tbuckley/cabot-search huggingface dataset:
Abstract 4128457: Trends in Hypertension-Related Mortality Among Younger Adults in the United States From 1999-2021
Authors: Muhammad Talha Maniya, Ahmed Siddiqi, Kumail Mustafa Ali, Ali Salman, Adarsh Raja, Laibah Khan, Tariq Jamal Siddiqi, Michael Hall
Journal: Circulation (2024)

Background: The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated. Aim: We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S. Methods: Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region. Results: Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0). Figure 1. Conclusion: Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.
Abstract 4131674: ADP-Ribosylation In a Mouse Model of Atherosclerosis: a Potential Novel Link Between Dyslipidemia and Inflammation in Cardiovascular Disease
Authors: Constance Delwarde, Diego Pestana, Taku Kasai, Shiori Kuraoka, Yuto Nakamura, Takeshi Okada, Julius Decano, Sarvesh Chelvanambi, Rile Ge, Andrew Mlynarchik, katelyn Perez, Alesandra Campedelli, Abhijeet Sonawane, Elena Aikawa, Sasha Singh, Masanori Aikawa
Journal: Circulation (2024)

Background: Inflammation and lipid accumulation are major features of atherosclerosis, a leading cause of death and morbidity worldwide. Our previous study recognized ADP-ribosylation, a post-translational modification, as a novel regulator of macrophage activation. We also have established mass spectrometry-based ADP-ribosylation proteomics. Using this technology, we evaluated the completely uncharacterized role of ADP-ribosylation in atherogenesis. We hypothesized that ADP-ribosylated proteins circulate from liver, accumulate in aorta and promote atherogenesis. Methods and Results: We harvested the aorta, liver, and plasma of LDL receptor-deficient ( Ldlr -/- ) mice that were on a regular chow or high-fat diet for 3 or 6 months (n=40/condition). To increase ADP-ribosyl peptide signals in the aorta, we applied our novel recently optimized ion mobility mass spectrometry strategy to generate ADP-ribosylation proteomics data. We analyzed 160 mice aortas and identified 3 APOA1 and 3 APOE ADP-ribosylated peptides in both the aorta and the liver (Fig. A). In addition, these peptides were differentially abundant in the aorta of HFD-fed mice, compared to controls (i.e, APOA1 ARPALEDLR peptide relative abundance (Fig. B)). Using the same mouse plasma, we then validated the presence of ADP-ribosylated APOA1 and ADP-ribosylated APOE in HDL and chylomicron/VLDL/LDL fractions (Western blot), respectively. This finding indicates that classical apolipoproteins circulate as ADP-ribosylated forms, representing a completely novel class of modified apolipoproteins. Immunohistochemistry confirmed the enrichment of aortic lesions in macrophages and ADP-ribosylation signal (5-fold increase, p=0.0006). Conclusions: This work provides the first in vivo evidence that ADP-ribosylation occurs in atherosclerotic lesions, which may originate from the liver via circulating blood (Fig. C). Future studies will examine whether ADP-ribosylation of apolipoproteins, specifically APOA1, alters anti-atherogenic functions of HDL.
Abstract 4128962: Medicaid Work Requirements and Changes in Insurance Coverage, Employment, Access to Care, and Health Status Overall and Among People with Cardiovascular Disease
Authors: Eden Engel-Rebitzer, Lucas Marinacci, ZhaoNian Zheng, Rishi Wadhera
Journal: Circulation (2024)

