BACKGROUND:While there is evidence of the benefits of healthy maternal lifestyle behaviors (eg, physical activity plus a healthy diet) on cardiometabolic health, there are limited data on the independent association between physical activity and cardiometabolic health among women with a history of gestational diabetes mellitus (GDM). OBJECTIVE:In this study, our aim was to explore the association between device-assessed physical activity and cardiometabolic outcomes in Chinese American women, a group disproportionately affected by GDM and type 2 diabetes. METHODS:A cross-sectional study was conducted among 33 Chinese American women (0.5-5 years after delivery) with a history of GDM in New York City in 2023 to 2024, in which we collected their device-assessed physical activity data, online survey data (in Mandarin and English), and cardiometabolic data (via fasting blood samples). Descriptive, unadjusted, and adjusted regression analyses were performed. RESULTS:Participants' mean age was 38.2 ± 3.3 years (2.6 ± 1.5 years after delivery), and body mass index was 23.5 (interquartile range: 21.7-25.1) kg/m 2 . Among the 33 participants, 27.3% had prediabetes, 51.5% had lipid dysregulation, and 21.2% had elevated blood pressure. The duration of moderate-to-vigorous physical activity per week was 132.4 (interquartile range: 90.5-272.0) minutes, and 46.9% of the cohort met the physical activity recommendation of ≥150 minutes moderate-to-vigorous physical activity per week. In regression models, meeting the physical activity recommendations was inversely associated with total cholesterol (-27.6 ± 12.7 mg/dL) and low-density lipoprotein cholesterol (-25.5 ± 10.6 mg/dL) levels (both P < .04). CONCLUSIONS:The majority of participants engaged in suboptimal physical activity levels. However, meeting physical activity recommendations was associated with better total and low-density lipoprotein cholesterol levels. Targeting physical activity may be a key strategy for improving cardiometabolic health in Chinese American women recently diagnosed with GDM.

OBJECTIVE:Masked hypertension [nonhigh office blood pressure (BP) and high out-of-office BP] is associated with cardiovascular risk. Obstructive sleep apnea (OSA) is associated with high office BP, but few data exist on its association with masked hypertension, especially in Black adults who have a high prevalence of both conditions. METHODS:We analyzed pooled data from 1078 Black adults, 713 in the Jackson Heart Study and 365 in the Coronary Artery Risk Development in Young Adults study, with office BP less than 140/90 mmHg, who completed 24-h ambulatory BP monitoring. Masked hypertension was defined as mean awake BP at least 135/85 mmHg, asleep BP at least 120/70 mmHg, or 24-h BP at least 130/80 mmHg. A high likelihood of OSA was defined using sleep questionnaires and physical measurements. Poisson regression was used to estimate prevalence ratios, adjusting for demographics, lifestyle behaviors, and comorbidities. Analyses were stratified by antihypertensive medication use. RESULTS:Overall, 34% of participants had a high likelihood of OSA; 53.3% had masked hypertension. Among participants not taking antihypertensive medication ( n  = 505), adjusted prevalence ratios comparing those with versus without a high likelihood of OSA were 1.31 [95% confidence interval (CI) 1.06-1.61], 0.88 (95% CI 0.59-1.29), 1.37 (95% CI 1.09-1.73), and 1.35 (95% CI 1.00-1.83) for any, awake, asleep, and 24-h masked hypertension. Among those taking antihypertensive medication ( n  = 573), the adjusted prevalence ratios were 1.15 (95% CI 0.99-1.32), 1.04 (95% CI 0.83-1.31), 1.14 (95% CI 0.97-1.33), and 1.19 (95% CI 0.96-1.47), respectively. CONCLUSION:A high likelihood of OSA was associated with a higher prevalence of masked hypertension among participants not taking antihypertensive medication.

Background:Lifestyle interventions are effective in reducing cardiovascular disease (CVD) risk, but few target mothers of toddlers and preschool-aged children. Cardiovascular risk factors may emerge or worsen during this life stage due to high child-rearing demands, with the potential to persist long-term. We scoped the literature to synthesize findings and highlight future research opportunities regarding CVD prevention interventions among mothers of young children. Methods:We searched PubMed, Scopus, Web of Science, CINAHL, Embase, and APA PsycINFO for 2010-2024 peer-reviewed, English-language articles about CVD risk reduction lifestyle interventions for mothers with young children aged 1-5 years. Due to limited initial results, we broadened this demographic criterion to include mothers with children either <1-5 years (infants to young children) or 1-12 years (young to school-age children). Results:Six of 424 studies were eligible for review. Only one study exclusively enrolled mothers with children aged 1-5 years. Three enrolled mothers with children between <1 and 5 years; two enrolled mothers with children between 1 and 12 years. Four interventions were conducted in-person and two via digital formats. All interventions targeted ≥1 cardiovascular health component as defined by Life's Essential 8, including weight (n = 4), diet (n = 4), physical activity (n = 3), blood pressure (n = 3), blood glucose (n = 2), and blood lipids (n = 2). None addressed nicotine exposure nor sleep. Five studies reported statistically significant results for at least one of their outcomes. Conclusion:Very few studies discuss lifestyle interventions for CVD prevention among mothers of young children, highlighting a salient gap and opportunities for additional research in this population.

