bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P084: Associations of Anger and Hostility with the Metabolic Syndrome: Cross-sectional Analyses from the Jackson Heart Study
Authors: Williams Janice E , Wyatt Sharon B , Sims Mario , Mosley Thomas H , Dubbert Patricia M , Payne Thomas H
Published: July 2021

There is evidence that anger and hostility are positively associated with the metabolic syndrome. In turn, the metabolic syndrome mediates the association between anger and hostility and adverse cardiac events. Very little is known about these associations in African-American populations. We assessed the hypothesis that anger and hostility are positively associated with the metabolic syndrome in an African-American cohort. Participants were 2,732 African-American men and women, ages 45 – 95, who were enrolled in the Jackson Heart Study at baseline. Anger was measured using the Spielberger State-Trait Anger Inventory, and hostility was measured using the Cook-Medley Hostility Scale. The metabolic syndrome was defined by the National Cholesterol Education Program, Adult Treatment Panel III criteria. Overall anger, components anger-in and anger-out, and hostility scores were entered into separate logistic regression models as continuous variables. In models adjusted for age, sex, educational level, and physical activity, higher levels of overall anger (β = 0.024, p = 0.006), anger-in (β = 0.028, p = 0.04), anger-out (β = 0.037, p = 0.04), and hostility (β = 0.021, p = 0.04) were associated with an increased prevalence of the metabolic syndrome. The correlation between anger and hostility was statistically significant but not strong (r = 0.38, p <0.0001). In men, 5 of the 16 individual anger items were significantly associated with the metabolic syndrome. The strongest was “I lose my temper” (β = 0.395, p = 0.003) and “I tend to harbor grudges” (β = 0.314, p = 0.008). In women, only 1 anger item, “I make sarcastic remarks” (β = 0.189, p = 0.04) was associated with the metabolic syndrome. In conclusion, higher levels of overall anger, anger-in, anger-out, and hostility were associated with an increased prevalence of the metabolic syndrome in middle- and older-aged African-American men and women. In men, an angry temperament and a tendency to hold grudges were particularly strong correlates of the metabolic syndrome. Increased understanding of the negative emotions anger and hostility among African-Americans may provide greater insights into cardiovascular disease risk in their population.
Abstract P091: Temporal Trends in Incidence of Acute Myocardial Infarction and Revascularization in People With and Without Mental Illness
Authors: Bresee Lauren , Tonelli Marcello , Manns Braden , Hemmelgarn Brenda
Published: July 2021

Objective:
The objective of this study was to evaluate the temporal trends in the incidence of acute myocardial infarction (AMI) and receipt of revascularization procedures in people with and without mental illness.

Hypothesis:
Individuals with mental illness will have higher rates of AMI, and lower rates of revascularization compared to people without mental illness.

Methods:
We did a population-based study using provincial administrative data from April 1, 1998 until March 31, 2009. We identified individuals 20 years of age and older as having mental illness (psychotic disorder [PD] or mood disorder [MD]) based on physician billing claims and hospitalization data, and compared them to those without mental illness by this definition. We identified incident AMI using a validated algorithm applied to hospitalization data. We used procedure codes to identify receipt of cardiac catheterization, coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA) in those with incident AMI. Rates were age-adjusted using the 2001 Canadian census population to perform direct standardization. Relative change over time was calculated by comparing rates in 2009 to rates in 1998.

Results:
A total of 3,639,480 subjects were included, of whom 576,411 (15.8%) had a mood disorder only, 38,116 (1.0%) had a psychotic disorder only, and 72,430 (2.0%) had both a MD and PD. People with MD were more likely to be female, whereas those with PD were older, than the other mentally ill and non-mentally ill populations. Incidence of AMI was highest in people with PD (210 per 100,000 in 2009) and lowest in people without mental illness (160 per 100,000 in 2009), however, incidence of AMI decreased over time in all groups. Use of catheterization decreased over time in people with MD (19% relative decrease) and PD (25% relative decrease), while increasing in people without mental illness (10.8% relative increase). Use of PTCA increased in all groups except people with PD (21.1% relative decrease).

Conclusions:
Incidence of AMI decreased over time in people with and without mental illness, however, people with mental illness consistently had a higher incidence of AMI compared to individuals without mental illness. Use of catheterization and PTCA increased in people without mental illness while decreasing in people with PD over the study period.
Abstract P092: Sexual Self-Perception and Adjustment of Cardiac Patients: A Psychometric Analysis
Authors: Steinke Elaine E , Mosack Victoria , Hill Twyla J
Published: July 2021

Introduction:
The psychological impact of a cardiac event includes feelings of sexual inadequacy, poor sexual quality, and less sexual satisfaction. Few studies have examined sexual self-perception of cardiac patients. Aim: Validate the Sexual Self-Perceptions and Adjustment Questionnaire (SSPAQ) in cardiac patients.

Methods:
Mailed questionnaires sent to those previously hospitalized during a 1-year period with specific cardiac diagnoses (336 respondents). The SSPAQ was developed and significantly revised from another instrument, adding 5 items (total 30 items), rewording double barreled/redundant items, and making response sets more understandable. Subscales included sexual anxiety, depression, self-efficacy, and satisfaction. The scale-level content validity index was 0.97. Statistical analyses: correlation matrices for item representativeness of underlying factors, and construct validity with confirmatory factor analysis and with known groups, comparing sexually active to not active using t-tests.

