tbuckley/cabot-search huggingface dataset:
Abstract MP25: Effect of Marine Omega-3 Fatty Acids on Risk of Incident Cardiovascular Disease Among Individuals With Non-Alcoholic Fatty Liver Disease: Secondary Analysis of a Randomized Clinical Trial
Authors: Frank Qian, Remi N Ajala, Chunying Li, Heike Luttmann-Gibson, Olga Demler, Nancy R Cook, I-Min Lee, Julie Buring, Xuehong Zhang, Jacqueline Danik, JoAnn Manson, Samia Mora
Journal: Circulation (2024)

Background: Individuals with non-alcoholic fatty liver disease (NAFLD) are at increased risk for developing cardiovascular disease (CVD), often attributed to adverse metabolic derangements such as insulin resistance and elevated triglycerides. Marine omega-3 (n-3) fatty acids may partially ameliorate these metabolic consequences. Whether supplementation with n-3 fatty acids can reduce the risk of CVD in NAFLD remains unknown. Aims: To investigate the association between a NAFLD phenotype and incident CVD as well as assess whether randomization to n-3 fatty acids can modify this risk. Methods: Among 16,824 participants from the Vitamin D and Omega-3 Trial (VITAL; NCT01169259; a 2x2 factorial randomized trial of 1 g/d of EPA+DHA or 2000 IU/d of vitamin D 3 ) who provided baseline blood samples, we measured liver function tests. NAFLD was defined as baseline alanine aminotransferase (ALT)&gt;40 U/L and/or aspartate aminotransferase (AST)&gt;35 U/L, per guidance from the American Association for the Study of Liver Diseases. Incident CVD was a composite of myocardial infarction (MI), stroke, and CVD death. Multivariable-adjusted Cox models (adjusted for demographics, cardiovascular risk factors, and treatment assignment) were used to estimate hazard ratios (aHRs) and 95% confidence intervals (CI) for NAFLD with incident CVD. Effect of randomization to n-3 fatty acids was assessed among individuals with and without NAFLD. Results: We identified 2,495 participants with NAFLD at baseline, who tended to be younger, male, and non-White compared to individuals without NAFLD. After a median follow-up of 5.3 years, 522 CVD events were ascertained, with 101 occurring among those with NAFLD. Compared to individuals without NAFLD, those with NAFLD were at higher risk of developing CVD, aHR (95%CI): 1.48 (1.19, 1.84), P =0.0004. This association was predominantly driven by a higher incidence of total stroke, 1.53 (1.08, 2.17), P =0.02, compared with MI, 1.15 (0.81, 1.64), P =0.43. Randomization to n-3 fatty acids did not significantly reduce CVD incidence among individuals with, 1.13 (0.77, 1.68) or without NAFLD, 1.02 (0.85,1.24), P interaction =0.70. Conclusion: In a large primary prevention trial of older individuals, NAFLD was associated with a higher risk of CVD, particularly stroke. Randomization to n-3 fatty acids did not significantly reduce CVD outcomes in this high-risk population.
Abstract P410: Prevalence and Short Term Follow Up Rates Across the Childhood and Adolescent Obesity Population in a Community Hospital
Authors: Priya Thanneeru, Shivani Desai, Daisy Lall
Journal: Circulation (2024)

Background: Obesity is a global pandemic, which is 20.7% prevalent among 6-11 yr old and 22.2% prevalent among 12-19 year old(CDC). Aim is to understand the prevalence across different age groups in a community hospital setting. Secondary aim is to assess the variance of follow up rates across childhood and adolescence as follow up is crucial for the success of any physician intervention. Methods: We considered pediatric patients between 5 to 20 years old visiting primary care clinics within a 3-month period with a diagnosis of obesity for our study. We determined the follow up rate for 3 month scheduled weight checks for obese patients relative to the age groups. Results: We identified a total of 264 patients with obesity diagnosis (&gt;95th percentile BMI) visiting outpatient clinics within a three month period. In our sample, the prevalence of obesity in childhood years (5-11) was 58.7%(155 of 264) and prevalence of obesity in the adolescent age group(12-20) was 41.2% (109 of 264). We recorded 30.3%(108 of 155) follow up in childhood years and 33.9%(72 of 109) follow up in the adolescent age group. The calculated p value was &gt;0.05, hence the follow up rates across different age groups are not statistically significant. Conclusions: Focused intervention on the childhood age group will decrease the prevalence rates of obesity in a community hospital setting. This study emphasizes the need to formulate a plan to increase the follow up rates in the pediatric obesity population given its high prevalence in community hospital settings. No statistical significance has been found with follow up rates across various age groups. Further research controlling the confounding factors like environmental and socioeconomic factors help us understand the factors hindering follow ups across various age groups.
