Circulation, Volume 150, Issue Suppl_1, Page A4113188-A4113188, November 12, 2024. Introduction:Physical activity (PA) may be associated with a lower risk of atrial fibrillation (AF), but this relationship remains controversial. In particular, further research is needed on the association between changes in PA intensity and AF risk among older adults.Hypothesis:We hypothesized that an increase in PA intensity would be associated with a reduced risk of AF among older adults aged 65 years and older in South Korea.Aim:This cohort study aimed to evaluate the association between changes in metabolic equivalent tasks (METs)-min/week and the risk of AF in the elderly using a nationally representative database.Methods:We conducted a retrospective cohort study using the Korea National Health Insurance Service (KNHIS) database. This cohort included 1,726,697 individuals aged 65 years and older without a history of cardiovascular disease diagnosis who underwent two consecutive health screening examinations from 2009 to 2012. PA was defined as MET-min/week derived from two consecutive health examinations during 2009-2010 (1st period) and 2011-2012 (2nd period), respectively. The primary outcome was an AF diagnosis during the follow-up period from 2013 to 2021. We estimated the sub-distribution hazard ratio (sHR) and 95% confidence interval (CI) for the association of changes in PA intensity with AF using Fine-Gray sub-distribution hazard models after adjustment for covariates.Results:This study included 1,726,697 participants (mean age 71.08; 46.78% male). An increase in PA intensity was associated with a reduced risk of AF (P for trend
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Abstract 4139542: Left or Bilateral Cardiac Sympathetic Denervation: Comparison of Antiarrhythmic Efficacy and Complications
Circulation, Volume 150, Issue Suppl_1, Page A4139542-A4139542, November 12, 2024. Background:Cardiac sympathetic denervation (CSD) is a well-established procedure to prevent ventricular arrhythmias in genetic and acquired arrhythmia syndromes. It is unknown whether initial bilateral (B) CSD or left (L) CSD, followed by right (R) CSD for breakthrough events is the better strategy.Aims: We compared the antiarrhythmic efficacy and complications of primary B vs L CSD at a single center where both are performed routinely.Methods:Patients who underwent CSD were retrospectively identified. At our center L CSD is performed in children while B CSD is performed in adults by operator preference. Demographic data, procedural indications, complications, and arrhythmia events (arrhythmic syncope, sudden cardiac arrest, appropriate shock) were collected. Arrhythmia events (AE) were compared before and after CSD in those with arrhythmia indications. Complications were compared in all subjects and in the subset with arrhythmia indications.Results:Between 2011 and 2023, 65 patients underwent 68 CSD procedures (39 B, 26 L, 3 R after initial L). As expected, BCSD patients were older [median 32 (IQR 21-48) years vs. 16 (6-38) years; P=0.002]. Overall complication rates were similar [BCSD 17/39 (44%) vs 12/29 (41%), P=0.85]; most were transient/minor. Complications that required intervention were rare (n=5) and only observed after BCSD. Forty CSD were for an arrythmia indication (18 B, 21 L, 1 R). AEs were reduced from a median of 3 (1-4) before CSD to 0 (0-1) after CSD (p
Abstract 4144894: Patient Frailty Rather than Procedural Approach Associated with Loss of Life and Limb
Circulation, Volume 150, Issue Suppl_1, Page A4144894-A4144894, November 12, 2024. Objectives:Evidence behind frail patients preferentially undergoing endovascular interventions for peripheral arterial disease remains sparse; thus, we evaluated the association of frailty and revascularization-approach with long-term mortality and major adverse limb events (MALE).Methods:VQI-Medicare linked VISION databases were queried for patients who had their first infrainguinal open or endovascular (endo) procedure between 2011-2015 [N=27,200]. Frailty was measured using the VQI-Risk Analysis Index (RAI) and dichotomized into “frail” (RAI≥37) and “non-frail” (RAI
Abstract 4145353: Sex Differences in Post-PCI Myocardial Injury and Long-Term All-Cause Mortality
