tbuckley/cabot-search huggingface dataset:
Abstract 19: Time-Varying Exposure to Food Retailers and Cardiovascular Disease Incidence and Mortality in the Netherlands: A Nationwide Prospective Cohort Study
Authors: Maria Gabriela M Pinho, Yvonne Koop, Joreintje Mackenbach, Jeroen Lakerveld, Mariana Simoes, Roel Vermeulen, Alfred Wagtendonk, Ilonca Vaartjes, Joline W Beulens
Journal: Circulation (2024)

Background: The food environment is suggested as a risk factor of cardiovascular disease (CVD), but current evidence is inconsistent and does not account for changes in the food environment. We aimed to explore if time-varying exposure to the food environment was associated with hospitalisation and mortality due to total and specific types of CVD in The Netherlands. We hypothesized that favourable time-varying trends in food environment exposure would be associated with decreased risk of CVD, stroke, heart failure (HF), and coronary heart disease (CHD) morbidity and mortality among the Dutch general population. Methods: A prospective cohort study was performed among all Dutch residents aged 35+ years who did not change residence in 2002-2018 without CVD in 2004, identified through registry data from Statistics Netherlands (n=4,641,435; 51.3% female, 91.2% Dutch). Time-varying Food Environment Healthiness Index (FEHI) scores (range: -5 to 5) and time-varying Kernel density of six specific food retailers (food delivery outlets, fast food outlets, restaurants, local food shops, supermarkets and convenience stores) around the home location were based on bi-annual updates between 2004-2018. Hospitalisation and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020 were used as outcomes, based on hospital and death registries. Models were adjusted for age, sex, ethnic origin, household composition, income, marital status and neighbourhood urbanisation level and effect modification by age, sex, urbanization and income was studied. Results: Each unit increase in the FEHI, representing a 10% improvement, was associated with a lower hospitalisation and mortality of CVD (hospitalization Hazard Ratio (HR h )=0.90, 0.89-0.91, mortality Hazard Ratio (HR m )=0.85, 0.82-0.89), CHD (HR h =0.88, 0.85-0.91, HR m =0.80, 0.75-0.86), stroke (HR h =0.89, 0.84-0.93, HR m =0.89, 0.82-0.98), and HF (HR h =0.90, 0.84-0.96, HR m =0.84, 0.76-0.92). Increased density of local food shops, fast food outlets, supermarkets and convenience stores, and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke and HF incidence and mortality, albeit with small effect sizes. Stratified analyses suggest slightly stronger associations in highly urbanized areas, younger adults and those with higher incomes. Conclusions: Favourable trends in time-varying food retailer exposure were associated with a risk reduction in CVD hospitalisation and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.
Volatile sedation practices in patients with severe acute respiratory distress syndrome under VV-ECMO support
Authors: Sara Alcántara Carmona, Ana del Saz, Sofía Contreras, Jordi Riera, Aaron Blandino, José Manuel Gómez, Andoni García, Sergi Tormo, Manuel Pérez Torres, Carolina Joya Montosa, Manuela García Sánchez, Susana Temprano Vázquez, Ana Royuela
Journal: Intensive Care Medicine (2024)
Abstract 06: Residential Segregation and Thrombo-Inflammatory Biomarkers Related to Hypertension in Black and White Americans
Authors: Debora Kamin Mukaz, Andrew Sparks, Suzanne E Judd, Virginia J Howard, April P Carson, Timothy B Plante, D. Leann Long, Katharine L Cheung, Mary Cushman
Journal: Circulation (2024)

Background: Thrombo-inflammation is involved in hypertension pathogenesis. Black people have higher thrombo-inflammatory biomarkers and hypertension burden than White people. It is unclear whether residential segregation, a driver of health inequities, has a differential impact on thrombo-inflammation in Black and White Americans. Hypothesis: Higher residential segregation is associated with adverse levels of thrombo-inflammatory biomarkers, and this association is greater among Black relative to White adults. Methods: This cross-sectional study included 4,362 participants of the biracial REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. County-level segregation was measured with the (1) dissimilarity index (DI, the difference in racial distribution of census tracts relative to their county), (2) isolation index (ISI, the degree to which Black people are exposed only to one another in a county), and (3) interaction index (ITI, the degree to which Black people are exposed to White people in a county). Linear regression was used to assess correlations of residential segregation indices with 7 thrombo-inflammatory biomarkers associated with hypertension risk: C-reactive protein (CRP), D-dimer, E-selectin, Factor IX, interferon (IFN)-γ, interleukin (IL)-6, and tumor necrosis factor (TNF)-α. Results: Worse ISI, ITI, and DI were associated with adverse levels of most biomarkers even with Bonferroni adjustment (Table). For example, CRP was 12% (95% CI: 9-16%) higher per SD higher ISI, 5%(95% CI: 1- 8%) higher per SD higher DI, and 9% (95% CI: 6-12%) higher per SD lower ITI. None of the associations differed significantly by race (p race* residential segregation index &gt;0.1). Conclusions: Several thrombo-inflammatory biomarkers important in hypertension were more adverse with greater residential segregation by three metrics, regardless of race. This indicates that residential segregation, a manifestation of structural racism, may become embodied in thrombo-inflammatory processes.
