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Insights into the antibacterial mode of action of cress polysaccharide-mediated NiO nanoparticles
Abstract MPTH71: Vitamin E Intake May Mitigate the Risk of <i>APOL1</i> -Associated Kidney Disease Progression Among African Americans
Introduction: Carrying two high-risk alleles (G1 and G2) in the apolipoprotein L1 ( APOL1 ) gene markedly increases the risk of chronic kidney disease (CKD) and its progression. Due to evolutionary selection from Trypanosoma brucei , African Americans have a disproportionately higher prevalence of these alleles. However, only a subset of APOL1 high risk genotype carriers develop CKD or experience rapid progression, suggesting the presence of modifying factors. Vitamin E exerts antioxidant, anti-inflammatory, and endothelial-protective effects, which may counteract APOL1 -associated kidney injury. Therefore, we examined whether circulating vitamin E metabolites modify APOL1 -associated CKD progression among African Americans patients with CKD. Hypothesis: Higher circulating levels of vitamin E metabolites attenuate the risk of APOL1 -associated CKD progression among African American patients with CKD. Methods: We analyzed data from 1,513 African American participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC). Plasma levels of 12 vitamin E-related metabolites were quantified using the untargeted Metabolon platform. APOL1 genotypes were classified as high-risk (two risk alleles) or low risk (0 or 1 risk alleles). CKD progression was defined as developing end-stage kidney disease or having estimated glomerular filtration rate declined by 50% in up to 20 years of follow-up. Cox proportional hazards models were used to test APOL1 -metabolite interactions while adjusting for age, sex, BMI[CL1] , total cholesterol, smoking, drinking, physical activity, education, diabetes, hypertension, and use of ACE inhibitors or ARBs. The 12 metabolites formed 4 independent clusters (pairwise ρ<0.5). So, a Bonferroni corrected significance threshold of P <0.0125 was applied. Results: γ-CEHC glycine significantly ( P for interaction=0.01) and α-CEHC glucuronide nominally ( P for interaction=0.04) modified the APOL1 -CKD progression association. The APOL1 high-risk genotype was associated with faster CKD progression only among those with below-median levels of γ-CEHC glycine (HR=1.88, 95% CI: 1.47 – 2.42, P<0.001[CL2] ), but not among those with above-median levels (HR=1.31, 95% CI: 0.99-1.73, P=0.06). Similar patterns were observed for α-CEHC glucuronide . Conclusions: Vitamin E metabolism may represent a modifiable pathway that mitigates APOL1 -associated CKD progression among African Americans.
Abstract TH838: Home-Based Cardiac Rehabilitation: Patient Perspectives from Kaiser Permanente Southern California
Background: Home-based cardiac rehabilitation (HBCR) is linked to fewer hospitalizations than center-based programs and offers greater flexibility and accessibility. Despite these benefits, enrollment is suboptimal, and barriers to participation and completion are not well understood. Objective: To assess patient-reported perceptions and barriers to HBCR. Methods: Using stratified purposeful sampling, we completed 206 surveys among Kaiser Permanente Southern California (KPSC) patients referred to an 8-week HBCR program between January 1, 2023, and December 31, 2024. Telephone surveys were conducted from June to August 2025 among 4 groups: Group 1 (referred but not enrolled), Group 2 (enrolled but did not participate), Group 3 (participated but did not graduate), and Group 4 (graduated). Sampling targeted ~50% of patients in Group 1 and ~16% in each of Groups 2–4. Surveys assessed motivations and barriers to enrollment and completion, technology use, and qualitative feedback on the HBCR program. Results: Overall there were 102, 35, 34, and 35 survey completions in Groups 1–4, respectively. Most patients (65%) recalled their doctor discussing HBCR. In Group 1, the most common enrollment barriers were preference for self-management (35%) and unfamiliarity with HBCR (31%). Among Groups 2–4, most reported enrolling to help manage their condition (89%) and improve their health (87%). In Group 2, the main barrier to participation was feeling overwhelmed by information or technology (58%), while in Group 3, the main barrier to completion was not noticing health improvement (56%). Most Group 4 patients stated they completed the program to improve their health (97%). Overall, 62% of patients agreed they could use technology applications, 57% could set up video chats, and 51% could resolve basic technical issues without assistance. The most common suggestion for improvement was to extend the program to 6–12 months. Patients valued nurse and staff support, as well as the program’s accountability, flexibility, and education. Conclusion: HBCR may be a convenient alternative to center-based programs, but patients reported barriers including self-management preference, limited awareness, and technology challenges. Stronger physician communication, structured onboarding, and longer program duration may improve participation and cardiovascular outcomes. Despite telehealth support, additional or tailored help may be needed to address these barriers and increase participation.