Abstract P453: Racial Disparities in Early Use of Transcarotid Artery Revascularization Among High-Risk and Symptomatic Black and White Adults With Carotid Artery Stenosis
Authors: Katherine M McDermott, Sanuja Bose, Midori White, Elizabeth Selvin, Caitlin W Hicks
Journal: Circulation (2024)

Introduction: Differential access to new technologies may contribute to racial disparities in health outcomes. We examined the adoption of transcarotid artery revascularization (TCAR) among high-risk Black and white adults undergoing surgery for carotid artery stenosis. Hypothesis: We hypothesized that Black adults would be less likely than white adults to receive TCAR since its introduction to the US market in 2015. Methods: We conducted a retrospective analysis of the prospectively collected Vascular Quality Initiative surgical database from 1/2015 to 12/2021, which includes 100% of the TCAR procedures performed during this period. Non-Hispanic Black and non-Hispanic white adults were included if they met Centers for Medicare &amp; Medicaid Services high-risk criteria due to anatomy, medical comorbidities, and/or recent symptoms (ipsilateral stroke or transient ischemic attack). We used logistic regression to quantify associations of race with receipt of TCAR (versus other surgical procedure for carotid stenosis) overall and by specific high-risk features. Results: There were 119,128 surgical procedures performed for carotid artery stenosis (14.3% TCAR) (mean age 72 years, 5.3% Black, 38.5% female). Black patients were less likely than white patients to receive TCAR after adjustment for patient and disease characteristics (aOR 0.91, 95% CI 0.83, 0.99). Among patients with only one high-risk feature (e.g., only high-risk anatomy), TCAR use did not vary by race. However, Black patients were less likely to receive TCAR in subgroups with multiple high-risk features ( Figure ). Not all hospitals performed TCAR, and Black patients were less likely to be treated at TCAR-capable hospitals (aOR 0.93, 95% CI 0.88, 0.98). TCAR use did not vary by race at TCAR-capable hospitals ( Figure ). Conclusions: Adoption of TCAR was lower among Black compared to white high-risk patients, for whom TCAR offers the most benefit. Differential access to hospitals with newer technology may explain these disparities.
Abstract P111: Pre-Diagnostic Free Testosterone and Estradiol Influence Heart Failure Risk in Both Women and Men: A Prospective Cohort Study in the UK Biobank
Authors: Jungeun Lim, Maryam Hashemian, Batel Blechter, Veronique L Roger, Jason Y Wong
Journal: Circulation (2024)

Introduction: Heart failure (HF) is a highly fatal manifestation of many cardiovascular diseases (CVDs). Free testosterone and 17β-estradiol have been linked to future risk of CVD. However, their roles in the pathogenesis of HF in both men and women are unclear. Hypothesis: We investigated the associations between free testosterone and 17β-estradiol (unbound to sex hormone binding globulin), and future risk of HF in the UK Biobank. Methods: Multivariable Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of incident HF (first hospitalization) in relation to quartiles (Q) of free testosterone and 17β-estradiol, and potential confounders, while stratifying by sex and in women by menopausal status. Non-linear relationships were tested using cubic splines. Results: There were 180,712 men (5585 cases with free testosterone and 571 cases with 17β-estradiol), and 177,324 women (2858 cases with free testosterone and 314 with 17β-estradiol). Increased free testosterone was associated with decreased HF risk in both men (HR Q4 vs. Q1 =0.86, 95%CI: 0.79-0.94, p-trend continuous &lt;0.0001) and post-menopausal women (HR Q4 vs. Q1 =0.83, 95%CI: 0.73-0.95), with non-linear relationships. Additionally, 17β-estradiol was significantly associated with decreased HF risk among men (HR Q4 vs. Q1 =0.76, 95%CI: 0.59-0.98), but positively associated among pre-menopausal women (HR Q4 vs. Q1 =2.16, 95%CI: 1.11-4.18). Conclusions: In this large cohort free of CVD at baseline, we detected a significant protective association between free testosterone and new HF diagnosis among men. In women however, the association differed by menopausal status as increased free testosterone was associated with elevated risk of HF before menopause but not after menopause. Further, 17β-estradiol was associated to elevated HF risk among pre-menopausal women but not post-menopausal women and men. Our findings suggest that sex hormones influence the pathogenesis HF and may offer potential pathways for interventions.
