Tera, Chenna Reddy

Background: Geographic and temporal distribution of disparity authorships is unclear. Our aim was to examine authorship trends in 2020-2023 American Heart Association (AHA) abstracts reporting social and demographic disparities. Methods: We reviewed 801 AHA conference abstracts, analyzing 723 reports. Regional information of authors and their reported disparities related to gender, race, region, healthcare access (HCA), comorbidities (CO), socioeconomic status (SES) were collected. Descriptive and trend analyses were performed using Chi-square tests, and Pearson's and Kendall's Tau b correlation tests. P <0.05 was considered significant. Results: We analyzed 1440 primary and senior authorships from 723 abstracts. The majority of authors (92%) were from North America, predominantly USA (90%), with a significant representation from the South (33.6%) vs. other regions (Image 1). Disparities on outcomes such as race, gender, SES, CO, geographical locations, and HCA were reported as 53.9%, 33.9%, 26.6%, 24.9%, 17.8%, and 13.6% respectively. From 2020 to 2023, there was a declining trend in authors reporting on gender (ptrend<0.001) and HCA (ptrend-0.03) disparities, whereas disparities on SES had an increasing trend (ptrend<0.001). An increase in reporting of gender disparities was associated with increased reporting of racial disparities (r = .081, τb = .081). We also found positive correlations between SES and HCA (r = .155, τb = .155). Conversely, there was a negative correlation between gender and SES (r = -0.133, τb = -0.133), and between CO and healthcare access HCA (r = -0.078, τb = -0.078). All correlations were statistically significant (p < 0.05). Conclusion: The trends show that authors have reported more SES disparities in recent times compared to HCA, race, and gender. With expected financially challenging times ahead, to address these findings, it remains important to focus research on income based equalities in HCA and outcomes.

Aim: Studies in the past have linked obesity as a risk factor for atrial fibrillation (AF). However, there is a paucity of data on this influence in young adult males. This meta-analysis aims to evaluate and stratify the association between BMI and AF among young men. Methods: PubMed, Scopus, and Google Scholar databases were systematically reviewed for studies reporting long term-incidence of atrial fibrillation in young male adults (18-49 years) with obesity (BMI>30 kg/m 2 ), and overweight BMI (BMI 20-25 kg/m 2 ). Random effects models were used for the meta-analyses and subgroup analyses. I 2 statistics were used to identify (>50%) heterogeneity. A sensitivity analysis was performed using leave-one-out method. Results: Six studies with a total of 21,856,538 individuals were screened, out of which 6,732,531 young males with higher BMI and obesity were evaluated for the risk of Atrial fibrillation for a median follow-up duration of 6.3 years (3.3 - 29 years range). South Korean and Japanese studies together constituted 99.86% of the study population. Most commonly associated comorbidities were hypertension, diabetes mellitus type 2, dyslipidemia and smoking. The unadjusted HR showed a significant association between overweight (BMI 25-30) [OR:1.42, (95%CI:1.28-1.58, I 2 : 75.86%; p< 0.01] and obesity (BMI >30) and AF [OR: 2.02, (95%CI: 1.77-2.29, I 2 :64.3%; p=0.02] in young adult males. After multivariable analysis, the association remained significant for overweight [OR:1.22, 95%CI: 1.14-1.32, I 2 : 82.74%; p< 0.01] and obesity [OR:1.48, 95%CI: 1.29-1.71, I 2 : 90.43%; p< 0.01]. Sensitivity analysis indicated that no single study unduly influenced the pooled estimates. Conclusion: This meta-analysis revealed that higher BMI (overweight and obese) in young males is associated with an increased long-term risk of AF over a median follow-up duration of 6.3 years.

