Adjustment For Race Research Articles

Analysis of Cardiovascular Complications During Delivery Admissions Among Patients With Systemic Lupus Erythematosus, 2004-2019

Individuals with systemic lupus erythematosus (SLE) have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. To investigate whether SLE is associated with an increased risk of acute peripartum cardiovascular complications during delivery hospitalization among individuals giving birth. This population-based cross-sectional study was conducted with data from the National Inpatient Sample (2004-2019) by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify delivery hospitalizations among birthing individuals with a diagnosis of SLE. A multivariable logistic regression model was developed to report an adjusted odds ratio (OR) for the association between SLE and acute peripartum cardiovascular complications. Data were analyzed from May 1 through September 1, 2022. Diagnosed SLE. Primary study end points were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary end points included ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury (AKI), venous thromboembolism (VTE), length of stay, and cost of hospitalization. A total of 63 115 002 weighted delivery hospitalizations (median [IQR] age, 28 [24-32] years; all were female patients) were identified, of which 77 560 hospitalizations (0.1%) were among individuals with SLE and 63 037 442 hospitalizations (99.9%) were among those without SLE. After adjustment for age, race and ethnicity, comorbidities, insurance, and income level, SLE remained an independent risk factor associated with peripartum cardiovascular complications, including preeclampsia (adjusted OR [aOR], 2.12; 95% CI, 2.07-2.17), peripartum cardiomyopathy (aOR, 4.42; 95% CI, 3.79-5.13), heart failure (aOR, 4.06; 95% CI, 3.61-4.57), cardiac arrhythmias (aOR, 2.06; 95% CI, 1.94-2.21), AKI (aOR, 7.66; 95% CI, 7.06-8.32), stroke (aOR, 4.83; 95% CI, 4.18-5.57), and VTE (aOR, 6.90; 95% CI, 6.11-7.80). For resource use, median (IQR) length of stay (3 [2-4] days vs 2 [2-3] days; P < .001) and cost of hospitalization ($4953 [$3305-$7517] vs $3722 [$2606-$5400]; P < .001) were higher for deliveries among individuals with SLE. This study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization.

Preference-based comparison of quality of life associated with vision loss in Black and White ophthalmic populations in the US

ObjectifLe concept d'utilité consiste en une estimation des préférences individuelles, dont la fourchette s’étend normalement de 1,00 (meilleur état de santé possible) à 0,00 (décès). L'utilité permet de mesurer l'amélioration de la qualité de vie en lien avec une intervention de soins de santé. Conjointement à l'augmentation de l'espérance de vie, elle permet – selon le type d'intervention – d’évaluer le gain total de valeur lié à l'intervention en années de vie ajustées en fonction de la qualité, lequel peut être intégré aux coûts dans le cadre d'une analyse coût-utilité. À notre avis, il était pertinent de vérifier si la race représentait un facteur de confusion de l'utilité en ce qui a trait à la vision. MéthodesOn a réalisé une analyse des données transversales des dossiers de patients noirs et caucasiens ambulatoires consécutifs qui ont consulté les cabinets d'ophtalmologie du Wills Eye Hospital (Philadelphie, Pennsylvanie), cabinets prenant part à une étude de longue durée (1999 à 2016) évaluant l'utilité relative à la vision au moyen de la technique de l'arbitrage temporel (ou TTO, time trade-off). Chaque participant a été interviewé par un chercheur grâce à un outil d'arbitrage temporel validé et fiable de mesure de l'utilité relative à la vision, puis une cote de 1 à 5 était attribuée à la vision en fonction de l'acuité visuelle du meilleur œil. Les résultats de l'analyse d'utilité ont été comparés à l'aide d'un test t bilatéral et du test U de Mann-Whitney. RésultatsAinsi, 1125 patients consécutifs qui étaient en mesure de répondre aux questions ont été inclus à notre étude. En présence d'une vision 20/200–20/800, les résultats moyens de l'analyse d'utilité relative à la vision des patients caucasiens/noirs s’élevaient respectivement à 0,58/0,59 (p = 0,84); en présence d'une vision 20/70–20/100, les résultats s’élevaient respectivement à 0,72/0,70 (p = 0,85); en présence d'une vision 20/50–20/60, les résultats s’élevaient respectivement à 0,78/0,79 (p = 0,86); en présence d'une vision 20/25–20/50, les résultats s’élevaient respectivement à 0,84/0,88 (p = 0,16) et, enfin, en présence d'une vision 20/20, les résultats s’élevaient respectivement à 0,91/0,90 (p = 0,43). ConclusionsL'analyse de l'utilité relative à la vision par arbitrage temporel chez des patients noirs et caucasiens qui consultent un cabinet d'ophtalmologie a donné des résultats semblables, et ce, aux différents degrés d'acuité visuelle. On peut donc conclure à une qualité de vie similaire, de sorte que les valeurs d'utilité relatives à la vision acquises par arbitrage temporel qui sont utilisées dans les analyses coût-utilité n'ont pas besoin d’être ajustées en fonction de la race (noire ou caucasienne) des patients qui reçoivent des soins ophtalmologiques aux États-Unis.

