tbuckley/cabot-search huggingface dataset:
Abstract P282: Pooled Cohort Equation Performance at Quantile Thresholds of African and European Ancestry Among Hispanic/Latino: Findings From Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Bede N Nriagu, Karen Flores Rosario, Spencer Hansen, Priscilla Duran Luciano, Robyn McClelland, Parag H Joshi, Anurag Mehta, Amit V Khera, Robert Kaplan, Tamar Sofer, Carmen A Peralta, Carlos J Rodriguez
Journal: Circulation (2024)

Background: Current recommendations include using the non-Hispanic White (NHW) pooled cohort equation (PCE) for 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation among Hispanic individuals and the non-Hispanic Black (NHB) PCE when African ancestry is present. We studied PCE performance at thresholds of African and European ancestry among US Hispanics. Methods: Hispanic participants from the Multi-Ethnic Study of Atherosclerosis (MESA), ages 44-75 years without diabetes mellitus or prior cardiovascular disease were included. ADMIXTURE software was used to estimate quantile thresholds of continental genetic ancestry (African and European). We compared 10-year survival Kaplan-Meier estimates among Mexican Hispanics, Caribbean Hispanics and Other Hispanics using a log-rank analysis. We calculated the predicted-to-observed (P/O) ASCVD event ratios using the NHW and NHB PCE across quantile threshold of African and European ancestry. Results: 966 MESA Hispanics were stratified into: Mexican (n=504), Caribbean (n=284) or Other Hispanic (n=178). At 10-years, there were 179 ASCVD events [Mexicans (n=107), Caribbean (n=49), Other Hispanic (n=23)]. We observed overestimation using the NHW and NHB PCE as evidenced by P/O ratios &gt;1. Both PCEs performed better (P/O ratios converge toward 1) with increasing quantiles of European Ancestry and performed worse (P/O ratios diverge from 1) with increasing quantiles of African Ancestry. At a greater than 0.7 quantile of African ancestry, a sharp increase in overestimation was recorded for both PCEs. (Fig1A). Though Mexican Hispanics had the lowest ASCVD-free survival probability at 10 years’ time mark, results were not statistically significant. (Fig 1B) Conclusion: We observed overestimation in the 10-year ASCVD risk estimation using the NHW and NHB PCE among Hispanics as evidenced by P/O ratios &gt;1. Both PCEs performed better with increasing quantiles of European ancestry and performed poorly with increasing quantiles of African ancestry.
Abstract P351: The Associations of Short-Term, Chronic Localized and Chronic Widespread Pain With Life Expectancy Free of Major Chronic Diseases
Authors: Minghao Kou, Xiang Li, Hao Ma, Xuan Wang, Yoriko Heianza, Lu Qi
Journal: Circulation (2024)

Introduction: Pain is among the top underlying causes of years lived with disability. Hypothesis: Pain with higher chronicity and widespreadness is associated with shorter life expectancy free of major chronic diseases (cardiovascular disease, cancer, type 2 diabetes, and dementia), and longer lifespan lived with chronic diseases. Methods: The study included a total of 427,464 women and men from the UK Biobank study, free of major chronic diseases at baseline and with available information of pain (categorized as short-term pain, chronic localized pain, and chronic widespread pain), followed up until May 31, 2021. Population-based multistate life tables were used to calculate life expectancy with and without major chronic diseases. Results: Chronic localized pain was associated with significant but modest loss in healthy life expectancy and gain in lifespan lived with chronic diseases. Chronic widespread pain was associated with the largest loss in healthy life expectancy. Men and women with chronic widespread pain at age 50 years had 3.17 (95% confidence interval, 3.07 - 3.30) and 2.74 (2.66 - 2.83) shorter life expectancy free of major chronic diseases, 1.86 (1.73 - 1.97) and 1.84 (1.75 - 1.92) longer life expectancy with major chronic diseases as compared to individuals without pain ( Figure ). Chronic widespread pain was associated with ~15% and ~10% shorter life expectancy free of major chronic diseases in men and women at age 50 years, respectively, which increased to ~40% and ~30% after age 80 years. In terms of life expectancy in the presence of major chronic diseases, chronic widespread pain was constantly associated with ~25% and &gt;30% longer life expectancy as compared to those without pain in men and women, respectively. Conclusions: Chronic pain, especially chronic widespread pain, was associated with larger loss in healthy life expectancy and more lifespan lived with chronic diseases. Our study suggests chronic pain as a potential intervention target to improve quality of life.
