tbuckley/cabot-search huggingface dataset:
Abstract P3073: Racial/Ethnic Disparities in the Hypertension Control Cascade Among U.S. Young Adults
Authors: Ciaran Kohli-Lynch, Norrina Allen
Journal: Circulation (2025)

Introduction: Treating hypertension in young adulthood can reduce the cumulative burden of elevated BP and prevent end organ damage. Despite marked improvements in from 2000-2010, hypertension prevalence, awareness, treatment, and control rates (the ‘hypertension control cascade’) plateaued among US adults after 2010. No recent study has examined trends in young adult hypertension control across race/ethnicity groups. Objective: We aimed to estimate the prevalence of hypertension control cascade elements by age-group and race/ethnicity in CVD-free U.S. adults, using contemporary data. Methods: Analyses were completed with 2015-March 2020 NHANES data. Survey-weighted logistic regression estimated the odds ratio for race/ethnicity and each element of the hypertension control cascade, adjusting for age and sex. Analyses were completed separately for young and older adults. Finally, we projected the total number of young adults living with hypertension and uncontrolled hypertension by combining prevalence data, the proportion of each age-group that was CVD-free, and population estimates from the U.S. census bureau. Results: Hypertension prevalence was substantially higher for older adults compared to young adults (44% vs 9.7%). Rates of awareness (83% vs 70%), treatment (77% vs 55%), and control (56% vs 43%) were higher for older versus younger adults. Around 9.4M (95% CI: 7.1M-11M) CVD-free young adults have hypertension, of whom, around 5.3M (95% CI: 4.7-6.0M) have uncontrolled hypertension. Compared to Non-Hispanic White (NHW) young adults, Non-Hispanic Black (NHB) counterparts had a significantly elevated likelihood of having hypertension (odd ratio [OR]: 1.04, 95% CI 1.01-1.07). Among those with hypertension, NHB young adults also had significantly lower likelihood of hypertension treatment (OR 0.80, 95% CI: 0.71-0.90) and control (OR 0.77, 95% CI 0.68-0.87). Similarly, Hispanic young adults had significantly lower likelihood of hypertension awareness (OR 0.78, 95% CI: 0.67-0.92), treatment (OR 0.74, 95% CI: 0.64-0.85), and control (OR 0.79, 95% CI: 0.69-0.90). Conclusion: Rates of hypertension control are significantly lower for young adults and especially for those from racial/ethnic minority groups. This likely leads to disparity in later life health outcomes. Unequal hypertension control across racial/ethnic groups in older adulthood may be partly explained by differences in awareness and treatment in young adulthood.
Abstract P2084: Independent prognostic factors of mortality in young patients after STEMI
Authors: Dmytro Bilyi, ALEXANDER PARKHOMENKO, Yaroslav Lutay, Oleg Irkin, Anton Stepura
Journal: Circulation (2025)

Young patients (pts) with acute myocardial infarction and ST-segment elevation (STEMI) are a specific subset of a population with different risk factor profiles, clinical presentations, and prognosis as compared to older patients. Despite the more favorable hospital course of STEMI in young pts, major CV events after discharge from hospital remains at a high level. The Aim: To identify independent markers of high death risk in young STEMI pts during long-term follow-up. Materials and Methods: The data of long-term observation of 130 pts aged&lt;45 years (mean 39.4±5.7 years) hospitalized with a diagnosis of STEMI were analyzed. The follow-up period of patients was 4.89±2.66 years. The development of death from any cause assessed. Identification of independent risk factors performed using multivariate analysis (Cox regression). Results: During the 5 years of follow-up, 11 deaths from any cause were recorded (8% or 14.5 cases per 10,000/months). The median time to death is 34 months. The main risk factors for death were smoking (aHR14.17: 95%CI, 2.14-93.69) and arterial hypertension (aHR6.42: 95%CI, 1.45-28.39). More than half of the deaths (6/11) occurred among patients who had both factors – smoking and hypertension. Conclusions: The combination of independent risk factors for death in young pts after STEMI (smoking and arterial hypertension) is important marker of long-term prognosis.
Abstract MP05: Consuming Pecans as a Snack Improves Lipids/Lipoproteins Compared to Usual Diet in Adults at Increased Risk for Cardiometabolic Diseases: A Randomized Controlled Trial
Authors: Tricia Hart, Penny Kris-Etherton, Kristina Petersen
Journal: Circulation (2025)

