Cardiovascular disease (CVD) is the leading cause of death among women in the United States, with Black women disproportionately affected by hypertension. These disparities are not fully explained by traditional risk factors but are attributed to chronic social and environmental stressors. Chronic psychosocial stress may accelerate biological and vascular aging, increasing CVD susceptibility. Although psychological resilience may mitigate adverse effects of chronic stress, its protective effects may vary across social and environmental contexts. The Contribution of Chronic Stress and Resilience on Aging in Young and Early Midlife Black Women Study is a sequential mixed-methods study examining whether accelerated biological aging represents a pathway linking chronic stress to subclinical vascular dysfunction. Eighty-five Black women aged 30-44 years from metropolitan Atlanta completed psychosocial assessments and underwent clinical biomarker evaluation, DNA methylation-based epigenetic aging analyses, inflammatory biomarker assessment, and subclinical vascular function measures. Following quantitative data collection, semi-structured qualitative interviews explored perceptions of stress, resilience, and health. This study integrates clinical, epigenetic, vascular, and qualitative data to characterize how chronic psychosocial stress and resilience relate to biological aging and vascular function, a marker of CVD risk during early midlife. Findings will inform strategies to reduce CVD disparities among Black women.

Background: Adults with obesity face multifaceted barriers to physical activity (PA), including stigma, low self-efficacy, and limited access to relatable content. Traditional interventions fail to address these obesity-specific barriers. Objective: To evaluate the feasibility and preliminary effects of a web-based PA for the Heart (PATH) intervention among insufficiently active adults with obesity. Methods: This 6-month pilot randomized controlled trial enrolled 89 participants (aged ≥18 years, BMI ≥30 kg/m2, <150 minutes moderate-to-vigorous PA [MVPA]/week) randomized 1:1 to PATH intervention or control. PATH participants received access to PATH platform with curated workouts, health coaching, and self-monitoring tools. Controls received the "Be Active Your Way" guide. Data were analyzed using t-tests and ANCOVA models adjusting for baseline values. Outcomes included platform acceptability, PA changes and cardiometabolic risk factors. Results: The sample was 91% female, 46% white, with mean BMI of 40.35±7.20 kg/m2 and mean age 48.66±12.17 years. The study demonstrated feasibility (recruitment completed in 6 months, 91% retention). PATH demonstrated high acceptability, with mean System Usability Scale (SUS) score of 81.4±13.5, 85.3% weekly engagement, and 97.2% rating PATH workouts as culturally appropriate. There were significant baseline imbalances in Fitbit MVPA (control 351.5 vs PATH 176.2 min/wk, p=0.021) and weight-loss medication use at end of study (Control: 9.1%, PATH: 2.2%, p=0.159). Within-group analyses showed significant PA decline in the control group (ActiGraph MVPA: -47.0/wk, p=0.090; Fitbit MVPA –104.4, p=0.232, steps -941.6/day, p=0.096) while the PATH group maintained baseline levels (ActiGraph MVPA: -0.5, p=0.985; Fitbit MVPA -12.2, p=0.715, steps -318.4/day, p=0.543). Sensitivity analyses adjusting for baseline Fitbit MVPA confirmed robustness of findings. The PATH group showed significant improvements in exercise goal setting (Cohen's d=0.347, p=0.002) and PA enjoyment (Cohen's d=0.59, p=0.007). Conclusions: The PATH intervention demonstrated strong acceptability and protective effects against natural PA decline in adults with obesity, supporting technology-enhanced approaches for this high-risk population.

Social variables have a significant impact on the quality of life (QoL) of people living with Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (PLWHA). Understanding how marital status, employment, and current illness influence QoL is critical for establishing holistic care strategies. Using the World Health Organization Quality of Life for HIV – Brief version (WHOQOL-HIV BREF) instrument, this study investigates the association between these socioeconomic variables and quality of life across various domains. One hundred and fifty-seven participants living with HIV/AIDS were included in this cross-sectional study. Data were collected using the WHOQOL-HIV BREF questionnaire, which assessed six domains of QoL: Physical Health, Psychological Well-being, Level of Independence, Social Relationships, Environment, and Spirituality/Religion/Personal Beliefs. Data were organized using Microsoft Excel 2019 and analyzed with SPSS Version 26 and R software. Descriptive statistics summarized participant characteristics. Using the Kruskal-Wallis and Wilcoxon rank-sum tests, bivariate analyses identified associations between sociodemographic factors and QoL domains. Variables with p-values less than 0.25 were included in multivariate logistic regression models to identify significant determinants of QoL. In 157 participants, 70.7