White matter integrity as a mediator between socioeconomic status and executive function.

Lower socioeconomic status (SES) is associated with poorer executive function, but the neural mechanisms of this association remain unclear. As healthy brain communication is essential to our cognitive abilities, white matter integrity may be key to understanding socioeconomic disparities. Participants were 201 African American and White adults (ages 33-72) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study. Diffusion tensor imaging was used to estimate regional fractional anisotropy as a measure of white matter integrity. Adjusting for age, analyses examined if integrity of the anterior limb of the internal capsule (ALIC), external capsule (EC), superior longitudinal fasciculus (SLF), and cingulum mediated SES-executive function relations. Lower SES was related to poorer cognitive performance and white matter integrity. Lower Trails B performance was related to poorer integrity of the ALIC, EC, and SLF, and lower Stroop performance was associated with poorer integrity of the ALIC and EC. ALIC mediated the SES-Trails B relation, and EC mediated the SES-Trails B and SES-Stroop relations. Sensitivity analyses revealed that (1) adjustment for race rendered the EC mediations non-significant, (2) when using poverty status and continuous education as predictors, results were largely the same, (3) at least some of the study's findings may generalize to processing speed, (4) mediations are not age-dependent in our sample, and (5) more research is needed to understand the role of cardiovascular risk factors in these models. Findings demonstrate that poorer white matter integrity helps explain SES disparities in executive function and highlight the need for further clarification of the biopsychosocial mechanisms of the SES-cognition association.

Impacts of the COVID-19 Pandemic on Assessment of M-Protein and Free Light Chain Levels in Patients with Multiple Myeloma

Background The COVID-19 pandemic impacted cancer care in the U.S. in many ways. Changes in the frequency of laboratory assessments may lead to surveillance bias in real-world studies of progression in patients (pts) with MM. This study compared patterns of myeloma-protein (M-Protein) and free light chain (FLC) laboratory assessments and real-world endpoints in the one-year periods before and after the onset of the COVID-19 pandemic, overall and by race. Methods In this retrospective observational study, we used the nationwide de-identified, electronic health record-derived Flatiron Health database. The analysis included pts with MM who initiated first-line (1L) systemic therapy in the pre-pandemic (Mar 1 to Nov 30, 2019) or pandemic (Mar 1 to Nov 30, 2020) eligibility periods with follow-up ending on Mar 1, 2020 and Mar 1, 2021, respectively. The monthly rates of M-Protein and FLC labs were calculated as the number of assessments divided by the follow-up time during 1L in months. Real-world derived progression (dP) events were based on changes in abstracted M-Protein values or structured FLC labs and thresholds aligned to the International Myeloma Working Group (IMWG) criteria. Real-world overall survival (rwOS) and derived progression-free survival (dPFS) were followed from 1L initiation until the first of death, dP, or end of the study period using Kaplan-Meier methods. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) comparing survival outcomes between the pre-pandemic and pandemic periods with adjustment for age, gender, race, and International Staging System (ISS) Stage. Analyses of monthly assessment rates and survival endpoints were further stratified by race. Results Overall, 860 (Black: 142; White: 504) eligible pts with MM were included in the pre-pandemic period and 762 (Black: 152; White: 403) in the pandemic period. Median dPFS and rwOS were not reached. Mean rates of assessments per month during 1L were approximately the same in the two periods (0.90 [95% CI 0.84-0.97] vs. 0.90 [95% CI 0.85-0.96]) overall, slightly lower in the pandemic period for Black pts (0.96 [95% CI 0.82-1.10] vs. 0.85 [95% CI 0.76-0.94]), and slightly higher in the pandemic period for White pts (0.89 [95% CI 0.79-0.98] vs. 0.97 [95% CI 0.88, 1.06]). The proportion of pts initiating 1L in the pandemic period with an observed dP event was lower compared to the pre-pandemic period (12.8% [95% CI 10.5%-15.5%] vs. 11.4% [95% CI 9.1%-14.1%]), overall, and by race (Black: 16.5% [95% CI 11.0%-24.2%] vs 7.5% [95% CI 4.1%-13.2%]; White: 13.1% [95% CI 10.2%-16.8%] vs. 12.3% [95% CI 9.2%-16.3%]). In multivariable models, dPFS was similar comparing the pandemic period to pre-pandemic period (HR 0.88 95% CI 0.67, 1.15) overall and stratified by race (Black: HR 0.62, 95% CI 0.33-1.16; White: HR 0.80, 95% CI 0.56-1.15). The findings were consistent in multivariable analyses of rwOS comparing the pandemic period to the pre-pandemic period overall (HR 0.88, 95% CI 0.64-1.21), and by race (Black: HR 1.39, 95% CI 0.64-3.00; White: HR 0.71, 95% CI 0.47-1.08). Conclusions In this study of newly-diagnosed MM pts initiating 1L treatment prior to and during the COVID-19 pandemic, we did not observe statistically significant differences in rates of assessment for MM progression or survival outcomes when comparing the pre-pandemic and pandemic periods. The mean rate of assessments in the pandemic period was directionally lower in Black pts and higher in White pts, and the proportion of pts with a dP event was lower in the pandemic period for both Black and White pts, with the decrease being greater in Black pts. These findings do not support the hypothesis that COVID-19-related cancer care changes led to substantial surveillance bias in real-world studies of pts with MM. However, the results of analyses stratified by race suggest trends in racial inequities in cancer care during the COVID-19 pandemic that deserve clinical attention and further investigation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Relationships between neighborhood disadvantage and cardiovascular findings at autopsy in subjects with sudden death

