bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP32: Race-sex differences in hyperlipidemia awareness, treatment and control in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study
Authors: Safford Monika M , Muntner Paul , Durant Raegan , Glasser Stephen , Gamboa Christopher , Shikany James , Brown Todd M , Zweifler Richard , Howard George , Levitan Emily
Published: July 2021

Introduction:
To identify potential targets for eliminating disparities in cardiovascular disease outcomes, we examined race-sex differences in awareness, treatment and control of hyperlipidemia in the REGARDS cohort.

Methods:
REGARDS recruited 30,239 blacks and whites aged ≥45 residing in the 48 continental US between 2003-7. Baseline data were collected via telephone interviews followed by in-home visits. We categorized participants into coronary heart disease (CHD) risk groups (CHD or risk equivalent [highest risk]; Framingham Coronary Risk Score [FRS] >20%; FRS 10-20%; FRS <10%) following the 3
rd
Adult Treatment Panel. Prevalence, awareness, treatment and control of hyperlipidemia were described across risk categories and race-sex groups. Multivariable models examined associations for hyperlipidemia awareness, treatment and control between race-sex groups compared with white men, adjusting for predisposing, enabling and need factors.

Results:
There were 11,677 individuals at highest risk, 847 with FRS >20%, 5791 with FRS 10-20%, and 10,900 with FRS<10%; 43% of white men, 29% of white women, 49% of black men and 43% of black women were in the highest risk category. More high risk whites than blacks were aware of their hyperlipidemia but treatment was 10-17% less common and control was 5-49% less common among race-sex groups compared with white men across risk categories. After multivariable adjustment, all race-sex groups relative to white men were significantly less likely to be treated or controlled, with the greatest differences for black women vs. white men (Table). Results were similar when stratified on CHD risk and area-level poverty tertile.

Conclusion:
Compared to white men at similar CHD risk, fewer white women, black men and especially black women who were aware of their hyperlipidemia were treated and when treated, they were less likely to achieve control, even after adjusting for factors that influence health services utilization.
Abstract MP34: In Praise of Demanding Parenting: The Effects of Parenting Style and Poverty on Obesity Risk in Children: Evidence from a Nationally Representative Sample
Authors: Kakinami Lisa , Barnett Tracie , Paradis Gilles
Published: July 2021

Background:
One-quarter of children are already overweight or obese when they enter preschool, underscoring a critical need to improve our understanding of childhood determinants of health, including both sociodemographic (such as poverty) and social-familial influences (such as parenting style), as well as how these determinants may interact with one another.

Objective:
To examine the effects of parenting style on the risk of obesity in youth and determine if poverty is a mediator or moderator for this association.

Methods:
Participants (age 0-11) were from the National Longitudinal Survey of Children and Youth (NLSCY), a representative cross-sectional survey of youth collected bi-annually (1994-2008) throughout Canada. Factor analysis identified 4 parenting styles consistent with Baumrind’s theory of authoritative (demanding and responsive), authoritarian (demanding but not responsive), permissive (responsive but not demanding), and negligent (not demanding and not responsive) parenting control prototypes. Multivariable logistic regression assessed the risk of a child being obese (BMI percentile ≥ 97.7
th
compared to age- and sex-specific WHO growth curves) based on parenting style after adjusting for age, sex, parental education, immigration status, family functioning score, birth order, and maternal age. Analyses were stratified by age (younger: 2-5 years of age, n=19,026; school-age: 6-11 years of age, n=18,551) due to age-related differences in parenting styles. Mediation or moderation by poverty (household income < low income cut-offs adjusted for household size and geographic region) was assessed. Analyses used sampling and bootstrap weights.

Results:
Younger children’s parents were primarily authoritative (42%, n=7357), followed by negligent (22%, n=3763), permissive (20%, n=3436), and authoritarian (16%, n=4470). Parenting styles in school-age children were similar (authoritative: 32%, n=7195, negligent: 31%, n=5586, permissive: 22%, n=3850, authoritarian: 15%, n=1920). In multivariable analyses, compared to authoritative parenting, younger and school-age children with authoritarian parents were 30% (95% CI: 1.1-1.5, p=0.0002) and 37% (CI: 1.1-1.7, p=0.006) more likely to be obese, respectively. In younger children, poverty moderated this association: authoritarian and negligent parenting was associated with 39% (CI: 1.2-1.6, p<0.0001) and 28% (CI: 1.1-1.5, p=0.002) increased risk of obesity, respectively, only among the children not living in poverty. In school-age children, poverty was not a mediator or moderator.

Conclusions:
Parenting style is associated with a child’s risk of obesity but is moderated by poverty in younger children. Successful strategies to combat childhood obesity need to reflect the independent and interactive effects of sociodemographic and social-familial influences on health especially in early childhood.
Abstract MP45: National Women’s Knowledge of Stroke Warning Signs, Overall and by Race/Ethnic Group
Authors: Mochari-Greenberger Heidi , Towfighi Amytis , Mosca Lori
Published: July 2021

Background:
Early treatment is associated with better clinical outcomes in stroke, but women must recognize the warning signs of a stroke to reduce delays in treatment. The purpose of this study was to evaluate contemporary knowledge of stroke warning signs and intent to call 9-1-1 first if warning signs occur, among a nationally representative sample of women, overall and by race/ethnic group.