Introduction: Medicaid work requirements have been at the forefront of health policy debate. Proponents argue that these policies increase employment, reduce poverty, and improve health. Critics have raised concerns that work requirements lead to loss of coverage and impede access to care. Hypothesis: We hypothesized that Medicaid work requirement implementation would be associated with decreased insurance coverage and healthcare access without impacting employment. Methods: We used the Behavioral Risk Factor Surveillance System (a nationally representative survey administered by the CDC) to estimate the impact of Medicaid work requirements on insurance coverage, employment, access to care, and self-reported health. We used a difference-in-differences (DID) approach to compare changes in outcomes in Arkansas (where work requirements were implemented) versus control states. Outcomes were self-reported and included: 1) insurance coverage, 2) employment, 3) presence of a personal healthcare provider, 4) inability to see a doctor due to cost, and 5) self-reported health. The analysis was conducted among all respondents and among respondents with cardiovascular disease, who were hypothesized to be particularly vulnerable to negative sequelae of insurance loss. Results: The implementation of Medicaid work requirements in Arkansas was associated with decreased insurance coverage compared with control states (adjusted DID estimate -4.3%, CI -8.4%, -0.1%), but no increase in employment rates (-2.2% CI -7.0%, 2.6%). There was a trend toward decreased likelihood of having a personal healthcare provider (-4.7% CI -9.9%, 0.5%). There was no change in inability to see a doctor due to cost or self-reported good health. When this analysis was repeated among participants with cardiovascular disease, work requirement implementation was not associated with changes in any of the outcome variables. Conclusions: The implementation of Medicaid work requirements in Arkansas was associated with decreased insurance coverage and no change in employment. Our findings are particularly relevant given national policy debate about work requirement expansion and the recent implementation of Medicaid work requirements in Georgia. Despite the null findings among respondents with cardiovascular disease (likely the result of a small sample size), this study has important implications for cardiovascular health given the close association between insurance coverage and cardiovascular outcomes.
Abstract 4131424: Exercise Stress Perfusion Cardiac MRI in Pediatric Patients with Coronary Anomalies
Authors: Elizabeth Carter, Rebecca Moore, Matthew Harris, Julie Brothers
Journal: Circulation (2024)

Introduction: Anomalous aortic origin of a coronary artery (AAOCA) can result in sudden cardiac death in the young and risk stratification is challenging. Though dobutamine stress cardiac MRI (DS-CMR) is feasible in pediatric patients, exercise stress CMR (ES-CMR) has lower rates of adverse events, higher diagnostic accuracy, and the ability to better reflect the physiologic changes occurring with exercise. No studies have evaluated ES-CMR in the pediatric population. We aim to describe our institution’s experience with ES-CMR using supine bicycle ergometry in patients with AAOCA. Methods: We retrospectively reviewed the medical records of AAOCA patients who underwent ES-CMR at our institution between 2011 and 2024 for demographic, clinical presentation, cardiopulmonary exercise test (CPET) and ES-CMR data. The exercise-based portion of the CMR consisted of supine cycle ergometry utilizing a ramp protocol, immediately after which perfusion imaging was performed. We used descriptive statistics for data analysis. Results: Of 38 patients who underwent ES-CMR, the median age was 16 years (range 13-24) and 68% were male. Diagnoses included anomalous right coronary artery (N=28), anomalous left coronary artery (N=8), and single coronary artery (N=1 single right, N=1 single left). Median maximal heart rate (HR) during ES-CMR was 160 bpm (range 130-190, median 80% predicted) with a median maximal HR during patients’ most recent CPET of 187 bpm (range 160-203, median 97% predicted). No patients had perfusion defects at rest or with exercise stress, or evidence of myocardial scarring. There were no adverse events. Discussion: We demonstrate for the first time the use of ES-CMR in a cohort of pediatric and young adult patients with AAOCA. ES-CMR can provide a unique modality to assess for ischemia at rest and stress as a means of risk stratification and simulate physiologic changes occurring with exercise stress in a single study. Although maximum heart rates during supine cycle ergometry are lower than those reached during CPET, they are similar to those reached during DS-CMR. ES-CMR can be a helpful and safe diagnostic tool in patients with AAOCA.
Abstract 4128369: Inpatient Mortality After Catheter Ablation for Atrial Fibrillation Among Heart Failure Patients: A 6-Year Nationwide Analysis
Authors: Zaid Abood, M. Fuad Jan, Muddasir Ashraf, Suhail Allaqaband, Asad Ghafoor, M. Eyman Mortada, Atul Bhatia, A. Jamil Tajik, Arshad Jahangir
Journal: Circulation (2024)

