tbuckley/cabot-search huggingface dataset:
Abstract P1146: A Multifaceted Blood Pressure Intervention Improves Medication Adherence in Low Income Adults with Hypertension
Authors: Marie Krousel-Wood, Erin Peacock, Katherine Mills, Farah Allouch, Alecia Cyprian, Gerrelda Davis, Sonja Fuqua, Darie S Gilliam, Angel Greer, Tammy Mitchell, Lea Gray Winfrey, Shondra Williams, Gary Wiltz, Keith Winfrey, Jing Chen, Jiang He
Journal: Circulation (2025)

Methods: A secondary analysis from the I mplementation of M ultifaceted Pa tient- C entered T reatment S trategies for Intensive BP Control (IMPACTS) cluster randomized trial in federally qualified health centers in the Gulf South was done. Participants were randomized to intervention (standardized BP measurement education, stepped-care treatment algorithm, team-based care, health coaching, home BP monitoring) versus EUC. Adherence was measured with the Krousel-Wood Medication Adherence Scale-4 item (K-Wood-MAS-4; range 0-4); score&lt;1=high adherence. SBP&amp;diastolic BP (DBP) were assessed with a standard protocol using automated BP devices. A multivariable mixed effects logistic regression model with group-by-time interaction estimated predicted probabilities of high adherence for each group at each time point; between-group differences were assessed. A multivariable mixed effects linear regression model estimated difference in SBP for high versus low adherence across all time points. Models were adjusted for baseline socio-demographics, SBP, hypertension duration, number antihypertensive drugs, and comorbidities. Results: Data from 1,272 hypertensive adults from 36 clusters (mean cluster size 35.3, SD 10.6, range 21-60) were analyzed: mean age was 58.3 years (SD 8.9), 56.7% female, 66.5% Black; 62.9% household income &lt;$20K. At baseline, mean SBP&amp;DBP were 147.6 mm Hg (SD 12.5) and 84.6 mm Hg (SD 10.9), respectively; mean K-Wood MAS-4 score was 0.82 (SD 0.89); only 44.3% reported high adherence. Adjusted percent of high adherence at baseline, 6-, 12-&amp;18 months: Intervention group: 43% (95% CI 39%, 47%), 53% (95% CI 48%, 57%), 53% (95% CI 49%, 58%)&amp;54% (95% CI 50%, 59%), respectively; EUC group : 46% (95% CI 42%, 50%), 44% (95% CI 40%, 48%), 48% (95% CI 44%, 53%)&amp;55% (95% CI 50%, 59%), respectively. Between-group differences in probability of high adherence were higher in intervention versus EUC groups at 6 (p=0.001)&amp;12 months (p=0.018) but not 18 months (p=0.463). Across all visits, high versus low adherence was associated with mean 4.35 mm Hg lower SBP (p&lt;0.001). Conclusion: The multifaceted intervention versus EUC increased adherence at 6M and 12M post randomization; higher adherence was associated with lower SBP.
Abstract P1027: Associations between sleep quality and individual lipid abnormalities in Hong Kong Chinese women: Findings from the MECH-HK study
Authors: Mingyu Chen, Yao Jie Xie, Kin Cheung
Journal: Circulation (2025)

Background: Many studies on the relationship between sleep quality and dyslipidemia have been conducted, but the findings have been inconsistent. Dyslipidemia refers to the presence of one or more of individual lipid conditions: high total cholesterol (TC) level, high triglycerides (TG) level, high low-density lipoprotein cholesterol (LDL-C) level, and low high-density lipoprotein cholesterol (HDL-C) level. Few studies have investigated the relationships between sleep and individual lipid components in Chinese population. Identifying the specific lipid components associated with sleep might help target prevention and improving precise management of dyslipidemia. Methods: Baseline data (collected between October 2019 - December 2020) of the Migraine Exposures and Cardiovascular Health in Hong Kong Chinese women (MECH-HK) cohort were used for analyses. Sleep quality was measured by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). It has an overall score and 7 domains. Poor sleep quality was defined as overall score &gt; 5. Blood lipids in terms of TC, TG, LDL-C, and HDL-C were measured by CardioChek PA device, and categorized as normal or abnormal according to the Chinese guidelines for lipid management (2023). Results: A total of 3531 adult women were included. The prevalence of poor sleep quality, abnormal TC, TG, LDL-C, and HDL-C was 64.7%, 12.9%, 21.7%, 4.8%, and 3.4% respectively. The association between sleep quality and dyslipidemia was not significant. As for individual lipid abnormalities, poor sleep quality was only associated with 3.0% greater odds of abnormal LDL-C (95% CI: 0.5~5.5%). Regarding sleep pattern, sleep duration ( OR =1.018, 95% CI : 1.006~1.030) and sleep disturbances ( OR =1.033, 95% CI : 1.012~1.055) were associated with abnormal LDL-C. Sleep duration ( OR =1.021, 95% CI : 1.008~1.034) and sleep disturbances ( OR =1.027, 95% CI : 1.005~1.050) were also associated with abnormal TC, while sleep latency ( OR =1.007, 95% CI = 1.001~1.014) and sleep efficiency ( OR =1.005, 95% CI : 1.001~1.009) were associated with abnormal HDL-C. No significant associations were observed between any of the sleep components and abnormal TG. Conclusion: The association of poor sleep quality with dyslipidemia appeared mainly between sleep and abnormal LDL-C. Different sleep patterns were linked to specific lipid components, suggesting that future research may focus on tailored management strategies based on specific sleep patterns and types of dyslipidemia.
