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Abstract P2140: Changes in Cardiovascular Health in Midlife Following a Pregnancy Complicated by Preeclampsia and/or Placental Maternal Vascular Malperfusion Lesions
Introduction: Preeclampsia (PE) with or without evidence of maternal vascular malperfusion (MVM) lesions in the placenta is a key risk factor for future maternal cerebrovascular and cardiovascular disease, and midlife is a crucial time during which subclinical disease may be developing. However, the trajectory of traditional risk factors in midlife following PE and/or MVM is not clear. We aimed to identify whether differential midlife changes in cardiovascular health were evident in those with or without PE and/or MVM to inform future intervention strategies. Methods: Participants (38.3±6.1 years, 33% racial/ethnic minority) with and without PE and/or MVM (-PE/-MVM, n=67; -PE/+MVM, n=37; +PE/-MVM, n=9; +PE/+MVM, n=11) were assessed 9.2±0.9 and 14.5±0.8 years following the index pregnancy. Cardiovascular health scores (0-100, higher is healthier) were generated using seven of the Life’s Essential 8 components: diet, smoking, sleep duration, body mass index (BMI), blood pressure, lipids, and glucose. Linear mixed effects regression assessed changes across time between PE/MVM exposure groups. Results: No significant differences in change across time were found between PE/MVM exposure groups for the overall cardiovascular health score (p=0.09), but the +PE/+MVM group demonstrated significantly more deterioration in component scores for diet, smoking, and lipids compared to the -PE/-MVM group ( Table ). The +PE/-MVM group also demonstrated significantly worsening diet scores, while the -PE/+MVM group showed a significant improvement in blood glucose scores compared to the -PE/-MVM group. Conclusions: Those with PE, both with and without MVM lesions, appear to demonstrate a worsening cardiovascular health profile in middle age driven by modifiable components including diet, smoking, and cholesterol. Interventions to encourage healthy behaviors and lipid control should be considered in this time frame, as they may be impactful to prevent disease progression.
Abstract 024: Should Women Have Lower Blood pressure Goals Than Men? Sex Differences in Blood Pressure and Cardiovascular Disease in the UK Biobank
Background: Recent studies show that the risk of cardiovascular disease (CVD) increases from a lower level of systolic blood pressure (SBP) in women than men, and increases at a steeper rate. This has led to a suggestion for sex-based SBP thresholds for hypertension diagnosis. Aims: To investigate sex differences in the association of SBP and incident CVD. Methods: The UK Biobank recruited over 500,000 participants aged 40-70 years between 2006 and 2010, with follow up until May-October 2022. The present study included 420,649 participants with no prior history of CVD. The primary outcome was incident CVD, defined as a first diagnosis of fatal or non-fatal coronary heart disease (CHD) or stroke. Age-adjusted sex-specific risks, relative risks and risk differences relating SBP to CVD were estimated using Poisson and Cox regression. Results: The mean (SD) age among 235,556 (56.0%) women was 56.1 (8.0) years and among 185,093 men was 56.1 (8.2) years. Over a mean follow-up of 13.2 years, there were 28,628 CVD events. CVD risks across SBP levels showed a “J-shape”, and were higher in men than women at all BP levels. The lowest risk for CVD among women was at SBP 100-<105 mmHg (15.6 [95% CI 11.8-23.1] events per 10,000 person-years) and SBP 110-<115 among men (47.2 [95% CI 41.8-53.0]). Compared with SBP 100-<110 mmHg, sex-specific relative risks at SBP above 120 mmHg were higher in women than men, but risk differences were higher in men than women at all levels of SBP. Furthermore, compared to men at SBP100-<110 mmHg (i.e. the men with least risk), risks in women were lower at all levels of SBP below 170 mmHg, and the relative risk at the highest SBP (≥180 mmHg) in women (1.3 [95% CI 1.1-1.5]) remained lower than men (2.4 [95% CI 2.0-2.7]) at the same SBP level. Conclusions: Consideration of the risks and sex-combined analyses do not support that women should have lower BP thresholds than men.
Abstract MP38: The Implications of COVID-19 Pandemic for The Black-White Diabetes Mortality Gap: Has The Disparity’s Dynamic Changed?