Background: Nut intake is associated with lower risk of cardiometabolic diseases through reductions in low density lipoprotein cholesterol (LDL-C) and triglycerides and improvements in measures of glycemic control. The cardiometabolic effects of pecan consumption have been less studied in comparison with other nuts. Objectives: The aim of this trial was to examine how substitution of usual snack foods with 57 g/day of pecans affects lipids and lipoproteins and measures of glycemic control compared to continuing usual dietary intake after 12-weeks in individuals at increased risk for cardiometabolic diseases. Methods: A 12-week single-blinded, parallel, randomized controlled trial was conducted. Adults with overweight or obesity and with ≥1 criterion for metabolic syndrome who were free from cardiovascular disease and type 2 diabetes were included. Participants were provided with 57 g/day of pecans and instructed to replace the snacks usually consumed with the provided pecans. The control group was instructed to continue consuming their usual intake. Lipids/lipoproteins and glycemic outcomes (i.e., fasting plasma glucose, hemoglobin A1C and insulin) were measured over two days approximately 24 hours apart at baseline and after 12 weeks. The between-group difference in the change from baseline for each outcome was evaluated by linear regression with adjustment for the baseline value, age, sex and body mass index. Results: In total, 138 participants (46 ± 13 years, 29.8 ± 3.7 kg/m 2 ; 59% female) were randomized. Both groups had 69 participants. Compared to the usual diet group, pecan intake reduced total cholesterol (-8.1 mg/dL; 95% CI -14.5, -1.7), LDL-C (-7.2 mg/dL; 95% CI -12.3, -2.1), non-HDL-C (-9.5 mg/dL; 95% CI -15.3, -3.7), and triglycerides (-16.4 mg/dL; 95% CI -30.0, -2.9) from baseline to 12 weeks. No between-group differences were observed for high-density lipoprotein cholesterol (HDL-C) or measures of glycemic control. Conclusions: Replacing usual snacks with 57 g/day of pecans for 12 weeks improved lipids and lipoproteins in adults at increased risk for cardiometabolic diseases.
Abstract MP03: Metabolite Signature of Ultra-processed Foods Intake and Cardiovascular Morbidity and Mortality Among Low-income Black and White Americans
Authors: Lei Wang, Martha Shrubsole, Qiuyin Cai, Deepak Gupta, Loren Lipworth, Xiao-Ou Shu, Danxia Yu
Journal: Circulation (2025)

Background: High ultra-processed foods (UPF) intake may increase risks of CVD morbidity and mortality, but the mechanisms are unclear, and there is no biomarker for UPF intake. We aimed to identify UPF-related circulating metabolite signature (UPFsig) and evaluate its associations with incident coronary heart disease (CHD) and CVD mortality in a cohort of mostly low-income Black and White Americans. Methods: Untargeted profiling of baseline plasma metabolites was conducted in two nested case-control studies of incident CHD (n=1023) and incident prostate cancer (n=665). An 89-item food frequency questionnaire was administered at baseline (2002-2009). UPF intake (classified by Nova) was calculated as % of weight per day. The associations of UPF intake with 1,100 metabolites were evaluated by linear regression, adjusting for fasting status, batch, age, sex, race, education, income, smoking, alcohol drinking, physical activity, sitting hours, daily calories, BMI, and history of diabetes, hypertension, and hypercholesterolemia. Metabolites with P &lt;0.05 were selected by elastic net with repeated 10-fold cross-validation to construct the UPFsig. Conditional logistic and Cox regression were used to examine the associations of UPFsig with incident CHD and CVD mortality, respectively. Results: Of 1,688 participants, 70% were men, 61% were Black, and the mean baseline age was 56.5 (SD:12.0) years. The mean intake of UPF was 41.1% (SD:15.3). A total of 126 metabolites were selected to construct UPFsig (correlation r=0.51, P &lt;0.0001). The UPFsig was associated with incident CHD (adjusted OR [95%CI] per SD increase =1.43 [1.20-1.69]), particularly among Black (1.73 [1.35-2.22]) compared to White participants (1.17 [0.93-1.47], P interaction =0.01). Additionally, during a mean 13.4-year follow-up, 285 CVD deaths were noted. The UPFsig was associated with CVD mortality (adjusted HR [95%CI] per SD increase =1.22 [1.07-1.39]), even after adjusting for UPF score (1.17 [1.01-1.36]). The adverse associations were largely consistent across participants of varied sociodemographics, lifestyles, and metabolic disease status. Conclusions: We identified a metabolite signature of UPF and demonstrated its significant associations with CVD morbidity and mortality. The UPFsig may serve as a biomarker and provide insight into mechanisms of UPF intake on CVD. The racial difference in the association of UPFsig with incident CHD warrants further research.
Abstract P3052: Ttitle: Multi-Omic Responses to Low-Calorie Diet Intervention for Remission of Type 2 Diabetes and Individual Variability Short title: Multi-Omics, Low-Calorie Diet, and Diabetes Remission
Authors: Shuxiao Shi, Sujing Wang, Wu DeShan, Kexin Li, Guangrui Yang, Lan Xu, Nannan FENG, Xihao Du, Victor Zhong
Journal: Circulation (2025)

