tbuckley/cabot-search huggingface dataset:
Abstract 4123373: Estimating obesity-attributable cardiovascular disease burden in the United States: a Bayesian network analysis
Authors: Sunny Sheth, Samantha Clark, Anthony Fabricatore, Mads Faurby, Azadeh Houshmand-Oeregaard, Joshua Toliver, Warren Stevens
Journal: Circulation (2024)

Background: Obesity is a known contributor to the development of cardiovascular disease (CVD) and increases the risk of subsequent mortality. To fully understand the burden of obesity, accurate information regarding its effects on CVD is necessary. Current estimates are limited by a focus on direct effects, use of non-representative data sources, and a reliance on inaccurate diagnosis codes. Aim: To determine the size of CVD burden attributable to obesity in the US and identify the mechanisms through which obesity affects CVD. Methods: This study used data collected from US adults (aged ≥35 years) participating in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 and US Census projections. NHANES data were longitudinally adapted, and participants were excluded if they had missing data for weight history, risk factors, or a given outcome of interest. Bayesian networks (BNs) mapping out the relationship between risk factors and each outcome were constructed to estimate current CVD risk and expected CVD risk in the absence of obesity. Obesity-attributable CVD burden was then calculated for each outcome, and the direct and indirect pathways through which changes in CVD risk occur were characterized. A subgroup analysis was conducted in non-smoking participants aged ≤65 years for whom obesity is likely the primary CVD risk factor. Results: The final sample included data from approximately 29,000 participants. Of these, 1286 (4.3%) had a history of myocardial infarction (MI), 1283 (4.4%) had a history of stroke, 1092 (3.7%) had a history of heart failure (HF), and 1992 (6.7%) had a history of CVD (composite of MI, stroke, angina, coronary heart disease, and HF). Results from the fitted BN indicate that 21% of MI, 16% of stroke, 38% of HF, and 19% of CVD cases were attributable to obesity, with ≥80% of this burden due to the effect of obesity on intermediate risk factors (hypertension, type 2 diabetes, and prior cardiovascular events). In the subgroup analysis, the obesity-attributable CVD burden was approximately twice as high for non-smokers aged ≤65 years, with 39% of MI, 32% of stroke, 65% of HF, and 38% of CVD cases attributable to obesity. Conclusion: Through a sophisticated network modeling approach, we generated estimates of obesity-attributable CVD burden in the US. Results highlight the importance of obesity as a CVD risk factor, particularly in younger non-smokers, and provide insight into the nature of this relationship.
Abstract 4123804: Joint associations of sleep and daily step count with cardiometabolic health markers: a pooled analysis of the ProPASS consortium
Authors: Angel Bian, Matthew N Ahmadi, Raaj Kishore Biswas, Joanna Blodgett, Andrew Atkin, Hsiu-Wen Chan, Borja del Pozo Cruz, Kristin Suorsa, Esmee Bakker, Richard Pulsford, Gregore Mielke, Peter Johansson, Pasan Hettiarachchi, Nicholas Koemel, Dick Thijssen, Sari Stenholm, Gita Mishra, Armando Teixeira Pinto, Vegar Rangu, Lauren Sherar, Ulf Ekelund, Alun Hughes, I-Min Lee, Peter Cistulli, Andreas Holtermann, Annemarie Koster, Mark Hamer, Emmanuel Stamatakis
Journal: Circulation (2024)