Abstract P181: Association Between Non-Alcoholic Fatty Liver Disease Risk SNP Variants and Lipid Metabolism
Authors: Hiroaki Ikezaki, Masayuki Murata, Nobuyuki Shimono, Ernst J Schaefer
Journal: Circulation (2024)

Introduction: The impact of non-alcoholic fatty liver disease (NAFLD) risk SNP variants on ipid metabolism in the general population has yet to be determined. We aimed to assess this association using a large prospective cohort study. Methods: A total of 1488 Japanese men and women (median age 62 years and median body mass index 24.7 kg/m2) free of cardiovascular disease were studied. Among NAFLD risk SNPs, variants of patatin-like phospholipase domain containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), glucokinase regulator (GCKR), and neurocan (NCAN) were assessed. Plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL3-C, triglycerides (TG), lipoprotein(a), and adiponectin were measured at both baseline and after a five-year follow-up. Univariate and multivariate analyses, Kruskal-Wallis, Wilcoxon’s rank sum, and paired t-tests were performed to examine the associations between NAFLD risk SNPs and lipoproteins. Results: All of the measured lipoproteins increased significantly over the 5 years. The TM6SF2 variant did not affect lipoproteins at baseline. However, after 5 years, the non-major allele group had significantly lower HDL-C and HDL3-C and significantly higher LDL-C, sdLDL-C, and LDL-TG than the major allele group. For the GCKR variant, TG, LDL-C, sdLDL-C, and LDL-TG were significantly higher in the non-major allele group at baseline; LDL-C, sdLDL-C, and LDL-TG were still significantly higher in the non-major allele group at 5 years than the CC group. The PNPLA3 and NCAN variants did not affect lipoproteins in this study. Conclusions: NAFLD risk SNP variants might influence atherogenic lipoprotein metabolism.
Abstract P232: Toxic Stress is Associated With Greater Odds of Cardiovascular Disease Among Younger but Not Older Women in the Go Red for Research Dataset
Authors: Saam Honarvar, Samaah Sullivan
Journal: Circulation (2024)

Introduction: The incidence of certain cardiovascular diseases (CVD) such as heart attack and stroke have been increasing among younger women (ages 35-54 years). Psychosocial stress may be an important risk factor for CVD among this group of women. We examined whether toxic stress was associated with an increased odds CVD and whether this association was greater among younger women (&lt; 55 years of age) compared to older women (≥ 55 years of age). Hypothesis: Toxic stress would only be associated with CVD among younger women. Methods: We utilized data from participants enrolled in the American Heart Association Research Goes Red Registry, an online research platform powered by Verily. Women were asked if they had been diagnosed with any of the following heart related conditions (heart attack, hemorrhagic stroke, prior revascularization, or blocked arteries). Women were also asked whether they had experienced toxic stress defined as a significant life-defining stressful activity over a prolonged period unaccompanied by sufficient social resources or support such as loss of a child, racial discrimination, or job loss. Logistic regression models were used to estimate odds ratios between toxic stress and CVD as well as differences by age (&lt; 55 versus ≥ 55 years of age) using an interaction term. Results: The analytic dataset included 1,354 women who completed both the RGR Survey and the Healthcare and Experience Survey. The mean age of participants was 47.8 (SD: 12.6), 70% were less than 55 years of age, 83% were Non-Hispanic White, 59% indicated that they had experienced toxic stress, and 12% had CVD. In final multivariable models, there were significant differences in the association between toxic stress and CVD by age group (toxic stress-by-age interaction = 0.05) such that toxic stress was only significantly associated with an increased odds of CVD among women &lt; 55 years of age (OR: 2.00; 95% CI: 1.17, 3.44; p-value: 0.0119). In contrast, toxic stress was not significantly associated with an increased odds of CVD among older women ≥ 55 years of age (OR: 0.97; 95% CI: 0.59, 1.61; p-value: 0.9052). Conclusions: Toxic stress was associated with an increased odds of cardiovascular disease among younger, but not older women in this cross-sectional study. Stress may be an underrecognized risk factor for CVD, especially among younger women who may benefit from interventions to mitigate and prevent stress. These findings should be corroborated in future longitudinal or other study designs that can establish temporality and stronger inferences of causality.