Background: Social support has been associated with morbidity and mortality among adults with coronary artery disease, but its relationship to health status among adults with recent myocardial infarction (MI) is less well understood. Objective: We examined the association between social support (ENRICHD Social Support Inventory [ESSI]) and health status (Seattle Angina Questionnaire [SAQ-7]) among a cohort of adults post-MI, overall and by sex. We hypothesized that higher social support would be associated with better health status and that the strength of association would differ by sex. Methods: This was a cross-sectional analysis of baseline data from an ongoing study examining the role of stress among adults with MI. Participants were ≥ 18 years old and had a MI within the last 3 months, defined by the Universal Definition. We conducted multivariate linear regression analyses to examine associations between ESSI score and SAQ-7 summary score, as well as SAQ domain scores for Physical Limitation (SAQ-PL), Angina Frequency (SAQ-AF), and Quality of Life (SAQ-QoL). We controlled for demographics (age, race, ethnicity, sex), clinical history (history of prior MI), and psychosocial covariates (Perceived Stress Scale 4 scores). Results: The sample (n=156) comprised 37% women, and 67% identified as non-Hispanic White. Mean age was 59 years (standard deviation 13 years). Median [interquartile range] ESSI score was 28 [22.5; 32] and SAQ-7 score was 76 [56; 89], which did not differ by sex (p=0.25). After adjustment, ESSI was positively associated with SAQ-7 (β 0.6 [increase in SAQ-7 score per unit increase in ESSI score], 95% confidence interval (CI) [0.1-1.1], p=0.03) and SAQ-AF (β 0.5, 95% CI [0.5-1.0], p=0.03), but not SAQ-PL (p=0.07) nor SAQ-QoL (p=0.15). In adjusted analyses stratified by sex, ESSI was more strongly associated with SAQ-7 in women than men (β 1.0, 95% CI [0.2-1.9], p=0.02 versus β 0.6, 95% CI [-0.1-1.2], p=0.08). Associations with SAQ-AF and SAQ-QoL were also stronger in women than men (β 0.9, 95% CI [0.1-1.7], p=0.03 versus β 0.4, 95% CI [-0.2-1.0], p=0.19 and β 1.3, 95% CI [0.2-2.5], p=0.02 versus β 0.5, 95% CI [-0.6-1.5], p=0.38, respectively). Conclusions: We found that higher social support is associated with better health status in adults post-MI, and this relationship is stronger in women compared to men. Results suggest that screening for low social support and identifying strategies to bolster it may benefit recovery post-MI.

Social determinants of health (SDoH), health care use, and cardiovascular disease (CVD) risk perception are understudied among men who identify as Black and Hispanic. In this study we sought to describe these factors among a cohort of urban-residing Black men, participants in a community-engaged trial on hypertension prevention. We focused on presenting intermediary SDoH, including material circumstances, health behaviors, and psychosocial factors, which allow for a more robust understanding of health inequities but are underexplored. We analyzed baseline trial data (N=430) and compared subgroups (44% of participants self-identified as having Hispanic ethnicity and a Black racial identity). Average age was 38 years, with mean blood pressure of 129/83 mmHg. Hispanic Black (HB) men reported higher unemployment (21.4% versus 11.1%, P=.02) and more housing instability (28.7% versus 18.6%, P=.01) than did non-Hispanic Black (NHB) men. Overall, HB men reported worse household conditions compared with NHB men. Approximately half of both groups reported high stress, 45% (HB) and 51% (NHB), respectively. Both groups had low perception of personal CVD risk and underutilized health care. Hispanic Black men were less likely to have a primary care provider than were NHB men (17.6% versus 29.3%, P<.001). Non-Hispanic Black men reported lower physical activity than did HB men (median, 2655 vs 2547 metabolic equivalent minutes/week, P=.03). Recognizing heterogeneity among Black populations, including in social drivers of CVD disparities, will allow for more precision in designing CVD health promotion interventions. Findings also suggest that perception of personal CVD risk and health care utilization may be important targets for CVD prevention in Black men.