Background: Poor sleep and physical inactivity are lifestyle-related behaviors that impact cardiometabolic health, but there is limited insight into their combined association with cardiometabolic markers. Aims: This study investigated the joint association of device-measured sleep patterns (regularity and duration) and daily step counts with cardiometabolic biomarkers. Methods: Harmonized individual participant data of 12,223 adults (mean±SD age:54.6±9.5 years; 54.8% female) from the pooled Prospective Physical Activity, Sitting and Sleep consortium (ProPASS), comprising six cohorts with thigh-worn accelerometry data were analysed. Sleep regularity was assessed using the validated Sleep Regularity Index (SRI, range 0-100), quantifying day-to-day sleep consistency. We used generalized linear models to examine cross-sectional joint associations between sleep patterns, regularity (SRI tertiles ≤75.8, low; 75.8-84.5, medium; &gt;84.5, high) and duration (&lt;7h, short; 7-8h, adequate; &gt;8h, long), and daily step counts (step tertiles &lt;8488, low; 8488-11601, medium; &gt;11601, high steps/day) with a composite cardiometabolic health score and individual biomarkers, including BMI, waist circumference, total cholesterol, HDL cholesterol, triglycerides, and HbA1c. Results: Lower sleep regularity, deviation from adequate sleep, along with lower step counts were adversely associated with the composite cardiometabolic health risk score. Compared to optimal sleep patterns (SRI&gt;84.5 or 7-8h/day) and high step groups, low sleep regularity and short sleep duration were separately associated with the least favourable composite cardiometabolic health (z-score [95%CI] 0.32 [0.28,0.37] and 0.25 [0.21,0.29], respectively) among participants with low volume of steps. Low sleep regularity and low daily steps were jointly associated with higher BMI (2.98 [2.67,3.29] kg/m 2 ), waist circumference (8.61 [7.81,9.4] cm), total cholesterol (0.15 [0.08,0.23] mmol/L), and lower HDL levels (0.17 [0.14,0.2] mmol/L), regardless of sleep duration. For short/long sleep duration and low daily step count, such associations were only evident in BMI and waist circumference. Conclusions: Our findings suggest that the potential deleterious associations of irregular or inadequate sleep duration with cardiometabolic health outcomes may be exaggerated by lower daily step counts. Future studies should examine the prospective joint association of sleep patterns and physical activity on cardiometabolic health.
Abstract 4123826: Very Short-Term Blood Pressure Variability Determined by Pulse Transit Time Predicts Major Adverse Cardiac and Cerebrovascular Event in Patients with Heart Failure
Authors: Yu Sato, Akiomi Yoshihisa, Naoto Ohashi, Ryohei Takeishi, Toranosuke Sekine, Kazuto Nishiura, Ryo Ogawara, Shohei Ichimura, Yusuke Kimishima, Tetsuro Yokokawa, Shunsuke Miura, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Kazuhiko Nakazato, Yasuchika Takeishi
Journal: Circulation (2024)

Introduction: It has been reported that day-to-day blood pressure (BP) variability (BPV) is associated with major adverse cardiac and cerebrovascular events (MACCE) in patients with heart failure (HF). However, the clinical significance of beat-to-beat BPV is unclear. Methods and Results: We recruited data on patients with HF who underwent nighttime pulse transit time (PTT)-based continuous beat-to-beat BP measurement (n = 379, median age 71, male sex 53.6%). Standard deviation (SD) of PTT-based BP was considered as BPV. The primary outcome was MACCE defined as coronary artery disease, stroke, or death due to HF, acute coronary syndrome or ventricular fibrillation. Median values (25th and 75th percentiles) of SD of PTT-based systolic, diastolic, and mean BP were 4.2 (3.5, 5.3), 3.3 (2.7, 4.1), and 3.4 (2.8, 4.1) mmHg, respectively. During the follow-up period of median 1,083 days after BPV evaluation, 43 patients experienced MACCE. When patients were divided into three tertiles based on the systolic, diastolic, and mean BPV, MACCE occurred more frequently in those with higher tertiles of BPV ( Figure ). In the Cox proportional hazard analysis, systolic, diastolic, and mean BPV as continuous variables were associated with MACCE (hazard ratio, 1.191, 1.228, and 1.243, respectively). Conclusion: Beat-to-beat BPV was associated with MACCE in patients with HF.
