bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P236: Breastfeeding and Drug Free Moms and Babies Project: Comparing Rates in a Rural Appalachia Project to Project Watch to Support Healthy Baby Outcomes
Authors: LILLY Christa , Umer Amna , Breyel Janine , Hamilton Candice , John Collin C
Published: March 2020

Breastfeeding is linked to improved cardiovascular health for both child and mother; however, many hospitals do not encourage or provide support for breastfeeding while either in the hospital or after delivery. This is particular true of mothers with substance use disorder (SUD) more generally or with opioid use disorder (OUD) more specifically. The Drug-Free Moms and Babies Project (DFMB) program was designed to develop and evaluate programs that provide treatment and recovery services for pregnant and postpartum women with SUD; data is now available for 2018 and up to October 2019. Project WATCH collects data on all births in West Virginia (WV) and includes questions about breastfeeding intent and actual breastfeeding practices. A special focus for both programs includes encouraging or assessing breastfeeding in WV, which ranked 46
th
in the nation for ever breastfeeding in 2015. There were 688 pregnant women in DFMB 2018-2019 with information on breastfeeding intent; at program entry, 54.8% intended to breastfeed. Relative to all births in WV in 2018 (Project WATCH data; N=18177), 57.4% intended to exclusively breastfeed. Among all births with intrauterine substance exposure (IUSE) in 2018 (N=2558), 31% intended to exclusively breastfeed. Of the 688 in the DFMB program, 528 completed the program through delivery and had breastfeeding information. Of those, 225 (42.6%) actually breastfed after birth, and 80.6% were given the opportunity to breastfeed before leaving the hospital. For actual breastfeeding rates among all births in WV (Project WATCH), 37.4% exclusively breastfed before hospital discharge, and among births with IUSE, 32.0% exclusively breastfed. We also examined breastfeeding rates among those infants born with NAS in the DFMB program (N=220, 42.8%). Of these women, 49.7% intended to breastfeed, 37.4% breastfed after birth, and 73.5% were given the opportunity to breastfeed before hospital discharge. Among all 2018 WV NAS births (N=901), actual breastfeeding rate was 9.1%. Results suggest DFMB programs improve breastfeeding rates when compared against all births in the state, and among births with IUSE. The program continues to intervene with this high-risk group to improve breastfeeding rates, which we believe will later impact cardiovascular health for both mothers and babies.
Abstract P262: Atherosclerotic Cardiovascular Disease Risk in Hispanic United States Veterans
Authors: Ho Yuk-Lam , Gagnon David R , Park Yojin , Galloway Ashley , Cho Kelly , Wilson Peter W
Published: March 2020

Background:
Atherosclerotic cardiovascular disease (ASCVD) incidence is greater in Hispanic population. Traditional 2013 Pooled Cohort Equation (PCE) models tend to over-predict risks among Veterans by two-fold. Assessment of ASCVD risk with statin therapy has not been extensively investigated in Hispanic Veterans.

Objective:
We compared 5-year ASCVD incidence of White Hispanic vs White Non-Hispanic Veterans, 18-79 years at baseline in a cohort during 2002-2014.

Methods:
Ethnicity was determined from census and electronic health data where a Veteran’s last name has a 0.76 positive predictive value for Hispanic ethnicity. We used sex and ethnicity specific Cox models to predict 5-year ASCVD morbidity and mortality. The analyses included PCE variables (age, cholesterol, HDL-C, systolic pressure, blood pressure treatment, smoking, diabetes) plus statin use.

Results:
A total of 1,383,993 Veterans were in our study with 69,055 (4.9%) females and 81,773 (5.9%) Hispanics. Mean age, cholesterol and HDL-C levels were similar for Hispanics and Non-Hispanics. Smoking, BP therapy, and statin use were less common in Hispanics. Over 5 years of follow-up, 3.9% of Hispanic and 4% of Non-Hispanics developed ASCVD, and 1.3% of Hispanics and 2% of Non-Hispanics experienced ASCVD death. Discrimination of ASCVD events was improved by retraining prediction models using traditional ASCVD risk factors and statin use, with the following concordance statistics: Male Hispanic (0.73), Male Non-Hispanic (0.66), Female Hispanic (0.80), Female Non-Hispanic (0.79). Statin use was associated with a 17% lower ASCVD risk in Hispanics of both sexes and 9% lower ASCVD risk for Non-Hispanics of both sexes.

Conclusions and Relevance:
Traditional variables plus statin use are efficient predictors of ASCVD morbidity and mortality in a contemporary cohort of Hispanic U.S. Veterans. Baseline statin use was associated with lower risk of ASCVD events in Hispanics compared to Non-Hispanics.
Abstract P292: THE LACK OF FASTING INSULIN MEASUREMENT DELAYS THE MANAGEMENT OF PREDIABETES IN OBESE ADOLESCENTS.
Authors: St-pierre Julie , Sirois Maude , Paquin Genevieve , Jean-Baptiste Elisa , Robert Maryline
Published: March 2020

Background:
Insulin resistance is a medical complication associated with obesity and metabolic syndrome in youth. Data have shown that pediatric obesity can stop or even decrease by an adequate clinical management of the insulin resistance-associated syndrome. Despite those new evidences, measurement of insulin resistance in youth remains quite low.