Abstract P3050: Diabetes Incidence Before and After the COVID-19 Pandemic Shelter-in-Place Mandate in Adults with Prediabetes
Authors: Luis Rodriguez, Maher Yassin, Obidiugwu Duru, Romain Neugebauer, Brandon Towns, Tainayah Thomas, Wendy Dyer, Rahel Demissie, Nickolas Nguyen, Holly Finertie, Deanne Wiley, Susan Brown, Yelba Castellon-Lopez, Julie Schmittdiel
Journal: Circulation (2025)

Background: We evaluated changes in type 2 diabetes (T2D) incidence associated with onset of the COVID-19 pandemic shelter-in-place (SIP) mandate; and if changes were greater among public (Medicaid) vs. commercially insured patients, and Asian, Black, and Hispanic vs. White patients, who have greater T2D risks. Methods: We examined electronic health records of 323,609 adults ages ≥18-89 years with BMI ≥25 (≥23 if Asian) and prediabetes (fasting glucose 100-125 mg/dL, or A1c 5.7-6.4%) from 1-1-2019 to 12-31-2021, at Kaiser Permanente Northern California. We defined T2D as having one inpatient discharge diagnosis or any of the following two within 24 months: A1c ≥6.5%, fasting glucose ≥126 mg/dl, random glucose ≥200 mg/dl, 2-hour 75-g oral glucose tolerance test ≥200 mg/dl, outpatient diagnosis code, and/or filled T2D medication. In a sub-analysis, we used only the first positive lab test in the T2D range. Using an interrupted time-series analysis, we evaluated whether an increase in T2D incidence was associated with the start of the pandemic SIP mandate (March 2020). The analysis was operationalized by fitting segmented linear regression models using generalized least squares, accounting for autocorrelation, and with monthly cases per 10,000 patients as the outcome. Results: In the 10 months before the pandemic SIP mandate, the average monthly T2D incidence was 12.2 cases (and 268 lab positivity cases) per 10,000 patients with stable trends. At the start of the SIP mandate, there was a nonsignificant steady increase in the monthly incidence of 0.8 (95% CI: -0.2,1.8) cases/month which persisted through 2021. There was also a steady and significant increase in the monthly lab positivity incidence rate of 8 (1, 16) cases/month, which persisted through 2021. In stratified analyses of lab positivity changes, the rate increase was similar across insurance types. However, compared to White patients, at the start of the SIP mandate, there was an immediate significantly greater increase in lab positivity of 104 (75, 133) cases/month for Hispanic patients, followed by an increase in monthly incidence that continued through 2021. There were no differences between Asian or Black and White patients. Conclusion: The COVID-19 pandemic and SIP mandate were associated with a steady increase in the T2D lab positivity rate among adults with prediabetes that persisted through 2021. The increase was larger among Hispanic compared to White patients, reflecting disparities.