Abstract P350: Increased Trunk Fat and Decreased Limb Fat Linked to Elevated Cardiovascular Risk in Hong Kong Chinese Women
Authors: Qingling Yang, Yao Jie Xie, Lin Yang, Chun Hao
Journal: Circulation (2024)

Introduction: Despite known links between overall body fat and cardiovascular disease (CVD) risk, the relationship involving regional body fat (arm, trunk, and leg) remains underexplored in Chinese populations. This study examined the associations between overall and regional body fat percentage (BFP) and CVD risk in Hong Kong Chinese women. Hypothesis: We hypothesized that higher overall and trunk BFP were associated with increased CVD risk, whereas higher arm and leg BFP predicted decreased risk. Methods: This study used baseline data of 3616 women (mean age 56.12±8.51) from an ongoing cohort named ‘MECH-HK’ (Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women). The recruitment was conducted between October 2019 and October 2021. BFP was measured using the bioelectrical impedance analysis device of Inbody 270 model. Framingham 10-Year Risk Score (FRS) was calculated to present the CVD risks. Multivariate linear models were used to estimate the BFP-FRS associations. Potential non-linear relationships were assessed with restricted cubic spline models. Results: Mean overall BFP was 32.55%, and regional BFP for arm, trunk and leg were 4.59%, 15.38% and 10.76%, respectively. Non-linear associations between overall BFP and FRS were observed (P for non-linear = 0.03). After adjustment for age, education level, monthly family income, smoking and drinking status, physical activity level, family history of CVD and BMI, the overall BFP was associated with increased FRS (β: 0.04, 95% CI: 0.00 to 0.08, P = 0.03) when overall BFP &lt; 35%. However, no significant association was observed when overall BFP &gt;= 35% (β:-0.07, 95% CI: -0.16 to 0.02, P = 0.13). Higher trunk BFP was associated with increased FRS (β: 0.30, 95% CI: 0.21 to 0.38, P &lt; 0.001), while higher arm (β: -0.69, 95% CI: -0.98 to -0.40, P &lt; 0.001) and leg (β: -0.38, 95% CI-0.50 to -0.25, P &lt; 0.001) BFP were associated with decreased FRS. Conclusions: Increased overall (when &lt; 35%) and trunk BFP and decreased arm and leg BFP are associated with elevated CVD risk.
Abstract P186: Does Lipoprotein (a) Level Have a Predictive Value in Reintervention After Iliofemoral Vein Stenting?