Background: Previous studies have investigated racial disparities in diabetes mellitus, including the existence of diabetes mortality gap between African Americans and whites. However, it remains unknown whether the coronavirus SARS-CoV-2 (COVID-19) pandemic changed the magnitude of earlier documented Black-White gap in diabetes mortality. Study Objective: To investigate the dynamic change in the magnitude of the Black-White diabetes mortality gap in relation to COVID-19 pandemic. Methods: Diabetes mortality rates in relation to race, adjusting for major covariates, were analyzed using the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying causes of death in the United States. Diabetes mortality was analyzed for the three years preceding the pandemic (2017-2019; defined as pre-COVID era diabetes mortality) and the first three years of the pandemic (March 2020 to February 2023; defined as COVID-era diabetes mortality). Diabetes deaths were identified in the CDC WONDER database using the ICD-10 codes E10-E11. To adjust for multiple covariates, general linear modeling (GLM) analysis was conducted (SAS, ver. 9.4). Results: Both African Americans and whites experienced an increase in diabetes mortality rates from the pre-COVID-era to COVID-era period: from 11.0/100,000 to 15.1/100,000 (crude mortality rates) and from 12.4/100,000 to 15.9/100,000 age-adjusted mortality rates) in African Americans; from 10.9/100,000 to 14.1/100,000 (crude mortality rates) and from 8.3/100,000 to 10.3/100,000 age-adjusted mortality rates) in whites. However, when comparing the magnitude of the change in diabetes mortality rates between the pre-COVID and COVID-era periods, the multivariate-adjusted diabetes mortality rate increase in African Americans was 4.26/100,000 greater than in whites (p=0.028). Conclusions: COVID-19 pandemic had a statistically significant impact on the magnitude of racial gap in diabetes mortality. Further research investigating the underlying mechanisms of these findings is warranted.
Association of expenditure on ultra-processed foods and beverages and anthropometric indicators in Mexican children: A longitudinal study
The prevalence of obesity in Mexico has been rising dramatically from school age onward. The high consumption of ultra-processed food has been identified as a contributing factor. We explored the longitudinal association between household expenditure on ultra-processed foods and beverages (UPF) and changes in anthropometric indicators of obesity among Mexican children aged 5 to 10 years in 2002. We used data from the Mexican Family Life Survey (MxFLS), a longitudinal, probabilistic, multipurpose, and representative survey of the Mexican population conducted in 2002, which reports household expenditure on the main food and beverage groups, as well as anthropometric indicators and sociodemographic characteristics of household members, across three rounds surveyed between 2002 and 2012 (n = 2,677). The exposure variable was UPF expenditure, categorized into tertiles, and the outcomes studied were BMI z-score for age, waist circumference, and waist-to-height ratio. We estimated random effects models and generalized estimating equation models for longitudinal data. Using an interaction term between tertiles of UPF expenditure and survey rounds, we found that household membership in the middle and upper tertiles of UPF expenditure in 2002 was associated with an increase in waist circumference and waist-to-height ratio, particularly after three years of follow-up. For instance, the middle tertile of UPF expenditure was associated with an increase of 4.43 centimeters in waist circumference compared to the low tertile of UPF expenditure after three years of follow-up (p < 0.01). Our findings suggest that higher UPF expenditure in households with children aged 5–10 years drives abdominal obesity in the short and medium term, underscoring the need for comprehensive policies to limit the purchase and consumption of UPF from an early age.
Abstract P3016: Blood Pressure Measures are Not Associated with Early Metabolic Imbalance: The U.S. National Health and Nutrition Examination Survey
Introduction: Early metabolic imbalance (EMI) is a hidden condition prevalent in teens and young adults. It is characterized by compensated insulin resistance, where fasting glucose, triglycerides, HDL cholesterol, and hemoglobin A1c are all within normal limits (Fig. 1). Thus, EMI does not meet the criteria for prediabetes or metabolic syndrome and eludes risk screening for type 2 diabetes and CVD. In addition to hyperinsulinemia, EMI is associated with chronic inflammation, oxidative stress, and hypoxia. The overproduction of nitric oxide from high circulating insulin may keep blood pressure low. Therefore, we investigated the association of blood pressure with EMI. Hypothesis: In EMI, blood pressure measures are lower or unchanged compared to healthy balanced metabolism. Methods: The fasting subsample from the 2015-2018 U.S. National Health&Nutrition Examination Survey was analyzed: 6,227 observations representing 270.2 million people in the U.S. ages 12 and up. Population-weighted multinomial logistic regression was performed using Stata v18.5. The outcome variable was cardiometabolic health, categorized into 1 of 4 groups: healthy balanced metabolism, EMI, prediabetes/dyslipidemia (PD), or type 2 diabetes/ASCVD (Fig. 1). EMI was defined as elevated fasting insulin with normal glucose, A1c, TG and HDL, using prognostic insulin cutpoints from timeROC analysis of the CARDIA cohort. The 1° exposure was systolic BP. Diastolic BP, mean arterial pressure, and pulse pressure were 2° exposures. The adjusted covariates were age, male gender, race/ethnicity, waist circumference, sedentary behavior, low-salt diet, and BP medications. For measuring association, the effect size was relative risk ratio with 95% confidence interval and p-value. Results: After adjusting for confounders, no significant change in systolic blood pressure was observed between the EMI and balanced metabolism groups (Table 1). By contrast, the PD and diabetes/ASCVD groups were associated with increases in systolic BP. Nearly identical results were obtained when diastolic BP, mean arterial pressure, or pulse pressure was substituted for systolic BP. Age emerged as the most influential confounder for the association between blood pressure and EMI. Conclusion: In EMI, blood pressure measures were unchanged compared with healthy balanced metabolism. Higher blood pressure values or taking BP medications may serve as a marker to help differentiate other cardiometabolic health categories from EMI.