Circulation, Volume 150, Issue Suppl_1, Page A4145353-A4145353, November 12, 2024. Background:Myocardial injury complicating percutaneous coronary intervention (PCI) is associated with mortality, but sex differences in outcomes are uncertain. We explored sex differences in the incidence and long-term outcomes of post-PCI myocardial injury (PPMI).Methods:Adults who underwent PCI at NYU between 2011-2020 were included in this retrospective analysis. Patients with ACS as the indication for PCI were excluded. PPMI was defined as a peak CKMB concentration >99% of the upper reference limit. The incidence of PPMI by sex was compared by Chi-square tests. Independent predictors of elevated CKMB post-PCI were evaluated with linear regression models in subgroups by sex. Cox proportional hazard models were generated to evaluate relationships between PPMI and all-cause mortality by sex.Results:Of 10,807 adults undergoing PCI, 24.9% (2,694) were female. Females were older than males at the time of PCI (68.9 vs. 65.8, p
Abstract 4143806: Long-Term Risks of Cardiovascular Disease in the U.S. Population Based on the American Heart Association PREVENT Equations
Circulation, Volume 150, Issue Suppl_1, Page A4143806-A4143806, November 12, 2024. Background:The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations were recently developed to estimate risk of cardiovascular disease (CVD). Long-term risks of cardiovascular disease based on the PREVENT equations in the U.S. population are unknown.Methods:Using data on adults aged 30-79 years from the National Health and Nutrition Examination Survey between 2011 and 2020, we determined long-term risks of total CVD (atherosclerotic cardiovascular disease or heart failure) based on the PREVENT equations. Age-standardized and survey-weighted risk prevalence was determined with further stratification by age group, sex, race and ethnicity.Results:The study population included 14,256 participants representing 160.6 million U.S. adults (mean [SD] age 51.9 [11.2] years, 49.2% women, 66.4% non-Hispanic white, 9.8% non-Hispanic black, 5.7% non-Hispanic Asian and 14.8% Hispanic). Among adults aged 30-79 years, 9.6% had existing CVD and 20.2% were CVD-free but had intermediate or high (≥7.5%) 10-year risk of CVD. The prevalence of CVD-free US adults with low or borderline (
Abstract 4132288: Associations Between Health-Related Social Needs and Cardiovascular Health Among US Adults
Circulation, Volume 150, Issue Suppl_1, Page A4132288-A4132288, November 12, 2024. Background Unfavorable:health-related social needs (HRSNs) have the potential to worsen health and wellbeing and drive health disparities. Its associations with cardiovascular health (CVH), assessed by Life’s Essential 8 (LE8), have not been comprehensively examined among US adults.Research Questions/Hypothesis:Whether unfavorable HRSNs are associated with worse CVH.Goals/Aims:To determine associations between unfavorable HRSNs and CVH in a large, diverse, nationally representative sample of US adults.Methods:We used the National Health and Nutrition Examination Survey 2011–March 2020 data for adults aged ≥20 years. We grouped LE8 scores as low (0–49), moderate (50–79), and high (80–100) CVH. We identified 8 unfavorable HRSNs: unemployed, low family poverty-to-income ratio, food insecurity, less than high school education, no healthcare access, no health insurance, no homeownership, and living alone. We assigned a value of 1 for the unfavorable status of each. The number of unfavorable HRSNs was summed and ranged from 0 to 8, with higher numbers indicating more unfavorable HRSNs. We categorized unfavorable HRSNs as none, 1–2, 3–4, and ≥5. We used multivariable linear and multinomial logistic regression to examine the association between HRSNs and CVH.Results:We included 14 947 participants (n=7340 male [49.3%]; mean [SE] age, 46.4 [0.35] years). Of those, 29.1% were categorized as having HRSNs 0, 40.4%; HRSNs 1–2, 21.5% HRSNs 3–4, and 9.0% HRSNs ≥5. The prevalence of low, moderate, and high CVH was 14.7%, 63.5%, and 21.8%, respectively. Every one-unit increase in unfavorable HRSNs was associated with 1.59 points lower LE8 scores (P
Abstract 4137914: Eligibility for Semaglutide in US Adults with Diabetes and Potentially Preventable Cardiovascular Events Projected from the SUSTAIN-6 Trial