Discrimination drives racial and ethnic disparities in maternal mortality and morbidity, imposing both a human and economic burden. Yet, discrimination is challenging to measure accurately. Little is published in perinatal literature about nonresponse bias to experiences of discrimination and how to mitigate this effect to obtain more complete information. In this secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), we used the Experiences of Discrimination (EOD) scale to examine missing responses to a question about racial or ethnic discrimination during medical care. We categorized responses as "yes," "no," or "nonresponse." Independent variables included racial and ethnic identification, age, body mass index (BMI), education, and poverty level. Logistic regression estimated the odds of nonresponse. Among 9289 participants, 121 (1.3%) reported discrimination, 8598 (92.6%) reported no discrimination, 570 (6.1%) did not respond. In the final adjusted model, racial and ethnic identification was the only statistically significant predictor of nonresponse (p < 0.001). Compared to the most numerous racial group, non-Hispanic white participants, Hispanic participants had 1.8 times the odds of nonresponse [95% CI: 1.3-2.3], and non-Hispanic Black participants had 1.6 times the odds [95% CI: 1.1-2.2]. When individuals most likely to experience discrimination are also the least likely to disclose it, nonresponse bias may result, leading to underestimation of prevalence and obscuring lived experiences of those most affected. Understanding the predictors of nonresponse in patient experience surveys can inform improvements in measurement of discrimination through participant recruitment, survey design, execution, and interpretation.

Addressing the mounting plastic waste problem requires system-level solutions, along with interventions that promote behavioral change. In low-resource countries, inadequate, if not absent, waste management systems lead to unsafe disposal practices, including open burning. While theory-informed approaches are essential for identifying enablers and barriers to target behavior change, their application is limited in these settings. Given the lack of a theory-driven synthesis of behavioral strategies to address plastic waste, this systematic review aimed to: (1) synthesize behavioral interventions related to plastic waste management in low-resource countries; (2) map these interventions to the behavior change wheel (BCW), using the capability-opportunity-motivation-behavior model, and the theoretical domains framework (TDF); and (3) classify implementation strategies to inform theory-driven intervention design. This review is the first to use the BCW to examine behavioral interventions related to plastic waste management in low-resource countries. Nine bibliographic databases: APA PsycInfo, CINAHL, Embase, Environment Complete, Global Health, GreenFile, Health Source: Nursing Academic, PubMed, and Web of Science Core Collection were searched. We included English-language human studies up to 9 April 2025, that evaluated interventions or policies targeting individual- or community-level behaviors related to plastic waste management in low-, lower-middle, or upper-middle income countries. We excluded studies from high-income countries, and those focused on environmental impacts, industrial or municipal waste streams, ecosystems or animals without human behavioral components, COVID-19-specific waste, or hypothetical modeling without real-life interventions. Forty-three studies met the inclusion criteria. Study quality was assessed using the mixed methods appraisal Tool. Interventions spanned 27 low-resource countries and targeted diverse populations, including schoolchildren, households, market vendors, and community organizations. Education was the most frequent BCW intervention function (76.7%), followed by environmental restructuring, incentivization, persuasion, and training. Mapping revealed that behavioral interventions relied most frequently on the TDF domains of environmental context, knowledge, skills, and social influences. Some domains, such as beliefs about capabilities, reinforcement, and identity, received moderate attention, while appealing to emotion or the use of behavioral regulation, were underutilized. Behavioral interventions for plastic waste management in low-resource countries have predominantly emphasized awareness-raising but insufficiently leveraged other BCW intervention functions and TDF domains. Integration of motivational, emotional, and identity-based strategies alongside structural support can enhance the sustainability of behavior change.

