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Abstract P2015: Perceptions of Health Coaching for Weight Loss Maintenance in Primary Care: Results from the MAINTAIN PRIME Trial
Introduction: Health coaching can expand the capacity of primary care providers (PCPs) in supporting patient self-management of overweight and obesity. Current platforms for weight management health coaching include in-person meetings, phone calls, and asynchronous online messaging. We seek to understand patient perceptions and facilitators and barriers to engagement with asynchronous, online coaching through the patient portal of the electronic health record (EHR). Hypothesis: Patients will find EHR- and primary care-integrated health coaching acceptable for weight management. Methods: Participants in MAINTAIN PRIME were primary care patients with BMI ≥25 before intentional weight loss of ≥5%, randomized to health coaching with tracking tools (coaching) vs. tracking tools alone. Coaching was performed by trained primary care staff via EHR messaging. We are conducting semi-structured interviews at 24-months with active and inactive participants in the coaching arm (active defined as remaining enrolled in trial and responding to messages within 1 week). An interview guide includes the domains of EHR platform for health coaching, patient-coach relationship, and coaching integration with primary care. We analyzed interviews via thematic analysis. Results: Six of 11 completed interviews have been analyzed. Half of participants (3/6) were active, 66.7% were female (4/6), and average age was 39.6 years. Results to date reveal positive perceptions of the EHR platform for health coaching. Most participants found the platform convenient and liked the integration with other health records. Others stated a preference for separating coaching from medical care. Participants liked engaging with coaches at the time of their choosing. Messages were overall helpful, though sometimes felt impersonal and templated. Participants felt coaches were professional but lacked a personal connection, which could have improved with an initial in-person or video meeting. Lastly, many participants were unaware of coaching integration with their PCP teams other than the initial referral to coaching. Conclusions: Overall, participants had positive perceptions of the coaching experience though noted some areas for improvement such as adding a face-to-face meeting with the health coach and further personalizing messages to promote stronger coaching relationships. Discussions between PCPs and coaching participants regarding weight management could bolster a sense of integration and support.
Abstract 009: Association of Accelerated Biological Aging in Midlife with Cardiovascular and Health Outcomes in the Framingham Offspring Study
Introduction: Biological age acceleration (BAA) constructed from multi-organ system biomarkers may better elucidate the aging process relative to chronological age (CA). We evaluated the association of BAA with long-term health outcomes among middle-aged adults. Hypothesis: We related mid-life accelerated BA to the incidence of death, CVD, and dementia. Methods: We modeled BAA using multiple biomarkers (anthropometric and biochemical indicators of vital organ systems) at the sixth examination cycle (1995-1998) for up to 2038 Framingham Offspring participants. Stratified by sex, we estimated BA using the Klemera and Doubal method (KDM) with principal components. Standardized residuals from regressing KDM-BA on CA were used to define accelerated BA (>1 SD), moderate BA ([-1 to 1 SD]), and slow BA (<-1 SD; referent). Utilizing multivariable-adjusted Cox proportional hazards and competing risk models, we related BAA to incident death, CVD, and dementia. Results: Over a median follow-up of 24 years (max 27 years), participants (mean age 57 years, 57% women) experienced 656 deaths, 454 new-onset CVD events, and 170 incident dementia outcomes. Men and women with accelerated BA had a 2.1-fold (95%CI [1.40-3.21]; p=0.0004) and a 1.7-fold higher risk for death (95%CI [1.10-2.55]; p=0.02), respectively, compared to the referent group. Women with accelerated BA had a 1.8-fold higher risk of CVD (95%CI [1.12-2.90]; p=0.02) compared to slow BA. Higher BAA was associated with a higher dementia risk (HR per SD-increase 1.25, 95%CI [1.03-1.53]; p=0.03) in women. Conclusions: Multiple biomarkers that signal the aging of biological organ systems can be combined to reflect BA. In our community-based sample, accelerated midlife BA was characterized by a higher risk of death and CVD in both sexes and with dementia risk in women. These findings underscore the importance of healthy multisystem aging over the life course.