Abstract P124: Associations of SARS-CoV-2 Infection and Cardiorespiratory Fitness: Findings From the Cooper Center Longitudinal Study
Authors: Laura F Defina, Matthew S Durstenfeld, David Leonard, Beth B Wright, Kerem Shuval, Andjelka Pavlovic, Nina Radford, Jarett D Berry, Kelley P Gabriel
Journal: Circulation (2024)

Introduction: Prior studies suggest that SARS-CoV-2 infection may be associated with declines in cardiorespiratory fitness (CRF), especially with Long COVID. Few studies have pre-pandemic CRF measures and appropriate comparison groups to evaluate differences in CRF by infection status. Thus, we aim to address these gaps using the well-characterized Cooper Center Longitudinal Study (CCLS) cohort. We hypothesize that SARS-CoV-2 infection will result in greater CRF decline compared to no infection and that CRF declines will be greatest among those with Long COVID. Methods: Data are from 3532 CCLS participants (26.6% women [938 of 3532]; mean age: 51.9 years) who presented for a Cooper Clinic preventive exam during 01/17-12/22 and had CRF assessed twice, i.e., pre-infection and after the COVID questionnaire was available (01/21). Reported SARS-CoV-2 infection status was defined as never diagnosed, diagnosed with symptoms ≤3 or &gt;3 months (Long COVID). CRF was estimated as final workload in METs via a modified Balke treadmill protocol. Linear mixed effects regression models were used to compare pre-post fitness changes among COVID groups after adjustment for age, sex, smoking, BMI and face mask use during the test. Results: A total of 35.4% (1250 of 3532) of the sample reported SARS-CoV-2 infection and 1.7% (61 of 3532) reported symptoms ≥3 months. All 3 groups exhibited significant but minor decreases in mean CRF (0.2 METs). When compared to those without SARS-CoV-2, there were no differences in CRF changes among those with SARS-CoV-2 related symptoms ≤3 or &gt;3 months after full covariate adjustment. Conclusions: Over an average of 2.8 years follow-up, CRF did not significantly vary by SARS-CoV-2 infection status or persistence of symptoms. While potential acute changes to CRF were not captured, these findings suggest that COVID infection does not accelerate age-related declines in CRF regardless of symptom length. Future longitudinal research will clarify if differences in CRF by infection status emerge over longer follow-up.
