Browse Articles

Abstract P2142: Hypertensive disorders of pregnancy (HDP) and cardiovascular disease (CVD) in American Indians: The Strong Heart Family Study (SHFS)

Introduction: American Indian populations have high risks of both hypertensive disorders of pregnancy (HDP) and cardiovascular disease (CVD) yet few studies have evaluated associations of HDP and CVD in these populations. Aim: To determine if the odds of hypertension outside of pregnancy (HTN), carotid artery plaque, left ventricular mass indexed to body surface area (LVM/BSA), ejection fraction (EF), or clinical CVD events are higher in HDP cases compared to controls from the SHFS. Methods: We included 66 cases of HDP (preeclampsia and gestational hypertension) confirmed by medical records and/or birth certificates, matched on date of delivery (±3 years) to 185 controls. We defined HTN as systolic blood pressure (BP) ≥140 mm HG, diastolic BP ≥ 90 mmHg, or taking HTN medication. We used ultrasounds to measure carotid artery plaque, echocardiograms to measure LVM/BSA and EF, and physician adjudication to determine CVD events. We used conditional logistic regression to determine if the odds of HTN, plaque, LVM/BSA, EF, or CVD were different in HDP cases compared to controls while controlling for maternal age, center (Arizona, Oklahoma, or Dakotas), body mass index, smoking, and diabetes. Results: Of the total sample (n=251), 44 had HTN outside of pregnancy (23 were HDP cases), 29 had plaque (9 were HDP cases), and 12 had CVD (4 were HDP cases). Mean LVM/BSA was 70.4 (std=12.8) and mean EF was 59.7% (std=4.3%). The odds of HTN and CVD were higher in HDP cases compared to controls, while controlling for covariates (HTN OR= 7.53, 95% CI=2.22-25.67; CVD OR=6.04, 95% CI=1.05-34.91, Table 1). The univariate odds of LVM/BSA were higher in HDP cases compared to controls (OR=1.024, 95% CI=1.001-1.048), but the association attenuated when controlling for covariates. Conclusions: These data suggest that HDP is associated with HTN outside of pregnancy and CVD events in American Indian populations, which has never been demonstrated. Thus, these analyses may provide a critical step toward reducing HTN or CVD in American Indians diagnosed with HDP.

Abstract P3024: Phenotypic vs. Genetic Mismatch of Body Mass Index and Its Risk Factors: Evidence from the China Kadoorie Biobank and the UK Biobank

Background: The mismatch between phenotypic and genotypic BMI (BMI-PGM) contributes to the sky-rocketing obesity prevalence in both developed and developing countries. However, little is known about BMI-PGM and its risk factors. Methods: We included 86,205 participants who were genotyped and with valid BMI measurements from the China Kadoorie Biobank (CKB). BMI-PGM was calculated for each participant as the difference between the percentile for his/her adjusted BMI and the percentile for his/her adjusted polygenetic risk score of BMI (BMI-PRS), ranging from -100 to 100. A higher BMI-PGM means one’s measured BMI was much greater than his/her genetically-determined BMI. We then categorized participants into three groups according to BMI-PGM quartiles: discordantly low (bottom quartile), concordant (2nd and 3rd quartiles), and discordantly high (top quartile). Potential risk factors of BMI-PGM, including socio-demographic characteristics and lifestyle factors, were tested by multivariate linear regression. External replication analyses were performed among 102,514 UK Biobank (UKB) participants. Results: In both CKB and UKB, BMI-PGM exhibited a symmetric and normal distribution. Across all four BMI categories (underweight, normal weight, overweight, and obese), the concordant BMI-PGM group accounted for approximately 50% of participants. Of interest, over 50% of obese and underweight adults were categorized into the discordantly high BMI-PGM group and the discordantly low BMI-PGM group, respectively. In both cohorts, participants with higher BMI-PGM were more likely to be younger, current smokers, physically inactive, and meat lovers. However, the associations of BMI-PGM with sex, urban-rural status, education level, household income, alcohol consumption, fruit intake, and sleep duration varied between the two cohorts. Conclusions: A new metric was developed to quantify the mismatch between phenotypic and genetic BMI in both East Asian and European adults. The obesogenic environment affects obesity in different populations with both commonalities and distinct differences.