Abstract 4123814: Long-term Incidence of Cardiovascular Events and Mortality in Patients with and without Weight Regain After Bariatric Surgery in the Swedish Obese Subjects Study
Authors: Lena Carlsson Ekander, Kajsa Sjoholm, Ida Arnetorp, Markku Peltonen, Bjorn Carlsson
Journal: Circulation (2024)

Background: Obesity shortens life expectancy, while bariatric surgery causes large weight loss and increases median life expectancy by approximately 3 years. However, weight regain after bariatric surgery is common, and its impact on health remains uncertain. In this study, we examined whether weight regain following bariatric surgery is associated with long-term cardiovascular outcomes and mortality. Methods: We analyzed patients undergoing bariatric surgery in the prospective Swedish Obese Subjects study, aged 37-60 with a BMI≥34 (men) or ≥38 (women), recruited 1987-2001. Patients who regained ≥20% of their 1-year weight loss after 4 years (regain group; n=715) were compared to those who regained less (maintenance group; n=631). Information on cardiovascular disease as well as overall and cardiovascular mortality was obtained from the Swedish Population and Address Register, the Swedish Cause of Death Register, and the Swedish National Patient Register. Median follow-up was 27 years. Results: Average weight change from year 1 to year 4 was +12.8 kg and -0.2 kg in the regain and maintenance groups, respectively. The incidence of major adverse cardiovascular events (myocardial infarction, stroke and heart failure) was similar between the groups, with 185 events in the regain group and 137 in the maintenance group. This corresponds to 11.6 events per 1000 person-years (95% CI: 10.1-13.5) for the regain group, and 10.0 events per 1000 person-years (95% CI: 8.3-12.4) for the maintenance group. The adjusted HR was 1.16 (95% CI: 0.92-1.46), p=0.213. During follow-up, there were 216 deaths in the regain group and 184 in the maintenance group, resulting in nearly identical overall mortality rates of 12.4 per 1000 person-years for both groups (95% CI for regain: 10.9-14.2, maintenance: 10.9-14.3). The number of deaths from cardiovascular disease was 77 in the regain group and 57 in the maintenance group, corresponding to similar incidence rates of 4.4 per 1000 person-years (95% CI: 3.5-5.5) and 3.8 per 1000 person-years (95% CI: 3.0-5.0), respectively (p=0.550). Conclusions: The incidence of major adverse cardiovascular events, as well as total and cardiovascular mortality, was similar between the weight regain and maintenance groups. This suggests that the beneficial association between bariatric surgery and reduced cardiovascular events persists despite weight regain.
Abstract 4122948: Lipoprotein(a) associated risk of atherosclerotic cardiovascular disease is independent of C-reactive protein
Authors: Peter Engel Thomas, Signe Vedel-Krogh, Shoaib Afzal, Borge Nordestgaard, PIA KAMSTRUP
Journal: Circulation (2024)

Background: Elevated lipoprotein(a), present in 1 in 5 individuals, is considered a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Recent studies have reached contrasting conclusions on whether low-grade inflammation measured by elevated C-reactive protein (CRP) modifies the risk of ASCVD from high lipoprotein(a). We tested the hypothesis that high lipoprotein(a) associates with risk of recurrent ASCVD irrespective of elevated or low CRP. Additionally, we performed meta-analyses of previous studies on lipoprotein(a)-associated ASCVD risk stratified by CRP levels and by incident or recurrent events. Methods: We included 3,543 individuals with prevalent ASCVD from the Copenhagen General Population Study (CGPS), a contemporary, prospective Danish cohort study. Hazard ratios (HR) for ASCVD were examined using multivariable adjusted Cox regressions stratified by CRP (&lt;2 mg/L and ≥2 mg/L). Random-effects meta-analyses in primary (incident events) and secondary (recurrent events) prevention were conducted separately, including studies on lipoprotein(a) and risk of ASCVD stratified by CRP. Results: During a median of 7.5 years of follow-up of 3,543 CGPS participants with established ASCVD, 1,425 experienced a recurrent ASCVD event. Multivariable adjusted HRs for ASCVD for high vs. low lipoprotein(a) were 1.41 (95% confidence interval: 1.19-1.67) and 1.31 (1.08-1.59) in individuals with low or elevated CRP with no evidence of effect modification (Figure 1A, p for interaction=0.11). When risk estimates for ASCVD were summarized in separate meta-analyses for primary and secondary prevention settings, a 50 mg/dL higher lipoprotein(a) was robustly associated with increased risk of ASCVD irrespective of CRP levels (Figure 1B). In primary prevention, a 50 mg/dL higher lipoprotein(a) associated with similar summary HRs of 1.18 (1.15-1.20) in low CRP vs. 1.16 (1.14-1.19) in elevated CRP, and likewise in secondary prevention settings, with similar HRs of 1.10 (1.07-1.14) and 1.14 (1.10-1.17), respectively. Conclusion: High lipoprotein(a) was associated with increased risk of ASCVD irrespective of CRP levels both in primary and secondary prevention settings.