Background:Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men. Objectives:This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI. Methods:Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups. Results:The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (-0.52 [95% CI: -0.77 to -0.28]) but not the heart disease education arm (-0.19 [95% CI: -0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036). Conclusions:MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.

BACKGROUND:Black men are underrepresented in hypertension trials, even though this population has higher prevalence and more adverse sequelae from hypertension, compared to other groups. In this article, we present recruitment and community engagement strategies for the Community-to-Clinic Linkage Implementation Program (CLIP), a cluster-randomized trial on hypertension prevention among Black men. METHODS:Using a 2-stage recruitment process, (i) we enrolled Black-owned barbershops from zip codes with high hypertension prevalence and (ii) recruited Black male participants who fulfilled the eligibility criteria and were customers of the barbershops. Barbershop and participant recruitment was conducted by a partner community-based organization. RESULTS:The study met the recruitment goals for barbershop enrollment (N = 22) and individual participants. Of eligible individuals (N = 461), 430 enrolled in the study (93% consent rate, exceeding the original enrollment goal of N = 420 participants). Throughout recruitment, the study team conducted 101 unique engagements (41 prior to recruitment and 60 during recruitment), totaling engagement with 180 partners across all events, including individual and group meetings, attendance at community events, and educational presentations. In addition to a primary partner community organization, the study team collaborated with a Community Advisory Council, comprised of residents, and civic and community leaders, and with the local health department and varied other organizations. CONCLUSIONS:In CLIP, a high number of academic-community engagement encounters and close collaboration with community partners contributed to successful recruitment of Black men at risk for hypertension and with adverse social determinants. Our experience may serve as to inform investigators focused on recruiting underserved populations in hypertension research trials. CLINICALTRIALS.GOV IDENTIFIER:NCT05447962.

BACKGROUND:Epilepsy self-management (ESM) by people living with epilepsy (PWE) can reduce seizure frequency and increase quality of life (QOL). ESM among Hispanic PWE is under-investigated and lacks adequate sampling and ESM assessment. The purpose of this study was to assess ESM and associated variables among Hispanic PWE using aggregate data from the Managing Epilepsy Well Network Integrated Database. METHODS:The sample comprised Hispanic PWE (n = 211) from nine ESM intervention studies that used common measures for socio-demographics, health status, prior 30- day seizures, depression (PHQ-9, NDDI-E), QOL (QOLIE-10), and ESM. RESULTS:The sample was 39.3 (±12.8) years, mostly female (56.1 %), preferring Spanish language (59 %), U.S. born (62.2 %), high school or college educated (35.7 %), single/partnered (43.9 %/41.0 %), employed/unemployed (33.0 %/32.1 %), with income <$25,000 (59.0 %), with depressive symptoms (35.1 %), and a seizure in the past month (52.5 %). Total ESM item mean scores were positively skewed (3.6 ± 0.4 on a 5-point scale). Medication, seizure, and safety management exceeded that for information and lifestyle management. In adjusted multivariable models, medication management was associated with age and employment (homemaker) and inversely associated with marital status (never married) and depression. Lifestyle management was associated with employment (unable to work) and inversely associated with sex (female), depression, and QOL. CONCLUSION:Hispanic PWE were more competent in managing the medical aspects of their condition than lifestyle and informational issues. This study is significant because it leverages the analytic power of a large aggregate Hispanic PWE sample to describe ESM and can inform future study design, data collection, and tailoring of ESM interventions.

AIMS:The Managing Epilepsy Well (MEW) Network has led the development, testing and scale-up of epilepsy self-management (ESM). The MEW Integrated Database (MEW DB) is a pooled repository of archival studies that facilitates aggregate analysis. This report describes an implementation evaluation tool for ESM adopters. METHODS:Publicly available materials on program implementation, adoption and sustainability as well as readiness surveys used by the MEW Network were reviewed, as were content domains and format styles relevant to ESM implementation. Requirements for data Tiers included: 1) survey Tier should be short (≤6 items) and completed quickly (< 3 min), 2) question and response format should be consistent, 3) data elements are relevant to ESM adopters and 4) the tool should be applicable across ESM programs. Iterative review, discussion and item-ranking yielded a final set of 3 distinct data element Tiers. RESULTS:Implementation data elements assess the characteristics of organization that may be a potential ESM adopter (Tier 1), organizational readiness to ESM implementation (Tier 2) and perceptions of ESM program effects or impact by adopters at the individual and program levels (Tier 3). There are 18 data elements, 6 elements in each Tier. Organizational characteristics reflect health disparities among people with epilepsy and common comorbidities. Implementation readiness barriers include motivational factors, training and resources. Implementation experience/outcomes include perceived ESM duration, credibility, impact, likability and effectiveness. CONCLUSIONS:A brief and practical implementation evaluation tool for ESM has potential value and important clinical and policy implications in advancing care for people with epilepsy.