Results:
After item analysis, 28 items were retained, 7 per subscale; Chronbach's alpha were >0.90, indicating item appropriateness for the combined scale (0.97). Using confirmatory factor analysis, factor loadings showed items were related to the 4 latent factors. For sexual anxiety, depression, and self-efficacy, loadings were above 0.60, and sexual satisfaction had 1 loading of 0.54, but all other loadings were above 0.70, suggesting subscales were reliable and valid. Construct validity comparing sexually active to inactive showed those not active had significantly lower sexual self-perception (
Table
).

Conclusions:
The SSPAQ is reliable and valid for measuring sexual anxiety, sexual depression, sexual self-efficacy, and sexual satisfaction, and overall sexual perception and adjustment. The instrument may be useful in both research and clinical settings to further assess cardiac patient adaptation, allowing better assessment of this aspect of sexual quality of life.

Sexual Self-Perception & Adjustment Factors and Sexual Activity

Factor
Not Sexually Active

Sexually Active

T-test

Mean
SD
Mean
SD

Sexual Anxiety (R=7-35)
17.71
7.52
13.81
6.04

3.45
**

Sexual Depression (R=7-35)
21.36
6.08
14.65
6.33

6.20
***

Sexual Self-Efficacy (R=7-35)
19.88
7.16
26.38
5.77

−5.42
***

Sexual Satisfaction (R=7-35)
18.37
6.18
25.84
5.87

−6.19
***

Total Sexual Self-Perception(R=28-140)
85.00
22.10
108.85
20.52

−5.12
***

**

p<.01

***

p<.001 Higher scores= more of subscale attribute; total=greater self-perception
Abstract P117: Elevated Liver Transaminases are Associated with an Increased Risk of Atrial Fibrillation
Authors: Sinner Moritz F , Wang Na , Fontes Joao D , Rienstra Michiel , Magnani Jared W , Vasan Ramachandran S , Calderwood Audrey H , Pencina Michael J , Sullivan Lisa M , Ellinor Patrick T , Fox Caroline S , Benjamin Emelia J
Published: July 2021

Background:
For the management of an initial episode of atrial fibrillation (AF), guidelines recommend assessment of liver function tests; nonetheless, the rationale and supporting evidence for the recommendation remain unclear. We tested the hypothesis that elevated liver transaminases, assessed by alanine transaminase (ALT) and aspartate transaminase (AST) are associated with the incidence of AF in a community-based cohort.

Methods and Results:
From the Framingham Heart Study Original and Offspring cohorts we investigated 3779 participants (mean age 65±10 years, 56.8% females). After up to 10 years of follow-up (29,099 person years), 383 individuals developed AF. We used Cox proportional hazards models to assess the association between liver transaminases and AF incidence, and adjusted the model for established AF risk factors and alcohol consumption. Both ALT and AST showed significant association with incident AF (Table). When we excluded participants with moderate / severe alcohol consumption, the associations for ALT and AST remained consistent (Table). Additional adjustment for C-reactive protein (inflammatory marker) only mildly lowered the effect estimates for both transaminases, but decreased the level of significance (Table). We additionally estimated the ability of transaminasess to predict AF risk. When assessed by the continuous net reclassification improvement, both ALT and AST marginally improved AF risk prediction [ALT: 0.18 (95% confidence interval, 0.07-0.29; p=0.002); AST: 0.16 (95% confidence interval, 0.04-0.28; p=0.003)].

Conclusions:
Higher mean levels of ALT and AST, are associated with the incidence of AF, even when adjusted for various established AF risk factors. However, transaminases contribute only subtly towards an improvement in AF risk prediction. Pathophysiologic mechanisms explaining the association are uncertain and merit further investigation.
Abstract P125: Eating Behaviour Profiles of Severely Obese People Differ in Regard to Gender and Hypertension Status
Authors: Bonneville Nadine , Martin Julie , Auclair Audrey , Bastien Marjorie , Provencher Véronique , Poirier Paul
Published: July 2021

INTRODUCTION:
The prevalence of severe obesity has tripled in Canada in the past few decades. Nevertheless, cognitions and eating behaviours in this population have not been extensively studied as for their relationships with anthropometric characteristics and comorbidities. Therefore, the aim of this study was to link 3 factors related to cognitions and eating behaviours: restraint, disinhibition and susceptibility to hunger, according to gender, body composition and hypertension (HTA) status.

HYPOTHESIS:
Cognitive and behavioural profiles of severely obese people differ in regard to gender and HTA status.

METHODS:
A total of 125 severely obese people [Body Mass Index (BMI) of ≥ 40 or ≥ 35 kg/m
2
with comorbidities] were recruited through the bariatric surgery clinic of our institution. They were invited to complete a validated French version of the Three-Factor Eating Questionnaire (51-items). Weight, fat-free mass, and body fat mass of participants were measured using a bioelectric impedance balance and HTA status was recorded.

RESULTS:
Participants were 41 ± 10 years, weighted 133.9 ± 27.4 kg with a BMI of 48.7 ± 7.6 kg/m
2
, a lean mass of 66.0 ± 14.1 kg, a fat mass of 32.6 ± 17.9 kg and a fat percentage of 50.3 ± 5.7%. Age and BMI were similar between men and women, but men’s weight, body fat, and fat-free mass were higher than in women. In the entire cohort, a negative correlation was observed between susceptibility to hunger and fat mass (r=-0.273; p=0.035). In men, positive correlations were observed between restraint vs. weight (r=0.394; p=0.016) and BMI (r=0.459; p=0.004). In women, negative correlations were observed between restraint vs. weight (r=-0.215; p=0.044) and lean mass (r=-0.278; p=0.009), while positive correlations were observed between disinhibition vs. weight (r=0.211; p=0.049) and fat mass (r=0.215; p=0.044). Overall, 56% (70/125) of all participants showed HTA. A greater proportion of participants with a higher restraint score suffered from HTA than in participants presenting a lower restraint score (67 vs. 48%; p=0.027). Restraint profile also differed between women suffering with HTA vs. without HTA (p=0.008). A greater proportion of participants showing a lower disinhibition score suffered from HTA than those with a higher disinhibition score (64 vs. 48%; p=0.051).