Abstract 45: Elevated Long-Term Triglyceride-Glucose Index Variability From Childhood is Linked to Poorer Midlife Cognitive Function: The Bogalusa Heart Study
Authors: Soo Jung Kang, Ileana De Anda-Duran, Camilo Fernandez, XUANYI JIN, Owen Carmichael, Lydia A Bazzano
Journal: Circulation (2024)

Background: Insulin resistance has been linked to a higher risk of cardiovascular events and cognitive impairment in older adults. Recently, an elevated triglyceride-glucose (TyG) index, a noninvasive marker of insulin resistance, has been linked to a greater risk of cardiovascular disease. Whether long-term TyG index variability from childhood to midlife impacts midlife cognitive function (CF) is unclear. Hypothesis: We hypothesized that elevated TyG index variability from childhood to midlife is associated with poorer midlife CF. Aim: We aimed to identify the impact of elevated TyG index variability from childhood to midlife on midlife CF. Methods: We studied 1,100 midlife Bogalusa Heart Study participants (age at enrollment: mean 9.5 years +/- standard deviation(SD) 3.5 years; age at midlife: 48.1 +/- 5.2 years; 60.3% women(663 of 1100), 34% Black(374 of 1100)) with ≥ 3 lipid and glucose measurements across follow-up. Participants with Type 2 diabetes mellitus were excluded. TyG index levels were calculated as ln [(serum fasting triglyceride in mg/dL x serum fasting glucose in mg/dL)/2]. TyG index measures of each individual were fitted into random-effects models stratified by race and sex, and individual growth curves were obtained. Visit-to visit TyG index variability from childhood to midlife was calculated by the deviation from age-predicted values (DEV) and residual SD (RSD) from these models. Midlife CF was measured from 10 neuropsychological (NP) tests, which were categorized into 3 distinct NP profiles (optimal, average, and mixed-low) using cluster analysis. Associations between TyG index variability and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status and the mean of TyG index levels from childhood to midlife. DEV and RSD were standardized to z-scores according to race and sex before regression analysis. Interactions according to race and sex were performed. Results: Every 1 SD increase in DEV increased the odds of having a mixed-low CF by 48.9% (95% CI 1.201, 1.847) and an average CF by 22.9% (95% CI 1.046, 1.443) compared to optimal CF, after adjusting for education status and mean TyG levels. Every 1 SD increase in RSD increased the odds of having a mixed-low CF by 51% (95% CI 1.217, 1.873) and an average CF by 25.4% (95% CI 1.068, 1.472) compared to optimal CF, adjusting for education status and mean TyG levels. Neither race nor sex modified the effects of DEV nor RSD on CF. Conclusions: Greater long-term TyG index variability was linked with poorer midlife CF. Further studies are needed to elucidate the brain effects of higher long-term variability in insulin resistance from childhood to midlife.
Abstract 33: Population Trends in Gestational Diabetes From 2000-2019: An Emerging Urban Epidemic?
