tbuckley/cabot-search huggingface dataset:
Abstract P221: Association of Posttraumatic Stress Disorder With Physical Activity Among Vietnam-Era Male Twin Veterans
Authors: Kara Suvada, Viola Vaccarino, Dayna A Johnson, Yi-An Ko, Nicholas Smith, James Douglas Bremner, Minxuan Huang, George Haddad, Hashir Ahmed, Amit J Shah
Journal: Circulation (2024)

Introduction: Post-traumatic stress disorder (PTSD) can develop after a traumatic event and is associated with cardiovascular diseases (CVDs), but the mechanisms are not clear. Behavioral factors like physical activity (PA) may play a role if associated with PTSD, but few studies have examined whether PTSD may be associated with lower PA. By studying twins, we can examine this relationship and adjust for demographic and shared familial characteristics. Methods: We studied the relationship between current PTSD diagnosis and PA in 146 male twins (73 pairs) from the Emory Twin Study within the Vietnam Twin Registry. Twin pairs were discordant for PTSD symptoms. PA was continuously measured over 7 days using wrist actigraphy and used validated algorithms to calculate daily hours of sedentary time and moderate-to-vigorous PA (MVPA). We also examined self-reported leisure PA score with the Baecke questionnaire. We controlled for familial effect using generalized linear regression within PTSD discordant twin pairs. We dichotomized MVPA based on established cutpoints for normal values and estimated the prevalence ratio (PR) of the likelihood of achieving the minimum recommended average daily MVPA using Poisson regression. Multiple imputation was used to reduce the impact of missing data. Results: Veterans (mean (SD) age: 68.2 (2.1); 97% (142/146) White) had a low prevalence of achieving daily MVPA goals —35% among those with PTSD and 25% among those without and spent over 9 average sedentary hours per day. We did not find any significant relationship between current PTSD diagnosis and any of the PA outcomes in fully adjusted models. Discussion: Our findings reveal low PA and high levels of sedentary behavior among Veterans, with PTSD showing no significant impact on average PA. This suggests that PA is unlikely to explain excess CVD risks that have otherwise been observed in PTSD. Nonetheless, in this cohort of Vietnam era veterans, interventions to increase PA are warranted regardless of PTSD status.
Abstract P418: Pre-Stroke Use of Loop Diuretics in Elderly Patients Aggravates Renal Function at the Onset of Acute Stroke: A Propensity Score-Matched, Retrospective Cohort Study
Authors: Takahisa Mori, Tetsundo Yano, Kazuhiro Yoshioka, Yuichi Miyazaki
Journal: Circulation (2024)

Introduction: Renal function is often impaired in elderly patients experiencing acute stroke (AS) due to pre-existing chronic kidney disease (CKD), which can progress to severe renal dysfunction (SRD). SRD can limit pharmacological treatments, such as anticoagulants, antiplatelets, diabetes medicines, or antihypertensives during the AS phase. Therefore, preventing CKD progression to SRD and minimizing the use of renal-impairing agents before SRD development is crucial. Loop diuretics, commonly prescribed for heart failure, have been reported to exacerbate renal function. Sex-based differences in renal function due to gonadal hormones exist. However, the impact of loop diuretics on the risk of SRD before AS in both sexes remains unclear. Hypothesis: The pre-stroke use of loop diuretics in elderly patients aggravates renal function at the onset of AS in both sexes. Methods: We conducted a propensity score-matched, 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 SRD as a calculated creatinine clearance (Ccr) of &lt;30 ml/min. We analyzed logistic regression using variables for pre-stroke loop diuretics initiation, calculated propensity scores for pre-stroke loop diuretics usage, and implemented a one-to-one propensity score matching (PSM) by sex. We compared the incidence of SRD between loop diuretics users and non-users within each sex group. Results: Among 4294 patients with AS, 3472 met the inclusion criteria. Among these, 129 male and 143 female loop diuretic users were matched with non-users using the one-to-one PSM. After the PSM, median ages were 80 years in males and 86 years in females, respectively. The SRD incidence was 38.0% (49/129) versus 16.8% (21/129) in males (p&lt;0.0001) and 50.4% (78/143) versus 23.1% (48/143) in females (p&lt;0.0001), comparing users to non-users. Conclusions: The pre-stroke use of loop diuretics in elderly patients may increase the risk of SRD at the onset of AS in both sexes. Therefore, cautious utilization of loop diuretics in elderly patients is recommended to prevent SRD before AS. A possible option is to switch loop diuretics to other medications, which have been shown to have better renal protective effects. Further prospective studies are needed to validate our findings and establish the appropriate usage of loop diuretics in elderly patients before AS.
Abstract P198: Developing a Practical, Evidence-Based Framework for Evaluating Community Nutrition Security Interventions
Authors: Jessica Donze-Black, Kylie Picou, Mel Downey-Piper, Cheryl Toner, Mei Ling Ellis, Ronda Zakocs, Sally Honeycutt
Journal: Circulation (2024)