Abstract MP29: Cardiovascular Health Effects of a Free-Sugar-Restricted Diet vs. a Usual Diet: A Randomized Clinical Trial in Adolescent Boys with MASLD

Introduction: High intake of added sugars (>10% total energy) is associated with major cardiovascular risk factors and cardiovascular disease (CVD). Less is known about the effects on cardiovascular health (CVH) that could result from free-sugar restriction, particularly in adolescence, a critical period of CVH loss. Hypothesis: An 8-week low free-sugar diet will improve CVH more than a usual diet in adolescent boys with metabolic dysfunction-associated steatotic liver disease MASLD (formerly NAFLD). Methods: This is a secondary analysis of data from a randomized controlled open-label trial designed to test the effects of a diet that restricted free-sugar intake on hepatic steatosis (NCT02513121). Boys aged 11–16 years old with a diagnosis of MASLD (n=40) were randomized to an 8-week, study-provided low free-sugar diet (<3% of daily calories from sugar) or their usual diet in a 1:1 ratio. CVH was measured using the AHA Life’s Essential 8 (LE8) criteria to estimate a continuous score (range: 0-100) and a categorical variable (high: 80-100, moderate: 50-79, low: 0-49) by averaging the scores from 4 CVH metrics (blood pressure, BMI, non-HDL cholesterol, and glucose). Intention-to-treat mixed model analyses were employed, adjusting for age, study site (Emory or UCSD) and total energy intake. Analyses were performed in SAS (v.9.4) with significance evaluated two-sided at 0.05. Results: All 40 randomized participants (mean (SD) age 13.0 (±1.8) years; 95% Latinx) completed the study. At baseline, the mean LE8 scores were 63.0 ±14.6, and 10% of boys had high, 75% moderate, and 15% low CVH. From baseline to 8-weeks, the mean CVH scores of boys in the low free-sugar diet (n=20) significantly improved by 8 points (mean difference (MD) 8.27; 95% Confidence Interval (CI), 2.9, 13.7; P=0.003) from 62.7 ±13.5 to 67.7 ±11.7. Among boys in the usual diet (n=20), the mean CVH scores had a non-significant decrease of MD=1.15 points (95% CI, -6.6, 4.3) from 63.4 ±15.8 to 62.2 ±13.6 (P=0.68). After 8 weeks, the mean changes in CVH scores for the free-sugar diet were not significantly different from those of the usual diet (MD=4.98, 95% CI, 0.6, 10.6; P=0.08). Conclusion: In this small sample of adolescents, a low free-sugar diet was associated with improvements in CVH after only 8-weeks, but outcomes were not statistically different from the usual diet. Further research is needed to determine if a free-sugar diet can support the maintenance of CVH in youth with and without MASLD.

Improving the fast-charging capability of NbWO-based Li-ion batteries

Abstract The discovery of Nb-W-O materials years ago marks the milestone of charging a lithium-ion battery in minutes. Nevertheless, for many applications, charging lithium-ion battery within one minute is urgently demanded, the bottleneck of which largely lies in the lack of fundamental understanding of Li+ storage mechanisms in these materials. Herein, by visualizing Li+ intercalated into representative Nb16W5O55, we find that the fast-charging nature of such material originates from an interesting rate-dependent lattice relaxation process associated with the Jahn-Teller effect. Furthermore, in situ electron microscopy further reveals a directional, [010]-preferred Li+ transport mechanism in Nb16W5O55 crystals being the “bottleneck” toward fast charging that deprives the entry of any desolvated Li+ through the prevailing non-(010) surfaces. Hence, we propose a machine learning-assisted interface engineering strategy to swiftly collect desolvated Li+ and relocate them to (010) surfaces for their fast intercalation. As a result, a capacity of ≈ 116 mAh g−1 (68.5% of the theoretical capacity) at 80 C (45 s) is achieved when coupled with a Li negative electrode.