Abstract 069: Healthy Lifestyle and Risk of Cardiovascular Disease Incidence and Mortality Among Survivors with Stages I-III Colorectal Cancer
Introduction: Colorectal cancer (CRC) is a prevalent cancer and a leading cause of cancer deaths in the US. CRC survivors have a high risk of developing cardiovascular disease (CVD), which accounts for nearly 20% of their total mortality, likely due to shared risk factors including lifestyle. Hypothesis: We hypothesized that maintaining a healthy lifestyle after a CRC diagnosis is associated with a lower risk of CVD incidence and mortality. Methods: We analyzed data from 2,737 survivors with stages I-III CRC in the Nurses’ Health Study and Health Professional Follow-up Study. A lifestyle score, ranging from 0 to 5, was calculated for participants based on diet quality, smoking status, alcohol intake, physical activity, and body mass index. We calculated cumulative averaged scores before and after CRC diagnosis and used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence and mortality. We further examined changes in pre- and post-diagnostic lifestyle in relation to CVD outcomes and assessed potential effect modification by age, tumor characteristics, and medical history. Results: Over a median follow-up of 13.3 years after CRC diagnosis, we documented 449 incident CVD cases, including 201 coronary heart disease and 104 stroke cases, and 307 CVD-specific deaths. After adjustment for demographics, medical history, tumor characteristics, and pre-diagnostic lifestyle score, one unit increase in post-diagnostic score was associated with a 13% lower CVD incidence (HR [95% CI]: 0.87 [0.77-0.98]; p-trend: 0.03) and 29% lower CVD mortality (0.71 [0.61-0.83]; <0.0001). When stratified by tumor stage, the inverse association with CVD incidence was observed for stage I (0.74 [0.60-0.92]) but not stages II-III CRC (1.12 [0.93-1.35]; p-interaction: 0.005); whereas no differential associations were found for CVD mortality. Survivors who maintained a healthy lifestyle (score ≥4) pre- and post-diagnosis had a 28% lower risk of CVD incidence (0.72 [0.57-0.92]) and a 48% lower risk of CVD mortality (0.52 [0.39-0.70]) compared to those with a constantly poor lifestyle (score <4). Conclusions: In conclusion, a healthy lifestyle after CRC diagnosis was associated with a substantially lower risk of CVD incidence and mortality, highlighting the role of a healthy lifestyle in improving survivorship. These findings offer valuable insights for integrating lifestyle interventions into CRC oncology care.
Geographical distribution and the impact of socio-environmental indicators on incidence of Mpox in Ontario, Canada
Background Ontario, being one of Canada’s largest provinces, has been central to the high incidence of human Mpox. Research is scarce on how socio-environmental factors influence Mpox incidences. This study seeks to explore potential geographical correlations and the relationship between indicators of social marginalization and Mpox incidence rate in Ontario. Methodology We used surveillance data on confirmed human Mpox cases from May 1, 2022, to March 31, 2024, extracted from the Public Health Ontario website for this study. Spatial autocorrelation of Mpox incidence was investigated using spatial methods including Moran’s Index, Getis–Ord Gi*statistic, and spatial Poisson scan statistic. Following this, we adopted a generalized Poisson regression (GPR) model to estimate the incidence rate ratios (IRRs) based on the association between Ontario PHU-level marginalization and Mpox incidence, while adjusting for age and sex. The goodness-of-fit of the models was assessed using the Log Likelihood (LL), Akaike Information Criterion (AIC), Akaike’s Information Criterion corrected (AICc), and the Bayesian Information Criterion (BIC). Results Our analysis revealed significant localized spatial heterogeneity in Mpox incidence across Ontario. Statistically significant local clusters of Mpox cases were identified in Toronto ( R R = 11.34 , L L = 511.97 ), Ottawa ( R R = 3.21 , L L = 19.88 ), and a secondary cluster, overlapping Hamilton PHU with nine local districts ( R R = 2.07 , L L = 9.64 ), all with p − v a l u e < 0.05 . The incidence rate of Mpox was statistically significantly associated with a higher proportion of ethnic concentration (racialized groups, migrants, or visible minorities) I R R = 9.478 ; 95 % C I = 5.062 − 17.747 , gender I R R = 5.150 ; 95 % C I = 1.159 − 8.324 and higher residential instability I R R = 14.112 ; 95 % C I = 6.596 − 30.189 . Conclusion We identified major Mpox hotspots in Toronto. According to our model results, the high incidence rate may be influenced by the greater population of internal migrants and younger individuals. Based on these insights, we recommend targeted interventions in the high-risk neighborhoods. Efforts to improve Mpox diagnosis and promote health equity among socioeconomically vulnerable populations, including racial and ethnic minorities, should be implemented.
Abstract P3011: Empirically derived biomarker patterns in the REasons for Geographic and Racial Differences in Stroke Study
Background: Contemporary molecular epidemiologic approaches often consider individual or small groups of biomarkers and their relationship to cardiovascular disease risk factors or events. Factor analysis can group many biomarkers that represent the physiology and dysfunction of multiple organ systems into a small number of distinct patterns. These patterns may better reflect the complexity of human physiology and advance understanding of cardiovascular disease onset. We sought to empirically identify such patterns using factor analysis, and hypothesized that biomarkers would cluster into distinct patterns. Methods: REGARDS recruited 30,239 Black and White adults aged ≥45 years from the continuous US in 2003-2007 with a second visit in 2013-2016. Specialized biomarkers were measured in specimens collected at baseline from 4,400 participants who attended both visits; lipids, C-reactive protein (CRP), cystatin C, urine albumin/creatinine ratio, complete blood count, blood urea nitrogen (BUN), and serum albumin were measured in all or most participants. Factor analysis was used to derive patterns in a random split sample. Scree plot guided selection of factors used an eigenvalue cut point of 1. Validity was confirmed across race, sex, and age groups (<55, 55 to <65, 65 to <75, and ≥75 years) A congruence test coefficient >0.5 was considered acceptable. Final factor patterns were derived in the entire analytical sample using a 3-factor solution and named based on biologically known pathways. Results: Of the 4,400 participants, 31% were excluded who were missing any biomarker leaving an analytical sample of 2,723. The congruence coefficient between the factors was >0.78 for all subgroup comparisons. As is shown in the Figure , the “thrombo-inflammatory” pattern (pattern 1) had higher levels of inflammation, coagulation, and leptin; the “renal-inflammatory” pattern (pattern 2) had high levels of inflammation, renal dysfunction, and also high NT-proBNP and proenkephalin; the “dyslipidemic-inflammatory” pattern (pattern 3) had high levels of inflammation and triglycerides and low levels of HDL and adiponectin. Discussion: Three observed biomarker patterns had strong congruence across race, sex, and age groups. Future research will determine if these patterns are associated with cardiovascular risk factors and events.
