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Abstract P2009: Education, Income, and Long-Term Risks of Cardiovascular Disease in the U.S. Population from 2011-2020
Background: The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations estimate long-term cardiovascular disease (CVD) risk. The distribution of total CVD risk in the U.S. population across different education and income levels based on the PREVENT equations is currently unknown. Methods: Using the PREVENT base model equations and data on adults aged 30-79 years from the 2011-2020 National Health and Nutrition Examination Survey, we determined age-standardized and survey-weighted risk of CVD based on education and income. Those with existing CVD were excluded from PREVENT model calculations. Results: The study population included 12,852 participants, representing 160.6 million U.S. adults (mean age 51.8 [SD 13.3] years). Overall, adults with lower education and income were more likely to have intermediate to high 10-year risk (≥7.5%) of CVD, particularly those <65 years of age (Table). The prevalence of existing CVD among those with a high school (HS) diploma/GED or below, some college degree, or a college graduate or above education was 12.5%, 9.6%, and 6.3%, respectively. The prevalence of CVD-free U.S. adults with intermediate or high (≥7.5%) predicted 10-year risk of CVD was 21.6% for HS diploma/GED or below, 21.1% for some college degree, and 17.8% for college graduate or above education. Among U.S. adults with low, middle, or high income, the prevalence of existing CVD was 15.7%, 11.1%, and 6.4%, respectively. The prevalence of CVD-free U.S. adults with intermediate or high predicted 10-year risk of CVD was 23.4% for low income, 21.2% for middle income, and 18.6% for high income. Conclusions: U.S. adults who have not graduated from college and those with low or middle income had higher long-term risks of total CVD, with the disparities becoming apparent as early as 30-44 years old. Public health efforts should prioritize reducing these disparities early in life to improve cardiovascular outcomes in vulnerable populations.
Abstract P1045: Relationship Between Cardiovascular Risk Factors and All-Cause and Cancer-Specific Mortality Among Cancer Survivors in the United States
Background: To address the growing burden of cardiovascular disease among cancer survivors, prior studies have assessed the association between cardiometabolic risk factors and mortality among individuals with cancer but have largely focused on specific cancer types or been limited by small sample sizes. We used nationally representative data to examine the relationship between cardiovascular risk factors and mortality among US cancer survivors. Methods: We analyzed data from the National Health Interview Survey (2012-2018), linked to National Death Index, for adults aged ≥18 years with a self-reported cancer history (excluding non-melanoma skin cancer) and cardiovascular risk factors. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, obesity, smoking, and physical inactivity, categorized as low risk (0 factors), intermediate (1-2), or high (3+). Multivariable Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CI for all-cause and cancer-specific mortality. Results: Among 15,690 cancer survivors (median age 68.0 years; 60.4% female), representing 14.8 million survivors annually, 5.3%, 38.8%, and 55.9% were at low, intermediate, and high cardiovascular risk, respectively. Cancer survivors at intermediate and high risk had a 3.1-fold (HR: 3.11, 95% CI: 2.09-4.64) and 3.6-fold (HR: 3.60, 95% CI: 2.42-5.35) increased risk of all-cause mortality compared to survivors at low risk, respectively. A similar relationship was present for cancer-specific mortality (intermediate vs. low HR: 2.53, 95% CI: 1.50-4.24; high vs. low HR: 2.44, 95% CI: 1.45-4.09). Conclusions: In a sample of cancer survivors, most individuals were at high cardiovascular risk, which in turn was associated with an increased risk of all-cause and cancer-specific mortality. Identifying those at the highest risk as part of oncology survivorship care could impact survival among this vulnerable population.