Methods:
A study of cardiovascular disease awareness and knowledge was conducted by the American Heart Association in 2012 among English speaking US women > 25 years identified through random digit dialing (N=1,205; 54% white, 17% black, 17% Hispanic, 12% other). Demographic data, including race/ethnic group, were evaluated using standardized categorical questions. Knowledge about warning signs of stroke, and what to do first if experiencing signs of a stroke, was assessed by standardized unaided questions. Data were weighted to reflect the US population of women based on the US Census Bureau’s March 2011 Current Population Survey, overall and within ethnic strata.

Results:
In 2012, half of women surveyed (51%) identified sudden weakness/numbness of face/limb on one side as a stroke warning sign; this did not vary by race/ethnic group. Loss of/trouble talking/understanding speech was identified by 44% of women, and more frequently among white versus Hispanic women (48% vs. 36%; p<.05). Fewer than one in four women identified sudden severe headache (23%), unexplained dizziness (20%), or sudden dizziness/loss of vision (18%) as warning signs, and one in five (20%) did not know one stroke warning sign; these results did not vary by race/ethnicity. The majority of women said that they would call 9-1-1 first if they thought they were experiencing signs of a stroke (84%), and this did not vary among black (86%), Hispanic (79%), or white/other (85%) women.

Conclusions:
Knowledge of stroke warning signs was low among a nationally representative sample of women, especially among Hispanics. In contrast, knowledge to call 9-1-1 when experiencing signs of stroke was high. These data suggest effort to improve recognition of the warning signs of stroke has potential to reduce treatment delay and improve outcomes among women.
Abstract MP68: Age at Menarche is Inversely Associated with Liver Steatosis and Abdominal Fat Depots: CARDIA Study
Authors: Mueller Noel T , Pereira Mark A , Demerath Ellen W , Dreyfus Jill G , MacLehose Richard F , Carr J J , Terry James G , Jacobs David R
Published: July 2021

Introduction:
Age at menarche is associated with cardiometabolic disease risk later in life; whether hepatic steatosis (fatty liver) or regional depots of abdominal fat play a role in this association is unclear. In a community-based sample of African American and White women free of diagnosed liver disease, we tested the hypothesis that age at menarche is inversely associated with hepatic steatosis and abdominal fat depots in midlife, after control for demographic and lifestyle factors and early adult BMI.

Methods:
Women in the Coronary Artery Risk Development in Young Adults (CARDIA) study with complete measures of recalled age at menarche (at exam years 0 (1985-86) and 2), multiple slice abdominal CT (at year 25) of hepatic steatosis (HS), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IAT) were included. We defined nonalcoholic fatty liver disease as liver attenuation ≤ 48 Hounsfield units (HU) after excluding other causes of liver disease. We used multivariable linear regression (continuous outcomes) and Poisson regression (binary outcomes).

Results:
The mean (±sd) menarcheal age for the 1215 women eligible for this analysis was 12.6±1.5 y. A 1-year increment in age at menarche was associated with lower liver steatosis (0.8±0.2 HU; greater HU = less steatosis), VAT (-6.6±1.2 cc), IAT (-7.3±1.4 cc), SAT (-19.3±3.3 cc), and NAFLD prevalence (prevalence ratio=0.86; 95% CI: 0.78, 0.94) after confounder adjustment (
Table
). Associations remained after further adjustment for year 0 BMI (ages 18-30 y; all
p
for trend <0.05), but were attenuated (all
p
for trend >0.05) after adjustment for year 25 BMI (a mediator) when participants were 43-55 y.

Conclusion:
These findings indicate age at menarche is inversely associated with midlife liver steatosis and visceral and subcutaneous abdominal fat, independent of early, but not late, adult BMI. Whether these associations mediate the higher cardiometabolic disease risk observed in early maturing females needs to be determined.
Abstract MP77: Will the World Health Organization’s “25 x 25” Goal Be Achieved? An Ecologic Time Trend Analysis of Relative and Absolute Premature Mortality Risk Due to Non-Communicable, Chronic Diseases
Authors: Baldridge Abigail , Pandit Jay , Huffman Mark
Published: July 2021

Objectives:
To evaluate country-level time trends (1994-2011) in premature (30-69 years) mortality from non-communicable, chronic diseases (NCDs), including cardiovascular diseases, and to create forward projections to 2025 to evaluate the WHO’s goal of reducing the risk of premature mortality from NCDs by 25% by 2025.

Methods:
Using publicly available data from the WHO Mortality Database, we created annual estimates of risk of premature (30-69 years) NCD mortality (1994-2011). The sample included data from all countries reporting NCD mortality data from ≥2 years (n=116) and all countries reporting population estimates over the same years (n=135). We matched these datasets by country, year, division, administrative grouping and sex to reach a final sample of 60 countries (193 WHO Member States, 2011). We used ordinary least squares and log-linear Poisson regression models stratified by sex to evaluate the annual change in risk of premature mortality. We then created forward projections through 2025 using log-linear models. We used extrapolated premature mortality risk at 2025 and compared risk to 2010, with projected United Nations age- and sex-specific population estimates, to evaluate trends.

Results:
Among all included countries, the average (SD) risk of premature mortality from NCDs based on log-linear models in 1994 was 6.8 (4.2) and 3.9 (2.1) per 1,000 persons in men and women, respectively (Table 1). In 2010, men in lower-middle income countries had the highest rates of premature NCD mortality (7.2 [1.8] per 1,000), and women from high-income OECD countries had the lowest rates (2.0 [0.5] per 1,000). If recent trends continue, the median risk of premature mortality from NCDs will decrease by 25.1% (IQR 16.4, 37.0) by 2025.