Circulation, Volume 150, Issue Suppl_1, Page A4137914-A4137914, November 12, 2024. Background:The Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6) trial showed cardiovascular disease (CVD) benefits of semaglutide therapy in patients with type 2 diabetes mellitus (T2DM).Purpose:To estimate the number of US adults with T2DM that may be eligible for semaglutide based on SUSTAIN-6 eligibility criteria and the number of preventable CVD events from semaglutide treatment based on observed CVD event reductions in SUSTAIN-6.Methods:We included US adults with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2011– 2020 who had eligibility criteria from SUSTAIN-6. This included an HbA1c >7.0%, age >50 with established CVD, heart failure, or chronic kidney disease or an age >60 with at least one CVD risk factor. We estimated the number of primary composite and secondary CVD endpoints that would occur based on SUSTAIN-6 treated and placebo published event rates, with the difference indicating the number of preventable events (and annualized based on median 2.1 year follow-up time).Results:Among 5002 (projected to 34.0 million [M]) adults we identified with T2DM, we estimated 1,132 (6.9 million) (20.3%) to fit SUSTAIN-6 eligibility criteria. Compared to SUSTAIN-6 trial participants, our sample was slightly older, had a higher proportion of Black participants, shorter duration of diabetes, lower HbA1c and diastolic blood pressure, but similar body mass index and systolic blood pressure. Prior history of ischemic heart disease, myocardial infarction, and stroke were also less common in our NHANES sample. From SUSTAIN-6 semaglutide and placebo primary composite CVD event rates of 6.6% and 8.9%, respectively, we estimated 456,060 and 614,990 events would occur, respectively, for a total of 159,930 preventable CVD events, or 75,681 on an annualized basis. We similarly estimated annualized preventable events for secondary outcomes as shown in the Figure.Conclusion:Semaglutide may prevent many fatal and non-fatal CVD events if provided to US adults meeting SUSTAIN-6 eligibility criteria. More efforts are needed to educate the healthcare providers on the CVD benefits from newer diabetes therapies, including semaglutide.
Abstract 4141874: Social Determinants Of Aging Speed Among Hispanic/Latino Adults From The Hispanic Community Health Study/Study Of Latinos (HCHS/SOL, 2008-2017)
Circulation, Volume 150, Issue Suppl_1, Page A4141874-A4141874, November 12, 2024. Background:From 2018 to 2060 the proportion of US seniors (age 65+) will increase from 16% to 23%, with much of this growth driven by Hispanic/Latino seniors. Adverse social determinants of health (SDoHs) are drivers of poor health outcomes and accelerated aging.Objective:To examine the association between SDoHs (education, income, and nativity) and aging speed among Hispanic/Latino adults.Methods:The Hispanic Community Health Study/Study of Latinos is a longitudinal cohort of Hispanic/Latino adults from four US urban communities. Participants completed questionnaires, underwent clinic examinations, and provided biospecimens at visit 1 (V1: 2008-2011) and visit 2 (V2: 2014-2017). Education, income, and nativity were self-reported at V1. The Klemera-Doubal Method, an algorithm consisting of equations using biomarkers from different organ systems (waist-to-hip ratio, pulse pressure, lipids, glycosylated hemoglobin, alanine aminotransferase, cystatin C, and albumin-to-creatinine ratio), was used to calculate biological age (BA) among 5,316 females and 3,087 males ages 30 to 75 at either V1 or V2. Aging speed was defined as the difference between change in BA from V1 to V2 and follow-up time from V1 to V2. We used multivariable linear regression models to determine the sex-specific association between each SDoH with aging speed.Results:At V1, mean chronological age was 47 years for females and 46 years for males. Over an average of six years, females aged biologically by 5 years and males aged biologically by 4 years. Compared with having more than a high school education, aging speed was greater by 0.69 years (95% CI: 0.45, 0.94) among females with less than a high school education but not among males (ß=0.57, 95% CI: -0.04, 1.17). Compared with an income ≥$50K, aging speed was greater by 0.67 years (95% CI: 0.30, 1.04) among females with an income
Abstract 4135286: Comparative Efficacy of Intracardiac and Transesophageal Echocardiography in Left Atrial Appendage Occlusion: A Meta-Analysis of Clinical Outcomes
