tbuckley/cabot-search huggingface dataset:
Abstract P126: Presentation Differences in ST-Segment Elevation Myocardial Infarction Between 2019-2021 Related to COVID-19
Authors: Rebekah Lantz, Casey Walk, Dylan Hefner
Journal: Circulation (2024)

Between March 2020 to October 2021, COVID-19 accounted for 12.2% of deaths, about 350,000 people in the United States. The pandemic virus accounted for the third leading cause of death behind heart disease and cancer. Importantly heart disease deaths increased 4.1% in the first year of exposures from 2019 to 2020 which may reflect delay to pursue medical care due to COVID. Because of lockdown mandates it was suspected that chronic and incident diseases had poorer disease control and delayed diagnosis of primary conditions due to decreased contact within the medical system with the purpose of decreasing viral spread. We wished to collect background presentation differences in a specific cohort at risk, STEMI-activated patients, for years 2019 to 2021. 1001 adults were STEMI-activated January 2019 to December 2021. Patient demographics, risk factors, details of presentation and rationale for cath-lab activation were obtained. Average age 63.5 years old, BMI 30.2 kg/m2, and 68.8% males, which was not statistically significant. Hypertension, hyperlipidemia, diabetes, peripheral vascular disease, chronic lung disease, prior CABG, tobacco use, dialysis renal disease, history and newly diagnosed congestive heart failure were not significant between years. However cerebrovascular disease(CVA) was three times more prominent for patients presenting in 2019 compared to 2020. There were no differences in details of presentation for location of cardiac arrest (out-of-hospital, transfer, in-hospital). Rationale for cardiac cath was significant for new onset angina significant in 2019 and 2021. Worsening angina was significant in 2019. COVID-19 continues to affect many aspects of society and healthcare but how it has affected background disease control remains unclear. Patients in our sample were similar age, BMI and gender. Background risk factors were significant for CVA which was 1.87 times higher in 2019. New onset angina led to more caths in 2019 and 2021, and worsening angina was a significant complaint in 2019 compared to other years. There were not the amount of differences we expected suggesting that chronic diseases and new diagnoses remained at near the same level through years of pandemic consideration.
Abstract P369: Patterns of American Heart Association "Life's Essential 8" Scores in Children With Down Syndrome
Authors: Boris Tirado, Robert Merrill, Sarah D De Ferranti, Linda M Lambert, Brian W McCrindle, Richard V Williams, Adam L Ware
Journal: Circulation (2024)

Introduction: Children with Down syndrome (DS) have unique cardiovascular (CV) risk profiles. AHA’s “Life’s Essential 8” (LE8) scores were developed to track comprehensive CV health over the life span. LE8 scores have not been described for children with DS. Methods: Children 8-18 years old with DS were enrolled in a multi-site, cross-sectional study. LE8 measures were obtained prospectively and scored as described previously. Controls were obtained from published National Health and Nutrition Examination Survey (NHANES) data. Table 1 describes components of each composite score (not all components available in NHANES). Results are presented by age group (8 to &lt;12, ≥12 to 19 years). Statistics were descriptive with 1 sample t tests to compare the cohort with population means. Results: A total of 54 patients with DS, 28 (52%) females, mean age 14.3. years (range 8-18 years) were enrolled. Table 1 lists LE8 scores by age group and LE8 component. The composite LE8 score for children with DS is worse at ages 8-11 and similar at 12-19 compared to the general population. At 8-11 years patients with DS had worse activity, and non-HDL cholesterol scores. At 12-19 years patients with DS had better diet and tobacco scores, but worse non-HDL-C scores. Conclusion: Children with DS have unique cardiovascular risk profiles compared to the general population. Composite LE8 scores are worse for young children with DS due to inactivity and cholesterol scores. Composite scores improved in older children with DS compared to the general population based on a stable diet score and less tobacco exposure, but cholesterol scores remained low. Variability in LE8 components can be used to guide preventive practices and health counseling in children with DS.
Abstract P281: Pre-Stroke Use of Dipeptidyl Peptidase-4 Inhibitors in Elderly Patients May Reduce Neurological Severity at the Onset of Stroke: A Retrospective Cohort Study
Authors: Takahisa Mori, Tetsundo Yano, Kazuhiro Yoshioka, Yuichi Miyazaki
Journal: Circulation (2024)