Abstract P2044: Racial discrimination, preeclampsia and hypertension status 12-15 years after pregnancy
Introduction: Experiences of discrimination are associated with increased risk of preeclampsia during pregnancy and cardiovascular disease later in life. We examined the association of discrimination with hypertension in the years after pregnancy. Methods: Participants (n=580) were recruited at Magee-Womens Hospital (Pittsburgh PA) with births in 2008-2012 and questionnaires (Everyday Discrimination Scale [EDS], health history, demographics) completed in 2024 (mean age 43 years). Prior preeclampsia was abstracted from medical records. Self-identified race was Black (n=150) compared to a composite of non-Black (White [n=415], Latina [n=6] or Asian [n=9]) due to small numbers of some groups. Outcome was self-reported hypertension, validated in a subset (n=171) with measured blood pressure following a standardized protocol (positive and negative predictive values were 91% and 59%, respectively). Logistic models estimated the association between discrimination and hypertension after pregnancy adjusted for age, education, preeclampsia, and body mass index; results were stratified by race. Results: Black women were younger (39.2 ±6 vs. 43.6 ±6), more likely to have a high school education or less (36.9% vs. 12.9%), more likely to report current hypertension (31.1% vs. 16.7%, p=0.0002) and had higher discrimination scores (22.5 ±10.9 vs. 17.7 ±7.2, p<0.001) than non-Black women. Black women indicated the main reason for discrimination was race or ancestry (69.4% vs. 6.8%; p <0.001); non-Black women reported the main reason was gender (32.6% vs. 18.0%; p= 0.007). Each unit increase in discrimination was associated with 2.4% increased odds of hypertension, adjusted for age, education, and preeclampsia (aOR 1.024, 95% CI 1.0, 1.049, p=0.05), and BMI (aOR 1.029, 95% CI 0.99, 1.06). The magnitude of this association was similar to that of age (aOR 1.06, 95% CI 1.02, 1.11 per year). The association between discrimination and hypertension was restricted to Black women (aOR 1.027, 95% CI 0.99, 1.06; p=0.130) and was not detected in non-Black women (aOR 0.995, 95% CI 0.96, 1.04; p=0.816). Discussion: Black women reported higher discrimination in the years after pregnancy that was related to higher rates of hypertension, independent of prior preeclampsia and other risk factors. It is imperative to understand the biological implications of discrimination, particularly during pregnancy, which may provide a unique view of the impacts of racism on cardiovascular health.
Neutrophil CRACR2A Promotes Neutrophil Recruitment in Sterile Inflammation and Ischemic Stroke
BACKGROUND: Ca 2+ release-activated Ca 2+ channel regulator 2A (CRACR2A) has been linked to immunodeficiency attributable to T-cell dysfunction in humans. We discovered that neutrophil CRACR2A promotes neutrophil adhesive and migratory functions by facilitating Ca 2+ mobilization and β2 integrin activation. METHODS: Myeloid-specific Cracr2a conditional knockout mice and intravital microscopy were used to investigate the physiologic role of neutrophil Cracr2a in neutrophil recruitment in vascular inflammation. Cracr2a-deficient neutrophils or dHL-60 (differentiated human promyelocytic leukemia) cells and Cracr2a-derived peptides were used in flow cytometry, immunoprecipitation, cytosolic Ca 2+ mobilization, and flow chamber assays to elucidate the molecular mechanism. Four-dimensional confocal intravital microscopy of mice after focal brain ischemia and single neutrophil behavioral analysis demonstrated the pathologic role of neutrophil Cracr2a in brain damage. RESULTS: Compared with wild-type control mice, Cracr2a conditional knockout mice exhibited significantly reduced adhesion, crawling, and transmigration of neutrophils on ear and cremaster venules in tumor necrosis factor–α–induced sterile inflammation. Neutrophil Cracr2a rapidly interacts with Stim1 (stromal interaction molecule 1) after agonist stimulation and facilitates Ca 2+ mobilization, increasing the ligand-binding function of β2 integrin. Our findings in Cracr2a-deficient mouse neutrophils are recapitulated in dHL-60 cells, in which CRACR2A is deleted by CRISPR/Cas9. Furthermore, overexpression of CRACR2A in CRACR2A KO dHL-60 cells restores normal function. Using a series of peptides covering the coiled-coil region of Cracr2a, we identified a palmitoylated 20-mer that blocks Stim1-Cracr2a interaction. Treating neutrophils with this 20-mer inhibits Ca 2+ mobilization and β2 integrin activation after agonist stimulation, reducing neutrophil recruitment to an activated endothelial cell monolayer under venous shear stress and to ear venules in tumor necrosis factor–α–challenged mice. Cerebral 4-dimensional intravital microscopy of mice after focal brain ischemia revealed that neutrophil Cracr2a enhances the emergence of highly migratory neutrophils by increasing the surface level of αMβ2 integrin, thereby facilitating neutrophil infiltration into brain tissue and exacerbating brain injury. CONCLUSIONS: Our results demonstrate that neutrophil CRACR2A promotes neutrophil recruitment to sites of sterile inflammation, such as ischemic stroke. Blocking the STIM1–CRACR2A interaction may be a novel therapeutic strategy to mitigate inflammation and consequent tissue injury.
