjust for adherence when interested in understanding the effect of dynamic, sustained treatments in pragmatic trials.
Abstract 018: Nocturnal Wakefulness and Eating Behavior Among Young Adults
Authors: Kathryn Kennedy, David Negelspach, Kyle Smith, Marie-Pierre St-Onge, Fabian-Xosé Fernandez, Michael Grandner
Journal: Circulation (2025)

Introduction: Chronic sleep deprivation and circadian misalignment are associated with cardiometabolic dysfunction, but few have studied the effects of nocturnal wakefulness-induced cognitive deficits on food decision making, and whether this exacerbates obesity risk. Hypotheses: In line with previous work, we hypothesized that short sleep would lead to greater next-day caloric intake, and nocturnal wakefulness would be associated with greater impulsive eating. Methods: Young, healthy adults (18-25 years; n = 17; 9 female) participated in a three-week protocol in which they tracked their habitual sleep and food intake from home during weekdays and spent two consecutive weekends in the lab. During lab visits, participants completed serial neurocognitive assessments, ate ad libitum , and experienced partial sleep restriction (on Weekend 1 with an advanced wake time and on Weekend 2 with a delayed bedtime). Results: A principal component analysis (PCA) was used to model eating behavior throughout both in-lab weekends. Energy intake (total calories) was significantly correlated with the PCA in both the advanced wake (R = 0.996; p &lt; 0.0001) and delayed sleep (R = 0.998; p&lt;0.0001) conditions. Thus, energy intake was shown to increase over time when partial sleep restriction occurred, regardless of nocturnal wakefulness timing. The Three Factor Eating Questionnaire Cognitive Restraint subdomain score was significantly correlated with caloric intake for both the advanced wake (R = 0.603; p = 0.01) and delayed sleep (R = 0.554; p = 0.02) conditions. Thus, lower self-reported cognitive restraint was associated with higher caloric intake. Normalized Monetary Choice Questionnaire score (an instrument used to measure delayed discounting/impulsivity) was significantly associated with caloric intake in the advanced wake (R = 0.604; p = 0.01), but not the delayed sleep (R = 0.0367; p = 0.15) condition. Pittsburgh Sleep Quality Index score was not associated with caloric intake in either condition. Conclusions: An advanced wake time may increase the risk of obesity among young adults who exhibit greater impulsivity, though any circadian perturbations may promote greater next-day caloric intake. Impaired dietary decision-making due to circadian misalignment and sleep loss may be a previously underappreciated public health concern, with implications for early morning shiftwork schedules and college start times.
Abstract P2013: Underrepresentation of African Countries in Randomized Controlled Trials: A 2022 Analysis Across Five Leading General Medical Journals
Authors: Bamba Gaye, Gurbinder Singh, Daouda Seck, Moustafa Morsy, Marvellous Adeoye, Elizabeth Emmanuel, Gabriela De Jesus Cipriano Flores, Elisabeth Sattler, David Kitara, Pasquale Maffia
Journal: Circulation (2025)