Neighborhood disadvantage is associated with a higher risk of sudden cardiac death. However, autopsy findings have never been investigated in this context. Here, we sought to explore associations between neighborhood disadvantage and cardiovascular findings at autopsy in cases of sudden death in the State of Maryland. State of Maryland investigation reports from 2,278 subjects within the CVPath Sudden Death Registry were screened for street addresses and 9-digit zip codes. Area deprivation index (ADI), used as metric for neighborhood disadvantage, was available for 1,464 subjects; 650 of whom self-identified as Black and 814 as White. The primary study outcome measurements were causes of death and gross and histopathologic findings of the heart. Subjects from most disadvantaged neighborhoods (i.e., ADI ≥ 8; n=607) died at younger age compared with subjects from less disadvantaged neighborhoods (i.e., ADI ≤ 7; n=857; 46.07 ± 14.10 vs 47.78 ± 13.86 years; P=0.02) and were more likely Black or women. They were less likely to die from cardiac causes of death (61.8% vs 67.7%; P=0.02) and had less severe atherosclerotic plaque features, including plaque burden, calcification, intraplaque hemorrhage, and thin-cap fibroatheromas. In addition, subjects from most disadvantaged neighborhoods had lower frequencies of plaque rupture (18.8% vs 25.1%, P=0.004). However, these associations were omitted after adjustment for traditional risk factors and race. Neighborhood disadvantage did not associate with cause of death or coronary histopathology after adjustment for cardiovascular risk factors and race, implying that social determinants of health other than neighborhood disadvantage play a more prominent role in sudden cardiac death.

Abstract 13995: Relationships Between Neighborhood Disadvantage and Cardiovascular Findings at Autopsy in Subjects With Sudden Death

Introduction: Neighborhood disadvantage is associated with a higher risk of sudden cardiac death. However, autopsy findings have never been investigated in this context. Here, we sought to explore associations between neighborhood disadvantage and cardiovascular findings at autopsy in cases of sudden death in the State of Maryland. Methods: State of Maryland investigation reports from 2,278 subjects within the CVPath Sudden Death Registry were screened for street addresses and 9-digit zip-codes. Area Deprivation Index (ADI), used as metric for neighborhood disadvantage, was available for 1,464 subjects; 650 of whom self-identified as Black and 814 as White. The primary study outcome measurements were causes of death and gross and histopathologic findings of the heart. Results: Subjects from most disadvantaged neighborhoods ( i.e. , ADI ≥ 8; n = 607) died at younger age compared with subjects from less disadvantaged neighborhoods ( i.e. , ADI ≤ 7; n = 857; 46.07 ± 14.10 versus 47.78 ± 13.86 years; p = 0.02) and were more likely Black or women. They were, however, less likely to die from cardiac causes of death (61.8% versus 67.7%; p = 0.02) and had less severe atherosclerotic plaque features, including plaque burden, calcification, intraplaque hemorrhage, and thin-cap fibroatheromas. In addition, subjects from most disadvantaged neighborhoods had lower frequencies of plaque rupture (18.8% versus 25.1%, p = 0.004). However, these associations were omitted after adjustment for traditional risk factors and race. Conclusion: Neighborhood disadvantage did not associate with cause of death or coronary histopathology after adjustment for cardiovascular risk factors and race, implying that social determinants of health other than neighborhood disadvantage play a more prominent role in cardiovascular pathology.