Authors: Keva Li, Andrew Min, Halbert Bai, Jason Storch, Jenny Chen, Windsor Ting
Journal: Circulation (2024)

Background: Lipoprotein (a), Lp(a), is associated with cardiovascular complications and atherothrombosis in arteries. However, the effects of Lp(a) in venous disease are unknown and uninvestigated. Hypothesis: Utilizing a patient population with iliofemoral stenosis from external compression (May-Thurner Syndrome) of which 30% had a prior deep vein thrombosis (DVT), we hypothesize that elevated Lp(a) levels may be associated with an increased risk of major reoperations after intravascular vein stenting (IVS) when compared to patients with non-elevated Lp(a) levels. Methods: In this study, 584 patients who underwent IVS for chronic iliofemoral stenosis between 2011 and 2019 were retrospectively studied. Patients with acute DVT, any prior IVS, or no Lp(a) results were excluded. Patients were stratified into two groups according to Lp(a) levels: non-elevated Lp(a) &lt;50 mg/dL (N=472 patients), and elevated Lp(a) ≥50 mg/dL (N=112). Statistical analysis of demographics, clinical outcomes, and venous clinical severity score (VCSS) included paired t-tests and chi-squared tests. Kaplan-Meier curves and Cox proportional hazard models assessed the relationship of Lp(a) with time to major reoperation requiring venography and/or intravascular ultrasound (IVUS). Results: Patients with elevated Lp(a) levels were more likely to be Black (14% vs. 2.3%; p &lt;0.001), hypertensive (56% vs. 44%; p = 0.025), higher preop VCSS pain (2.0 vs. 1.6; P&lt;0.01), and greater number of reoperations (2.1 vs. 1.7; p = 0.037), specifically major reoperations (54% vs. 21%; p = 0.012) than those with non-elevated Lp(a) levels. Both non-elevated and elevated Lp(a) demonstrated comparable changes in composite VCSS scores during post-op, 1, 2, and 3-year follow-up (p = 0.12, 0.3, 0.4, and 0.5, respectively). However, multivariate analysis, controlling for demographic variables and comorbidities, showed no significant association between elevated Lp(a) and major reoperation (HR: 1.3; 95% CI: 0.84-2.00; p = 0.2). A statistically significant interaction was found between Lp(a) and hypertension status (p = 0.003). Compared with the reference group (Lp(a)) &lt;50 mg/dL and no hypertension), those with Lp(a) ≥50 mg/dL and hypertension demonstrated a statistically significant increase in risk for reoperation (p = 0.01). Conclusion: This study found that elevated Lp(a) levels were not associated with major reoperations in patients undergoing IVS for chronic iliofemoral stenosis. While Lp(a) levels have a significant impact in arterial disease, this study suggested that Lp(a) may have a lesser influence in venous disease. As such, the utility of Lp(a) as a predictive biomarker in venous disease may be limited.
Abstract P286: The Impact of Obesity Severity on Left Ventricular Mass Index in Adults With Congenital Heart Disease
Authors: Stephen C Ream, Andrew H Tran, May Ling Mah, Marc Lee, Curt Daniels, Kan N Hor
Journal: Circulation (2024)

Introduction: Obesity is a global epidemic. Adult congenital heart disease (ACHD) patients are obese at rates comparable to the general population. Obesity is associated with left ventricular hypertrophy (LVH) which can be assessed by LV mass index [LVMI = LVM/Ht 2.7 (g/m 2.7 )]. Elevated LVMI is known to be associated with adverse cardiovascular events in non-CHD populations, however, there is a paucity of data on the relationship of obesity severity and the rate and extent of LVH in ACHD. Hypothesis: The rate and extent of LVH in a cohort of obese ACHD patients will increase as obesity class increases. Methods: We reviewed transthoracic echocardiogram data including LVMI, BMI, and blood pressure in obese, repaired, ACHD patients 18+ years of age from 2012-2020. Patients were grouped by sex and NIH/WHO obesity class and LVMI was analyzed. Outcome differences were assessed using one-way ANOVA (p &lt; 0.05 = statistically significant). Results: We included 386 patients, 202 of whom were female, as seen in Table 1. There were no blood pressure differences between obesity classes (P = 0.18). LVMI was higher with increasing obesity class (42.4±13.5 g/ht 2.7 vs 43.6±12.7 g/ht 2.7 vs 48.9±13.2 g/ht 2.7 respectively, P = 0.004 for females and 45.9±12.8 g/ht 2.7 vs 48.9±13.8 g/ht 2.7 vs 55.3±16.8 g/ht 2.7 , P = 0.019 for males). For females, 36.4% of class I, 31.9% of class II, and 58.3% of class III met LVH criteria ≥ 47 g/ht 2.7 . For males, 29.9% of class I, 44.4% of class II, and 59.4% of class III met LVH criteria ≥ 51 g/ht 2.7 . Conclusion: Obesity severity correlates with progressive LVMI and LVH in ACHD patients. Elevated LVMI is most striking in patients with class III obesity. This highlights the potential negative impact of obesity in this population and additionally suggests that even in obese patients, prevention of progression to class III obesity may help prevent deleterious cardiac changes. Further research is needed regarding how this association impacts this high-risk population.