Introduction: Addressing nutrition insecurity at a population level is complex and requires changing policies, systems, and environments. The American Heart Association (AHA) has identified 17 research informed systemic interventions that have the potential to increase nutrition security over time. These interventions can be leveraged individually or together based on community needs and assets. Evaluating these interventions is essential for understanding impact, improving implementation, and allocating resources to effective strategies. This project sought to establish a pragmatic yet rigorous framework for evaluating the health impact of these strategies in communities across the United States. Hypothesis: We assessed the hypothesis that we could evaluate community nutrition security interventions by using program records, secondary data sources, and judicious use of primary data collection. Methods: Researchers reviewed details from the AHA's community impact database detailing 188 research informed nutrition security projects in communities across 29 states and the District of Columbia. Impacts were assessed for reach of intervention and strength of evidence to determine relative population dose of interventions. Seven interventions were determined to be ‘high dose,’ and researchers identified community and proximal outcomes for three high-dose interventions where the AHA is typically the catalyst that is leading and influencing work with community partners. Researchers reviewed 11 national databases to identify existing community-level data aggregated at the county, city, zip code, or census track that may be associated with the three high dose impact opportunities. Researchers then reviewed the evidence-based literature associated with proximal outcomes - organizational, environmental, policy, or individual/household changes - that have been documented in research studies in association with the three high dose interventions. Using the insight from both reviews, researchers were able to develop a model evaluation framework for assessing the impact of community level interventions over time. Results: Researchers were able to identify 17 proximal outcomes and two community level outcomes with evidence associated with the three high dose interventions. Conclusion: Demonstrating the impact of community level nutrition security interventions is challenging given the complexity of the environments in which they are implemented and the limitations of evaluation resources. This approach prioritizes high dose evidence-based interventions and then leverages existing community level datasets and organizational measures to assess impact. It provides a framework for other organizations to prioritize specific systemic interventions to evaluate and further informs the evidence base for future interventions.
Abstract P525: Polygenic Risk Scores for Morning Chronotype and Longer Sleep Duration Are Associated With Weight and Glycemic Outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Rocio Barragan, Danielle Wallace, Bin Cheng, Tamar Sofer, CAROLINA ORTEGA, Xiuqing Guo, Jerome I Rotter, Steven Shea, Susan Redline, Dolores Corella, Marie-Pierre St-Onge
Journal: Circulation (2024)

Introduction: Circadian rhythms regulate key physiological processes, including sleep-wake. Alterations in the circadian rhythm have been associated with greater risk of metabolic diseases. Genome-wide association studies (GWAS) have revealed genes variants associated with sleep phenotypes. Hypothesis: Polygenic risk scores (PRS) for significant SNPs reported in GWAS of chronotype (C), sleep duration (SD), and short sleep (SS, &lt;7/h) are associated with metabolic parameters. Methods: We carried out a longitudinal analysis in 6,814 adults (aged 45-84 y at baseline) from the Multi-Ethnic Study of Atherosclerosis (MESA). Glucose, insulin, insulin resistance (HOMA-IR), body mass index (BMI) and waist circumference (WC) were assessed at baseline (2000-2002) and 16-18 y follow-up (Exam 6, N=3,303). DNA was extracted from whole blood, and genotyping data were obtained by the Affymetrix 6.0 SNP array. PRS for the following phenotypes were constructed as weight sum of genoma-wide significant alleles: 1) chronotype [PRS-C]; 2) continuous SD [PRS-SD]; and 3) SS duration [PRS-SS]. Multivariable linear regression models adjusted by sociodemographic, obesity, smoking, Mediterranean diet, physical activity and antidiabetic drugs were performed to assess associations between PRS and study outcomes (fasting glucose and insulin, HOMA-IR, hemoglobin A1c, BMI, and WC) cross-sectionally and longitudinally. Results: At baseline, none of the PRS were associated with glucose, insulin or HOMA-IR (p&gt;0.05). A significant positive association was detected for PRS-C with BMI and WC: greater genetically determined morningness was associated with lower BMI (β=-20.0±3.0; p&lt;0.001) and smaller WC (β=-44.1±8.0; p&lt;0.001). Similar results were observed with PRS-SD (BMI: β=-0.1±0.0; p=0.005; WC: β=-0.3±0.1; p=0.008) and PRS-SS (BMI: β=9.3±2.8; p&lt;0.001; WC: β=19.8±7.4; p=0.007). In longitudinal analyses, we observed prospective associations between PRS-C with BMI (β=-43.5±12.2; p&lt;0.001), WC (β=-116.0.1±29.1; p&lt;0.001), and glucose (β=-204.7±90.0; p=0.024). PRS-SS was longitudinally associated with HOMA-IR (β=214.1±88.0; p=0.017) and a trend was observed for hemoglobin A1c (β=-6.6±3.4; p=0.053), but not with anthropometrics parameters. No associations were noted for PRS-SD with obesity and glycemic outcomes in longitudinal analyses. Conclusion: In the MESA population, PRS for chronotype, sleep duration, and short sleep are associated with anthropometric but not with glycemic measures in cross-sectional analyses. However, PRS for chronotype and short sleep was associated with anthropometric and glycemic parameters in longitudinal analyses, suggesting the importance of genetic predisposition for morningness and adequate sleep duration for metabolic health.
Abstract MP13: Association Between Visceral Adiposity Index and Non-Alcoholic Liver Fibrosis Among United States Adults With Prediabetes
Authors: Sarah Abdel-Meguid, Matthew Pelton, Aayush Visaria
Journal: Circulation (2024)