Introduction: Remission of type 2 diabetes (T2D) can be achieved by a low-calorie diet (LCD) intervention, but molecular mechanisms remain poorly understood. Furthermore, whether responders for T2D remission and non-responders to an LCD intervention have distinct molecular responses and genetic determinants is yet clear. Methods: A 6-month LCD intervention (815-835 kcal/d) was conducted among Chinese patients with T2D who had BMI of 24-45 kg/m 2 and HbA1c level of 6.5-12.0%. Clinical biomarkers, genome, serum proteome, metabolome (serum and feces), and gut microbiome were measured at baseline and weeks 1, 12, and 24. Linear mixed models were used to identify significant changes in multi-omic markers during the 24-week intervention. A noise-augmented von Mises-Fisher mixture model was used to cluster the trajectories of significant omic markers. Different multi-omic responses between responders for T2D remission and non-responders were identified using linear mixed models, adjusting for age, sex, T2D duration, visit time, and baseline BMI as fixed effects and participant ID as random effect. Genome-wide association analysis (GWAS) was used to find single nucleotide polymorphisms (SNPs) associated with T2D remission. We used the Benjamini-Hochberg procedure to control the false discovery rate &lt; 5% for all analyses. Results: Thirty-two participants were analyzed (mean age: 39.8 years, BMI: 29.8 kg/m 2 , HbA1c: 8.0%; 34% women). Significant changes in omic markers post intervention were observed in 46 proteins, 106 serum metabolites, 222 fecal metabolites, and 153 gut bacteria, clustering into 6-8 distinct trajectories per omics. Pathway enrichment analysis mapped these signatures to cholesterol metabolism, glycolysis, and TCA cycle pathways. Between responders and non-responders, 261 proteins, 197 serum metabolites, 212 fecal metabolites, and 171 gut bacteria differed; among these markers, 11 proteins, 27 serum metabolites, 37 fecal metabolites, and 23 gut bacteria also changed significantly post the LCD intervention. However, no SNP was associated with T2D remission. Significant associations of multi-omic markers with muscle mass, liver fat, glycemic control, insulin resistance, and insulin secretion were found. Conclusions: Dramatical changes in multi-omic markers, enriched in glucose, lipid, and energy metabolism pathways, were observed following an LCD intervention. Multi-omic differences between responders and non-responders for T2D remission were delineated.
Abstract P3094: Digital Cardiovascular Health Promotion Among Adolescents In Nepal
Authors: Dayana Shakya, Jon Victor Bankler, Hua Bai, Ulf Wilhelmsson, Nawi Ng, Natalia Oli, Abhinav Vaidya, Alexandra Krettek
Journal: Circulation (2025)