Objective:
The objective was to review and evaluate the proportion of pediatric obese patients referred to a 2nd line pediatric multidisciplinary obesity clinic among whom insulin resistance was screened or not.

Material & Method:
We have looked, retrospectively, at the initial blood tests among 133 obese patients (body mass index above 97th percentile with respect for age and sex) above 10 years of age, between July 2017 and April 2019. Sixty percent (60%) of our urban cohort is represented by 1st and 2nd generation immigrants. Hyperinsulinemia was defined as a value above 100 pmol/L. Pediatric obese patients were referred by general practitionniers or community pediatricians.

Results:
Among the 133 medical files revised, 91 patients shown hyperinsulinemia (68%). Of those 91 patients, 64 were not initially screened for hyperinsulinemia (70%). Interestingly, in the hyperinsulinemia pediatric group, mean HDL-cholesterol was lower, mean triglycérides were higher, as well as the mean alanine transaminase (ALT) compared to the normal insulin group (p smaller than 0.05). In the hyperinsulinemia group, 71,8% of our pediatric cohort was started on metformin therapy in addition to a multidisciplinary intensive educational family interventions as recommended by WHO.

Conclusions:
Fasting insulin can be variable among puberty stages and general guidelines for the use of metformin in the pediatric population are still to come. However, measurement of elevated fasting insulin among pre- and post-pubertal patients was previously associated with markers of cardiovascular and hepatic complications in obese young patients. Fasting insulin is a simple, cheap, easily accessible measure in all clinical settings. Multidisciplinary health care for pediatric obesity is still embryonic and difficult to access. Appropriate and complete initial clinical investigations, including fasting insulin measurement, should be performed in order not to delay its medical intensive multidisciplinary management both in 1st and 2nd lines practitioners.
Abstract P297: Sex Differences in Cardiovascular Risk Factors Before and After Ascertainment of Diabetes and Risk for Incident Cardiovascular Disease; The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: BANCKS Michael , Akhabue Ehimare , Rana Jamal S , Reis Jared P , Schreiner Pamela , Yano Yuichiro , Lewis Cora E
Published: March 2020

Introduction:
Prevalent diabetes mellitus (DM) in mid-life is a stronger risk factor (RF) for cardiovascular disease (CVD) mortality in women than men. However, it is unclear whether (1) changes in CVDRFs before and after incident DM differ by sex, and (2) if such differences are associated with the relationship of incident DM with subsequent CVD events.

Hypothesis:
Rates of change in CVDRFs after incident DM will be worse in women and incident DM will have a stronger association with CVD events in women than men.

Methods:
We included 4893 black and white CARDIA participants, ages 18-30 years at enrollment (1985-86). We ascertained incident DM (n=827) and assessed sex differences in annual change in body mass index (BMI); systolic and diastolic blood pressure (SBP/DBP); total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol before and after the ascertainment of DM using piecewise regression, stratified by race. We estimated hazard ratios (HR) for incident CVD over a median of 30.9 years of follow-up (range: 2, 32) and assessed effect modification between sex and DM. All analyses included adjustment for time-varying behavioral and clinical CVDRFs.

Results:
Age at DM ascertainment was lower for women than men (42.0 vs 45.8 years, sex-difference: 3.8, 95% confidence limits: 2.5, 5.0). Rates of change in CVDRFs before the ascertainment of DM did not differ by sex (Table). However, compared to men, women had greater annual changes in SBP, DBP, total cholesterol, and LDL, but not BMI and HDL, after DM. Median age at CVD did not differ by sex (48.8 years). Incident DM was associated with higher HR for incident overall CVD (HR: 1.45, 95%: 1.07, 1.96) and this association did not differ by sex (p interaction=0.8). Women had lower HR for incident CVD than men (HR: 0.57; 95%: 0.44, 0.74).

Conclusion:
While CVDRFs worsened more rapidly after DM for women, women had lower absolute and relative risks for incident CVD in mid-life than men. The association of incident DM by mid-life with subsequent CVD events did not differ by sex.
Abstract P302: Adverse Health Behaviors Identified in Africans Living With Undiagnosed Diabetes in America
Authors: Hormenu Thomas , Hobabagabo Arsene F , Shoup Elyssa M , Dubose Christopher W , Horlyck-Romanovsky Margrethe F , Sumner Anne E
Published: March 2020

Background:
For African born blacks living in America, lifestyle and food choices may promote or exacerbate diabetes.

Objective:
Our goal was to determine by OGTT the prevalence of diabetes in 451 self-identified as healthy African-born blacks living in America and then compare social and metabolic characteristics according to whether diabetes was detected.

Methods:
When the lifestyle questionnaires were administered, neither the participant nor the health care provider knew the results of the OGTT. Waist circumference (WC), inflammatory markers and lipids were obtained. Computerized tomographic scans were done to measure visceral adiposity (VAT).

Results:
Diabetes was identified in 7% (30/451) of participants. Data provided in the Table. Age and years in the United States were higher in the group with diabetes. After adjusting for age, BMI did not differ by diagnosis, but WC and VAT was higher with diabetes. Homocysteine, hsCRP, and TG were higher and HDL lower in the group with diabetes. The prevalence of both smoking and alcohol intake were higher in the group with diabetes. In addition, the rate of consumption ≥5 servings/day of fruits and vegetables tended to be lower. Education, income, and health insurance did not differ by diagnosis.