Abstract WE472: Challenges in muti-disciplinary approaches to heart failure with preserved ejection fraction.
Background: Heart failure (HF) with preserved ejection fraction (HFpEF) is a common yet complex condition managed by primary care providers (PCPs) and requires a multidisciplinary approach to treatment. Prior research showed that, compared to patients with heart failure with reduced ejection fraction (HFrEF), patients with HFpEF are less likely to be recognized and referred by PCPs to cardiology and HF specialty services. We explored PCP-reported challenges and opportunities for HFpEF referrals to cardiology and ancillary services. Methods: A mixed methods analysis included semi-structured interviews and online surveys of PCPs recruited from academic and community practices in the US Southeast. During interviews, participants were asked how they manage HFpEF, refer patients to cardiology, cardiac rehabilitation (CR), and collaborate with other specialty and ancillary services. Surveys collected data on the number of years in practice, practice setting, and factors affecting referral of HFpEF patients to specialty services. Qualitative data were analyzed using thematic analysis in NVivo15 and quantitative data were analyzed using Chi-square tests in SAS. Results: Forty-six PCPs completed the online survey, and another 14 PCPs completed interviews. Of the survey participants, 65% (30) were in academic practice and 35% (16) were in community practice. Of the interviewees, 85.7% (12) were in an urban area and 14.3% (2) practiced in a rural area. Among survey respondents, 50% believed that cardiology should primarily manage HFpEF, while the other half believed that PCPs should do so. Most of the study sample (80.8%) were unlikely to refer patients to cardiology when a HFpEF diagnosis was suspected but not confirmed. 82.6% of PCPs did not refer HFpEF patients to cardiac rehabilitation. Consistent with survey data, thematic analysis identified 3 themes: inconsistency in referrals for HFpEF to cardiology, underutilization of CR and supervised exercise for HFpEF and variable use of ancillary services (i.e. nutrition education, clinical pharmacy) (Figure). Conclusions: Variability in HFpEF management by PCPs suggests that it is not yet standardized, and referrals to cardiology and other services are largely dependent on regional and financial availability. The subjectivity in patient management and structural barriers are the primary drivers of under-utilization of specialty and ancillary services for patients with HFpEF.
A scalable hybrid computational intelligence framework with bio inspired optimization for high dimensional malicious URL inference
Abstract The increasing complexity and scale of internet infrastructure demand computational frameworks capable of performing accurate, scalable, and interpretable inference over high-dimensional network data. Conventional detection strategies often struggle to maintain robustness and efficiency when confronted with heterogeneous feature spaces and rapidly evolving threat patterns. This study presents a scalable hybrid computational intelligence framework that integrates discriminative statistical modeling, gradient-based inference, and bio-inspired meta-heuristic optimization to address large-scale malicious URL detection. The proposed framework couples Linear and Quadratic Discriminant Analysis with a categorical gradient-boosted inference engine, while automated parameter exploration is conducted using the Mother Optimization Algorithm and the Osprey Optimization Algorithm. A large-scale dataset consisting of 63,191 URLs, described by both application-layer and network-layer attributes, is employed to rigorously evaluate the framework’s performance. Statistical robustness is evaluated through exploratory distribution assessment (Shapiro–Wilk), nonparametric hypothesis testing (Kruskal–Wallis), pairwise model comparison, and cross-validation-based performance consistency. These procedures provide quantitative support for model comparison and feature relevance under non-Gaussian conditions. Model transparency and reproducibility are further strengthened using SHAP-based feature attribution to quantify the influence of individual variables. Results demonstrate that the bio-inspired optimized models achieves superior performance, attaining an accuracy of 96.35%, precision of 96.54%, recall of 96.35%, F1-score of 96.40%, and specificity of 96.36%. These findings indicate that the synergistic integration of hybrid discriminative intelligence and bio-inspired optimization significantly enhances inference capability in real-world URL classification dataset with moderate-dimensional features. Beyond cybersecurity, the proposed framework offers a transferable and computationally efficient paradigm for high-dimensional classification and decision-making tasks across engineering systems and data-intensive scientific applications.