CONCLUSION:
Higher score of susceptibility to hunger observed in severely obese individuals is linked to a lower body fat mass. Despite similar eating behaviour profiles, different associations coexist according to gender between restraint vs. disinhibition factors and anthropometric characteristics. Among women, those suffering with HTA present a higher level of restraint, but lower disinhibition score. These findings in severely obese people differ from actual literature in overweight and obese people.
Abstract P144: Smoking, Menthol Cigarettes and Peripheral Arterial Disease in the 1999– 2004 National Health and Nutrition Examination Survey (NHANES)
Authors: Jones Miranda R , Apelberg Benjamin J , Navas-Acien Ana
Published: July 2021

Introduction:
Cigarette flavorings, with the exception of menthol, have been banned under the Family Smoking Prevention and Tobacco Control Act. Previous studies have found strong associations between active smoking and peripheral arterial disease. While there is substantial interest in evaluating the health effects of menthol as compared to regular cigarette use, no information is available on the influence of cigarette type (non-menthol or menthol) on the risk of peripheral arterial disease.

Objective:
To investigate the association of cigarette smoking, menthol cigarette use and the prevalence of peripheral arterial disease in US adults

Methods:
We studied 5,978 adults 40 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999–2004. Information on participant smoking status and cigarette type were derived from self-reported questionnaire data. Peripheral arterial disease was defined as an ankle-brachial blood pressure index <0.9 in at least one leg.

Results:
The weighted prevalence of peripheral arterial disease in the study population was 4.9%. Fifty percent of participants were never smokers compared to 31%, 14% and 5% of former, current non-menthol and current menthol cigarette smokers, respectively. After adjustment for demographics and cardiovascular risk factors, the odds ratio for peripheral arterial disease was 1.98 (95% CI: 1.41, 2.80), 5.24 (95% CI: 3.41, 8.05), 3.37 (95% CI: 1.86, 6.10) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. After further adjustment for pack-years and serum cotinine, the odds ratio for peripheral arterial disease was 1.44 (95% CI: 0.97, 2.15), 3.65 (95% CI: 1.57, 8.50) and 2.51 (95% CI: 1.09, 5.80) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. The significant association between smoking and peripheral arterial disease was similar for smokers of non-menthol and menthol cigarettes (p-value for heterogeneity= 0.53).

Conclusions:
In a representative sample of the US population, current menthol cigarette use was associated with increased prevalence of peripheral arterial disease with no difference compared to smoking non-menthol cigarettes.
Abstract P154: Association of Coronary Calcium Score with Cardiovascular Risk Factors in African Americans: The Jackson Heart Study (JHS)
Authors: Smith Che L , Yeboah Joseph , Sims Mario , Harman Jane L , Terry J G , Crump Mary E , Doherty Michael , Carr J J , Taylor Herman A
Published: July 2021

Background:
It remains unclear if individuals with low Framingham risk score (FRS) could benefit from coronary artery calcium (CAC) screening for coronary heart disease (CHD) risk, especially in African Americans (AA) who have a lower prevalence of CAC and in whom the FRS is less robust. The CAC score has previously been shown to independently predict hard events in AA men and women. We assessed the association of CAC with cardiovascular risk factors and its distribution by the FRS categories in AA who were part of the Jackson Heart Study (JHS).

Methods:
CAC was measured with non-contrast cardiac CT in 2944 participants between April 2007 and February 2010 in the JHS, a NHLBI-funded cohort study of AA based in Jackson, MS. Participants were dichotomized based on the presence or absence of CAC. FRS was calculated based on 10 year risk for each participant and categorized as low (<10%), intermediate (10–20%) and high (>20%). Multi-variable linear and logistic regression analyses were used to estimate the associations of CAC with cardiovascular risk factors by FRS categories in AA.

Results:
The mean age of the cohort is 60 years, 65% were females, 26% had diabetes mellitus, 50% were obese (BMI≥30) and 30% were current or former smokers. Participants with CAC were significantly older (mean age 65 vs. 55 years, p<0.0001), had high mean SBP (131 vs.124mmHg, p<0.0001) and had lower HDL. Males were more likely to have CAC compared with females [odds ratio (95% CI): 1.50(1.29 – 1.75), p<0.0001], current and former smokers were also more like to have CAC compared with never smokers [OR (95%CI): 2.24(1.75 – 2.89), p<0.006 and 2.10(1.73 – 2.55), p<0.002 respectively]. Diabetics were more likely to have CAC compared with non diabetics [OR (95%CI): 3.27(2.70 – 3.96), p<0.0001]. Total cholesterol and BMI were not different among subjects with CAC or without CAC. The distribution of CAC stratified by FRS groups of low, intermediate and high 10 year risk of CHD results in mean [median, range] CAC scores of 132.3 [0, (0–3884)], 101.8 [0, (0–5498)] and 315.1 [33.8, (0–10801)] and CAC prevalence of 39.7%, 42.1%, and 65.8%, respectively. After adjusting for age, gender, smoking status, systolic blood pressure and diabetes status, subjects with high FRS were about 3 times as likely to have CAC compared with subjects in the intermediate or low risk category [OR(95%CI): 2.92(2.41 – 3.51), p<0.0001]. Individuals with intermediate FRS had similar rate of CAC compared with low FRS individuals.