Background: Critically ill patients in the intensive care unit (ICU) report thirst as one of the most distressing symptoms they experience. Despite thirst being identified as a distressing symptom, it is not assessed or treated by nurses. Strategies to mitigate thirst are essential for quality patient outcomes. Purpose: The purpose of this study was to compare protocols to decrease thirst in patients in an ICU. Methods: This study used a cross-sectional descriptive pre-intervention/post-intervention design to evaluate the effectiveness of an alternative oral care protocol as compared with standard/usual oral care on decreasing patients’ level of thirst. Results: One hundred patients participated. Fifty were randomized to standard oral care and 50 to the spray bottle group. The biggest difference was on Day 4 when the spray bottle group had lower scores than usual care. There was a significant difference between the 2 groups over the 5 days for both thirst intensity (p<.001) and thirst distress scores (p<.001). Conclusions: Both thirst and dry mouth are distressing and go untreated. It is important for nursing staff to assess for thirst without depending on patients’ reports of thirst. This study suggests the spray bottle intervention reduced thirst intensity and distress compared to usual care.

BACKGROUND AND OBJECTIVES:Tele-Savvy, a psychoeducation program for dementia care partners, was designed to improve caregiver mastery (e.g., confidence). While the program focused on care partner's outcomes, there were potential benefits to the quality of the relationship between the person living with dementia and the care partner. RESEARCH DESIGN AND METHODS:This secondary data analysis examined the dyadic relationship quality (i.e., positive interaction and dyadic strain) as reported by 261 care partners from baseline to 6 months postintervention across three treatment arms of the clinical trial: Active group who immediately received Tele-Savvy (n = 96), a Healthy Living attention control group (n = 111), and a Waitlist Control group (n = 54), which care partners received Tele-Savvy after 6 months. RESULTS:In the Tele-Savvy group, care partners reported significant improvements in positive interactions and reduction in dyadic strain over time compared with the care partners in both the Healthy Living and Waitlist Control groups. After all groups received Tele-Savvy, all care partners improved their positive interaction with the person living with dementia and experienced less dyadic strain over time. DISCUSSION AND IMPLICATIONS:The focus of Tele-Savvy is not on improving the quality of dyadic relationships. Our results suggest that interventions focused on the care partner's self-efficacy have the potential to improve the dyadic relationship from the perspective of the care partner, and interventions should include dyadic measures even if from the perspective of one member of the dyad. CLINICAL TRIAL REGISTRATION NUMBER:NCT03033875.

Healthcare transition readiness is crucial for adolescent and young adult childhood cancer survivors (AYA CCS) to ensure continuity of care as they move from pediatric to adult healthcare services. A systematic review of the evidence linking social determinants of health (SDoH) and healthcare transition readiness is needed to provide valuable insights into the impact of disparities on transition. A mixed-methods systematic review (MMSR) was conducted on studies published through November 2025. Quantitative data were extracted to assess measurable outcomes related to healthcare transition readiness and SDoH, while qualitative studies exploring the perceptions and experiences of AYA CCS, their families, and healthcare providers on transition readiness were analyzed using thematic synthesis. The final synthesis followed a convergent integrated approach, guided by the Healthy People 2030 SDoH framework. Seventeen studies (five quantitative and twelve qualitative) were included. Healthcare access and quality emerged as the most influential SDoH, with consistent evidence showing that relationships with knowledgeable healthcare providers, and access to health insurance and healthcare services were associated with healthcare transition readiness. Social and community context – including parental and peer support – also contributed to readiness. Evidence for economic stability was mixed, while education access and quality and neighborhood factors were the least examined and remain inconclusive. Integrated analysis indicated that structural (e.g., insurance, provider access) and relational SDoH (e.g., communication quality, family and peer support) influence healthcare transition readiness among AYA CCS. This MMSR provides a comprehensive understanding of how SDoH impact healthcare transition readiness among AYA CCS. The findings underscore the need for future research to address gaps in the current literature and to improve transition outcomes and reduce disparities during the transition process in this population.

Background/Objectives: Non-pharmacological approaches are urgently required for managing chronic pain in sickle cell disease (SCD). This multiple-method, exploratory pilot randomized trial was conducted to evaluate preliminary benefits of an in-home virtual reality (VR) intervention (EaseVRx), compared to content-matched audio attention control, for chronic pain reduction and changes to chronic pain-related outcomes in adults with SCD. Methods: Participants were randomized to VR (19) or audio (25), with 2-16 min daily modules for eight weeks, a daily pain diary survey, VR surveys, assessments of chronic pain grade and chronic pain correlates every 4 weeks for 3 months, and a qualitative interview. Analyses were conducted using quantitative and qualitative methods. Clinical Trial Registration: ClinicalTrials.gov, NCT04906707, 27 May 2021. Results: Average intervention use was 19.1 and 12.1 min per day in VR and audio, respectively. Preliminary benefits of VR included decreased pain (p = 0.002), improved pain coping (pain catastrophizing [p = 0.005] and chronic pain acceptance [p = 0.002]), and improved sleep (p = 0.009). Additionally, symptoms associated with cybersickness were significantly lower (p = 0.012) after VR use than before VR use. Among interviewees, the interventions were acceptable and helpful in managing pain, although there were some barriers and challenges to use. Conclusions: Study findings suggest that in-home VR may be a self-management resource for adults with SCD and warrants additional research.