Abstract P1152: Association of the Alternative Healthy Eating Index with Coronary Artery Calcification Volume and Density: the Multi-Ethnic Study of Atherosclerosis
Introduction: The Agatston score is a measure of coronary artery calcification (CAC) used to predict atherosclerotic cardiovascular disease (ASCVD) events. Notably, the score is upweighted for calcium density, despite evidence that density is inversely associated with cardiovascular disease after accounting for volume. Some studies have found associations between dietary components and the Agatston score, but none have evaluated diet in relation to CAC density and volume. Hypothesis: The Alternative Healthy Eating Index-2010 (AHEI), a measure of diet quality, is associated with lower CAC volume and higher CAC density. Methods: During the baseline exam of the Multi-Ethnic Study of Atherosclerosis, diet was assessed with a 120-item food frequency questionnaire from which the AHEI was derived. At the same exam, CAC was measured from computed tomography scans. In 3,099 participants with non-zero CAC volume, we modeled the associations of AHEI and natural log of Agatston score, natural log of volume, and density with linear regression. Models adjusted for age, sex, race/ethnicity, education, energy intake, cigarette smoking, and physical activity. We further adjusted for volume when density was the outcome and density when volume was the outcome. Results: The analytic sample included non-Hispanic White (45%), Black (23%), Hispanic (20%) and Chinese American (12%) individuals (mean age 66 years; 42% female). The median (Q1, Q3) Agatston score was 88 (22, 299) and volume was 85 mm 3 (25, 277). The mean (standard deviation [SD]) density score was 2.8 (0.7). After adjustment, the association of a one SD higher AHEI and Agatston score was not statistically significant (95% confidence interval [CI]: -0.10, 0.02; p=0.24). Conversely, in models assessing the relationship of AHEI with volume and density independent of one another, associations were significant (p=0.02 for volume; p=0.02 for density). A one SD higher AHEI was associated with a 0.05-unit lower log of volume (95% CI: -0.10, -0.01) and 0.02-unit higher density (95% CI: 0.00, 0.04). Conclusions : Our finding that higher AHEI was associated with lower CAC volume and higher CAC density aligns with research showing that diet is a risk factor for ASCVD. The null association with Agatston score appears to reflect the cancelling effects of the positive associations of density with higher AHEI and volume with lower AHEI, rather than the absence of a potential impact of dietary intake on subclinical atherosclerosis.
Abstract P2067: Artificial Light at Night and Asleep Blood Pressure in Black Adults
Background: Misalignment between internal circadian timing and environmental time cues, such as light, has been associated with poor cardiometabolic health. We examined whether artificial light at night (ALAN) was associated with higher asleep blood pressure (BP) and lower melatonin levels in a sample of Black adults. Methods: Normotensive Black adults were recruited from a parent study examining circadian contribution to BP. Participants wore the Philips Respironics Actiwatch 2 for seven consecutive days and during the first 24 hours, they also completed 24-hour ambulatory BP monitoring (ABPM) using the SpaceLabs 90227 device. Saliva was collected hourly during a 30-hour constant routine protocol, one of the gold standard methods to assess circadian amplitude in humans. Radioimmunoassay (RIA) was performed to quantify salivary melatonin. Pearson correlations were performed to examine the associations between 1) ALAN exposure duration and asleep BP and 2) salivary melatonin amplitude and asleep BP. Results: Nine participants with complete data from the parent study were included in the analyses, including 5 women (56%) and 4 men (44%) with a mean age of 39.67 ± 15.11 years. Actigraphy revealed a mean sleep duration of 393.44 ± 77.11 minutes (6.56 hours), mean wake after sleep onset (WASO) of 69.42 ± 78.40 minutes and mean white light exposure equivalent to 713.58 ± 1890.25 lux during the sleep period of ABPM. There was no significant correlation between ALAN exposure duration and asleep systolic BP or diastolic BP, r(7) = .56, p = 0.12; r(7) = .45, p = .23. RIA is ongoing and analyses to determine whether there is a correlation between salivary melatonin amplitude and asleep BP will be presented at the meeting. Conclusions: Preliminary findings suggest that ALAN is not correlated with asleep BP in normotensive Black adults; however, our interpretation is limited by small sample size. Given the existing literature demonstrating a relationship between ALAN and asleep BP in other populations, it is possible that this relationship exists in Black adults. Participants exhibited suboptimal sleep, which may have also contributed to their elevated asleep BP. Findings from the salivary melatonin data will provide helpful insights into a potential circadian mechanism underlying elevated asleep BP. Our study is one of few examining the impact of an environmental determinant of circadian health on cardiovascular health in Black adults.