Abstract 14071: Sleep as a Contributor to Socioeconomic Disparities in Hypertension: The Midlife in the United States (MIDUS) II Study

Introduction: Hypertension is highly prevalent among adults in the United States and is a major risk factor for cardiovascular disease (CVD). Previous research has found that hypertension is distributed inequitably, with a higher burden of hypertension among individuals of lower socioeconomic status (SES). However, limited studies have investigated the role of sleep quality, a risk factor for CVD, in understanding socioeconomic disparities in hypertension. Methods: We used cross-sectional data from the Midlife in the United States (MIDUS) II. Participants underwent seven days of actigraphy and completed biological assessments, including blood pressure measurements. Sleep quality was measured as actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Our analysis consisted of participants with complete data on educational attainment, our proxy for SES (n=426). Poisson and linear regression models were fit to examine associations between SES, sleep quality, and hypertension or blood pressure (continuous). We controlled for age, gender, race, body mass index, and perceived stress. Sensitivity analyses measuring SES with the Socioeconomic Index Score were also conducted (n=274). Results: Participants had a mean age of 53.5 years (SD=12.4), were 59.6% female, and were 42.5% Black American. The prevalence of poor WASO (&gt; 30 minutes), low SE (&lt;85%), and hypertension was 77.7%, 67.1%, and 61.0%, respectively. Low SES was associated with a higher prevalence of hypertension but was attenuated after adjustment for race. SES was not associated with sleep or hypertension after adjustment for covariates. Individuals with high (vs. low) sleep efficiency had 19% lower prevalence of hypertension (PR=0.81, 95% CI: 0.66, 0.98), lower systolic blood pressure (β= -4.69, 95% CI: -8.63, -0.75), and lower diastolic blood pressure (β= -2.59, 95% CI: -5.00, 0.18) after adjustment for covariates. There was no evidence of sleep mediating the SES-hypertension relation. Conclusions: Effective interventions to lower the prevalence of hypertension should consider strategies that target sleep efficiency. Future research should explore the intersectionality of SES and race, as race may modify the association between SES and hypertension.

Abstract 11239: Gender Disparities in the Utilization of Catheter-Directed Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism

Introduction: Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before. Methods: Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy. Results: We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value - .03). Males were more likely to have saddle PE (33% vs. 29%, p-value &lt; .01) and less likely to have vasopressor use (3% vs. 5%, p-value &lt; .01). Baseline characteristics are shown in Table 1. Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value &lt; .01), as shown in Table 2. Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value &lt; .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value &lt; .01). Conclusion: Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.

Abstract 10180: Systolic Blood Pressure Time in Target Range and Cognitive Outcomes: Insights From the SPRINT Trial

Introduction: Systolic blood pressure (SBP) time in target range (TTR) was proven to be a new parameter to predict cardiovascular outcomes. However, the prognostic value for cognitive function is unclear. Hypothesis: Higher TTR was associated with lower incidence of cognitive outcomes. Methods: We performed a post hoc analysis from the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized controlled trial comparing intensive (&lt;120 mm Hg) and standard (&lt;140 mm Hg) SBP interventions in 9361 individuals with hypertension. SBP target range was defined as 110 to 130 mm Hg for the intensive group and 120 to 140 mm Hg for the standard group. Participants who had less than 3 SBP measurements during this period or no cognitive assessment in the follow-up were excluded. TTR was calculated by linear interpolation using SBP from baseline to the first 3 months of follow-up. Cognitive outcomes were probable dementia, mild cognitive impairment (MCI), and a composite of probable dementia or MCI. Cox regression models were used to evaluate the relationship between TTR and cognitive outcomes. Results: A total of 8415 patients were included in this study. In univariate Cox regression analysis, higher time in target range was associated with lower risk of probable dementia. After adjustment for age, sex and race, a 1-SD increase in TTR was independently associated with a 16% lower risk of probable dementia (hazard ratio [HR] =0.84, 95% CI 0.75-0.93, P =0.002) (Figure). When we further added demographics, medical history and mean SBP to the multivariate Cox regression model, TTR remained significantly associated with a decreased risk of probable dementia (HR =0.84, 95% CI 0.74-0.96, P =0.012). No significant relationship was found between TTR and MCI or a composite of probable dementia or MCI. Conclusions: In this post hoc analysis of the SPRINT trial, SBP time in target range was an independent predictor of probable dementia beyond mean SBP levels.