Introduction: Functional outcomes after acute stroke (AS) are related to the initial neurological severity. Therefore, neuroprotective agents to reduce initial brain damage at AS onset shows promise as a preventive approach. Dipeptidyl peptidase 4 inhibitors (DPP4i) have been reported to reduce stroke volume in mice. Therefore, DPP4i may exert neuroprotective effects on brain damage caused by AS. However, the association between pre-stroke use of DPP4i and neurological severity at the onset of AS has not been well studied. Hypothesis: Pre-stroke DPP4i use reduces neurological severity (NS) at the onset of AS. Methods: We conducted a retrospective cohort study involving patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined mild NS as a score of ≤5 points on the National Institutes of Health Stroke Scale. We used logistic regression analysis using variables for pre-stroke DPP4i initiation, calculated propensity scores for pre-stroke DPP4i use and implemented one-to-one propensity score matching (PSM). We compared the incidence of mild NS between the two groups. Results: Out of 4294 patients with AS, 3472 met the inclusion criteria. After PSM, we had 221 patients in each group. The median ages of DPP4i users and non-users were 79 and 78 years, respectively. Among the 221 DPP4i users and the 221 non-users, 140 (63.4%) and 121 (54.8%) patients had reduced NS, respectively (p=0.0659 by chi-square test, standardized difference=0.1756). The chi-square test did not show a significant difference in the matched cohort, but the standardized difference of 0.1 or more suggested that the two groups were not balanced on the incidence of mild NS. Conclusions: The pre-stroke use of DPP4i among elderly patients was associated with mild NS at AS onset, suggesting a potential neuroprotective effect of DPP4i on initial brain damage caused by AS. Further prospective studies with larger sample size are needed to verify the causal relationship between pre-stroke DPP4i use and NS at AS onset.
Abstract P159: Echocardiographic Cardiac Phenotype in Val122Ile Variant Transthyretin Amyloidosis Among Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Ambarish Pandey, Priscilla Duran Luciano, Katrina Swett, Robert Kaplan, Gregory A Talavera, Martha L Daviglus, Neil Schneiderman, Barry E Hurwitz, Sanjiv J Shah, Tamar Sofer, Scott D Solomon, Susan Cheng, Larissa Aviles-Santa, Humberto Parada, Bharat Thyagarajan, Franklyn Gonzalez, Mayank M Kansal, James M Tauras, Mathew S Maurer, Carlos J Rodriguez
Journal: Circulation (2024)

Background: Transthyretin amyloidosis, most often caused by Val122Ile mutation, is linked to a higher risk of heart failure (HF) and mortality. Subclinical abnormalities in cardiac structure and function linked to Val122Ile mutations are less well defined in Hispanics/Latinos. We studied the cardiac phenotype of Hispanic/Latino Val122Ile carriers versus non-carriers. Methods: Val122Ile carrier status was determined with genome-wide data. We analyzed echocardiographic data from adults 45 years or older (unweighted n= 6376) from HCHS/SOL and the Echocardiographic Study of Latinos, Echo-SOL. Measures of cardiac structure and function (Table) were compared among Val122Ile carriers and non-carriers using age-and-sex-adjusted least square means (continuous variables) and proportions (categorical variables). Prevalence of pre-HF, identified by the presence of at least one abnormal echocardiographic parameter, was also compared among those with vs. without Val122Ile mutation. Complex survey statistics and sample weights are utilized for all analyses. Results: Val122Ile carriers (0.8%; unweighted n= 40) were younger (mean ±SE, 55.5 years ±1.7), had higher systolic blood pressure (mean ±SE, 130 mmHg ±3.6), but lower body mass index (mean ±SE, 28.5 kg/m 2 ±1.4) than non-carriers, p &lt;0.0001. Lower mean values of left ventricle (LV) ejection fraction, LV end diastolic volume, right ventricle (RV) fractional area change, lateral peak e’ velocity and lower pre-HF prevalence was seen among carriers vs non-carriers. Val122Ile carriers also had higher LV mass, worse concentric remodeling, and worse measures of diastolic function than non-carriers. Most measures of RV function were higher among carriers vs non-carriers (Table) . However, none of the differences found in cardiac phenotype of carriers vs non-carriers were statistically significant (p &gt;0.05). Conclusion: There is a lack of difference in the echocardiographic cardiac phenotype among Hispanic/Latinos who carry the Val122Ile mutation versus non-carriers.
Abstract P249: Association Between Loneliness and Functionality in an Elderly Population
Authors: Karina Bertoldi, Cristina P Baena, Rafaella S Bernardelli, Leandro Z Karam, Ariele B Haagsma, Javier J Roig
Journal: Circulation (2024)