Background: Significant advancements have been made in the safety of catheter ablation for atrial fibrillation (AF) over the past decade. However, large-scale data regarding inpatient mortality among heart failure (HF) patients (HF with reduced ejection fraction [HFrEF] and HF with preserved ejection fraction [HFpEF]) who undergo AF ablation are lacking. Aim: To compare mortality rates and trends between patients with HF (HF group) and without HF (non-HF group) following AF catheter ablation. Methods: The National Inpatient Sample was utilized from January 2015 to December 2020 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcome was in-hospital mortality for patients with and without HF undergoing ablation for AF, and the secondary outcome was mortality in patients with HFrEF compared with those with HFpEF. Results: We evaluated 142,860 patients hospitalized for AF who underwent catheter ablation. Of these, 42.2% (n=60,334) had HF (29% HFrEF; 71% HFpEF). The HF cohort was older (69.7 years) and predominantly male (61.3%) compared with non-HF (66.7 years, P&lt;.001 and 55.7%, P&lt;0.00, respectively). Overall mortality in the HF group was 3-fold higher (1.6% vs 0.5%, P&lt;.001). Within the HF group, mortality in HFrEF was 1.8 times higher than in HFpEF (2.4% vs 1.3%, P&lt;.001). Over the study period, mortality rates declined in the HF cohort (Fig. 1A), both in HFrEF (from 4.1% to 2.2%, P=.012) and HFpEF (from 2.7% to 1.3%, P=.006) (Fig 1B). In non-HF, mortality rates remained relatively unchanged during the study period (from 1.4% to 1.6%, P=.344). Conclusion: Overall mortality following AF ablation is relatively low. Despite the higher mortality observed in patients with HF, the overall rate declined in both HFrEF and HFpEF over the study period. This reduction in mortality may reflect improvements in HF treatment and ablation techniques. Further research is needed to elaborate on the factors contributing to these trends and to develop targeted interventions to reduce mortality in this high-risk population.
Abstract 4129709: Aspirin-Nanoparticle for Dual Therapies: Targeted Anti-Inflammatory and Prolonged Anti-Platelet Effects for Atherosclerosis
Authors: Seyong Chung, Seung Eun Yu, Jueun Kim
Journal: Circulation (2024)

Background: The current unmet needs for aspirin usage in atherosclerosis lie in its short half-life and narrow indication for anti-platelet effects. Daily aspirin intake is mandatory, and the anti-inflammatory effects of aspirin for atherosclerosis have not successfully translated to clinical practice. Nanoparticles remain in circulation for 2-3 days, with a large portion being cleared by splenic monocytes, which are known to inherently target inflamed sites. Hypothesis: By altering the pharmacokinetics of aspirin through loading into nanoparticles, aspirin-nanoparticles can exert prolonged anti-platelet effects and target atherosclerosis sites via monocyte carriers for anti-inflammatory effects, resulting in dual therapies. Methods: Splenic monocytes were loaded with aspirin-liposomes and co-cultured with endothelial cells or platelets to examine the interactions between them using high-resolution time-series microscopy. Prolonged anti-platelet effects and targeted anti-inflammatory effects of aspirin were validated in intact mice and hindlimb ischemia models, respectively. Furthermore, the dual therapies of aspirin-liposomes were validated in an atherosclerotic mouse model created by partial carotid ligation and a western diet in apoE gene knock-out mice. Results: When splenic monocytes were loaded with aspirin-liposomes, they emitted extracellular vesicles (EVs) loaded with aspirin towards endothelial cells or platelets. As inflamed cells upregulate caveolin expression, they uptake an increased amount of transferred EVs compared to non-inflamed cells. Additionally, aspirin-liposomes showed prolonged circulation time and increased splenic accumulation compared to aspirin itself, resulting in prolonged anti-platelet effects (&gt;7 days) and targeted anti-inflammatory effects at inflamed sites. Compared to the daily oral aspirin group in the atherosclerosis model, the weekly intravenous aspirin-liposome group showed superior therapeutic effects, including attenuated systemic and local inflammation and patent lumen in atherosclerotic sites. Conclusion: Aspirin-nanoparticles can exert prolonged anti-platelet effects combined with targeted anti-inflammatory effects, resulting in superior therapeutic effects on atherosclerosis.
Abstract 4127417: Trends in Atherosclerotic Cardiovascular Disease Related Mortality Among Older Adults in the United States From 1999-2021
Authors: Ahmed Siddiqi, Muhammad Talha Maniya, Kumail Mustafa Ali, Ali Salman, Adarsh Raja, Laibah Khan, Tariq Jamal Siddiqi, Michael Hall
Journal: Circulation (2024)

Background: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established. Aims: This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults &gt;65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7). Figure 1. Conclusion: Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.
Abstract 4127513: Cardiopulmonary long-term effects 6, 18 and 30 months after severe covid-19 infection
Authors: Julia Niebauer, Ahmet Iscel, Sarah Schedl, Christophe Capelle, Michael Kahr, Simon Schamilow, John Faltas, Marc Srdits, Michael Lichtenauer, Alexander Zoufaly, Rosmarie Valenta, Silvia Charwat-Resl, Christian Krestan, Wolfgang Hitzl, Christoph Wenisch, Diana Bonderman
Journal: Circulation (2024)