Conclusion:
CAC in AA is strongly associated with traditional CV risk factors. Interestingly, AA with low and intermediate FRS have similar amounts and prevalence of CAC. This finding suggests that further refinement of traditional CHD risk models, such at FRS, may allow improved prediction of CHD and better targeting of prevention in the AA community.
Abstract P206: Control of Cardiovascular Risk Factors among Diabetic Patients in an Outpatient Setting
Authors: Holland Ariel T , Zhao Beinan , Wong Eric C , Choi Sarah , Wong Nathan D , Palaniappan Latha P
Published: July 2021

Background:
Previous studies have shown that cardiovascular risk factors among Hispanic and Black patients with type 2 diabetes are poorly controlled, but no studies have been conducted in Asian American populations.

Objective:
To examine racial/ethnic differences in control of cardiovascular risk factors in patients with type 2 diabetes across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), compared to Non-Hispanic Whites (NHWs) in a multi-specialty healthcare organization in California.

Methods:
Electronic health records of 12,804 active primary care Asian American (n=4,594) and NHW (n=8,210) patients, ages 35 years and older, with type 2 diabetes were examined from 2007-2009. Diabetes was classified through ICD-9 codes, abnormal laboratory values, or use of anti-diabetic medications. Sex-age directly standardized prevalence rates and multivariate adjusted odds ratios (OR) were calculated for attainment of the following cardiovascular risk factor goals: glycosylated hemoglobin (A1C) < 7%, blood pressure (BP) < 130/80 mmHg, and low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, and simultaneous control (A1C, BP, and LDL-C). ORs were calculated accounting for race/ethnicity, age, sex, BMI, insurance, and number of clinic visits.

Results:
The ranges of standardized goal attainment rates among Asian American subgroups and NHWs were as follows: A1C (58.5% in Filipinos to 75.3% in Vietnamese), BP (39.9% in Vietnamese to 53.4% in Chinese), LDL-C (50.3% in Koreans to 65.5% in Asian Indians), and simultaneous control (18.1% in Filipinos to 24.8% in Chinese). After adjusting for patient characteristics, Asian Americans had significantly lower odds of A1C goal attainment (OR=0.76, 95% CI: 0.69-0.85), and higher odds of LDL-C goal attainment (1.17, 1.05-1.29), compared to NHWs. Among Asian subgroups, Asian Indians, Filipinos, Japanese and Koreans had significantly lower odds of goal attainment for A1C, compared to NHWs. Asian Indians (OR= 1.15, 95% CI: 1.01-1.32) and Chinese (1.28, 1.12-1.46) had significantly higher odds of goal attainment for BP, compared to NHWs. Odds of LDL-C goal attainment were also significantly higher for Asian Indians (1.29, 1.11-1.49) and Filipinos (1.19, 1.01-1.39), compared to NHWs.

Conclusion:
Among our type 2 diabetes patients, Asian Americans have worse control of A1C, despite better control of LDL-C and BP, compared to NHWs. There is also significant heterogeneity in control of cardiovascular risk factors among Asian American subgroups. Optimal simultaneous goal attainment was seen in a small proportion of diabetes patients. Achieving goals for cardiovascular risk factors is difficult and health care providers may need to alter their treatment focus for different racial/ethnic groups.
Abstract P214: Adherence to Dietary Patterns after Gestational Diabetes Mellitus and Risk of Subsequent Type 2 Diabetes
Authors: Tobias Deirdre K , Hu Frank , Chavarro Jorge , Rosner Bernard , Mozaffarian Dariush , Zhang Cuilin
Published: July 2021

Background:
Adherence to healthful dietary patterns is associated with lower risk of type 2 diabetes (T2DM) in the general population. Women with a history of gestational diabetes mellitus (GDM) are at particularly high risk for future type 2 diabetes (T2DM), though relations of dietary patterns with incident T2DM in this population are unknown. Hypothesis: We hypothesize that adherence to healthful dietary patterns among women with prior GDM is inversely associated with incident T2DM.

Methods:
We evaluated 4,413 participants from the Nurses' Health Study II longitudinal cohort with a history of GDM in one or more pregnancies. GDM was ascertained by self-report of a physician's diagnosis and has been previously validated in a subsample with confirmation of over 90% by medical record review. Participants were free of chronic disease at baseline and followed from 1991 through 2007. Dietary pattern adherence scores were derived for the alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and the alternate Healthy Eating Index (aHEI) based on validated food frequency questionnaires assessed after GDM and updated every 4 years thereafter. Incident T2DM was assessed every 2 years through previously validated questionnaire responses. Multivariable Cox proportional hazards models estimated the relationship of each dietary pattern with incident T2DM, adjusting for age, total energy intake, parity, age at first birth, race/ethnicity, parental history of T2DM, oral contraceptive use, menopausal status, and smoking status. Body mass index (BMI) was included in a subsequent model.