Abstract P288: Sex Differences in Krebs Cycle Metabolites May Explain Differential Predisposition to Cardiovascular Disease
Authors: Christopher Stone, Dwight Harris, Madigan Stanley, Debolina Banerjee, Mark Broadwin, Krishna Bellam, Yonatan Najman-Licht, Frank W Sellke, Anny Usheva
Journal: Circulation (2024)

Introduction: Although there have been numerous observational studies in the literature describing differential predisposition to cardiovascular disease between sexes, there is relatively little in the literature that provides a biochemical account suitable to explain these disparities. We hypothesized that there may be a fundamental biochemical distinction between sexes, productive first of differential metabolic contexts, and thence ultimately of the differential predisposition to disease states described in the epidemiologic literature. Methods: We employed metabolomic analysis together with an unsupervised learning approach to uncover sex-specific alterations in the abundance of several polar metabolites. Blood was collected from healthy volunteers (5 female, 4 male). Polar metabolites were extracted and analyzed using targeted liquid chromatography coupled with tandem mass spectrometry; we then utilized nonnegative matrix factorization (NMF) to search for metabolomic differences. Results: The female and male signatures differ in metabolites related to Krebs Cycle (KC). In males, we observed statistically significant or nearly significant decreases in citrate (P=0.054), isocitrate (P=0.006), and malate (P=0.076); while aconitate, succinate, fumarate, oxaloacetate, and glyoxylate, an intermediate in an alternative KC pathway, were non-significantly decreased. GABA P=0.0008) was also strikingly decreased in males. The KC product GTP (P=0.014) was significantly decreased as well. Conclusion: We observed significant decreases in several KC intermediates in males when compared with female counterparts, in GABA, and in GTP, which plays important roles in protein synthesis, gluconeogenesis, and cellular signal transduction. The status of the KC as the central hub of metabolism confers wide-ranging implications on this data: the reduced KC functionality observed in our study may confer disproportionate exposure to processes requiring efficient energy production in males.
Abstract P345: Is a Fixed Value of the Rate of Gas Exchange Appropriate to Indicate the Maximum Effort of Obese and Nonobese Adults Undergoing a Treadmill Cardiopulmonary Exercise Test?