Conclusions:
Africans with undiagnosed diabetes are unhealthier than their counterparts without diabetes. Difficult to address social characteristics such as education, income and health insurance did not differ between groups. Nonetheless, identification of undiagnosed diabetes is important because behavior change in regard to smoking, alcohol, and fiber intake could improve health status.
Abstract P311: Engagement of a Community Advisory Board Informs an Exercise Intervention in Older African-American Couples
Authors: Hornbuckle Lyndsey M , Rauer Amy
Published: March 2020

Introduction:
Older African-Americans (AA) are vulnerable to cardiometabolic health disparities. As physical inactivity is highly prevalent in this population and regular exercise can help mitigate cardiometabolic disease, collaborations between the local community and academic researchers are needed to create sustainable exercise interventions. To this end, the current investigators formed a community advisory board (CAB) to consult on an interdisciplinary pilot intervention study that would examine the effects of couples-based resistance training plus walking on: 1) exercise adherence; 2) cardiometabolic risk factors (abdominal obesity, blood pressure, insulin resistance, hemoglobin A1c, high-density lipoprotein and total cholesterol, triglycerides, C-reactive protein, fibrinogen); and 3) the provision of partner support and receptivity to partner health influence in older AA romantic couples.

Hypothesis:
CAB consultation would enhance the proposed pilot study methods and facilitate community engagement.

Methods:
Seven local community members/leaders with a stake in the health of the AA community were invited to participate in two CAB meetings. In the meetings, investigators proposed ideas to pilot a novel exercise intervention in older AA couples and solicited input in four key areas: 1) priority health concerns of the target population; 2) the proposed study protocol; 3) cultural relevance; 4) and sustainability. Recorded responses were summarized and coded using a qualitative thematic analysis approach.

Results:
Multiple themes surfaced within each of the four focus areas including confirmation of the need to study cardiometabolic disease risk (e.g. hypertension, diabetes) in this population, potential recruitment challenges and suggestions to relax exclusion criteria, exclusion of potentially beneficial program components (e.g. flexibility training, education), the need for culturally-specific adaptations (e.g. incorporating music, providing AA role models), and long-term community engagement (i.e. future efforts to launch the intervention at the community level). Investigators made multiple study modifications per CAB recommendations.

Conclusions:
CAB feedback suggested the proposed intervention would be well-received and considered both beneficial and relevant by the community. CAB-recommended study modifications underscore the value of a community-partnered approach to intervention design that promotes cultural relevance and sustainability. These characteristics support the ultimate goal of reducing cardiometabolic health disparities in AA communities. Although the investigators recognize the current method deviates from true community-based participatory research that originates within a community, the model presented is beneficial as it engages the community in the developmental stage of evidence-based research.
Abstract P328: Current Status Of HIV-infected Men Who Have Sex With Men: A Real-world Cross-sectional Study In Underdeveloped Southwest China
Authors: Ran Liyu , Huang Yi , He Xiaoqing , Huang Wei
Published: March 2020

Background:
The prevalence of human immunodeficiency virus (HIV) among men who have sex with men (MSM) remains high and has shown an upward trend in China. However, the status of HIV-infected MSM in the underdeveloped southwest of China is unknown. The study aimed to evaluate the real-world status of HIV-infected MSM and to compare the characteristics between HIV-infected ‘men who have sex with men only’ (MSMO) and ‘men who have sex with men and women’ (MSMW).

Method:
The study was conducted with HIV-infected MSM patients in Chongqing in 2017. A questionnaire addressing socio-demographic characteristics, sexual behaviors, condom use, clinical signs and symptoms, and HIV detection and transmission routes was used.

Results:
A total of 865 HIV-infected MSM were enrolled. More than 70% of MSM had experienced their first sexual intercourse before 20 years old. More than 55.8% of the patients had a high income. Compared with MSMW, more MSMO went to college (60.2% vs. 48.7%), and more often (20.9% vs. 8.7%) use condom during anal sex. Weight loss was the most common sign (15.1%). The numbers of male partners and high-risk sexual behaviors among HIV-infected MSM remained high (30.6%), and few patients (4.6%) agreed to voluntary counseling and testing (VCT). Routine health examination was the most frequently (72.7%) used detection method . Homosexual behavior may be the most frequent transmission route (87.9%) among HIV-infected MSMO and MSMW.

Conclusion:
The findings indicate that the government should promote more prevention strategies against HIV transmission and detection among MSM.
Abstract P344: Comparison of Visceral Adipose Tissue Measurements in Adolescents Between Magnetic Resonance Imaging and DXA
Authors: Kracht Chelsea L , Katzmarzyk Peter T , Staiano Amanda E
Published: March 2020

Introduction:
Excess Visceral Adipose Tissue (VAT) is linked to cardiometabolic risk in adolescents. VAT is mainly measured using Magnetic Resonance Imaging (MRI), yet dual-energy x-ray absorptiometry (DXA) is more affordable and available. The purpose was to compare VAT from MRI and DXA in adolescents.