Results:
There were 491 cases of incident T2DM over 52,743 person-years of observation. In multivariable analyses, the aMED, DASH, and aHEI dietary patterns were each inversely associated with incident T2DM. For each 1 standard deviation increase in score, the aMED pattern was associated with a 24% lower risk (HR=0.76 [95% CI: 0.67, 0.86] p<0.0001), DASH with an 18% lower risk (HR=0.86 [95% CI: 0.73, 0.92] p=0.0005), and aHEI with a 30% lower risk (HR=0.70 [95% CI: 0.61, 0.79] p<0.0001). Further adjustment for BMI moderately but not completely attenuated these findings: (aMED: HR=0.85 [95% CI: 0.75, 0.97] p=0.014; DASH: HR=0.91 [95% CI: 0.80, 1.02] p=0.11; aHEI: HR=0.84 [95% CI: 0.73, 0.96] p=0.009).

Conclusions:
Adherence to healthful dietary patterns is associated with a lower incidence of T2DM among women following a diagnosis of GDM, and may be partially mediated by BMI. These findings have implications for prevention efforts in this high-risk population.
Abstract P219: Plasma Uric Acid and Risk of Type 2 Diabetes: The Influence of a Uric Acid Related Dietary Pattern and Metabolic Risk Factors
Authors: Sluijs Ivonne , Beulens Joline W , van der A Daphne L , Spijkerman Annemieke M , Schulze Matthias B , van der Schouw Yvonne T
Published: July 2021

Background:
Current evidence suggests a positive relation of uric acid with diabetes risk, but it is still unclear whether this association is independent of other risk factors such as obesity and diet.
Objective:
To investigate whether plasma uric acid concentrations are independently associated with incident type 2 diabetes, and to investigate the role of a uric acid related dietary pattern in this association.

Methods:
We used a case-cohort study, nested in the European Prospective Investigation into Cancer and Nutrition - Netherlands (EPIC-NL) study. The study included 2318 subcohort members and 845 incident diabetes cases, with a mean follow-up of 10 years. At baseline, blood samples were taken and diet was assessed using a validated food frequency questionnaire. A dietary pattern was obtained with reduced rank regression. Diabetes was mainly self-reported, and verified against general practitioner records.

Results:
Mean plasma uric acid concentrations were 275 and 217 µmol/L for males and females respectively. After adjustment for age, sex, measures of adiposity, hypertension, biochemical markers and other confounders, uric acid related to a statistically significant higher risk of diabetes (HR 1.59 [95%CI: 1.06, 2.40]). A uric acid related dietary pattern (high: alcohol, meat , French fries, sugared soft drinks, snacks, low-fibre bread, low: soy products, tea) did not influence the relation.

Conclusions:
This study supports that high uric acid concentrations increase risk of diabetes, independent of risk factors such as obesity and diet.
Abstract P237: Common Genetic Variation in Caspase Enzymes and Survival of Sudden Cardiac Arrest
Authors: Johnson Catherine O , Lemaitre Rozenn N , Sotoodehnia Nona , McKnight Barbara , Rice Kenneth M , Hesselson Stephanie , Kwok Pui-Yan , Siscovick David S , Rea Thomas D
Published: July 2021

Background:
Reperfusion following ischemia due to sudden cardiac arrest (SCA) is necessary for survival, but results in additional injury to affected tissues. Regulation of apoptosis has been shown to be important in determining the extent of reperfusion injury. Caspases (CASP) are essential enzymes in the apoptotic cascade and we therefore hypothesized that genetic variation in these enzymes might influence cardiac and brain resuscitation after SCA. To test this, we examined three genes (CASP2, CASP3, CASP9) in a population-based study of SCA survival.

Methods:
Subjects (mean age 67, 80% male, of European descent) were out-of-hospital SCA patients found in ventricular fibrillation (VF) and attended by paramedics in King County, WA (n=1614). To investigate cardiac resuscitation, we compared subjects who survived to hospital admission (n=827) with those who did not (n=787); for brain resuscitation, we compared subjects who survived to hospital discharge (n=448) with those who did not (n=1166). Associations of 19 SNPs were examined using logistic regression comparing each additional copy of the minor allele. Based on
a priori
hypotheses, models were adjusted for: age; gender; time from 911 call to arrival of emergency medical services; whether the event was witnessed; occurred in public; and whether bystander CPR was administered. We used within-gene permutation tests to adjust p-values for multiple comparisons.

Results:
Two SNPs in CASP3 were associated with SCA survival. The A allele of rs4647688 (minor allele frequency (MAF) 0.20) was associated with lower rates of survival to hospital admission (OR (95% CI), adjusted p-value: 0.78 (0.65, 0.93),
p
=0.043). The T allele of rs2705897 (MAF 0.26) was associated with a higher rate of survival to hospital admission (1.27 (1.07, 1.51),
p
=0.049). These two SNPs are in almost complete linkage equilibrium (r
2
=0.091). No SNPs in CASP3 were significantly associated with survival to hospital discharge, and no SNPs in CASP2 or CASP9 were significantly associated with either outcome.

Conclusions:
CASP3 variants are associated with SCA survival in this population. Further work is needed to explore the effect of these variants on regulation of apoptosis during reperfusion following VF arrest, and to replicate these findings in other populations.
Abstract P238: Long-Term Survival Trends in Hospitalized Heart Failure Patients
Authors: Smith Lindsay G , Adabag A. Selcuk , Berger Alan K , Luepker Russell V
Published: July 2021

Background:
Long-term survival data on patients with heart failure (HF) in community-based populations are limited. Preserved ejection fraction (PEF) is present in 50-60% of HF patients. We examined whether trends in long-term survival differed between HF patients with preserved (ejection fraction >/= 45) and reduced ejection fraction (REF) in the context of modern treatment.