Conclusions:
Among included countries, if recent trends in risk of premature death from NCDs continue to 2025, 50% of countries will achieve the WHO’s 25 x 25 goal. However, data are disproportionately missing from low- and middle-income countries, which appear less likely overall to achieve this goal.
Abstract MP84: Use of Lifestyle Strategies Following Intervention and Impact on Longer-term Weight Loss Success
Authors: Lott Margaret , Kinzel Laura , Barinas-Mitchell Emma , Winger Daniel G , Wang Li , Conroy Molly B
Published: July 2021

Background:
Behavioral weight loss interventions are successful in producing weight loss; however, weight regain following cessation of intervention is common. Little is known about use of lifestyle strategies following interventions, differences in use by sex, and how use of strategies relates to longer-term weight trajectories.

Methods:
This analysis includes participants in the Slow the Adverse Vascular Effects of excess weight (SAVE) study with 24 month follow-up data. SAVE included 349 men and women aged 20-45 years with body mass index 25-39.9kg/m
2
. The SAVE weight loss intervention lasted for 18 months, with sessions decreasing in frequency over time. At 24 months, participants completed a survey about lifestyle strategies used in the past six months, including self-monitoring, group support, behavioral skills, and professional support. Chi-square and Fischer exact tests were used to compare frequency of strategies by sex. T tests were used to compare percent change in weight between baseline and 24-month by use of strategies vs. no use.

Results:
214 participants completed 24 month visit (61% of baseline cohort). 74% were female and 86% were white, which did not differ from the baseline cohort. Overall, 65% used self-monitoring, 67% used group support, 94% used behavioral skills, and 27% used professional support within past 6 months. Recording physical activity (52%) and calories (43%) were the most common self-monitoring strategies. Self-weighing (83%), cue management (71%), and portion management (74%) were commonly used behavioral skills. Women were more likely than men to use group support (72% vs. 54%; p = .01). Women were also more likely to use the behavioral skills of rewarding success (32% vs. 9%; p = .001), portion management (78% vs. 64%; p = .046), and cue management (77% vs. 52%; p = .000). Women more frequently reported receiving professional support of diet counseling (48% vs. 15%; p = 0.04) or physical activity counseling (59% vs. 23%; p =0.02) from their PCP than men. Participants who used behavioral strategies had a significantly greater percent change in body weight at 24 months than those who did not (-3.9% vs. -0.7%; p =0.02). No significant differences were found in percent change in body weight at 24 months between participants who used self-monitoring, group support and professional support and those who did not.

Conclusions:
Participants who completed a weight loss intervention report using a variety of lifestyle strategies after cessation of intervention. Women reported more frequent use of lifestyle strategies than men. Behavioral strategies may be particularly important in longer-term weight loss. Attention should be paid to developing strategies to ensure longer-term weight loss after interventions.
Abstract MP86: Depressive Symptoms are Associated with Mental Stress-Induced Myocardial Ischemia After Acute Myocardial Infarction
Authors: Wei Jingkai , Pimple Pratik , Shah Amit J , Rooks Cherie , Bremner Douglas , Nye Jonathon A , Ibeanu Ijeoma , Murrah Nancy , Shallenberger Lucy , Raggi Paolo , Vaccarino Viola
Published: July 2021

Objectives:
Previous studies indicated that depressed mood may act as a trigger of acute coronary syndromes, although the mechanisms are not clear. We aimed to examine the association between depression and mental stress-induced myocardial ischemia in young survivors of a myocardial infarction (MI), and the possible differential association of somatic and cognitive depressive symptom dimensions.

Hypothesis:
Higher levels of depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress.

Methods:
We studied 98 patients (49 women and 49 men) age 38-59 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging with [99mTc]sestamibi single-proton emission computed tomography at rest, after mental stress (speech task), and after exercise treadmill stress. If unable to exercise (N=16), patients underwent pharmacological stress test with regadenoson. Myocardial perfusion defect scores were obtained with observer-independent software. A summed difference score, the difference between stress and rest perfusion defect scores, was used to quantify myocardial perfusion defects due to ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms. Two separate scores of somatic and cognitive depressive symptoms were calculated. Multivariate linear regression models were used in the analysis.

Results:
There was a significant and graded positive association between depressive symptoms and summed difference score with mental stress. After adjustment for demographical and lifestyle factors, severity of coronary heart disease and medications, each incremental depressive symptom was associated with 0.14 higher ischemia perfusion defect score [β=0.14, 95% CI: (0.03, 0.24), p=0.01]. When somatic and cognitive depressive symptoms were examined separately, both somatic symptoms [β=0.17, 95% CI: (0.04, 0.30), p=0.01] and cognitive symptoms [β=0.31, 95% CI: (0.07, 0.56), p=0.01] showed a significant association with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress.