Methods:
Adolescents 10-16 years of age were recruited. Abdominal MRI was performed using a General Electric (GE) Signal Excite scanner (3.0 Tesla; GE Medical Systems) with IDEAL-IQ imaging software. A series of scans between specific points on the liver and kidney were conducted. A trained technician manually drew VAT and used additional calculations to determine VAT volume (L). A whole-body DXA (GE iDXA scanner) was performed and software calculated VAT within the android region. Paired samples t-tests were used to determine differences between VAT values, within sex, race (White, African American, and Other race), and BMI categories (normal, overweight, and obese). VAT values were standardized to a mean of zero and unit standard deviation and compared with a Bland Altman plot.

Results:
A total of 330 adolescents participated. The mean age was 12.6±1.9 years, and the sample was 52.3% female, 58.5% White, 14.7% overweight (14.7%), and 33.5% obese. Average VAT from MRI (0.58±0.47 L) and DXA (0.35±0.41 L) significantly differed (
p
=0.001). The error and absolute error were -0.23 ±0.20 L and 0.23±0.20 L respectively, with DXA measuring lower than MRI. DXA values were significantly lower from MRI values for each sex, race, and BMI categories (
p
<0.01 for all). DXA values were closest to MRI values in African American adolescents (-0.14 ±0.20 L) and furthest away for those who had overweight (-0.31±0.17 L). All standardized values fell within ±1.96 standard deviations (Figure 1).

Conclusions:
In this sample, DXA measured VAT values were consistently lower overall and in subgroups compared to MRI. In general, DXA values were not comparable to MRI values.
Abstract P345: Left Ventricular Hypertrophy Screening via Machine Learning for Young Adults
Authors: Lin Gen-min
Published: March 2020

Background:
A use of conventional 12-lead electrocardiographic (ECG) criteria and machine learning for the ECG parameters to identify the presence of left ventricular hypertrophy (LVH) is estimated 20%-30% in the general population. We developed an ECG system with simple anthropometric data using machine learning to increase the sensitivity in screening for LVH.

Methods:
In a large sample of 2,196 males, aged 17-45 years, the support vector machine (SVM) classifier with linear kernel is used as the machine learning method for 31 characteristics including age, body height, and body weight in addition to 28 ECG parameters such as axes, intervals and voltages to link the output of LVH. The diagnosis of LVH is based on the echocardiographic criteria for young adult males as 116 g/m
2
(left ventricular mass (LVM)/body surface area) or 49 g/m
2.7
(LVM/body height
2.7
). The samples are divided into a training/validation set and a test set. By applying the synthetic minority over-sampling technique (SMOTE) in pre-processing of training data, the imbalance in sample size between the Non-LVH and LVH cases can be solved.

Results:
For the test set with 440 cases, average accuracy, specificity, sensitivity, precision and F
1
score are 76.1%, 75.1%, 92.6%, 19.5% and 32.3%, respectively. The AUCs of ROC and PR curves are 0.871 and 0.272, respectively. To compare with the Cornell and Sokolow-Lyon voltage criteria as shown in Fig.1, all data of the 2,196 young males are also tested in the model. With the specificity of 73.3%, our SVM technique provides much better sensitivity 86.7% compared to 3.3% and 52.7% for the Cornell and Sokolow-Lyon voltage criteria, respectively. The body height and body weight are the most important factors among the 31 features in our SVM model.

Conclusions:
We provide a novel screening tool using simple anthropometrics and several ECG data to identify LVH in young adults and improves much in sensitivity as compared with the conventional ECG criteria or using machine learning for ECG data alone to identify LVH.
Abstract P352: Trend of Salt Consumption in Italy From 2008 to 2018: Preliminary Results of the Cuore Project
Authors: Donfrancesco Chiara , Lo Noce Cinzia , Russo Ornella , Minutoli Daniela , Di Lonardo Anna , Buttari Brigitta , Profumo Elisabetta , Galeone Daniela , Giampaoli Simona , Bellisario Paolo , Palmieri Luigi , Strazzullo Pasquale
Published: March 2020

Introduction:
The WHO Global Action Plan for the Prevention of Non-Communicable Diseases (NCDs) recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI).

Hypothesis:
Agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. Within the NPP, initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators are implemented. In order to estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project.

Methods:
Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from random samples of persons aged 35-79 years, resident in all Italian 20 Regions. A new survey is ongoing (2018-2019) involving random samples of persons aged 35-74 years, resident in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the seven regions examined up to now in the ongoing survey and the age range of 35-74 years.

Results:
Within the 2018-2019 survey, mean level of sodium chloride per day in 673 men and 709 women was 161 mmol (95% confidence interval: 156-166 mmol) and 122 mmol (119-126 mmol) respectively, whereas in the 2008-2012 survey the corresponding mean levels in 642 men and 627 women was 183 mmol (95% confidence interval: 178-189 mmol) and 140 mmol (135-144 mmol), respectively. A sodium chloride intake level within the WHO recommended upper level of 85 mmol (or 5 grams of salt) per day was detected in 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019 vs 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012.