Abstract WE430: Food Insecurity and Cardiovascular Disease Among U.S. Adults with Diabetes: Moderation by SNAP
Background: Food insecurity (FI) is a major social determinant of health and disproportionately affects individuals with diabetes, potentially increasing their risk for cardiovascular disease (CVD). Participation in food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) may buffer this relationship by improving food access, yet national evidence remains limited. We aimed to examine the association between FI and CVD among adults with diabetes in the U.S., and the possible modifying role of SNAP participation. Methods: We conducted a cross-sectional analysis of data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) for 31,313 adults aged ≥18 years who self-reported a diabetes diagnosis. FI was assessed with a single question about whether food ran out in the last 12 months due to financial constraints. Outcomes included self-reported coronary heart disease (CHD), myocardial infarction (MI), stroke, and a composite of the three. Weighted multivariable logistic regression to determine the association between FI and CHD, MI and stroke adjusted for sociodemographic and behavioral covariates. Results: Approximately 18.4% of adults with diabetes reported FI, 15.1% participated in SNAP, 12.5% had CHD, 12.2% had MI, 8.8% had a stroke, and 23.8% had at least one condition of the CVD composite. Individuals experiencing FI had significantly higher odds of CVD composite (adjusted odds ratio 1.39, 95% CI: 1.16-1.66) compared to those with food security. Specifically, FI was associated with higher adjusted odds of CHD (1.48, 1.17-1.87), MI (1.33, 1.05-1.68) and stroke (1.29, 1.03-1.63). SNAP participation did not modify the associations between FI and CVD (all p>0.05). Conclusions: Our findings reveal that FI is associated with CVD among adults with diabetes. If replicated in longitudinal studies, these results would provide arguments for incorporating routine FI screening into clinical settings to identify and offer additional support to high-risk individuals.
Abstract TU198: Exercise-induced Elevation of Fibroblast growth factor-1 Observed in MoTrPAC Data Promotes Skeletal Muscle Insulin Sensitivity in Mice.
Exercise is well-known to improve metabolic function and reduce the risk of development of cardiometabolic diseases, however, the molecular mechanisms underlying the exercise benefits remain incompletely understood. Fibroblast growth factor-1 (Fgf1) is secreted from brown adipose tissue and skeletal muscle upon acute exercise in rats. We observed increased expression of Fgf1 in skeletal muscle after single bout of exercise in mice. Recent study shows that recombinant FGF1 (rFGF1) injection lowers blood glucose levels in diet-induced obese mice to a healthy range. However, the role the of endogenous FGF1 induced by endurance exercise training in whole-body insulin sensitivity are unknown. To address this question, we have generated loss-of-function Fgf1- knock-in (KI) mice by using CRISPR/Cas9-mediated gene editing. Three-month-old WT and KI (male and female) mice were subjected to voluntary wheel running for 4 weeks with sedentary controls followed by measurements for whole-body metabolism (energy expenditure, locomotor activity and food intake by CLAMS) body composition (Echo MRI), exercise capacity (metabolic treadmill), cardiac function, cognitive function, as well as whole-body and skeletal muscle insulin signaling (GTT, ITT, HOMA-IR and serum insulin levels during GTT). Our data shows that Fgf1KI mice failed to improve glucose tolerance after 4-week training. We therefore, for the first time, demonstrate that Fgf1 plays a critical role in improving insulin sensitivity in response to endurance exercise training in mice. Altogether, our findings support an important role of Fgf1 in promoting insulin sensitivity in response to endurance exercise training, which has improved our understanding of molecular mechanisms underlying exercise-associated health benefits.
Abstract 75: Replacing Sedentary Behavior with Physical Activity or Sleep and Incidence of Atrial Fibrillation: Results From UK Biobank
Background: Sedentary behavior (SB) has been associated with the risk of cardiovascular disease, independent of physical activity (PA) and sleep. However, the effect of replacing SB with PA or sleep on atrial fibrillation (AF) risk remains unclear. Methods: This study included participants from the UK Biobank who wore wrist-worn accelerometers for seven days consecutively in 2013-2015. Those with prevalent AF, insufficient wearing time, and invalid or uncalibrated accelerometry data were excluded. Daily time spent in light PA (LPA), moderate to vigorous PA (MVPA), sedentary behavior (SB), and sleep were derived from accelerometer recordings, based on a previously trained and validated machine learning model in UK sample. Incident AF was classified by at least 1 ICD-10 code for the condition listed as either a primary diagnosis, secondary diagnosis, or cause of death through hospital and death registry data linkage (I48.x). Follow up began at accelerometer assessment and continued until the earliest of AF onset, loss to follow-up, death, or study censoring date. Using the proportional hazard model, isotemporal substitution was applied to examine the effect of replacing 30 minutes of SB with equivalent durations of each type of PA and sleep on AF risk, adjusting for demographic, socioeconomic, behavioral, and clinical covariates. Stratified analyses by sex and age (<65 vs. ≥65 years) were performed. Results: Among 86,101 participants (57% female, mean age 56±7.8 years, 97% White race), 4,040 AF cases were identified during a median of 7.9 years of follow-up. On average, participants spent 9.0 ± 1.9 hours in SB, 4.8 ± 1.3 hours in LPA, 0.7 ± 0.6 hours in MVPA, and 8.5 ± 1.3 hours in sleep per day. Replacing 30 minutes of SB with PA was associated with a slightly lower risk of AF in the model adjusted for age, sex, race and ethnicity, and assessment centers [LPA: HR 0.98, 95% CI (0.97, 0.99); MVPA: HR 0.89, 95% CI (0.87, 0.92)]. The associations were attenuated after full adjustment [LPA: HR 1.00, 95% CI (0.99, 1.02); MVPA: HR 0.98, 95% CI (0.95, 1.02)]. Results were consistent across sex and age strata. No association with sleep was observed when substituting SB with sleep. Conclusion: In a large population-based cohort in the UK, substituting SB with other daily activities or sleep did not reduce AF risk after accounting for confounding factors. Whether these findings are generalizable to more diverse populations warrant further investigation.