Conclusion:
Among young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with exercise/pharmacological stress. Future studies should explore whether mental stress-induced ischemia explains the poorer prognosis associated with depressive symptoms in post-MI patients.
Abstract MP93: Impact of Reducing Sedentary Time on Vascular Endothelial Function in Previously Sedentary Older Adults
Authors: Suboc Tisha M , Knabel Daniel , Strath Scott J , Malik Mobin , Couillard Allison , Widlansky Michael
Published: July 2021

Background:
We have previously reported that increasing habitual moderate intensity (3-6 METs) physical activity (PA) reverses aging-associated vascular endothelial dysfunction, a surrogate marker of cardiovascular risk, in previously sedentary adults ≥ 50 years old. However, whether this relationship is in part related to a reduction in sedentary time concomitant with increased PA is unknown.

Methods:
A post hoc analysis on data from 96 sedentary adults ages ≥ 50 years (average age 62±7 years) who participated in a randomized control trial evaluating the impact of a 12 week intervention to increase PA was performed. The intervention aimed to increase moderate intensity PA using pedometer guidance with or without the aid of an interactive website which taught participants how to integrate PA into their daily routine. Amount and intensity of PA were measured pre- and post-intervention by accelerometer. Subjects were divided into tertiles of based on change in percent of sedentary activity (< 1. 5METs) over the study period: (1) 5% or greater reduction in sedentary time, (2) 0-4.99% reduction, and (3) increase in sedentary time. Vascular endothelial function was measured by brachial artery flow mediated dilation (FMD%) prior to and at the end of a 12 week intervention period. Data were analyzed by two-way mixed ANOVA with post hoc testing as appropriate.

Results:
Sedentary time decreased in the study population (P=0.001), driven by a 101 minute drop in sedentary time in group 1 (N=27, 653±121 to 552±100 min, P < 0.001), a 42 minute drop in group 2 (N=29, 699±92 to 657±70 min P=0.003), and a 44 minute increase in group 3 (N=40, 629±93 to 673±120 min, P =0.02). While FMD% increased in the entire study population (P=0.008), this increase was not influences by differences in the change in sedentary time (P=0.73, group 1: 5.4±2.9 to 7.0±3.6%, group 2: 5.7±2.9 to 6.9±4.3%, group 3: 6.0±2.5 to 6.7±3.6%). No differences in endothelium-independent vasodilation were seen. Using equal tertiles for change in sedentary time or higher thresholds for reductions in sedentary time (7.5% or 10%) for group 1 did not alter these results.

Conclusion:
Increasing moderate intensity PA improves endothelial function in adults ≥ 50 years but this improvement is not associated with the reduction in the amount of sedentary time. Greater than a 10% reduction in the amount of sedentary time may be necessary to see its favorable impact on the vascular endothelium.
Abstract P001: Plasma Phospholipid Saturated Fatty Acids and Incident Atrial Fibrillation: the Cardiovascular Health Study
Authors: Fretts Amanda M , Mozaffarian Dariush , Siscovick David S , Djousse Luc , Heckbert Susan R , King Irena B , McKnight Barbara , Sitlani Colleen , Sacks Frank M , Song Xiaoling , Sotoodehnia Nona , Spiegelman Donna , Wallace Erin R , Lemaitre Rozenn N
Published: July 2021

Background:
Prior studies suggest that circulating fatty acids may influence the risk of atrial fibrillation (AF), but little is known about the associations of circulating saturated fatty acids (SFA) with risk of AF. SFAs of different length differ in dietary and metabolic origin, incorporation into membrane lipid species, membrane properties, and biological activities that may influence the pathophysiology of AF. Moreover, both diet and metabolic pathways are determinants of circulating SFAs.

Methods:
The study population included 2,899 participants from the Cardiovascular Health Study, a community-based longitudinal cohort of adults aged 65 years or older, free of prevalent coronary heart disease and AF. Cox regression was used to assess the association of all the long-chain saturated fatty acids, palmitic acid (16:0), stearic acid (18:0), arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0), with incident AF.

Results:
During 29,864 person-years of follow-up, 707 cases of incident AF occurred. After adjustment for other AF risk factors, higher levels of circulating 16:0 were associated with a higher risk of AF (hazard ratio comparing highest to lowest quartiles: 1.48. 95% CI: 1.18, 1.86). On the other hand, higher levels of circulating 18:0, 20:0, 22:0 and 24:0 were each associated with a lower risk of AF. The hazard ratios (95% CI) for AF in the top versus bottom quartile were 0.76 (0.61, 0.95) for 18:0; 0.78 (0.63, 0.97) for 20:0; 0.62 (0.50, 0.78) for 22:0; and 0.68 (0.55, 0.85) for 24:0.

Conclusions:
Results from this prospective cohort study of older adults demonstrate divergent associations of circulating 16:0 versus longer-chain saturated fatty acids with incident AF, highlighting the need to investigate both determinants of these levels and potential pathways of the observed differential risk.
Abstract P007: Ongoing Resuscitation Research is Associated with Higher Odds of Receiving Bystander CPR
Authors: Wander Pandora L , Fahrenbruch Carol , Husain Sofia , Eisenberg Mickey , Rea Thomas D
Published: July 2021

Introduction:
The act of conducting a research study could potentially improve quality of care by focusing providers on the study condition or detract from care by distracting providers with complex protocols. We hypothesized that odds of receiving bystander cardiopulmonary resuscitation (CPR) would be higher during a trial of dispatcher-assisted CPR instructions than during periods immediately before and after.