Authors: Jonathan McGavock, Nicole Brunton, Heather Prior, Kevin Friesen, Charles Burchill, Jennifer Yamamoto
Journal: Circulation (2024)

Introduction: There is little information describing rates of gestational diabetes (GDM) over the last two decades among population sub-groups, particularly within an urban context. Hypotheses: Rates of GDM will increase over time, particularly among rural dwelling women and those living in low socio-economic neighbourhoods. Research Design and Methods: We performed a registry-based administrative cohort study of women that delivered a child between 2000 and-2019 (n = 293 514) in the entire province of Manitoba, Canada. GDM was defined as incident diabetes diagnosis between 21 weeks’ gestation and 6 weeks’ postpartum using ICD-10-CM codes (O24, E12-E14). Difference-in-differences analyses were used to compare incident rates of GDM during two time periods 2000-2009 (period 1) and 2010-2019 (period 2) for the entire population in Manitoba, Canada and among women in rural/urban areas, and low vs high income areas. Geospatial mapping examined changes in rates of GDM by neighbourhood-level. Results: Between period 1 and period 2, the number of deliveries increased from 51.3 /1000 (11,525 per year) to 53.8/1000 (12, 534 per year). During period 1 age standardized rates of GDM were 2 to 3-fold higher in women over 35 years old, compared to women 18-25 yrs (2.2 vs 4.7%). Between period 1 and period 2, incident rates of GDM in the province increased 3.5-fold (2.5 vs 8.7%), with trends more pronounced among women over 35 yrs compared to women 18-25 yrs (absolute difference-in-difference: 3.83%; 95% CI: 3.12 to 4.53%) and women living in urban areas, compared to women in rural areas (absolute difference-in-difference: 1.68%; 95% CI: 1.37 to 1.99%). Geospatial mapping suggests that the increased incidence of GDM in urban areas is occurring in neighbourhoods with a larger representation of new immigrants. Conclusions: Rates of GDM increased over 3-fold from 2000-2019, affecting 9% of pregnancies in 2019, particularly among women over 35 years old (14% of pregnancies) and women living in urban areas (10% of pregnancies). Geospatial mapping suggests urban trends in GDM are occurring in areas where recently immigrated women have settled.
Abstract 61: Differential Associations of Cardiovascular Health Factors With Vascular Health in Adults Free of Cardiovascular Disease
Authors: Mawra Jha, Zhiyong Dong, Maria Ruda, Brenton Prescott, Martin Larson, Matthew G Nayor, Vanessa Xanthakis, Emelia J Benjamin, Ramachandran Vasan, Ramachandran Vasan, Gary F Mitchell, Connie W Tsao
Journal: Circulation (2024)

Background: There is limited understanding of the association of the AHA's Life's Essential 8 (LE8), reflecting cardiovascular health (CVH) behaviors and factors, with vascular stiffness and hemodynamics in adults without cardiovascular diseases (CVD). Methods: In 2330 Framingham Heart Study Offspring participants (Exam 7, 1998-2002) with applanation tonometry and LE8 data (diet, physical activity, smoking, sleep health, BMI, lipids, glucose, blood pressure), we calculated CVH scores per AHA guidelines. In multivariable linear regression analyses adjusting for CV risk factors, we analyzed LE8 as a predictor of vascular health, assessed by carotid femoral pulse wave velocity (PWV) and central pulse pressure (CPP). We examined for effect modification by age (dichotomized at median) and sex in the associations between LE8 and arterial stiffness. We set p=0.05 and p=0.10 as thresholds for significance in primary and secondary analyses, respectively. Mediation analysis was utilized to discern the indirect effects of PWV and CPP on the relationship between LE8 and both all-cause and CVD mortality. Results: In our sample (60±9 years; 57% women; LE8 = 69±12), higher LE8 indicating better CVH, was associated with lower PWV and CPP (Table). Age and sex interactions were noted for PWV (p=0.01 and 0.07, respectively). Higher LE8 was associated with lower PWV in adults ≥59 years and women but not in &lt;59 years or men (Table). With low CVH category as referent, intermediate CVH category had no significant association with PWV and high CVH category had lower PWV. CPP was lower in the intermediate and high CVH categories compared to low CVH category (Table). PWV mediated 19% and CPP 10% of the association between LE8 and CVD mortality and 17% and 15%, respectively, for all-cause mortality. Conclusion: In our community cohort, we observed age and sex differences in the relationship between CVH and vascular health. Mediation analyses revealed indirect effects on mortality, warranting further study. Table
