bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP42: Reduction in Dietary Transfat Intake is Associated with Improved Lipid Particle Number in a Primary Prevention Population
Authors: Garshick Michael , Mochari-Greenberger Heidi , Mosca Lori
Published: July 2021

Background:
Recent public policy has focused on elimination of dietary transfats. The extent to which changes in transfat intake correlate with changes in cardiovascular disease (CVD) risk in real world settings is not established. Lipid Particle Number (LPN) is a novel marker of CVD risk and data from the Framingham Offspring Study indicate a doubling of CVD risk among those with LPN values in the highest versus lowest quartile. The purpose of this study was to determine if a decrease in transfat intake is associated with a decrease in LPN in a free living population at risk of CVD.

Methods:
This was a 1 year follow-up study of family members (n = 400, 33% male, 36% racial/ethnic minority, mean age 48 +/- 13) of patients hospitalized with CVD who participated in a 1 year NHLBI sponsored randomized controlled primary prevention lifestyle intervention trial and had complete dietary data and LPN measures at baseline and 1 year. Transfat (% of total kilocalories per day) was assessed by the validated Block Food Frequency Questionnaire and LPN (nmol/L) was measured at a central lab using NMR spectroscopy at baseline and 1 year. Traditional CVD risk factors and potential confounders were assessed by trained research personnel using standardized measures and questionnaires. Change in transfat as a percentage of total diet and mean absolute change in LPN at 1 year was assessed using multivariate adjusted linear regression models.

Results:
Over 1 year 57% (n = 226) of the study population decreased their transfat intake which did not vary significantly by group assignment. There was a significant positive correlation between baseline dietary transfat intake and LPN (p = 0.04). At baseline higher mean LPN was also associated with male sex (p < 0.001), overweight/obesity (≥ 25 kg/m
2
, p < 0.001), waist size (men ≥ 40 inches, women ≥ 35 inches, p < 0.001), HgA1c (≥ 6.5%, p = 0.003), and current smoking (p = 0.01). Over 1 year, for every 1 percent change in transfat intake there was a 27 nmol/L change in LPN (p = 0.04). The association between the change in transfat intake and change in LPN was independent of baseline predictors, confounders, and group assignment (p = 0.03).

Conclusion:
In a free living population at risk of CVD, a reduction in transfat intake over 1 year was significantly associated with a reduction in LPN. These data suggest how improved LPN may be one potential mechanism by which elimination of transfat may confer CVD benefit, and provide insight into the potential for a decrease in transfat intake to decrease the burden of CVD.
Abstract MP87: Major Life Events and Social Strain are Associated with Incident Coronary Heart Disease: Results from the Women’s Health Initiative (WHI)
Authors: Kershaw Kiarri N , Brenes Gretchen , Charles Luenda E , Coday Mace , Daviglus Martha L , Denburg Natalie , Kroenke Candyce , Safford Monika , Savla Tina , Tindle Hilary A , Tinker Lesley F , Van Horn Linda
Published: July 2021

Background:
Despite the longstanding notion that psychosocial stressors are associated with higher CHD risk, findings from epidemiologic studies are mixed. Recent research suggests positive associations may be driven by angina pectoris, a condition more susceptible to reporting bias, rather than MI. We assessed associations of major life events (MLE) and social strain with incident CHD defined as the first occurrence of clinical MI, definite silent MI, or death due to definite or possible CHD. We also examined whether these relationships were mediated by several health behaviors.

Methods:
WHI participants (baseline ages 50-79) with complete data on all covariates were included. Baseline MLE scores were calculated and broken into quartiles based on the occurrence of 11 different life events in the past year and the extent to which each event upset them. Baseline social strain was assessed with four questions and divided into tertiles. Mean follow-up time was 11.2 years. Cox proportional hazard models were used to separately estimate associations of MLE and social strain with incident CHD. Structural equation modeling was used to quantify mediation by health behaviors (current smoking, heavy alcohol use, poor diet, and physical activity) measured at baseline and Year 3.

Results:
Greater MLE and social strain were positively associated with incident CHD. Health behaviors accounted for 30.1% of the association between highest (vs. lowest) MLE category and incident CHD and 23.0% of the high (vs. low) strain-CHD relationship. Current smoking was the strongest mediator for both MLE (23.6%) and strain (16.3%), followed by physical activity (4.6% each) and poor diet (2.1% and 2.6%, respectively).

Conclusions:
We found MLE and social strain were both associated with incident CHD, and that these relationships were mediated by the same set of health behaviors. However, a substantial proportion of these associations were not explained by health behaviors alone, suggesting alternative pathways need to be explored.
Abstract P038: Associations of Plasma Phospholipid and Dietary Alpha Linolenic Acid with Mortality, Coronary Heart Disease and Stroke in Older Adults: The Cardiovascular Health Study
Authors: Fretts Amanda M , Mozaffarian Dariush , Siscovick David , Sitlani Colleen , Psaty Bruce M , Rimm Eric B , Song Xiaoling , McKnight Barbara , Spiegelman Donna , King Irena B , Sacks Frank M , Lemaitre Rozenn
Published: July 2021

Objective:
To examine the association of α-linolenic acid (ALA 18:3n-3), an essential n-3 fatty acid derived from plants and vegetable oils, with mortality, coronary heart disease, and stroke among older adults. Due to the low correlation between dietary and circulating ALA that may reflect differences in diet and metabolism, we evaluated plasma phospholipid ALA and dietary ALA separately.