Black caregivers of persons living with Alzheimer's disease and related dementias (ADRD) experience significant health disparities, including elevated cardiovascular risk and high stress levels. This study evaluates the effects of a culturally tailored psychoeducational intervention, with and without exercise, on caregiver health, stress, and coping. In this randomized controlled trial (NCT01188070), 142 Black caregivers were assigned to one of three groups: attention control, psychoeducation, or psychoeducation plus exercise. The psychoeducational intervention, The Great Village , focused on culturally relevant caregiving strategies, while the exercise component included a home-based walking and resistance program. Outcomes assessed at baseline and six months included cardiovascular risk markers, perceived stress, and coping. Group differences were analyzed using ANCOVA, adjusting for baseline values. The psychoeducation group showed significant reductions in diastolic blood pressure ( p  = 0.034) and blood glucose ( p  = 0.021). Both intervention groups reported lower perceived stress ( p  = 0.048). However, the psychoeducation plus exercise group did not demonstrate expected improvements in physical function or cardiovascular risk and showed a decline in positive reappraisal coping ( p  = 0.048). Culturally tailored psychoeducation may improve cardiovascular risk and stress outcomes in Black dementia caregivers. The added exercise component did not yield additional benefits, suggesting the need for alternative strategies to enhance physical activity in this population. Future research should explore longer-duration interventions and ways to support exercise adherence within the context of caregiving.

Black transgender women report high levels of discrimination, which is associated with poor health outcomes. Some evidence suggests that intersectional discrimination—that is, interacting forms of marginalization related to one’s real or perceived social identities or positions that contribute to unique dynamics and effects on health—is associated with worse health-related quality of life; however, little evidence explores this possible association among Black transgender women. Addressing this gap is crucial in understanding how overlapping experiences of racism and cisgenderism contribute to poor health outcomes in this population. We used cross-sectional survey data from 151 Black transgender women ages 18 to 67 (mean = 35.9 ± 11 years) to examine the associations between age, intersectional discrimination via the Day-to-Day Intersectional Discrimination Index (INDI-D), and aspects of Health-Related Quality of Life (HRQoL; i.e., self-perceived quality of general health [GenHealth] and number of health days in the past 30 days), via T-tests, Pearson’s correlations, stepwise sequential linear regression (SSLR) to test for moderation, and the PROCESS macro for SPSS to test for indirect effects. Increased INDI-D was consistently significantly associated with worse GenHealth and decreased number of healthy days across adjusted and unadjusted models. However, adjusted moderation and indirect effects analyses did not support moderation or mediation hypotheses. Future research should further investigate how discrimination and aging affect the health of Black transgender women, with attention to weathering and coping. Additional studies are needed to develop and improve interventions to support the well-being of this marginalized community.

Background Stress is an internationally well-known consequence of nurse work. This can impact delivery of optimal patient outcomes. Mindfulness-based interventions are suggested as effective strategies to cope with occupational stress and burnout among nurses. Purpose To determine the effects of coloring on stress levels in an academic medical center. Method This study used a preintervention/postintervention design. The Perceived Stress Scale-10 (PSS-10) was used. Findings Participants who started with higher PSS-10 or higher color stress prescores had more decreases in their pre-to-post change scores. Older participants (baby boomers) had the lowest postcoloring stress scores. Discussion The results of this study corroborate previous literature findings. Following coloring activities, stress scores decreased to 2.4 ± from 4.2 ± 2.1 before coloring. Data from our study supported that participants with higher levels of stress precoloring reported the most significant stress improvement postcoloring.