BACKGROUND: COVID-19 patients are at higher risk of major adverse cardiovascular and cerebrovascular events (MACCE). The underpinning effect of cancer in COVID-19 enhances this risk. Currently, we have limited nationwide data on MACCE events in cancer patients hospitalized with COVID-19. This study aims to identify demographic and clinical predictors of MACCE in this population. METHODS: We identified COVID-19-hospitalized cancer patients using the 2020 National Inpatient Sample. MACCE, inpatient mortality, and baseline demographics and comorbidities were assessed. Predictors of MACCE were calculated using multivariable regression analysis. RESULTS: Of 68,755 cancer patients hospitalized with COVID-19, 24% had MACCE, and 20.4% died in the hospital, with both outcomes being more significant among males, Asian or Pacific Islanders, and those in the fourth income quartile (all p<0.05). Comorbidities exhibited statistically significant associations for MACCE (all p<0.05). Higher adjusted odds of MACCE were found in age groups >65 (OR 4.17; 95% CI 2.94-5.91) and 45-64 (OR 1.77; 95% CI 1.26-2.48) than 18-44 years, self-paying patients (OR 2.15) than Medicare, urban non-teaching (OR 1.25) and urban teaching hospitalizations (OR 1.24) than rural, prior MI (OR 1.36; 95% CI 1.11-1.66), CKD (OR 1.37; 95% CI 1.22-1.54), severe sepsis (OR 2.75; 95% CI 2.42-2.13), respiratory failure (OR 2.67; 95% CI 2.41-2.96), and mechanical ventilation (OR 12.15; 95% CI 10.40-14.21). Compared to the Northeast, hospitals in the Midwest, West, and South had lower odds of MACCE. Obesity, tobacco use, hyperlipidemia, and prior chemotherapy also exhibited lower odds of MACCE (all p<0.05) (Table. 1). CONCLUSION: Our study using contemporary large-scale data found a concerning burden and higher risk of MACCE, particularly in the elderly, patients with CKD, prior MI, severe sepsis, respiratory failure, and mechanical ventilation.

Introduction: Cognitive impairment has a significant impact on functional recovery and quality of life in stroke patients. Given the emerging role of high sensitivity C-reactive protein (hs-CRP) as a biomarker for predicting post-stroke cognitive decline, we conducted a meta-analysis to investigate this association. Methods: We systematically searched SCOPUS, PubMed, and Google Scholar databases until May 2023 using relevant keywords. Pooled effect sizes were estimated using a random-effects model, and I2 statistics and leave-one-out sensitivity analysis were performed to assess heterogeneity and robustness, respectively (p-value < 0.05 considered significant). Results: The final analysis included five studies spanning the years 2018-2023, with a total sample size of 9,625 patients, all from China, and predominantly male (57.85%). The median follow-up period was 3 months. Patients with higher hs-CRP levels had a higher burden of smoking, alcohol consumption, hypertension, diabetes, hyperlipidemia, and lower education levels. The meta-analysis revealed an increased risk of cognitive impairment after ischemic stroke associated with higher hs-CRP levels (adjusted odds ratio [aOR] 1.15; 95% CI: 1.01-1.30, p - 0.03). Substantial heterogeneity was observed among the studies (I2 = 79.23%; p < 0.01). However, a leave-one-out sensitivity analysis confirmed the robustness of the findings, indicating that no single study strongly influenced the overall results. Conclusion: This meta-analysis provides evidence of an association between elevated hs-CRP levels and cognitive impairment following ischemic stroke. However, the limited number of studies, mainly from a specific population, highlights the need for further research to enhance the generalizability of these findings.

Background: Limited research has focused on the rising incidence of major adverse cardiac and cerebrovascular events (MACCE) among young women (aged 18-44) with at least one traditional cardiovascular disease risk factor (CVD), especially in rural hospital settings. We aimed to address this research gap by providing insights into the burden of CVD in this population. Methods: Using data from the National Inpatient Sample (2019), we identified young women (aged 18-44) with at least one cardiovascular risk factor admitted to rural hospitals. Baseline demographics, comorbidities, and outcomes were assessed, including MACCE and all-cause mortality. Multivariable logistic regression was performed, adjusting for age, race, income, and comorbidities. Results: Among 179,410 young women, MACCE occurred in 2,455 individuals (1.4%), with varying rates among racial groups: whites (1.2%), blacks (2.4%), Hispanics (1.3%), Asian or Pacific Islanders (API) (2%), Native Americans (NA) (1.6%), and others (1%). All-cause mortality was observed in 385 women (0.2%), with rates of 0.2% for whites and 0.4% for blacks. Blacks had twice the event rates of MACCE, and all-cause mortality compared to whites. Comorbidities and substance abuse were associated with MACCE (P<0.001). In higher-income households, multivariable analysis adjusted for confounders revealed significantly higher odds of MACCE in blacks (OR 1.23, 95% CI 0.11-14.08), API (OR 4.48, 95% CI 1.06-18.93), and NA (OR 10.22, 95% CI 1.03-101.50) compared to whites. In contrast, mortality rates were lower for Hispanics than whites (OR 0.24, 95% CI 0.02-3.80) (all p < 0.001) (Table 1). Conclusion: In higher-income households, greater odds of MACCE were noted among blacks, API, and NA compared to whites. Future research should focus on understanding factors contributing to these disparities and developing interventions to prioritize equitable healthcare access for rural women across diverse ethnic and income classes.