Background: SARS-CoV-2 infection affects the cardiopulmonary system in both the acute and long-term phase. This study aimed to comprehensively assess symptoms and potential long-term impairments 6, 18 and 30 months in patients previously hospitalized for severe Covid-19 infection. Methods: This prospective registry included patients hospitalized for PCR-confirmed Covid-19 infection. Approximately 6 months post-discharge, follow-up examination included patient history, clinical examination, echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a comprehensive laboratory panel. Patients with pathologic findings during the first visit underwent a second (at 18 months) and third (at 30 months) follow-up examination. Those without pathologic findings or who refused further medical examinations were contacted via phone to inquire about symptoms. Results: Between July 2020 and April 2022, 200 patients (91% general ward, 9% intensive care unit) were recruited. Due to dropouts, the second visit was conducted in 170 patients, and the third visit in 139 (74 in person, 65 via telephone). Long Covid criteria were fulfilled by 73% at 6 months, 52% at 18 months and 49% at 30 months post-discharge, with fatigue being the most common symptom (Figure 1). Echocardiography at 6 months showed impaired left ventricular function in 15 patients, with normalization in 80% at 18 months and further 66% at 30 months (Figure 2). cMRI revealed pericardial effusions in 28 patients at 6 months, which resolved in 47% at 18 months and in further 60% at 30 months. Signs of peri- or myocarditis were present in 7 patients at 6 months and were resolved in all 4 patients who attended control studies at 18 months. Chest CT scans at 6 months identified post-infectious residues in 41 patients, with full recovery in 20% at 18 months without further normalization after 30 months. The length of in-hospital stay was identified as a significant predictor for persisting Long Covid 6 months after discharge (95% CI: 1.005 - 1.12, p=0.03). Conclusion: While the prevalence of Long Covid decreased over time, a significant symptom burden persisted at 6, 18 and even 30 months after severe Covid-19 infection. Structural and functional abnormalities were less frequent compared to reported symptoms, posing a challenge in substantiating the causes of these symptoms.
Abstract 4128250: Healthier Lifestyle is Associated with Better Arterial Health in People without Prevalent Cardiovascular Disease
Authors: Maria Ruda, Lu Zhang, Mawra Jha, Zhiyong Dong, Brenton Prescott, Vanessa Xanthakis, Emelia Benjamin, Ramachandran Vasan, Gary Mitchell, Connie Tsao
Journal: Circulation (2024)

Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of LE8 with AH and extent to which carotid-femoral pulse wave velocity (PWV) mediates the association of LE8 with outcomes in a sample free of CVD. Methods: In 3 Framingham Heart Study cohorts, we studied the relations of LE8 (total score and components) with AH, assessed by arterial stiffness (PWV, by tonometry) and coronary calcification score (CAC, by computed tomography) using multivariable-adjusted linear regression (p&lt;0.01 considered significant after Bonferroni correction). We evaluated the extent to which PWV mediates the association of LE8 with outcomes using Cox proportional hazards regression models (p&lt;0.05 considered significant). Results: We studied 5222 participants, aged 50±15 years, 56% women. Characteristics of the sample are presented in Table . Higher LE8 score (better cardiovascular health) was associated with more favorable AH measures (PWV inverse transformed, standardized; CAC log(CAC+1); all β±SE, x10 -3 ): β PWV =-14.4±0.7, β CAC= -51.9±7.8, both p&lt;0.01). Of the LE8 components, BMI (β PWV =-1.53±0.31), BP (β PWV =-9.74±0.36), fasting glucose (β PWV =2.03±0.45), lipids (β PWV =-1.54±0.31, β CAC =-16.14±3.30) and smoking (β CAC =-17.9±2.8) were the greater contributors to AH (all p&lt;0.01). PWV mediated modest degrees of the associations between LE8 and CHD, HF, CVD, and CVD mortality [ Figure ]. Conclusions: In people without prevalent CVD, healthier lifestyle was associated with better AH. Arterial stiffness mediates the association between lifestyle measures and CHD, HF, CVD, and CVD-mortality. Our results support studying lifestyle interventions to improve arterial health and their benefits for CVD outcomes.