tbuckley/cabot-search huggingface dataset:
Abstract P3176: Burden of Stroke Attributable to Air Pollution in India and its Trend from 1990-2021: A cross State Comparative Assessment
Authors: Deval Surana, Parth Adrejiya, Kushagrita Singh, Jeevanjyot Malhans, Janmay Vala, Shrey Goel, Saif Syed, Mohit Lakkimsetti, VISHRANT AMIN, JUHI PATEL, HARDIK DESAI
Journal: Circulation (2025)

Background: Stroke is a leading cause of mortality and disability worldwide, with environmental factors such as air pollution increasingly recognized as significant contributors. This study aims to evaluate the burden of stroke attributable to air pollution in India over a 31-year period. Methods: We conducted a retrospective analysis using burden of disease study 2021 from 1990 to 2021. The study focused on particulate matter (PM2.5 and PM10) as primary pollutants. The population attributable fraction (PAF) of stroke due to air pollution was calculated using risk estimates from contemporary studies, adjusted for demographic changes. Results: Over the three-decade period, the total recorded deaths attributable to air pollution-induced strokes amounted to 8,533,316, with an average of 7,983 deaths per year. The total Disability-Adjusted Life Years (DALYs) accrued due to strokes were over 204 million, averaging around 205,890 DALYs annually. Additionally, the total Years of Life Lost (YLLs) summed up to about 14,836,982, with a mean annual YLL of 192,675. Maharashtra reported the highest burden with 56,407 deaths, around 654,246 DALYs, and 611,353 YLLs due to stroke, indicating it as the state most affected by air pollution-related stroke incidents. In contrast, Sikkim reported the lowest stroke burden, with the smallest numbers across all measures: 109 deaths, 1,436 DALYs, and 1,250 YLLs. Males experienced a slightly higher stroke burden due to air pollution with 168,709 deaths and about 4,040,735 Years of Life Lost (YLLs). Females had about 148,785 deaths and approximately 3,377,256 YLLs. The 65-69 years age group had the highest number of deaths at 51,944 and over 1.26 million YLLs. This was closely followed by the 70-74 years age group, with about 54,945 deaths and over 1.10 million YLLs. Conclusion: Our findings underscore the critical need for stringent air quality control measures and public health strategies to mitigate the impact of air pollution on stroke incidence in India. Younger age groups, particularly below 25 years, show significantly lower numbers, indicating that air pollution primarily impacts the elderly in terms of stroke burden. Addressing this environmental risk factor is crucial for reducing the future burden of stroke and improving public health outcomes.
Abstract P3174: The Benefits of Probiotic Administration in Stroke Risk, Stroke-Related Gastrointestinal Complications, and Intestinal Flora Dysbiosis: A Meta-Meta-Analysis
Authors: Urvish Patel, Sarayu Devabhaktuni, Aishah Khan, Gaurav Sudhir, Devansh Gupta, Sindu Mukesh, Arpita Bhriguvanshi, Aakash Baskar, Tarun Parvataneni, Kogulavadanan Arumaithurai, Rohan Arora
Journal: Circulation (2025)

Introduction: Stroke is the second largest cause of death and third leading cause of disability worldwide. Some high-income countries have one in five lifetime cases and one in two in low-income countries. Due to the high stroke burden and aging population, better preventive and treatment approaches are needed. Recent research shows that stroke patients have a different gut microbiota than healthy people, suggesting a relationship between dysbiosis and stroke incidence and prognosis. Probiotics may improve stroke outcomes by strengthening the intestinal barrier and reducing inflammation. Hypothesis: Our study seeks to evaluate the potential benefits of probiotic supplementation in reducing the risk of ischemic stroke in healthy individuals as well as its impact on the prognosis of stroke patients, specifically in reducing gastrointestinal complications and improving gut microbiota balance (reduce dysbiosis). Methods: We conducted an umbrella meta-analysis of meta-analyses published in the last 10 years using PRISMA guidelines in PubMed. Using RevMan 5.4, we performed an inverse variance random effects model to calculate log (odds