Conclusions:
These preliminary data show that the average habitual sodium intake in Italy is still largely higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives for reduction of sodium intake and its monitoring in the population.
Abstract P360: Dietary Saturated Fats From Different Food Sources Show Inconsistent Associations With Various Indices of Diet Quality in the Canadian Population
Authors: Harrison Stephanie , Brassard Didier , Lemieux Simone , Lamarche Benoit
Published: March 2020

Background:
Canadian dietary guidelines include a recommendation to limit the consumption of foods high in saturated fats (SFA), regardless of their dietary source. The same guidelines also recommend consumption of lean red meat and low-fat dairy products. Yet, the association between the consumption of SFA from different food sources and diet quality is currently unknown. The objective of this study was to examine associations between SFA from various food sources and different indices of diet quality.

Methods:
Analyses are based on a sample of 11 106 respondents representative of Canadian adults (19-70 y) from the 2015 Canadian Community Health Survey (CCHS 2015). Dietary intakes and diet quality indices were calculated using a single interview-administered 24-hour recall. Food sources of SFA were classified according to the 2019 Canada’s Food Guide categories: 1) vegetables and whole fruits, 2) whole grain foods and 3) protein foods (including dairy and meat, among others). Foods not included in these three categories were grouped as
All other foods
. The 2010 alternative Healthy eating index (aHEI), the 2015 Healthy eating index (HEI-2015) and the 2007 Canadian Healthy eating index (C-HEI) were calculated. Due to the unreliability of data for
trans-fat
consumption in the CCHS 2015 database, the
trans-fat
subscore of the aHEI was removed from the original score.

Results:
While total SFA intake and SFA from
All other foods
were inversely correlated with all indices of diet quality (-0.55<r<-0.10, all p<0.001), associations with SFA from dairy and meat were inconsistent. SFA from dairy were inversely correlated (p<0.001) with the aHEI (r=-0.14) and the HEI-2015 (r=-0.16) but showed a weak positive correlation with the C-HEI (r=0.05, p<0.001). SFA from meat were negatively correlated with the aHEI (r=-0.21, p<0.001) and positively correlated with the C-HEI (r=0.11, p<0.001). Removing subscores directly related to SFA intake in diet quality indices yielded positive correlations between SFA from dairy and the HEI-2015 (r=0.13, p<0.001) and the C-HEI (r=0.19, p<0.001).

Conclusion:
Consumption of SFA from different food sources are inconsistently associated with different indices of overall diet quality. Unsurprisingly, SFA from
All other foods
, which include low nutritive value foods, showed the strongest negative correlation with all diet quality scores. These results provide further support to the notion that guidance on SFA in future health policies should focus on food sources rather than on total intake of SFA.
Abstract P373: Are Generic Drugs Used in Cardiology as Effective and Safe as Their Brand-name Counterparts? A Systematic Review and Meta-analysis
Authors: Leclerc Jacinthe , Thibault Magalie , Midiani Gonella Jennifer , Beaudoin Claudia , Sampalis John
Published: March 2020

Background:
Generic drugs constitute lower cost alternatives when the original drug patent expires. Two large systematic reviews and meta-analyses (2008; 2016) concluded to similarity in outcomes between brand-name and generic drugs in cardiology. These meta-analyses were possibly biased by the inclusion of ≥ 50% comparative bioavailability studies, not designed nor powered to detect a difference in efficacy or safety between drug types. We aimed to summarize best evidences regarding the effectiveness and safety of generic versus brand-name drugs used in cardiology.

Methods:
To conduct this systematic review of the literature, scientific databases (MEDLINE and EMBASE) were searched from the latest date among their inception or January 1984, to March 2018. Original research reports comparing the clinical impact of brand-name vs. generic cardiovascular drugs on humans treated in real-life setting were included. Meta-Analyses and subgroup analyses were performed. Heterogeneity (I
2
) and risk of bias were tested.

Results:
Among the 3,148 screened abstracts, 72 met inclusion criteria. The studies included a total of 1,048,499 patients who used generic or brand-name cardiovascular drugs. Mean age was 65 +/- 10 years old and 42% were women. The most commonly studied therapeutic classes were antiplatelets, statins and anticoagulants. Platelet function, international normalized ratio and systolic blood pressure were similar in generic and brand-name groups. The risk of bias was modest to serious in the majority of studies. The overall relative risk of all-cause hospitalizations was 1.14 (95% Confidence interval: 1.06 to 1.23; I
2
: 98%), while it was 1.05 (0.98 to 1.14; I
2
: 68%) for cardiovascular hospitalizations (both pooled: 1.10 [1.04 to 1.15]; I
2
: 93%).

Conclusion:
The risk of hospitalization seemed higher for patients exposed to generics. However, evidences are insufficient and too heterogeneous to conclude that generics are as effective and safe as brand-name drugs in cardiology.
Abstract P375: Prospective Associations of Accelerometer-measured Physical Activity and Sedentary Time With Cardiometabolic Multimorbidity in the CARDIA Study
Authors: Full Kelsie M , Gabriel Kelley , Whitaker Kara M , Lewis Cora E , Sternfeld Barbara , Barone Gibbs Bethany , Sidney Stephen , Reis Jared P , Jacobs David R , SCHREINER Pamela
Published: March 2020

Background:
Cardiometabolic multimorbidity is rising rapidly in the US. This condition is associated with greater health care burden and risk for adverse outcomes, including mortality. We investigated the relations of sedentary time (ST), light intensity physical activity (LPA), and moderate to vigorous intensity physical activity (MVPA) with future cardiometabolic multimorbidity in mid-life.