Abstract P422: Lifestyle Intervention Improved Blood Pressure and Cardiovascular Disease Biomarkers in Patients With Chronic Kidney Disease and Resistant Hypertension: Insights From the TRIUMPH Randomized Clinical Trial
Authors: Crystal C Tyson, Andrew Sherwood, Alan L Hinderliter, Patrick J Smith, Stephanie Mabe, Linda Craighead, Lana L Watkins, Pao-Hwa Lin, William E Kraus, James A Blumenthal
Journal: Circulation (2024)

Introduction: Evidence is limited regarding the effect of lifestyle modification on health outcomes in patients with chronic kidney disease (CKD). Hypothesis: We hypothesized that lifestyle modification involving the DASH diet, exercise and weight loss would improve blood pressure (BP) and cardiovascular disease (CVD) biomarkers in CKD patients with resistant hypertension. Methods: The Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial randomized patients with resistant hypertension to either a 16-week cardiac rehabilitation (CR) facility-based lifestyle modification program involving thrice weekly aerobic exercise and weekly classes on DASH diet and behavioral weight loss (C-LIFE) or to a standard education and physician advice (SEPA) control condition. We conducted a secondary analysis involving participants with CKD. CKD was defined as having eGFR &lt;60 mL/min/1.73 m 2 or albuminuria at baseline. Primary outcome was mean change in clinic systolic BP. Secondary outcomes were mean changes in clinic diastolic BP, 24-hour ambulatory BP, and CVD biomarkers including baroreflex sensitivity (BRS), high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass index. Results: Ninety-seven (69%) of 140 TRIUMPH participants were considered to have CKD. Mean age was 62 years, 57% self-identified as Black race, 67% were male, and the majority (82%) had CKD stage 3. Participants with CKD randomized to C-LIFE achieved greater reduction in clinic SBP and greater improvement in BRS compared to SEPA. There were no differences between groups in ambulatory BP or other CVD biomarkers. Conclusions: A structured 16-week diet, exercise and weight management program conducted in a CR setting improved BP and resting BRS in resistant hypertension patients with CKD. Future studies are needed to confirm the beneficial effect of multi-component lifestyle modification on CVD biomarkers in CKD and to determine the persistence of benefit over time.
Abstract P393: Trends in Risk Factor Control Among US Adults With Cardio-Kidney-Metabolic Multimorbidity, 1999-2020
Authors: John W Ostrominski, Jamie Hirsch, Benjamin Miao, Bonnie M Donato, Jonathan Woolley, Christina Parrinello, Thomas O'Connell, Muthiah Vaduganathan
Journal: Circulation (2024)

Background: Risk factor control is foundational to preventing the onset and progression of cardiovascular, kidney, and metabolic (CKM) syndrome. Although risk factor control has been evaluated for these conditions individually, less is known about individuals with CKM syndrome. Objective: To evaluate the control of key risk factors among US adults with CKM syndrome. Methods: Nationally representative, cross-sectional data on US adults from the 1999-2020 NHANES cycles were evaluated. CKM conditions included cardiovascular disease (ASCVD or HF), at least moderate-risk chronic kidney disease, and type 2 diabetes (self-reported or HbA1c ≥6.5%). Among adults with advanced-stage CKM syndrome (≥2 conditions), the proportion with joint control of risk factors was estimated. Risk factor control was defined as: BP &lt;140/90 mmHg, HbA1c &lt;8%, and LDL-C &lt;100 mg/dL. Sensitivity analyses included a stricter definition (BP &lt;130/80, HbA1c &lt;7%, and LDL-C &lt;70) and an expanded set of risk factors (BMI &lt;30 kg/m 2 and current non-smoking status). Results: Between 1999-2014, the proportion of US adults with CKM syndrome with joint control of BP, HbA1c, and LDL-C increased from 10.5% (95% CI: 7.8%, 13.2%) to 32.5% (29.6%, 35.5%), then declined to 28.8% (24.4%, 33.1%; estimated number without joint control = 14.5 million) in 2015-2020, per the main definition ( Figure ). Considering more contemporary thresholds, joint risk factor control was observed in less than 1 in 10 US adults across the study interval. Using the most comprehensive definition (BP &lt;130/80, HbA1c &lt;7%, LDL-C &lt;70, BMI &lt;30, non-current smoking) only 2.2% (1.3%, 3.1%) demonstrated optimal control in 2015-2020. Conclusions: Despite improvement between 1999-2014, comprehensive risk factor control among US adults with CKM syndrome declined in 2015-2020. More than 2 in 3 contemporary US adults with CKM syndrome are estimated to have suboptimal risk factor control, amplifying the need for integrative approaches in this high-risk population.