Abstract 4123370: Distance to a Cardiac Imaging Center and Likelihood of Imaging Receipt: Defining Imaging Deserts
Authors: Nicholas Spetko, Yang Song, Hibiki Orui, Constance Angell-James, Madeline Cassidy, Ron Blankstein, Sanjay Divakaran, MARCELO DI CARLI, Rishi Wadhera, Jordan Strom
Journal: Circulation (2024)

Background: Cardiovascular imaging is critical for the diagnosis and management of cardiovascular disease. Whether geographic distance to a cardiovascular imaging center (CVIC) impacts access to care is unknown. Methods: We evaluated all Medicare beneficiaries (Fee-for-service and Medicare Advantage) from 2018-2022, excluding those &lt; 65, without continuous Medicare enrollment in the previous year, individuals missing zip code of residence, or CVICs missing zip codes. We estimated distance from the centroid of an individual’s zip code of residence to the centroid of the zip code with the nearest CVIC (defined as &gt; 10 imaging procedures/year). Multivariable regression models were used to estimate likelihood of imaging receipt by distance. Results/Data: A total of 64,260,530 individuals (age 73.0 ± 8 years, 54.6% female, 80.1% White) received care at 3,886 CVICS. The vast majority (95%) lived within 16 miles of a CVIC, but varied considerably by modality with substantially greater distances for cardiac CT, cardiac MRI, and PET (Median [IQR] distance in miles to CVIC, Echo: 3.4 [0.4-7.0]; SPECT: 3.8 [1.3-7.9]; cardiac CT: 8.1 [3.7-21.3]; cardiac MRI: 17.4 [7.3-43.3]; PET: 88.9 [26.2-194.6]). CVICs performing cardiac CT, cardiac MRI, or PET were nearly all in metropolitan locations. Likelihood of imaging receipt was triphasic: lowest within 0-10 miles of a CVIC (mainly metropolitan locations), greater within 10-15 miles, and then increasingly lower beyond 15 miles ( Figure 1 ). Sites beyond the 16-mile threshold were predominantly in the Midwest and West ( Figure 2 ). Conclusions: In this study of 64 million Medicare beneficiaries, 2018-2022, 95% of the US population was found to live within 16 miles of a CVIC, though varied by modality. While those living &gt; 16 miles from a CVIC received less imaging, the lowest use was identified among individuals living in the same zip code as a CVIC, suggesting a possible disconnect between access to imaging care and proximity.