Background: Black adults have a higher risk for heart failure (HF) than others, which may be related to higher cardiovascular risk factors and also inflammatory dietary patterns. The Western diet is associated with inflammation and contributes to HF. Trimethylamine N-oxide is a diet-linked metabolite that contributes to inflammation and is associated with higher tumor necrosis factor-alpha (TNF-alpha) levels, especially in HF populations. The dietary inflammatory index score measures a diet's inflammatory potential and food's inflammatory effects. Objective: The purpose of this pilot study was to explore associations between the Western diet, dietary inflammatory index, trimethylamine N-oxide, relevant covariates and variables, and TNF-alpha in Black persons with HF. Methods: Thirty-one Black participants (mean age = 55 years, 68% women) with HF were enrolled. Trimethylamine N-oxide and TNF-alpha levels were analyzed using immunoassays. A food frequency questionnaire was completed, and dietary inflammatory index scores and food groups were calculated. Analyses included correlations and I-test statistics. Results: Mean dietary inflammatory index score was -0.38, noting an anti-inflammatory diet with slightly higher inflammatory diet scores in men compared to women. The dietary inflammatory index score showed a negative association with dietary choline but not with trimethylamine N-oxide or TNF-alpha. Trimethylamine N-oxide and age were positively correlated, along with the correlation for TNF-alpha with a moderate effect size. No relationship was found among dietary inflammatory index, TNF-alpha, and trimethylamine N-oxide variables. Discussion: A greater understanding of intake of inflammatory foods and relationships with immune factors is warranted to inform intervention development. In Black adults with HF, it is important to consider the intake of inflammatory foods as increased age may affect the retention of dietary metabolites. Metabolites may also increase the levels of inflammation. Knowledge about these relationships could lead to tailored dietary interventions based on diet, age, and culture patterns.

Early life adverse experiences, including childhood maltreatment, are major risk factors for psychopathology, including anxiety disorders with dysregulated fear responses. Consistent with human studies, maltreatment by the mother (MALT) leads to increased emotional reactivity in rhesus monkey infants. Whether this persists and results in altered emotion regulation, due to enhanced fear learning or impaired utilization of safety signals as shown in human stress-related disorders, is unclear. Here we used a rhesus model of MALT to examine long-term effects on state anxiety and threat/safety learning in 25 adolescents, using a fear conditioning paradigm (AX+/BX-) with acoustic startle amplitude as the peripheral measure. The AX+/BX- paradigm measures baseline startle, fear-potentiated startle, threat/safety cue discrimination, startle attenuation by safety signals, and extinction. Baseline startle was higher in MALT animals, suggesting elevated state anxiety. No differences in threat learning, or threat/safety discrimination were detected. However, MALT animals showed generalized blunted responses to the conditioned threat cue, regardless of the safety cue presence in the transfer test, and took longer to extinguish spontaneously recovered threat. These findings suggest adverse caregiving experiences have long-term impacts on adolescent emotion regulation, including elevated state anxiety and blunted fear conditioning responses, consistent with reports in children with maltreatment exposure.

Background: Cardiovascular disease (CVD) will be the leading cause of mortality in Africa by 2030. Yet, little is known about the key drivers of CVD risk in the region. Objective: To examine the risk factors associated with CVD risk in a sample of rural midlife and elderly Kenyans. Methods: Cross-sectional study design. Data were collected following established protocols and included physical activity (PA), body mass index (BMI), waist circumference, blood pressure (BP), and self-reported medical history. Absolute CVD risk scores [Framingham risk scores (FRS)] were computed using non-lab-based Framingham algorithm. Descriptive and inferential statistics were used to evaluate factors associated with CVD risk scores and related sex-specific differences. Results: The sample (N = 102; mean age 59.8 ± 7.3 years; 57.8% female) was on average highly active (median 8891 steps/day) with 61.8% hypertension prevalence. Females versus males had higher BMI (29.2 vs. 24.8 kg/m2; P < 0.001) and central adiposity (84.8 vs. 18.6%; P < 0.001). However, they had lower systolic BP (129.3 vs. 138.3 mmHg; P = 0.032) and didn't smoke (0.0 vs. 11.6%; P = 0.012). Females also were 6.6 years younger (P < 0.001) and had fewer years of education (P < 0.001) and less PA (P = 0.046). Overall, 34.3% of the sample was at high risk of CVD (FRS ≥20%), but females had lower risk compared with males (median FRS 7.4 vs. 25.0%; P < 0.001). Higher CVD risk was associated with higher education (P < 0.001) and having adequate income (P = 0.048). When considering females separately, none of the sociodemographic characteristics or PA measures were associated with CVD risk, but for males, higher CVD risk was associated with higher education (P = 0.025) and lower PA (P = 0.009). Conclusion: Age, BMI, BP, and smoking partially explain sex differences in CVD risk burden. However, sex differences also exist with males being older with higher education-factors associated with higher CVD risk. More research is needed to examine factors associated with absolute CVD risk in females.