Abstract MP24: Contemporary Trends in Incident Ischemic Stroke, Intracranial Hemorrhage, and Mortality in Individuals With Atrial Fibrillation
Authors: Jean Jacques Noubiap, Janet J Tang, Thomas A Dewland, Gregory M Marcus
Journal: Circulation (2024)

Background: The prognosis for atrial fibrillation (AF) patients is based on data that is decades old. Given evolving standards of clinical practice that may now include lifestyle factor modification, catheter ablation, and DOACs, we evaluated temporal trends in clinically important outcomes among patients with AF. Methods: California’s Department of Health Care Access and Information databases were used to identify adults aged ≥18 years with AF receiving hospital-based care in California. We compared 3 time-periods in this population-based cohort corresponding to 2005-2009, 2010-2014, and 2015-2019. The outcomes were incident ischemic stroke, intracranial hemorrhage, and mortality. Results: We included 1,859,901 patients with AF (52.7% males, 71.0% Whites, and mean age of 74.8 years), divided in 3 cohorts: 2005-2009 (n=680,872), 2010-2014 (n=558,365), and 2015-2019 (n=620,664). Each of these outcomes became substantially less common with time: compared to 2005-2009 ( Figure 1A ), AF patients diagnosed in 2015-2019 experienced a 42% (adjusted hazard ratio [HR] 0.58, 95% CI 0.57-0.60), 17% (HR 0.83, 95% CI 0.80-0.88), and 28% (HR 0.72, 95% CI 0.71-0.73) reduction in risk of incident ischemic stroke, intracranial hemorrhage, and mortality, respectively. Between 2005-2009 and 2015-2019, the decline in the incidence rate of adverse outcomes was greater in patients aged ≥65 years (p&lt;.001), females (p=.02), and Whites (p&lt;.001) for ischemic stroke; more pronounced in patients aged ≥65 years (p=.008), females (p=.02), and Whites and Asians (p=.005) for intracranial hemorrhage; and greater in patients aged ≥65 years (p&lt;.001), in males (p=.04), and in Whites (p&lt;.001) for mortality ( Figure 1B ). Conclusion: The risk of stroke, intracranial hemorrhage, and mortality have significantly declined among AF patients, although significant disparities in the magnitude of improvement of these outcomes by demographic groups were observed. Estimates of the prognosis for AF patients should be updated to reflect contemporary care.
Abstract P123: Obesity-Related Inflammasome Activation in COVID-19 and Chronic Conditions: A Post-Mortem Lung Biopsies Study
Authors: Raissa DAmico, Lucas Baena Carstens, Julio C DAgostini, Elisa Hlatchuk, Sofia B Silva, Seigo Nagashima, Cristina P Baena
Journal: Circulation (2024)

Background: Obesity has been identified as an independent risk factor for severe COVID-19 outcomes. The association between viral infections and obesity, observed previously, suggests that obese individuals are more prone to severe complications. Several factors, such as increased ACE2 receptor expression, anatomical effects on lung function, and chronic inflammation contribute to this relationship yet the activation of the NLRP3 inflammasome pathway is a key element in understanding this mechanism. Objective: This study, conducted with post-mortem lung biopsies of obese individuals who died from COVID-19 (Group A) and from chronic conditions (Group B), focused on the involvement of the NLRP3 inflammasome pathway. Our primary goal was to determine whether chronic NLRP3 inflammasome activation in obese individuals is different in critical COVID-19 and in critical chronic conditions. Methodology: We conducted a retrospective analysis utilizing clinical data and post-mortem lung tissue samples from two distinct groups. Group A comprised 14 obese patients who succumbed to COVID-19, while Group B consisted of 9 obese individuals who passed away