Background: Young women in Puerto Rico (PR) experience a high burden of psychological distress, a non-traditional risk factor for cardiovascular disease. Mindfulness practice may help reduce psychological distress and improve health behaviors, benefiting cardiovascular health. However, conventional 8-week mindfulness-based stress reduction (MBSR) programs’ time requirements and in-person format pose participation barriers. We evaluated the feasibility and acceptability of a virtual, 4-week MBSR program tailored for young PR women and explored post-intervention changes in distress and health behaviors. Methods: Participants (n=24; mean age=25.7y±3.1) were PR women with elevated stress and no severe depression or self-harm thoughts. Recruitment (February 2024) was through social media and email blasts. The program consisted of weekly group sessions and daily at-home practice. Feasibility was measured through recruitment, enrollment, retention, attendance, and at-home practice. Acceptability was assessed via satisfaction ratings. Symptoms of depression, anxiety, post-traumatic stress disorder, perceived stress, emotional eating, and physical activity were assessed through validated scales at baseline, post-intervention, and 2-mo. Analyses included paired t-tests and McNemar tests for comparisons between baseline vs. post-intervention and baseline vs. 2-mo. Results: Recruitment, enrollment, and retention rates were 66%, 100%, and 96%, respectively. Median number of sessions attended was 4; 84% attended all sessions. Half of the participants practiced at-home exercises > 3-4 times/week; frequency declined at 2-mo. Participants were very/somewhat satisfied (96%) with the intervention. There were significant reductions in depression (-5.1; p<0.01), anxiety (-3.0; p<0.01), PTSD (-1.8; p<0.01), and stress (-2.7; p<0.01) symptom scores at post-intervention (vs. baseline). These differences remained at 2-mo. There was a significant decrease in emotional eating scores at 2-mo (-0.2; p=0.03) and a marginal increase in the proportion of participants meeting the guidelines of 150min/week of physical activity at post-intervention (38% vs. 50%; p=0.08). Conclusion: This 4-week virtual MBSR program had good feasibility and acceptability among PR women, with the potential to reduce psychological distress and emotional eating. Strategies are needed to boost at-home mindfulness practice. Future studies should assess how 4-week MBSR programs may improve cardiovascular health.

Background Women with chronic coronary disease have more frequent angina and worse health status than men, despite having less coronary artery disease (CAD). We examined whether perceived stress and depressive symptoms mediate sex differences in angina, and whether this relationship differs in the setting of obstructive CAD or ischemia with no obstructive coronary artery disease (INOCA). Methods We analyzed the association between sex, stress (Perceived Stress Scale‐4) and depressive symptoms (Patient Health Questionnaire‐8) on angina‐related health status (Seattle Angina Questionnaire [SAQ]) at enrollment in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial and CIAO‐ISCHEMIA (Changes in Ischemia and Angina Over 1 Year Among ISCHEMIA Trial Screen Failures With No Obstructive CAD on Coronary CT [Computed Tomography] Angiography) ancillary study. Results Scores for the SAQ, Perceived Stress Scale‐4, and Patient Health Questionnaire‐8 were available in 1626 participants (N=1439 CAD and N=187 INOCA). Women had lower (worse) SAQ‐7 summary scores than men in both CAD and INOCA cohorts (CAD: median 76 [25th, 75th percentiles 60, 90] versus 83 [70, 96], P<0.001; INOCA: 80 [64,89] versus 85 [75, 93], P=0.012). Higher stress and depressive symptoms were associated with worse angina in both cohorts. Female sex, Perceived Stress Scale‐4 score, and Patient Health Questionnaire‐8 score were each independently associated with lower SAQ summary score, but CAD versus INOCA cohort was not. There was no interaction between sex and stress (−0.39 [95% CI, –1.01 to 0.23]) or sex and depression (−0.00 [95% CI, –0.53 to 0.53]) on SAQ summary score. Conclusions High stress and depressive symptoms were independently associated with worse angina and poorer health status, without interaction with sex with or without obstructive CAD. Factors other than stress or depression contribute to worse health status in women with obstructive CAD or INOCA. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02347215, NCT01471522.