Abstract MP42: Metabolomic signatures of carbohydrate quantity and quality in association with risk of type 2 diabetes
Authors: Xiaowen Wang, Pengfei Xia, Fenglei Wang, Zhiyuan Wu, Yang Hu, A Heather Eliassen, Oana Zeleznik, Shilpa Bhupathiraju, Seyed Mousavi, Walter Willett, Qi Sun
Journal: Circulation (2025)

Objective Metabolomic indices that summarize metabolomic responses to diet may be instrumental for the examination and establishment of associations between diet and diseases. We aim to identify metabolomic signatures of the amounts and types of carbohydrate intake and examine their association with type 2 diabetes (T2D) risk. Research design and methods The discovery phase utilized data from the Lifestyle Validation Studies, which included 1,196 participants with plasma metabolomics and primary food sources assessed using 7-day dietary records, which included intakes of carbohydrate, added sugar, whole grain, refined grain, vegetable, fruit, potato, and legume. Elastic net regression within a cross-validation framework was used to calculate metabolite profiles correlated with carbohydrate intake. The association of these profiles with incident T2D was investigated using multivariable Cox regression in 11,454 participants from the Nurses' Health Study (NHS), NHS II, and Health Professionals Follow-up Study. Results Metabolites positively associated with total carbohydrate and added sugar intake mainly included glycerolipids, while glycerophospholipids were negatively associated with these variables. Whole grain consumption was positively associated with betaine, 3-indolepropionic acid (IPA), and hippuric acid. For vegetables and legumes, IPA, N-acetylornithine, and pipecolic acid were among the top positive metabolites. Fruit was positively associated with proline-betaine and IPA. Identified metabolomic signatures showed significant correlations with carbohydrate intake (Pearson r ranging 0.56-0.80 with true intake assessed using the triad method). Signatures for total carbohydrate, added sugar, refined grain, and potato were positively associated with T2D incidence [HR per SD: 1.07 (1.06-1.12), 1.07 (1.02-1.12), 1.12 (1.07-1.18), and 1.36 (1.29-1.44), respectively]. Conversely, signatures for whole grain, vegetable, fruit, and legume were inversely associated with T2D [HR per SD: 0.73 (0.70-0.77), 0.95 (0.90-0.99), 0.88 (0.83-0.92), and 0.93 (0.88-0.97), respectively]. Conclusions This study identified a panel of plasma metabolites related to the total and specific types of carbohydrate consumption. The metabolomic signatures of carbohydrate intake from different dietary sources were differentially associated with the risk of T2D. These findings corroborated the observations of carbohydrate intake assessed using questionnaires or other recall-based instruments.
Abstract MP45: Proton Pump Inhibitors Increase Pathobiont Species in the Gut Microbiome: Findings from the Baltimore Longitudinal Study of Aging
Authors: Bruno Bohn, Toshiko Tanaka, Curtis Tilves, Chee Chia, Noel Mueller
Journal: Circulation (2025)

Background: Proton pump inhibitors (PPIs) have been linked to increased risk of heart and kidney disease, but causal mechanisms remain to be elucidated. Cross-sectional studies have linked PPI use with higher pathobiont bacteria (e.g., Streptococcus ) in the gut microbiome. Here, we aimed to examine the effects of PPIs on the gut microbiome through new-user target-trial emulation. Methods: We included participants from the Baltimore Longitudinal Study of Aging who had ≥2 visits with microbiome data, were ≥60 years old, not on antibiotics, and not on PPIs at baseline. New users were defined as those who initiated PPIs within 2 follow-up visits, while eligible controls reported no PPI use. We matched each new PPI user to 2 non-user controls using a nearest neighbor algorithm and propensity scores based on baseline age, sex, race, ever smoking, history of gastrointestinal conditions (ICD-9 530), obesity, and antidiabetic medication use. We evaluated PPI-related changes in microbial diversity and in the relative abundance (RA) of selected bacteria with ANCOVA and estimated the average treatment effect in the treated using g-computation of marginal effects. Results: After matching each of the 16 new PPI users to 2 non-users, selected from 403 eligible controls, there were no differences in baseline covariates by treatment group. Participants were, on average, 75.5 years old, 60.4% female, and 79.2% white. Mean follow-up was 716.3±251.7 days. By follow-up, PPI initiation non-significantly increased gut microbiome richness by 6.9 species (95% CI: -0.9—14.6) compared to no initiation (Figure). PPI initiation was associated with change in several bacteria in the gut, including the oral pathobionts Streptoccocus parasanguinis and S. salivarius , whose RA were respectively increased by 0.7% (0.02–1.2%) and 3.7% (0.7–6.8%) in the PPI initiators vs controls. Conclusion: PPI initiation increased several pathobiont species in the gut, including Strepcococci spp. commonly found in the oral microbiome and linked to cardiovascular disease.