Abstract 10261: Adverse Childhood Experiences Are Linked to High Blood Pressure During the First Trimester and Hypertensive Complications During Pregnancy

Introduction: Adverse Childhood Experiences (ACEs) are associated with impaired vascular function in young adult women, and increased blood pressure and CVD risk later in life. Hypotheses: We hypothesized that exposure to ACEs would be associated with an increased risk of first trimester hypertension and subsequently with hypertensive complications during pregnancy. Methods: Exposure to ACEs, self-reported incidence of first trimester hypertension (HT) and hypertensive complications in pregnancy (HTCs), as well as age, education, chronic health conditions, gravidity and BMI were obtained from women enrolled in a clinic-based longitudinal study of women ages 16-38 who were enrolled in their first prenatal visit. To avoid potential confounding of severe obesity, we restricted analyses to only those women with a BMI &lt;40 kg/m 2 . Consequently, 135 pregnant women (age = 26 ± 6; BMI = 27 ± 6; gravidity = 2.7 ± 1.5) were included in this analysis; however, data from 20 women was missing for HTC incidence (n =115). The sample was diverse (49% Non-White) and had a high prevalence of ACEs (41% with ≥4 ACEs). Logistic regression models were used to examine the association of ACE exposure with the probability of HT and HTCs. Models included: (1) ACEs alone, and (2) ACEs following adjustment for age, BMI, gravidity, Race, and chronic health conditions. Results: Exposure to ACEs predicted HT (OR [95% CI] = 1.32 [1.10 - 1.59]) and HTC (1.26 [1.03 - 1.52]) incidence. Following full adjustment, the odds of HT increased 51% for each additional ACE (1.51 [1.03 - 2.22]). Following full adjustment, the odds of HTC increased 40% for each additional ACE (1.40 [1.06 - 1.83]). In each of the fully adjusted models, only chronic health conditions were also a significant predictor. Conclusions: ACE exposure is an important risk factor for HT and HTC, especially when considered alongside existing chronic health conditions. Screening for ACEs may be a worthwhile public health strategy to identify women at risk for hypertension and hypertensive complications in pregnancy. However, larger scale, longitudinal cohort studies are needed to confirm and to further understand these associations.

Abstract 11498: County-Level Social Vulnerability si Associated With Higher Rates of Vascular Amputations in Florida

Introduction: Peripheral arterial disease (PAD) is a highly prevalent condition that disproportionately affects patients in minority groups and results in high morbidity and mortality. We seek to determine the association between county-level social vulnerability and vascular amputations in Florida. Methods: We queried the Florida State Inpatient Database (SID) for hospitalizations with a primary diagnosis of PAD between October 2015 and December 2019. We linked patient-level hospitalizations with the county-level social vulnerability index (SVI). We used multivariable regression models to compare rates of major or minor amputations between SVI quartiles for overall SVI and each of the four SVI themes. We also examined in-hospital mortality, 60-day readmissions, total hospital charges, and other secondary outcomes as stratified by socioeconomic status SVI quartile. Results: 38,488 hospitalizations for PAD were identified during the study period. Patients in worse overall SVI quartiles were younger, more likely to be racial minorities (53.7% in 4 th quartile compared to 19.1% in 1 st quartile, p &lt;0.0001), and more likely to have emergent or urgent hospitalizations. Overall amputation rate during hospitalization was 22%. Patients in the worst overall SVI quartile demonstrated higher rates of amputations (OR 1.30, 95% CI: 1.11-1.53) when compared to the most favorable SVI quartile. Socioeconomic status SVI was associated with a higher risk of amputations (OR 1.40, 95% CI: 1.21-1.64) even after adjustment for patient race (OR 1.32, 95% CI: 1.13-1.54). Worse socioeconomic SVI was also associated with longer hospital lengths of stay and higher costs but was not associated with increased in-hospital mortality or readmissions. Conclusions: Patients with worse social vulnerability are more likely to require amputations for PAD in an urgent or emergent clinical setting and have longer lengths of stay and higher costs. Patient socioeconomic status predicts adverse outcomes for PAD even after adjusting for race. Our data suggest a socioeconomic basis for disparities in PAD outcomes. Policymakers should allocate additional resources for areas with worse SVI to design and evaluate interventions to improve care and outcomes.