Methods:
The investigation was a cohort study of 8,626 adult subjects who suffered non-traumatic out-of-hospital cardiac arrest prior to emergency medical services (EMS) arrival in greater King County, Washington, between January 1, 1999, and December 31, 2011. Bystander CPR status was assessed through review of audio dispatch tapes and EMS reports to classify any bystander CPR (any B-CPR). Any B-CPR was further categorized as bystander CPR with dispatcher assistance (DA-CPR) or bystander CPR without dispatcher assistance (B-CPR, no DA). We used multivariable logistic regression to evaluate the odds of any B-CPR before, during, and after the Dispatcher Assisted Resuscitation Trial (DART), a randomized trial of dispatcher-assisted CPR instruction comparing chest compressions alone with compressions plus rescue breaths, which ran from June 1, 2004, to September 30, 2009. We also evaluated whether the odds varied by type-specific B-CPR.

Results:
Patient and arrest circumstances were similar across the study periods. Compared to the period before DART, odds of receiving any B-CPR were higher during DART (OR=1.35, 95% CI = 1.23-1.49), but no different after OR=1.11, 0.98-1.25). Similarly, compared to the before period, the odds of DA-CPR were higher during DART (OR=1.79, 1.59-2.02) but no different after (OR=0.94, 0.80-1.10) (Table 1).

Discussion:
Odds of bystander CPR were higher during the study compared to periods before and after. The increase seems to be largely related to higher likelihood of DA-CPR, suggesting a possible community-wide benefit from this research protocol.
Abstract P012: Short Leukocyte Telomere Length is Associated With Obesity in American Indians: The Strong Heart Family Study
Authors: Chen Shufeng , Lin Jue , Matsuguchi Tet , Blackburn Elizabeth , Lee Elisa T , Howard Barbara V , Zhao Jinying
Published: July 2021

Background:
Obesity is an independent risk factor for diabetes and cardiovascular disease. Telomere length shortens progressively with age, and shorter leukocyte telomere length (LTL) has been associated with a wide range of age-related disorders. However, the association between LTL and obesity has not been well established.

Objective:
To examine the association of LTL with obesity and related traits in American Indians participating in the Strong Heart Family Study (SHFS, 2001-2003), independent of known risk factors.

Methods:
A total of 3,162 participants (18-93 years old, 1,938 women) from 94 multigenerational families were included in this analysis. Obesity-related traits included body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio. LTL was measured by quantitative PCR. Association of LTL (continuous or in quintiles) with each adiposity index was examined using generalized linear mixed model, adjusting for age, sex, study center, education, lifestyle factors (current smoking, current drinking, physical activity, and total energy intake), hypertension (yes/no) and diabetes (yes/no). The association of LTL with prevalent obesity (BMI ≥30 kg/m2) was examined by multivariate logistic regression using the GLIMMIX procedure in SAS 9.3.

Results:
Prevalence of obesity was 59.6% (1,883 of 3,162). LTL was negatively correlated with age (r=-0.3, P<0.0001). Obese participants had significantly shorter LTL than non-obese participants (age-adjusted P=0.0004).

Multivariate regression analyses demonstrated that, LTL was significantly and inversely associated with all obesity indices (β= -2.68 [95% confidence interval (CI), -3.96 [[Unable to Display Character: ‒]] -1.40] for BMI; -6.28 [95% CI, -9.29 [[Unable to Display Character: ‒]] -3.27] for waist circumference; -3.95 [95% CI, -6.61 [[Unable to Display Character: ‒]] -1.29] for hip circumference; and -0.02 [95% CI, -0.03 [[Unable to Display Character: ‒]] -0.01] for waist-to-hip ratio). Participants with shorter LTL had significantly larger BMI (P trend across quintiles =0.0006), waist circumference (P trend =0.0005), hip circumference (P trend =0.01), and waist-to-hip ratio (P trend =0.002) compared to those with longer LTL. Multivariate-adjusted odds ratio (95% CI) for prevalent obesity was 1.32 (1.05-1.67), 1.29 (0.99-1.67), 1.29 (1.01-1.65) and 1.18 (0.89-1.57), respectively, for the 1st through 4th quintiles of LTL in comparison with the 5th quintile (P for trend =0.02). Excluding participants with diabetes and cardiovascular disease did not change our results.

Conclusion:
Shorter LTL was significantly associated with obesity and related measures in American Indians, independent of known risk factors. Our results may shed light on the complex pathophysiology of obesity and its related disorders.
Abstract P027: Fasting Glucose And Risk Of Heart Failure
Authors: Khan Hassan , Kunutsor Setor , Kauhanen Jussi , Kurl Sudhir , Gorodeski Eiran , Adler Amanda , Butler Javed , Laukkanen Jari A
Published: July 2021

Background:
There remains uncertainty regarding the association between fasting glucose (FG) and the risk of heart failure (HF) in individuals without a history of diabetes.