The burden of cardiovascular diseases (CVDs) and the risk factors in adolescents are rising in Nepal, a low-income setting. Therefore, focusing on health education related to diet and physical activity for adolescents in their formative years is urgent. A digital medium may be an efficient way to reach this technologically oriented group. We developed a digital educational game through a collaboration between researchers in health and informatics from Nepal and Sweden and piloted the game as part of the ‘Heart-Related Intervention with Digitalization Among Young Adolescents (HRIDAYA)’ study. We found that 99% of adolescents had access to smartphones and 92% had access to the internet. The digital game was developed for android devices due to their predominance in Nepal. First, a survey was conducted among 649 adolescents to identify their digital prerequisites as well as their gaps in CVD-related knowledge, attitude, and practice. Second, the identified gaps defined the learning goals of the game, forming the foundation for an initial draft of the game concept. Third, we created a game paper prototype and tested it among 10 adolescents to explore their visual recognition and preferences. Based on the findings, we chose two levels of fidelity and tested them with 44 adolescents. We found that a higher-fidelity abstract style resulted in more positive feelings. This style was subsequently used for the final game. Fourth, the game was developed through an iterative process, which included both culturalization efforts and ensuring educational viability. Finally, the completed digital educational game ‘Happy Heart’ was played by 176 adolescents. It consisted of seven mini-games related to sugar, salt, and fat in different food items, physical activities, balanced diet, and nutrition groups. Immediate audio and video feedback kept the players motivated. Written texts in the game journal addressed knowledge gaps that could not be converted to game mechanics. In conclusion, a digital education like Happy Heart may be helpful in increasing knowledge, attitude and practice regarding CVDs among Nepalese adolescents. The development process indicated that the digital game has the potential to reach many adolescents and that they were receptive to the game. As the game is a low-cost educational effort that can easily be scaled up, it provides a promising avenue for cardiovascular health promotion in similar low-income settings.
Abstract P1140: PREVENT 30-Year CVD Risk Associated With Greater Odds of Adverse Pregnancy Outcomes
Authors: Alexa Freedman, Sadiya Khan, Ellen Francis, Lauren Keenan-Devlin, Linda Ernst, Gregory Miller, Ann Borders
Journal: Circulation (2025)

Introduction: Poor pre-pregnancy cardiovascular health is associated with adverse pregnancy outcomes (APOs). We sought to investigate whether estimated 30-year CVD risk from the PREVENT equation similarly predicts APOs. Hypothesis: We hypothesized that higher 30-year CVD risk mid-pregnancy would be associated with greater risk of APOs, including preterm delivery and preeclampsia. Methods: Participants are from the Stress, Pregnancy, and Health (SPAH) study, conducted in Evanston, IL between 2018-2023. During the 2 nd trimester study visit, blood pressure was measured and participants provided a blood sample. Nuclear magnetic resonance was used to measure serum cholesterol and creatinine (used to estimate eGFR). Medication use, pre-gestational diabetes diagnosis, and APOs, including preterm delivery (&lt;37 weeks gestation), early preterm delivery (&lt;34 weeks) and preeclampsia, were abstracted from medical records. The PREVENT equation was used to estimate 30-year CVD risk based on 2 nd trimester measures. Logistic models were used to test associations between CVD risk in pregnancy and APOs, adjusted for race/ethnicity, as a marker of structural factors, socioeconomic position, based on household educational attainment and occupational prestige, and gestational age at the study visit. Results: SPAH included 605 participants, 524 of whom had complete data to estimate 30-year CVD risk from the 2 nd trimester study visit (mean gestational age at visit: 23.7 weeks, SD: 1.7). The mean age of participants was 33.3 years (SD: 5.5) and 18% identified as Black, 21% as Hispanic, 49% as White, and 12% as another group. The mean 30-year CVD risk during pregnancy was 7.6% (SD: 6.6), 11% delivered preterm, and 10% developed preeclampsia. In the adjusted model, a 1 SD increase in CVD risk was associated with 41% greater odds of preterm delivery (95% CI: 1.14, 1.74), 67% greater odds of early preterm delivery (95% CI: 1.27, 2.19), and 71% greater odds of developing preeclampsia (95% CI: 1.36, 2.14; Figure 1). Conclusions: Results suggest that a higher PREVENT 30-year estimated CVD risk in mid-pregnancy is associated with greater odds of delivering preterm and developing preeclampsia. These APOs are associated with long-term offspring CVD risk, also highlighting the intergenerational implications of PREVENT CVD risk estimates.
Abstract P1141: Breastfeeding and Postpartum Cardiovascular Health Behaviors at 3 Months in the Postpartum 24/7 Cohort
Authors: Elly Marshall, Kara Whitaker, Kathryn Chmelik, Taylor Marske, Amna Umer, Christa Lilly, Bethany Barone Gibbs
Journal: Circulation (2025)