Methods:
The Minnesota Heart Survey, a community-based population study conducted in the Minneapolis-St. Paul metropolitan area, abstracted a random sample of hospital records for patients aged 35-84 with a discharge diagnosis of HF in 1995 and 2000. In the absence of a gold standard diagnosis of HF, hospitalization records that met at least four of six published classification algorithm definitions were considered HF related. Mortality was ascertained from medical records and by linkage to death certificates from the Department of Health. Kaplan-Meier was used for unadjusted survival and Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR).

Results:
In 1995 1269 HF patients (PEF, n = 423; REF, n = 846) and in 2000 1103 HF patients (PEF, n = 413; REF, n = 690) were identified. The prevalence of hypertension, diabetes mellitus and hyperlipidemia were significantly higher in 2000; the utilization of ACE-Inhibitors, beta-blockers and revascularization were also significantly greater in 2000. In 1995, the unadjusted 9-year survival was 21% in REF and 28% in PEF; in 2000 these numbers were 28% in REF and 29% in PEF (Figure). After adjustment for sex and age the HR for 9-year mortality in 1995 was 0.77 (95% CI: 0.68 - 0.89) for HF patients with PEF compared to REF, p = 0.0003; in 2000 the adjusted HR for 9-year mortality in patients with PEF compared to REF was 0.95 (95%CI: 0.82 - 1.10), p = 0.48.

Conclusion:
Survival after a HF related hospitalization is low with less than 30% of patients surviving nine years. The increased utilization of ACE-Inhibitors and beta-blockers may partially explain the improved survival among HF patients with REF.
Abstract P250: Incidence of Hospitalized Peripheral Arterial Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Kalbaugh Corey A , Kucharska-Newton Anna , Loehr Laura , Selvin Elizabeth , Folsom Aaron R , Chambless Lloyd E , Heiss Gerardo
Published: July 2021

Introduction:
Lower extremity peripheral arterial disease (PAD) affects between 12% and 20% of Americans over the age of 65. PAD compromises quality of life, contributes a high burden of disability and its related health care costs exceed $4 billion/year, yet this preventable CVD outcome remains understudied.

Aims:
Assess the incidence of hospitalized PAD, and of the most severe form of PAD, critical limb ischemia (CLI), in middle-aged men and women, and evaluate their risk factors in a bi-ethnic, population-based cohort. We hypothesized that incidence of hospitalized PAD and CLI are higher in African Americans, and that modifiable atherosclerosis risk factors in middle age predict these sequelae of PAD.

Methods:
We analyzed data from 13,865 participants from the Atherosclerosis Risk in Communities Study aged 45–64 without PAD at baseline (1987–89). Incident PAD and CLI events were identified using ICD-9 codes from active surveillance of all hospitalizations among cohort participants from 1987 through 2008. All estimates are incidence rates per 10,000 person-years; nominal statistical significance was achieved for all baseline characteristic comparisons reported.

Results:
There were 707 incident hospitalized PAD during a median of 18 years of follow-up (249,570 person-years). The overall age-adjusted incidence of PAD and limb-threatening CLI were 26.0 and 9.6 per 10,000 person-years, respectively. Incidence of hospitalized PAD was higher in African Americans than whites (34.7 vs. 23.2) and in men compared to women (32.4 vs. 26.7). Baseline characteristics associated with age-adjusted incident PAD (per 10,000 person-years) compared to their referent groups were diabetes (91.2 vs. 19.0), history of smoking (33.6 vs. 16.2), hypertension (42.6 vs. 18.6), coronary heart disease (81.4 vs. 24.1), and obesity (41.5 vs. 20.2). Incidence of CLI also was higher among African Americans (21.0 vs. 5.9) and in men (10.5 vs. 8.9 per 10,000 person-years). Baseline characteristics associated with incident CLI were similar to those for PAD.

Conclusions:
The absolute risk of hospitalized lower extremity PAD in this community-based cohort is of a magnitude similar to that of heart failure and of stroke. As modifiable factors are strongly predictive of the long-term risk of hospitalized PAD and CLI, particularly among African Americans, our results highlight the need for effective risk factor prevention and control.
Abstract P265: Physical Activity is Inversely Associated with Multimorbidity in Men: Results from the Population-Based KORA-Age Augsburg Study
Authors: Autenrieth Christine S , Kirchberger Inge , Heier Margit , Zimmermann Anja , Peters Annette , Thorand Barbara , Döring Angela
Published: July 2021

Background:
The co-occurrence of two or more chronic diseases in one individual, commonly known as multimorbidity, has become a major public health problem among the elderly. Physical activity has proven to be an essential means to mitigate chronic morbidity and disability. Therefore, we hypothesized that physical activity was inversely associated with multimorbidity. Currently, epidemiological studies addressing this research question are lacking.

Methods:
Using data from 1,007 men and women aged 65–94 years who participated in the population-based KORA-Age project conducted in Augsburg/Germany and two adjacent counties in 2009, thirteen chronic conditions were identified through a standardized telephone interview and a self-administered questionnaire. Physical activity scores were calculated based on the self-reported physical activity scale for the elderly (PASE), comprised of occupational, household and leisure activity items. Sex-specific logistic regression adjusted for age, BMI, education, and nutritional status was applied to determine the relation of the continuous physical activity score and multimorbidity (yes/no).