BACKGROUND:Chronological age (CA) is independently associated with arterial stiffness, but it is not a sufficient measure of aging or the disparities related to disease risk. While biological age (BA) is considered a more accurate indicator of disease risk, the relationships among BA, CA, and arterial stiffness remain inconclusive. METHODS:In 222 women (n = 143 White, n = 79 Black) enrolled in the Predictive Health Institute cohort (age range 25-49), arterial stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV), measured by applanation tonometry (SphygmoCor). BA was estimated using the Klemera-Doubal method from 11 different clinical biomarkers and CA. Accelerated age (AccA) was calculated as the difference between BA and CA. Overall and race-specific associations between BA and arterial stiffness adjusting for sociodemographics, health behaviors, and clinical factors were estimated using multiple linear regression. RESULTS:Mean (SD) CA was 41.4 (6.3) years in Black women and 39.8 (6.0) years in White women, respectively. Mean (SD) BA, AccA, and cfPWV were 43 (13.1) and 1.6 (12.9) years, and 7.3 (1.1) m/s in Black women and 36 (10.8) and -3.2 (10.6) years, and 6.3 (0.8) m/s in White women (Black-White difference in BA: 6.4 years, P = <0.001). Higher BA was associated with a 0.015 m/s per year (95% CI: 0.002, 0.029, P = 0.028) higher cfPWV after adjustment for demographic and CVD risk factors, without evidence of an interaction by race (P = 0.65). CONCLUSIONS:BA was associated with arterial stiffness in the fully adjusted model. Targeting modifiable risk factors may promote healthy vascular aging and reduce subclinical CVD progression.

Background: Despite the high prevalence of moral distress in nursing, empirical evidence is lacking about the best educational approaches to foster moral resilience. Purpose: This study evaluates the effectiveness of an ethics simulation in a prelicensure program, 6 months into nursing practice. Methods: We used an exploratory design, including 2 instruments and open-ended questions. One instrument measured moral distress, the other measured moral resilience. Alumni who participated in the simulation were compared to alumni who received didactic teaching only. Results: Six months into practice, the quantitative data from this study did not show a statistical significance between those who received didactic training only and those who received a simulation, except for one element of the moral resilience scale (relational integrity), in which the control group had a higher score. Open-ended questions confirmed that alumni recognized the positive impact of the simulation in practice. Conclusions: Further study is needed to determine the best educational strategies for teaching ethics in prelicensure nursing programs, with a focus on improving retention and resilience in practice.

BACKGROUND:Comorbidities such as Type 2 diabetes mellitus significantly and adversely influence heart failure outcomes, especially in Black adult populations. Likewise, heart failure has a negative effect on diabetes and cardiometabolic outcomes. Dyspnea, a common symptom of heart failure, often correlates with disease severity and prognosis. However, the relationship between comorbid diabetes, dyspnea severity, and cardiometabolic biomarkers in Black adults with heart failure remains understudied. OBJECTIVES:The purpose of this pilot study was to examine differences in the distressing heart failure symptom of dyspnea and in cardiometabolic and inflammatory biomarkers in Black adults living with heart failure with and without diabetes. METHODS:Black adults with heart failure were enrolled in this cross-sectional pilot study. Cardiometabolic and inflammatory biomarkers were measured via multiplex immunoassay. Univariate general liner models were used to identify group differences between persons with heart failure with comorbid diabetes and those without, controlling for age, sex, and comorbid burden. RESULTS:Participants were mostly female with a mean age of 55 years and mean left ventricular ejection fraction of 33%. Participants with diabetes exhibited higher dyspnea scores compared to those without diabetes, indicating greater symptom burden. Moreover, individuals with comorbid diabetes demonstrated higher levels of cardiometabolic and inflammatory markers. DISCUSSION:Comorbid diabetes was associated with higher dyspnea severity and adverse cardiometabolic profiles in Black adults with heart failure. These findings underscore the importance of targeted interventions addressing diabetes management and cardiometabolic risk factors to improve symptom control and outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and develop tailored therapeutic strategies for managing comorbidities in persons with heart failure, particularly in minoritized communities.