Abstract P1149: SAHAS-CR: Improving Cardiovascular Disease and Stroke Prevention Awareness in South Asians using a Culturally Tailored Approach
Introduction: The risk of cardiovascular disease (CVD) is nearly doubled in the South Asian population. South Asians experience earlier disease onset and increased morbidity and mortality compared to other ethnic groups. Culturally tailored health education has been shown to improve disease knowledge and clinical outcomes. However, the effectiveness of such initiatives within the South Asian population is not well known. This study aims to investigate changes in knowledge following a culturally tailored CVD and stroke education session in South Asians. Methods: A 20-minute CVD and stroke prevention education session tailored to South Asian culture was conducted at a local community center. Surveys with clinically focused and culturally focused questions were administered pre- and post- session to assess changes in knowledge. Statistical analysis comparing mean change in knowledge was performed using paired t-tests. Results: The session was attended by 161 participants who identified as South Asian, with a mean age of 49 years old, 48% female, and a mean length of residence in the US of 20 years. The following risk factors of CVD were identified amongst participants: hypertension in 31%, diabetes mellitus in 24%, obesity in 17%, hyperlipidemia in 34%, arrhythmias in 5%, prior stroke in 3%, and prior myocardial infarction in 7%. The average pre-session knowledge score was 53 +/- 17 % which increased to 63 +/- 18% post-session (p<0.001). Post-session change in knowledge for questions addressing culturally tailored lifestyle modifications were significantly higher than change in knowledge for questions addressing pathophysiological concepts (p<0.02). Further stratification also reveals that changes in knowledge post-session were greater for questions addressing medical concepts taught in a culturally relevant context than concepts which were not (p<0.05). Conclusion: Community health education appears to be associated with improved CVD and stroke knowledge in the South Asian community. Furthermore, education provided from a cultural perspective is associated with a greater improvement in knowledge than that provided from a clinically focused perspective. These insights are critical for the development of patient education strategies that align with the cultural practices and values of South Asian individuals, who bear a substantial burden of cardiovascular disease.
Assessing Hepatitis B virus infection, risk factors and immunization among particularly vulnerable tribal groups in Eastern India
The DEAD-box helicase eIF4A1/2 acts as RNA chaperone during mitotic exit enabling chromatin decondensation
Abstract During mitosis, chromosomes condense and decondense to segregate faithfully and undamaged. The exact molecular mechanisms are not well understood. We identify the DEAD-box helicase eIF4A1/2 as a critical factor in this process. In a cell-free condensation assay eIF4A1/2 is crucial for this process, relying on its RNA-binding ability but not its ATPase activity. Reducing eIF4A1/2 levels in cells consistently slows down chromatin decondensation during nuclear reformation. Conversely, increasing eIF4A1/2 concentration on mitotic chromosomes accelerates their decondensation. The absence of eIF4A1/2 affects the perichromatin layer, which surrounds the chromosomes during mitosis and consists of RNA and mainly nucleolar proteins. In vitro, eIF4A1/2 acts as an RNA chaperone, dissociating biomolecular condensates of RNA and perichromatin proteins. During mitosis, the chaperone activity of eIF4A1/2 is required to regulate the composition and fluidity of the perichromatin layer, which is crucial for the dynamic reorganization of chromatin as cells exit mitosis.
Abstract P1007: Detecting Physical Frailty Phenotype Using Wearable Device
Introduction: Identifying and monitoring frailty can inform optimal care for older adults. This study aimed to detect frailty using wearable device-measured movement behaviors (MBs). Hypothesis: We hypothesized that random forest models were able to detect frailty using MBs. Methods: This cross-sectional study included 44 older adults living in the community (79.6±9.3 years old; 84% females). The Fried Frailty Phenotype (FFP) was defined as having 3 or more of unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. Participants wore a thigh-worn ActivPAL for 10 consecutive days. MBs were quantified as: 1) overall activity (activity score, daily steps and number of sit-to-stand), 2) time in postures (standing, stepping, sitting and lying), 3) time in bed, 4) time in sitting bouts over 30 min and 60 min, 5) stepping counts and time in <1, 1-5, 5-10 and 10-20 min bouts, 6) stepping counts and time in cadences >75 and >100, and 7) peak stepping counts in 10 seconds, 2, 6, and 10 min. Random forest models were developed to classify FFP and its 5 individual components, with age, sex, BMI, and MBs as predictor variables. Results: Eleven (25%) participants were frail. The average ActivPAL wear time was 9.14±1.49 days. The model achieved an AUC [95% CI] of 0.85 [0.71-0.99] for FFP. The 5 most important predictors were time in standing, stepping time in < 1 min bouts, time in stepping, stepping counts in 10-20 min bouts, and stepping counts in 1-5 min bouts (Table). The models for individual FFP components also achieved AUC [95% CI] of 0.90 [0.77-1.00] for unintentional weight loss, 0.89 [0.78-1.00] for exhaustion, 0.88 [0.76-0.99] for slowness, 0.81 [0.63-0.99] for low physical activity, and 0.94 [0.87-1.00] for weakness (Table). Conclusions: A thigh-worn wearable device can detect FPP with high accuracy. Once validated in an independent sample, our algorithm can be useful for frailty assessment and monitoring.