Methods and Results:
We assessed the association between FG and HF risk in a population-based cohort of 1,740 men aged 42-61 years free from HF or diabetes at baseline. Additionally, we performed a meta-analysis of relevant prospective studies identified from MEDLINE, EMBASE, and Web of Science databases. During a mean follow-up of 20.4 years, 146 participants developed HF (4.1 cases per 1000 person-years). In models adjusted for age, the hazard ratio (HR) for HF per 1 mmol/L increase in FG was 1.34 (95% confidence interval [CI], 1.22, 1.48). This association persisted after adjustment for established HF risk factors (HR 1.27, 95% CI 1.14, 1.42). Compared with FG< 5.6 mmol/L, there was an increased risk amongst those with FG 5.6-6.9 mmol/L (HR 1.24, 95% CI 0.82, 1.88) and ≥ 7.0 mmol/L (HR 3.25, 95% CI 1.50, 7.08). HRs remained consistent across several clinical subgroups. In a meta-analysis of 10 prospective studies (Figure 1) involving a total of 4,213 incident HF cases, the HR for HF per 1 mmol/L increase in FG level was 1.11 (95% CI 1.04, 1.17), consistent with a linear dose-response relationship with evidence of heterogeneity between studies (I2=79%, 63-89%; P<0.001).

Conclusions:
A positive, continuous, and independent association exists between FG and risk for HF. Further studies are needed to evaluate the causal relevance of these findings.
Abstract P028: Fruit and Vegetable Consumption and the Risk of Heart Failure in Women
Authors: Rautiainen Susanne , Levitan Emily B , Mittleman Murray A , Wolk Alicja
Published: July 2021

Background:
Although numerous studies have investigated fruit and vegetable consumption in association with cardiovascular disease, a limited number of studies have investigated the association with heart failure specifically. The aim of this study was to assess the association between fruit and vegetable consumption and the incidence of heart failure among middle-aged and elderly women.

Methods:
In September 1997, 33,669 women (aged 49-83 y) from the Swedish Mammography Cohort free of cancer, CVD and diabetes at baseline completed a food-frequency questionnaire. Women were followed for incident heart failure (hospitalization or mortality of heart failure as the primary cause) through December 2011 using administrative health registries. Cox proportional hazard models were used to calculate relative risks (RR) and 95% confidence intervals (CI). In multivariable models we adjusted for age at baseline, educational level, smoking status, body mass index, physical activity, hypertension, diabetes, family history of myocardial infarction, alcohol consumption, total energy intake, and dietary supplement use.

Results:
During 13.1 years of follow-up (442,324 person-years), we identified 1407
incident cases of
heart failure. Total fruit and vegetable consumption was inversely associated with the risk of heart failure (the multivariable-adjusted RR in the highest quintile compared to the lowest was 0.81 (95% CI: 0.68-0.97, p for trend=0.03). When investigating fruit and vegetables separately we observed a statistically significant lower risk for vegetables (RR: 0.82; 95% CI: 0.69-0.98, p for trend=0.10) but not for fruits (RR: 0.94; 95% CI: 0.79-1.12, p for trend=0.24).

Conclusions:
In this population-based prospective cohort study of women, higher total consumption of fruits and vegetables was inversely associated with the risk of heart failure.
Abstract P045: Association of Renal Function and Blood Pressure Reactivity to the Cold Pressor Test: the GenSalt Study
Authors: Zhao Qi , Zhang Mingzhi , Gu Dongfeng , Cao Jie , Chen Jichun , Li Jianxin , Mills Katherine , Chen Jing , He Jiang
Published: July 2021

Exaggerated blood pressure (BP) reactivity to the cold pressor test (CPT) has been associated with increased risk of hypertension and cardiovascular disease. We examined the association between estimated glomerular filtration rate (eGFR) and BP reactivity to the CPT among the participants of the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) study. We conducted the CPT among 1,961 GenSalt participants from north rural China. The average age of the participants (SD) was 39.9 (10.2) years, and 52.8% of the participants were male. BP was measured using a standard mercury sphygmomanometer prior to and at 0, 1, 2, and 4 minutes after the participants immersed their right hand in ice water for 1 minute. The maximum responses (SD) were 13.9 (10.2) and 7.8 (6.2) mm Hg for systolic and diastolic BP, respectively. Serum creatinine was measured and used to calculate eGFR using the Modification of Diet in Renal Disease (MDRD) formula. The average eGFR (SD) was 87.7 (25.8)ml/min per 1.73m
2
. After adjusting for multiple covariates, including age, sex, body mass index, baseline BP, education, cigarette smoking, alcohol drinking, and physical activity, eGFR was significantly associated with maximum systolic BP response to the CPT (P < 0.0001). A standard deviation decrease in eGFR was associated with a 1.2 mm Hg higher maximum systolic BP response to the CPT. In addition, we observed that the effect of eGFR on BP response to the CPT increased with age (
P
for interaction < 0.0001). For example, a standard deviation decrease in eGFR was associated with a 0.6, 1.1, and 2.5 mm Hg greater maximum systolic BP response to the CPT for age groups < 35, 35-44, and ≥ 45 years, respectively. In conclusion, this large study suggests a relationship between decreased renal function and greater cardiovascular reactivity to stress. Further investigation is warranted to identify factors that mediate this relationship and potential adverse clinical consequences of cardiovascular hyperreactivity in subjects with reduced renal function.
Abstract P054: The CUORE Project: The Predictive Role Of Cardiovascular Risk Factors Among Elderly Persons
Authors: Palmieri Luigi , Donfrancesco Chiara , Vanuzzo Diego , Ferrario Marco M , Panico Salvatore , Cesana Giancarlo , Dima Francesco , Pilotto Lorenza , Veronesi Giovanni , Mattiello Amalia , Giampaoli Simona
Published: July 2021

Background:
The number of elderly persons with cardiovascular disease (CVD) is rapidly increasing, mainly due to worldwide aging population. All CVD risk scores consider age as risk factor but most of them assume that the etiological role of other established risk factors is similar at all ages. This analyses aimed to assess the predictive role of cardiovascular risk factors in elderly persons.