Abstract P2130: Identifying Predictors of Achieving 150 Minutes of Weekly Walking in Aging Latinx Adults Enrolled in a 12-month Physical Activity RCT: Insights from Signal Detection Analysis

Physical activity, a key component of Life’s Essential 8, is critical for cardiovascular health, especially among older Latinx adults—a demographic with a high prevalence of at least one cardiovascular disease (CVD) risk factor. Despite previous interventions aimed at helping older adults meet age-specific physical activity (PA) guidelines, achieving this objective continues to be a challenge. This study utilized signal detection analysis (SDA) to identify combinations of baseline demographic, clinical, behavioral, and psychosocial factors, alongside intervention type, that predicted meeting the ≥ 150 minutes per week walking goal at the 12-month study endpoint among insufficiently active older Latinx adults enrolled in COMPASS (Computerized Physical Activity Support for Seniors) – a cluster-randomized physical activity (PA) effectiveness trial. From July 2014 to July 2016, a total of 245 participants aged 50 and older from the San Francisco Bay Area were randomly assigned to either a human peer advisor or a virtual advisor intervention arm. The PA goal was assessed using the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. SDA, a recursive partitioning exploratory method, was used to explore subgroups of participants most and least likely to achieve the goal of ≥150 minutes of walking per week, based on the intervention arm and other predictors. Overall, 49.8% of participants met the walking goal. Among those living in smaller households (<3 people), higher acculturation to US media (score of 5) and lower resting systolic blood pressure (<117 mmHg) were the strongest predictors of success. For participants in larger households (≥3 people), fewer hours of sedentary behavior (<33.8 hr/week) and lower resting heart rate (<64 bpm) were key predictors of success. Notably, the intervention arm was not a significant factor in achieving the PA goal. Study findings underscore the need to focus on specific subgroups to optimize PA interventions. Combinations of factors such as acculturation, cardiovascular health markers, and sedentary behavior may play a critical role in achieving PA outcomes among older Latinx adults. These findings support a precision exercise approach to PA interventions that target the unique needs of aging, underactive minority populations.

Abstract P3076: Incident hypertension by biomarker patterns: REasons for Geographic and Racial Differences in Stroke (REGARDS) stud

Background: We recently empirically identified 3 novel patterns of cardiovascular risk factor biomarkers with factor analysis: Renal-inflammatory, thrombo-inflammatory, and dyslipidemic-inflammatory. Hypertension is a major cardiovascular disease risk factor. Whether these patterns are associated with incident hypertension are unknown. Objectives: To determine the association between novel risk patterns and incident hypertension. Methods: REGARDS recruited 30,239 Black and White adults from the 48 contiguous US states in 2003-2007 with a second visit in 2013-2016. Baseline fasting lipids, C-reactive protein (CRP), cystatin C, urine albumin/creatinine ratio, blood urea nitrogen (BUN), complete blood count, and serum albumin were measured in all or most participants. A robust set of other baseline biomarkers was measured in a sex-race stratified sample of 4,400 participants who attended both visits. Factor scores for each pattern were developed and applied to each of the 2,723 participants with all available baseline biomarkers. Hypertension was defined as baseline blood pressure (BP) ≥140/90 mm Hg or self-reported use of antihypertensive medications. We excluded participants with prevalent hypertension. Tertiles of each factor score were computed in the analytical population. Modified Poisson regression estimated the adjusted relative risk (RR) of incident hypertension by factor pattern tertile, testing for pairwise interactions between each factor. Because of a significant thrombo-inflammatory*dyslipidemic-inflammatory interaction on hypertension (P=0.06; interaction significance threshold <0.10), these groups were stratified across each other’s tertiles. Results: Among the 1,223 included (mean [SD] age 61 [8] years, 25% Black race, 64% women), 34% developed incident hypertension. There was no difference in age, sex, race, or baseline systolic BP-adjusted RR of hypertension by tertile of the renal-inflammatory pattern ( Figure ). Relative to the lowest tertile combination, there was a higher RR of incident hypertension across higher dyslipidemic- and thrombo-inflammatory pattern tertiles (3 rd tertile of each: RR 1.67; 1.10 to 2.52). Discussion: Among Black and White adults, thrombo-inflammatory and dyslipidemic-inflammatory biomarker patterns were strongly associated with incident hypertension. Behavioral or medical therapies targeting specific biological pathways represented by these patterns may provide targets to prevent hypertension and its sequelae.