Introduction: Women and men may recover from myocardial infarction (MI) differently. Resilience promotes psychological recovery post-MI but its association with health status, including health-related quality of life, angina frequency, and physical limitations, has been underexplored. Hypothesis: We hypothesized that higher resilience would be associated with better post-MI health status, and that this relationship would be stronger among women compared to men. Methods: We analyzed a cross-sectional sample of adult participants in the Heart Attack Research Program, a longitudinal study of adults post-MI. Resilience was measured with the Brief Resilience Scale (BRS), range 0-6, and dichotomized to low (BRS score <3) and normal/high (BRS score ≥ 3) resilience. We used Wilcoxon rank-sum tests to assess differences in scores of overall health status (Seattle Angina Questionnaire [SAQ-7]) and its 3 domains – angina frequency (SAQ-AF), physical limitations (SAQ-PL), and quality of life (SAQ-QL), by resilience group. We used multivariable linear regression to examine the association between SAQ scores and resilience. Covariates included age, sex (except in sex-stratified analyses), race, ethnicity, BMI, history of diabetes, hypertension, or hypercholesterolemia, and prior history of MI. Results: The study sample included 161 participants, 38% female, 76% white, with a mean age of 63±13 years. Median time from MI to data collection was 37 days, interquartile range [IQR 21-59 days]. Median SAQ7 score was 75 [IQR 57-89], and 19% of participants reported low resilience. Wilcoxon rank-sum tests showed significant differences in SAQ7, SAQ-QL, and SAQ-AF scores among those with low vs normal/high resilience, p=0.002, p=0.001, p=0.006, respectively, but not in SAQ-PL scores (Figure 1). After full adjustment, SAQ7 and SAQ-QL scores were positively associated with resilience (β 0.21, p=0.01 and β 0.25, p=0.003, respectively), but SAQ-AF and SAQ-PL were not (p=0.201 and p=0.184, respectively). When stratified by sex, the associations between SAQ7 and SAQ-QL, and resilience remained significant among female participants (β 0.33, p=0.036 and β 0.33, p=0.030, respectively), but not among male participants. Conclusions: Normal/high resilience was associated with better health status and higher health-related quality of life among this post-MI cohort, and particularly among women. Resilience building interventions may be considered as strategies to improve post-MI recovery.

Introduction: Disparities in sleep are well documented and may increase the risk of poor cardiovascular disease (CVD) outcomes in racial and ethnic minoritized groups. These groups are also more likely to report adverse childhood experiences (ACEs), which can impact sleep. The relationship between ACEs and sleep quality in adults with CVD, including those recovering from myocardial infarction (MI), is underexplored. Objective: To examine the association between ACEs and sleep quality in patients with recent MI. Methods: We analyzed baseline data from an ongoing longitudinal study of adults post-MI. Exposure to five ACEs was assessed (each yes/no): living with someone with chronic illness/disability, mental illness or substance abuse; parental separation/divorce; long-term financial problems. Sleep quality over the past 7 days was assessed with a single item rated 0–10, dichotomized as poor (0–3) vs. fair/good/excellent (4–10). Participants completed validated measures of anxiety, depressive symptoms and perceived stress. We used chi-square tests and linear regression to test associations between ACEs exposure and sleep quality. Results: The 161 participants (36.9% women, 34.4% from racial and ethnic minoritized groups, age 62±13 years) completed questionnaires at median 37.5 days post-MI (IQR=21–61). About half of participants (50.9%) reported ≥1 ACE and 21.7% reported poor sleep; these were somewhat more common among participants from minoritized groups vs. non-Hispanic White adults (≥1 ACE, 60.0% vs. 46.7%, p=0.08; poor sleep, 30.9% vs. 17.1%, p=0.04). Participants from minoritized groups with ≥1 ACE were more likely than those with no ACEs to report poor sleep (45.4% vs. 9.1%, p=0.006). This association was significant after adjusting for sociodemographic (age, sex, race/ethnicity, low income, marital status) and clinical (time since MI, diabetes, hypertension, body mass index) factors (B=-1.683, p=0.03), and was no longer significant when psychological factors (anxiety, depressive symptoms, perceived stress) were added (B=-1.344, p=0.10). There was no difference in poor sleep between non-Hispanic White participants who did vs. did not report ACEs in univariate (18.4% vs. 16.1%, p=0.80) or multivariate analyses (B=-0.054, p=0.91). Conclusions: ACEs exposure was associated with poorer self-reported sleep quality in MI patients from racial and ethnic minoritized groups. This association was mediated in part by effects of ACEs on psychological distress.