ratio) and converted it to pooled OR and 95% confidence interval to obtain a forest plot keeping alpha criteria 0.05. Heterogeneity and risk of bias assessment (by Newcastle-Ottawa Scale) were assessed. Results: While probiotic supplementation in healthy individuals did not significantly decrease the risk of ischemic stroke (OR 0.87 [95%CI 0.75-1.01]), it showed notable benefits in stroke patients. These positive effects included a substantial reduction in the odds of specific GI complications (constipation, diarrhea, gastric retention, esophageal reflux, vomiting, stress ulcers, and gastrointestinal bleeding) by 62% (0.38, 0.29-0.51), non-specific GI complications by 72% (0.28, 0.24-0.34), infection by 73% (0.27, 0.21-0.33) and a significant improvement in gut flora balance, reducing the odds of dysbiosis by 79% (0.21, 0.12-0.36). (p&lt;0.00001) The inter-study heterogeneity was 91% with (p&lt;0.00001, Chi 2 =128.76), a moderate risk of bias. Conclusion: Our umbrella meta-analysis highlights the potential benefits of probiotic supplementation in stroke patients, particularly in mitigating stroke-related GI complications and alleviating intestinal flora dysbiosis. These findings underscore the crucial role of gut-brain interactions in stroke and suggest that probiotics may serve as a promising component of stroke management.
Abstract P3098: Differences in Diet Quality Across US Census 2020 Regions: A Secondary Analysis in the Women’s Health Initiative
Authors: Matthew Landry, Jaylen Lee, Lesley Tinker, Aladdin Aladdin, Linda Van Horn, Sparkle Springfield, Linda Snetselaar, Marian Neuhouser, Abu Taiyab Nazmus Saquib, JoAnn Manson, JC Chen, Qian Xiao, Haley Hedlin, Shawna Follis, Marcia Stefanick
Journal: Circulation (2025)

Diet quality is a key modifiable risk factor for cardiovascular health. Racial and ethnic disparities in diet quality have been well-documented. However, few studies test how geographical context affects these associations in older women. Furthermore, these inequities have been reported to be unevenly distributed across different geographic regions in the United States (US). This analysis aimed to examine differences in diet quality across the four US Census 2020 regions (i.e., Northeast, Midwest, South, West) using data from the Women's Health Initiative (WHI) study. Informed by prior studies, we hypothesized that diet quality would differ across the four US Census regions, with the Northeast having the highest diet quality and the South having the lowest diet quality. In a secondary analysis of baseline data from the WHI, a large-scale longitudinal study of postmenopausal women, participants' dietary intake was assessed using a food frequency questionnaire. A Healthy Eating Index (HEI-2020) score was calculated as a measure of overall diet quality. Linear regression models were used to compare HEI-2020 scores across the four US Census regions adjusting for relevant sociodemographic covariates (age, education, income, employment, marital status, and race and ethnicity). In 161,299 women (M age = 63.2 ±7.2) with dietary intake data, mean HEI-2015 scores differed across regions, with the highest score in the West (63.7 ±0.1) and the lowest score in the Northeast (62.1 ±0.1). These regional differences persisted even after adjusting for sociodemographic covariates (p&lt;0.001). Statistically significant interactions between race/ethnicity and census region on HEI-2020 total score were observed. Non-Hispanic White women living in the West region had the highest diet quality (64.9 ±0.2), while Hispanic women of any race in the Northeast had the lowest diet quality (61.1 ±0.1). This analysis reveals significant regional differences in diet quality among postmenopausal women across the US. Contrary to our hypothesis, WHI participants in the West region exhibited the healthiest diets and women in the Northeast region exhibited the least healthy diets. Findings highlight a need for targeted dietary assessments and public health initiatives to assess for regional differences in dietary intake. Given the disparities in diet observed in this analysis, other population-wide cohort studies should further account for potential geographic differences involving diet analyses.