A novel nowcasting (estimation) model based on an adaptive network neutrosophic hesitant fuzzy inference system (ANNHFIS): a case study of Istanbul
Abstract Although biomass power plants are cleaner than fossil-fuel-based plants, they emit nitrogen dioxide (NO₂), which can degrade urban air quality and pose respiratory health risks. Therefore, reliable estimation (nowcasting) of NO₂ levels around these facilities is crucial for public health and air quality management. This study proposes an adaptive network-based neutrosophic hesitant fuzzy inference system optimized by particle swarm optimization (ANNHFIS-PSO) to estimate NO₂ concentrations near biomass plants in Istanbul. To our knowledge, this is the first adaptive neuro-fuzzy inference system (ANFIS)-based framework that incorporates neutrosophic hesitant fuzzy sets to represent environmental uncertainty. The proposed model integrates a neural network with neutrosophic hesitant fuzzy membership functions and employs a hybrid learning scheme that combines PSO-based global optimization with Adam-based fine-tuning to capture nonlinear relationships. Its performance was benchmarked against multilayer perceptron artificial neural network (MLP-ANN), ANFIS-PSO, grid-search-tuned ANFIS (ANFIS-GS), long short-term memory (LSTM) network and ANNHFIS-GS. Model accuracy was evaluated using metrics including root mean square error (RMSE) and coefficient of determination (R²). On the test dataset, ANNHFIS-PSO achieved an RMSE of 3.6488 µg/m³ and an R² of 0.8938, yielding the lowest RMSE and a high R² among the evaluated models. These results suggest that the proposed approach may support decision-making for air quality management near biomass plants.
DNA methylation in invertebrate genomes and cell lineage plasticity
The extent of DNA methylation varies widely across animal genomes, from almost undetectable levels in some taxa to high, pervasive methylation in others. Although DNA methylation has been linked to gene regulation, genome defense, and cellular memory, the evolutionary forces shaping its diversity across taxa remain unresolved. Using phylogenetic comparative analysis of 175 invertebrate species spanning 14 phyla, we show that species with greater regenerative capacity exhibit higher genome-wide CpG methylation, independent of phylogenetic relatedness. This relationship suggests that higher genomic DNA methylation is associated with traits indicative of greater somatic lineage renewal and cell lineage plasticity. We propose that, under such conditions, variation in DNA methylation among dividing cells may influence how cell lineages persist, expand, or are replaced within tissues. Thus, we hypothesize that cross-species variation in DNA methylation may reflect differences in somatic lineage renewal and and opportunities for within-body selection.