Background: Functionality plays a pivotal role in the well-being and autonomy of older individuals. Discovering new predictors of functional decline is a pressing concern, with loneliness emerging as an unconventional risk factor for chronic diseases. However, its role in functional limitations remains poorly understood. Hypothesis: Loneliness is an independent predictor of limitations in Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) among individuals aged 80 or older. Methods: A cross-sectional analysis was conducted using data from Wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), spanning 28 European countries, for participants aged 80 and above, excluding residents in long-term care institutions. Loneliness was assessed using a reduced version of the R-UCLA Loneliness Scale, including measures of companionship, feeling left out, and isolation on a 3-point Likert scale ("often," "some of the time," "hardly ever or never"). Participants scoring 4 to 9 were categorized as lonely. The outcome was defined as the presence of limitations in one or more of the six ADLs and/or the nine IADLs. Logistic regression models were employed to control for potential confounding factors. Multivariate analysis included covariates with p&lt;0.200 and no multicollinearity. Model quality was evaluated using the area under the ROC curve, and the significance level was set at 5%. The analysis was conducted using IBM SPSS, version 28.0. Results: The study included 7,434 individuals, with 58.2% (n=4,323) being female and a mean age of 84.4 (±3.8) for both genders. A majority of participants (52.5%, n=3,879) had low levels of education (ISCED-97 from 0 to 2). Comorbidities included cardiovascular disease (22%, n=1,634), stroke (7%, n=523), diabetes mellitus (17.2%, n=1,281), cancer (6.6%, n=494), and obesity (16.8%, n=1,180). In the univariate analysis, older adults classified as lonely exhibited an odds ratio (OR) of 2.213 (95% CI: 2.016 - 2.428) for presenting limitations in one or more ADLs/IADLs. The multiple model showed an OR of 1.472 (95% CI: 1.313 - 1.649) for having one or more ADLs/IADLs limitations in the presence of loneliness. This association remained significant even after adjusting for confounders (age, gender, education, chronic diseases, hip fracture, pain and European region). The AUC was 76,4%. Conclusions: Our study reveals an independent link between loneliness and limitations in ADLs and IADLs among individuals aged 80 or older from the SHARE dataset. These findings lend support to interventions aimed at preventing loneliness and preserving functionality in this age group.
Abstract P279: Proteomic Profiling Identifies Mortality-Associated Markers in Coronary Artery Disease
Authors: Chang Liu, Qin Hui, Arshed A Quyyumi, Viola Vaccarino, Yan Sun
Journal: Circulation (2024)