Experimental study on operation limit of ground heat exchanger based on ground source heat pump unit
The heat transfer performance of a ground heat exchanger (GHE) directly influences the operational performance of a ground source heat pump (GSHP) system. The fluid temperature within the GHE is constrained by the protective temperature limits of the GSHP unit. Specifically, the inlet water temperature has an upper limit in summer and a lower limit in winter. These temperature limits further affect the heat exchange efficiency between the GHE and the surrounding soil. In this study, an experimental station featuring a single U-shaped GSHP system was constructed, and a three-dimensional model of the system was developed. Experiments were conducted by operating one or two GHEs to investigate the heat transfer per unit well depth and the matching relationship between cooling capacity and indoor load when the inlet water temperature of the heat pump unit approaches its summer and winter limits. In summer, when operating a single GHE, the heat transfer per unit well depth reached 134.4 W/m at an inlet temperature of 45 °C. When the cooling supply just matched the cooling load demand, the heat transfer per unit well depth was 131.5 W/m. However, prolonged operation led to a scenario where the cooling supply could no longer meet the load demand. In winter, operating a single GHE resulted in a heat transfer per unit well depth of 43.95 W/m at an inlet temperature of 5 °C. These results indicate that when the number of heat exchangers is insufficient, the inlet water temperature of the heat pump unit may reach or exceed the limit value, leading to decreased unit efficiency. Additionally, inadequate heat exchange between the GHE and the soil results in insufficient cooling or heating capacity, failing to meet the indoor load requirements.
Abstract P2124: Association between accelerometer-corrected physical activity and the prevalence of hypertension, diabetes, and obesity: Results from Korea National Health and Nutrition Examination Survey, 2014-2017
Background: Self-reported measurements have been used as a monitoring approach because it is difficult to objectively assess physical activity levels at a population level. Our aims were to assess the validity of self-reported physical activity data compared with accelerometer-based measurements in adults and to investigate the association between self-reported physical activity (Study 1) and the prevalence risk of hypertension, diabetes, and obesity, had physical activity been measured by accelerometer instead (Study 2). Methods: We used data from the 2014-2017 Korea National Health and Nutrition Examination Survey, which involved a nationally representative sample of n=20,059 Korean adults aged 20-79 years. Participants in our Global Physical Activity Questionnaire (GPAQ) survey wore an accelerometer (Actigraph GT3X+) for a period of seven days. We used a regression model to calculate validity coefficients and attenuation factors using accelerometer-measured physical activity as the criterion measure. Associations between moderate-to-vigorous physical activity status and the prevalence of hypertension, diabetes, and obesity were determined using multiple logistic regression calibration method. Results: The results from Study 1 showed that participants tended to overreport their physical activity levels when measured through GPAQ, with this tendency being more pronounced among those with lower levels of physical activity. Additionally, women and individuals with higher education or income were more accurate in reporting their physical activity levels than others. Study 2 revealed that the associations between the prevalence of hypertension, diabetes, and obesity and adjusted physical activity were considerably deattenuated, after correcting for measurement error in self-reported physical activity. The prevalence ratio (PR) for hypertension and diabetes for higher levels of self-reported physical activity, using the inverse hyperbolic sine function (IHS) transformation, was 0.79 (95% CI: 0.78, 0.80) and 0.75 (95% CI: 0.74, 0.77), respectively. Conclusions: The associations between physical activity and the prevalence risk of hypertension, and diabetes are significantly attenuated by the overestimation of self-reported physical activity, suggesting that the beneficial effects of physical activity may have been underestimated in the past. Further research will analyze the association between physical activity and mortality.
Abstract 041: A Novel Machine Learning Strategy to Integrate Multi-Omics Data and Detect Genomic Loci and Gene-Environment Interactions for LDL Cholesterol
Introduction: LDL cholesterol (LDLC) is highly heritable, and understanding its mechanism is crucial for cardiovascular disease treatment and prevention. While multi-omics data is widely available, integrating different omics in etiologic research of LDLC is limited due to computational challenge. Machine learning (ML) methods can address the challenge but are primarily used for risk prediction, and their “black box” nature complicates model interpretation. Hypotheses: We hypothesized that top important single nucleotide polymorphisms (SNPs) ranked by an ML-based genomic model contained novel genetic loci for LDLC, and that adding metabolomics data to the genomic model would change SNP importance due to mediation by internal metabolites and interaction with external metabolites. Methods: We developed a random-forest based genomic prediction model for LDLC using genome-wide SNPs among 1239 participants of the Bogalusa Heart Study (BHS), then incorporated 792 known metabolites to develop a multi-omics model. We compared variable importance matrix (VIMs) for SNPs between models. For SNPs losing importance, we tested whether metabolites mediated their associations with LDLC; for those gaining importance, we tested their interactions with all metabolites on LDLC. All analyses controlled for age, sex, race, and the first 10 genetic principal components. Results: VIMs changed significantly between the genomic and multi-omics models. Among the 20 SNPs with the largest drop in VIMs, we found that ( Table 1 ): 1) 256 metabolites, mostly (n=252) in lipid pathways, mediated ( P <0.05) their associations with LDLC. 2) These metabolites were top-ranked inputs in the multi-omics model. 3) Twelve loci have been reported by GWAS of lipid phenotypes, including 5 for LDLC. 4) Five genes, ELOVL6 , VAV2 , CDH10 , ACKR3 , and LMF1 were not reported by lipid GWAS, but were involved in lipid metabolism in animal models. For the 20 SNPs with the largest increase in VIMs, interacting metabolites were of non-lipid pathways or xenobiotics ( Table 2 ). Conclusion: We developed a novel ML strategy to integrates genomics and metabolomics data and provided empirical evidence of using it to discover new loci and gene-environment interactions for LDLC. This strategy can be expanded to other omics.