Results:
Multimorbidity was prevalent in 62.3% and 68.5% for men and women, respectively. Physical activity (mean PASE score ± SD) was higher in men (125.1 ± 59.2) than in women (112.2 ± 49.2). Among men, the OR for multimorbidity was 0.57 (95% CI: 0.41–0.78) for a 100-unit increase in the PASE score. No significant results could be observed for women (OR: 1.17; 95% CI: 0.73–1.89) (p-value for sex interaction=0.271). Additional analyses of physical activity quartiles showed that the effect among men were mainly observed in the highest quartile versus the lower ones (Figure 1).

Conclusion:
Our data suggest an inverse association between physical activity and multimorbidity in men, but not in women. Physical activity may counteract the development or progression of chronic diseases in men; further large population-based studies are needed to explore the possible sex-differences.
Abstract P274: Predictive Value of the International Physical Activity Questionnaire of the Aerobic Capacity in Sedentary Hypertensive Women.
Authors: Bravo Miguel , Romero Tomás , Romero Camila X , Koch Elard , Sandoval Daniela , Gatica Sebastián , Ahlers Ivonne , HenrÍquez Oscar , Garrido Javiera
Published: July 2021

Background:
There is consensus in the value of assessing and counseling hypertensive patients in reference to their physical activities (PA). The International Physical Activity Questionnaire (IPAQ) is a commonly used instrument to asses the energy expenditure (EE) through different domains of daily activity.
Objectives:
The main purpose of this study was to assess the relation of self-reported PA through the IPAQ and the aerobic capacity using oxygen consumption (VO
2
) measured directly in hypertensive sedentary women.

Methods:
Cross-sectional study in a simple random sub-sample of 64 hypertensive women between 35 and 55 years old, without physical limitation or coronary event. PA was evaluated using the Spanish version of the IPAQ to assess the energy expenditure (EE) and PA intensity (moderate or vigorous) in different domains (work, transport, domestic, leisure). VO
2
peak was measured directly, breath to breath (Fitmate Pro®), at a submaximal (85% [85 of 100] maximal heart rate) exercise test with 25 watt/3 min load increments in a bicycle ergometer.

Results:
Mean age was 48.4±5.2 years. Measured peak VO
2
was 16.5±2.6 mL/Kg/min with a predicted VO
2
max of 23±3.7 mL/Kg/min, both corresponding to a sedentary level. The greater proportion of EE was observed in work and domestic domains in contrast to leisure activities that had the lowest. Over 50% (1 of 2) of the PA was done at moderate intensity. Peak VO
2
showed a direct correlation with total EE, work and domestic, and finally, with the cost in PA done at moderate intensity.

Table.

Relationship between self-reported PA (IPAQ) and direct measurements of VO
2

Domain or PA type IPAQ

EE (MET-min/week)
*

EE(%)
†

Pearson's Correlation coefficient

VO
2
peak (ml/Kg/min)

p-value

IPAQ total
3,613 (1,976 - 5,589)
−
0.539
0.001

Work
358 (0 - 2,230)
25.4
0.577
0.001

Transport
396 (89 - 795)
15.5
−0.103
0.542

Domestic
1,465 (893 - 2,520)
47.1
0.385
0.018

Leisure
153 (0 - 664)
13.1
−0.011
0.950

Moderate
1,672 (978 - 3,275)
57.4
0.560
0.001

Vigorous
0 (0 - 1,216)
12.8
0.249
0.136

*

Data expressed as median (percentiles 25 and 75)

†

Percentage of mean EE of the domain or PA type according to total EE.

Conclusion:
In sedentary hypertensive women self reported PA

using IPAQ is predominantly related to domestic and work activities at moderate intensity. Work, and domestic EE or moderate intensity global PA correlated well with the peak VO
2
directly measured during a sub maximal exercise

test. Thus, IPAQ appears as an adequate instrument to assess the EE of hypertensive patients and its impact on their aerobic capacity.
Abstract P287: Sex Differences in Stroke Incidence: The REGARDS Study
Authors: Howard Virginia J , Judd Suzanne E , Letter Abraham J , Kleindorfer Dawn O , McClure Leslie A , Safford Monika M , Rhodes James D , Cushman Mary , Moy Claudia S , Soliman Elsayed S , Kissela Brett M , Howard George
Published: July 2021

Background:
There are strikingly few national data available to describe sex differences in age-specific stroke incidence.

Methods:
REGARDS is a national, population-based, longitudinal study of black and white participants aged > 45 years old, with oversampling of blacks and residents of the stroke belt. Between 2003 and 2007, 30,239 participants were enrolled and examined; follow-up is every 6 months by telephone for self- or proxy-reported stroke, with retrieval and adjudication of medical records by physicians. This analysis included 27,756 participants with follow up data who had no physician-diagnosed stroke at baseline. Stroke incidence rates were calculated as the number of stroke events divided by the person-years at risk with 95% confidence limits. Proportional hazards models were used to assess the race-specific association of sex with stroke risk by age strata (<65, 65–74, and 75+) after adjustment for socioeconomic factors, and Framingham stroke risk factors.

Results:
There were 613 incident strokes events over 135,551 person-years of follow-up. Stroke incidence rates increased with age (from 237/100,000 to 1003/100,000), and were higher in men than women in both blacks and whites (left panel of figure). After multivariable adjustment, men had higher risk than women at younger ages (<75) but for the 65–75 age group, the difference is larger for blacks than whites (right panel of figure).