Methods:
The study population included participants from the Cardiovascular Health Study, a community-based longitudinal cohort of adults aged 65 or older, free of prevalent coronary heart disease and stroke. A total of 2,709 participants comprised the plasma phospholipid analysis group and 4,214 participants comprised the dietary analysis group. Plasma phospholipid ALA, an objective measure of circulating levels of ALA over the past 4-8 weeks, was measured using stored samples from 1992-1993. Dietary fatty acid intake was ascertained using food frequency questionnaires administered in 1989 and 1996. ALA was expressed as percent of total fatty acids and percent of total dietary fat for the plasma phospholipid and dietary analyses, respectively. Cox regression was used to assess the associations of plasma phospholipid and dietary ALA with mortality, and incident coronary heart disease or stroke.

Results:
Dietary ALA and plasma phospholipid ALA were modestly correlated (r=0.18). We found no statistically significant associations of plasma phospholipid ALA with mortality, incident CHD or stroke (table). After adjustment for potential confounders, dietary intake of ALA was associated with a lower risk of total and non-CVD mortality. We found no statistically significant associations of dietary ALA with CVD mortality, incident CHD or stroke (table).

Conclusions:
Results from this prospective cohort study of older adults suggest that dietary, but not plasma phospholipid ALA, is associated with a lower risk of total and non-CVD mortality in older adults.
Abstract P050: Glycated Hemoglobin Versus Fasting Glucose in Defining Metabolic Syndrome and Prediction of Coronary Heart Disease
Authors: Bower Julie K , Nambi Vijay , Lazo Mariana , Rawlings Andreea , Foster Meredith C , Selvin Elizabeth
Published: July 2021

Introduction.
Fasting glucose (FG) is part of the Adult Treatment Panel III (ATP III) criteria for defining the metabolic syndrome (MetS). Glycated hemoglobin (HbA1c) is a measure of 2-3 month endogenous glucose exposure and is now recommended for diabetes diagnosis and screening for high-risk individuals. The aim of this study was to evaluate if replacing FG with HbA1c to define MetS improves prediction of incident coronary heart disease (CHD) in the Atherosclerosis Risk in Communities (ARIC) cohort.

Methods.
We included 11,194 ARIC participants without diabetes (based on diagnosis, medication use, FG ≥126 mg/dL, or HbA1c ≥6.5%) or prevalent CHD at baseline (1990-92). Cox proportional hazards models (adjusted for age, race, and study center) were used to compare the association between MetS defined using HbA1c (5.7-6.4%) or FG (100-125 mg/dL, based on ATP III guidelines) and risk of CHD (defined by myocardial infarction or fatal CHD, event data available through 2009).

Results.
Study participants had a mean age at baseline of 57 years, 43% were male, and 79% were white; median follow-up time was 16 years. Thirty-four percent of the study population had both normal FG (<100 mg/dL) and HbA1c (<5.7%), 37% had elevated FG and normal HbA1c, 4% had normal FG and elevated HbA1c, and 25% had both elevated FG (100-125 mg/dL) and HbA1c (5.7-6.4%). The association of combined FG and HbA1c categories with incident CHD are shown in the Figure. The adjusted hazard ratio predicting for incident CHD from MetS status was 1.43 (95% CI: 1.25-1.63, c-statistic: 0.61) using FG in the definition of MetS and 1.69 (95% CI: 1.48-1.93, c-statistic: 0.62) in the model replacing FG with HbA1c.

Conclusions.
Incorporating HbA1c into the definition of the MetS may help in identifying individuals who should be targeted for aggressive CHD risk factor reduction. Additionally, HbA1c may be useful clinically and in research settings for identifying individuals with MetS in cases where FG measures are not available.
Abstract P055: Changes in Red Meat Consumption and Subsequent Risk of Type 2 Diabetes: Three Cohorts of US Men and Women
Authors: Pan An , Sun Qi , Manson JoAnn E , Willett Walter C , Hu Frank B
Published: July 2021

Introduction:
Red meat consumption has been consistently associated with an increased risk of type 2 diabetes (T2D). However, it remains largely unknown whether changes in red meat intake are related to subsequent T2D risk.

Methods:
We followed 26,358 men in the Health Professionals Follow-up Study (HPFS, 1986-2006), 48,710 women in the Nurses’ Health Study (NHS, 1986-2006) and 74,077 women in NHS II (1991-2007). Diet was assessed by validated food frequency questionnaires and updated every 4 years. Incident T2D was confirmed by a validated supplementary questionnaire. Time-dependent Cox proportional hazard models were used to calculate relative risks (RRs) for changes in red meat consumption during a 4-year interval in relation to risk of T2D in the subsequent 4 years, with adjustment for age, family history, race, marital status, initial red meat consumption, initial and changes in other lifestyle factors (physical activity, smoking status, alcohol intake, and dietary quality). The results in the three cohorts were pooled by inverse-variance-weighted random-effects meta-analyses.