Abstract 10883: Cigarette Smoking and Mitochondrial Function in Peripheral Artery Disease

Introduction: In humans without peripheral artery disease (PAD) and animal models, exposure to cigarette smoke is associated with reduced mitochondrial respiratory function. Many people with PAD smoke cigarettes, but the association of smoking with mitochondrial function in lower extremity skeletal muscle of people with PAD is unknown. Methods: From the Chicago, IL area, 31 people with PAD (ankle brachial index (ABI) &lt; 0.90) were enrolled and consented to gastrocnemius muscle biopsy. Mitochondrial oxidative capacity in gastrocnemius muscle was measured with respirometry. Western blots were performed to quantify mitochondrial membrane abundance via voltage-dependent anion channel (VDAC), mitochondrial biogenesis via peroxisome proliferator-activated receptor-γ coactivator (PGC-1α) , and electron transport chain complexes I-V. Results: Among 31 people with PAD (mean 72.1 years, mean ABI 0.64), 14 (45.2%) smoked cigarettes currently. Participants who currently smoked had higher abundance of PGC-1α (0.75 vs. 0.45 arbitrary units (AU), P&lt;0.01), VDAC (0.62 vs. 0.37 AU, P=0.022), electron transport chain complex I (0.46 vs. 0.21 AU, P=0.031), and complex III (0.76 vs. 0.42 AU, P=0.031), compared to those who did not currently smoke. After normalizing to VDAC, participants who currently smoked had lower mitochondrial oxidative capacity per unit of mitochondrial membrane compared to those who did not currently smoke (complex I+II-mediated oxidative phosphorylation (156.3 vs. 287.0 AU, P=0.017), complex I+II-mediated electron transport chain capacity (184.8 vs. 343.1 AU, P=0.019), complex I-mediated fatty acid oxidative phosphorylation (45.9 vs. 82.1 AU, P=0.034)). After statistical adjustment for age, sex, race, ABI, and body mass index (BMI), most associations were attenuated but remained statistically significant for the higher abundance of VDAC (0.65 vs. 0.35 AU, P=0.037) and complex I (0.50 vs. 0.18 AU, P=0.038) in participants who currently smoked compared to those who did not currently smoke. Conclusions: Results suggest that among people with PAD, current cigarette smoking may stimulate a compensatory increase in mitochondrial biogenesis that may counteract effects of reduced oxidative capacity per unit mitochondrial membrane.

Association between Surgical Fibroid Removal and Blood Pressure: A Retrospective Case-Control and Prospective Cohort Study

<h3>Study Objective</h3> Fibroids, monoclonal proliferations of uterine smooth muscle cells, are common in women and have recently been associated with cardiometabolic risk factors including hypertension. The objective of this study is to determine whether fibroids are biomarker of systemic hypertension, and whether they may contribute to elevation in blood pressure. <h3>Design</h3> IRB-approved retrospective case-control study and prospective cohort study. <h3>Setting</h3> Single academic institution. <h3>Patients or Participants</h3> Retrospective chart review of 313 patients undergoing hysterectomy or myomectomy for fibroids and patients undergoing other surgical procedures for benign gynecological indications with similar demographic characteristics (control). Prospective cohort of 9 women undergoing myomectomy or hysterectomy for fibroids. <h3>Interventions</h3> Hysteroscopy, laparoscopy, open myomectomy or hysterectomy for fibroids (or non-fibroid indications as control). <h3>Measurements and Main Results</h3> In our retrospective cohort (n=294; mean age 41.9±10.6, 43.5% Black, 50% with fibroids), we found consistently that compared to patients without fibroids, patients with fibroids had significantly elevated systolic BP (pre-op 128 vs 122mmHg, p=0.0005; post-op 126 vs 122mmHg, p=0.02) but not diastolic BP (pre-op 77.6 vs 75.9mmHg, p=0.17; post-op 76.7 vs 75.0, p=0.19). Among patients with fibroids, surgical fibroid removal was associated with a small but not statistically or clinically significant drop in systolic (Δ=-2.21mmHg, p=0.062) but not diastolic BP (Δ=-0.93mmHg, p=0.39). The direction and magnitude of effect for change in systolic BP remained consistent after adjustment for age, race, and presence of diagnosed hypertension (β=-2.45, p=0.17). In our prospective cohort, there was a significant decrease in SBP of 9.9mmHg (pre- versus post-operatively), but no change in DBP following fibroid removal (p=0.03, p=0.14, respectively). Serum levels of Ang-II and ACE were not significantly altered following surgical fibroid removal (p=0.39, p=0.80, respectively). <h3>Conclusion</h3> Altogether, these findings demonstrate that fibroids are associated with hypertension and suggest that fibroid removal may lead to a clinically significant decrease in systolic blood pressure. These changes may occur by a mechanism independent of the renin-angiotensin-aldosterone system.

Intermuscular adipose tissue in patients with systemic lupus erythematosus

ObjectivePatients with SLE frequently have debilitating fatigue and reduced physical activity. Intermuscular adipose tissue (IMAT) accumulation is associated with reduced physical exercise capacity. We hypothesised that IMAT is increased in...