Abstract P3076: Incident hypertension by biomarker patterns: REasons for Geographic and Racial Differences in Stroke (REGARDS) stud
Authors: Timothy Plante, Annie Green Howard, Stephen Juraschek, Kathryn Foti, Mary Cushman, Virginia Howard, George Howard, Nels Olson, Leann Long, Paul Muntner, Suzanne Judd
Journal: Circulation (2025)

Background: We recently empirically identified 3 novel patterns of cardiovascular risk factor biomarkers with factor analysis: Renal-inflammatory, thrombo-inflammatory, and dyslipidemic-inflammatory. Hypertension is a major cardiovascular disease risk factor. Whether these patterns are associated with incident hypertension are unknown. Objectives: To determine the association between novel risk patterns and incident hypertension. Methods: REGARDS recruited 30,239 Black and White adults from the 48 contiguous US states in 2003-2007 with a second visit in 2013-2016. Baseline fasting lipids, C-reactive protein (CRP), cystatin C, urine albumin/creatinine ratio, blood urea nitrogen (BUN), complete blood count, and serum albumin were measured in all or most participants. A robust set of other baseline biomarkers was measured in a sex-race stratified sample of 4,400 participants who attended both visits. Factor scores for each pattern were developed and applied to each of the 2,723 participants with all available baseline biomarkers. Hypertension was defined as baseline blood pressure (BP) ≥140/90 mm Hg or self-reported use of antihypertensive medications. We excluded participants with prevalent hypertension. Tertiles of each factor score were computed in the analytical population. Modified Poisson regression estimated the adjusted relative risk (RR) of incident hypertension by factor pattern tertile, testing for pairwise interactions between each factor. Because of a significant thrombo-inflammatory*dyslipidemic-inflammatory interaction on hypertension (P=0.06; interaction significance threshold &lt;0.10), these groups were stratified across each other’s tertiles. Results: Among the 1,223 included (mean [SD] age 61 [8] years, 25% Black race, 64% women), 34% developed incident hypertension. There was no difference in age, sex, race, or baseline systolic BP-adjusted RR of hypertension by tertile of the renal-inflammatory pattern ( Figure ). Relative to the lowest tertile combination, there was a higher RR of incident hypertension across higher dyslipidemic- and thrombo-inflammatory pattern tertiles (3 rd tertile of each: RR 1.67; 1.10 to 2.52). Discussion: Among Black and White adults, thrombo-inflammatory and dyslipidemic-inflammatory biomarker patterns were strongly associated with incident hypertension. Behavioral or medical therapies targeting specific biological pathways represented by these patterns may provide targets to prevent hypertension and its sequelae.
Abstract MP15: Different Questions Lead to Different Answers: Comparing Different Survey Methods for Assessing Relationships between Sleep Duration and Cardiometabolic Health Risk Factors
Authors: Michael Grandner
Journal: Circulation (2025)

Introduction: Sleep Duration is part of Life’s Essential 8, and sleep duration items are included in surveys. Yet, sleep duration can be assessed in several ways. The present study examined the degree to which assessing sleep duration using different survey items produces different results when examining associations with cardiometabolic health. Methods: Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study was used. SHADES is a community-based study of adults in southeastern Pennsylvania (N=1007). Habitual sleep duration was assessed in four ways: the National Health and Nutrition Examination Survey (NHANES) item assessed hours on a typical weeknight, the Behavioral Risk Factor Surveillance System (BRFSS) item assessed typical hours in 24h, the Pittsburgh Sleep Quality Index (PSQI) item assessed hours on a typical night, and the Sleep Timing Questionnaire (STQ) computed typical weeknight and weekend sleep from self-reported bed and wake times. These were evaluated continuously and categorized as short (≤6h), normal (7-8h, reference), and long (≥9h). Correlations among variables were computed. Binary logistic regression analyses adjusted for age and sex examined each of these sleep continuously and categorically relative to obesity, hypertension, hypercholesterolemia, and arrhythmia. Results: Although questions were asked of the same participants at the same time, there was notable variability in responses. No pairs were collinear in either Pearson or Spearman correlations; most correlations were weak to moderate. The Table shows results of regression analyses. As a continuous variable, increased sleep duration was associated with decreased likelihood of obesity and hypertension, but this was only observed using some variables. Also, short and long sleep were associated with obesity and hypertension, and long sleep was associated with increased likelihood of hypertension, hypercholesterolemia, and arrhythmia, but these results were only observed using certain variables. Conclusions: Despite similarly-worded self-report items, there was a high degree of inconsistency regarding whether sleep duration variables were associated with cardiometabolic disease risk factors. This has implications for epidemiologic studies attempting to assess Life’s Essential 8. Assessments that differentiate time in bed vs sleep, and nighttime vs 24-hour sleep, may produce differing results.