Importance:Black and Hispanic patients have high rates of recurrent stroke and uncontrolled hypertension in the US. The effectiveness of home blood pressure telemonitoring (HBPTM) and telephonic nurse case management (NCM) among low-income Black and Hispanic patients with stroke is unknown. Objective:To determine whether NCM plus HBPTM results in greater systolic blood pressure (SBP) reduction at 12 months and lower rate of stroke recurrence at 24 months than HBPTM alone among Black and Hispanic stroke survivors with uncontrolled hypertension. Design, Setting, and Participants:Practice-based, multicenter, randomized clinical trial in 8 stroke centers and ambulatory practices in New York City. Black and Hispanic study participants were enrolled between April 18, 2014, and December 19, 2017, with a final follow-up visit on December 31, 2019. Interventions:Participants were randomly assigned to receive either HBPTM alone (12 home BP measurements/week for 12 months, with results transmitted to a clinician; n = 226) or NCM plus HBPTM (20 counseling calls over 12 months; n = 224). Main Outcomes and Measures:Primary outcomes were change in SBP at 12 months and rate of recurrent stroke at 24 months. Final statistical analyses were completed March 14, 2024. Results:Among 450 participants who were enrolled and randomized (mean [SD] age, 61.7 [11.0] years; 51% were Black [n = 231]; 44% were women [n = 200]; 31% had ≥3 comorbid conditions [n = 137]; 72% had household income <$25 000/y [n = 234/324]), 358 (80%) completed the trial. Those in the NCM plus HBPTM group had a significantly greater SBP reduction than those in the HBPTM alone group at 12 months (-15.1 mm Hg [95% CI, -17.2 to -13.0] vs -5.8 mm Hg [95% CI, -7.9 to -3.7], respectively; P < .001). The between-group difference in SBP reduction at 12 months, adjusted for primary care physician clustering, was -8.1 mm Hg (95% CI, -11.2 to -5.0; P < .001) at 12 months. The rate of recurrent stroke was similar between both groups at 24 months (4.0% in the NCM plus HBPTM group vs 4.0% in the HBPTM alone group, P > .99). Conclusions and Relevance:Among predominantly low-income Black and Hispanic stroke survivors with uncontrolled hypertension, addition of NCM to HBPTM led to greater SBP reduction than HBPTM alone. Additional studies are needed to understand the long-term clinical outcomes, cost-effectiveness, and generalizability of NCM-enhanced telehealth programs among low-income Black and Hispanic stroke survivors with significant comorbidity. Trial Registration:Clinical Trials.gov Identifier: NCT02011685.

BACKGROUND:Caregiving has been associated with high blood pressure in middle-aged and older women, but this relationship is understudied among younger Black women, a population at high risk for hypertension. We examined the associations of caregiving stress and caregiving for high-needs dependents with incident hypertension among reproductive-age women in the JHS (Jackson Heart Study), a cohort of community-dwelling Black adults. METHODS:We included 453 participants, aged 21 to 44 years, with blood pressure <140/90 mm Hg, and not taking antihypertensive medication at baseline (2000-2004). Caregiving stress over the past 12 months was assessed via a single item in the global perceived stress scale. Caregiving for a high-needs dependent status was assessed via a question on hours per week spent caregiving for children (≤5 years or disabled) or older adults. Incident hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or self-report of taking antihypertensive medication at follow-up exams in 2005 to 2008 and 2009 to 2013. RESULTS:Over a median follow-up of 7.4 years, 43.5% of participants developed hypertension. Participants with moderate/high versus no/low caregiving stress had a higher incidence of hypertension (51.7% versus 40.6%). Higher caregiving stress was associated with incident hypertension after adjustment for sociodemographic and clinical factors, health behaviors, and depressive symptoms (hazard ratio, 1.39 [95% CI, 1.01-1.94]). Being a caregiver for a high-needs dependent was not associated with incident hypertension (adjusted hazard ratio, 0.88 [95% CI, 0.64-1.21]). CONCLUSIONS:Higher caregiving stress among reproductive-age Black women was associated with incident hypertension. Hypertension prevention approaches for this high-risk population may include caregiving stress management strategies.

The 24-hour day consists of physical activity (PA), sedentary behavior, and sleep, and changing the time spent on one activity affects the others. Little is known about the impact of such changes on cardiovascular risk, particularly in Asian American immigrant (AAI) women, who not only have a higher cardiovascular risk but also place greater cultural value on family and domestic responsibilities compared to other racial/ethnic groups. The purpose of this study was to evaluate the effects of reallocating 30 minutes of each 24-hour activity component for another on BMI, waist circumference, and blood pressure in AAI women. Seventy-five AAI women completed 7 days of hip and wrist actigraphy monitoring and were included in the analysis (age = 61.5±8.0 years, BMI = 25.5±3.6 kg/m2, waist circumference = 85.9±10.2 cm). Sleep was identified from wrist actigraphy data, and moderate-to-vigorous PA (MVPA), light PA, and sedentary behavior identified from hip actigraphy data. On average, the women spent 0.5 hours in MVPA, 6.2 hours in light PA, 10 hours in sedentary activities, and 5.3 hours sleeping within a 24-hour day. According to the isotemporal substitution models, replacing 30 minutes of sedentary behavior with MVPA reduced BMI by 1.4 kg/m2 and waist circumference by 4.0 cm. Replacing that same sedentary time with sleep reduced BMI by 0.5 kg/m2 and waist circumference by 1.4 cm. Replacing 30 minutes of light PA with MVPA decreased BMI by 1.6 kg/m2 and waist circumference by 4.3 cm. Replacing 30 minutes of light PA with sleep also reduced BMI by 0.8 kg/m2 and waist circumference by 1.7 cm. However, none of the behavioral substitutions affected blood pressure. Considering AAI women's short sleep duration, replacing their sedentary time with sleep might be a feasible strategy to reduce their BMI and waist circumference.