Background: Coronary artery disease (CAD) is a leading global cause of mortality. Proteomics has emerged as a promising tool for understanding CAD prognosis. We explored proteomic profiles in CAD patients to identify protein markers which predict mortality. Methods: The discovery cohort included 2,072 participants from the UK Biobank (UKB) with proteomics data and prevalent CAD at enrollment, defined by the ICD-10 and OPCS-4 codes from the in-patient Hospital Episode Statistics data. All-cause mortality was ascertained based on the Death Register records. Plasma proteomic profiling of 1,463 unique proteins at enrollment was conducted using the Olink platform. The validation cohort included 91 participants from the Mental Stress Ischemia Prognosis Study (MIPS), a prospective study of CAD patients enrolled from Emory University hospitals in whom plasma proteomic profiling of 6,159 proteins was measured by the SomaScan Assay. We analyzed 1,203 common proteins in both cohorts with missing rate &lt; 20%. In the UKB, we examined the proteome-wide associations between the rank-based inverse normal transformed protein levels and mortality, using Cox proportional hazards models adjusting for race, sex, age, body mass index, diabetes, hypertension, heart attack history, frequent drinking (≥ 3 times /week), smoking history, high- and low-density lipoprotein, triglycerides, C-reactive protein and estimated glomerular filtration rate. Mortality-associated proteins at Bonferroni corrected p &lt; 0.05 were analyzed for pathway enrichment. LASSO regression was used to further select the best performing proteins in predicting mortality. Prediction performance of the proteins was evaluated using the C statistic. The mortality-associated proteins were validated in MIPS, using Cox models adjusting for race, sex, and age. Results: The UKB cohort was 69% male, 96% White, with mean age of 62 years, and there were 646 (31%) deaths during median follow-up of 13.3 years. The MIPS cohort was 79% male, 24% Black, with mean age of 64 years, and 11 (12%) died during median follow-up of 6.3 years. A total of 274 proteins were significantly associated with mortality in the UKB, representing enriched pathways such as inflammatory response. Seven proteins, including GDF15 , TNFRSF10B , PLAUR , SPON1 , CXCL17 , ANGPT2 , and ICAM5 were identified by LASSO model as key predictors. Adding these proteins to the model with traditional risk factors improved the prediction of mortality by 5.3% (75.8% vs 70.5%, 95% CI 3.7% - 6.9%). All associations except for CXCL17 were validated in the MIPS. Conclusion: The findings suggest the potential added value of plasma proteins for predicting mortality in CAD patients beyond traditional factors. The functions of mortality-associated proteins indicate underlying biological mechanisms, such as inflammation and cell growth regulation, linked to CAD progression.
Abstract P158: Prevalence of Val122Ile Variant Transthyretin Amyloidosis Mutation Among Hispanics/Latinos: Insights From the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)
Authors: Priscilla Duran Luciano, Ambarish Pandey, Katrina Swett, Robert Kaplan, Gregory A Talavera, Martha L Daviglus, Neil Schneiderman, Barry E Hurwitz, Sanjiv J Shah, Tamar Sofer, Scott D Solomon, Susan Cheng, Larissa Aviles-Santa, Humberto Parada, Bharat Thyagarajan, Franklyn Gonzalez, Mayank M Kansal, James M Tauras, Mathew S Maurer, Carlos J Rodriguez
Journal: Circulation (2024)

Background: Val122Ile variant is the most common mutation causing hereditary transthyretin amyloidosis. The prevalence of Val122Ile among Hispanics/Latinos, a population with admixed genetic ancestry (African, European, Amerindian), is still unknown. Methods: We utilized genome-wide data (unweighted n=12687 adults) from the population-based HCHS/SOL to identify Val122Ile mutation. Continental proportions of African (AA), European (EA) and Amerindian (AM) ancestry were computed with an ADMIXTURE software, with thresholds set at 30%, 40%, and 50%. Complex survey analysis was employed to determine weighted frequencies of Val122Ile overall, across ancestry and across disaggregated Hispanic/Latino background groups (Cuban, Puerto Rican, Dominican, Mexican, Central American, and South American). Results: The prevalence of Val122Ile mutation in the cohort overall was 0.8%. Participants with (vs. without) Val122Ile were younger (37.3 vs. 41.6 years) and more commonly female (52.5% vs. 48.8%). Val122Ile prevalence was significantly higher among individuals with higher AA (&lt;30% AA vs. &gt;50% AA: 0.4% vs. 3.4%) and lower among individuals with higher EA (&lt;30% EA vs. &gt;50% EA: 1.7% vs. 0.8%) ( Figure 1A ). AA &gt;50% was related with higher odds of Val122Ile mutations (OR= 7.9, 95% CI: 3.5 - 17.8) vs. AA &lt;30%. An inverse relationship was seen with EA &gt;50% and Val122Ile mutations (OR= 0.3, 95% CI: 0.1 - 0.6) vs. EA &lt;30%. No statistically significant difference was found among Val122Ile by proportion of AM. Individuals with Val122Ile mutation were primarily of Dominican and Mexican descent, accounting for 33.7% and 31.7% of carriers, respectively ( Figure 1B) . Dominicans have the highest Val122Ile prevalence (2.6%) when compared to other Hispanic/Latino background groups ( Figure 1C) . Conclusion: Val122Ile mutation was mostly identified in Hispanics/Latinos at younger ages. African Ancestry is strongly correlated with Val122Ile mutations in Hispanics/Latinos with those of Dominican descent having the highest prevalence.
Abstract P253: Lifetime Risk of Dementia by Midlife Vascular Risk Factor Burden: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Jiaqi Hu, Michael Fang, Rebecca F Gottesman, Pamela L Lutsey, Thomas Mosley, Elizabeth Selvin, Joe Coresh
Journal: Circulation (2024)