Discussion:
These national data confirm the patterns in male/female stroke risk observed in the Greater Cincinnati/Northern Kentucky Stroke Study, with smaller sex differences at older ages, and for men, larger excess risk in whites than blacks.
Abstract P292: The Economic Burden To Medicare Of Stroke Events In Atrial Fibrillation Populations With And Without Treatment
Authors: Patel Aarti A , Ogden Kristine , Veerman Mark , Mody Samir , Nelson Winnie W , Neil Nancy
Published: July 2021

Purpose:
About 2.3 million in the US have atrial fibrillation (AF), a diagnosis which confers a 5-fold increased stroke risk. Prevention is paramount as AF-related strokes are often severe. Anticoagulation reduces the annual incidence of stroke in AF patients by 30–40%. However, anticoagulation is prescribed for only about half of appropriate AF patients. More strokes may be prevented with wider use of anticoagulation therapy. This study estimates the economic burden to Medicare of stroke events in AF cohorts, and the estimated economic implications of stroke reduction associated with increased anticoagulant prophylaxis among moderate to high risk stroke patients.

Methods:
We used a microcosting model to estimate the annual economic burden of ischemic and hemorrhagic strokes in a hypothetical Medicare AF population who were candidates for anticoagulation. The hypothetical AF population of 1,000 included 45% untreated, 10% on antiplatelet and 45% on anticoagulation therapy. AF prevalence, stroke risk (based on CHADS
2
) and stroke risk-reduction were adjusted for age (≥ 65 yrs), comorbidities and anticoagulation/antiplatelet status. Annual incremental stroke-related healthcare costs were drawn from published literature and adjusted to 2010 US$.

Results:
The base case model estimated 132 ischemic strokes (21 fatal) and 49 hemorrhagic strokes (19 fatal) generating an estimated $12.25 million in stroke-related healthcare costs to Medicare. Keeping all other variables constant, a 10% increase in anticoagulant use from the untreated population would reduce ischemic stroke events by 12 (to 120; 19 fatal), hemorrhagic stroke events by 4 (to 44; 18 fatal), and stroke-related costs by more than $1 million.

Conclusion:
A 10% increase in anticoagulant use in a hypothetical AF cohort is expected to reduce stroke events, stroke-related fatalities and stroke-related costs by nearly 9%. Increased use of anticoagulation, with the potential to reduce the incidence of ischemic and hemorrhagic stroke, could significantly decrease stroke events, fatalities, and related healthcare costs.
Abstract P302: Baseline Measures of Adiponectin, Systolic Blood Pressure and Drinking Alcohol are Associated with More Aortic Stiffness Progression among Men: The ERA JUMP Study
Authors: El Khoudary Samar R , Barinas-Mitchell Emma , Curb J. David , Shin Chol , Ueshima Hirotsugu , Masaki Kamal , Evans Rhobert W , Miura Katsuyuki , Edmundowicz Daniel , Kuller Lewis H , Sutton-Tyrrell Kim , Sekikawa Akira
Published: July 2021

Objective:
Aortic stiffness, a significant marker of vascular aging, is independently associated with CVD and all-cause mortality. Limited data are available about risk factors for the progression of aortic stiffness in healthy population. We examined several baseline risk factors as possible independent predictors of aortic stiffness progression among US men.

Design:
Participants were a population-based sample of black and white men aged 40–49 from the Pittsburgh site of the ERA JUMP Study, who were free of CVD at baseline. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV) using an automated waveform analyzer at baseline and after 4.6±0.21(mean±SD) years of follow-up. Progression of cfPWV was evaluated as: 1) occurrence of progression (defined as ≥ 75th percentile of the change in cfPWV since baseline (≥ 118.5 cm/s increase); and 2) severity of progression as the difference between the natural-log cfPWV at follow-up and the natural-log cfPWV at baseline. Systolic BP (SBP), BMI, visceral adiposity, lipids, glucose, insulin, adiponectin, PAI-1, fibrinogen, CRP, alcohol drinking, and smoking status at baseline were evaluated as possible risk factors for occurrence and severity of cfPWV progression. Stepwise logistic and linear regression models were utilized as appropriate. In univariate analysis, risk factors found to be associated with cfPWV progression at a P value ≤ 0.25 were eligible for stepwise regression analysis. Variables were dropped from models at a P value > 0.1. Age at baseline, follow-up time, race, heart rate, and medication use were forced in all models.

Results:
A total of 240 men (White:82.5%, Black:17.5%) who were 45.0±2.9 years old at baseline, were included in this analysis. During follow-up, cfPWV progressed in 125 participants (52.0%) with a median increase of 113.5 cm/s (Q1=46.0, Q3=204.5). Final models revealed that independent predictors of the occurrence of cfPWV progression were lower levels of adiponectin (OR: 0.46, 95%CI: 0.23, 0.95, P=0.04), higher levels of SBP (OR: 1.03, 95%CI: 1.002, 1.06, P=0.04) and drinking alcohol ≥ 2 times/week (OR: 1.92, 95%CI: 1.01, 3.64, P=0.046) at baseline. Similarly, adiponectin (β=−0.097(SE=0.04), P=0.02) and drinking alcohol ≥ 2times/week (β=0.084(SE=0.04), P=0.02) were also independent predictors of severity of cfPWV progression. No significant interactions were found between these predictors and race.

Conclusions:
Independent of age at baseline, follow-up time, race, heart rate and medication use, lower levels of adiponectin, higher levels of SBP and drinking alcohol ≥2 times/week at baseline are associated with greater progression in aortic stiffness among relatively young middle-aged US men.