Methods:
We considered 10,979 men and 16,533 women aged 35-74 years from cohorts in North, Centre and South of Italy with 10 years median follow-up time for fatal and non fatal coronary and cerebrovascular events (819 in men and 467 in women) validated according to MONICA criteria. In all cohorts risk factors were assessed by using standardized procedures. Two age groups were defined: adult 35-54 years of age (6,353 men and 10,358 women) and elderly 55-74 years (4,626 men and 6,175 men). Cox models were implemented including age, systolic blood pressure (SBP), total (TC) and HDL cholesterol (HDL-C), smoking, diabetes (DM - fasting blood glucose >=126 mg/dl or under glucose treatment) and hypertension treatment (HT). For continuous variables, hazard ratios (HR) were reported at 1 standard deviation higher level and for dichotomized variables, yes vs no.

Results:
For adult men SBP resulted having a stronger impact on CVD risk than for elderly even if not statistically significant: adult HR 1.32, 95% confidence interval 1.18-1.48, vs elderly HR 1.25, 1.15-1.36; similar results for TC (HR 1.47 vs 1.25), smoking (HR 1.91, vs 1.52), DM (HR 1.76 vs 1.56), HT (HR 2.30 vs 1.25). HDL-C resulted not significantly associated with CVD risk in elderly men. Among adult women a stronger impact was found than in elderly for SBP (HR 1.59 vs 1.26), HDL-C (0.65 vs 0.84), smoking (2.43 vs 1.99), and HT (2.34 vs 1.45); the opposite for TC (1.19 vs 1.27). DM resulted not significantly associated with CVD risk in adult women. Age resulted having a stronger impact in elderly persons both in men and women (HR 1.22, 1.07-1.39, vs 1.44, 1.29-1.61; 1.45, 1.17-1.80, vs 1.63, 1.42-1.86 respectively).

Conclusions:
SBP and HT resulted having a pronounced lower impact on CVD risk in elderly than in adult as well as HDL-C for men; age shows a stronger impact in elderly than in adult. Further analyses are recommended to study the reliability of risk scores based on age-specific risk models, evaluating the introduction of different risk factors and considering survival probability derived from data in elderly population.
Abstract P073: Urinary Isoflavonoids And Risk Of Ischemic Stroke In Postmenopausal Women
Authors: Yu Danxia , Shu Xiao-Ou , Li Honglan , Yang Gong , Cai Qiuyin , Xiang Yong-Bing , Franke Adrian A , Gao Yu-Tang , Zheng Wei , Zhang Xianglan
Published: July 2021

Background:
Postmenopausal hormone therapy has been shown to increase stroke risk. It is unclear whether high exposure to pytoestrogens, such as soy isoflavones, may confer the same risk of stroke.

Objective:
To examine associations of urinary isoflavonoids, which reflect isoflavones intake, absorption, and metabolism, with risk of ischemic stroke in postmenopausal Chinese women.

Design:
A nested case-control study.

Method:
We identified 1438 incident cases of ischemic stroke druing 1997-2010 and individually matched them to 1438 controls on age, date and time of sample collection, time since last meal, and recent use of antibiotics. All subjects were postmenopausal women who had never used hormone therapy and had no history of CVD or cancer at baseline. Seven isoflavonoids were measured by LC-MS and standardized by urinary creatinine.

Results:
We found no significant difference between case-control pairs in mean levels of total or individual urinary isoflavonoids, including 3 parent compounds (daidzein, genistein, and glycitein) and 4 metabolites derived from intestinal bacteria (dihydrogenistein, dihydrodaidzein, O-desmethylangolensin, and equol). Multivariate analyses revealed that women in the highest quintile of equol concentration had a lower risk of ischemic stroke (OR=0.77, 95%CI=0.60-0.98). Analyses stratified by equol producing status showed a significant inverse association between isoflavone bacterial metabolites and stroke risk in equol producers (31.8% of the study population, OR=0.40 across extreme quartiles, 95%CI=0.18-0.87, Ptrend=0.002), but no association in equol non-producers.

Conclusion:
Overall, this large prospective study suggests that urinary isoflavonoids are not associated with risk of ischemic stroke in postmenopausal Chinese women. High level of bacteria-derived metabolites of isoflavones, however, was associated with a reduced risk in equol producers, suggesting a possible interaction between gut microbiome and soy foods in the pathogenesis of ischemic stroke.
Abstract P079: Sugar-Sweetened Soda Consumption is Associated with Shorter Leukocyte Telomere Length among Healthy Adults
Authors: Leung Cindy W , Laraia Barbara A , Needham Belinda L , Rehkopf David H , Adler Nancy E , Epel Elissa S
Published: July 2021