Abstract P2095: Demographics, Vascular Risk Factors, and History of Cardiovascular Disease in Relation to Prevalent Epilepsy in Older Adults: A Pooled Analysis of ARIC, CHS, MESA, NOMAS, and WHICAP Cohorts
Authors: Sofia Pelagalli Maia, Stephany Diaz Andino, Oluwadamilola Obalana, Brian Petersen, Hyunmi Choi, Jose Gutierrez, Cheng-Shiun Leu, Tian Wang, Jiying Han, Sylwia Misiewicz, Emily Johnson, W Longstreth, Mary Lou Biggs, Annette Fitzpatrick, Steven Shea, Craig Johnson, Mitchell Elkind, Tatjana Rundek, Kevin Strobino, Lisandro Colantonio, Lei Huang, Carolyn Zhu, Richard Mayeux, Danurys Sanchez, Dolly Reyes-Dumeyer, Deborah Levine, Natalie Bello, Evan Thacker
Journal: Circulation (2025)

Introduction: Epilepsy is the third most common neurological disorder in older adults after dementia and stroke. Previous research suggests that vascular risk factors (VRFs) and cardiovascular disease (CVD) are more common in people with epilepsy. Pooling multiple cohorts with detailed characterization of vascular risk factors, CVD, and harmonized epilepsy case ascertainment increases diversity of the sample to be more representative of the US population and increases the numbers of epilepsy cases for greater statistical power. Methods: We pooled individual participant data from five cohorts, including ARIC, CHS, MESA, NOMAS, and WHICAP. For this analysis, we included participants who were 65 years of age or above. In ARIC, CHS, MESA, and WHICAP, which were linked to Medicare Claims, we included participants who had a minimum 2-year continuous Medicare enrollment and ascertained prevalent epilepsy using an algorithm based on ICD codes and antiepileptic medication. In NOMAS, which was not Medicare-linked, prevalent epilepsy cases were ascertained by telephone interview, medical record review, and ICD codes in New York Statewide Planning and Research Cooperative System (SPARCS) data. Risk factors were assessed by self report, blood measures, ECG, physical exams, and medications at cohort baseline. We calculated unadjusted prevalence of epilepsy in each risk factor category and prevalence differences and prevalence ratios adjusted for age, sex, race/ethnicity, and cohort. Results: Among 26,476 participants, 264 had prevalent epilepsy (9.9 cases per 1,000). Unadjusted prevalence of epilepsy was higher in older age groups, women, non-Hispanic Black and Hispanic groups, those with less education, never or current smokers, heavier alcohol drinkers, those with hypertension, diabetes, high cholesterol, underweight, obesity, history of stroke or heart disease, or 2 APOE e4 alleles (Table). Adjusted prevalence of epilepsy was higher among participants in the non-Hispanic Black group (5.3 additional cases per 1,000 [95% CI: 2.1, 8.5]) and among participants who had a history of stroke (12.9 additional cases per 1,000 [95% CI: 3.5, 22.3]). Conclusions: In this pooled cohort analysis, adjusted for age, sex, race/ethnicity, and cohort, prevalence of epilepsy in those over the age of 65 was higher among non-Hispanic Black individuals and among those with a history of stroke.