LBSUN321 Development And Pilot Testing Of Barriers To Diabetic Foot Care With A Qualitative Assessment

Abstract Objectives Foot care is an essential component of diabetes care. We explored patient barriers to proper foot care in a disadvantaged population using surveys of patient perceptions on barriers and self-care. Methods Participants were recruited from an outpatient diabetes clinic at a safety-net hospital in Atlanta, Georgia from October 2021- January 2022 and stratified into two groups: 1) Complications defined as patient reported foot pain, history of foot ulcer or amputation and 2) No Complications defined as diabetes and no foot complications. A sample of 60 consecutive patients completed the surveys. The survey addressed patients’ experience in daily foot care and barriers to care. Survey data was supplemented by medical history information obtained from medical records. Based on the questions, a composite score was created for delay in care and missed appointments due to transportation challenges. Logistic regressions were utilized to perform univariate and multivariate assessments of delay in care and foot complications with stepwise adjustments for race, gender, age, employment, and education. Results Of the 60 participants, 41 (82%) had no reported foot complications and 11 (18%) reported foot complications. As compared to those without foot complication, those who had foot complications tended to be older (56.8 ± 10.2 years vs 60.4 ± 12.4), more often male (80% vs 40%), Black race (72% vs 94%), have diabetes for &amp;gt;10 years (63% vs 37%) and be retired/unemployed (27%/27% vs 37%/30%). Those with complications tended to have lower education level (high school/GED education level (55% vs 43%) and lower employment status (37% vs 4%). Those with complications were more likely to have discussion regarding foot care with their health care provider (91% vs 74%) and less likely to miss an appointment due to transportation challenges (81% vs 49%). Those with complications were less likely to report the composite of delay in care or missed appointments (18% vs 59%). In the unadjusted regression model, delayed care was associated with 0.153 odds of having had foot related complications as compared to no complication (Confidence interval: 0. 03, 0.786). After adjusting for demographics age, race, and gender the likelihood of delayed care was 0.117 (CI: 0. 013, 1. 031) for those with complications as compared to those without complications. In the fully adjusted model, adjusting for demographics, education and employment status, the odds of delayed care was 0. 064 for those with complications as compared to those without (CI: 0. 004, 1. 003). Conclusion Based on our survey, transportation was identified as a barrier to access foot care. People without a history of foot complications were more likely to have delays in care and missed appointments. Avenues to improve access, especially early in the disease course, should be further explored within this patient population to assist with improving foot care. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

The Effect of CKD-EPI Race Adjustment on CKD Lab Monitoring Guidelines

The Effect of CKD-EPI Race Adjustment on CKD Lab Monitoring Guidelines

Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019).

Background Gestational diabetes (GD) is associated with increased risk of long-term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004-2019). International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends<0.01). Individuals with GD versus those without GD had a higher prevalence of obesity, hypertension, and dyslipidemia. After adjustment for age, race or ethnicity, comorbidities, insurance, and income, GD remained independently associated with cardiovascular complications including preeclampsia (adjusted odds ratio [aOR], 1.97 [95% CI, 1.96-1.98]), peripartum cardiomyopathy (aOR, 1.15 [1.08-1.22]), acute kidney injury (aOR, 1.16 [1.11-1.21]), stroke (aOR, 1.15 [1.09-1.23]), and arrhythmias (aOR, 1.48 [1.46-1.50]), compared with no GD. Moreover, delivery hospitalizations among individuals with GD were associated with increased length (3 versus 2 days, P<0.01) and cost of hospitalization ($4909 versus $3682, P<0.01). Even in the absence of preeclampsia, GD was associated with elevated cardiovascular risk. Conclusions Individuals with GD had a higher risk of preeclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and arrhythmias during delivery hospitalizations. As rates of GD are increasing globally, efforts to improve preconception cardiometabolic health and prevent GD may represent important strategies to improve peripartum maternal outcomes and mitigate long-term cardiovascular risk.

GFR Estimation in Potential Living Kidney Donors: Race- and Nonrace-based Equations and Measured GFR