Consumption of sugar-sweetened beverages (SSBs) is linked to increased risks of metabolic disease, but the biological mechanisms underlying this association are still under investigation. Leukocyte telomere length maintenance underlies healthy cellular aging, and may provide a link between SSB consumption and risk of disease. Given the known effects of SSBs on oxidative stress and insulin resistance, we examined the associations between sugar-sweetened beverage, diet soda, and fruit juice consumption, and leukocyte telomere length in 5,309 healthy adults with no prior history of diabetes or cardiovascular disease, using data from the 1999-2002 National Health and Nutrition Surveys (NHANES). We hypothesized that beverages with high sugar content would be most detrimental to cellular aging. Leukocyte telomere length was assayed from DNA specimens collected from adult NHANES participants. Diet was assessed using 24-hour dietary recalls. Because 24-hour dietary recalls may not accurately reflect long-term intake, the National Cancer Institute statistical method was used to estimate usual dietary intake. After adjustment for sociodemographic characteristics, smoking behavior, physical activity, dietary quality, and body mass index (BMI), each 8-ounce daily serving of sugar-sweetened sodas was associated with shorter telomeres (β=-0.010, 95% CI -0.019, -0.001), roughly equivalent to 1.8 additional years of aging. Twenty-one percent of study participants consumed ≥20 ounces of sugar-sweetened soda a day, translating into approximately 4.4 additional years of aging for heavy soda drinkers. No significant associations were observed between consumption of diet sodas, non-carbonated SSBs, or 100% fruit juice and telomere length. In conclusion, regular consumption of sugar-sweetened sodas was associated with shorter telomeres in a nationally representative sample of healthy, nonelderly adults independent of BMI and other individual characteristics. These results suggest that SSBs may influence metabolic disease development through accelerated cell aging. Although more research is needed to confirm these associations, these findings strengthen the rationale for limiting the consumption of SSBs.
Abstract P094: Association of Body Mass Index (BMI) with Abnormalities of Cardiac Structure and Function: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Bello Natalie , Shah Amil M , Santos Angela B , Querejeta Roca Gabriela , Vardeny Orly , Claggett Brian , Aguilar David , Folsom Aaron R , Butler Kenneth R , Kitzman Dalane W , Coresh Josef , Solomon Scott D
Published: July 2021

Aim:
Obesity is a prevalent condition associated with a heightened risk of cardiovascular disease. We assessed the association between normal weight, overweight, and obesity defined by body mass index (BMI) and cardiac structure and function in a sample of 4,845 older adults, aged 66-90 years.

Methods:
We performed a cross-sectional analysis of ARIC cohort participants during visit 5 (2011-2013), excluding those with prevalent coronary heart disease, heart failure, or prior myocardial infarction, or race other than black or white. The sample was grouped into 3 categories: normal (n=1326, BMI <25 kg/m
2
), overweight (n=1881, BMI 25-30 kg/m
2
), and obese (n=1638, BMI ≥30 kg/m
2
). Cardiac structure and function were assessed by 2D echocardiography by a core lab. Non-parametric trend, χ
2
tests, linear, and logistic regression were used for this analysis. A two-sided p-value <0.05 was considered significant.

Results:
Participants who were obese were younger, more likely to be black, and had higher rates of diabetes and hypertension than those who were overweight or had a normal BMI (table). Participants with obesity had larger biventricular cavity sizes, higher left ventricular (LV) mass index, more diastolic dysfunction, and more abnormal geometry (concentric/eccentric hypertrophy or concentric remodeling) than those who were overweight or normal (all p <0.0001). After adjustment (table), right ventricular (RV) function was lowest in obese participants, but there was no significant difference observed in LV ejection fraction.

Conclusion:
In ARIC, obesity is associated with increased LV remodeling, impaired diastolic function, and decreased RV function even after adjustment for significant covariates. The relationship of these findings to subsequent clinical events and whether they can be mitigated by weight loss or maintenance warrants further study.
Abstract P121: Meta-analysis of the Randomized Controlled Trials of Sodium Intake Reduction and Urinary Albumin Excretion
Authors: Strazzullo Pasquale , D'Elia Lanfranco , Schiano di Cola Michele , Savino Ivana , Iannotta Clementina , Galletti ferruccio
Published: July 2021

Background:
Urinary albumin excretion (UAE) is a predictor of chronic kidney disease and of higher cardiovascular morbidity and mortality. A number of studies investigated the effect of reduced dietary sodium intake on UAE but their results were not consistent. Therefore, our study assessed the effect of sodium restriction on UAE and/or on albumin/creatinine ratio (ACR) through an updated meta-analysis of the available randomised controlled trials (RCT).

Methods:
A systematic search of the on-line databases was conducted including RCTs that assessed UAE/ACR at the start and the end of the trial and outcomes expressed as difference between the effect of two different sodium intake regimens. For each study, the mean difference (MD) and 95% confidence intervals (95%CI) were extracted and pooled using a random effect model. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed.

Results:
Nine studies were identified, providing 21 cohorts with overall 454 participants and 1-6 weeks follow-up time. In the pooled analysis, lower sodium intake was associated with a 26.7% (95% CI: -40.7 to -12.6) reduction of UAE, with no evidence of publication bias.The effect of lower sodium intake was highest in the cohorts including patients on concomitant RAAS-blocking therapy (-37.7%; -56.5 to -19.9), in those with intervention lasting at least 2 weeks (-32.4%; -47.2 to -17.7), and among participants with evidence of kidney damage (-32.6%; -47.5 to -17.6). The changes in BP occurring during intervention were a significant source of heterogeneity. >The analysis of changes in ACR, where available, provided similar results.

Conclusions:
This meta-analysis indicated that sodium intake reduction markedly reduces albumin excretion, more so among patients with hypertension and/or kidney damage and during concomitant RAAS-blocking therapy.