from causes unrelated to COVID-19, including thromboembolic events, metastatic neoplasms and acute myocardial infarction. The average age of the groups A and B is, respectively, 67 (ranging from 51 to 86) and 62.6 (ranging from 42 to 79) years. Immunohistochemical analysis was employed to assess the expression of twelve markers associated with inflammation (IL-6, IL-8, TNF-α, IL-18, IL-1β and HIF 1-α.) and the NLRP3 inflammasome pathway (NLRP3, ASC, CASP-1, CASP-9, gasdermin-D). Statistical analysis was performed using Mann-Whitney, Student’s t-test and Fischer’s exact test. Results: Group B showed significantly higher expression of IL-6 (p &lt;0.0001), NLRP3 (p = 0.0004), IL-18 (p = 0.002), HIF 1-α (p = 0.0327), CASP-9 (p &lt; 0.0001), and NF-Kb (p &lt; 0.0001). No significant differences were found for IL-8 (p = 0.8291), TNF-α (p = 0.2349), IL-1β (p = 0.5856), gasdermin-D (p = 0.3301), and ASC (p = 0.0572). CASP-1 expression was higher in Group A (p = 0.0142) marking pyroptosis in the COVID-19 group. Conclusion: While our study did not confirm chronic NLRP3 inflammasome activation was different between the two obese groups, it did reveal a distinctive pattern of cell death through pyroptosis, prevalent in obese individuals with COVID-19. Our findings underscore the necessity for additional research to unveil obesity as the underlying mechanism governing disease severity in infectious diseases.
Abstract P259: Favorable Ventricular-Arterial Mechanics Among Women is Associated With Better Mitochondrial Oxidation in the Left Ventricle
Authors: Jie Jun Wong, Hongzhou Zhang, Fei Gao, Shuang Leng, Ru S Tan, Liang Zhong, Jean Paul Kovalik, Angela S Koh
Journal: Circulation (2024)

Background: Traditional risk factors insufficiently characterize the biological phenomena underlying sex differences in ventriculoarterial coupling (VAC). We hypothesize that sex differences in VAC are due to differences in left ventricular global longitudinal strain (LVGLS), a fuel-dependent chamber closely linked to mitochondrial fuel oxidation pathways. Methods: Community older adults without cardiovascular disease were prospectively recruited for cardiac magnetic resonance imaging and concurrent serum metabolomics sampling. VAC was determined as aortic pulse wave velocity (PWV) divided by LVGLS. Multivariable models adjusted for clinical risk factors and metabolites. Results: Among 202 participants (46.0% female), fewer women were smokers compared to men (3.2% vs 25.7% p&lt;0.001). Despite similarities in age, (women: 69.7 vs men: 70.7 p=0.432) women had better VAC (-0.39 vs -0.47 p = 0.003), LVGLS (-21.9 vs -20.1% p &lt;0.001), and LV mass index (LVMI) (41.7 vs 49.5 g/m 2 p &lt;0.001) compared to men. Both sexes had similar PWV (8.41 vs 9.13 m/s p = 0.087). LVGLS was inversely related to LVMI (β = -0.09 p &lt;0.001). Among women, metabolomic determinants of better LVGLS, independent of LVMI, were lower levels of long chain acylcarnitines (LCACs) [C12:2-OH/C10:2-DC (OR 0.830 adj. p=0.020), C16:3-OH/C14:3-DC (OR 0.334 adj. p=0.048), C16-OH (OR 0.756 adj. p=0.029) and higher levels of C20:2 (OR 1.987 adj. p=0.033)] (Figure A). Among men, determinants of better LVGLS included lower levels of C12:2-OH/C10:2-DC (OR 0.864 adj. p=0.020), C12:1-OH (OR 0.969 adj. p=0.016), C16:1 (OR 0.923 adj. p=0.025), C16:3-OH/C14:3-DC (OR 0.566 adj. p=0.028)] and higher levels of C5:1 (OR 1.096 adj. p=0.026). Conclusion: Better LV longitudinal function contributed to better VAC among older women. Lower LCAC fatty acid metabolism intermediaries was linked to better LVGLS, implying improved mitochondrial β-oxidation. Circulating metabolites may represent novel precision medicine factors for sex-based stratification of vascular risks.