Psychological stress associated with prognostic uncertainties in recently diagnosed Parkinson’s disease patients: A qualitative study
Background Parkinson’s disease (PD) is a common neurodegenerative disorder that negatively impacts thousands of patients in Canada. The unexpected nature of PD is associated with a decline in mental health. The highest level of psychological stress occurs during the early years following the diagnosis. Objectives To understand the psychological stress associated with prognostic uncertainties in recently diagnosed PD patients, uncover the gaps in the current support systems, and recommend areas for improvement in the support services that aim to decrease the psychological stress associated with receiving the PD diagnosis. Methods An exploratory qualitative study was conducted using semi-structured interviews with 13 PD patients diagnosed for more than 6 months and less than 5 years. Participants were recruited from the Toronto Western Hospital Movement Disorders Clinic, Toronto, Ontario, Canada until saturation of key themes was reached. Results Five major themes were identified capturing the lived experiences of PD patients following diagnosis: 1) the circumstances of receiving the diagnosis and its psychological impact on PD patients, 2) the impact of intrapersonal factors on the PD journey, 3) the role of social relationships in PD patient’s life, 4) the interaction of PD patients with different elements of the healthcare system, and 5) support services available for recently diagnosed PD patients. Conclusions This study uncovers the psychological burden faced by PD patients due to prognostic uncertainties and insufficient support systems. It emphasizes the importance of a patient-centered approach for improving their quality of life and healthcare experiences through personalized support services.
Abstract P3010: Association of sedentary behavior with cardiovascular risk biomarkers in a population with overweight or obesity: the PREDIMED-Plus trial
Background: Sedentary behavior is linked to a higher risk of cardiovascular disease (CVD). Examining its association with CVD-related biomarkers can help understand the underlying mechanisms. Methods: We studied 98 participants (55-75 years, BMI 27-40 kg/m2, with metabolic syndrome) in PREDIMED-Plus, a multicenter randomized trial in Spain for the primary prevention of CVD. Accelerometer was used to measure physical activity (PA) at baseline and at least once during follow-up at years 3 and 5. Blood samples were collected at each time point to measure CVD-related biomarkers: propeptide of procollagen type I (PICP, cardiac fibrosis), high-sensitivity (hs) troponin T (hsTnT, myocardial damage), hs C-reactive protein (hsCRP, inflammation), 3-nitrotyrosine (3-NT, oxidative stress), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP, cardiac overload). Sedentary time was assessed as inactive time (< 1.5 METs in waking time). Using isotemporal substitution, we analyzed the impact of replacing 30-min sedentary time per day with low-intensity PA (LPA, 1.5–3 METs), moderate to vigorous PA (MVPA, > 3 METs) and time in bed (time difference between going to bed and leaving) on log-transformed biomarkers cross-sectionally and longitudinally. Results: At baseline, year 3 and 5, 98, 72 and 65 participants had valid data. Participants averaged 65 years old (SD 4.9), BMI 32.2 kg/m2 (SD 3.3), and 40% were female. Cross-sectionally, replacing 30-min sedentary time with LPA, MVPA, or time in bed had no significant effect on biomarkers. After 5 years, reallocating baseline 30-min of sedentary time per day with LPA or MVPA was associated with a lower hs-TnT level compared to baseline (-0.05, 95% CI -0.08, -0.02; -0.01, 95% CI -0.06, 0.04, respectively). Substituting 30-min sedentary time with LPA or MVPA showed nonsignificant reductions in NT-proBNP (-0.04, 95% CI -0.12, 0.04; -0.04, 95% CI -0.16, 0.09, respectively), but not a consistent impact on other biomarkers (Table). Conclusion: In overweight/obese individuals, prolonged sedentary time, when compared to engaging in PA, was associated with unfavorable levels of hs-TnT over 5 years, but not with other CVD risk biomarkers. Further research is warranted to confirm these results in other populations.