Objective: To evaluate the representation of African countries in randomized controlled trials (RCTs) published in five leading general medical journals in 2022. Methods: This systematic review assessed RCTs involving human subjects published between January 1, 2022, and December 31, 2022, across The New England Journal of Medicine , The Lancet , JAMA , Nature Medicine , and BMJ . Trials included were conducted in diverse settings, encompassing hospitals, research institutions, and community health centers. Geographic locations and participant demographics were extracted for analysis. The primary outcome was the proportion of RCTs conducted solely within African countries. The secondary outcome assessed African representation in multi-continental RCTs. Data were aggregated to determine the percentage of Africa-exclusive RCTs and African representation in multi-continental trials within each journal. Results: Of the 390 RCTs meeting inclusion criteria ( BMJ : 31, JAMA : 73, The Lancet : 97, Nature Medicine : 40, NEJM : 149), only 1.6% were conducted exclusively in Africa, with an additional 6.9% representing multi-continental studies where at least one African location was included. A total of 9 Africa-exclusive RCTs were published in 2022: The Lancet (4.1%), NEJM (2.7%), and Nature Medicine (2.5%). No Africa-exclusive RCTs appeared in BMJ or JAMA . Of multi-continental RCTs, NEJM included 14.8% with African sites, followed by The Lancet (9.3%), Nature Medicine (5.0%), and JAMA (1.4%). The BMJ published no RCTs with African representation. Within Africa, study sites were unevenly distributed. South Africa accounted for 67.5% of African RCTs, Northern Africa (7 countries) contributed 8.2%, Eastern Africa (22 countries) contributed 51.0%, Western Africa (17 countries) contributed 22.4%, Southern Africa (5 countries) contributed 75.5%, and Central Africa (9 countries) accounted for only 2.0% of the African representation. Conclusion: This analysis reveals a significant underrepresentation of African countries in RCTs published in top medical journals in 2022. The findings underscore the critical need for increased African participation in RCTs. Expanding African representation is essential for the generalizability of clinical research and the promotion of equitable health outcomes globally.
Abstract P1133: Higher Risk of Adverse Pregnancy Outcomes Among Black Women with Hypertrophic Cardiomyopathy Compared to White and Hispanic Women in The United States.
Authors: Duke Appiah, Oluwatobi Oladeji, Eric Broni, Imo Ebong, Catherine Kim
Journal: Circulation (2025)

Introduction: Pregnancy outcomes among women with hypertrophic cardiomyopathy (HCM) are not well described primarily due to small samples. The extent to which race/ethnicity influence pregnancy in this population Is not well studied. Hypothesis: We tested the hypothesis that among women with HCM, the risk of adverse outcomes during pregnancy and the puerperium will be higher among non-Hispanic Black and Hispanic compared to non-Hispanic White women. Methods: Data consisted of 18.1 million pregnancy-related hospitalizations among women aged 18 to 44 years, as recorded in the National Inpatient Sample from 2000-2021. Joinpoint regression was used to estimate annual percent changes (APC) in HCM trends. Logistic regression models were used to estimate the odds of adverse pregnancy outcomes (gestational diabetes, preeclampsia, fetal growth restriction, preterm birth, heart failure exacerbations and maternal mortality). Results: From 2000-2021, the prevalence of HCM among pregnant women increased by about 400% from 1.65 to 8.66 per 100,000. The increase differed by race/ethnicity (p=0.021): Black (APC: 11.4; 95%CI:8.8-16.8), Hispanic (APC: 7.6; 95%CI:4.2 -13.3) and White (APC: 7.3; 95%CI:5.2-9.9) (Figure). Among the women with HCM (n=591), Black women had higher odds for preeclampsia (Odds ratio [OR]=2.25; 95% confidence interval [CI]:1.17-4.33), gestational diabetes (OR=2.24; 95%CI:1.14-4.42), preeclampsia (OR=2.28; 95%CI:1.19-4.37), fetal growth restriction (OR=2.67; 95%CI:1.41-5.05), and heart failure (OR=4.06; 95%CI:1.71-9.67) compared to White women. Adjustment for sociodemographics, behavioral/lifestyle factors and chronic conditions prior to pregnancy attenuated these estimates but were mostly significant. Although maternal deaths were rare in this population, they all occurred among Black women. Conclusions: During the 21-year period, the prevalence of HCM among pregnant women increased the most among Black women, who also had higher risk of adverse pregnancy outcomes.
Abstract P1021: Leadless Pacemakers: A Systematic Review on Superior Alternative for Cardiac Support in Post-Valvular Interventional Patients
Authors: Yamunesh Patel, Vibhu Amrutiya, Gareema Naik, Panthi Soni, Dhaval Patel, Kashish Parmar, Mansi Lunagariya, Manishkumar Jyani
Journal: Circulation (2025)