INTRODUCTION: The relentless toll of cardiovascular disease in the United States demands a breakthrough in reliable and cost-effective prognostic markers. Amidst the limited knowledge surrounding the role of adiponectin in stable coronary artery disease (CAD), this study aims to unveil its power in predicting all-cause mortality and major adverse cardiovascular events (MACE) among patients with stable coronary artery disease (CAD). METHODS: We systematically screened PubMed, Scopus, and Google Scholar for articles until May 2023 to identify relevant studies. Random-effects model estimated the pooled odds ratio (OR) with 95% confidence intervals (CI), and I2 statistics assessed heterogeneity. The leave-one-out method was used for sensitivity analysis. RESULTS: Following the screening, five prospective studies involving 3225 patients with a median follow-up duration of 3.8 years were included. In the study population, hypertension, diabetes, hyperlipidemia, and smoking were prevalent risk factors, and common medications included angiotensin-converting enzyme inhibitors, beta-blockers, and statins. The pooled adjusted OR for all-cause mortality was 2.51 (95%CI: 1.36-4.62), with moderate heterogeneity (I2=65.51%, p=0.03), and the pooled adjusted OR for MACE was 1.04 (95%CI: 1.02-1.06), with no significant heterogeneity (I2=0%, p=0.68) (Fig. 1) . The leave-one-out sensitivity analysis showed that no single study significantly influenced the meta-analysis results, indicating robustness. CONCLUSION: Higher adiponectin levels were associated with higher odds of long-term mortality and MACE in stable CAD patients, highlighting its potential as a cost-effective marker for risk stratification and guiding management strategies. Further studies exploring the role of adiponectin can significantly impact clinical decision-making and resource allocation in cardiovascular care.

AbstractObservational studies indicate that pleural effusion has an association with risk and the clinical prognosis of COVID‐19 disease; however, the available literature on this area is inconsistent. The objective of this systematic review and meta‐analysis is to evaluate the correlation between COVID‐19 disease and pleural effusion. A rigorous literature search was conducted using multiple databases. All eligible observational studies were included from around the globe. The pooled prevalence and associated 95% confidence interval (CI) were calculated using the random effect model. Mantel–Haenszel odds ratios were produced to report overall effect size using random effect models for severity and mortality outcomes. Funnel plots, Egger regression tests, and Begg–Mazumdar's rank correlation test were used to appraise publication bias. Data from 23 studies including 6234 COVID‐19 patients was obtained. The overall prevalence of pleural effusion in COVID‐19 patients was 9.55% (95% CI,I2 = 92%). Our findings also indicated that the presence of pleural effusions associated with increased risk of severity of disease(OR = 5.08, 95% CI 3.14–8.22,I2 = 77.4%) and mortality due to illness(OR = 4.53, 95% CI 2.16–9.49,I2 = 66%) compared with patients without pleural effusion. Sensitivity analyses illustrated a similar effect size while decreasing the heterogeneity. No significant publication bias was evident in the meta‐analysis. The presence of pleural effusion can assist as a prognostic factor to evaluate the risk of worse outcomes in COVID‐19 patients hence, it is recommended that hospitalized COVID‐19 patients with pleural effusion should be managed on an early basis.