Abstract P1154: Childhood Parental Incarceration, Cardiovascular Health, and Subclinical CVD in Young Adults: the Future of Families and Cardiovascular Health Among Young Adults (FF-CHAYA) Study
Background: Few studies have prospectively examined associations of parental incarceration during childhood with offspring cardiovascular health (CVH). We assessed: (1) associations between parental incarceration and subclinical cardiovascular disease (subCVD) in young adulthood, and (2) whether associations were mediated by CVH. Methods: Data are from the FF-CHAYA Study, an ancillary study of the Future of Families and Child Wellbeing Study. Incarceration of mothers and fathers as well as the number of times the father was incarcerated (never, once, ≥2 times) was collected via interviews at birth and ages 1, 5, and 9y. Carotid intima-media thickness (IMT) was measured at age 22 using B-mode ultrasound and analyzed as a continuous or dichotomous (high IMT ≥75 th percentile) outcome. In linear and logistic regression models, covariates included age, sex, race, mother’s poverty level, young adult’s arrest history, and CVH (Life’s Essential 8 score at age 22). Attenuation by adjustment and formal mediation analyses were performed to understand how much of the association between parental incarceration and subCVD was explained by CVH. Results: Among 1,372 participants, 54% identified as female, 51% as Black, 27% as Hispanic, 17% as non-Hispanic White, and 4% as Other or Mixed; 278 (20.3%) experienced incarceration of a parent prior to age 9y. Most parental incarceration was paternal (n=222; 79.9%); 106 (47.7%) reported their father was incarcerated once and 116 (52.3%) reported their father was incarcerated ≥2 times. Parental incarceration was associated with higher mean-mean (Model 2: b= 0.86; 95% CI: 0.05, 1.67) and mean-max cIMT (b=0.94; 95% CI: 0.06, 1.82) but was attenuated and nonsignificant after adjustment for CVH (Model 3). There was significant mediation by CVH (22.3% and 25.7% for mean-mean and mean-max cIMT, respectively, P < 0.05). Paternal incarceration ≥2 or more times (versus never) was associated with high mean-mean (OR=1.66; 95% CI: 1.01, 2.73) and mean-max (OR=2.05; 95% CI: 1.25, 3.36) IMT. Conclusions: In these young adults, the association between parental incarceration and subCVD was partially mediated by CVH, suggesting that promotion of CVH earlier in life may lessen future CVD risk, although other pathways may also be important. Further, a greater number of paternal incarcerations was associated with developing high IMT suggesting that targeted interventions may help mitigate future CVD risk among this vulnerable population.
Abstract P2046: Gestational Hypertension in the Latine Population by Race, Ancestry, and Nativity: An Intersectional-MAIHDA Approach
Objectives: Gestational hypertension (GH), hypertension during pregnancy, is associated with greater risk of cardiovascular disease later in life. Aggregating Latine populations may mask important heterogeneity in the burden of this adverse pregnancy outcome. Differences have been examined by nativity, but few have accounted for potential heterogeneity by race or ancestry, and none have accounted for all three simultaneously. Thus, the purpose of this research is to use a novel intersectional modeling approach to estimate the prevalence of GH among Latine birthing people by race, nativity, and ancestry. Methods: 2020 Natality Public Use Data of 863,907 Latine birthing people’s live births were analyzed. Data on GH (yes/no), birthing person’s nativity (U.S. Born/Not U.S. Born), race (White, Black, Native American/Native Alaskan [Native A/A], Asian, Native Hawaiian/Pacific Islander [NOPI], and more than 1 race) and ancestry (Mexican American, Puerto Rican, Dominican, Cuban, Central South American [C/S American] and Other) were extracted from birth certificates. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) was used to examine variation in GH across strata of nativity, race, and ancestry. This modeling approach allows for assessment of intersectionality in a way that maximizes statistical efficiency. Results: Mean GH prevalence among Latine birthing people was 7.1%. Black birthing people were more likely to develop GH than White birthing people, and non-U.S. born individuals were less likely to develop GH than U.S. born (Table 1). Puerto Rican, Dominican, and Cuban birthing people were more likely to develop GH than Mexican birthing people (Table 1). I-MAIHDA produced 72 nativity-race-ancestry strata, ranging in size from 10 to 278,584 birthing people (mean: 11,998.7). Birthing people with the lowest predicted probability of GH were predominately non-U.S. C/S Americans, while those with the highest predicted probability were predominately Black and Indigenous U.S. Born Puerto Rican and Dominican (Table 2). Approximately 14% of the between-stratum variance in GH was explained by nativity-race-ancestry intersectional effects (versus the main additive effects of each). Conclusion: We found evidence of variation in GH prevalence within the Latine birthing population. Future research should consider which factors drive heterogeneity in GH prevalence among Latine birthing people.
Improvement of RT-DETR model for ground glass pulmonary nodule detection
Currently, pulmonary nodules detection work mostly focus on recognition and diagnosis of solid nodules. However, ground glass nodules have higher probability of malignancy, posing greater identification challenges and thus greater value for detection. To achieve rapid and accurate detection of ground glass nodules. This article proposed an algorithm based on RT-DETR model with the following enhancement: 1) optimize the backbone network with FCGE blocks to increase the detection accuracy of small-sized and blurred edge nodules; 2) replace the AIFI module with HiLo-AIFI module to reduce redundant computation and improve the detection accuracy of pure ground glass pulmonary nodules and mixed ground glass pulmonary nodules; 3) replace the DGAK module with CCFF module to address the issue of capturing complex features and recognition of irregularly shaped ground glass nodules. To obtain a more lightweight model, modules are designed for smaller number of parameters and higher computational efficiency. Model are tested on mixed dataset composed of LIDC-IDRI data and clinical data from cooperating hospitals. Compared to the baseline model, it shows an average precision improvement (mAP50/mAP50:95) of 2.1% and 1.7%, with a reduction parameters by 5.2 million. On a specialized dataset containing both pure and mixed ground glass nodules, our model outperformed the baseline model in all evaluation metrics. In general, the model proposed in this paper achieves improvement on lightweightness and detection accuracy. However, the model exhibits poor noise resistance and robustness, suggesting optimization in future work.