Background: Although type 2 diabetes is a well-established risk factor for non-alcoholic fatty liver disease (NAFLD) and downstream liver fibrosis, little is known about the risk factors associated with NAFLD fibrosis in adults with prediabetes. We aimed to understand whether visceral adiposity was associated with liver fibrosis, independent of insulin resistance, among participants with prediabetes. Methods: In this nationally representative, cross-sectional study, we selected non-pregnant adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 with prediabetes, defined as HbA1c of 5.7-6.4%, fasting blood glucose of 100-125 mg/dl, or a self-reported diagnosis of prediabetes. We excluded those with acute transaminitis (aspartate or alanine aminotransferase &gt;500 IU/L), excessive alcohol consumption (&gt;1 drinks/day for females, &gt; 2 drinks/day for males), iron overload (transferrin saturation &gt;50%), and positive hepatitis serology. Visceral adiposity was estimated using the validated Visceral Adiposity Index (VAI) and categorized into tertiles (&lt;1.17, 1.17-2.19, &gt;2.19). Our primary outcome was clinically significant liver fibrosis, defined dichotomously as median Fibroscan vibration controlled transient elastography liver stiffness measurements of 7.9 kPa or greater (≥F2). We used survey design-adjusted logistic regression, adjusting for covariates determined a priori (age, sex, race/ethnicity, income, education, smoking status, physical inactivity, hypertension, hemoglobin A1c (HbA1c), total caloric intake, and Homeostatic Model Assessment for Insulin Resistance [HOMA]) to estimate odds of fibrosis. Results: Among 1,290 prediabetic adults (mean age 62y [SD, 10], 44% female, 62% non-Hispanic White, representing 37,401,474 adults across the U.S.), 121 (10%) had NAFLD fibrosis. Participants in the highest tertile of VAI were more likely to be female, older, have higher waist circumference, and have comorbid cardiac conditions. The highest tertile of VAI was associated with three times higher odds of fibrosis (highest vs. lowest tertile; OR [95% CI], 3.81 [1.65, 8.79], middle vs. lowest tertile: 4.93 [1.74, 13.34]). There was no significant multiplicative interaction between VAI and HOMA (p=0.44). The highest tertile was also associated with 170% higher odds of F1 (mild) liver fibrosis (2.70 [1.10, 6.63], middle vs. lowest tertile: 2.69 [1.26, 5.77]). Conclusion: Nearly 1 in 10 adults with prediabetes have clinically significant liver fibrosis. High visceral adiposity was associated with more than 3 times the likelihood of fibrosis, independent of insulin resistance and traditional risk factors.
Abstract P411: Child Opportunity and Behavioral Cardiovascular Health in Youth: The Young Hearts Study
Authors: Amy Yu, Aashima Chopra, Rachel Zmora, Darci Phillips, Amanda M Marma, Yaojie Wang, Ileah Rios, Sarah de Ferranti, Darwin R Labarthe, Matthew M 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, Donald M Lloyd-Jones, Norrina B Allen
Journal: Circulation (2024)