Abstract P2106: Serum Metabolomic Markers of Dietary Potassium and Incident Chronic Kidney Disease Risk
Introduction: Potassium is found in many foods and has been inversely associated with incident chronic kidney disease (CKD). Untargeted metabolomic profiling is a powerful approach for discovery of novel diet biomarkers and to highlight metabolic pathways that explain associations between dietary potassium and CKD. Methods: Dietary potassium was derived from food items assessed using an interviewer-administered questionnaire administered at visit 1 (1987-89). Incident CKD was a composite outcome using reduced estimated glomerular filtration rate (<60 mL/min/1.73 m 2 and ≥25% eGFR decline), hospitalization and death codes related to CKD stage 3+, or end-stage kidney disease identified via US Renal Data System registry. Participants were followed for CKD until December 31, 2020. Cross-sectional associations between dietary potassium (mg/1000 kcal) and 359 serum metabolites were evaluated with linear regression models. Prospective associations between significant potassium-related metabolites and CKD were studied with Cox regression models. Analyses were adjusted for covariates and accounted for multiple comparisons. Results: In 3,822 U.S. adults, we identified 53 significant associations between dietary potassium and serum metabolites, representing 6 super-pathways (amino acids, n=17; lipids, n=11; cofactors and vitamins, n=9; xenobiotics, n=8; carbohydrate, n=5; peptides, n=3). Over two decades of follow-up, 1,618 (42%) of participants developed incident CKD. Ten of the 53 metabolites from the cross-sectional analysis were prospectively associated with incident CKD. Two metabolites, kynurenine and glycerate, had the a priori expected directions of associations with dietary potassium and CKD ( Table ). There was a significant trend of CKD risk across quartiles of kynurenine and glycerate. Conclusions: Kynurenine and glycerate and their respective pathways may be representative of dietary potassium’s metabolic impact on CKD development.
Respiratory rate and its associations with disease and lifestyle factors in the general population – results from the KORA-FF4 study
Objective The aim of the study was to derive median age- and sex-specific respiratory rates in a population-based sample of adults and to identify disease and lifestyle factors associated with elevated respiratory rates. Methods In the population-based KORA FF4 study conducted in Augsburg, Germany, 5-minute 12-lead resting electrocardiograms (ECGpro-system, AMEDTEC) were recorded in 2,224 participants from 39 to 88 years. Respiratory rate was derived from these electrocardiograms. Sex- and age-specific medians, IQRs, and percentiles were calculated. Associations of sociodemographic, disease, and lifestyle variables with elevated resting respiratory rate were assessed by univariable and multivariable logistic regression analyses. Results Respiratory rate decreased slightly from youngest to middle-aged women and men and increased in old age. Overall, median (IQR) was 15.80 (3.16) breaths per minute (brpm). Five percent of the participants had values lower than 12.06 brpm, and five percent had values above 20.06 brpm (95th percentile). Elevated respiratory rates of ≥ 18.6 brpm were found in 13.8% (n = 308). In an adjusted logistic regression model, age, abdominal obesity, diabetes, COPD, smoking, and low education were significantly associated with elevated respiratory rate. Stratified analyses showed that education appeared to be more relevant in women, while the effect of diabetes was more pronounced in men. Conclusions High respiratory rate may be an indicator of impaired health in the general population, especially regarding pulmonary and metabolic characteristics, and unfavorable lifestyle and living conditions. Individuals with an increased respiratory rate should therefore be examined and followed up more closely to recognize diseases and adverse progressions at an early stage and to possibly prevent them.
