Browse Articles

Abstract P3072: Midlife Depressive Symptoms and Hypertension Status Modify The Association Between Long-Term Systolic Blood Pressure Variability From Childhood and Midlife Cognitive Function: The Bogalusa Heart Study

Background: Hypertension (HTN) and depression have been speculated to have a bidirectional relationship, and linked to risk of dementia. Long-term systolic blood pressure (SBP) variability has been associated with HTN in adults. Evidence regarding long-term SBP variability and worse cognitive function in older adults is increasing. Whether depressive symptoms at midlife modifies the association between long-term SBP variability from childhood and midlife cognitive function is unclear. Methods: We examined 1104 midlife participants of the Bogalusa Heart Study (age at enrollment: 9 ± 3 years, follow-up: 39 ± 3 years, age at last exam: 48 ± 5 years, 61% women, 35% Black participants) with ≥3 measurements of SBP across follow-up. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (scores of ≥10 defined as having depressive symptoms). Long-term SBP variability from childhood was measured as the deviation from age predicted value (DEV). DEV is the mean of the difference between each observed SBP value and predicted SBP value for age, which were obtained by fitting repeated SBP measures across follow-up to random effects models. Midlife cognitive function was measured by 8 neuropsychological tests, which were standardized by age, race, and sex, then averaged into a global cognitive score (GCS). Associations between long-term variability of SBP and GCS were analyzed using multivariable linear regression models Stratified analyses by midlife depressive symptom and HTN status were performed. Results: DEV of the study population was 7 ± 3 mmHg. A total of 692 (63%) and 360 (33%) participants had HTN and depressive symptoms at midlife, respectively. Of the 692 participants with HTN, 250 (36%) had depressive symptoms. Higher long-term variability of SBP was linked to poorer midlife cognitive function. Stratified analysis by depressive symptom and HTN status showed higher effect sizes in participants with depressive symptoms and HTN at midlife, compared to those without (Table). Conclusions: Both depressive symptoms and HTN status at midlife may interact with SBP variability and influence midlife cognitive function. Screening for both depressive symptoms in addition to SBP variability in individuals with HTN may be beneficial to preserve midlife cognitive function.

Abstract P2029: Objectively Measured Daytime, Evening, and Nighttime Ambient Light Exposure and Mortality Risk: Findings from a US Nationally Representative Cohort

Introduction: Light is the strongest zeitgeber (time cue) for the human central circadian clock, and its effects on health may vary depending on the time of day by either strengthening or dampening circadian rhythms. However, the relations between various light exposures and human health remain largely unknown, partly due to the lack of available measurements. Hypothesis: We hypothesized that greater nighttime and evening light exposure would be associated with a higher mortality risk, while greater daytime light exposure would be associated with a lower mortality risk. Methods: This population-based prospective cohort study included 7,909 participants aged ≥20 years, with ≥4 days of data from wrist-worn accelerometers with light sensors measuring ambient light (lux) at 1 Hz from the U.S National Health and Nutrition Examination Survey 2011-2014. Mortality data through 2019 were obtained via linkage to the National Death Index. The average intensity of ambient light exposure during daytime (6:00 AM-7:59 PM), evening (8:00-11:59 PM), and nighttime (0:00-5:59 AM) were calculated. Cox models were used to estimate hazard ratios (HRs) for mortality. Results: During a median (IQR) follow-up of 6.8 (5.7-7.8) years, 803 deaths were documented, including 255 from cardiovascular disease and 192 from cancer. The multivariable-adjusted HRs (95% CIs) for all-cause mortality were 0.82 (0.66-1.03) for the second quartile of daytime light exposure, 0.83 (0.67-1.04) for the third quartile, and 0.67 (0.51-0. 89) for the highest quartile, compared to the lowest quartile ( P for trend <0.001). Conversely, there was no association between nighttime ( P for trend = 0.14; HR for the highest vs lowest quartile: 0.94 [0.75-1.19]) or evening light exposure ( P for trend = 0.46; HR for the highest vs lowest quartile: 0.85 [0.71-1.03]) and all-cause mortality risk. Similar inverse associations of daytime light exposure were observed for cardiovascular disease mortality ( P for trend = 0.04; HR for highest vs lowest quartile: 0.65 [0.36-1.20]) but not for cancer mortality ( P for trend = 0.27; HR for highest vs lowest quartile: 0.89 [0.54-1.48]). Conclusions: In this nationally representative sample of U.S. adults, greater objectively measured ambient light exposure during daytime was inversely associated with all-cause and cardiovascular disease mortality risk. These findings may have significant public health implications given the reduced exposure to daytime light in modern society.