Circulation, Volume 150, Issue Suppl_1, Page A4135286-A4135286, November 12, 2024. Background:Left atrial appendage occlusion (LAAO) is essential for stroke prevention in patients with non-valvular atrial fibrillation where anticoagulation is contraindicated. Intracardiac Echocardiography (ICE) has been proven effective and safe for LAAO since 2011, yet adoption rates remain low, with only 2.2% of LAAOs guided by ICE between 2015 and 2019. Transesophageal Echocardiography (TEE), the current gold standard, and ICE differ significantly in operational dynamics and patient impacts, influencing procedural outcomes.Objective:This study aims to compare the efficacy and safety of ICE and TEE in facilitating LAAO, offering insights into their comparative clinical use.Methods:A systematic review and meta-analysis were conducted according to PRISMA guidelines. Searches were performed in MEDLINE/PubMed, OVID, and Scopus through December 2023, comparing ICE and TEE in LAAO. Inclusion criteria centered on studies reporting technical success, with secondary outcomes including length of stay (LOS), mortality, and adverse outcomes such as stroke, transient ischemic attacks (TIA), pericardial effusion, cardiac tamponade, device thrombosis, device embolization, and peri-device leaks. Data synthesis employed statistical methods utilizing R Studio.Results:Fourteen studies involving 4184 patients were included. The meta-analysis revealed no significant differences in technical success (OR 1.34, 95% CI: [0.76, 2.36]), LOS (OR 1.66, 95% CI: [0.80, 3.42]), or mortality (OR = 1.00, 95% CI: [0.50, 2.00]) between ICE and TEE. Similarly, non-significant differences were noted in stroke, TIA, pericardial effusion, and device leaks, with minimal heterogeneity (I2= 0%).Conclusion:ICE and TEE provide comparable clinical outcomes in LAAO, with no significant efficacy or safety differences. These results suggest that the choice between ICE and TEE should be based on procedural convenience, patient anatomy, and resource availability, rather than clinical outcomes alone. The equivalence in performance between these modalities allows for flexibility in clinical practice, ensuring that patient care can be customized to individual needs without compromising safety or effectiveness.
Abstract Sa101: Prehospital advanced airway management across age groups in out-of-hospital cardiac arrest: Registry-based cohort study from the Resuscitation Outcomes Consortium Epidemiologic Registry
Circulation, Volume 150, Issue Suppl_1, Page ASa101-ASa101, November 12, 2024. Background:Emergency medical services clinicians commonly perform advanced airway management (AAM: i.e., supraglottic airway placement and endotracheal intubation) for out-of-hospital cardiac arrest (OHCA). Nevertheless, the heterogeneity of the treatment effect of prehospital AAM across age groups is still unclear.Aim:To determine the association between prehospital AAM and survival after OHCA, compared with no AAM, across age groups.Methods:This cohort study used the Resuscitation Outcomes Consortium Epidemiologic Registry database, a prospective OHCA registry at ten sites in the US and Canada from 2011 through 2015. Patients were stratified into ten sub-cohorts based on their first documented rhythm (shockable or non-shockable) and five age groups (0-9 years; 10-24; 25-44; 45-64; or ≥65) given the potential impact of rhythm and age on effect modification. To address resuscitation time bias, patients who received AAM during cardiopulmonary resuscitation (CPR) were sequentially matched with patients at risk of receiving AAM within the same minute based on time-dependent propensity scores. Matching was performed in each sub-cohort, and the matched sub-cohorts were integrated for the main analysis. The primary outcome was survival to hospital discharge.Results:Of the 44,403 eligible patients, 39,157 (88.2%) received prehospital AAM during CPR. After time-dependent propensity score sequential matching, 29,973 who received AAM were matched with patients who had not yet received AAM at the same minute. AAM was associated with survival: 5.4% vs 4.8%, risk ratio (RR) 1.40 (95% CI 1.30-1.51). The associations were similar toward better survival in both the shockable (RR 1.27 [95% CI 1.17-1.38]) and non-shockable (RR 1.75 [95% CI 1.53-2.01]) cohorts. There was no apparent heterogeneity of the treatment effect of AAM on survival in all age groups: 0-9 years, RR 1.07 (95% CI 0.45-2.56); 10-24 years, 1.61 (1.07-2.45); 25-44 years, 1.68 (1.35-2.10); 45-64 years, 1.33 (1.19-1.48); 65 years or older, 1.40 (1.23-1.59).Conclusions:In this study of the large multicenter OHCA registry in North America, prehospital AAM was associated with survival to hospital discharge regardless of the first documented rhythm. No apparent heterogeneity was found in the associations between AAM and survival among all age groups, suggesting that both pediatric and adult populations might benefit from prehospital AAM.