Abstract P2149: Obstructive Sleep Apnea Is Associated With Lower In-Hospital Mortality Among Non-ST Segment Myocardial Infarction Patients With Gender Disparities In Cardiac Intervention
Introduction: Obstructive Sleep Apnea (OSA) is a known risk factor for cardiovascular diseases and has been linked to a higher incidence of non-ST segment elevation myocardial infarction (NSTEMI). However, the impact of OSA on in-hospital outcomes remains controversial. This study investigates the association of OSA with in-hospital mortality and clinical outcomes in NSTEMI patients, including gender-based differences. Hypothesis: We hypothesized that OSA would be associated with worse in-hospital outcomes among NSTEMI patients. Methods: This retrospective cohort study used Nationwide Inpatient Sample (NIS) data from 2016 to 2021, identifying 3,935,084 NSTEMI admissions. Multivariable logistic regression and propensity score matching (PSM) adjusted for demographics, comorbidities, and hospital characteristics. Gender-specific outcomes were analyzed using logistic regression. Primary outcomes included in-hospital mortality, with secondary outcomes covering cardiac arrest, cardiogenic shock, arrhythmias, mechanical and ventilatory support, healthcare utilization and cardiac procedures. Results: OSA patients had lower in-hospital mortality (aOR: 0.8; 95% CI: 0.7–0.8; p < 0.001) and reduced odds of sudden cardiac arrest, invasive ventilation, cardiogenic shock, and thrombolysis. However, they were more likely to require non-invasive ventilation (aOR: 2.2; 95% CI: 2.1–2.3; p < 0.001) and had higher odds of atrial fibrillation, atrial flutter, and pacemaker insertion. Female NSTEMI patients with OSA showed lower in-hospital mortality (aOR: 0.9; 95% CI: 0.8–0.9; p < 0.001). However, they underwent fewer procedures, including PCI (aOR: 0.8), CABG (aOR: 0.6), and coronary angiography (aOR: 0.9; p < 0.001 for all). Females also had a higher risk of venous thromboembolism (aOR: 1.12; 95% CI: 1.1–1.2). Hospital costs were $6,460.93 lower for OSA patients, with females incurring $11,104.87 less than males. Length of stay differences were not statistically significant (p = 0.251). Conclusions: OSA is associated with improved in-hospital survival among NSTEMI patients despite the increased need for non-invasive ventilation and arrhythmias. The gender-specific analysis highlights disparities, as female patients had lower mortality but underwent fewer diagnostic and interventional procedures, raising concerns about potential under-treatment. These findings call for further investigation into the role of sex differences in guiding care for NSTEMI patients with OSA.
Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association
Critical care cardiology refers to the practice focus of and subspecialty training for the comprehensive management of life-threatening cardiovascular diseases and comorbid conditions that require advanced critical care in an intensive care unit. The development of coronary care units is often credited for a dramatic decline in mortality rates after acute myocardial infarction throughout the 1960s. As the underlying patient population became progressively sicker, changes in organizational structure, staffing, care delivery, and training paradigms lagged. The coronary care unit gradually evolved from a focus on rapid resuscitation from ventricular arrhythmias in acute myocardial infarction into a comprehensive cardiac intensive care unit designed to care for the sickest patients with cardiovascular disease. Over the past decade, the cardiac intensive care unit has continued to transform with an aging population, increased clinical acuity, burgeoning cardiac and noncardiac comorbidities, technologic advances in cardiovascular interventions, and increased use of temporary mechanical circulatory support devices. Herein, we provide an update and contemporary expert perspective on the organizational structure, staffing, and care delivery in the cardiac intensive care unit; examine the challenges and opportunities present in the education and training of the next generation of physicians for critical care cardiology; and explore quality improvement initiatives and scientific investigation, including multicenter registry initiatives and randomized clinical trials, that may change clinical practice, care delivery, and the research landscape in this rapidly evolving discipline.
Abstract P3018: Spanish Language Preference is not associated with Prediabetes Risk among Hispanic Adolescents with Overweight or Obesity in an Integrated Healthcare System
Introduction: Nationally, up to 1 in 5 Hispanic adolescents have prediabetes. While obesity and other metabolic risk factors contribute to their disproportionate metabolic risk, fewer studies have examined the role of sociodemographic factors such as language proficiency. In this study, we examined whether primary language preference is associated with differences in prediabetes prevalence among Hispanic youth with overweight or obesity. Methods: This retrospective study was conducted using data from Kaiser Permanente Northern California. The cohort included 37,578 Hispanic youth aged 10-17y with body mass index (BMI)≥85 th percentile at exam visits in 2013-2019 and hemoglobin A1c measured within 1 year of the visit. Youth with diabetes or A1c ≥6.5% were excluded. Prediabetes (outcome) was defined by A1c ≥5.7%-6.4%. We also examined A1c ≥6% (secondary outcome). Family/self-reported English vs Spanish language preference was obtained from health records. BMI was classified as overweight (85th to <95th percentile) and obesity (≥95th percentile). A neighborhood deprivation index (NDI) was calculated using area of residence and US Census data. Modified Poisson regression was used to examine the association of language preference with prediabetes, reporting relative risks (RR) and 95% confidence intervals [CI]. Results: The cohort included 37,578 Hispanic youth (mean age 13.1±2.3y), of whom 26,910 (71.6%) reported English and 10,668 (28.4%) reported Spanish as their preferred language. Prediabetes prevalence was 19.3% for both English and Spanish language groups and was similar among those with overweight (13.3% vs 14.3%) and obesity (21.4% vs 21.0%). Adjusting for age, sex, NDI quartile, and BMI (percent of 95 th percentile), the risk of prediabetes for those with Spanish language preference remained similar to those with English language preference (RR 0.99 [0.95-1.04]. There were no differences within overweight or obesity subgroups, when A1c ≥6.0% was used as the outcome, and when analyses were restricted to older or younger age subsets. Conclusion: Prediabetes prevalence was similar among Hispanic youth with elevated BMI who had Spanish compared to English language preference. While differences in dietary and lifestyle factors were not examined, these findings point to similar metabolic risk profiles among Hispanic youth regardless of language preference, when examined in a healthcare system focused on preventive health and uniform access to language services.