Results:
During 1,965,911 person-years of follow-up, we documented 7,521 incident T2D cases. In the multivariate-adjusted models, increasing red meat intake during a 4-year interval was associated with an increased risk of subsequent 4-year T2D risk in each cohort (all P-trend <0.001), and the pooled RR for one serving/d increment of red meat consumption was 1.30 (95% CI: 1.23, 1.38). The RR was attenuated to 1.20 (95% CI: 1.13, 1.27) after adjustment for baseline body mass index and concurrent weight change. We found significant interaction between initial red meat consumption and changes in red meat consumption with the subsequent risk of T2D; among participants with initial low (<2 servings/wk) or moderate (2-6 servings/wk) levels of red meat consumption, an increase of one serving/d during a 4-year interval was related to an elevated risk of incident T2D in the subsequent 4 years, and the pooled RR was 1.99 (95% CI: 1.47, 2.70) and 1.51 (95% CI: 1.25, 1.81), respectively. However, the association was much weaker (pooled RR 1.16; 95% CI: 1.05, 1.27) in individuals with high initial red meat consumption levels (≥1 serving/d), and the association was not linear in the HPFS and NHS II.

Conclusions:
Increasing red meat consumption over time is associated with an elevated subsequent risk of T2D, and the association is partly mediated by body weight changes. The association also depends on the initial red meat consumption levels. Our results add further evidence that limiting red meat consumption over time can confer benefits on diabetes prevention.
Abstract P058: Impact of Comorbid Hypertension and Obesity on Glycemic Control in Adults with Type 2 Diabetes Mellitus from a National Representative US Population
Authors: Chen Shih-Yin , Chuang Chien-Chia , Wu Sophia , Quon Nicole
Published: July 2021

BACKGROUND:
Type 2 diabetes mellitus (T2DM) is a concerning epidemic, and sub-optimal glycemic control could lead to higher risk of complications and needs for additional care. Hypertension and obesity are common comorbid conditions, yet their impact on glycemic control has not been quantified. We hypothesize that comorbid hypertension and/or obesity are associated with a higher likelihood of uncontrolled glycemic level.

METHODS:
Data from a nationally representative sample of US population participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were analyzed in a cross-sectional retrospective observational study. Adults aged 20 years or older with self-reported diabetes and anti-diabetes medication use were included. Pregnant women were excluded. T2DM was defined by excluding diabetes patients who were diagnosed before age 30 and took only insulin. Uncontrolled hypertension was defined as blood pressure of ≥130 mmHg (systolic) or ≥80 mmHg (diastolic) based on American Diabetes Association’s guidance for hypertension in diabetes patients. Obesity was determined if body mass index ≥30 kg/m
2
. Uncontrolled glycemic level was defined as HbA1c ≥7%. We estimated the prevalence of uncontrolled hypertension and obesity among T2DM patients. Rates of uncontrolled glycemic level were reported and compared by uncontrolled hypertension and/or obesity status using Chi-square tests. Population weights were applied to account for multi-stage sampling design to produce nationally representative estimates.

RESULTS:
After applying the population weights to the 2,203 respondents with T2DM, findings from these respondents were extrapolated to an estimated 15.4 million T2DM patients in the US (prevalence of T2DM=7.4%), of which 61.1% were obese. Among US T2DM patients, the prevalence of uncontrolled hypertension was 52.6%. Among US T2DM patients, the prevalence of patients who had uncontrolled hypertension and who were obese was 31.2%. No statistically significant differences were found in uncontrolled glycemic level rates between those with and without uncontrolled hypertension (44.0% vs. 41.0%; p=0.31). Obese patients had a statistically significant higher rate of uncontrolled glycemic level than non-obese (44.5% vs. 37.9%; p=0.03). T2DM patients with comorbid uncontrolled hypertension and obesity had a statistically significant higher rate of uncontrolled glycemic level than the rest of the T2DM patients (47.1% vs. 40.0%; p=0.02).

CONCLUSIONS:
Prevalence of uncontrolled hypertension and obesity was high in US adults with T2DM. Obese patients, especially those who had uncontrolled blood pressure, had sub-optimal glycemic control. Interventions targeting these patients should be considered.
Abstract P066: Associations Between Coronary Artery Calcium and HDL Particle Characteristics in MESA Participants with Very-High Levels of HDL Cholesterol (>80mg/dL)
Authors: Wilkins John , Stone Neil , Liu Kiang , Mackey Rachel , DeGoma Emil , Rader Daniel , Burke Greg , LLoyd-Jones Donald M
Published: July 2021