Abstract 026: Poor Hypertension Care Cascade Performance in Adults from South-Central Uganda: A Population-Based Cohort Study
Authors: Helena Baffoe-Bonnie, Joseph Ssuuna, Charles Batte, Joseph Kagaayi, M. Kate Grabowski, Godfrey Kigozi, Gertrude Nakigozi, Larry W. Chang, Wendy Post
Journal: Circulation (2025)

Background: Hypertension, a potent risk factor for cardiovascular disease, is increasingly prevalent in sub-Saharan Africa. Identifying intervention targets requires an examination of hypertension management. This study analyzed the hypertension care cascade—prevalence, awareness, treatment, and control—to identify management gaps in adults &gt; 25 years in south-central Uganda. Methods: Data from the Rakai Community Cohort Study, a longitudinal, open, population-based cohort from 34 communities in south-central Uganda, were used. Hypertension was defined as systolic BP &gt; 140 mmHg, diastolic BP &gt; 90 mmHg, or current use of anti-hypertensive medication. A care cascade was constructed to describe hypertension prevalence, awareness, treatment, and control, stratified by age (25-49 and &gt; 50 years) and HIV serostatus. Modified Poisson regression was used to assess factors associated with hypertension and cascade levels by estimating adjusted prevalence ratios (aPR). Results: Among 10,132 adults aged 25-49 years and 1,647 adults &gt; 50 years, hypertension prevalence was 13% and 36%, respectively. Of participants with hypertension aged 25-49, 23% were aware of their diagnosis, 9% were receiving treatment, and 4% had controlled hypertension. Men aged 25-49 with hypertension had a 1% control rate. Among those &gt; 50 years, the cascade rates were 44%, 27%, and 12%, respectively. Adjusted analyses showed that factors associated with higher prevalent hypertension included older age [aPR 1.62 (1.57–1.68)], male sex [aPR 1.13 (1.02–1.24)], obesity [aPR 2.01 (1.79-2.26)], moderate to heavy alcohol consumption [aPR 1.37 (1.24–1.52)], and living in a trading community [aPR 1.16 (1.06–1.27)]. Older age and higher BMI were also linked to higher rates of diagnosis awareness, treatment, and BP control. Male sex, however, was associated with lower attainment of all care cascade levels. Persons with HIV were more likely to be on treatment [aPR 1.39 (1.07–1.80)] and controlled [aPR 1.65 (1.12–2.42)]. Conversely, new study participants were less likely to be aware of their hypertension [aPR 0.74 (0.59–0.91)] and on treatment [aPR 0.61 (0.42–0.91)]. Conclusions: These findings reveal that hypertension is prevalent in this population, with substantial gaps throughout the care cascade, particularly among men. Urgent improvements in diagnosis, treatment, and control are needed. Cost-effective interventions and integrated care models are essential to improve hypertension management in this region.
Abstract P3177: Longitudinal Recovery after Intracerebral Hemorrhage: Insights from BASIC Study
Authors: Muhammad Zia ul Haq, Madeline Kwicklis, Darin Zahuranec, Lewis Morgenstern, Lynda Lisabeth
Journal: Circulation (2025)

Background: Intracerebral hemorrhage (ICH) is a severe stroke type with high mortality, significantly affecting survivors' quality of life (QOL) through functional, cognitive, and psychosocial impairments. Objective: To investigate longitudinal trajectories of functional, neurological, cognitive, and QOL outcomes following ICH, utilizing data from the Brain Attack Surveillance in Corpus Christi (BASIC) project (2014-2019). Methods: Baseline demographic and clinical characteristics were collected. Neurological, functional, cognitive, and QOL outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living (ADL/IADL), Modified Mini-Mental State Exam (3-MSE), and Stroke-Specific QOL (SS-QOL) scale at 3-, 6-, and 12-months post-stroke. Linear regression models with generalized estimating equations assessed changes over time, adjusting for covariates including age, sex, race/ethnicity, education, pre-stroke status, and comorbidities. Inverse probability weighting and multiple imputation were applied. Results: Analysis included 328 first-ever ICH patients, with 117 completing at least one follow-up. Baseline demographics: 63.1% Mexican American, 55.5% male, mean age 68.9 years. One-year mortality was 43.3%. Among the 117, functional outcomes improved significantly: from 2.48 (SD=1.00) at 3 months to 2.14 (SD=0.93) at 12 months (adjusted difference: -0.33; 95% CI: -0.49 to -0.18; p&lt;0.001). NIHSS scores reduced from 3.45 (SD=4.38) to 2.6 (SD=5.14) (adjusted change: -20%; 95% CI: -30% to -9%; p&lt;0.001). Cognitive scores increased from 79.2 (SD=15.2) to 82.3 (SD=13.0) (adjusted difference: 5.13; 95% CI: 1.56 to 8.71; p=0.005). QOL improved from 3.16 (SD=1.09) to 3.45 (SD=1.01) (adjusted difference: 0.30; 95% CI: 0.16 to 0.44; p&lt;0.001). Conclusion: Despite a high mortality rate of ICH, survivors demonstrated significant improvements in all outcomes over the first year. For most outcomes, the most notable gains occurred in the initial 3 to 6 months, though functional outcomes and quality of life showed continued improvement from 6 to 12 months. These findings emphasize the potential for recovery and the importance of early and intensive rehabilitation efforts to optimize long-term outcomes for ICH patients.