The mitochondrial genome of the steppe carpenter moth (Paracossulus thrips Hübner, 1818): Structural analysis and phylogenetic implications

Abstract Paracossulus thrips (Lepidoptera: Cossoidea) is a rare micromoth species native to the Eurasian steppe that occurs in fragmented populations across its distribution area. In Europe, it persisted only in a few isolated populations, which warranted protection by the EU’s Habitats Directive. We assembled the first complete mitochondrial genomes of two individuals of P. thrips using shotgun whole-genome sequencing data. The assembled mitogenomes were complete and circular; they contained 13 protein-coding genes, 22 tRNA genes, and two rRNA genes. The A + T-rich control region (CR) was identified between the 12 S rRNA and tRNA-Met (CAU) regions. We performed phylogenetic tree reconstruction focusing on the Cossoidea superfamily within the Lepidoptera order by incorporating the new mitochondrial genome assemblies presented in this study. Using available mitogenomes of the superfamily, the mitochondrial phylogeny placed P. thrips within the Cossinae subfamily as a sister to the only other species with an assembled mitogenome. These assemblies may provide valuable genetic resources for further large-scale phylogenetic studies of the Cossoidea superfamily, a poorly studied group of the Lepidoptera order. This work could also support the long-term conservation management of this unique species by providing resources for conservation genetic research.

Redirecting immune signaling with cytokine adaptors

Abstract Cytokines are signaling molecules that coordinate complex immune processes and are frequently dysregulated in disease. While cytokine blockade has become a common therapeutic modality, cytokine agonism has had limited utility due to the widespread expression of cytokine receptors with pleiotropic effects. To overcome this limitation, we devise an approach to engineer molecular switches, termed cytokine adaptors, that transform one cytokine signal into an alternative signal with a different functional output. Endogenous cytokines act to nucleate the adaptors, converting the cytokine–adaptor complex into a surrogate agonist for a different cytokine pathway. In this way, cytokine adaptors, which have no intrinsic agonist activity, can function as conditional, context-dependent agonists. We develop cytokine adaptors that convert IL-10 or TGF-β into IL-2 receptor agonists to reverse T cell suppression. We also convert the pro-inflammatory cytokines IL-23 or IL-17 into immunosuppressive IL-10 receptor agonists. Thus, we show that cytokine adaptors can convert immunosuppressive cytokines into immunostimulatory cytokines, or vice versa. Unlike other methods of immune conversion that require cell engineering, cytokine adaptors are soluble molecules that leverage endogenous cues from the microenvironment to drive context-specific signaling.

Abstract P2031: Indoor Radon Concentrations Are Associated with Leukocyte and Platelet Counts