Abstract 011: Physician-Level Variation in Lipid Management for Secondary Prevention of Atherosclerotic Cardiovascular Disease: Opportunities for Practice Improvement
Introduction: While prior studies have documented suboptimal lipid therapeutic management and low rates of LDL-C goal achievement in patients with ASCVD, the degree of variability between cardiologists in lipid-lowering therapy (LLT) practice patterns is less well described. Hypothesis: Significant variability exists between cardiologists in their use of LLT and achievement of LDL-C goals in patients with ASCVD. Methods: We evaluated the use of LLTs and achievement of LDL-C <70 mg/dL among adults with ASCVD (peripheral arterial disease, coronary artery disease, or ischemic cerebrovascular disease) followed by a cardiologist at a large academic medical center from 1/1/22-6/30/24. LLT utilization and LDL-C goal achievement were modeled using mixed-effects logistic regression with clustering at the cardiologist level, adjusting for patient age, insurance, ASCVD type, and diabetes. From this model, we quantified physician-level variability using the adjusted median odds ratios (aMOR). Results: Among 10,531 patients with ASCVD (mean age 68.5 years, 61.1% male, 69.8% White) seen across 55 cardiologists, 80.6% were on any statin, 51.5% were on a high-intensity statin, 14.9% were on ezetimibe, 5.6% were on bempedoic acid or a PCSK9 inhibitor, and 15.1% were not on any LLT. Of those with a lipid panel in the past year (n= 7,555), 45.9% achieved an LDL-C < 70 mg/dL. Lipid management strategies varied substantially across cardiologists ( Figure ). In mixed-effects models adjusting for patient-level factors, significant physician-level variation was observed in high-intensity statin use (aMOR 1.33, 95% CI 1.25-1.45), ezetimibe use (aMOR 1.62, 95% CI 1.46-1.85), bempedoic acid or PCSK9 inhibitor use (aMOR 2.03, 95% CI 1.75-2.45), and attainment of LDL-C < 70 mg/dL (aMOR 1.27, 95% CI 1.20-1.38). Conclusion: Even among cardiologists at the same academic medical center, practice patterns varied widely in the use of LLT and achievement of LDL-C goals for secondary prevention. Understanding the reasons for this variability and standardizing lipid management across the specialty may improve quality of care for patients with ASCVD.