Abstract P2017: Baseline Androgenic State Modifies the Effect of Intensive Lifestyle Intervention on Triglyceride Levels in Males with Diabetes: The Look AHEAD Trial Sex Hormone Study

Background: In people with type 2 diabetes (T2D), weight loss due to an intensive lifestyle intervention (ILI) reduces triglyceride (TG) levels, a risk factor for cardiovascular disease. However, efficacy of treatment varies between people. Both testosterone and estradiol are associated with TG level. We examined whether baseline androgenic state, i.e., the ratio of testosterone to estradiol (T/E), modifies the treatment effect and partially explains the TG variability. Methods: The Look AHEAD Study was a randomized control trial of 5145 individuals with T2D and overweight/obesity to evaluate the effect of ILI compared to the control group on cardiovascular outcomes. We selected a random sample of 1166 postmenopausal females and 1166 males (mean age 60 years [SD 6.2]) to examine heterogeneity of treatment effect by baseline T/E ratio on changes in TG at years 1 (weight loss nadir) and 4. We created longitudinal mixed models stratified by sex, and modeled the interaction between log-transformed baseline T/E ratio, ILI (vs control), and year, with log-transformed TG as the outcome. We plotted the estimated treatment effects over time for 25 th and 75 th percentile of baseline T/E ratio. Results: Figure, panel A, shows that males with T/E ratio at the 75 th percentile (vs 25 th percentile) had a larger reduction in TG due to ILI (vs control) at year 1 (p = 0.002), which is no longer statistically significant at year 4 (p = 0.14, overall heterogeneity for both years, p = 0.009). We did not detect any statistically significant heterogeneity in TG levels by T/E ratio for females (panel B, p = 0.87). Conclusion: Greater baseline androgenic state (T/E ratio) in males, but not females, was associated with a larger reduction in TG due to ILI, compared to the control at year 1 but not year 4. Males with lower T/E ratio might need more aggressive lipid treatment to achieve TG-reducing benefits of ILI.

Correction for Ganley et al., Iron limitation triggers roseoceramide biosynthesis and membrane remodeling in marine roseobacter

SVLearn: a dual-reference machine learning approach enables accurate cross-species genotyping of structural variants

Abstract P3069: Effect of cocoa extract supplementation on incident hypertension in the COSMOS trial

Backgrounds: Cocoa flavanols have potential blood pressure (BP)-lowering effects in shorter-term, smaller-scale randomized clinical trials (RCTs), but its effect on incident hypertension has not been examined in a large-scale RCT. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) evaluated whether longer-term cocoa extract supplementation had an effect on incident hypertension in older adults. Methods: COSMOS is a 2x2 factorial, double-blind, placebo-controlled RCT testing cocoa extract (including 500 mg/day cocoa flavanols, with 80 mg/day (-)-epicatechin) and a multivitamin among 21,442 women aged ≥65y and men aged ≥60y. In 8,905 COSMOS participants free from baseline self-reported hypertension, we investigated the effect of cocoa extract on incident hypertension using Cox proportional hazards models. Incident hypertension was defined as self-reported first-time physician diagnosis, initiation of anti-hypertensive medications, or self-reported elevated systolic BP (SBP) ≥ 140 mmHg or diastolic BP (DBP) ≥ 90 mmHg. Results: Mean age at baseline was 71.1 years (SD: 6.2) and 58.8% of the participants were women. 48.6% had baseline SBP < 120 mmHg, corresponding to the normal range. Baseline characteristics were balanced between the cocoa extract and placebo groups. Over a median follow-up of 3.4 years, in intention-to-treat analyses cocoa extract supplementation had no significant effect on incident hypertension, with the incidence rates (IRs) of 71.2 and 73.8 per 1000 person-years in cocoa and placebo groups, respectively (hazard ratio [HR]: 0.96 [95% confidence interval: 0.88, 1.05]). A significant interaction was observed between treatment assignment and baseline SBP (p=0.002). Cocoa extract supplementation reduced the incidence of hypertension among participants with baseline SBP < 120 mmHg (IR: 38.2 vs. 50.3 per 1000 person-years; HR: 0.76 [0.64, 0.90]), but not among those with SBP of 120-139 mmHg (IR: 101.4 vs. 96.8 per 1000 person-years; HR: 1.05 [0.93, 1.18]; Figure ). Consistent results were obtained in sensitivity analyses using different definitions of hypertension: physician diagnosis, initiation of anti-hypertensive medications, or elevated BP alone. Per-protocol analysis using inverse probability weighting to account for non-adherence also supported the effect in SBP < 120 mmHg. Conclusion: In older adults, years-long supplementation of cocoa extract may reduce the risk of incident hypertension among those with normal BP levels.