Abstract P3093: Impact of Health Technology on Cardiopulmonary Resuscitation Trainings, Globally: A Narrative Review
Introduction: Sudden cardiac death is a major global health concern, responsible for 15-20% of all deaths in developed countries. Timely cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use significantly improves survival rates. Advances in health technology have expanded CPR/AED training options to meet global demand, offering in-person, online, and hybrid formats. Methods: We conducted a global review of available CPR/AED training programs. Data were gathered from official health organizations, resuscitation councils, and nonprofits to map current training trends and regional adaptations, focusing on accessibility and scalability. Countries offering online training were analyzed for content, delivery methods, and skills assessments. Additionally, we identified collaborations with the American Heart Association (AHA) for standardized course delivery across different regions. Results: Our review identified 36 organizations offering CPR/AED training. The British Heart Foundation was the only one providing a standalone video-based skills assessment focused solely on recognizing CPR rates. AHA offered the most comprehensive online skills assessment, utilizing video conferencing, feedback devices, and a web application. The European Resuscitation Council introduced an innovative augmented reality game for CPR training. Five organizations provided only in-person skills training, supported by online knowledge assessments. Conclusion: Online and hybrid CPR/AED training modalities have increased accessibility, especially in developed countries. Expanding digital access to CPR/AED training and skills assessments globally could further enhance emergency response outcomes and improve survival rates worldwide.
Abstract MP74: Physical Activity Patterns and Cardiovascular-Kidney-Metabolic (CKM) Syndrome: An All of US Research Program Study
Background: Increased physical activity (PA) benefits cardiovascular, kidney, and metabolic health individually. However, its impact on cardiovascular-kidney-metabolic (CKM) syndrome, which integrates these interconnected disorders, is unknown. This study evaluated the association between PA and CKM syndrome among adults ≤70 years old from a population-based cohort. Methods: Using data from the National Institutes of Health All of Us Research Program, we defined the outcome, CKM syndrome stages, as follows: stage 0 (no risk factors), stage 1 (excess/dysfunctional adiposity or prediabetes), stages 2-3 (metabolic risk factors, moderated-to-high risk kidney disease, or subclinical cardiovascular disease [CVD]), and stage 4 (clinical CVD). PA was quantified using Fitbit data or self-reported surveys as sedentary mins/week, moderate-to-vigorous PA (MVPA) metabolic equivalent task (MET)-mins/week, and total PA MET-mins/week. Multinomial logistic regression models assessed the association between PA measures in quintiles and CKM syndrome stages, adjusting for demographics, socioeconomic status (individual and neighborhood levels), lifestyle factors and healthcare access. Results: Among 17,118 adults (mean age 50±13 years, 70% female, 81% White), 48% had CKM syndrome (24% stage 1, 20% stages 2 and 3, 3.9% stage 4). Mean (SD) sedentary mins/week, MVPA MET-mins/week, and total PA MET-mins/week were 4,046 (2,048), 1,670 (1,729), and 3,111 (1,965), respectively. Compared to the lowest quintile, adults in the highest quintile of sedentary time (>5729 vs ≤1704 mins/week) had a significantly higher odds of CKM syndrome across all stages ( Figure ), with the strongest association for stage 4 (OR 3.09, 95% CI 2.36-4.05). For MVPA, adults in the highest quintile (>2861 vs ≤480 MET-mins/week) had a significantly lower odds of CKM syndrome, most pronounced for stage 4 (OR 0.26, 95% CI 0.20-0.34). Similarly for total PA, the highest quintile (>4483 vs ≤1686 MET-mins/week) was associated with lower odds of CKM syndrome, particularly for stage 4 (OR 0.40, 95% CI 0.31-0.53). Dose-response relationships were observed across all measures and CKM stages. Conclusion: Exceeding the recommended 500-1000 MET-mins/week of MVPA is associated with a significant CKM Syndrome risk reduction across all stages.