Despite the inverse association between HDL-C and CHD risk across HDL-C values of 20-80mg/dL CHD risk persists in people with very-high levels of HDL-C (> 80mg/dL). These risks may be explained by traditional risk factors and by structural and functional polymorphisms in HDL particles in people with HDL-C >80mg/dL. In Multi-Ethnic Study of Atherosclerosis (MESA) participants with HDL-C >80mg/dL we assessed differences in traditional risk factors and NMR-spectroscopy-derived (NMR) HDL particle characteristics between individuals with and without CAC. We included MESA participants with HDL-C values > 80mg/dL (not on niacin, fibrates, or statins), traditional risk factor and CAC data at baseline exam. We examined the associations between HDL-C, NMR data (HDL particle number, particle size, and the concentrations of large, medium and small-HDL particles and in
post hoc
analysis ratios of particle size concentrations) and baseline CAC > 0 in separate logistic regression models. We included 269 participants in the analysis, 105 had prevalent CAC. Individuals with CAC>0 were older, had higher fasting blood glucose, higher carotid IMT; there were more men, more people taking blood pressure lowering medications, and more with diabetes as well. There were no significant differences in mean values of traditional lipid fractions between groups, however individuals with CAC>0 had a lower concentration of medium-sized HDL particles and a higher ratio of large to medium HDL particle concentration. There were no significant associations between NMR HDL characteristics and CAC> 0 after multivariable adjustment. In
post hoc
analysis there was a significant adjusted association between the ratio of large to medium sized HDL particle concentration and the presence of CAC>0 (OR [95% CI]: 1.86 [1.15, 3.00]). In conclusion, participants with CAC and very-high HDL-C had a higher burden of traditional risk factors. However, the ratio of particle size concentrations may help differentiate those with HDL>80mg/dL who are at risk for CAC as well.
Abstract P096: Excess Sodium and Inadequate Potassium Dietary Intake by Italian Children and Adolescents: Results of the MINISAL Survey
Authors: Campanozzi Angelo , Avallone Sonia , Galeone Daniela , Strazzullo Pasquale
Published: July 2021

Introduction:
The MINISAL survey aimed to assess the age-, gender- and region-specific habitul sodium and potassium intake and its association with relevant anthropometric characteristics in a national sample of Italian healthy children and adolescents referred to centers recognised by the Italian Society of Gastroenterology and Pediatric Nutrition.

Methods:
The study population included 1422 6 to 18 yrs. old subjects from ten regions. Main anthropometric indexes, blood pressure (BP) and 24h urinary sodium and potassium excretion (as proxy for habitual sodium and potassium intake) were measured using carefully standardised procedures.

Potentially incomplete 24h collections were identified and excluded from the analysis based on values of urinary creatinine/Kg body weight and/or a urinary volume below the 5
th
percentile of the overall distribution. The analysis was carried out upon stratification by gender (M=788, F=644), puberal age category: <9 yrs, 9-11 yrs. and 5 months, >11 yrs. and 5 mo. (male); < 8 yrs., 8-10 yrs. and 2 mo., > 10 yrs. and 2 mo. (female), and scholar age category: 6-10 yrs., 11-13 yrs. and 14-18 yrs (both male and female participants).

The relationships among body weight, sodium, potassium and creatinine excretion were analysed using Z-scores as an index of body mass.

Results:
The 24h sodium and potassium excretion were higher in male than in female participants (respectively, 130±63 vs 119±56 mmol; p=0.001 and 39±18 vs 37±16 mmol; p=0.003).

Upon stratification by puberal age and gender, 24h urinary sodium and potassium excretion were respectively 109±54 and 36±19 mol in category 1, 134±60 and 40±16 in category 2 and 152±69 and 43±17 in category 3 for male subjects (p<0.01); 98±39 and 33±13 in category 1, 105±45 and 34±13 in category 2 and 137±63 and 40±18 mmol in category 3 for female individuals (p<0.05).

The expected gender difference in 24h urinary creatinine was observed in all age categories (p<0.05).

Male individuals had consistently greater sodium, potassium and creatinine excretion than female individuals (p between <0.001 and <0.05).

Upon stratification of the study population in four body weight categories (BMI Z-score <0, 0 to <0,9, 1 to <1,9 and ≥2), 24h sodium excretion was significantly greater in obese compared to normal weight children.

24h potassium excretion was also greater in obese children and adolescents compared with their normal weight counterparts (p=0.002).

No significant difference was observed in either sodium or potassium excretion by geographical area.

Conclusions:
The MINISAL survey indicates a substantial age-, gender- and body mass-related variation with average values of sodium intake definitely high when related to true physiological needs or to the “adequate intakes” defined by the health institutions. By contrast, the habitual potassium intake was relatively low and such to indicate an inadequate fruit and vegetable consumption.
Abstract P146: Association of Discriminatory Experiences on Sedentary Behaviors: The Coronary Artery Risk Development in Young Adults Study (CARDIA)
Authors: Womack Veronica Y , Puterman Eli , Van Horn Linda , Siddique Juned , Loucks Eric B , Sternfeld Barbara , Carnethon Mercedes
Published: July 2021

Background:
Sedentary behaviors such as television viewing or “playing games on the computer” are associated with obesity and increased cardiovascular risk. Little is known about the relationship between sedentary behaviors and adverse social contexts, particularly discriminatory experiences.
Objective:
To explore the cross-sectional relation of sedentary behavior and adverse social contexts in a large sample of middle-aged black and white men and women.