Methods:
Participants were 1,863 adults (mean ± SD age=45±4 years, 58% female, 39% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who wore an ActiGraph 7164 accelerometer in 2005-2006 (baseline). Cardiometabolic multimorbidity was defined as ≥2 measured cardiometabolic conditions (untreated/uncontrolled hypertension and hyperlipidemia, diabetes mellitus, chronic kidney disease, and clinical cardiovascular outcomes). Separate logistic regression models provided estimates of prospective associations of accelerometer-measured ST, LPA, and MVPA with cardiometabolic multimorbidity 10 years later in participants with <2 cardiometabolic conditions at baseline. Interactions by age, sex, and race were explored.

Results:
The highest (>47.3 min/d) vs. lowest (<17.5 min/d) quartile of MVPA was associated with lower odds of cardiometabolic multimorbidity (OR: 0.61; CI: 0.37, 0.99) 10-years later. This association did not differ by age, race, or sex. Overall, there was no association between ST and cardiometabolic multimorbidity. However, a significant interaction was observed by age (p value=0.03). In age-stratified analyses, among participants ≥46 years at baseline, the highest (>9.3 hr/d) vs. lowest (<7.1 hr/d) quartile of ST was associated with higher odds of cardiometabolic multimorbidity (OR: 2.86; CI: 1.36, 6.17). No associations were observed between LPA and cardiometabolic multimorbidity.

Conclusions:
In mid-life adults with <2 conditions at baseline, greater daily MVPA was associated with lower odds of future cardiometabolic multimorbidity burden 10 years later.
Abstract P395: Low Neighborhood Income is Associated With Increased Hypertension Incidence in the Reasons for Geographic and Racial Differences in Stroke Study
Authors: Koh Insu , McClure Leslie A , Judd Suzanne E , Lovasi Gina S , Colabianchi Natalie , Plante Timothy B , Schwartz Aaron J , Zakai Neil
Published: March 2020

Introduction:
Prior studies have investigated the relationship between neighborhood income and incident hypertension but have lacked participant-level details or studied specific subpopulations. We assessed the relationship between neighborhood income and incident hypertension accounting for individual level factors in the racially and geographically diverse REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Hypothesis:
Low neighborhood income is associated with increased hypertension incidence.

Methods:
REGARDS recruited 30,239 white and black adults aged ≥45y from the contiguous US in 2003-7 with follow-up between 2013-6. We excluded individuals with baseline hypertension (≥130/80 mm Hg or using antihypertension medications, n=22,325), missing follow-up (n=3,365) and not residing at the same address for ≥5 years (n=1,075). Neighborhood income was measured within 1 and 5 km buffers around the participant’s home using a spatial overlay of census tract-level median household income, and then classified into tertiles. We used Poisson regression to calculate risk ratio for incident hypertension adjusting for demographic, socioeconomic, and health habit factors.

Results:
Among the 3,474 individuals (58% women, 24% black, mean age 62y), 1,499 individuals (43%) developed hypertension. After adjusting for individual-level risk factors, the incident rate ratio of hypertension for individuals living in low-income neighborhoods was 1.16 (95% CI 1.04, 1.31) and middle-income was 1.12 (95% CI 1.01, 1.25) as compared to high income, when neighborhood was defined as a 1 km buffer. The result was similar but not significant in middle-income for the 5 km buffer neighborhoods (Table 1). There were no significant interactions with age, gender, or race (p-interaction > 0.1).

Conclusions:
In REGARDS, neighborhood income was associated with incident hypertension. Understanding the specific social and environmental inequities associated with hypertension will require further study.
Abstract P412: Toward A Biomarker Kit Suitable For Clinical Practice; A Novel Metabolomic Biomarker Risk Score Improves The Prognostic Value Of Cardiovascular Mortality In Elderly Congestive Heart Failure Patients
Authors: McGranaghan Peter , Saxena Anshul , Rubens Muni , Radenkovic Jasmin , Bach Doris , Schleußner Leonhard , Pieske Burkert , Edelmann Frank , Trippel Tobias
Published: March 2020

Aims:
The Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite-based biomarkers that has previously shown to improve the diagnostic value of NT-proBNP. Little is known about its usefulness in predicting outcomes. In this study, the aim was to develop a risk score for 4-year cardiovascular death in elderly CHF patients.

Methods and Results:
We included 280 patients >65 years of age with CHF randomly selected from the CIBIS-ELD trial. A targeted metabolomic analysis of the three CLP biomarkers was performed on baseline serum samples. Cox proportional hazards regression was used to determine the relationship of the biomarkers with the outcome and adjusted for established risk factors (age, sex, BMI, creatinine, LDL, triglycerides, and LVEF). The CLP risk score was calculated by counting the number of biomarkers above a cut-off determined using the Youden’s indexes. During the follow-up period, mean 50 months [±8 months], 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve (AUROC) for the model based on only clinical variables was 0.72, the second model with clinical variables plus NT-proBNP was 0.79, and the final model with clinical variables, NT-proBNP, plus the CLP was 0.83.