Recent studies evaluated and proposed new race-neutral, creatinine-based glomerular filtration rate (GFR) estimation equations. The performance of these equations in diverse potential living kidney donors requires study. Cross-sectional study. 637 potential living kidney donors from one tertiary hospital with serum creatinine concentration measurement and GFR measurement by iohexol plasma clearance between October 2016 and December 2020. Creatinine-based estimation of GFR by Chronic Kidney Disease Epidemiology Collaboration (2009, CKDEPI09; 2021, CKDEPI21) and Modification of Diet in Renal Disease equations with and without inclusion of race coefficient, where applicable. Equation bias, precision, accuracy, and accurate classification of GFR as equal to and above or below 80mL/min/1.73m2. GFR estimation equation performance compared to measured GFR (mGFR) by iohexol clearance. The median bias of the CKDEPI21 equation underestimated mGFR by 2.8mL/min/1.73m2. The bias in the Black subgroup underestimated mGFR by 9.0mL/min/1.73m2. Compared to CKDEPI09 with and without race adjustment, the accuracy of CKDEPI21 increased across all subgroups. On average, 3.9% of individuals were misclassified by CKDEPI21 as having a GFR greater than, and 8.9% misclassified less than, 80mL/min/1.73m2, compared to 3.1% and 13.2% for CKDEPI09 with race adjustment, respectively. Total misclassification (either above or below 80mL/min/1.73m2) was 16.3% for CKDEPI21 and 16.0% for CKDEPI09 (with race adjustment). Limited sample of individuals identifying as Black. Lack of cystatin C data. In our potential living donor sample, GFR estimation by creatinine-based CKDEPI21 is less biased and more accurate than previous creatinine-based estimated GFR equations. When evaluated by race, this summative improvement remains in individuals identifying as Asian, Hispanic, or White. More external validation is needed to assess whether the new equation is an improvement over the previous CKDEPI equation with a race coefficient.

Circulating Cell-Free Genomic DNA Is Associated with an Increased Risk of Dementia and with Change in Cognitive and Physical Function.

Altered cell homeostasis, seen in cognitive decline and frailty, leads to cell death and turnover, releasing circulating cell-free DNA (ccf-DNA). The goal of this study is to determine if serum genomic cell-free DNA (ccf-gDNA) is associated with physical and cognitive decline in older adults. We used serum from 631 community-dwelling individuals from the Religious Orders Study or Rush Memory and Aging Project who were without cognitive impairment at baseline. ccf-gDNA fragments in serum were quantified using digital PCR. An array of cognitive and physical traits, risk of dementia, global cognition, and frailty at or nearest the time of blood draw were regressed on ccf-DNA, with adjustment for age, sex, race, and education. Cross-sectionally, higher ccf-gDNA levels were associated with lower global cognition score and slower gait speed at the evaluation nearest to blood draw. Higher ccf-gDNA levels were associated with increased odds of incident dementia (OR 1.27, 95% CI 1.05, 1.54). Longitudinally, higher levels of ccf-gDNA were associated with steeper general cognitive decline and worsening frailty over eight years of follow up. This study demonstrates that ccf-gDNA fragments have utility for identifying persons at higher risk of developing dementia and worsening cognition and frailty.

Association of Visual Health With Depressive Symptoms and Brain Imaging Phenotypes Among Middle-Aged and Older Adults

Vision loss and depression are common conditions with major health implications. However, mechanisms of the association of visual health (across the full acuity spectrum) with depression remain unclear. To characterize the association between visual health and depression and investigate the association between depression and brain microstructure and macrostructure in subgroups divided by visual acuity. In the UK Biobank Study cohort, 114 583 volunteers were included at baseline from March to June 2006 to July 2010. Habitual distance visual acuity was examined using the logarithm of the minimum angle of resolution (LogMAR) characters. Depression was identified based on Patient Health Questionnaire (PHQ) or through an interview-based psychiatric diagnosis. Subgroup participants completed multimodal magnetic resonance imaging (MRI) of the brain and PHQ evaluation during the imaging visit after 2014. Data were analyzed from May 5 to August 9, 2022. Depression, depressive symptoms, and imaging-derived phenotypes from T1-weighted and diffusion MRI. Of the 114 583 participants from the UK Biobank Study, 62 401 (54.5%) were women, and the mean (SD) age was 56.8 (8.1) years (range, 39-72 years). A 1-line worse visual acuity (0.1 LogMAR increase) was associated with 5% higher odds of depression (odds ratio, 1.05 [95% CI, 1.04-1.07]) after adjustment for age, sex, race and ethnicity, Townsend index, educational qualifications, smoking, alcohol consumption, obesity, physical activity, history of hypertension, diabetes, hyperlipidemia, and family history of depression. Of the 7844 participants eligible for MRI analysis, there were linear associations between PHQ score and the left volume of gray matter in supracalcarine cortex (coefficient, 7.61 [95% CI, 3.90-11.31]) and mean isotropic volume fraction (ISOVF) in the right fornix (cres) and/or stria terminalis (coefficient, 0.003 [95% CI, 0.001-0.004]) after correction for multiple comparison. In addition, their association could be moderated by visual acuity, whereby increased PHQ score was associated with higher ISOVF levels only among those with poorer visual acuity (P = .02 for interaction). This study suggests an association between visual health and depression and that the diffusion characteristic of ISOVF in the fornix (cres) and/or stria terminalis is associated with depressive symptoms in participants with poorer visual acuity.