Methods:
Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study with measures of discriminatory experiences and sedentary behaviors from the Year 25 exam in 2010 were included in the analysis (n=3,267). Participants were coded as experiencing discrimination if they responded yes to feeling discrimination based on gender, race, SES, or weight. The primary outcome variable, sedentary behavior, was defined by self-report as the overall number of hours per week spent in 6 behaviors: watching television, using the computer for non-work activities, listening to music, reading, talking on the phone, or texting. Linear regression was used to model the association of discrimination with sedentary time adjusted for age, race, gender, education and traditional CHD risk factors.

Results:
Participants were 50.2 years old (SD= 3.6), average time spent in sedentary behavior was 6.95 hrs/ day (SD=3.7), and 55% of the participants reported 1+ discriminatory experiences. In the full sample, there was a marginally significant positive relationship between discriminatory experiences and sedentary behavior (β=0.27, SE=0.3, p=.06), whereby participants who reported discrimination spent more time in sedentary behavior than those who did not report discrimination independent of demographic and traditional cardiovascular risk factors. Black participants spent more time sedentary than White participants (8.33 (SE=4.16) hrs/day vs. 5.78 (SE=2.75) hrs/day; p<.01), however, discriminatory experiences were only associated with sedentary behaviors among White participants (β=0.27, SE=0.1, p<.05). There were no differences in the relationship of discriminatory experiences with sedentary behavior by gender.

Conclusions:
The association of discriminatory experiences with sedentary behaviors was only present among White participants in the study. Future research should investigate other psychosocial factors that may be negatively associated with sedentary behaviors among Black Americans.
Abstract P152: Obesity Susceptibility Loci and Longitudinal BMI from Adolescence to Young Adulthood in an Ethnically Diverse Cohort
Authors: Graff Mariaelisa , North Kari E , Richardson Andrea S , Young Kristin L , Mohlke Karen L , Lange Leslie A , Lange Ethan M , Harris Kathleen M , Gordon-Larsen Penny
Published: July 2021

Genome-wide association (GWA) studies have identi[[Unable to Display Character: ﬁ]]ed nearly 50 common variants for obesity, many of which influence body mass index (BMI), a common proxy for obesity assessed in large epidemiological studies.

The associations of these variants with change in BMI across the life course are not well understood, but are of particular interest during the transition from adolescence to young adulthood, a high risk period for weight gain. The current study assessed the association of 41 established obesity SNPs with change in BMI during the period between adolescence and young adulthood in an ethnically diverse, nationally representative cohort, the National Longitudinal Study of Adolescent Health, followed for 13 years. Race/ethnicity-stratified linear mixed models accounted for sampling design, family relatedness, and repeated measures of BMI. Models included a SNP-by-year interaction term and adjusted for sex, age at baseline, current smoking, and geographic region. Analyses included 6383

European American (EA), 2252 African American (AA) and 1700 Hispanic American (HA) participants with measurements from 1996 (ages 12-21 y) to 2008 (ages 24-34 y), with an average of 2.6 observations per individual. For analyses in AA we excluded SNPs (n=14) that failed to capture signal of functional variant in a recent African

American population genome-wide association study (Monda et al 2012). Average BMI gain over the 13-year period was 4.9 (SD=5.0) kg/m
2
, with higher increases in AA 5.8 (SD=5.7) kg/m
2
and HA 5.5 (SD=5.6) kg/m
2
. Model results for the 41 SNPs in EA and HA and 27 SNPs in AA suggest that SNP by year interactions show nominal significance (p<0.05) for 12 SNPs in EA, 2 SNPs in HA and 1 SNP in AA. After correction for multiple testing (n=41 tests, p<0.0012), 1 SNP remained significant for EA (rs2287019, near
QPCTL
) and none in AA or HA. Each effect allele for rs2287019 contributed an increase of 0.030(SE=0.009) kg/m
2
per year to BMI in EA. These findings suggest that the locus near
QPCTL
and possibly other obesity loci play a role in the trajectory of BMI across the period from adolescence to young adulthood, a period with high risk for subsequent adult obesity. These findings may help inform the biological processes that influence weight gain at this vulnerable period of the life cycle and may provide information that is useful for the design of effective interventions to prevent weight gain.
Abstract P175: Frozen Single Serving Meals at Lunch Result in Reduced Blood Pressure and Cholesterol
Authors: Reimers Kristin , Yu Zhiping , Sinnett Stephanie , Nguyen Von , Rippe James
Published: July 2021