Introduction: Previous studies identified a possible association between indoor radon concentrations and increased risk of stroke; however, the underlying biological mechanisms are unclear. We therefore investigated the associations between indoor radon concentrations and leukocyte and platelet counts to explore inflammation and thrombosis as potential mechanisms of radon-related stroke. Methods: We conducted a repeated measures study in a prospective cohort of post-menopausal women enrolled in the Women’s Health Initiative (WHI) in 1993-1998 and examined at 5 visits over 19 years in 40 US centers. At each visit, we excluded women with hematologic malignancy, medication use affecting leukocyte/platelet counts, or extreme values of them. We estimated time-varying indoor radon concentrations (pCi/L) at geocoded, address-specific participant locations based on the 1993 US Geological Survey radon index and categorized them according to US EPA action levels: <2, 2-4, and >4 pCi/L. We also measured cell counts (cells/μL) in blood drawn at each visit on automated counters at local laboratories following standard quality assurance procedures. We imputed missing covariates (demographic; social; behavioral; clinical; environmental) by chained equations. Then we estimated covariate-adjusted, radon and log-transformed cell count associations using linear, mixed-effects models including a participant-level random intercept and a visit-year fixed effect. Results: Among 157,044 women at baseline (mean age: 63; 85% white; 9% African American, 5% Hispanic; 4% other; mean leukocyte and platelet counts: 5,866/μL and 247,619/μL), we found positive radon-platelet count and negative radon-leukocyte count associations (both p <0.001). At radon concentrations of 2-4 and >4 pCi/L, fully-adjusted platelet counts (95% confidence intervals) were 1,002 (215-1,788) and 2,934 (1,885-3,983) cells/μL higher and leukocyte counts were 38 (25-50) and 65 (48-81) cells/μL lower than at <2 pCi/L. Indeed, platelet counts increased by 625 cells/μL (457-792) and the leukocyte counts decreased by 9 cells/μL (6-12) per unit increase in the radon index. Conclusion: Our findings suggest radon-related stroke risk may be partly thromboembolic in origin and could involve activation or suppression of hematopoietic stem cells in the myeloid or lymphoid lineages. Further research is needed to clarify the hematologic effects of indoor radon and their potential roles in increased cerebrovascular risk.

Abstract P1169: Postpartum Care in Hypertensive Disorders of Pregnancy: Exploring Factors Affecting Follow-Up

Introduction: Hypertensive disorders of pregnancy (HDP) increase long-term cardiovascular risk, yet adherence to postpartum follow-up is poor, particularly among women facing socioeconomic barriers. This study explores how factors such as race, social determinants of health (SDOH), substance use, and admissions to NICU correlate with postpartum follow-up and adherence to current cardiovascular screening recommendations. Hypothesis: We hypothesize that disparities in race and SDOH influence postpartum follow-up and adherence to screening guidelines. Additionally, we hypothesize that high-risk factors such as NICU admissions may contribute to lapses in follow-up care. Methods: A retrospective review of 173 women with HDP diagnosis was conducted between July 2021 (after the easing of COVID-19 restrictions) and July 2024 at a community hospital. Thirty-one women were excluded due to incomplete records or HDP history prior to 2021. An additional fifteen women were excluded as it has not been one-year post-delivery. Data on postpartum follow-up, prior co-morbidities, race, alcohol use, NICU admission, and SDOH were collected (Table 1). Adherence to screening was assessed per AHA and ACOG recommendations. Results: Of the 127 women included in the study, 70.1% were White, and 27.5% were Black. In total, 21.3% had no postpartum follow-up and 31.5% frequently rescheduled appointments. Screening adherence was poor, with only 14% having some recommended labs drawn one year postpartum. Only 6.3% of women were screened with all five recommended labs (BMP, HbA1C, TSH, urine microalbumin/creatinine ratio, lipid panel). Chi-square analysis was performed for race, SDOH, NICU admission, and substance use. It was noted that NICU admission significantly impacted follow-up, with only 24% of women with babies admitted to NICU following up (p=0.007). Race, SDOH, and substance use did not significantly impact follow-up rates (p>0.05). (Table 2-5) Conclusion: There is a significant gap in postpartum follow-up and screening, particularly among women with babies requiring NICU care. This could be explained by complex post-natal care but has a significant impact on maternal health outcomes. While race and SDOH did not significantly affect follow-up, targeted interventions for high-risk populations are necessary to improve cardiovascular outcomes.