Abstract 4123849: Respiratory Syncytial Virus (RSV) Cases Involving Hospitalization Are Associated with an Increased Risk of Myocardial Infarction and All−Cause Mortality Among Adults Aged 50 Years and Older
Authors: David Singer, Yan Wang, Aozhou Wu, Liz La, Susan Gerber, Hongjiao Liu, Keith Betts
Journal: Circulation (2024)

Background: Older adults and adults with comorbidities are at increased risk for severe respiratory syncytial virus (RSV) disease and related complications. Aims: To estimate the risk of myocardial infarction (MI) and all−cause mortality among adults aged ≥50 years hospitalized with RSV compared to those with no recent acute respiratory illness (ARI) and those hospitalized with influenza. Methods: Data from Optum’s de−identified Clinformatics® Data Mart Database were analyzed (October 2015–June 2023) in this retrospective cohort study. Adults aged ≥50 years with ≥12 months of continuous enrollment were assigned to cohorts based on RSV or influenza hospitalization (from ICD−10 codes; RSV and flu cohorts) or no recent ARI (control cohort). Index dates for RSV and flu cohorts were the start of an ARI that included hospitalization. Baseline characteristics were measured in the 12 months pre−index. MI (from ICD−10 codes) and all−cause mortality were measured during follow−up and compared between cohorts using time−varying coefficient multivariable adjusted Cox models (MI results accounted for the competing risk of death). Results: In the RSV cohort (n=14,759), mean age (76.5 years) and mean Charlson comorbidity index (CCI; 3.3) were higher than the flu (n=77,468; 75.4 years, CCI=2.9) and control (n=73,795; 69.5 years, CCI=1.0) cohorts. Adjusted HRs (95% CI) for MI and all−cause mortality risk were significantly higher in the RSV vs control cohort across follow−up, ranging from 30.96 (26.22–36.54) within 30 days post−index to 2.26 (2.04–2.51) &gt;365 days post−index for MI and 10.77 (9.19–12.63) within 30 days post−index to 2.29 (2.18–2.42) &gt;365 days post−index for mortality. Compared to the flu cohort, adjusted MI and mortality risk in the RSV cohort were lower during the 30 days post−index (MI: 0.87 [0.82–0.92]; mortality: 0.84 [0.78–0.90]) but higher &gt;365 days post−index (MI: 1.11 [1.01–1.22]; mortality: 1.05 [1.01–1.10]). Conclusion: MI and all−cause mortality risk were higher for hospitalized RSV cases compared to controls. Smaller differences in outcomes were observed when comparing hospitalized RSV cases with hospitalized influenza cases, with varying direction over time. With existing evidence of increased MI and mortality risk after influenza and these findings on MI and mortality risk after RSV, future research should aim to further understand the impact of RSV on cardiovascular outcomes and assess the role of RSV prevention in lowering the risk of MI and mortality.
Abstract 4124182: Depression Symptomatology as Predictor of Incident Major Vascular Outcomes: Results from the Hispanic Community Health Study/Study of Latinos
Authors: Gabriela Trifan, Linda Gallo, melissa lamar, Sylvia Wassertheil-Smoller, Hector Gonzalez, Krista Perreira, Jianwen Cai, Tatjana Rundek, Bonnie Levin, Martha Daviglus, Amber Pirzada, Fernando Testai
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) has consistently been associated with higher depression symptoms and disorders. Conversely, fewer studies have shown that depression predicts risk of incident CVD and mortality. Objective: To examine the association of depression symptoms with incident major adverse cardiovascular events (MACE) among Hispanics/Latinos living in US. Methods: MACE-free Hispanic Community Health Study/Study of Latinos participants who underwent baseline evaluation between 2008-2011 (n=15,180) were included. MACE was defined as the composite of incident stroke, myocardial infarction (MI), or decompensated heart failure (HF), adjudicated using standard criteria up to year 2019. Depression symptoms were assessed at baseline with a 10-item Center for Epidemiological Studies Depression Scale (CES-D 10, range 0-30 points, 5 points increments), with clinically significant depression defined as CES-D 10 ≥10 points. The incident rate ratio (IRR) of MACE across CES-D 10 scores was determined using Poisson regression