Introduction: Adverse childhood experiences (ACEs) are associated with psychological distress in adulthood and increased cardiovascular disease (CVD) risk. Less is known about these relationships in patients with established CVD. Objective: To examine associations between ACEs and psychological distress and disease-specific health status in adults with recent myocardial infarction (MI). We hypothesized that MI patients with higher ACE exposure will report greater distress and poorer health status with stronger associations in women than men. Methods: We analyzed baseline data from an ongoing longitudinal study of adults post-MI. Five ACEs were assessed: living with someone with chronic illness/disability, mental illness or substance abuse; parental separation/divorce; long-term financial problems. Outcomes were elevated perceived stress (PSS4 ≥6) and depressive symptoms (PHQ2 ≥3) and disease-specific health status (Seattle Angina Questionnaire [SAQ7 summary score]). We used chi-square tests, t-tests and linear regression to test univariate and multivariate associations, overall and by sex. Results: The 143 participants (36.4% women, mean age 61.5 years [SD=13.4]) completed questionnaires at median 40.5 days post-MI (IQR=22-64.5). At least one ACE was reported by 51% of participants (53.8% women vs. 46.2% men, p=0.73). Women had somewhat poorer health status than men (69.2±22.8 vs. 74.5±18.8; p=0.07) but similar rates of elevated stress (64.7% vs. 51.7%, p=0.16) and depressive symptoms (21.6% vs. 16.9%, p=0.51). Women with ≥1 ACE had poorer health status (62.6 vs. 77.1, p=0.01) and higher rates of elevated stress (78.6% vs. 47.8%, p=0.02) and depressive symptoms (32.1% vs. 8.7%, p=0.04) than those without ACEs; there were no associations in men. After adjusting for age, body mass index, time since MI and participation in cardiac rehabilitation, greater ACEs exposure (0-5) was associated with poorer health status in women (B=-7.2, SE=2.4, p=0.005) but not in men (B=1.9, SE=2.2, p=0.38); the association in women was reduced when further adjusting for PSS4 and PHQ2 scores (B=-3.7, SE=2.8, p=0.20), suggesting a possible mediating effect of distress. Conclusions: Higher ACE exposure is associated with greater psychological distress and worse disease-specific health status in women post-MI. These associations were not observed in men despite similar levels of ACE exposure. ACEs screening may help identify women who could benefit from psychosocial support after MI.

Background Psychological well‐being is important among individuals with myocardial infarction (MI) given the clear links between stress, depression, and adverse cardiovascular outcomes. Stress and depressive disorders are more prevalent in women than men after MI. Resilience may protect against stress and depressive disorders after a traumatic event. Longitudinal data are lacking in populations post MI. We examined the role of resilience in the psychological recovery of women post MI, over time. Methods and Results We analyzed a sample from a longitudinal observational multicenter study (United States, Canada) of women post MI, between 2016 and 2020. Perceived stress (Perceived Stress Scale‐4 [PSS‐4]) and depressive symptoms (Patient Health Questionnaire‐2 [PHQ‐2]) were assessed at baseline (time of MI) and 2 months post MI. Demographics, clinical characteristics, and resilience (Brief Resilience Scale [BRS]) were collected at baseline. Low and normal/high resilience groups were established as per published cutoffs (BRS scores <3 or ≥3). Mixed‐effects modeling was used to examine associations between resilience and psychological recovery over 2 months. The sample included 449 women, mean (SD) age, 62.2 (13.2) years, of whom 61.1% identified as non‐Hispanic White, 18.5% as non‐Hispanic Black, and 15.4% as Hispanic/Latina. Twenty‐three percent had low resilience. The low resilience group had significantly higher PSS‐4 and PHQ‐2 scores than the normal/high resilience group at all time points. In adjusted models, both groups showed a decrease in PSS‐4 scores over time. Conclusions In a diverse cohort of women post MI, higher resilience is associated with better psychological recovery over time. Future work should focus on developing strategies to strengthen resilience and improve psychological well‐being for women with MI. Registration URL: https://clinicaltrials.gov/ct2/show/NCT02905357 ; Unique identifier: NCT02905357.