Abstract 4132341: Systematic Examination of the AHA PREVENT Equations
Circulation, Volume 150, Issue Suppl_1, Page A4132341-A4132341, November 12, 2024. Background:The novel AHA Predicting Risk of CVD Events (PREVENT) equations newly incorporate predictors (estimated glomerular filtration rate [eGFR]) and outcomes (heart failure [HF]) relevant to the novel construct of cardiovascular-kidney-metabolic (CKM) syndrome.Aims:We sought to characterize the intrinsic properties of the PREVENT equations by simulating different risk profiles across the age and CKM risk spectrum.Methods:We applied the PREVENT base equations to estimate 10-year predicted risk for total CVD, which includes atherosclerotic CVD and HF. First, we calculated risk estimates for a hypothetical individual varying age from 30-79 years with an average risk factor profile (mean population risk factor levels based on National Health and Nutrition Examination Survey 2011-2020 data without diabetes, not on anti-hypertensive or statin medication, and who does not smoke). Second, we examined at which age a hypothetical individual would exceed the previously defined intermediate risk threshold ≥7.5% established by national guidelines. Lastly, we examined the differences in predicted risk with or without diabetes and/or Stage 3 CKD (defined as eGFR 44.5 mL/min/1.73m2).Results:For hypothetical individuals aged 30-79 years with average risk factor levels, predicted 10-year CVD risk is shown in the figure for females (Panel A) and males (Panel B). The predicted risk would exceed the intermediate risk threshold at age 68 years if female and 63 years if male. If the individual had Stage 3 CKD, the predicted risk would exceed the intermediate risk threshold at 60 if female and 55 years if male. If the individual had diabetes, the predicted risk would exceed the intermediate risk threshold at 59 if female and 52 years if male. If both diabetes and Stage 3 CKD were present, the predicted risk would exceed the intermediate risk threshold at age 42 years if female and 35 years if male.Conclusions:The PREVENT equations enable more granular differentiation of risk among individuals with varying CKM profiles. Understanding risk estimates across the spectrum of age and CKM can support interpretability among clinicians and patients.
Abstract 4139892: Trends in ACS-Related Mortality in Older Adults in the United States from 1999 to 2020: An Analysis of Gender, Race/Ethnicity, and Geographic Disparities
Circulation, Volume 150, Issue Suppl_1, Page A4139892-A4139892, November 12, 2024. Background and Purpose:Specific populations of older adults in the United States are experiencing worsening trends in the incidence and prevalence of acute coronary syndrome (ACS). This study examined trends in ACS-related mortality among older adults in the United States.Methods:The CDC-WONDER (Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research) database was used to track deaths due to ACS in adults aged ≥ 65 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population were determined and stratified by year, sex, race/ethnicity, and geographic region. Joinpoint regression was used to analyze trends in AAMRs using annual percent change (APC).Results:Altogether, 3,017,769 deaths occurred due to ACS and the overall ACS-related AAMR was 327.5 from 1999 to 2020. Following an initial period of rapid decrease in mortality rates from 1999 to 2011 (APC: -5.98; 95% CI: -6.40 to -5.65), the rate of decline halved from 2011 to 2020 (APC: -3.02; 95% CI: -3.62 to -2.19). Men had consistently higher AAMRs (410.6) than women (267.8). In racial and ethnic groups, the Non-Hispanic (NH) Black or African American population had both the highest total AAMR (374.4) and was one of the two ethnicities that displayed increasing trends from 2018-2020 (APC: 4.74; 95% CI: 0.30 to 7.10). The second ethnic group with increasing trends was Hispanic or Latino (2018-2020 APC: 9.27; 95% CI: 3.22 to 13.16). Significant geographic disparities were observed, with nonmetropolitan areas having consistently higher AAMRs (433.5) than metropolitan areas (304.1). States in the top 90th percentile (District of Arkansas, Kentucky, Mississippi, Missouri, South Dakota, and Tennessee) had almost double the AAMRs than states in the bottom 10th percentile (Alaska, Colorado, Hawaii, Minnesota, Montana, and Nevada).Conclusion:Despite an overall decrease in mortality, the deceleration of decline since 2011is concerning. Men, NH Black/African American populations, and residents of nonmetropolitan areas displayed the highest burden of ACS-related mortality. Focused strategies are required to prevent and manage ACS in older adults to mitigate the rising levels of ACS-related mortality.