Abstract P2033: Cumulative Lifetime Estimated Lead Exposure Estimated From DNA Methylation at Midlife and Risk of Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Background: Lead (Pb) may increase risk of cardiovascular disease (CVD) through several pathways such as endothelial injury, inflammation, oxidative stress, lipid metabolism, and hypertension. Epigenetic biomarkers can be used to estimate cumulative Pb exposure. We tested the hypothesis that greater cumulative Pb exposure estimated through DNA methylation (DNAm)-based biomarkers would be associated with higher risk of CVD. Methods: We included 3,372 ARIC study participants who had Illumina 450K BeadChip DNAm data and were free of prevalent CVD in 1990-1995. We calculated two DNAm-based biomarkers of estimated cumulative Pb exposure that have been validated against measured tibia and patella bone Pb concentrations in an external sample of men. The tibia score was a weighted average of 138 CpG sites while the patella score used 59 CpG sites. ARIC participants were followed through 2021 for incident coronary heart disease (CHD), stroke, heart failure (HF), and a CVD composite. Cox regression was used. Results: Participants were an average of 57±5.9 years old, 62% were female and 70% self-identified as Black and 30% as White. There were 1,342 CVD events and 523 CHD events over a median of 22.0 years. For tibia Pb estimates, interactions (p<0.05) with sex were observed ( Table ). Men in the highest versus lowest quintile of estimated tibia Pb had a hazard ratio (95% CI) of 1.38 (1.03-1.85) for incident CVD and 1.93 (1.24-2.99) for incident CHD, after model 2 adjustments. Magnitudes of association were smaller for HF, and null for stroke. There was no evidence of an association in women. In both sexes, estimated patella Pb was unrelated to both outcomes. Discussion: Epigenetic estimates of cumulative tibia Pb exposure were associated with risk of incident CVD and CHD in this sample of men from the ARIC cohort. DNAm estimates were derived from a sample of men and may not be generalizable to women. There is a longer half-life of Pb in the tibia (a cortical bone) than in the patella (a trabecular bone). Our findings with estimated tibia Pb may reflect longer-term exposure. Additional research is needed to understand the role of cumulative Pb exposure on CVD risk.
Choroidal thickness as predictor of subclinical carotid atherosclerosis in adults with type 1 diabetes
Dual wavelength Brillouin laser terahertz source stabilized to carbonyl sulfide rotational transition
Abstract P2086: Sex and Racial Differences in Prescription Patterns to Guideline-directed Medical Therapy Among STEMI Patients.
Background: ST-elevation myocardial infarction (STEMI) is associated with serious complications and mortality. Percutaneous coronary intervention (PCI) is the principal reperfusion strategy for STEMI patients, followed by pharmacologic therapy to prevent recurrent cardiovascular (CV) events. The American Heart Association (AHA) and American College of Cardiology (ACC) recommend the use of guideline directed medical therapy (GDMT) prescribed at hospital discharge following a STEMI. Given the well-described sex and racial differences in the adherence to pharmacologic therapies, this study aimed to assess whether sex and racial differences also exist in GDMT prescribing patterns in STEMI patients at hospital discharge. Methods: Analyses were performed on 734 STEMI patients (176 females, 558 males; 78.5% white) that presented to two urban emergency departments between January 1, 2022, and March 31, 2024 and underwent PCI during admission. Discharge prescriptions for GDMT based on AHA/ACC guidelines (Aspirin, P2Y12 inhibitors, β-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and statins) were compared by sex and race using chi-square tests of association. Given that physicians commonly only prescribe ACEIs/ARBS when ejection fraction (EF) is low, sub-analyses were run on patients with EF <50%. Results: Table 1 shows differences in GDMT prescribed at discharge by sex and race categories. Among patients with successful PCI, 52.8% were prescribed all five GDMT and 70.0% were prescribed four secondary prevention medications (Aspirin, P2Y12 inhibitors, BBs, statins). Males were more likely to be prescribed all five GDMT at discharge compared to females (55.4 vs. 44.6%). The greatest difference in medication class prescribed between sexes was for BBs (80.1 vs. 72.2%). Racial disparities were also noted, as white patients were more likely to receive all five GDMT at discharge compared to non-white patients (53.7 vs. 47.7%). The greatest difference in medication class prescribed between white and non-white patients was for ACEI/ARBs (63.1 vs. 49.3%). Racial differences remained significant when only assessing patients with low EF (86.3 vs. 70.8% on ACEI/ARB). Conclusion: Optimal secondary prevention medications are effective in reducing the risk of repeat CV events. Strategies are needed to address sex and racial disparities in GDMT prescribing patterns to achieve AHA/ACC guidelines and improve patient outcomes.