Abstract 038: Association of Circulating Metabolites with Incident Heart Failure and its Subtypes in Multi-ethnic Populations

Introduction: Metabolic dysregulation is recognized in heart failure (HF). A comprehensive assessment of circulating metabolites, specifically on HF subtypes, in multi-ethnic populations is limited. Hypothesis: We hypothesize that circulating metabolites are significantly associated with the risk of HF and have differential effects on HF subtypes. Methods: Circulating metabolites from seven studies in the Trans-Omics for Precision Medicine Program were analyzed among 21,398 HF-free participants (58% non-Whites, 58% women), from which 1,160 incident HF, 373 HF with reduced (HFrEF), and 439 HF with preserved ejection fraction (HFpEF) events were ascertained with an average of 11.5 years of follow up. Cox proportional hazard regressions were applied by the study, followed by random-effect meta-analyses, to produce metabolite HF associations. Over-representation analyses were performed to identify relevant metabolite pathways. Results: Out of 1,015 metabolites analyzed, 54 were significantly associated with incident HF (Bonferroni corrected p<0.05) after accounting for clinical risk factors. Eleven metabolic pathways were mapped; pentose and glucuronate interconversions and pyrimidine metabolism demonstrated over-representation (FDR<0.05). Most identified metabolites (93%) were positively associated with HF, and the strength of the associations persisted with further adjustment of kidney function. Thirteen metabolites showed consistent effects from all participating studies, and subtype analyses indicated that most metabolites were more strongly associated with HFpEF than HFrEF ( Figure ). For example, N-acetylputrescine, a precursor of γ-aminobutyric acid (GABA), and 4-acetamidobutanoate, a derivative of GABA, were associated with an increased risk of HFpEF but not HFrEF. Conclusions: We identified circulating metabolites associated with the risk of HF in multi-ethnic populations, highlighting the need to better understand the differential metabolic etiology of HFpEF compared to HFrEF.

Abstract MP12: Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies

Background: Hypertension is the leading preventable risk factor for premature death and disability worldwide. Aims: We estimated global disparities in hypertension prevalence, awareness, treatment, and control in 2020 and compared secular changes from 2000 to 2020 worldwide. Methods: We searched MEDLINE from 1995 to June 2023 and supplemented with a manual review of retrieved article references. We applied sex- and age- specific prevalences from each country to population data to calculate the number of hypertensive adults in each region and worldwide. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates. Results: A total of 237 population-based surveys with 4,779,321 adults from 118 countries were included in analyses. We defined hypertension as SBP/DBP ≥140/90 mm Hg, or antihypertensive medication use and control of hypertension as SBP/DBP <140/90 mm Hg. An estimated 30.6% (95% CI, 30.0-31.2%) of the world’s adult population had hypertension in 2020. The prevalence was higher in low- and middle-income countries compared to high-income (Table). In 2020 an estimated 1.59 (1.57-1.61) billion people had hypertension; 378 (376-381) million in high-income and 1.21 (1.19-1.23) billion in low- and middle-income countries. From 2000 to 2010 the age-standardized prevalence of hypertension increased by 3.5% among men and 3.3% among women; from 2010 to 2020, the age-standardized prevalence increased by 2.1% among men and decreased by 1.0% among women. From 2000 to 2010 to 2020, worldwide proportions of hypertension awareness (38.7% vs 45.8% vs 48.0%), treatment (29.2% vs 36.9% vs 40.6%), and control among hypertensives (11.3% vs 14.0% vs 19.1%) increased. During the same period, proportions of awareness in high-income countries (57.3% vs 68.9% vs 68.6%) remained higher than in low-and middle-income countries (30.2% vs 37.6% vs 41.6%). Similar trends were identified for treatment in high-income countries (41.9% vs 56.2% vs 62.2%) compared to low- and middle- income countries (23.4% vs 28.8% vs 33.8%). Finally, control among hypertensives remained higher in high-income countries (15.1% vs 28.3% vs. 33.4%) compared to low- and middle-income countries (9.6% vs 9.0% vs 14.6%) in the same timeframe. Conclusions: Collaborative efforts are needed to address the high burden of hypertension worldwide, particularly in low- and middle-income countries.