Introduction: Vascular risk factors play an important role in the development of dementia and death over the lifecourse. However, no absolute lifetime risk of dementia by individual and composite number of vascular risk factors have been reported. Methods: We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study. We examined the associations of vascular risk factors with incident dementia. Risk factors were measured at visit 2 (1990-1992) and included hypertension (SBP140mmHg, DBP90mmHg or medication use), diabetes status (self-reported physician diagnosis, medication use or HbA1C6.5%) and smoking status. Incident dementia was ascertained via active surveillance involving cognitive function assessments, informant reports, hospitalization codes and death records. We performed survival analysis using age as time scale and accounted for death without dementia as a competing event. We used age 60 as the origin and age on December 31 st , 2019, as the administrative censoring endpoint. Results: Among 13,161 participants, 45%, 40%, and 15% had 0, 1 and 2+ risk factors. There was a dose-dependent association between number of risk factors and the cumulative incidence of dementia (Figure A) and death (Figure C) . In competing risk models ( Figure B ), the cumulative incidence of dementia (95% CI) in persons with 0, 1 and 2+ risk factors by age 80 was 7.5% (6.6-8.5%), 10.3% (9.2-11.5%) and 13.7% (11.5-15.7%). By age 90, due to higher risk of mortality among those with vascular risk factors, the dementia risk (95% CI) for 0, 1 and 2+ risk factors were 34.8 (32.3-37.3%), 31.2% (29.0-33.2%) and 26.7% (23.9-29.6%). Conclusion: Preventing vascular risk factors in midlife may substantially reduce the age-specific risk of dementia. However, since fewer risk factors also lead to longer survival to oldest ages where dementia risk is very high, reducing lifetime risk of dementia beyond age 90 years will require additional preventative strategies. Figure: Cumulative incidence of dementia using Kaplan Meier estimator (A), using cumulative incidence function with competing risk of death (B), and cumulative incidence of death (C), according to the number of vascular risk factors in mid-life.
Abstract P372: Behavioral Cardiovascular Health in Children With Chronic Conditions
Authors: Rachel Zmora, Yaojie Wang, Darci Phillips, Aashima Chopra, Amanda M Marma, Donald M Lloyd-Jones, Sarah D De Ferranti, Darwin R Labarthe, Matthew Davis, Lucia Petito, Stephen R Daniels, Marc Rosenman, Rashmi Narayan, Holly Gooding, Mark J Pletcher, Francis Alenghat, Rupali Gandhi, Cheryl Lefaiver, Amanda Luff, Huma Khan, Ileah Rios, Amy Yu, Norrina B Allen
Journal: Circulation (2024)

Background: A quarter of children in the United States have at least one chronic condition which translates to worse health than their peers. However, there is little information about cardiovascular health (CVH) among children with chronic conditions. Methods: We used data from the Young Hearts study, an ongoing longitudinal cohort of CVH trajectories in youth aged 0-20 years. Parents (and children aged 12+ years) completed surveys on CVH behaviors, medical history, and social context. We included children with complete baseline data. Participants were categorized as having at least one self-reported chronic condition or no chronic condition. We calculated CVH using the behavioral components of the American Heart Association Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep). Each component was scored from 0 (most adverse) to 100 (ideal) and averaged to create a composite behavioral (b) CVH score. We used linear regression to assess the association between chronic condition status (any, none) and bCVH score, adjusting for age, sex, race, ethnicity, insurance type, and household income. Results: We identified 1138 children with at least one chronic condition and 1406 children without any chronic conditions. Among those with chronic conditions, the most common were heart disease (14.9%), asthma (11.2%), and vision problems/blindness (9.7%). In fully adjusted models (Table), we found individuals with any chronic condition had a 1.3 point lower (95% CI -2.5, -0.2) bCVH score on average. Children with chronic conditions had lower (less favorable) scores for sleep (-4.2; 95% CI -7.1, -1.4) and physical activity (-3.7; 95% CI -6.3, -1.2) compared to their peers with no chronic conditions, but a higher (more favorable) nicotine exposure score (1.4; 95% CI 0.5, 2.4). Conclusion: As a group, children with chronic conditions had worse bCVH scores than their peers without chronic conditions. Further research is needed to understand these differences and support CVH promotion in children with chronic conditions.