Weight loss improves cardiovascular disease (CVD) risk profile, and strong evidence demonstrates that consuming smaller portions leads to weight loss. When prepared portion-controlled meals are compared to conventional meals as part of an overall weight-loss diet, results of clinical trials of up to one year in duration show greater and more sustained weight loss in those participants who consumed prepared single-serving meals. However, little is known about the effect of replacing just one conventional meal per day with a portion-controlled single-serving meal and no other dietary intervention. We assessed the hypothesis that replacing a typical cafeteria or restaurant hot lunch with a commercially available, frozen, single-serving meal would result in improved cardiovascular profiles. Thirty-five otherwise healthy overweight and obese participants (mean BMI 31.4 ± 3.1) ages 20-55 years were recruited from the community. They consumed and recorded, via duplicate plate method, their usual cafeteria or restaurant lunch for three days. For 30 days thereafter, participants replaced their typical lunches with commercially prepared single-serving meals (Healthy Choice®). They were asked to otherwise maintain their usual eating and exercise habits. Body weight, blood pressure, total cholesterol and LDL-cholesterol were measured at baseline and after completion of the 30-day intervention. In conjunction with weight loss (200.5 ± 32.0 lb. at baseline vs. 197.7 ± 31.1 lb. post intervention, p < 0.01), reductions in systolic and diastolic blood pressure (113.8 ± 12.8 vs. 109.3 ± 10.9 mmHg systolic, p < 0.05, and 76.0 ± 8.7 vs. 74.6 ± 8.0 mmHg diastolic, NS), serum total cholesterol (188.9 ± 29.1 vs. 176.1 ± 25.6 mg/dl, p < 0.01), and LDL-cholesterol (115.5 ± 26.7 vs. 108.8 ± 22.9 mg/dl, p < 0.001) resulted. These preliminary findings from a short-term study support the conclusion that consuming frozen single-serving meals at lunch provides a potential strategy for overweight and obese adults to reduce body weight, systolic blood pressure and LDL-cholesterol, primary risk factors for CVD.
Abstract P176: Pedometer Feedback - Superior for Increasing Daily Physical Activity in Cardiac Rehabilitation Patients
Authors: Kaminsky Leonard , Ozemek Cemal , Riggin Katrina , Byun Wonwoo , Strath Scott
Published: July 2021

Introduction:
Although cardiac patients obtain favorable cardiovascular outcomes and reduced risk of mortality when participating in cardiac rehabilitation (CR), it is well established that most do not typically achieve recommended amounts of daily physical activity (PA) solely through participation in CR. Therefore, the purpose of this study was to examine the relative effectiveness of three different individually tailored interventions designed to increase PA in cardiac patients attending CR.

Hypothesis:
We assessed the hypothesis that cardiac patients attending long-term CR who receive pedometer feedback (PF) or motivational messaging (MM) will achieve higher levels of PA than patients who receive usual care (UC) recommendations.

Methods:
A total of 99 (77 men and 22 women, 61.5±10.6 years, BMI 30.6 ± 5.1 kg/m2) patients entering a long-term CR program completed a 12-week PA intervention. Patients were randomized to: UC (time-based recommendation), PF, MM, or PF with individualized MM (PF+MM). Both PF groups were given a goal of increasing step counts/day by 10% of the individual’s baseline value each week. If the goal for the week was not reached, the same goal was used for the next week. PA was assessed for 7 days with Kenz Lifecorder PLUS monitors (Suzukan, Co, LTD, Nagoya, Japan) prior to beginning CR and on the 12
th
week of the intervention. Criteria for acceptable PA data were daily wear time > 10 hours on a minimum of 4 days (including at least 1 weekend day) with daily PA > 1000 steps.

Results:
A two-way ANOVA for change in PA from baseline to 12
th
week of the intervention for the 4 groups revealed a significant time and group interaction. Post-hoc testing showed significant increases for both PF and PF+MM, however, no significant change for UC or MM.

Conclusion:
The findings from this study demonstrate that using PF feedback is superior to the usual time-based recommendations patients are given in CR. CR programs can assist patients in increasing their daily PA by encouraging pedometer use with individualized step goals.
Abstract P272: Association of Small Molecule Metabolic Intermediates that Predict Cardiovascular Mortality with Peak VO2 in a Heart Failure Population
Authors: Kraus William E , Donahue Mark P , Shah Svati H , Whellan David J , Hellkamp Anne , O’Connor Christopher M , Felker G. M
Published: July 2021

Blood-borne small metabolic intermediates have been associated with disease severity and major adverse coronary events (MACE), including mortality alone, in a cardiovascular disease population. Specifically, short chain dicarboxylacylcarnitines (SCDC), long chain dicaboxylacylcarnitines (LCDC) and long neutral amino acids (LNAA) have been the strongest and most consistent diagnostic and predictive metabolic markers in our CATHGEN cohort. HF-ACTION was a randomized controlled trial of exercise training versus usual care in patients with chronic heart failure (HF) due to left ventricular systolic dysfunction (n=2331). In the study, baseline peak VO
2
was the most significant predictor of mortality in the this population (
X
2
=153). We hypothesized that small molecule blood-borne metabolic intermediates would be associated with peak VO
2
in HF-ACTION. Peak VO
2
was measured using a standard protocol across 82 centers and quality control was ensured in a core laboratory. We measured 15 amino acids and 45 acylcarnitines from baseline plasma samples in 447 individuals in the Duke Stedman Metabolomics Laboratory. The 60 metabolites were reduced into 13 independent factors using principal components analysis that accounted for a total of 43.8% of the total variance in these sample analytes. We assessed the ability of metabolite factors to predict baseline peak VO
2
in the presence of covariates modeled as significant predictors in previous published work in this population (age, gender, race, region, BMI, diabetes, PVD, NYHA Class, LVEF, ventricular conduction and test modality—bicycle or treadmill). Five metabolite factors were significant predictors of peak VO
2
, the three strongest being SCDC (estimate in SD factor score per mL/kg/min (VO
2
) = -1.004; p-value=0.002), LNAA (0.583; p=0.003); and LCDC (-0.903; p=0.008). The direction of change with increased peak VO
2
(related to decreased mortality in HF-ACTION) were consistent with the relation of metabolites to decreased mortality in CATHGEN. Thus, three classes of metabolic intermediates that are associated with MACE in a cardiovascular cohort study also were associated with functional capacity (peak VO
2
). To the best of our knowledge this is the first description of molecular metabolic biomarkers that independently related, even with our strongest clinical variables in the model, to functional capacity in HF. These metabolic intermediates may be functionally related to the reductions in functional capacity in HF and therefore serve as potential targets for new diagnostics or therapeutic interventions.
Abstract P301: Age Differences in the Association between Waist-to-height Ratio and Risk of Cardiovascular Disease: The Suita Study
Authors: Tatsumi Yukako , Watanabe Makoto , Kokubo Yoshihiro , Nishimura Kunihiro , Okamura Tomonori , Okayama Akira , Miyamoto Yoshihiro
Published: July 2021