Background: Low cardiovascular health (CVH) in childhood is linked to risk of cardiovascular events in adulthood in the US. Relationships between neighborhood characteristics could be important for CVH in children, as appears to be the case in adults. We sought to assess such associations, representing neighborhood characteristics by the Child Opportunity Index (COI) and using a composite behavioral CVH score in youth. Methods: We used baseline data from the Young Hearts study, which is studying CVH trajectories of children ages 0-20. We linked children’s addresses to the COI, with domains encompassing: (1) social and economic, (2) health and environmental, and (3) educational opportunity. CVH behaviors were defined using the Life’s Essential 8 framework and included: self-reported diet, physical activity, nicotine exposure, and sleep. Linear regression models assessed the association between COI and overall and component behavioral CVH scores after adjustment for child demographics, family SES, and moves in the last year. Overall CVH scores comprised of the mean value of 4 behavior-specific scores (each 0-100 points). Results: Participants (N=2202) were 9.5±5.4 years old; 46.3% were female, and 47.05% identified as non-Hispanic White, 25.3% as Hispanic, and 17.9% as non-Hispanic Black. Compared with high (favorable) COI, individuals with low COI had a 2.15-point lower (worse) mean behavioral CVH score (p=0.003); however, those with moderate COI did not have significantly lower mean scores. The pattern for the education domain was similar but weaker. In the social and economic domain, those with low and moderate COI both had lower behavioral CVH scores than those with high COI. The health and environment domain was not independently associated with CVH. Of individual metrics, only sleep scores (beta=68.32, p=0.005) were independently associated with COI after adjustment. Conclusion: COI, especially social and economic factors, were associated with overall behavioral CVH among a diverse population of children.
Abstract P178: Prevalence of Elevated LDL-C and Non-HDL-C in Adults With Total Serum Cholesterol in the Normal Range
Authors: Mohammed Essa, Zhiyaun Zhang, Seth S Martin, Erin D Michos, Steven R Jones, Erica S Spatz, Roger S Blumenthal, Kamil Faridi
Journal: Circulation (2024)

Background: Normal serum total cholesterol (TC) based on standard lab definitions is typically considered &lt;200 mg/dL. However, normal TC levels do not indicate optimal levels of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C), the two measures most associated with risk of atherosclerotic cardiovascular disease (ASCVD). Methods: This study included all adults ≥18 years of age in NHANES from 1999-2018 without ASCVD and with TC &lt;200 mg/dL while not on lipid-lowering therapy (n = 11,843). We evaluated age-adjusted, survey-weighted prevalence of LDL-C ≥100 mg/dL or non-HDL-C ≥130 mg/dL in the total population and within subgroups. Results: Among adults with normal TC, half (95% CI 48.5-51.3%) had either LDL-C ≥100 mg/dL or non-HDL-C ≥130 mg/dL. Among all subgroups, the highest prevalence of elevated LDL-C or non-HDL-C was seen in adults with elevated triglycerides (85.5% [95% CI 80.0-91.0%] for those with triglycerides &gt; 400 mg/dL and 67.0% [95% CI 64.0-69.9%] with 150-400 mg/dL) or metabolic syndrome (66.2%, 95% CI 63.2-69.1%). A higher prevalence of elevated LDL-C or non-HDL-C was also seen in adults who were male, 40-80 years of age, or of Hispanic ethnicity, as well as those with pre-diabetes, diabetes, or elevated body mass index (Table). Prevalence of elevated LDL-C or non-HDL-C was substantially lower with decreasing levels of TC, ranging from 37.4% (95% CI 36.0-38.8%) for adults with TC &lt;190 mg/dL down to 0.2% (95% CI 0.0-0.5%) for adults with TC &lt;150 mg/dL (Table). Conclusions: Among adults free of ASCVD with TC &lt;200 mg/dL and not on lipid lowering therapy, half have elevated serum LDL-C or non-HDL-C. Current definitions of normal TC are therefore insufficient to identify ASCVD risk in the general population, particularly those with metabolic syndrome, elevated blood glucose or triglycerides, or increased body weight. Lower goals for normal TC and increased emphasis on non-HDL-C should be considered as part of public health measures for primary prevention.
Abstract MP19: Patterns of Early-Onset and Late-Onset Dementia Incidence in the Dementia Risk Pooling Project
Authors: Katherine Giorgio, John Stephen, Maxwell Mansolf, Aïcha Soumare, Alden Gross, Allison Aiello, Archana Singh-Manoux, Mohammad A Ikram, Catherine Helmer, Christophe Tzourio, Claudia L Satizabal, Deborah A Levine, Donald M Lloyd-Jones, Emily M Briceno, Farzaneh A Sorond, Frank Wolters, Jayandra Himali, Lenore J Launer, Lihui Zhao, Oscar L Lopez, Stephanie Debette, Sudha Seshadri, Suzanne E Judd, Timothy M Hughes, Vilmundur Gudnason, Behnam Sabayan, Pamela L Lutsey, James S Pankow, Paul S de Vries, Natalia Lakomski, Rachel Zmora, Elizabeth Peterson, Denise Scholtens, Richard Maclehose, Norrina B Allen, Sanaz Sedaghat
Journal: Circulation (2024)