Abstract WE561: Sex-Specific Trends in Distribution of Heart Failure Subtype at First Heart Failure Hospitalization: Get With The Guidelines-Heart Failure, 2005-2022
Background: Based on data largely from ambulatory epidemiological cohorts, the prevalence of heart failure with preserved ejection fraction (HFpEF) has increased substantially in the past decade, particularly among women. However, contemporary trends and sex differences in the distribution of HF subtypes among US patients newly hospitalized with HF remains unknown. Here, we aimed to evaluate contemporary trends and sex differences in the distribution of HF subtypes among US patients newly hospitalized with HF in a national registry. Methods: Using the Get With The Guidelines®-Heart Failure registry, we assessed temporal trends in the proportions of heart failure subtypes (HFpEF; EF ≥ 50%; HF with mildly reduced/reduced EF [HFmr/rEF]; EF < 50%) in patients hospitalized with incident HF between 2005 and 2022. Linear regression was used to assess annual changes in the prevalence of HFpEF among hospitalizations with incident HF. Results: Of 372,623 patients with incident HF hospitalizations across 1,081 facilities, 184,977 (49.6%) had HFpEF, 180,731 (48.5%) were women, and 245,561 (65.9%) were age 65 years or older. Over the 18-year period, women with incident HF had a higher proportion with HFpEF (60.5%) versus men (39.3) (risk ratio = 1.54; 95% confidence interval [CI]: 1.53 – 1.55; p<0.001). Among women hospitalized with incident HF, the proportion with HFpEF increased from 51% in 2005 to 61% in 2022, an annual change of 0.39% (95% CI: 0.32% - 0.45%; p trend <0.001) per year. Over the same period among men, the proportion with HFpEF rose from 28% to 41%, an annual change of 0.61% (0.55%, 0.67%; p trend <0.001) per year. Conclusions: By 2022, approximately 50% of patients hospitalized with incident HF had HFpEF. More women with incident HF had HFpEF than men, but men had greater annual increase in the proportion of HFpEF among incident HF hospitalizations. Greater efforts for targeted prevention of HFpEF, particularly for women, are needed.
Abstract MPTU14: Social Determinants of Health and Incident Heart Failure among Black and White Individuals: The REasons for Geographic And Racial Differences in Stroke Study
Background: Social determinants of health (SDOH), or the conditions in which people live, work, and play, profoundly impact cardiovascular outcomes. While SDOH often cluster within individuals, joint impact of specific SDOH on incident heart failure (HF) is unclear and may differ by race. We aimed to identify, rank, and test high-risk combinations of SDOH associated with incident HF among Black and White adults. Methods: We included REGARDS participants who were free of HF during second in-home visit in 2013–2016 and were followed through 2020 for adjudicated HF hospitalization or HF-related mortality. Using oblique random survival forests (ORSF) models, we estimated permutation-based variable importance to identify SDOH most predictive of incident HF, overall and by race. A classification and regression tree (CART) algorithm was used to form high-priority SDOH triads, and Cox models estimated hazard ratios (HR) for incident HF. Bootstrapping (1,000 iterations) generated robust, distribution-free 95% confidence intervals for HRs, capturing uncertainty from both sampling variation and the data-driven CART selection process. Results: Among 13,042 participants (mean age 72.3 ± 9 years; 56% women; 36% Black), 486 had an incident HF event with a median follow-up of 5.9 years (IQR 4.7–6.5). Of 14 SDOH indicators considered, car ownership, health literacy, health insurance, household income, and ability to afford medical care were the strongest predictors of incident HF [Image 1]. Across high-priority triads, participants in the most adversely affected groups had markedly higher hazards of HF than the reference group [Image 2]. For example, compared with participants who owned a car, had adequate health literacy, and health insurance, those lacking all three had higher HF risk (HR 3.98; 95% CI 2.96–5.97). Among Black adults, the triad of no car, $20,000–$34,000 income, and limited health literacy conferred the highest risk (HR 6.00; 95% CI 3.46–11.24). Among White adults, the triad of no car, limited health literacy, and inability to afford medical care was most adverse (HR 5.37; 95% CI 3.71–8.10). Conclusions: Combinations of adverse SDOH, particularly transportation barriers, low health literacy, lack of insurance, lower income, and poor access to affordable care—were associated with substantially increased risk of incident HF. Patterns were consistent across racial groups, suggesting that addressing these access-to-care barriers may yield broad population benefits.