Authors: Victor Dourado, Agatha Matheus, Alan Barbosa, Marcello Romiti, Rodolfo Arantes
Journal: Circulation (2024)

Introduction: Obese individuals present a higher O2 uptake/workload during a treadmill cardiopulmonary exercise test (CPET) in addition to chronotropic and biomechanical impairment, which preclude them, many times, from reaching a maximal rate of gas exchange (Rmax) &gt; 1.0. Therefore, it is necessary to develop reference values for Rmax for a treadmill CPET according to age, sex, and a wide range of body mass index (BMI). Objectives: To establish reference values for Rmax for a treadmill CPET according to age, sex, and BMI. Methods: We re-examined 1,612 treadmill ramp CPETs of adults (893 women), of which 772 were obese (BMI ≥ 30 kg/m 2 ). We excluded tests of nonobese participants with HRmax &lt; 85% of predicted, of any participant with a rate of perceived exertion in the BORG scale &lt; 4 (intense), and of those that we had operational problems during the test. We produced a Rmax percentile table according to sex, age (&lt; 33, 34 to 46, and &gt; 46 years), and BMI (&lt; 30 and ≥ 30 kg/m 2 ). We fit stepwise multiple regressions to investigate the influence of age, sex, BMI, and cardiovascular risk on Rmax. We also presented an obesity-specific equation to estimate maximum heart rate (HRmax). Results: We evaluated 442 eutrophic participants (BMI &lt; 25 kg/m 2 ), 398 were overweighted (BMI = 25 - 29.99 kg/m 2 ), 295 had class 1 obesity (BMI = 30 - 34.99 kg/m 2 ), 247 had class 2 obesity (BMI = 35 - 39.99 kg/m 2 ) and 230 had class 3 obesity (BMI ≥ 40 kg/m 2 ). Age, sex, and BMI were the main determinants of Rmax (R 2 = 0.195). The table with percentiles confirmed that the lower limits of Rmax did not reach 1.0, especially in older, obese, and female participants (Table 1). In the obese participants, we could predict HRmax as 195.2 - (0.796 x age). Conclusions: The Rmax values in a treadmill CPET should be chosen considering attributes such as age, sex, and BMI. Our results suggest that fixed values of Rmax are not appropriate to indicate maximum effort, especially in people with low cardiorespiratory fitness.
Abstract P513: Coronary Artery Calcium Burden in Rural Alabama: Initial Findings From the Risk Underlying Rural Areas Longitudinal Cohort Study
Authors: Alexander C Razavi, Ramachandran S Vasan, Edwin van den Heuvel, Seamus P Whelton, Omar Dzaye, Mahasin S Mujahid, Tene T Lewis, Suzanne E Judd, Jerome I Rotter, Marly van Assen, Carlo N De Cecco, Arshed A Quyyumi, Michael J Blaha, Laurence Sperling, Matthew J Budoff, Viola Vaccarino
Journal: Circulation (2024)

Introduction: Individuals living in rural areas have a disproportionately high rate of cardiovascular disease (CVD) mortality. Coronary artery calcium (CAC) scanning may inform CVD risk stratification. However, the prevalence of CAC in rural areas is unknown. Research Question: What is the prevalence of CAC according to age, sex, and self-reported race (Black, White) in two rural counties in Alabama? Aims: To determine the prevalence of a CAC score &gt;0, a CAC score ≥100, and premature CAC among rural persons without clinical CVD and the extent to which they differ by demographic group. Methods: We studied 789 participants between the age of 25 and 64 years in the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study sample in Alabama who underwent CAC scoring on non-contrast cardiac computed tomography. Premature CAC was defined as CAC &gt;0 for men &lt;45 years old, and women &lt;55 years old. Multivariable logistic regression (including age, sex, race) estimated adjusted odds ratios (aOR) for CAC &gt;0 and CAC ≥100. Results: The median age was 51 years, 70% were women, and 80% were Black. Among the were 37% with CAC &gt;0 the median CAC score was 64, while 14% had CAC ≥100 and 12% had premature CAC. Significant differences in all three CAC categories were consistently observed across age and sex, but not race ( Figure ). After adjusting for age and race, women had an approximate 70% lower odds of CAC &gt;0 (aOR=0.29, 95% CI: 0.19-0.44) and CAC ≥100 (aOR=0.28, 95% CI: 0.18-0.43) compared to men. There were no significant differences in CAC &gt;0 (aOR=0.70, 95% CI: 0.43-1.12) or CAC ≥100 (aOR=0.76, 95% CI: 0.46-1.25) for Black versus White persons independent of age and sex. Conclusion(s): In a Southern rural cohort of young and middle-aged persons, approximately one in three had prevalent CAC and one in eight had premature CAC. In contrast to previously published urban cohorts, rural Black adults had a similar CAC burden to their White counterparts. There is a need to explore the factors implicated in the high CAC burden within Southern rural communities.