Background: Around 10% of patients need a permanent pacemaker due to conduction issues in heart post-valvular interventions. The transvenous pacemaker has many complications compared to novel Leadless pacemaker(LPM) implantation. Objective: The main aim of this review is to compare the outcomes between conventional transvenous pacemakers and leadless pacemaker implantation after valvular intervention. Method: We conducted a comprehensive search of PubMed and ScienceDirect databases for relevant studies published between 2019 and 2024 using the keywords- pacemaker implantation and valvular intervention. Studies available in full text and in English language were included. After removing duplicates using the Rayyan tool, the remaining studies were screened and selected based on predefined inclusion criteria. Eligible studies included retrospective analyses of patients aged over 40 years, with indications for leadless pacemaker implantation such as atrial fibrillation, sick sinus syndrome, complete heart block, or complications following pacemaker implantation. Patients who had previously undergone implantations were excluded. We performed a qualitative synthesis of data to note the comparisons. Result: A total of 9 studies were included, comprising 10,776 patients, of whom 1121 underwent LPM implantation and 9655 received conventional transvenous pacemakers. Indications for LPM following valvular interventions included atrial fibrillation(n=24), complete heart block(n=20), bradycardia(n=26), high-degree atrioventricular (AV) block(n=30), and left bundle branch block(n=9). For conventional transvenous pacemakers, complete heart block(n=24) and high-degree AV block(n=7) were the primary indications. Compared to LPM, patients with conventional pacemakers reported more complications like pocket formation, pericardial effusion, pneumothorax, and infections, along with increased hospital stay duration. A few patients with LPM suffered from device-related complications like device dislodgement and device thrombus formation. Conclusion: The above findings suggest that while both the devices showed some device related risks, LPMs presented with fewer overall adverse outcomes, and thus, may be a safer alternative than conventional pacemakers. There is insufficient data on the use of LPM after valvular interventions. Further studies are required to fully assess the risks and benefits of LPM and their usage in patients of conduction abnormalities after valvular interventions.
Abstract P1033: The Association of Adverse Pregnancy Outcomes with Left Ventricular Structure and Function in Early Midlife: Results from the Bogalusa Heart Study
Authors: Eunsun Gill, XUANYI JIN, Camilo Fernández Alonso, Elaine Urbina, Emily Harville, Lydia Bazzano
Journal: Circulation (2025)

Background: Studies about the association between the adverse pregnancy outcomes (APO) and cardiac structure and function in midlife are scarce despite evidence that APO increases the risk of cardiovascular disease in later life. Objectives: The current study aims to investigate the association of APO with left ventricular (LV) structure and function after follow-up of approximately 15 years post-pregnancy. Methods: The Bogalusa Heart Study (BHS) is an ongoing rural community-based cohort in Louisiana. We examined 454 women who experienced singleton pregnancies and had follow-up echocardiography performed post-pregnancy. APO included pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preterm birth, and miscarriage at any pregnancy. Echocardiographic parameters at follow-up included LV ejection fraction (LVEF), LV mass index (LVMi), and LV geometry. LV geometry was classified as normal, concentric remodeling, concentric and eccentric hypertrophy. Multivariable linear and logistic regression analyses were applied and adjusted for age, race, education, smoking, alcohol intake, systolic blood pressure, fasting blood glucose, and total cholesterol. Interactions by age and race were tested. Results: The mean age across any pregnancy was 23.0 ± 5.6 years, and 33.7% were Black. After a median follow-up period of 15.1 years, in adjusted analyses, preterm birth and miscarriage were not statistically associated with LVEF, LVMi, and LV geometry. However, PIH (β coefficient = 0.12; p = 0.014) was associated with greater LVMi in midlife, but not with LVEF or LV geometry. GDM was associated with LV geometry, specifically with an increased risk of concentric hypertrophy (Odds Ratio, 3.42; 95% Confidence Interval, 1.04-11.30; p = 0.044). Interactions by race and age were not statistically significant. Conclusion: We identified the association of APO, specifically PIH and GDM, with greater subsequent LVMi and concentric remodeling 15 years later. Further studies are warranted to replicate these findings; however, women with PIH and GDM might be at higher risk of heart disease later in life. Keywords: Adverse pregnancy outcome, pregnancy induced hypertension, echocardiography, left ventricular mass index