Abstract P2012: Motivational Themes in Digital Advertisements Enhance Recruitment Efficiency in Cardiovascular Trials
Background: Recruitment for clinical trials is driven by participants’ motivations, including scientific discovery, study incentives, personal health benefits, and community contribution. Recruitment success depends on balancing initial interest with a participant’s commitment to the study topic and their eligibility. There is little data characterizing the impact of distinct motivational themes on trial recruitment. Objective: To compare the impact of four distinct motivational themes on participant interest, commitment, and eligibility for the two hypertension trials. Methods: The GoFresh trials examine how healthy groceries affect blood pressure among Black adults from Boston food priority areas. Using Facebook’s “A/B testing” feature, users 18 years and older in qualifying ZIP codes were randomly assigned to view one of four digital ad themes emphasizing: science volunteerism, study incentives, blood pressure reduction, and wellness in the Black community between November 2023 and July 2024 (Figure). We captured the number of clicks to our website according to the ad version. ‘Inquiries’ (interest) were defined as those who completed an information request form on the trial website. These individuals underwent a prescreening telephone visit and an in-person screening visit. ‘Commitment’ was based on “no-shows” (persons who scheduled an in-person visit but did not attend), while ‘Eligibility’ was based on participants who qualified for the study following the in-person visit. Results: The ads generated 28,090 clicks, 233 inquiries, 65 scheduled visits, and 23 eligible participants. As shown in the Table, the community theme generated the most clicks and inquiries per click but showed lower commitment and lower eligibility. While the blood pressure theme had the lowest interest, these participants showed the highest commitment and the highest eligibility rate. Conclusion: Beyond generating study interest, motivational themes may select for participants with varying degrees of commitment and eligibility, which could affect the cost effectiveness of recruitment and long-term retention. These findings have important implications for timely and representative recruitment for cardiovascular trials.
Abstract P1077: A comparison of outpatient cardiac rehabilitation access between rural and urban counties in Tennessee
Background: Longer travel distance and time to outpatient cardiac rehabilitation (OCR) are linked with lower OCR attendance despite OCR being significantly associated with reduced hospital readmission and mortality following a myocardial infarction. With contemporary research on rural-urban differences in proximity to OCR being limited, we examined whether travel distance and time to the closest OCR facility differed between rural and urban Tennessee counties. With there being a known lack of resources throughout the cardiovascular disease care continuum in rural areas, we hypothesized that rural Tennessee counties would have significantly greater travel distance and time to OCR than urban counties. Methods: To identify Tennessee OCR facilities, we supplemented an existing Tennessee Association of Cardiovascular and Pulmonary Rehabilitation OCR listing by data scraping Google Maps using keywords associated with OCR from the literature. Counties with Rural-Urban Continuum Codes 1-3 were classified as urban counties and codes 4-9 denoted rural counties. County-level mean travel distance and time to the closest facility were determined for each county and Wilcoxon rank-sum tests were performed to examine if mean travel distance/time differed significantly by rural/urban county status. Results: Twenty-three out of Tennessee’s 61 OCR facilities (37.7%) were in rural counties. Mean county-level travel distance to closest OCR was 16.6 miles (SD + 10.0 miles) and mean county-level travel time was 27.9 minutes (SD + 13.6 minutes). When examined by rural/urban county status, rural counties had slightly higher median of mean travel distance and time (15.4 miles, 28.9 minutes) compared to urban counties (12.9 miles, 23.2 minutes). However, the p-values for the distance and time comparisons between rural and urban counties were not statistically significant being 0.182 and 0.284 respectively. Conclusions: While <40% of Tennessee’s OCR facilities were in rural counties, this did not correspond with significantly greater travel distance/time in rural versus urban counties, a contrast to what is usually observed for rural-urban distribution of services throughout the cardiovascular disease care continuum. With that said, additional efforts are warranted to help patients with actual or perceived high travel burden navigate the personal and structural factors precluding receiving OCR.