Introduction:
Waist-to-heightratio (WHtR) has been shown to be useful global screening tool forcardiovascular disease (CVD) in the recent meta-analysis. The impact of WHtR on the risks of CVD by age is not well known.

Hypothesis:
We assessed whether the association between WHtR and the risks of CVD was different by age categories.

Methods:
This study is a population-based cohort study in an urban area of Japan. Study participants comprised 5,488 Japanese urban residents (2,600 men and 2,888 women) aged 30-83 years with no history of CVD. At baseline (1989–1994), waist circumference was measured at the umbilical level and height with bare feet was measured. WHtR was calculated as waist circumference (cm) divided by height (cm). The criteria of myocardial infarction were based on the WHO Monitoring of Trends and Determinants in Cardiovascular Disease Projects. In addition to myocardial infarction, we also evaluated coronary angioplasty, coronary artery bypass grafting and sudden cardiac death, all of which were defined as coronary heart disease (CHD). A stroke was defined according to criteria from the US National Survey of Stroke and confirmed by computed tomography. We stratified participants by sex and age groups (30–49, 50–69 and 70–83 years). The Cox proportional hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CVD according to the quartiles of WHtR were calculated after adjustment for age, smoking and drinking status.

Results:
During the follow-up period (13.0 years in average), 428 CVD events (184 CHD and 244 strokes) were observed. Men with the highest quartile of WHtR aged 50–69 years had significantly increased the risks of CVD and CHD, compared with the lowest quartile; the HRs (95% CIs) were 1.81 (1.13–2.90) and 2.47 (1.17–5.20), respectively. There were statistically significant linear increases in the HRs of CVD (
p
for trend =0.01), CHD (
p
for trend =0.02) and cerebral infarction (
p
for trend =0.03) in this group. Women with the highest quartile of WHtR aged 50–69 years had significantly increased the risks of stroke; the HRs (95% CIs) was 2.43 (1.01–5.84). There were statistically significant linear increases in the HRs of CVD (
p
for trend =0.04) and stroke (
p
for trend =0.04) in this group. However, the similar results were not observed in the other age groups in both sexes. We observed a significant interaction between age groups and WHtR categories for the risks of CVD in men (
p
for interaction=0.02).

Conclusions:
The association between WHtR and CVD was different among age groups. WHtR could be useful to predict the risks of CVD in middle aged men and women.
Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Glasser Stephen P , Khodneva Yulia , Lackland Daniel , Prineas Ronald , Safford Monika
Published: July 2021

Objective:
The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death.

Methods:
REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors.

Results:
The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}).

Conclusion:
In this sample, preHTN may be associated with incident CHD among women but not men.
Abstract P337: Dietary Intakes of Rice, Bread, Pasta, Potatoes and Blood Pressure: The International Study of Macro/Micro-nutrients and Blood Pressure (INTERMAP)
Authors: Sakurai Masaru , Oude Griep Linda M , Daviglus Martha , Garside Danniel B , Van Horn Linda V , Miura Katsuyuki , Nakagawa Hideaki , Ueshima Hirotsugu , Chan Queenie , Elliott Paul , Stamler Jeremiah
Published: July 2021

Background:
Previous population-based cross-sectional studies have reported modest inverse relations of dietary starch intake and blood pressure (BP). However, studies that have evaluated associations of BP with starchy foods, e.g., rice, potatoes, pasta, bread, are limited.

Objective:
Data from INTERMAP were used to assess relations between consumptions of starchy foods and BP.

Methods:
INTERMAP is a cross-sectional epidemiologic study of 4,680 persons ages 40 to 59 years from 17 random population samples in China, Japan, United Kingdom (UK), and United States of America (USA). BP was measured 8 times; data on food and supplement use were obtained from 4 standardized in-depth multi-pass 24-hour dietary recalls and 2 timed 24-hour urine collections. Differences in BP for each food intake higher by two standard deviations (SD) were estimated by multivariable linear regression (2 SD values: rice: 177, pasta: 56, potatoes: 65, bread: 40, sum of these four: 177 g/1,000 kcal). Adjustment for possible confounders was performed sequentially; for age, gender, sample; plus dietary and other lifestyle factors.