Co-benefit of forestation on ozone air quality and carbon storage in South China

Abstract P3066: Barriers and Recommendations to Improve Engagement in Workplace Health Programs for Low-Wage Hospital Workers

Low-wage workers comprise 1/3 of workers in the U.S., are essential in many workplaces, and have high risk of cardiometabolic conditions compared to higher-wage workers. Workplaces have the potential to reduce health inequities by offering targeted employee health programs, however, these resources are often underutilized by low-wage workers. Mobile health tools (e.g., SMS, activity trackers) are effective in increasing engagement in health interventions, but their acceptability among low-wage workers is not well understood. This study aimed to explore barriers and facilitators of engagement in workplace health programs among low-wage hospital workers. Methods: Semi-structured qualitative interviews elicited workers’ experiences with workplace health programs, perspectives on mobile health tools, and suggestions for improving engagement. Participants were hospital service workers (janitorial and food service staff; n =43) in a San Diego health system. Interviews were audio-recorded, transcribed, and analyzed by two independent raters using Dedoose 9.0.107 software and structured thematic analysis. Results: Participants ( M age=49 years, range: 21-65) were mostly women (76%), Latinx (88%), and many preferred Spanish (45%). They reported low utilization of workplace health promotion or employee assistance programs. Barriers to engagement included lack of awareness, concerns about privacy, stigma, scheduling challenges, lack of programs in preferred languages, lack of time, and competing needs (e.g., food/housing insecurity). Recommended solutions included in-person vs. email program announcements, increased privacy, flexible delivery modality (e.g., phone, video), flexible scheduling, and resources for social needs (e.g., transportation, childcare, food). They reported high acceptability and willingness to use SMS and activity trackers. Many reported prior use of activity trackers (e.g., FitBits) and use of texts for health purposes (e.g., to communicate with a provider), but described important limitations (e.g., accessing texts only on breaks; not being allowed to wear watch-style trackers in food service work). Conclusions: To improve health equity and engagement in health programs among low-wage workers, employers should consider providing face-to-face announcements, flexible modality and scheduling, increased privacy assurances, social needs resources, and incorporation of mobile health tools - while considering important limitations.

Abstract P1101: Associations Between Cardiovascular Risk Behaviors and Sleep Duration in Young Adult Sexual Minority Men

Introduction: Young adult sexual minority men are at increased risk for cardiovascular disease due to social behaviors, particiulary tobacco use and excessive alcohol consumption. The American Heart Association's Life's Essential 8 provides a framework to enhance cardiovascular health. Tobacco use and excessive drinking are associated with significant cardiovascular risks, with tobacco linked to about one-third of all deaths from heart disease and excessive drinking increasing the risk of liver and heart disease. This study examined the associations between cardiovascular risk behaviors and sleep duration in young adult sexual minority men. Hypothesis: We hypothesized that tobacco use and excessive alcohol consumption would be associated with sleep duration and vary by sleep duration category (7-9 hrs vs. >9 hrs). Methods: Secondary data were analyzed from an HIV prevention behavioral trial with 322 young adult sexual minority men ages 18–34. A step-wise multinomial logistic regression analysis was conducted in R to examine the relationships between tobacco use, alcohol consumption, and sleep duration comparing individuals sleeping 7-9 hours and those sleeping more than 9 hours (reference category). Missing data were addressed using multiple imputation by chained equations. Results: Tobacco use was reported in 21% of participants, while 90% reported alcohol consumption. Tobacco use was significantly associated with increased odds of sleeping 7 to 9 hours (estimate = 0.978, p = 0.003), while alcohol consumption had a significant negative impact on this category (estimate = -0.182, p = 0.038). For those sleeping more than 9 hours, tobacco use was significantly associated with extended sleep (estimate = 0.846, p = 0.005), while alcohol approached significance (estimate = 0.164, p = 0.050). Age and income were not significant. Conclusions This study highlights the complex relationships between tobacco use, alcohol consumption, and sleep duration in young adult sexual minority men. The association of tobacco use with sleeping 7-9 hours is controversial, as tobacco is not cardioprotective and is linked to adverse health outcomes. Smoking may fulfill stress-reducing needs, affecting sleep patterns. Additionally, excessive alcohol consumption negatively impacts sleep duration and may worsen cardiovascular risks. Behavioral interventions grounded in Life's Essential 8 may be beneficial in reducing cardiovascular risk behaviors in young adult sexual minority men.