Conclusions:
A risk score based on a panel of 3 metabolite-based biomarkers was found to improve the prognostic value of traditional risk factors and NT-proBNP in a cohort of CHF subjects. Our next steps include validating the prognostic value of the CLP biomarker kit in order to provide a better clinical risk assessment of CHF patients.
Abstract P418: Increased Pro-neurotensin/neuromedin N is Associated With Incident Ischemic Stroke
Authors: Nicoli Charles D , Wettersten Nicholas , Howard George , Howard Virginia J , Judd Suzanne E , Cushman Mary
Published: March 2020

Introduction:
The neuropeptide neurotensin (NT) has been linked to cardiovascular and metabolic disease risk. Through measurement of its stable equimolar precursor, pro-neurotensin/neuromedin N (pro-NT/NMN), hyperactivity of NT has been associated with aggregate cardiovascular outcomes that include stroke. However, the exclusive association of pro-NT/NMN with incident ischemic or hemorrhagic stroke has not been studied.

Hypothesis:
Higher serum pro-NT/NMN is associated with incident ischemic and hemorrhagic stroke.

Methods:
Prospective case-cohort study in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. From 2003-2007, REGARDS enrolled 30,239 White or Black adults aged ≥45. Pro-NT/NMN was measured by immunoassay in 464 ischemic stroke cases, 49 hemorrhagic stroke cases, and 800 non-cases from a random cohort. Cox proportional-hazards models were used to calculate hazard ratios (HR) of stroke by pro-NT/NMN quartiles and per standard deviation (SD) of log pro-NT/NMN. Model 1 (both stroke types) included demographic factors as covariates, Model 2A (ischemic only) added ischemic stroke risk factors, and Model 2B (hemorrhagic only) added hemorrhagic stroke risk factors.

Results:
The table shows an increased HR of ischemic stroke for those in the 4th vs 1st-quartile pro-NT/NMN in Model 1 with a trend of increased risk across quartiles; this was attenuated in Model 2A. Prebaseline diabetes and coronary artery disease were the largest confounders of ischemic stroke risk, with each accounting for 19% of the association observed in Model 1. There was no association of pro-NT/NMN with hemorrhagic stroke in either model. There were no interactions of race or sex with log pro-NT/NMN.

Conclusions:
Higher pro-NT/NMN is associated with increased risk of ischemic stroke after adjusting for demographics, but this was not independent of stroke risk factors. No significant association with hemorrhagic stroke was observed; this analysis was limited by a small number of events.
Abstract P426: Cumulative 30-year Alcohol Use From Young Adulthood and Mid-life Cognitive Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Sidney Stephen , Jakob Julian , Gilsanz Paola , Lee Catherine , Jacobs David , Pletcher Mark J , Rana Jamal S , Reis Jared P , Roger Veronique L , Yaffe Kristine , Auer Reto
Published: March 2020

Introduction:
Alcohol use is common in the United States. Most studies describe a J-shaped relationship between alcohol consumption and cognitive function: frequent heavy consumption alters brain functions and decreases cognitive performance; regular light and moderate consumption may have protective impact. We are unaware of any reports utilizing longitudinally collected data to derive a cumulative exposure of alcohol use and assess its association with cognitive function.

Hypothesis:
Cumulative 30-year exposure to alcohol has a J-shaped association with mid-life cognitive function.

Methods:
We included 3,068 participants aged 18-30 years at the baseline examination (1985-86) and having up to 8 follow-up exams at 2- to 5-year intervals including at 30 years (2015-16). Cumulative “drink-years” exposure to alcohol was estimated at each exam by multiplying the usual number of drinks/day reported by the number of years since last exam, and then summing across exams. We used multivariable adjusted linear regression models to assess the independent associations of number of drink-years with 6 measures of cognitive function studied at Year 30: Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), Stroop Test, Montreal Cognitive Assessment (MoCA), Category Fluency Test, and Letter Fluency Test. We used inverse probability of censoring weighting to account for potential informative censoring. Linear regression models estimated standardized mean test scores for the cumulative alcohol use categories (drink-years: >0 and <15, 15-29.9, 30+). Too few participants were available for assessment of higher categories of use.

Results:
Compared with never drinking, the 3 categories of cumulative exposure were unassociated with any of the cognitive function measures.

Conclusions:
Cumulative 30-year alcohol use is not associated with cognitive function in middle-aged adults in the CARDIA study.
Abstract P431: ASSOCIATION OF LIPOPROTEIN(A) WITH CARDIOVASCULAR EVENTS IN YOUNG NON-FAMILIAL HYPERCHOLESTEROLEMIA
Authors: Chu Pao-Hsien
Published: March 2020

Background and aims:
Elevated lipoprotein(a) is an independent risk factor for atherosclerotic cardiovascular disease especially in familial hypercholesterolemia. The association of elevated lipoprotein(a) within non-familial hypercholesterolemia or healthy population however, is not known. Therefore, we investigated the associations between elevated lipoprotein(a) and the risk of cardiovascular disease in a non-familial hypercholesterolemia clinically healthy young age cohort.