Burnout and stress: new insights and interventions
Filamentation activates bacterial Avs5 antiviral protein
Abstract P2081: Characterization of Severe Hypercholesterolemia Phenotype within Electronic Health Records
Severe Hypercholesterolemia phenotype (SHP), defined as having low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, is a strong predictor for atherosclerotic cardiovascular artery disease (ASCVD). People diagnosed with SHP are recommended to start taking statins, however there are still gaps and disparities in treatment. The purpose of this study is to characterize SHP patients and describe treatment patterns using real-world data from electronic health records (EHR) at a large academic health system. We conducted a retrospective cohort study using EHR data of individuals who had a clinical encounter at the University of Wisconsin Hospitals and Clinics between 01/01/2013 and 07/30/2023. The study was approved by the University of Wisconsin-Madison IRB. Participants aged 18–55 years with elevated total cholesterol (>200 mg/dL) or LDL-C (≥130 mg/dL) were eligible for this study. Cases of secondary hypercholesterolemia and participants receiving statins at enrollment were excluded. Statistical analysis was conducted using Pearson’s chi-square and Student t-test and counts (%) for categorical and median (interquartile range) for continuous variables are reported. All analyses were done using R (v. 4.3.1) analytical software. This study included 33,418 participants, of which 43% were women, 86% were White, and 95% were non-Hispanic/Latino. SHP was identified in 2,822 participants, who tended to be male (61% vs. 54%, P < 0.001), have a personal (2.1% vs. 1.6%, P =0.02) or family (15.6% vs. 11.7%, P < 0.001) history of coronary artery disease, and higher all-cause mortality (1.0% vs. 0.6%, P =0.03), compared to non-SHP cohort. Statin prescription was lower among patients who were younger (median age: 40 vs. 43 years) or Hispanic/Latino (4.6% vs. 2.9%, P = 0.023), with some differences (statistically non-significant) across races. We noted that patients prescribed statins were more likely to have comorbidities – ASCVD (12.2% vs. 3.3%, P < 0.001), hypertension (24.4% vs. 14.6%, P < 0.001), or diabetes (9.1% vs. 4.5%, P < 0.001), compared to their untreated counterparts. Current study revealed that statin prescription was correlated with age and presence of comorbidities. Our results suggest need for further investigation of institutional, clinician, and patient-related predictors and barriers for statin prescription, to improve compliance with clinical guidelines for prevention of ASCVD and other SHP-related diseases.
Abstract MP14: Total dairy consumption is associated with healthy sleep patterns in US adults
Introduction: Emerging evidence suggests a bidirectional relationship between diet and sleep, with diet serving as a potential determinant of sleep health. Indeed, dairy products may improve sleep by increasing endogenous melatonin production. Despite this, few epidemiological studies have investigated the association between dairy consumption and sleep health in the US population. Therefore, we conducted a cross-sectional analysis to evaluate the association between dairy product consumption (total and sub-types) and sleep health in a nationally representative sample of U.S. adults. Hypothesis: Higher dairy intake will be associated with better sleep outcomes compared to lower intake. Methods: Participants included 23,000 men and women aged ≥18 y (mean age 46.7±0.3 y), pooled from the 2005-2020 National Health and Nutrition Examination Survey (NHANES). Dairy intake, including total and specific sub-types, was estimated from at least one 24-hour dietary recall. We categorized average dairy intake as low, moderate, and high based on the distribution of intake of the entire cohort. Sleep duration on weekdays and trouble sleeping (yes/no) were obtained from self-reported questionnaires. Sleep duration was categorized as: ≤7 h, 7–9 h (reference), and ≥9 h per night. Survey-weighted logistic regression was used to evaluate dairy intake in relation to sleep outcomes, adjusting for sociodemographic and clinical factors, lifestyle choices, sugar and saturated fat intakes, and the healthy eating index. Results: Mean total dairy intake was 1.76 cup eq/day. High total dairy intake was associated with lower odds of short sleep duration (OR high vs low =0.88; 95%CI 0.78-0.99; P-trend=0.033) and trouble sleeping (OR high vs low =0.86; 95%CI 0.75-0.98; P-trend=0.025). Those with high milk intake had 16% lower odds of short sleep duration, compared to those with low milk intake (OR high vs low =0.84; 95%CI 0.76-0.94; P-trend=0.0019). Moreover, high intake of whole and/or reduced fat dairy was associated with lower odds of trouble sleeping (OR high vs low =0.81; 95%CI 0.72-0.92; P-trend=0.0016). Conclusions: Our findings suggest that dairy consumption is associated with better sleep health, specifically lower odds of having insufficient sleep and trouble sleeping. However, these associations warrant confirmation in longitudinal studies and clinical interventions to further address causality.