Abstract TH809: A Randomized Feasibility Pilot of a Lifestyle Medicine Intervention to Improve Cardiovascular Health: The HeartBeet Clinic
Introduction: Lifestyle medicine focuses on six key behaviors (physical activity, plant-forward eating, sleep, avoiding risky substances, social connection, and stress management) to prevent and treat chronic disease like cardiovascular (CV) disease. However, integrating lifestyle medicine into cardiology clinics can be difficult due to lack of infrastructure for sustained behavior change support. Hypothesis: We hypothesized that the HeartBeet Clinic lifestyle medicine intervention could be feasibly delivered via virtual groups or a self-paced online course. Methods: This randomized pilot feasibility trial enrolled 60 adults with at least one CV risk factor from a preventive cardiology clinic within a large integrated health system. Participants (62% female, 33% male, 5% other gender; M age = 54.1 years, SD = 11.7; 82% White, 10% Black, 8% other race) were randomized to either a virtual group-based program or a self-paced online course. Both programs lasted 16 weeks and covered the six pillars of lifestyle medicine. In the group-based program, participants initially had a group visit with a cardiology physician assistant, followed by weekly virtual small-group meetings with a health coach. The self-paced group accessed the same educational content online. Pre- and post-intervention assessments included vitals (blood pressure, weight), laboratory measures (glucose and lipids), and surveys of lifestyle behaviors. Feasibility was evaluated through retention and intervention completion rates. Intervention plausibility was assessed using the Life’s Essential 8 (LE8) CV health measure (scale 0-100) and by determining whether individual risk factors improved to a clinically significant degree. Results: Retention rates were similar between the self-paced course and the group-based program (87% v. 77%, p = .32). In the self-paced program, 57% fully and 17% partially completed the online course. In the group-based program, 70% attended at least half of the sessions. Both groups showed comparable improvements in CV health scores (LE8 mean change: group = 6.6 units; self-paced = 7.2 units) over 16 weeks, with >80% improving at least one risk factor to a clinically significant degree. Conclusions: Delivering the HeartBeet Clinic through both virtual group and self-paced formats was feasible and associated with meaningful improvements in CV health. Future studies could consider tailoring delivery methods or adopting a stepped-care approach for optimal resource use.
Clinical feasibility of intratracheal tracheostomy sealing using a novel sealing disc prototype
Abstract After tracheostomy decannulation, stoma openings compromise airway integrity, reduce subglottic pressure, and impair cough efficiency. Conventional external dressings are often not airtight and require extensive maintenance, increasing the risk of delayed healing and pulmonary complications. We evaluated the feasibility, physiological impact, and patient-reported outcomes of an intratracheal sealing disc designed to maintain airway integrity during early post-decannulation healing. In this feasibility study, 21 tracheostomized patients were enrolled from the Department of Intensive Care at Aarhus University Hospital and Gødstrup Regional Hospital (pilot phase, n = 11; main study, n = 10). Immediately after decannulation, a sealing disc was inserted intratracheally and secured externally for up to 7 days. Spirometry, voice quality, and tracheostomy healing were assessed daily. Patient satisfaction was measured using a questionnaire with a 5-point Likert scale. The sealing disc provided an airtight closure during speaking and coughing. Placement and removal were quick and uneventful. Patient satisfaction overall reached a median (interquartile range) score of 5/5 (1). Forced vital capacity, forced expiratory volume in the first second, and voice quality improved significantly immediately after sealing and remained stable during wear and after removal. In this First-in-Man clinical feasibility study, intratracheal sealing immediately after decannulation proved feasible, well-tolerated, and may improve pulmonary function, phonation, and wound healing. Larger controlled studies are warranted. Trial Registration : This trial was retrospectively registered at ClinicalTrials.gov with the identifier NCT07149116 – date of registration: 08/08/2025.
Abstract WE558: Projected Health and Economic Impact of National Sodium Reformulation Policies in India: A Comparative Modeling Study
Background: Excess sodium intake contributes to nearly 200 000 cardiovascular deaths annually in India, where average daily salt consumption (8–11 g) exceeds the WHO recommendation by more than twofold. Despite global progress, India lacks large-scale implementation of sodium-reduction policies. This study modeled the potential health and economic benefits of national salt-reformulation strategies to inform policy design and prioritization. Methods: A comparative risk-assessment model estimated annual cardiovascular deaths and healthcare costs averted under three policy scenarios: voluntary 10 % sodium reduction, mandatory 20 % reduction, and mandatory 20 % reduction combined with front-of-pack labeling. Baseline sodium intake distributions were derived from national dietary surveys and adjusted for age, sex, and rural–urban strata. Relative risk functions for systolic blood pressure and cardiovascular outcomes were sourced from meta-analyses and the Global Burden of Disease study. Model inputs incorporated compliance assumptions, latency effects, and probabilistic sensitivity analyses. Direct medical costs were estimated from national health expenditure data (2024 USD). Results: Compared with current intake levels, the modeled policies were projected to avert approximately 79 000 (95 % UI 68 000–96 000), 158 000 (115 000–210 000), and 205 000 (150 000–270 000) cardiovascular deaths annually for the voluntary, mandatory, and combined scenarios, respectively. The comprehensive policy (Scenario 3) would yield an estimated US $1.2 billion (0.9–1.6 billion) in annual healthcare savings, with consistent benefits across sensitivity analyses. Potential risks of hyperkalemia from potassium substitution were minimal and offset by overall cardiovascular gains. Conclusions: National sodium-reformulation and labeling policies could prevent up to 200 000 cardiovascular deaths and generate substantial economic savings in India each year. Even partial adoption would produce meaningful health returns. Integration of mandatory sodium targets, industry monitoring, and consumer education into India’s National NCD Action Plan offers a cost-effective path toward achieving WHO sodium-reduction goals.