Abstract 4143939: A large-scale multi-view deep learning-based assessment of left ventricular ejection fraction in echocardiography
Circulation, Volume 150, Issue Suppl_1, Page A4143939-A4143939, November 12, 2024. Introduction:Recent studies using deep learning techniques have demonstrated promising left ventricular ejection fraction (LVEF) assessment from transthoracic echocardiograms (TTEs). However, most prior studies have focused on videos from a single apical view, a technique known to be subject to limitations given the regionality of LV systolic function. We hypothesized that a deep learning model trained to include echocardiographic video clips from multiple views from a large dataset will improve accuracy in LVEF assessment.Methods:We identified all adult TTEs with a clinically reported LVEF at Columbia University between 2019-2024. A view classification model was trained to identify apical 4 and 2-chamber and parasternal long and short-axis views for LVEF assessment. The internal dataset was split into train, validation and test sets to train spatiotemporal convolutional models for each of the 4 views to assess LVEF for each video clip. The median clip-level LVEF within a study was used to derive a study-level LVEF. The model was evaluated on an internal test set and a large external test set, which included all available adult TTEs from Weill Cornell Medical Center since 2011. As benchmark comparison, the previously published EchoNet-Dynamic model was also evaluated on the external test set.Results:The model was trained and validated on 97,566 internal studies, comprising 1,424,265 videos from 60,741 unique patients. The model achieved state of the art performance on the internal test set (16,396 studies), with mean absolute error (MAE) of 3.4% and root mean squared error (RMSE) of 4.6%. Multi-view results were superior to all single-view models. Model showed robust predictions on external test set (179,298 studies), with MAE of 5.6% and RMSE of 7.1% and outperformed EchoNet-Dynamic (Table).Conclusions:We developed a deep learning model trained on multiple echocardiographic views using the largest dataset to date. Our model achieved state-of-the-art accuracy in assessing LVEF with a level of agreement between the AI and cardiologist LVEF assessments comparable to cardiologist interobserver variability. Further studies are underway to study the implementation of these models within clinical systems.
Abstract 4146038: Inpatient Tricuspid Valve transcather and surgical procedural outcomes: A Propensity Matched analysis
Circulation, Volume 150, Issue Suppl_1, Page A4146038-A4146038, November 12, 2024. Background:Tricuspid regurgitation (TR) is a common valvular heart disease, and associated with increased cardiovascular mortality. Adverse events from surgical treatment of severe TR are limiting this approach.Aim:To analyze the outcomes of using surgical and transcatheter TV interventions across the United States.Methods:We used The National Inpatient Sample (NIS) data base and included data between January 1, 2011 and December 31, 2020. We selected patients who underwent Transcatheter tricuspid valve intervention (TTVI), surgical TR repair (STVr), and surgical TR replacement (STVR). TTVI patients were propensity-matched 1:1 to STVr and STVR using nearest neighbor matching. Analyses were conducted using STATA version 17.Results:Between 2011 and 2020, a total of 98,202 TV interventions were identified. Of these, 1,830 (1.9%) underwent TTVI, 76,747 (78.2%) underwent STVr and 19,625 (19.9%) underwent STVR. Patients receiving TTVI were older, more likely to be white and to be treated at a teaching hospital. STVR accounted for the highest proportion of TV procedure-related deaths overall, followed by surgical TV replacement, and lastly, TTVI. In our PSM analysis, STVr and STVR were associated with increased inpatient mortality (7% vs 2.3%, 11.6% vs 2.4%, respectively), when compared to TTVI (p
Abstract 4138426: Geographic Disparities in Cardiometabolic Health Widened Across US States Between 2011 and 2021