Abstract MP46: Protein Supplementation Reduces Metabolic Risk Score for Mild Cognitive Impairment: Evidence from the Protein and Blood Pressure Study

Introduction: Mild cognitive impairment (MCI) is a major public health challenge that affects up to 18% of individuals aged 60 or older. Prior studies have shown that soy and milk protein supplementation reduces blood pressure compared to carbohydrate. Given that hypertension is a major risk factor for dementia, it is important to investigate whether these benefits from protein supplementation translate to cognitive improvements. Additionally, evidence suggests that replacing ultra-processed foods with whole foods, particularly those containing soy protein, may enhance cognitive outcomes. We aimed to evaluate the impact of carbohydrate, soy protein, and milk protein supplementation on MCI risk, as indicated by a validated metabolomic risk score (MRS), in the Protein and Blood Pressure (ProBP) trial. Hypothesis: We hypothesize that the three dietary supplementations, particularly soy protein, would attenuate the MRS. Methods: The ProBP study was a double-blind, crossover randomized controlled trial involving 80 participants. Each participant received 40 grams daily of carbohydrate, soy protein, or milk protein supplementation for eight weeks in random order, with three-week washout periods between interventions. Untargeted metabolomic profiling was conducted at baseline and post-intervention to calculate the MRS. We used paired t-tests to assess net changes in the risk score after each intervention, and a mixed-effects model to compare the impacts of the three dietary interventions. Results: All three interventions significantly reduced the MRS for MCI (Table). Soy protein demonstrated the largest effect (net change = -0.207; P = 0.006), followed by milk protein (net change = -0.182; P = 0.008) and carbohydrate (net change = -0.137; P = 0.038). However, the effects of the protein supplementation were not significantly different from carbohydrate. Conclusion: Soy protein, milk protein, and carbohydrate supplementation all significantly reduced the MRS for MCI, with soy protein showing the greatest effect.

Author Correction: Hybridization of synergistic swarm and differential evolution with graph convolutional network for distributed denial of service detection and mitigation in IoT environment

Structural basis for intrinsic strand displacement activity of mitochondrial DNA polymerase

Abstract P2080: Interrelations between Atherogenic Index of Plasma, Subclinical Myocardial Injury, and Cardiovascular Mortality in the General Population

Background: The Atherogenic Index of Plasma (AIP), a novel biomarker of lipid metabolism, is linked to adverse cardiovascular disease (CVD) outcomes. Subclinical myocardial injury (SCMI) may precede clinically evident CVD. We examined the association between AIP and SCMI, and their combined impact on CVD mortality in the general population. Methods: We analyzed 7,093 participants without CVD from the Third National Health and Nutrition Examination Survey. AIP was calculated as the logarithmic ratio of triglycerides to HDL cholesterol. Participants were stratified into low or high AIP groups based on the median AIP value (0.958). SCMI was defined by a Cardiac Infarction/Injury Score (CIIS) ≥10 from 12-lead electrocardiograms. Four groups were created based on AIP and SCMI status. CVD mortality data were obtained from the National Death Index. Multivariable logistic regression models assessed the cross-sectional association between AIP and SCMI, while Cox proportional hazards models examined the relationship between different AIP/SCMI groups and CVD mortality. Results: At baseline, 1,861 participants had SCMI, and 3,533 had high AIP. In the cross-sectional analysis, adjusted for socio-demographics and CVD risk factors, high AIP was significantly associated with increased odds of SCMI [OR (95% CI): 1.20 (1.07–1.35)]. Compared to participants with low AIP and absent SCMI, those with SCMI, irrespective of AIP level, had a significantly higher risk of CVD mortality in multivariable Cox proportional hazard models. However, high AIP without SCMI was not associated with CVD mortality (AIP/SCMI interaction p-value = 0.477) (Table) . Conclusions: In a CVD-free general population, high AIP was associated with an increased risk of SCMI. While SCMI was linked to a higher risk of CVD mortality regardless of AIP levels, high AIP was only associated with CVD mortality when SCMI was present. These findings suggest that the reported adverse outcomes linked to high AIP may be driven by the development of SCMI.