BACKGROUND:In the United States, Black adults have the highest prevalence of obesity and hypertension, increasing their risk of morbidity and mortality. Caregivers of persons with dementia are also at increased risk of morbidity and mortality due to the demands of providing care. Thus, Black caregivers-who are the second largest group of caregivers of persons with dementia in the United States-have the highest risks for poor health outcomes among all caregivers. However, the physiological changes associated with multiple chronic conditions in Black caregivers are poorly understood. OBJECTIVES:In this study, metabolomics were compared to the metabolic profiles of Black caregivers with obesity, with or without hypertension. Our goal was to identify metabolites and metabolic pathways that could be targeted to reduce obesity and hypertension rates in this group. METHODS:High-resolution, untargeted metabolomic assays were performed on plasma samples from 26 self-identified Black caregivers with obesity, 18 of whom had hypertension. Logistic regression and pathway analyses were employed to identify metabolites and metabolic pathways differentiating caregivers with obesity only and caregivers with both obesity and hypertension. RESULTS:Key metabolic pathways discriminating caregivers with obesity only and caregivers with obesity and hypertension were butanoate and glutamate metabolism, fatty acid activation/biosynthesis, and the carnitine shuttle pathway. Metabolites related to glutamate metabolism in the butanoate metabolism pathway were more abundant in caregivers with hypertension, while metabolites identified as butyric acid/butanoate and R-(3)-hydroxybutanoate were less abundant. Caregivers with hypertension also had lower levels of several unsaturated fatty acids. DISCUSSION:In Black caregivers with obesity, multiple metabolic features and pathways differentiated among caregivers with and without hypertension. If confirmed in future studies, these findings would support ongoing clinical monitoring and culturally tailored interventions focused on nutrition (particularly polyunsaturated fats and animal protein), exercise, and stress management to reduce the risk of hypertension in Black caregivers with obesity.

Introduction: The COOL-HF (caregiver (CG) opportunities for optimizing lifestyles) randomized clinical trial tested a psychoeducational intervention (with and without exercise) for caregivers of persons living with heart failure (HF) to address cardiovascular (CVD) risk factors due to the burden of caregiving. The analyses presented here examine the moderating effects of caregiver self-efficacy confidence on the associations between biomarkers of CVD risk. Hypothesis: HF CGs with lower caregiving confidence will have stronger associations between adipokines, lipids and inflammatory biomarkers. Methods: Cardiovascular risk for the HF caregivers was assessed by measuring inflammatory biomarkers (high-sensitivity C-reactive protein (hs-CRP), Interleukin-6 (IL6)), adipokines (adiponectin, plasminogen activator inhibitor-1 (PAI-1), resistin), lipids (low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol, triglycerides) and insulin. Caregiver self-efficacy was measured using the family caregiver version of Self-Care of Heart Failure Index (SCHFI) competency scale. The moderating effects of caregiver competency on the associations between the biomarkers of cardiovascular risk were tested for measures at baseline using the PROCESS macro software. Results: The 127 CGs in the study were aged 55 +/- 11, 92% female, 58% Black, 55% spouses and 70% had a college or higher education. Among care recipients, HF severity ranged from NYHA class I (25%), II (25%), III (38%), to IV (12%). SCHFI family caregiver competency scores ranged from 4-16 with an average score of 9.8 +/- 2.8 which significantly moderated the associations between adiponectin and triglycerides (β=0.177, p=.049), between adiponectin and insulin (β=0.222, p=.012), between adiponectin and PAI-1 (β=0.222, p=.021), and between PAI-1 and resistin (β=-0.246, p=.005), where lower levels of confidence led to stronger associations between these risk factors. Conclusions: Caregiving burden is known to increase stress and cardiovascular risk in caregivers. These results support assessing caregivers for low caregiving competency levels which may increase the associations between biomarkers of cardiovascular risk. Targeted interventions that improve caregiver self-efficacy may moderate and reduce cardiovascular risk and improve overall health outcomes in caregivers of persons living with HF.