Effects of Tirzepatide on the Clinical Trajectory of Patients With Heart Failure, Preserved Ejection Fraction, and Obesity

BACKGROUND: Patients with heart failure with preserved ejection fraction and obesity have significant disability and frequent exacerbations of heart failure. We hypothesized that tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, would improve a comprehensive suite of clinical end points, including measures of health status, functional capacity, quality of life, exercise tolerance, patient well-being, and medication burden, in these patients. METHODS: We randomized (double-blind) 731 patients with class II to IV heart failure, ejection fraction ≥50%, and body mass index ≥30 kg/m 2 to tirzepatide (titrated up to 15 mg SC weekly; n=364) or placebo (n=367) added to background therapy for a median of 104 weeks (quartile 1, 66; quartile 3, 126 weeks). The primary end points were whether tirzepatide reduced the combined risk of cardiovascular death or worsening heart failure and improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. The current expanded analysis included sensitivity analyses of the primary end points, 6-minute walk distance, EQ-5D-5L health state index, Patient Global Impression of Severity Overall Health score, New York Heart Association class, use of heart failure medications, and a hierarchical composite based on all-cause death, worsening heart failure, and 52-week changes in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and 6-minute walk distance. RESULTS: Patients were 65.2±10.7 years of age; 53.8% (n=393) were female; body mass index was 38.2±6.7 kg/m 2 ; Kansas City Cardiomyopathy Questionnaire Clinical Summary Score was 53.5±18.5; 6-minute walk distance was 302.8±81.7 m; and 53% (n=388) had a worsening heart failure event in the previous 12 months. Compared with placebo, tirzepatide produced a consistent beneficial effect across all composites of death and worsening heart failure events, analyzed as time to first event (hazard ratios, 0.41–0.67). At 52 weeks, tirzepatide increased the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score by 6.9 points (95% CI, 3.3–10.6; P <0.001), 6-minute walk distance 18.3 meters (95% CI, 9.9–26.7; P <0.001), and EQ-5D-5L 0.06 (95% CI, 0.03–0.09; P <0.001). The tirzepatide group shifted to a more favorable Patient Global Impression of Severity Overall Health score (proportional odds ratio, 1.99 [95% CI, 1.44–2.76]) and New York Heart Association class (proportional odds ratio, 2.26 [95% CI, 1.54–3.31]; both P <0.001) and required fewer heart failure medications ( P =0.015). The broad spectrum of effects was reflected in benefits on the hierarchical composite (win ratio, 1.63 [95% CI, 1.17–2.28]; P =0.004). CONCLUSIONS: Tirzepatide produced a comprehensive, meaningful improvement in heart failure across multiple complementary domains; enhanced health status, quality of life, functional capacity, exercise tolerance, and well-being; and reduced symptoms and medication burden in patients with heart failure with preserved ejection fraction and obesity. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04847557.