Circulation, Volume 150, Issue Suppl_1, Page A4138426-A4138426, November 12, 2024. Background:Geographic inequities in cardiovascular mortality are pervasive in the US. Pandemic-related delays in screening and treatment, economic loss, and worsening social determinants may have widened geographic disparities in cardiometabolic health, particularly in states that were hardest hit by these spillover effects. Understanding changes in state-based inequities could inform targeted public health efforts to advance cardiovascular health.Questions:Did the prevalence of cardiometabolic risk factors (diabetes, hypertension, hyperlipidemia, obesity) and lifestyle factors (alcohol consumption, physical inactivity, tobacco use) change between 2011 and 2021? How did between-state differences change over this period?Methods:We included adults from the CDC’s Behavioral Risk Factor Surveillance System. Survey-weighted logistic regressions models were used to calculate age and sex-adjusted risk difference between states with the highest and lowest adjusted prevalence rates of each risk factor in 2011 and 2011, respectively. An interaction term for state and year was included to assess for differential changes in between-state disparities.Results:From 2011 to 2021, there were increases in the age- and sex-adjusted prevalence of diabetes (10.9% [95% CI, 10.7,11.0] to 12.4% [12.2,12.6]), hypertension (32.4% [32.1,32.7] to 33.7% [33.4,34.0]), and obesity (27.5% [27.2,27.7] to 33.1% [32.8,33.5]). Geographic inequities widened, with increases in the difference between states with the highest vs lowest prevalence of diabetes (5.7% [5.3,6.1] to 7.8% [7.3,8.3]), hypertension (14.2% [13.6,14.8] to 17.2% [16.4,17.9]) and obesity (14.3% [13.6,15.0] to (15.7% [14.7,16.7])(Table).The prevalence of alcohol consumption (18.0% [17.7,18.2] to 15.6% [15.3,15.8]), physical inactivity (25.7% [25.4,27.4] to 24.0% [23.6,23.7]), and tobacco use (44.9% [44.5,45.3] to 36.3% [35.8,36.8]) decreased, and between-state differences did not widen.Conclusion:In this national study, the prevalence of hypertension, obesity, and diabetes increased from 2011 to 2021, and state-based inequities widened. Our findings highlight the urgent need for public health interventions to address widening state-based disparities in cardiometabolic health.
Abstract 4144181: Sociodemographic and Clinical Correlates of Right Ventricular Structure and Function, and Serial Change among Hispanics/Latinos: The Echocardiographic Study of Latinos (ECHO-SOL)
Circulation, Volume 150, Issue Suppl_1, Page A4144181-A4144181, November 12, 2024. Introduction:The role of the right ventricle (RV) in influencing clinical outcomes and overall survival is well established. However,RV serial change over time and the influence of sociodemographic and clinical factors on RV structure/function remains understudied, especially among Hispanics/Latinos.Methods:ECHO-SOL comprehensively assessed RV structure and function in Hispanic/Latino 1643 adults at baseline (visit 1 2011-2014) and 4.3 years later (visit 2 2015-2019). RVfunctional parametersincluded were RV peak S’ velocity (PsV), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE);structural parameters: RV systolic (RVSA) and diastolic (RVDA) area; andhemodynamic parameters:maximal tricuspid pressure gradient (TR max PG), velocity time integral (VTI). Regression models were employed to assess the association of sociodemographic factors with RV structure/function at baseline. Marginal models were used to estimate RV change between visits. All analyses were weighted to account for complex survey design.Results:At baseline, 41.5% were female, mean age 56.38±0.39 years. Increasing age was associated with worse RV systolic function, evidenced by functional parameters (lower TAPSE, S’ velocity) but lower RVDA. Females had worse RV structure/function (greater RVDA and decreased FAC) but better RV longitudinal shortening (greater TAPSE, PsV). Higher BMI was related to worse RV functional (decreased FAC) and structural parameters (greater RVDA). Higher income ( >75K) correlated with better RV longitudinal shortening (PsV). First generation immigrants had worse RV structure with higher RVDA. (Table 1a)RV structure and function worsened over time (Table 1b), as evidenced by an change in all parameters: increased RV size (greater RVSA, RVDA), impaired systolic function (lower FAC) and longitudinal shortening (lower TAPSE,PsV), along with impaired stroke volume (lower TR max PG,VTI).Conclusion:Among Hispanic/Latinos, different sociodemographic and clinical factors were associated with RV morphology and function. Overall, RV structure and function worsened over time, suggesting that sociodemographic factors may play an important role in the decline of RV parameters in this population.