Abstract P1030: Role of Hypertension in the Cardiovascular-Kidney-Metabolic Syndrome among Black Adults: The Jackson Heart Study

Introduction: CKM consists of obesity, metabolic risk factors, chronic kidney disease (CKD) and cardiovascular disease (CVD). Hypertension is a key factor for stage 2 CKM and it is most common among Black adults. A better understanding of the role of hypertension in CKM progression is needed. Aim: To estimate the risk of progression to stage 4 CKM in Black adults, overall and among those with hypertension, in the Jackson Heart Study (JHS). Methods: We included 2,118 Black adults in the JHS without clinical CVD at baseline. Participants were categorized into: Stage 1 CKM: overweight/obesity, abdominal obesity or dysfunctional adipose tissue with no metabolic risk factors including hypertension; Stage 2 CKM: metabolic risk factors including hypertension, diabetes, hypertriglyceridemia, metabolic syndrome or CKD; Stage 3 CKM: subclinical CVD; or Stage 4 CKM: Clinical CVD. The incidence rate of stage 4 CKM for participants in stages 1, 2 and 3 CKM were estimated. We used Cox proportional hazards regression to estimate hazard ratios (HRs) for incident stage 4 CKM. Results: At baseline, 20%, 69%, and 11% of participants were in stages 1, 2 and 3 CKM. The prevalence of hypertension in stage 2 CKM and stage 3 CKM were 80% and 95%, respectively. The incidence rate per 1,000 person-years of stage 4 CKM for participants with stage 2 CKM and hypertension was 7.5 (95% CI 6.1, 8.9), and for stage 3 CKM and hypertension was 26.6 (95% CI 19.8, 33.3) ( Table ). The adjusted HRs of developing stage 4 CKM were 3.25 (95%CI: 1.56-6.80) and 5.11 (95% CI 2.05-12.78) for participants with stage 2 and 3 CKM with hypertension versus stage 1 CKM, respectively. Conclusion: The majority of JHS participants with stages 2 and 3 CKM had hypertension, which was associated with an increased risk for progressing to stage 4 CKM when compared to stage 1 CKM participants.

Abstract 027: Correlates of Cardiac Structure and Function from the First Population-based Study of Echocardiography in the African Caribbean Diaspora: a preliminary report of the Tobago Heart Study

Abnormal cardiac structure and function are associated with increased risk of heart failure and cardiovascular (CV) events. Persons with African ancestry are at high risk for hypertensive-related cardiac abnormalities; yet, there have been no population-based echocardiographic studies in African Caribbeans. Therefore, we aimed to perform echocardiography in men and women aged 50-80 years from Tobago (the Tobago Heart Study: THS). Between 2021-2024, 623 participants (81% female, mean age 60.7 years) underwent clinical examination including brachial-ankle pulse-wave velocity (PWV) and ankle brachial index (ABI, peripheral artery disease, PAD= ABI<0.9), and transthoracic echocardiography. Images were analyzed by a core lab to include left ventricular (LV) ejection fraction (EF), LV mass index (LVMI), diastolic dysfunction, and LV geometry (normal, concentric remodeling, or left ventricular hypertrophy [LVH]). Multivariable linear or logistic regressions were used. Risk factors were common in the THS, with 50% obesity and 78% hypertension yet only 12% BP control. Mean PWV was 1609 cm/s and 4.4% had PAD. Abnormal LV geometry was present in the majority (80%), most being concentric remodeling (68%). LVH was seen in 12% overall and was more prevalent in men than women (29% vs 9%, P<0.01). Mean EF was 64% with EF<50% in 1.4%. Diastolic dysfunction prevalence was 13.6%. In addition to age and sex, CV risk factors associated with echocardiographic indices in multivariable models included SBP, DBP and antihypertensive medication use. BMI, diabetes, statin use, smoking and sedentary behavior were not independent predictors of any echocardiography measure. Though greater alcohol intake (>4/week) was independently associated with greater odds of LVH (OR (95%CI): 4.1 [1.6-10.3]). After adjusting for CV risk factors, PWV was associated with greater odds of concentric remodeling (P=0.03; Table). Also, lower ABI was associated with lower LVEF (P=0.02, Table) and PAD presence was associated with greater odds of EF<50% (OR: 6.8; 95% CI: 1.3-37.6, not shown). The THS presents the first population-based assessment of cardiac structure and function in the African Caribbean diaspora. Cardiac structural remodeling is highly prevalent in the THS and is associated with arterial stiffness and PAD. Thus, these results further highlight the need for blood pressure control in this high-risk population.