Introduction: While social determinants of health (SDOH) are associated with cardiovascular disease (CVD) risk, limited data exist regarding their interrelated impact on distinct CVD events. Methods: Among 4,164 Black adults in the Jackson Heart Study (JHS) free of prevalent coronary disease (CHD), heart failure (HF), and stroke at baseline (2000-2004), we used consensus clustering - an unsupervised class discovery and validation approach - to identify subgroups of participants based on 9 SDOH measures reflecting the Healthy People 2030 framework: income, education, discrimination, food insecurity, healthy food stores within 1 mile, healthcare access, neighborhood violence, neighborhood disadvantage, and air pollution (PM2.5). We used multivariable Cox proportional hazards models to relate cluster membership to risk of incident CHD, HF, and stroke adjusting for age, sex, hypertension, diabetes, obesity, and chronic kidney disease. Results: Mean age was 55 ± 13 years and 63% were women. We identified 4 participant clusters with differential exposure to SDOH: Cluster 1 (n=1359) had the most favorable SDOH profile with highest income and lowest neighborhood disadvantage and violence; Cluster 2 (n=915) had highest PM 2.5 and lowest frequency of food stores; Cluster 3 (n=998) had lowest education level and highest neighborhood disadvantage and violence; and Cluster 4 (n=820) had lowest income and healthcare access and highest prevalence of food insecurity. Over a median of 11 [IQR 10 - 11] years, 255 participants developed HF, 159 CHD, and 167 stroke. Compared to Cluster 1, Clusters 3 and 4 were associated with higher risk of incident HF while Clusters 2 and 3 were associated with higher risk of stroke ( Figure ). Cluster membership was not associated with risk of CHD. Conclusions: Multiparametric SDOH assessment identifies unique clusters of individuals differentially burdened by individual-level social determinants and at heightened risk for distinct CVD events.

Background: Shift-and-persist (SP), defined as the ability to adapt the self to stressors while preserving focus in the future, is associated with favorable cardiometabolic outcomes. SP may be of great importance to individuals in Puerto Rico (PR) given their disproportionate exposure to social and environmental stressors. However, there is a scarcity of data on SP and cardiovascular health (CVH), and none in PR. This study examined the association between SP and CVH, as measured by the Life’s Essential 8 metric, among young adults in PR. Hypothesis: We hypothesize that greater SP will be associated with higher CVH scores. Methods: Baseline data from the PR-OUTLOOK study were used for this cross-sectional analysis. Young adults (18-29y, 64% women) completed baseline and clinic assessments between September 2020 and September 2022. Those with complete data on CVH were included (n=962). SP was measured with the Chen & Miller scale, with higher scores indicative of greater SP, and categorized in quartiles (SP Q1-Q4). Because dietary data are not yet available, we used questionnaires, anthropometric measurements, and fasting blood samples to calculate an adapted Life’s Essential 8 metric including physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure; thus, actual CVH scores may be lower due to potentially low diet quality scores. Relationships between CVH and SP scores were assessed with multivariable linear regression models. Results: SP was significantly associated with CVH and its components. After adjustment for confounders, individuals in SP Q2-Q4, vs. Q1, had significantly higher total CVH (b=2.81, 95%CI=0.60, 5.03; b=4.68, 95%CI=2.54, 6.82; and b=7.34, 95%CI=4.85, 9.83, respectively) and physical activity CVH-score (b=-11.5, 95%CI=3.96, 19.1; b=11.6, 95%CI=4.27, 18.9; and b=18.6, 95%CI=10.1, 27.1, respectively). Individuals in SP Q3-Q4 also had higher BMI CVH-score (b=8.89, 95%CI=3.10, 14.7; and b=10.4, 95%CI=3.61, 17.1, respectively) than those in Q1. Additionally, those in the SP Q4, vs. Q1, had higher blood lipids (b=7.10, 95%CI=2.24, 12.0), blood glucose (B=3.91, 95%CI=0.41, 7.41), and blood pressure (b=6.23, 95%CI=1.93, 10.5) CVH-scores. Estimates were similar by sex and socioeconomic status. Conclusion: Higher SP scores were associated with higher CVH among young adults in PR. Longitudinal analyses are needed to confirm our results. We need to further understand the potential benefits of SP for CVH and identify strategies to improve SP and promote CVH in underserved populations.