models, adjusting for baseline sociodemographic characteristics and Framingham Risk Scores. Analyses were weighted for complex survey design and non-response. Results: The mean age (95% CI) was 40.4 (39.9-40.9) years, and the mean CES-D 10 score was 8.4, 95%CI (7.2-9.5) for those with MACE vs 6.9, 95%CI (6.7-7.0) for individuals without MACE (p&lt;0.05). Clinically significant depression symptoms were present in 29% of the population. There were 321 total MACE outcomes that occurred between baseline and year 2019, with 120 MACE occurrences in individuals with CES-D 10 ≥10 points. In the fully adjusted model, increasing CES-D 10 was associated with higher incidence of MACE (for all: IRR 1.22, 95% CI (1.10-1.36); for those with CES-D 10 scores ≥10: IRR 1.62, 95% CI (1.21-2.17). Additionally, participants with CES-D 10 scores ≥10 were 1.4 times more likely to develop MACE compared to those with CES-D 10 scores &lt;10 (HR 1.41, 95% CI=1.13-1.83, Figure). Among MACE sub-components, incident HF was twice as high in the population with CES-D 10 ≥10 points versus those with CES-D 10 &lt;10 points (HR 2.36, 95% CI (1.58-3.51)). Conclusion: The findings of this cohort study indicate that depression symptomatology is associated with incident overall MACE and HF, and that clinically significant depression symptoms further increased risk for MACE and HF, making early treatment of depression a possible target for decreasing CVD incidence.
Abstract 4122650: 1-year comparison of quadruple therapy sequencing strategies for heart failure with reduced ejection fraction using an individual-based state-transition microsimulation model
Authors: Ricky Turgeon, Minh Tri Van, Peter Loewen, Nathaniel Hawkins, Mohsen Sadatsafavi, Wei Zhang, Kelly MacKay
Journal: Circulation (2024)

Introduction: Guidelines recommend quadruple therapy (angiotensin receptor blocker-neprilysin inhibitor [ARNI]), beta-blocker, mineralocorticoid receptor antagonist (MRA), and sodium-glucose co-transporter 2 inhibitor [SGLT2I]) as the cornerstone of heart failure (HF) with reduced ejection fraction (HFrEF) management. Yet, guidelines do not propose a specific order of initiation and titration (or “sequencing strategy”) of these agents, due to the absence of trial evidence. Aims: To model the 1-year efficacy and harms of proposed HFrEF quadruple therapy sequencing strategies using a microsimulation model. Methods: We conducted an individual-based state-transition microsimulation modeling study to compare the 1-year cumulative incidence of death, total HF hospitalization, and adverse events with 6 different HFrEF medication sequencing strategies (emulating 2 different traditional strategies, 2 two-drug combinations, a "cluster" strategy, and four-drug "simultaneous" strategy), each with two versions (weekly or biweekly medication adjustments), applied to treatment-naïve outpatients with HFrEF. We modeled death as an incidence at 1 year, and total HF hospitalization (first and recurrent events) and adverse events (bradycardia, hyperkalemia, hypotension, and renal impairment) as incidence rates per 100 patient-years. Results: At 1 year, an estimated 15.5% died without treatment compared to 6.9% with the traditional sequence adjusted biweekly, and 5.2-6.3% with other sequencing strategies. Similarly, the HF hospitalization rate decreased from 32.8 per 100 patient-years with no treatment to 11.1 per 100 patient-years traditional sequencing adjusted biweekly, and 6.9-9 per 100 patient-years with other strategies. The incidence rates of medication-related adverse events per 100 patient-years were: hypotension (5.8-6.9), renal impairment (4.6-6.0), bradycardia (2.9-3.2), and hyperkalemia (approximately 0.5). Conclusions: For treatment-naïve outpatients with HFrEF, pharmacotherapy sequencing strategies that started 2 to 4 medications on the first visit reduced the risk of death and hospitalization at 1 year compared to a traditional sequencing strategy. Weekly medication adjustments did not outperform biweekly adjustments when &gt;=2 medications were started on the initial visit. These findings can inform clinicians and policymakers in developing HFrEF medication optimization programs with sequencing strategy protocols that fit the local practical context.