Abstract WE485: "Racial Trends in Aortic Valve Disease-Related Mortality Among Postmenopausal Women in the United States (2018–2023): A CDC WONDER Joinpoint Regression Analysis"
Background: Aortic valve disease (AVD) remains a major cause of cardiovascular morbidity and mortality in postmenopausal women. While transcatheter aortic valve replacement (TAVR) has improved outcomes, racial disparities in mortality persist, and the COVID-19 pandemic may have further altered care patterns. This study evaluates racial trends in age-adjusted mortality rates (AAMR) from AVD among women aged 55–84 across four racial groups between 2018 and 2023. Methods: Mortality data were extracted from the CDC WONDER database for women aged 55–84 from 2018–2023. Segmented joinpoint regression was performed to identify temporal inflection points and calculate annual percent change (APC) and AAMR across racial groups: White, Black/African American, American Indian/Alaska Native, and Asian. Trends were compared, and statistical significance was assessed at p<0.05. Results: Between 2018 and 2023, 39,781 deaths from aortic valve disease occurred among U.S. women aged 55–84. White women had the highest age-adjusted mortality rate (AAMR) at 16.15 per 100,000, with a non-significant overall annual percent change (APC) of +0.38%; a slight increase was noted after 2020, followed by a modest decline. Black women had an AAMR of 11.15 and a significant APC of -2.93%, with a transient rise in 2020. American Indian/Alaska Native women showed the most volatility (AAMR 11.08), including a sharp drop in 2019, partial recovery, and decline after 2021 (overall APC -3.09%). Asian women had the lowest AAMR at 6.38, with a modest overall decline (APC -1.89%) and a dip during 2020 followed by gradual recovery. Notable breakpoints occurred around the COVID-19 pandemic years (2019–2021), highlighting racial differences in mortality trajectories. Conclusion: This analysis reveals substantial racial disparities in AVD-related mortality among postmenopausal women. While most groups experienced stable or declining mortality, White women exhibited a concerning upward trend post-pandemic onset. These findings suggest the need for equitable access to valve interventions and targeted surveillance in vulnerable populations. Future research should evaluate underlying structural and healthcare access contributors to these disparities.
Abstract TH805: The Association of Cardiovascular Morbidity and Testicular Cancer Survivorship
The purpose of this study was to conduct a comprehensive review and quality evaluation of the current literature on the relationship between testicular cancer (TC) treatment and the possible development of cardiovascular diseases (CVD). A total of 21 studies comprising both case-control and cohort designs were selected for review. Data on study design, location, participant demographics, and outcomes were extracted. For methodological quality, each study was evaluated using the Newcastle-Ottawa Scale (NOS). 17 out of the 21 assessed studies were deemed to be high quality, with the remaining 3 being average quality. The mean of the scores was 8.1/9.0. Results found that chemotherapy, specifically platinum-based or cisplatin regimens, was significantly related with increased risk of presenting cardiovascular events in the future. Radiotherapy showed elevated cardiovascular risk, while orchiectomy alone did not directly increase CVD risk. In addition, patient comorbidities were contributing factors for increased risk of CVD. TC patients given platinum-based chemotherapy treatment, particularly cisplatin, are more likely to experience increased cardiovascular risk. Addressing these risks through long-term monitoring and improved research design is crucial to enhancing follow-up care. It is imperative to highlight the need for a holistic post-treatment approach for testicular cancer survivors by incorporating cardiovascular health. A multidisciplinary approach that includes routine screening, lifestyle interventions, and individual support can enhance long-term quality of life.