Abstract 53: Effect of Race / Ethnicity on Attrition and Weight Loss in a Behavioral Intervention
Authors: John M Jakicic, Renee J Rogers
Journal: Circulation (2024)

Background: Race and ethnic disparities may contribute to differences in the prevalence of excess weight and adiposity. Thus, it is of clinical, public health, and ethical importance for interventions to demonstrate effectiveness for all persons, and if not demonstrated, to appropriately modify these interventions. Hypothesis: We hypothesize that attrition and weight loss in a behavioral intervention differs by race/ethnicity. Methods: Participants were adults with overweight/obesity (N=383, age=45.6±8.0 years, BMI=32.4±3.8 kg/m 2 ), with 68.9% self-identifying as non-Hispanic white (NHW) and 31.1% self-identifying as a race/ethnicity other than NHW (non-NHW). Randomization was to one of three weight loss interventions for 12 months: 1) behavioral intervention plus a prescribed energy-reduced diet (DIET), 2) DIET plus prescribed progression to 150 min/wk of moderate-to-vigorous intensity physical activity, 3) DIET plus prescribed progression to 250 min/wk of moderate-to-vigorous physical activity. Attrition was assessed across the intervention period. Weight loss was assessed at 6-months and 12-months. Results: Attrition at 6 months was 11.2%, with this being 8.7% for NHW and 16.8% for non-NHW (p=0.020). Attrition at 12 months was 15.9%, with this being 12.9% for NHW and 22.7% for non-NHW (p=0.015). For participants completing 6 months of the intervention, percent weight loss was greater in NHW (-10.8% [95% CI: -11.6, -10.1]) versus non-NHW (-7.8% [-9.0, -6.6]) (p&lt;0.001), with this not differing by intervention condition (p=0.666). Similar findings were observed for participants completing 12 months of the intervention (NHW = -12.0% [95% CI: -13.0, -10.9]; non-NHW = -8.5% [95% CI: -10.2, -6.8]) (p=0.001). At 6 months, 83.4% of NHW and 66.7% of non-NHW achieved weight loss of ≥5% (p=0.001) and at 12 months 80.9% of NHW and 59.8% of non-NHW achieved weight loss of ≥5% (p&lt;0.001). Conclusions: On average, a behavioral intervention results in significant weight loss in both NHW and non-NHW adults. However, weight loss is less and the percent of adults achieving a clinically meaningful weight loss of ≥5% is lower in non-NHW compared to NHW. These findings along with greater attrition warrant consideration when implementing a behavioral weight loss intervention. Whether this difference in weight loss also attenuates the beneficial effects on adiposity-related conditions warrants examination. Supported by the National Institute of Health (HL103646)
Abstract 44: Soluble CD14 and Risk of Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Emmanuel Ogunlana, Katherine Wilkinson, Russell P. Sawyer, Laura M Raffield, Timothy B Plante, Mary Cushman, Nels C Olson
Journal: Circulation (2024)

Introduction: Black adults in the U.S. experience a greater burden of systemic inflammation and cognitive impairment and dementia compared with White adults. Increasing evidence suggests peripheral inflammation is a risk factor for cognitive decline, however few longitudinal studies have investigated these relationships. CD14 is a pattern recognition receptor expressed by monocytes and macrophages that promotes inflammation. Concentrations of the soluble form of CD14 (sCD14) vary by race, and higher sCD14 was associated with incident coronary heart disease (CHD) and stroke in Black but not White participants in the REGARDS cohort study. We hypothesized higher sCD14 would also be more strongly associated with incident cognitive impairment (ICI) in Black compared to White adults. Methods: We performed a nested case-control study of ICI in the REGARDS study, a biracial cohort of 30,239 American adults ≥45 years old. Cases were 495 participants without cognitive impairment or stroke at baseline who developed ICI during a median 3.5 years of follow-up based on abnormal scores on ≥2 of 3 cognitive tests. 