Coupled CFD-DEM simulation of progressive failure of tunnel face in sand
Many studies have investigated tunnel face failure using the discrete element method (DEM). However, DEM simulations that incorporate water-soil interactions in tunnel face failure are still limited. In this study, the coupled CFD-DEM method is employed to simulate the progressive failure of the shield tunnel face in both saturated and dry sand. The dynamic mesh method is applied in the CFD component to accurately simulate the changes in the CFD domain due to the movement of the tunnel face. The excavation face is moved forward or backward at a uniform rate to simulate passive and active failure, respectively. The analysis focuses on progressive failure, ground surface displacement, tunnel face support forces, force chain distribution, and vertical stress distribution. Our results at both macro- and micro-scales reveal significant effects of soil-water interactions.
Abstract P3002: Hypoalbuminemia genetic variants are associated with higher cholesterol levels but not atherosclerotic heart disease
Introduction: Secondary hypoalbuminemia is associated with many clinical conditions including hypercholesterolemia, liver disease, kidney disease, and diabetes. These clinical conditions are often associated with atherosclerotic cardiovascular disease (ASCVD). It is unknown if primary hypoalbuminemia from genetic causes (rare monogenic variants or polygenic score [PGS]) is associated with hypercholesterolemia and ASCVD risk similar to secondary hypoalbuminemia. Here, we tested the hypothesis that primary hypoalbuminemia has the same association with cholesterol and incident ASCVD as secondary hypoalbuminemia. Methods: Geisinger’s MyCode cohort is a US-based healthcare cohort with linked genomic and electronic health record data for all participants. Among 146,030 MyCode participants with serum albumin measurements, a rare loss-of-function ALB variant was identified in 30 subjects. An albumin level PGS was calculated for each participant. Regression coefficients were calculated using linear models and hazard ratios (HR) were calculated using Cox proportional hazard models controlling for age at first serum albumin measurement, sex, diabetes, and principal components of ancestry. Results: With regard to LDL-C level, across the entire cohort, each standard deviation (SD) reduction in serum albumin was associated with a 3.4mg/dL (95% confidence interval [CI], 3.2-3.6) decrease in LDL-C. The relationship between the albumin PGS and LDL-C followed the same pattern. Each SD reduction in albumin PGS was associated with a 0.7mg/dL decrease in LDL-C (95% CI, 0.5-0.9). In contrast, ALB variant carriers had 0.69g/dL (95% CI, 0.57-0.81) lower albumin, but 37.7mg/dL (95% CI, 23.3-52.1) higher LDL relative to non-carriers. Contradictory results were observed with regard to ASCVD. Across the entire cohort, a reduction in serum albumin was associated with increased incident ASCVD (HR, 1.13 per SD reduction in albumin; 95% CI, 1.12-1.14; p=3.1x10 -90 ). However, neither the albumin PGS (HR, 0.99 per SD reduction in albumin PGS; 95% CI, 0.98-1.00; p=0.19) nor ALB variants (HR, 0.6; 95% CI, 0.19-1.85; p=0.37) were associated with incident ASCVD. Conclusions: The association of hypoalbuminemia with ASCVD is likely related to secondary causes as no association of albumin with incident ASCVD was seen with genetic causes. ALB variants are novel in that they are associated with higher LDL-C but are unrelated to incident ASCVD. Further investigation of the ALB gene is warranted.
Abstract P1134: Sedentary and Lighter-Intensity Activity Patterns across Trimesters of Pregnancy: the Pregnancy 24/7 Cohort
Background: At least 150 minutes/week of moderate intensity physical activity is recommended during pregnancy, yet pregnancy presents barriers to achieving these guidelines. Some data suggest that activities such as standing, daily steps, and breaking up sedentary behavior may also improve pregnancy health. We aimed to describe and compare typical patterns of these lighter intensity behaviors across pregnancy in a large cohort of pregnant women using gold standard, device-based measures. Methods: Pregnancy 24/7 is an ongoing multi-site cohort study in 500 pregnant participants conducted at the University of Iowa, University of Pittsburgh, and West Virginia University. The study’s primary objective is to identify optimal 24-h behavior compositions associated with the lowest risk of hypertensive disorders of pregnancy and other adverse pregnancy outcomes. Herein, we describe patterns of lower-intensity behaviors across trimesters. Participants aged 18-45 years, not on medications for blood pressure or diabetes, and without physical or medical conditions that severely impact 24-h behaviors, were recruited in the first trimester. They were instructed to wear a thigh-worn activPAL3 micro for 24-h x 7 full days and complete a concurrent wear diary during each trimester of pregnancy. Accelerometer data were processed by PALTechnologies software and a customized R program that quantified average daily standing (h/day), steps, sit-stand transitions, and prolonged sedentary behavior accumulated in 30-min or 60-min bouts (h/day) each trimester. Linear mixed models compared accelerometer outcomes across trimesters of pregnancy. Results: Participants (n=474) with valid accelerometer data for least one visit (to date) had an average age of 30.8 years and 84% reported Non-Hispanic White race/ethnicity. Sedentary behavior and lighter-intensity activities all differed across trimesters (p≤0.002, see Table ), with optimal patterns in the second trimester. Pregnant women were least likely to engage in standing and break up prolonged sedentary behavior (lower sit-stand transitions and higher sedentary behavior in bouts) in the first trimester, while steps were lower by ~500 steps per day in the third trimester. Conclusions: Sedentary behaviors, standing, and daily steps vary differentially across pregnancy. These patterns, along with how these behaviors associate adverse pregnancy outcomes, will guide the design of comprehensive activity interventions to promote pregnancy health.