Local-structure insight into the improved superconducting properties of Pb-substituted La(O, F)BiS2: a photoelectron holography study

Abstract Pb-substituted La(O, F)BiS 2 (Pb-LaOFBiS 2 ) exhibits improved superconducting properties and a resistivity anomaly around 100 K that is attributed to a structural transition. We have performed temperature( T )-dependent photoelectron holography (PEH) to study dopant incorporation sites and the local structure change across the anomaly. The PEH study of Pb-LaOFBiS 2 provided evidence for the dominant incorporation sites of Pb and F: Pb atoms are incorporated into the Bi sites and F atoms are incorporated into the O site. No remarkable difference in the local structures around Pb and Bi atoms was observed. Across the temperature of the resistivity anomaly ( T * ), photoelectron holograms of Bi 4f changed. Comparisons of holograms with those of non-substituted LaOFBiS 2 sample, as well as simulated holograms, suggested that (1), above T * , the tetragonal structure of Pb-LaOFBiS 2 is different from the tetragonal structure of LaOFBiS 2 and (2), below T * , the tetragonal structure still remains in Pb-LaOFBiS 2 . We discuss a possible origin of the difference in the structure above T * and the implication of the result below T * , which are necessary ingredients to understand the physical properties of Pb-LaOFBiS 2 .

Methane emissions from thermokarst lakes must emphasize the ice-melting impact on the Tibetan Plateau

Abstract Thermokarst lakes, serving as significant sources of methane (CH4), play a crucial role in affecting the feedback of permafrost carbon cycle to global warming. However, accurately assessing CH4 emissions from these lakes remains challenging due to limited observations during lake ice melting periods. In this study, by integrating field surveys with machine learning modeling, we offer a comprehensive assessment of present and future CH4 emissions from thermokarst lakes on the Tibetan Plateau. Our results reveal that the previously underestimated CH4 release from lake ice bubble and water storage during ice melting periods is 11.2 ± 1.6 Gg C of CH4, accounting for 17 ± 4% of the annual total release from lakes. Despite thermokarst lakes cover only 0.2% of the permafrost area, they annually emit 65.5 ± 10.0 Gg C of CH4, which offsets 6.4% of the net carbon sink in alpine grasslands on the plateau. Considering the loss of lake ice, the expansion of thermokarst lakes is projected to lead to 1.1–1.2 folds increase in CH4 emissions by 2100. Our study allows foreseeing future CH4 emissions from the rapid expanding thermokarst lakes and sheds new lights on processes controlling the carbon-climate feedback in alpine permafrost ecosystems.

Abstract 044: Urinary Metals and Incident Heart Failure: A Multi-Cohort Study and Meta-Analysis

Background: Environmental metals are recognized risk factors for cardiovascular disease, yet the role of urinary metals and metal mixtures on incident heart failure (HF) remains understudied. Objectives: To evaluate the prospective association of urinary metals on incident HF risk across three geographically and ethnically/racially diverse cohorts: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Strong Heart Study (SHS) in the United States, and the Hortega cohort in Spain. Methods: A total of 6,644, 2,917, and 1,334 adults 35-80 years old were included across MESA (39% non-Hispanic white, 27% non-Hispanic Black, 22% Hispanic/Latino, 12% Chinese-descent), SHS (100% American Indian), and Hortega (100% white), and followed up to 19 years. Urinary levels of inorganic arsenic, cadmium, molybdenum, selenium, and zinc were measured in all cohorts at baseline. The multi-adjusted (sociodemographic + clinical covariates) hazard ratios (HR) of HF per one interquartile range (IQR) difference in urinary metals were estimated for each metal using Cox proportional hazard models and a fixed-effects meta-analysis was run for each metal across cohorts. Flexible dose-response assessment was conducted using quadratic splines. We further estimated the HRs and 10-year-survival probability difference per IQR change in the mixture of five metals using Cox proportional hazard models with an Elastic Net penalty. Results: A total of 425 (MESA), 477 (SHS), and 103 (Hortega) participants developed HF over the study follow-up. Significant associations were identified for arsenic (Pooled HR (95%CI): 1.06 (1.00, 1.12), cadmium (HR: 1.15 (1.07, 1.24)), molybdenum (HR:1.14 (1.03, 1.26)), and zinc (HR: 1.23 (1.02, 1.49)) in the meta-analyses (Figure 1). A largely linear dose-response was identified for arsenic and cadmium (Figure 2). In fully adjusted models, the HRs (95% CI) and 10-year survival probability differences (95% CI) of incident HF per one IQR increase in the metal mixture were, respectively, 1.38 (1.00, 1.86) and -0.40 (-0.78, 0.00) in MESA, 1.55 (1.28. 1.97) and -1.24 (-2.20, -0.59) in SHS, and 1.08 (0.85, 1.63), and -0.03 (-0.21, 0.06) in Hortega. Conclusion: This multi-cohort study identified consistent associations between higher urinary metals and increased risk of heart failure across diverse populations, supporting the role of prevention strategies to reduce contaminant metal exposure to lower HF risk.