Methods:
In this retrospective cohort study, we reviewed medical records of 3,427 participants with lipoprotein(a) levels from a tertiary healthcare center in Taiwan. We further classified lipoprotein(a) level into four groups and analyzed cardiovascular events.

Results:
Our study population had a mean age 46 years old that were 78% male. Mean total cholesterol and low-density lipoprotein level were 195 mg/dL and 118 mg/dL respectively. Overall, 12.9% of the participants had an elevated lipoprotein(a) level (>30 mg/dL), and 2.7% had a very high level (>70 mg/dL). Thirty-three events including 6 participants with stroke and 27 with coronary artery disease were identified. A lipoprotein(a) level >70 mg/dL was associated with a higher risk of coronary artery disease events in Kaplan-Meier analysis. Aging was associated with a higher lipoprotein(a) value in the male participants but not in the female participants. However, the severity of fatty liver was not positively associated with lipoprotein(a) value.

Conclusions:
Elevated lipoprotein(a) was associated with coronary events but not the severity of fatty liver disease in non-familial hypercholesterolemia clinically healthy population. Aging may be associated with a higher lipoprotein(a) level in males but not females.
Abstract P475: Dementia and Heart Failure a Community Study
Authors: Manemann Sheila M , Knopman David , St. Sauver Jennifer , Bielinski Suzette J , Chamberlain Alanna M , Weston Susan A , Jiang Ruoxiang , Roger Veronique L
Published: March 2020

Background:
The effective self-management of heart failure (HF) is highly dependent on cognitive function. Dementia frequently coexists with HF, but its exact prevalence and impact on health care utilization and death is not well understood.

Methods:
Residents from 7 southeast Minnesota counties with a first-ever code for HF (ICD-9 428 and ICD-10 I50) between 1/1/2012 and 12/31/2017 were identified. Dementia before and after the HF diagnosis was ascertained with codes recommended by the US Department of Health and Human Services. Patients were followed through 12/31/2018 for death and hospitalizations. Cox and Andersen-Gill models were used to examine associations between dementia (prior and post HF) and death and hospitalizations, respectively. Dementia after HF was analyzed as a time-dependent variable.

Results:
Among 6,312 patients with HF (mean age 75 years, 49% female), 636 (10%) had a prior diagnosis of dementia. After a mean (SD) follow-up of 3.1 (1.8) years, 601 (9.5%) patients were diagnosed with dementia post HF. The median time from HF to dementia was 1.3 years, with 43% of dementia cases occurring within 1 year and 64% within 2 years post HF. During follow-up, 2,678 deaths and 15,095 hospitalizations occurred. After adjustment, patients with dementia before HF had nearly a 2-times increased risk of death and 10% increased risk of hospitalization compared to those that did not have dementia (Table). Dementia after HF was associated with a 78% increased risk of death and 63% increased risk of hospitalization compared to those that did not have dementia.

Conclusions:
Approximately 10% of patients had dementia prior to HF and 10% develop dementia shortly after HF diagnosis. Patients with HF and dementia have an increased risk of death and hospitalization compared to dementia-free counterparts. These data underscore the importance of recognizing the presence and impact of dementia on outcomes in HF to optimize care delivery.
Abstract P483: Living Arrangement Affects Urine Na/k Ratio Among 44,085 Residents: Tohoku Medical Megabank Project Community-based Cohort Study
Authors: Mikami Takahiro , Tanno Kozo , Sasaki Ryouhei , Takanashi Nobuyuki , Kotozaki Yuka , Kogure Mana , Hozawa Atsushi , Sakata Kiyomi , Sasaki Makoto
Published: March 2020

Introduction:
High dietary sodium-to-potassium (Na/K) ratio contributes to increased risk of cardiovascular disease (CVD) events. Previous studies on Japanese people suggested that women living in a multi-generational household (i.e., with spouse-children-parents; or spouse-parents) had a 2-3 fold higher risk of CVD events than women living with spouses only. However, few studies have examined the effect of living arrangement on urinary (U) Na/K. We clarified whether those living in a multi-generational household had higher UNa/K than those living with spouses only.

Methods:
We analyzed data of 44,085 residents (20-74 years), enrolled in the Tohoku Medical Megabank Project Community-based Cohort (TMM CommCohort) Study. UNa/K ratios were derived by dividing urinary Na levels (mEq/L) by urinary K levels (mEq/L) using spot urine samples. Participants were categorized into “living with spouse only”, “living with spouse and children”, “living with spouse and parents”, “living with parents and children”, “living with child only”, and “living with spouse, children and parents”. Using analysis of covariance, multivariate-adjusted geometric means of UNa/K ratios in each group were calculated by sex, with adjustments for other variables.

Results:
Those in a multi-generational household with spouse-children-parents had significantly higher multivariate-adjusted geometric means of UNa/K ratios in both sexes than those living with spouses. In male, those in a multi-generational household with spouse-childrenhad significantly higher multivariate-adjusted geometric means of UNa/K ratios than those living with spouses. In female those in a multi-generational household with spouse-parents or with children-parents had significantly higher multivariate-adjusted geometric means of UNa/K ratios than those living with spouses.

Conclusions:
This study suggests that those living in a multi-generational household have higher UNa/K ratios, which might contribute to an increased risk of CVD events.