Abstract P2071: Effects of Dietary Patterns and Sodium Intake on Blood Pressure Variability: Results from the DASH and DASH-Sodium Trials
Background: Increased blood pressure (BP) variability is associated with adverse cardiovascular disease outcomes. The Dietary Approaches to Stop Hypertension (DASH) diet and sodium reduction lower BP and cardiovascular risk, but their effects on office and ambulatory BP variability are uncertain. Methods: This study analyzed data from the DASH and DASH-Sodium trials, including those participants who were randomized to the DASH or Control diet and had both office and 24-hour ambulatory BP measurements. Office BP was measured at baseline and end of feeding periods using a random-zero sphygmomanometer. Ambulatory BP was measured at the end of intervention periods in both trials and at baseline in DASH trial. BP variability was quantified using the variation independent of the mean (VIM) and compared across groups using t-tests. We used bias-corrected and accelerated bootstrap methods to calculate 95% CIs for the difference in VIM. Results: The DASH trial analyses included 214 participants (mean age, 45 years; 48% Female; 59% Black) while the DASH-Sodium trial analyses included 337 participants (mean age, 49 years; 58% Female; 60% Black). After intervention, neither the DASH diet nor sodium reduction significantly affected BP variability in office or ambulatory measurements. In DASH trial, the difference in VIM for office systolic BP between DASH and Control diets was -0.17 (95% CI -0.82 to 0.47), and for ambulatory systolic BP was 0.59 (95% CI -0.23 to 1.41). In the DASH-Sodium trial, compared to high sodium levels, low sodium levels showed similar BP variability (e.g., ΔVIM for office systolic BP: 0.29, 95% CI -0.08 to 0.69; ΔVIM for ambulatory systolic BP: 0.05, 95% CI -0.27 to 0.37). No significant combined or interactive effects of diet and sodium level on BP variability were observed. Conclusion: While the DASH diet and reduced sodium intake effectively lower absolute BP levels, these dietary interventions do not significantly affect BP variability. These findings suggest that the BP-related benefits of the DASH diet and sodium reduction primarily result from reducing absolute BP rather than reducing BP variability.
Association of whole blood heavy metal concentrations with kidney function
Abstract Relatively elevated concentrations of arsenic, lead, and mercury are toxic to the kidneys. However, it is unknown whether kidney function is influenced by these metals in the general population without kidney diseases and without known exposure to these metals. We did a retrospective analysis of data collected from 58,864 outpatients in Germany from January 2014 to October 2022 undergoing measurements of arsenic, lead, and mercury. Routine clinical laboratory parameters were entered into the database if they were analyzed in the same patient within +/- four weeks of the metal analysis. The estimated glomerular filter rate (eGFR) was calculated using the 2021 CKD-EPI equation. The mean age of the study participants was 50.3 ± 17.1, of which 61.8% were women. Complete blood count, CRP, fasting glucose, liver and lipid values, and thyroid function parameters were within the normal range. Median (IQR) eGFR level was 92.14 (79.44-103.85) mL/min/1.73m2. Median (IQR) whole blood values for arsenic were 0.8 (0.4–1.5) µg/l, median (IQR) level for lead was 13.6 (9.5–19.5) µg/l, median (IQR) values for mercury were 0.8 (0.3–1.5) µg/l in whole blood. Arsenic (r= -0.131, p < 0.001, N = 11,211), lead (r = 0.318, p < 0.001, N = 21,733), and mercury (r= -0.149, p < 0.001, N = 22,670) levels correlate all inversely with eGFR. When plotting eGFR against whole blood metal concentrations, no lower safety thresholds were found. Multivariate analysis, considering age, sex, CRP, and fasting glucose as confounding factors, confirmed findings of independent associations of arsenic, lead, and mercury on eGFR. Subgroup analysis revealed that this inverse relationship was particularly pronounced in the lowest age tertile of all study participants. Concentrations of arsenic, lead, and mercury correlated independently inversely with eGFR in a German cohort that largely had a normal kidney function with no known exposure to heavy metals.