Abstract MP24: Socioeconomic Disparities in Cardiac Rehabilitation Perceptions and Delivery Mode Preferences: A Nationally Representative Survey Among Diverse Cardiac Patients.

Background: Cardiac rehabilitation (CR) is essential to secondary cardiovascular disease prevention and management of cardiac patients. Despite its proven benefits, CR remains underutilized with enrollment and completion rates ranging from 10-30% in the US. Yet, there is a scarcity of nationally representative data among diverse populations on socioeconomic differences in barriers and beliefs of CR participation and delivery mode preferences. Hypothesis: The perceptions (barriers, beliefs), CR delivery mode preferences, and CR utilization (prior enrollment) varies by socioeconomic status (SES) among CR-eligible individuals. Methods: We conducted an anonymous national electronic survey from March 2023 to January 2024 of individuals self-reporting a prior CR-eligible diagnosis. The 22-item CR Barriers Scale assessed perceived barriers to CR enrollment and participation using a 5-point Likert scale (strongly disagree to strongly agree). A 13-item, validated questionnaire assessed 4 subscales pertaining to patients’ beliefs about CR, each rated on a 5-point Likert scale (strongly disagree to strongly agree): perceived necessity, concerns about exercise, practical barriers and perceived suitability. CR delivery mode preferences were ascertained (eg, virtual, at-home, etc.). Mean barriers and belief scores as well as delivery mode preferences were stratified by SES. Low SES was defined as ≤ high school education, Medicaid insurance, or uninsured. High SES was defined as > high school education and non-Medicaid health insurance. Responses were analyzed using descriptive statistics with R software. Results: A total of 466 participants completed the survey (38.1% women, 30.6% minoritized racial/ethnic group, 29.6% low SES, 95% response rate) ( Table 1 ). The majority indicated prior enrollment in CR (81.5%) with no difference by SES. CR barrier scores did not differ significantly by SES (p=0.331) ( Table 2 ). Beliefs about CR perceived necessity and perceived suitability differed by SES (p<0.001 and p=0.025), but beliefs regarding concerns about exercise and practical barriers did not. The low SES group reported a higher preference for completely at-home CR compared to the high SES group (33.6% vs 7.4%, p<0.001). Conclusion: Our findings suggest that CR beliefs varied by SES while utilization did not. For CR-eligible patients experiencing socioeconomic disadvantage, at-home CR may be a preferred alternative to center-based CR to increase CR participation and adherence.