Abstract P1018: Incidence of Diagnosed Atrial Fibrillation in Community-Based Asian American, Native Hawaiian and other Pacific Islander Subpopulations: Findings from the PANACHE Study
Introduction: Atrial fibrillation (AF) is a potent risk factor for stroke, cardiovascular disease (CVD), and death. Data suggest variation in AF across racial and ethnic groups, but little is known among Asian American, Native Hawaiian, and other Pacific Islanders (AANHPI). We evaluated the incidence of AF in disaggregated AANHPI subgroups vs. non-Hispanic Whites (NHW) in California and Hawaii. Methods: We identified adults between 2012-2022 aged ≥30 years in Kaiser Permanente Northern California and Hawaii integrated healthcare delivery systems with no prior CVD. AANHPI subgroups included Filipino (N=193,327), Chinese (N=182,776), South Asian (N=92,738), Native Hawaiian/other Pacific Islander (NH/PI, N=64,488), Vietnamese (N=50,141), Japanese (N=45,502), other Southeast Asian (N=26,602), and Korean (N=21,989), with 1,975,444 NHW. Incident AF was defined as a hospitalization, emergency department visit, or ≥2 outpatient visits with a diagnosis code for AF through December 2023. We calculated age- and sex-adjusted rates of AF by race and ethnicity, and then used Cox regression to assess the association of AANHPI subgroup with incident AF after adjustment for age, sex, and clinical CVD risk factors. Results: Among 2,653,007 eligible adults, mean±SD age was 49±15 years and 53% were women. Age- and sex-adjusted incidence (per 1000 person-years) of AF was 6.64 in NHW, and significantly varied in AANHPI subgroups: NH/PI (8.13), Filipino (5.32), other Southeast Asian (4.40), South Asian (3.79), Japanese (3.70), Korean (3.54), Chinese (3.45), and Vietnamese (3.28). Compared to NHW, in the fully-adjusted model, the adjusted hazard ratio (aHR, 95%CI) for AF was modestly higher for NH/PI (aHR 1.07, 1.02-1.13) but variably lower for Filipino (aHR 0.71, 0.69-0.73), other Southeast Asian (aHR 0.64, 0.57-0.71), Vietnamese (aHR 0.54, 0.50-0.59), Korean (aHR 0.54, 0.49-0.60), Chinese (aHR 0.53, 0.52-0.55), South Asian (aHR 0.51, 0.48-0.55) and Japanese (aHR 0.50, 0.48-0.53) ( Figure ). Conclusions: Notable variation exists in incident AF across disaggregated AANHPI subgroups living in California and Hawaii, with a higher adjusted rate in NH/PI and variably lower rates for other subgroups compared with NHW that was not explained by demographic and clinical CVD risk factors. Differentiating potential pathophysiological mechanisms vs. variable ascertainment of AF across AANHPI subgroups will help improve personalized care strategies for prevention and treatment of AF.
Lung cancer associated autoantibody responses are detectable years before clinical presentation
The EarlyCDT-Lung® test detects elevated levels of tumour-associated autoantibodies generated in response to immune recognition of cancerous cells, and these autoantibodies have previously been shown to precede clinical presentation of lung cancer. Using a longitudinal cohort from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) study, we have established that elevated autoantibodies can be detected an average of four years in advance of clinical presentation, and in some cases up to 8 years prior to clinical presentation. This is the first study to establish pre-diagnostic elevation of autoantibodies using samples from a longitudinal prospective clinical trial using a clinically validated and commercially available biomarker panel.
Abstract P3099: Greater Adherence to the 2020-2025 Dietary Guidelines for Americans on Consumption of Dark Green Vegetables and Legumes is Associated with Lower Carotid Femoral Pulse Wave Velocity in a Cohort of Community-Dwelling Older Adults without Dementia
Introduction: Carotid-femoral pulse wave velocity (cfPWV) is the gold standard measure of arterial stiffness and is a well-established predictor of cardiovascular mortality and morbidity. Adherence to Dietary Guidelines for Americans, assessed by the Healthy Eating Index (HEI), has been associated with reduced cardiovascular mortality and morbidity and favorable blood pressure effects, potentially reducing arterial stiffness. Hypothesis: We hypothesize that greater adherence to the 2020-2025 Dietary Guidelines for Americans and its components is associated with lower cfPWV in a cohort of community-dwelling older adults aged 65-85 without dementia. Methods: We used the baseline data from the Arterial stiffness, Cognition, and Equol (ACE) trial, a multicenter RCT designed to test the effect of a 24-month intervention of equol supplementation on brain health among 400 self-reported White and Black/African Americans from Pittsburgh, PA, Winston-Salem, NC, and Atlanta, GA. Total cfPWV was measured supine after a 10-minute rest using the SphygmoCor XCEL system. Systolic blood pressure was assessed at the same visit without hypertension medication. Self-reported dietary intake from one weekday and one weekend interviewer-administered 24-hour dietary recalls was analyzed using the Nutrition Data System for Research software version 2022. The overall HEI-2020 and 13 component scores were determined. Multiple linear regression models were used to assess the associations of the HEI-2020 or individual components with cfPWV adjusting for demographic and cardiometabolic risk factors. Results: Our analytical cohort included 196 participants recruited at the Pittsburgh site. The cohort was 48.5% female and 8.7% Black/African American, with an average age of 71.9 years (SD: 4.6). Participants had a mean HEI-2020 score of 58.4 (SD: 13.8) and a mean cfPWV of 8.90 m/s (SD: 1.54). The participants were mostly in good health. Total HEI was not associated with cfPWV (p=0.78). On average, consuming adequate dark green vegetables and legumes (≥0.2 cup equiv. per 1,000 kcal) was associated with 0.6 m/s lower cfPWV than eating no dark green vegetables or legumes (p=0.03). Greater consumption of protein-dense food groups was positively associated with cfPWV (p=0.04); yet, total protein intake was not. Conclusion: Greater adherence to the 2020-2025 Dietary Guidelines for Americans on consumption of dark green vegetables and legumes is associated with lower cfPWV.