Introduction: Breastfeeding promotes long-term cardiovascular health (CVH), but breastfeeding or using a breast pump as a primary infant feeding method may limit a mother’s capacity to engage in healthy CVH behaviors during the postpartum period. This study aimed to evaluate whether breastfeeding status defined as direct or indirect (pumping) at 3 months postpartum is associated with Life’s Essential 8 (LE8) CVH behaviors, including physical activity, sleep, diet, and avoidance of nicotine. Hypothesis: Those breastfeeding at 3 months postpartum will have less optimal physical activity, sleep, and diet scores, but better nicotine exposure scores. Methods: This is a secondary analysis of the Postpartum 24/7 cohort (n=50) at 3 months postpartum. Breastfeeding status was self-reported (yes/no). CVH behavior scores were assessed using the LE8 framework, which included device-based measures of physical activity (activPAL), self-reported sleep duration (Pittsburgh Sleep Quality Index), a diet assessment tool (Mediterranean Eating Pattern for Americans), and self-reported past and current nicotine exposure. Each CVH behavior was scored from 0 (least healthy) to 100 (most healthy) and an overall mean score was calculated by averaging scores across components. Multiple linear regression evaluated the association between breastfeeding and CVH behavior score, adjusting for pre-pregnancy BMI, race, and education. Mann-Whitney U tests evaluated differences by breastfeeding status and each CVH component. Results: At 3 months postpartum, 80% of the cohort (n=40) reported breastfeeding. Adjusted models showed that overall mean CVH behavior scores were similar and moderate (ranged 50-79) for both breastfeeding [69.3 ± 2.9 (SE)] and non-breastfeeding [68.1 ± 5.1] groups (p=.81). For specific CVH behaviors, nicotine exposure scores were highest while diet scores were lowest (see Figure). Breastfeeding and non-breastfeeding groups also had similar median scores for sleep and nicotine exposure. However, breastfeeding mothers had higher median scores for diet and physical activity that were possibly clinically meaningful though not statistically significant. Conclusion: Overall, breastfeeding status was not associated with CVH behavior scores at three months postpartum. As postpartum women had only moderate CVH behavior scores, this indicates a significant opportunity in the life course for promoting CVH behaviors, and particularly diet, regardless of breastfeeding.
Abstract 009: Association of Accelerated Biological Aging in Midlife with Cardiovascular and Health Outcomes in the Framingham Offspring Study
Authors: Stephanie Pan, Vanessa Xanthakis, Vasan Ramachandran
Journal: Circulation (2025)

Introduction: Biological age acceleration (BAA) constructed from multi-organ system biomarkers may better elucidate the aging process relative to chronological age (CA). We evaluated the association of BAA with long-term health outcomes among middle-aged adults. Hypothesis: We related mid-life accelerated BA to the incidence of death, CVD, and dementia. Methods: We modeled BAA using multiple biomarkers (anthropometric and biochemical indicators of vital organ systems) at the sixth examination cycle (1995-1998) for up to 2038 Framingham Offspring participants. Stratified by sex, we estimated BA using the Klemera and Doubal method (KDM) with principal components. Standardized residuals from regressing KDM-BA on CA were used to define accelerated BA (&gt;1 SD), moderate BA ([-1 to 1 SD]), and slow BA (&lt;-1 SD; referent). Utilizing multivariable-adjusted Cox proportional hazards and competing risk models, we related BAA to incident death, CVD, and dementia. Results: Over a median follow-up of 24 years (max 27 years), participants (mean age 57 years, 57% women) experienced 656 deaths, 454 new-onset CVD events, and 170 incident dementia outcomes. Men and women with accelerated BA had a 2.1-fold (95%CI [1.40-3.21]; p=0.0004) and a 1.7-fold higher risk for death (95%CI [1.10-2.55]; p=0.02), respectively, compared to the referent group. Women with accelerated BA had a 1.8-fold higher risk of CVD (95%CI [1.12-2.90]; p=0.02) compared to slow BA. Higher BAA was associated with a higher dementia risk (HR per SD-increase 1.25, 95%CI [1.03-1.53]; p=0.03) in women. Conclusions: Multiple biomarkers that signal the aging of biological organ systems can be combined to reflect BA. In our community-based sample, accelerated midlife BA was characterized by a higher risk of death and CVD in both sexes and with dementia risk in women. These findings underscore the importance of healthy multisystem aging over the life course.