Abstract P3021: Inflammatory Metabolomic Profiles are Associated with Increased Cardiovascular Disease Risk in Women
Background: Cardiovascular disease (CVD) is the leading cause of death worldwide; ischemic stroke (IS) and coronary heart disease (CHD) are the two leading causes of CVD. The burden of CVD is particularly pronounced in women, who have a 20% higher lifetime risk of stroke than men and have worse outcomes for CHD and IS. Inflammation is a risk factor for CVD, yet the mechanisms through which chronic inflammation increases this risk remain uncertain. Methods: Metabolomic data from 11 case-control studies in the Nurses’ Health Study (NHS) focusing on chronic inflammatory disease outcomes were used. In this cohort, 1,734 women also had data on inflammatory biomarkers (i.e., hs-CRP, IL6, TNFaR2, adiponectin). A composite inflammatory score was created based on these four biomarkers, and elastic net regression was used to identify metabolites associated with the inflammatory score. A metabolomic signature index of inflammation (i-MSI) was subsequently calculated as the sum of retained metabolites with weights equal to their regression coefficients. In an independent NHS IS case-control study ( n = 405 cases and 405 controls), conditional logistic regression was used to determine the odds ratios (OR) for the i-MSI and IS risk, controlling for standard CVD risk factors. Additionally, the association between the i-MSI and CHD risk was assessed in a case-control dataset from the Women’s Health Initiative (WHI; n = 793 cases and 795 controls). Results: The i-MSI comprised 92 metabolites in the NHS and 87 overlapping metabolites in the WHI, showing enrichment in branched-chain amino acid biosynthesis and degradation pathways. Moreover, weighted coexpression network analysis revealed distinct pro- and anti-inflammatory metabolite clusters, identifying diacylglycerides in the pro-inflammatory cluster and cholesteryl esters in the anti-inflammatory cluster. Every standard deviation (SD) increase in the i-MSI was associated with an OR for IS of 1.31 (95% CI: 1.06 – 1.62), and women in the highest i-MSI quartile had an OR of 1.96 (95% CI: 1.12 – 3.42). These findings were consistent in the CHD case-control cohort from the WHI, where the OR for CHD was 1.27 (95% CI: 1.07 – 1.51) per SD of the i-MSI. Conclusions: These data identify an association between metabolites linked with inflammation and CVD risk. These findings may aid in identifying novel metabolic targets that can be utilized to develop therapies for mitigating IS and CHD risk in women.
Introducing carbon quantum dot-Capivasertib drug carrier complex for enhanced treatment of breast cancer
Capivasertib (AZD5363) is a 2023 FDA-approved pyrrolopyrimidine-derived compound that treats hormone receptor positive, HER2 negative metastatic breast cancer in adult patients. It is a novel pan-AKT kinase catalytic inhibitor in ER + breast cancer cell lines, including MCF7. The dominant influence of carbon quantum dots (CQDs) in combination with multiple chemotherapy drugs is also demonstrated as a drug delivery system that significantly enhances the effectiveness of cancerous tumour treatments by providing reduced side-effects, through targeted delivery of the drug, controlled release, enhanced solubility, permeability and retention. In this study, the impact of the conjugation of AZD5363 drug to N-doped, S-doped, and N/S-doped CQDs was investigated on inducing apoptosis by inhibiting the AKT signalling pathway in the MCF7 cell line. Initially, hydrothermal and pyrolysis methods were used to construct CQDs. Then, the synthesized quantum dots were conjugated with AZD5363 at three different concentrations, i.e., 0.03, 0.3, and 3nM. The MTT test results, on MCF7 cells, showed that although all the studied CQDs were biocompatible, the complex of N/S-doped CQD-AZD5363 at a concentration of 0.03nM was the most effective. After obtaining immunocytochemistry results, flow cytometry and cell invasion tests were employed to demonstrate the high potential of the introduced drug carrier complex in reducing AKT protein expression, induction of apoptosis and prevention of cell metastasis and invasion. According to these results, the binding of N/S-doped CQD to AZD5363 increases the effectiveness of this drug, with reducing the IC50 concentration, and more specificity to cancerous cells, introducing it as a suitable candidate for the treatment of breast cancer.