Results:
Rice intake higher by 2SD was associated with systolic/diastolic BP differences of -1.38 /-0.79 mm Hg (p <0.05 and p = 0.08) adjusted for age, gender, and sample. After further adjustment for dietary and other lifestyle factors, these associations were attenuated to -0.36 mm Hg for systolic BP (p = 0.61) and -0.28 mm Hg for diastolic BP (p = 0.55). Cross-country heterogeneity was detected for the associations between rice intake and systolic BP: inverse for Japan, China, and USA; direct for UK. Consumption of other starchy foods were not significantly associated with BP. After adjustment for age, gender, and sample, 2SD difference for the sum of these 4 starchy foods was associated with significant systolic/diastolic BP differences of -1.17/-0.84 mm Hg (p <0.05 for both); associations were not significant with adjustment for dietary and other lifestyle factors.

Conclusions:
Modest inverse associations were observed with BP and intake of rice and the sum of the four most common starchy foods in four countries. Higher consumption of these starchy foods may contribute modestly to lower blood pressure levels in other populations, and thereby potentially confer preventive benefits regarding hypertension and cardiovascular disease.
Abstract P344: Statin Therapy Does not Increase the Risk for a Medically-Treated Fall
Authors: Knight Stacey , May Heidi T , Horne Benjamin D , Anderson Jeffrey L , Muhlestein Joseph B
Published: July 2021

Background:
It has been suggested that taking statins may increase the risk of a fall due to myopathy. However, studies have reported contradictory evidence regarding the association between statin use and fall risk. The purpose of this study was to determine whether taking statins increases the risk of falls in patients undergoing a coronary angiography.

Methods:
The study population was a subset subjects from the Intermountain Heart Collaborative Study (n=1011). A subject was considered as taking statins if they were discharged with statins and had record of a filled statin prescription (n=810); they were considered as not taking statins if they had no prior statin use, were not discharged with statins, and had no record of a filled statin prescription (n=203). Electronic medical records were queried to determined medically treated falls (ICD-9: E8850-E8869; E888x) within 5 years of their angiography. Univariate association testing between falls and cardiovascular medications, co-morbidities, and demographic factors were done. Multivariate Cox regression analysis was used to test the association between statin use and fall risk while adjusting for the other factors found to be associated with fall risk in the univariate analyses.

Results:
Of the 1011 subjects, 112 (11%) had at least one medically-treated fall within 5 years. In the univariate analyses, statin use (p=0.024), age (p<0.001), sex (p=0.001), hypertension (p=0.040), diabetes (p<0.001), history of atrial fibrillation (AF) (p<0.001), and coumadin use (p=0.009) were associated with falls. Even after adjustment by other risk factors, statin use was associated with a decrease risk of a fall (HR=0.62; 0.40, 0.94). The factors conferring the most risk of a fall were diabetes, AF, and age (Table 1).

Conclusions:
Statin use was associated with a 1.6-fold decreased risk for a medically-treated fall. This suggests that clinicians may not need to caution patients taking statins regarding an increase risk of falls.
Abstract P370: Association of Coronary Calcium on Non-gated 6mm Chest CT with Mortality
Authors: Dominguez Arturo , Allison Matthew , Wassel Christina L , Rifkin Dena , Morgan Cindy , Wright Michael , Criqui Michael , Ix Joachim
Published: July 2021

Background:
Coronary artery calcification (CAC) predicts cardiovascular disease (CVD), but imaging to measure CAC is not covered by most insurance providers. Standard 6mm non-gated chest computed tomography (CT) is commonly performed for other clinical indications. Our objective was to compare the association between CAC scores on 3mm ECG gated cardiac CT to standard 6mm non-gated chest CT with risk of death.

Methods:
Between 2000-03, 4,544 community-living individuals self-referred for “whole body” CT scans had both a 3mm gated cardiac CT and 6mm non-gated chest CT and were followed for mortality through 2009. In this nested case-control study, we selected 173 cases who died, and age and gender frequency matched controls. CAC was scored by the Agatston method on both scans. Unconditional logistic regression determined odds of mortality.

Results:
The mean age was 68 years and 37% (257 of 691) were women. Spearman correlation of CAC scores between 6mm non-gated chest CT and 3mm gated cardiac CT was 0.79 (p 300 compared to the 3mm gated cardiac CTs. Compared to those without CAC, those with CAC >300 on 6mm non-gated CT scans were at 2.8-fold greater odds of mortality, while those with CAC >300 on 3mm gated CT scans had 1.8-fold greater odds in adjusted models (Table). As a continuous predictor (per 1SD higher Ln[CAC+1]), each SD higher CAC score had 1.50-fold (95% CI 1.20, 1.88) greater odds of death on 6mm chest CT and 1.27 (1.04, 1.55) on 3mm cardiac CT.

Conclusions:
CAC scores on non-gated 6mm chest CT are strongly correlated with 3mm gated cardiac CT and provide similar information about mortality risk. If confirmed, the many chest CTs done for other clinical purposes may provide valuable information on CVD risk.