Correction for Qian et al., Chemoptogenetic damage to mitochondria causes rapid telomere dysfunction

Responsive DNA artificial cells for contact and behavior regulation of mammalian cells

Abstract P2161: Validation Of a Novel Method to Evaluate Local-scale Community-based Interventions That Improve Access to Fruits and Vegetables

Background: Adequate intake of fruits and vegetables (FV) is important for cardiovascular health. Evaluating community-based dietary programs in under-resourced areas is challenging, necessitating innovative data collection methods. These methods must adapt to community contexts, enhancing the accessibility of impact evaluation for programs operating in neighborhood settings, including community centers, schools, and farmers’ markets. Aims: This study aimed to develop and pilot a survey instrument designed to overcome barriers in data collection within community-based programs, focusing on measuring changes in health behaviors. The tool aims to validate a concise set of process and outcome measures, addressing the evaluation challenges of small, local initiatives. Methods: The survey development was a theory-driven, participatory process with stakeholders to ensure the tool was culturally sensitive and capable of capturing data relevant to health outcomes. The survey was pilot tested in four Social Impact Fund programs in California, Florida, and Georgia. One program provided free meals, two provided discounted produce, and one was a traditional farmers’ market stand. The bilingual survey (English and Spanish) covered demographics, program participation, frequency of FV intake, and barriers to healthy eating. It was delivered via in-person interviews, tablets, and personal smartphones. Results: The pilot achieved high feasibility, with a 98.2% completion rate from 111 participants for the 20-item survey, taking an average of eight minutes. Overall, 62.5% (95% CI 49.7, 75.3) of participants said that their FV intake increased due to the programs, with the top reasons being affordability and quality. Participants also reported barriers to increasing FV intake, Figure 1, with 50% (95% CI 39.9, 60.1) saying cost, followed by time constraints and accessibility. Conclusion: The pilot results affirm the feasibility of evaluating programs aiming to improve diet in high-disparity neighborhoods. The results indicate a strong community desire for such programs and underscore a pivotal finding: when fruits and vegetables are affordable and accessible and meals are readily available at a low cost, community members are more likely to adopt healthier diets. This participatory approach proves that a well-validated, concise survey tool can efficiently collect health data in unconventional settings, promoting health equity by adapting to specific needs of communities.

Abstract P3174: The Benefits of Probiotic Administration in Stroke Risk, Stroke-Related Gastrointestinal Complications, and Intestinal Flora Dysbiosis: A Meta-Meta-Analysis

Introduction: Stroke is the second largest cause of death and third leading cause of disability worldwide. Some high-income countries have one in five lifetime cases and one in two in low-income countries. Due to the high stroke burden and aging population, better preventive and treatment approaches are needed. Recent research shows that stroke patients have a different gut microbiota than healthy people, suggesting a relationship between dysbiosis and stroke incidence and prognosis. Probiotics may improve stroke outcomes by strengthening the intestinal barrier and reducing inflammation. Hypothesis: Our study seeks to evaluate the potential benefits of probiotic supplementation in reducing the risk of ischemic stroke in healthy individuals as well as its impact on the prognosis of stroke patients, specifically in reducing gastrointestinal complications and improving gut microbiota balance (reduce dysbiosis). Methods: We conducted an umbrella meta-analysis of meta-analyses published in the last 10 years using PRISMA guidelines in PubMed. Using RevMan 5.4, we performed an inverse variance random effects model to calculate log (odds ratio) and converted it to pooled OR and 95% confidence interval to obtain a forest plot keeping alpha criteria 0.05. Heterogeneity and risk of bias assessment (by Newcastle-Ottawa Scale) were assessed. Results: While probiotic supplementation in healthy individuals did not significantly decrease the risk of ischemic stroke (OR 0.87 [95%CI 0.75-1.01]), it showed notable benefits in stroke patients. These positive effects included a substantial reduction in the odds of specific GI complications (constipation, diarrhea, gastric retention, esophageal reflux, vomiting, stress ulcers, and gastrointestinal bleeding) by 62% (0.38, 0.29-0.51), non-specific GI complications by 72% (0.28, 0.24-0.34), infection by 73% (0.27, 0.21-0.33) and a significant improvement in gut flora balance, reducing the odds of dysbiosis by 79% (0.21, 0.12-0.36). (p<0.00001) The inter-study heterogeneity was 91% with (p<0.00001, Chi 2 =128.76), a moderate risk of bias. Conclusion: Our umbrella meta-analysis highlights the potential benefits of probiotic supplementation in stroke patients, particularly in mitigating stroke-related GI complications and alleviating intestinal flora dysbiosis. These findings underscore the crucial role of gut-brain interactions in stroke and suggest that probiotics may serve as a promising component of stroke management.