Introduction: Early-onset dementia (EOD) is defined as dementia diagnosed before age 65. While much is known about late-onset dementia (LOD), research on EOD is scarce. The Dementia Risk Pooling Project (DRPP) harmonized data from nine community-based prospective studies, including under-represented racial/ethnic groups. We hypothesized that EOD incidence rates are higher for men than women, and non-Hispanic (NH) Black participants than other race/ethnicity groups. Methods: We used data from eight DRPP cohorts: Age, Gene/Environment Susceptibility-Reykjavik Study, Whitehall II study, Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Honolulu-Asia Aging Study, Multi-Ethnic Study of Atherosclerosis, Sacramento Area Latino Study on Aging, and six Framingham Heart Study cohorts. Individual data were pooled and rigorously harmonized. Race/ethnicity was categorized as self-reported Hispanic, NH White, NH Black, and NH other/unknown. Crude incidence rates and ratios were calculated per 10,000 person-years with 95% confidence intervals. Results: The analytic sample consisted of 56,607 participants, who experienced 7,504 cases of LOD and 124 cases of EOD over a median follow-up of 19.13 (IQR 10.46 - 31.11) years. EOD and LOD incidence rates per 10,000 person-years were 1.95 (95% CI 1.62 - 2.32) and 123.35 (95% CI 120.49 - 126.26), respectively. Compared to women, men had 1.17 (95% CI 0.82 - 1.66) times the rate of EOD but 0.82 (95% CI 0.79 - 0.86) times the rate of LOD. Similarly, compared to NH Whites, Hispanics and participants of other or unknown race/ethnicity had higher rates of EOD but lower rates of LOD. NH Blacks had a higher rate of both EOD and LOD compared to NH Whites, but the association with EOD was more pronounced. Conclusion: In this multi-cohort study with individual participant data, EOD and LOD incidence rates were different across sex and race/ethnicity groups. Some of these differences may be due to longer life expectancy in women and some race/ethnicity groups.
Abstract P415: Validation of an Algorithm to Identify End-Stage Kidney Disease Cases in Electronic Health Record Data
Authors: Chenxi Gao, Yunwen Xu, Yingying Sang, Alexander R Chang, Jamie Green, Morgan Grams, Jung-Im Shin
Journal: Circulation (2024)

Introduction: End-stage kidney disease (ESKD) is an important clinical outcome. However, there is limited work on validating algorithms to detect ESKD cases within electronic health record (EHR) data. Hypothesis: Algorithms using diagnostic and procedure codes in EHR data can accurately identify ESKD cases. Methods: Using data from Geisinger linked to the United States Renal Data System (USRDS), we developed algorithms to identify individuals with ESKD (either dialysis or kidney transplant, whichever occurred first) and validated them against ESKD cases ascertained from the USRDS data from January 1, 1996, through June 28, 2018 (gold standard). We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: To identify dialysis cases, we required 1) diagnosis codes of stage 5 chronic kidney disease or ESKD with dialysis codes within seven days or 2) three dialysis codes lasted longer than a month with any two consecutive codes occurring within 3 months. To identify kidney transplant cases, we required 1) one procedure code of kidney transplant or 2) one diagnosis code of kidney transplant in inpatients or problem list. Among 572,574 individuals (mean age, 41.6 years; female, 55.4%; White, 92.9%), the algorithms identified 4,187 ESKD cases (3,875 dialysis and 792 kidney transplant cases), while there were 4,529 ESKD cases (4,368 dialysis and 772 kidney transplant cases) by USRDS data. Our ESKD identifying algorithms’ sensitivity, specificity, PPV, and NPV were 71.1%, 99.8%, 76.9%, and 99.8%, respectively. Median (interquartile range) duration between incident dates by the algorithm and by the USRDS was -2 (-21, 86) days ( Table ). Conclusions: The algorithms developed by diagnostic and procedure codes accurately identified ESKD cases with high specificity in EHR data. Further validation is required in different health systems. Table The validity of the algorithms to identify ESKD cases IQR: interquartile range