Abstract P3033: Determining Decision Thresholds For Physicians And Parents For Instituting A Do-Not-Attempt-Resuscitation Order For Pediatric In-Hospital Cardiac Arrest Patients – A Cross-Sectional Study Of Parents And Physicians In The United States

Introduction: Decision-making about resuscitating a critically ill child is complex but common. We aimed to study the survival thresholds at which a physician, compared to parents, decides to treat or withhold resuscitating a child. Moreover, we aimed to compare physicians' estimates of survival with the estimates calculated using data from a nationwide registry. Methods: We conducted a cross-sectional survey-based study including parents and physicians in the United States. Clinical vignettes based on hypothetical survival probabilities were used to study and compare the decision thresholds for parents and physicians. Vignettes developed using the Get-With-The-Guidelines-Resuscitation registry were used to explore physicians’ decision thresholds and compare the physician-estimated survival with the survival from the data. Thresholds were determined for each vignette using mixed-effect logistic regression models. Results: A total of 167 parents and 43 physicians provided decisions for 501 and 257 vignettes respectively. The decision threshold for survival to discharge was 5.3% (95% CI: 3.7 to 7.0) for physicians and 1.2% (95% CI: -0.8 to 3.0) for parents. Whereas the decision threshold for survival to discharge with PCPC 1 or 2 was 3.5% (95% CI: 1.1 to 7.1) for physicians and 0.6% (95% CI: -1.2 to 1.8) for parents. Physicians overestimated the likelihood of survival. About 58% estimated a higher survival than that predicted by the multivariate model. The Do-Not-Attempt-Resuscitation threshold based on physician-estimated survival probability was 13% and the threshold based on model-based probability was 5.3%, the same as the one calculated using hypothetical survival probabilities. Conclusions: Using the model-based and hypothetical probability of survival, we estimated the decision threshold for physicians and parents to be 5.3% and 1.2% respectively. This illustrates that parents still want to attempt resuscitation at a survival probability where physicians would recommend withholding the resuscitation. These findings have implications for clinical practice and counseling the parents of critically ill hospitalized children.

Geographic inequalities and factors associated with unfavorable outcomes in diabetes-tuberculosis and diabetes-covid comorbidities in Brazil

PGRMC2 is a pressure-volume regulator critical for myocardial responses to stress in mice

Abstract 057: Associations between Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Risk Factors in Midlife: A Mediation analysis in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death in females globally. Sex-specific CVD risk factors such as adverse pregnancy outcomes (APOs) are on the rise. Pre-pregnancy obesity is a key modifiable risk factor for both APOs and CVD. However, whether APOs mediate the relationship between body mass index (BMI) and midlife CVD risk factors is unclear. Purpose: Determine the extent to which the associations between pre-pregnancy BMI and CVD risk factors 10-14 years after delivery are mediated by APOs. Methods: Participants ≥ 18 years enrolled at 28 weeks’ gestation (range: 24-32 weeks) in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study without pre-pregnancy hypertension or diabetes were included in analyses. Counterfactual causal mediation analysis assessed whether gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) mediated associations between self-reported pre-pregnancy BMI and CVD risk factors 10-14 years after delivery. Missing baseline data were computed using multiple imputation by chained equations to create 10 imputed datasets. The results from each imputed dataset were combined using Rubin rules. Covariates included maternal and gestational age, parity, field center, alcohol and smoking status in pregnancy, and fetal sex. Results: Participants (N = 4,269) were 30.0±5.6 years and 10.6% had a BMI≥30.0 kg/m2. During the HAPO pregnancy, GDM complicated 13.8% and HDP 10.7% of pregnancies. Compared to those with a pre-pregnancy of BMI of 18.5-24.9 kg/m2, those with a BMI ≥30.0 kg/m2 had a greater mean arterial pressure (7.1 mmHg; 95% CI: 6.0 - 8.1), triglyceride (28.5 mg/dL; 95% CI; 21.9 – 35.1), glucose (7.4 mg/dL; 95% CI: 4.9 – 9.8), and hemoglobin A1c (0.3%; 95% CI: 0.2 – 0.4) levels at midlife. Among indivdiuals with a pre-pregnancy BMI≥30.0 kg/m2, GDM mediated a statistically significant portion of associations with fasting glucose levels and hemoglobin A1c whereas HDP mediated the association with mean arterial pressure only ( Table ). Conclusions: In a multinational cohort of pregnant individuals, these findings suggest that APOs do not mediate a majority of the association between obesity and CVD risk factors in mid-life. Prioritizing weight management earlier in the life course before pregnancy may support maternal and future cardiovascular health.