Abstract P2070: Cardiovascular Health among Adults of African Heritage in the Groceries for Black Residents of Boston to Stop Hypertension (GoFresh) Program
Background: The American Heart Association’s Life’s Essential 8 (LE8) metrics offer a comprehensive assessment of cardiovascular well-being. However, it is unknown how these metrics differ among Black adults of African heritage recruited for a lifestyle intervention to improve cardiovascular health. Objective: To explore differences in LE8 metrics across different African heritage groups in the GoFresh Trial. Methods: We used screening data from the GoFresh Trial, two randomized controlled trials investigating the effects of the Dietary Approaches to Stop Hypertension (DASH) eating pattern on blood pressure after 12 weeks in adults living in Boston with and without treated hypertension. We examined cardiovascular health across African Heritage groups as assessed by the LE8 metrics. The LE8 metrics include the following components: diet quality, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure. The main predictor was African heritage group (African, Caribbean, and African American). We used linear regression to examine differences in cardiovascular health by African Heritage Group, adjusting for age, sex. Results: We examined data from 427 Black persons, 67% were female and the mean age (±SD) was 52 (±4) years. We observed variations in cardiovascular health metrics across African heritage groups. Persons identifying as African American generally showed lower scores for the LE8 metrics. Blood pressure and BMI scores were significantly lower for persons identifying as African American compared to those of African and Caribbean heritage. Caribbean participants exhibited the best sleep scores ( Table ). Conclusion: Significant differences in Life’s Essential 8 metrics were observed among Black adults of various African heritage backgrounds in the GoFresh Trial. The observed differences between the African heritage groups, underscore the importance of tailored interventions. These findings can guide the development of more effective, culturally sensitive strategies to improve cardiovascular health in these diverse populations, taking into account heritage.
Abstract P1038: Blood Metabolomic Signatures of Incident Coronary Heart Disease in Racially and Ethnically Diverse Populations
Background: Metabolic perturbation has been characterized in coronary heart disease (CHD), yet the comprehensive metabolic fingerprint of incident CHD and potential racial/ethnical differences remain unclear. Hypothesis: Circulating metabolite alterations are associated with CHD risk, but associations vary across race/ethnicity. Methods: We included 22,566 CHD-free individuals of multi-ethnic groups from 7 studies in the Trans-Omics for Precision Medicine Program ( Fig.a ). Associations between metabolites (1245 named metabolites) and incident CHD were assessed by study/race-specific Cox proportional hazards regression. Results were pooled via random-effect meta-analyses. Results: Over an average of 7.5~17.0 yrs of follow-up 1124 incident CHD cases were recorded. We found that 280 metabolites were associated with incident CHD after adjusting for sociodemographic, behavioral factors, medications use, physical activity, and diet (FDR < 0.05), with over 64% were independent of other major cardiometabolic traits ( Fig.b ). Over 90% of these metabolites showed positive associations, with strongest associations in metabolites of glycerolipids, phosphatidylethanolamine, fatty acids, lactoyl amino acid, histidine, aromatic amino acids, and branched amino acids ( Fig.b ). Race-specific analyses identified 70 metabolites presenting significant race/ethnicity differences (FDR<0.05) in associations with CHD, with 34 being race/ethnicity specific metabolites that were not found in all participants (16 in Blacks, 11 in Whites and 7 in Hispanics; Fig.c-e ). For example, guanidinosuccinate, a known uremic toxin, was associated with increased risk of CHD only in US Hispanics, reinforcing the chronic kidney disease (CKD)-cardiovascular diseases continuum, especially for populations at high risk of CKD. Conclusion: Our study characterized the most comprehensive metabolic signatures of incident CHD and revealed substantial racial differences, further emphasizing the need of multi-ethnic resources to uncover metabolic perturbation underlying CHD.
Intraindividual variability differentiated older adults with physical frailty and the role of education in the maintenance of cognitive intraindividual variability
Objectives Physical frailty is associated with increased risk of cognitive impairment. However, its impact on sustained cognitive processing as evaluated by intraindividual variability (IIV), and factors beneficial to IIV in physically frail older adults remain unexplored. This study aimed to quantify differences in IIV between older adults with and without physical frailty, and examine whether education facilitated maintenance of IIV. Methods This cross-sectional study included 121 community-dwelling older adults 65-90 years with/without physical frailty (PF and non-PF; n = 41 and n = 80 respectively). Physical frailty was determined via Short Physical Performance Battery. Dispersion across the seven components of the Montreal Cognitive Assessment (MoCA) was computed to ascertain IIV. Multivariate analysis of covariance was used to determine group differences in total score and IIV. Four moderation models were constructed to test the effects of education on age-total score and age-IIV relationships in PF and non-PF. Results Compared with non-PF, PF showed greater IIV ( p = .022; partial η² = 0.044). Among PF, education moderated age-total score (R-sq = 0.084, F = 5.840, p < 0.021) and age-IIV (R-sq = 0.101, F = 7.454, p = 0.010) relationships. IIV increased with age for those with five years (β = 0.313, p = 0.006) or no formal education (β = 0.610, p = 0.001). Greater than seven years of education (β = 0.217, p = 0.050) may be required to maintain IIV at older age. Conclusion IIV may be a sensitive method to differentiate physically frail older adults. Additionally, perceived cognitive benefits of education may be dependent on physical functioning.