Faunal exploitation at the elephant hunting site of Lehringen, Germany, 125,000 years ago
Abstract WE569: Multimorbidity Burden Differs by Stroke Subtype and Race/Ethnicity: Insights from the All of Us Research Program
Background: Clustering of vascular risk factors shapes stroke outcomes, but its variation by race/ethnicity and stroke subtype at presentation in diverse populations is poorly understood. We hypothesized that clustering would differ across these groups. Methods: We conducted a cross-sectional analysis of 4,954 adult stroke patients with electronic health record (EHR) and survey data from the All of Us Research Program (2016-2023). Stroke subtype (ischemic vs. subarachnoid hemorrhage [SAH]) was identified using standardized EHR diagnosis code groupings. Vascular risk factors included smoking, obesity (BMI ≥30 kg/m 2 ), hypertension (SBP ≥140 or DBP ≥90 mmHg), diabetes (HbA1c ≥6.5%), dyslipidemia (LDL ≥100 mg/dL), and statin use. We summarized the distribution of risk factor counts, including the proportion with ≥3, by stroke subtype and race/ethnicity. We then used Poisson regression to estimate relative risks (RRs) of higher clustering, with models including age, sex, race/ethnicity, and stroke subtype as predictors. Results: The cohort (mean age 62.9 ±12.1; 53.5% female; 49% White, 26% Black, 15% Hispanic, 9% Other, 1% Asian) included 95.9% ischemic strokes and 4.1% SAH. Clustering was frequent: 33% of ischemic and 25% of SAH patients had ≥3 risk factors. By subtype, ischemic patients more often had 3, 4, or 5 risk factors (24%, 9%, 1%) than SAH patients (19%, 5%, 1%). By race/ethnicity, ≥3 risk factors occurred in 39% of Black, 34% of Hispanic, 33% of Other, 27% of White, and 22% of Asian patients. In models adjusted for age, sex, and subtype, clustering was higher among Black (RR 1.21, 95% CI 1.15-1.27), Hispanic (RR 1.09, 95% CI 1.03-1.16), and Other patients (RR 1.16, 95% CI 1.08-1.24) versus White, and lower among Asian patients (RR 0.75, 95% CI 0.60-0.91). Female patients had modestly higher clustering than males (RR 1.06, 95% CI 1.01-1.10). SAH patients had fewer clustered risk factors than ischemic patients (RR 0.88, 95% CI 0.79-0.97). Conclusion: In this diverse cohort of stroke survivors, vascular risk factor clustering was common and varied by race/ethnicity, sex, and subtype. Absolute prevalence was highest among Black and Hispanic patients and lowest among Asian patients. SAH survivors exhibited fewer comorbidities than ischemic stroke survivors, reflecting both etiologic differences and survivor bias. These findings underscore the high comorbidity burden among stroke survivors and the importance of addressing disparities in post-stroke care.
Abstract TU278: Psychosocial Factors and Sleep Health among Postpartum Women
Background: Psychosocial factors are linked to poor cardiovascular health (CVH) and elevated CVD risk through biological and behavioral pathways that may impair sleep. Postpartum (PP) women remain understudied despite this period being characterized by heightened stress and cardiovascular vulnerability. This study examined associations between psychosocial factors and sleep characteristics in PP women. Methods: PP (<6mos) women from the NANIT baby monitor database were recruited (N=415, mean age=33±3.85y; 25% racial/ethnic minority). Sleep was assessed using validated instruments which measured sleep duration and quality (Pittsburgh Sleep Quality Index [PSQI]), chronotype (Morning-Eveningness Questionnaire [MEQ]), and insomnia symptoms (Insomnia Severity Index [ISI]). Depression, social support and caregiver strain were assessed using the validated Beck Depression Inventory-II (BDI-II), the ENRICHD Social Support Instrument (ESSI), and the Caregiver Strain Index (CSI), respectively. Logistic regression models evaluated associations between psychosocial factors and sleep outcomes, adjusting for age, race/ethnicity, education and insurance. Results: Overall, 43% of women reported depressive symptoms (BDI-II>13), 11% low social support, and 17% high caregiver strain (CSI>7). Short sleep duration (<7h/night) was reported by 63%, poor quality sleep (PSQI>5) by 75%, and insomnia symptoms (ISI≥8) by 50%; 5% were evening chronotype (MEQ score <42) and 30% took >20 min to fall asleep. After adjustment, depressive symptoms were associated with multiple sleep disturbances, including short sleep duration (OR:2.33, 95%CI=1.53-3.57), poor sleep quality (OR:5.71, 95%CI=3.22-10.77), and insomnia (OR:5.18, 95%CI=3.93-8.00), as well as sleep onset >20 min (OR:1.86, 95%CI=1.21-2.87) and evening chronotype (OR:2.53, 95%CI=1.04-6.56). Low social support was also associated with insomnia (OR:3.92, 95%CI=1.94-8.60). High caregiving strain was associated with poor sleep quality (OR:5.45, 95%CI=2.13-16.88). Conclusions: Among PP women, psychosocial challenges were common and strongly associated with sleep disturbances. Depression was associated with multiple adverse sleep outcomes. Low social support was associated with insomnia symptoms and high caregiving strain was associated with poor sleep quality. These findings underscore psychosocial pathways that may connect sleep and CVH in PP women, highlighting the potential for interventions to improve CVH during this vulnerable period.