Abstract P3079: Proton Pump Inhibitor Use and Incident Hypertension in Postmenopausal Women: Results from the Women’s Health Initiative.
Authors: Ahmed Soliman, Jean Wactawski-Wende, Kathleen Hovey, Amy Millen, Charles Eaton, Shelly Gray, Michael LaMonte
Journal: Circulation (2025)

Introduction: Proton pump inhibitors (PPI) could impact blood pressure regulation by suppressing gastric acid required for the conversion of oral nitrite into nitric oxide. Whether PPI use is associated with incident hypertension remains unknown. Methods: We included 64,720 postmenopausal women who were free from cardiovascular disease and hypertension at enrollment into the Women’s Health Initiative Observational Study (1993-1998). Baseline PPI use and duration was ascertained from medication inventories. The outcome was physician diagnosed-treated hypertension, assessed by self-report on annual questionnaires. Kaplan-Meier curves were used to visualize unadjusted annualized incident hypertension according to baseline PPI use. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox proportional hazard models for incident hypertension according to baseline PPI use (no/yes) and duration (&lt; 1 year, 1-3 years, &gt;3 years). Propensity score adjustment was used to account for residual confounding by indication. Results: A total of 28,951 cases of incident hypertension were accrued after a mean follow up of 8.7 years. PPI users had significantly higher annualized hypertension incidence compared to non-users over the follow-up time (Figure). PPI use was associated with 15% higher risk of hypertension compared to non-use in the fully adjusted model (HR: 1.15, 95%CI: 1.06-1.25) and the association remained significant after propensity score adjustment (HR: 1.17, 95%CI: 1.14-1.19). Longer PPI use durations were associated with higher risk of hypertension (HR: 1.11, 1.16, 1.28, respectively) and showed a significant trend (P &lt;.001). Conclusions: PPI use was associated with higher risk of diagnosed hypertension in postmenopausal women after adjusting for relevant confounders. The association showed a significant trend according to PPI duration of use. More research is needed to confirm such results.