587 controls were selected from a cohort random sample and free of cognitive impairment or stroke at baseline. Logistic regression models estimated odds ratios (OR) of ICI by concentration of sCD14 measured from stored baseline serum samples. We tested for a sCD14-by-race interaction a priori. Results: The sCD14-by-race interaction term was statistically significant in each model (p-interaction &lt;0.05). In analyses stratified by race, adjusting for demographic factors (age, sex, and region), a 1-SD increment sCD14 was associated with a 40% higher odds of ICI among Black adults (OR: 1.40; 95% CI: 1.07, 1.95) with no association among White adults (OR: 1.08; 95% CI: 0.90, 1.28). In models adjusted for cognitive and vascular risk factors (income, education, systolic blood pressure, hypertension medication use, dyslipidemia, BMI, history of heart disease, atrial fibrillation, diabetes, smoking, and alcohol use), the relationship was attenuated in Black participants (OR: 1.33; 95% CI: 0.96, 1.84) and remained null among White participants (OR: 0.99; 95% CI: 0.81, 1.22). Comparing those with sCD14 concentration &gt;90th percentile to below, adjusted for risk factors, Black participants had a 2.47 (95% CI: 1.08, 5.67) higher odds of ICI with no association in White participants (OR: 0.91; 95% CI: 0.46, 1.80). Discussion: Higher sCD14 was associated with ICI risk in Black but not White adults, similar to prior observations for stroke. Results suggest that sCD14-associated inflammatory responses may be a risk factor for ICI among Black adults.
Abstract 13: Associations Between Leisure-Time Physical Activity and Mortality by Sociodemographic Factors in a Nationally Representative Sample of 567,483 US Adults
Authors: Miriam E Van Dyke, Bryant J Webber, Eric T Hyde, John Williamson, William Boyer, Geoffrey P Whitfield
Journal: Circulation (2024)

Introduction: The 2018 Physical Activity Guidelines Advisory Committee Scientific Report called for investigating whether the established health benefits of meeting physical activity guidelines (PAG) differ by sociodemographic factors. Guidelines for adults recommend engaging in muscle-strengthening activities (MSAs; ≥2 days per week) and moderate-to-vigorous aerobic physical activity (MVPA; ≥150 minutes per week at moderate intensity, ≥75 minutes per week at vigorous intensity, or an equivalent combination). Objective: To examine associations between meeting MVPA and MSA guidelines (combined PAG) in leisure time and all-cause and heart disease mortality across sociodemographic factors. Methods: We used nationally representative data on 567,483 adults from the 1998-2018 US National Health Interview Survey (NHIS) and 2019 public-use linked mortality files from the National Death Index. Median follow-up was 9.5 years (range=1-21.8 years). We classified participants into categories (met combined PAG, met MVPA only, met MSA only, met neither) based on reported leisure-time physical activity. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between meeting the combined PAG vs. meeting neither guideline and all-cause and heart disease mortality, overall and stratified by sex (women, men), race and ethnicity (six groups), or education (four levels). Models were adjusted for sociodemographic and health factors. We conducted pairwise comparisons (adjusted for multiple comparisons) to determine if associations differed across sociodemographic factors. Results: Compared to meeting neither PAG, meeting the combined PAG was associated with a reduced mortality risk between 14-36% for all-cause mortality and 25-52% for heart disease mortality across sociodemographic groups. Reductions in mortality risk were larger for some groups compared with others. For example, reduction in all-cause mortality was larger for non-Hispanic White compared with Hispanic or Latino adults (HR=0.66 [95% CI: 0.64-0.69] vs. 0.86 [0.75-0.99]; pairwise p &lt;0.001) and for people with more vs. less education (college or more=0.64 [0.60-0.69] vs. less than high school=0.75 [0.69-0.82]; p &lt;0.001). Reduction in heart disease mortality was larger for women compared with men (0.54 [0.48-0.62] vs. 0.66 [0.60-0.73]; p &lt;0.001). Conclusions: Meeting the guidelines for MVPA and MSA generally provides a substantial reduction in risk of all-cause and heart disease mortality. There may be differences in the magnitude of benefit physical activity provides for health across sociodemographic groups. The reasons for these differences are unclear. Identifying factors contributing to these differences would further address research gaps identified in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.