Abstract MP22: A Measurement Model of Socioeconomic Status and its Association with Cardiovascular Disease in the Hispanic Community Health Study/Study of Latinos
Authors: Christina Cordero, Emma Romaker, Marissa Kobayashi, Morgan Gianola, Linda Gallo, Carmen Isasi, Krista Perreira, Leonor Corsino, Laura Zhou, Maria Llabre
Journal: Circulation (2025)

Objectives: Low socioeconomic status (SES) is consistently associated with adverse cardiovascular health. Three key indicators are typically used as proxies for SES: income, education, and occupation. However, these indicators may not fully capture the unique sociodemographic features relevant to the SES of Hispanics/Latinos in the U.S. This study aims to expand the traditional SES model by identifying and incorporating additional features specific to Hispanic/Latino persons, providing a more comprehensive assessment of SES and its relationship with cardiovascular disease (CVD). Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a community-based longitudinal cohort study of 16,415 adults self-identifying as Hispanic/Latino, enrolled from 2008-2011 from four U.S. urban communities. We utilized a multiple indicator multiple cause (MIMIC) model to identify formative and reflective indicators of a latent variable for SES. CVD was ascertained by self-report during the second in-person clinic examination from 2014-2017 (V2; N=11,623) and was defined as having had a heart attack, stroke, or angioplasty, stent, or bypass procedure. A survey logistic regression model was then used to examine the association of the latent SES with CVD at V2. Models were adjusted for age, sex, and study site. Results: Significant formative indicators of the SES latent variable included education level, whether the highest level of education was obtained in the US, employment status, and age at immigration (included in a second model with immigrants only; n=9,623). Significant reflective indicators of the SES latent variable included income, the MacArthur SES ladder, and affluence level. The measurement model demonstrated good fit to the data (RMSEA=0.016; CFI=0.984, SRMR=0.02). The SES latent variable was associated with CVD (OR=0.70, 95% CI 0.58, 0.84; for immigrants only OR=0.64, 95% CI 0.53-0.77). Conclusions: Incorporating indicators relevant to Hispanic/Latino populations provides a more comprehensive assessment of SES with potentially improved validity. The latent SES variable, including factors such as education location and age at immigration, was significantly associated with lower odds of cardiovascular disease. These findings highlight the importance of using a culturally-tailored SES framework when examining health outcomes in Hispanics/Latinos.
Abstract MP07: Derivations of Supine and Standing Blood Pressure and Their Associations with Adverse Cardiovascular and Hypotension-Related Events
Authors: Manfred Mate-Kole, Ruth-Alma Turkson-Ocran, Fredrick Larbi, Hannah Col, Md Marufuzzaman Khan, Long Ngo, Lynne Wagenknecht, B Gwen Windham, Elizabeth Selvin, Pamela Lutsey, Stephen Juraschek
Journal: Circulation (2025)

Background: Postural drops in systolic blood pressure (SBP) are associated with cardiovascular and hypotension-related adverse events (falls, syncope). These associations are traditionally thought to be secondary to low standing blood pressure; however, the role of both high and low SBP in supine and standing positions has not been thoroughly characterized. Objectives: To compare traditional and alternative derivations of supine and standing SBP with adverse cardiovascular and hypotension-related outcomes. Methods: The Atherosclerosis Risk in Communities (ARIC) study measured supine and standing SBP in adult participants aged 45-64 between 1987–1989 and followed them for over 30 years. We examined low and high values (see Table) of supine SBP, standing SBP, absolute and relative differences in SBP after standing, and mean SBP between both positions in relation to adjudicated coronary heart disease (CHD) or all-cause mortality events as well as medical claims-based falls and syncope. We used Cox regression with adjustment for CVD risk factors. Cutpoints were chosen to match a population percentile approximating a 20 mm Hg difference between supine and standing SBP (the traditional definition for orthostatic hypotension). Results: Among 11,399 participants (mean age 54 yr [SD, 5.7]; 56% female; 25% Black adults), relative or absolute drops in SBP were associated with CHD and mortality. Higher mean supine and standing BP was also associated with CHD (HR 1.72; 1.41, 2.09) and all-cause mortality (HR 1.74; 1.54, 1.96). An absolute decrease (HR 1.24; 1.02, 1.50) or increase (HR 1.27; 1.01, 1.60) in SBP was associated with falls. An absolute or relative decrease (both HRs 1.48) and higher supine SBP (HR 1.30; 1.07, 1.58) were associated with syncope. Lower supine SBP was inversely associated with CHD (HR 0.62) and all-cause mortality (HR 0.82). Lower standing SBP was also inversely associated with CHD (HR 0.78; 0.64, 0.94) but not with falls or syncope. Conclusion: While both cardiovascular and hypotension-related outcomes were associated with postural drops in SBP, these outcomes were not consistently associated with low standing SBP. Rather, high supine SBP was associated with a greater risk of CHD, syncope, and death. Moreover, a rise in SBP with standing was associated with falls. These findings call attention to high SBP as a risk factor for both cardiovascular and hypotension-related outcomes and may have implications for treatment strategies if replicated.