bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P264: Metal Exposures and Preeclampsia in the Boston Birth Cohort
Authors: Liu Tiange , Zhang Mingyu , Guallar Eliseo , Wang Guoying , Hong Xiumei , Wang Xiaobin , Mueller Noel T
Published: March 2019

Introduction:
Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, accounting for 50,000-60,000 deaths per year worldwide. Animal studies have linked metal exposures to its development but epidemiologic studies have had inconsistent findings. We assessed the associations between metal exposures and preeclampsia in a prospective cohort.

Methods:
A total of 1,346 women from the Boston Birth Cohort (enrolled from 1998 to 2018) had complete data on the exposures and outcome and were free of both chronic and gestational hypertension. Metal exposures, including manganese (Mn), cadmium (Cd), lead (Pb), mercury (Hg), and selenium (Se) were measured from red blood cells (RBCs) collected within 1 to 3 days after delivery. Preeclampsia (including HELLP syndrome) diagnosis was ascertained from medical records. Logistic regression models were fitted for each metal. Covariates adjusted for included age at delivery, race, pre-pregnancy body mass index, education, parity, and smoking status during pregnancy.

Results:
A total of 119 (8.84%) women developed preeclampsia. A 1 standard deviation (SD) (15.42 μg/L) increase in RBC Mn was associated with a 0.71 (95% confidence interval (CI): 0.56, 0.90) times lower odds of preeclampsia. Compared to the 1
st
quintile of RBC Mn, the 5
th
quintile was associated with 0.39 (95% CI: 0.20, 0.76) times lower odds of preeclampsia. In contrast, a 1 SD (0.68 μg/L) increase in RBC Cd was associated with a 1.17 (95% CI: 0.94, 1.46) times higher odds of preeclampsia, and the odds for the 5
th
quintile of RBC Cd was 2.04 (95% CI: 1.03, 4.04) times higher than the 1
st
quintile
(Figure)
. Null associations were observed for RBC Pb, Hg and Se.

Conclusion:
RBC Mn was associated with lower odds of preeclampsia, while Cd was associated with higher odds. Findings from this study help elucidate potentially modifiable causes of preeclampsia and inform interventions to reduce the burden of this important pregnancy complication.
Abstract P269: Combined Associations of Objective Sleep Efficiency and Overweight With the Prevalence of Hypertension in Japanese Adults
Authors: Hirata Takumi , Nakamura Tomohiro , Kogure Mana , Narita Akira , Miyagawa Ken , Nochioka Kotaro , Tsuchiya Naho , Obara Taku , Nakaya Naoki , Kuriyama Shinichi , Hozawa Atsushi
Published: March 2019

Introduction:
Poor sleep efficiency is a risk for prevalent hypertension, and also overweight is one of the major risk factors for hypertension. Generally, overweight participants have poor sleep efficiency, and thus, overweight may modify the association between poor sleep efficiency and hypertension. However, there are no previous reports to examine the impact of overweight on the association between poor sleep efficiency and hypertension.

Hypothesis:
Poor sleep efficiency is associated with increased with prevalent hypertension, particularly in individuals with non-overweight.

Methods:
We conducted a cross-sectional study of 779 participants aged 20 years or older who lived in Miyagi prefecture, Japan. All the participants were recruited from June 2017 to March 2018. Sleep efficiency was measured by HSL-101 sleep sensor, and then we classified all the participants into four groups according to their sleep efficiency (good; ≥90%/poor; <90%) and the presence or absence of overweight which was defined as BMI of 23 kg/m
2
or higher based on the Western Pacific Region of WHO criteria for Japanese. Hypertension was defined as morning home blood pressure ≥135/85 mmHg or receiving treatment for hypertension. Multivariable logistic regression models were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to assess the combined associations of poor sleep efficiency and overweight with prevalent hypertension. Models were adjusted for sex, age, alcohol drinking status, smoking status, average daily steps, urinary sodium/potassium ratio, and sleep duration.

Results:
Of the 779 participants (68.3% women, mean age 61.0 years), 252 (32.3%) had poor sleep efficiency, 331 (42.5%) had overweight, and 303 (38.9%) had hypertension. The prevalence of poor sleep efficiency was higher in men (41.7% in men vs. 28.0% in women), and the individuals with poor sleep efficiency had a higher proportion of overweight (52.8 % in participants with poor sleep efficiency vs. 37.6 % in those with good sleep efficiency) and shorter sleep duration. In a multivariable analysis, compared with individuals with good sleep efficiency and non-overweight for hypertension, the adjusted ORs (95% CIs) of those with poor sleep efficiency and non-overweight, good sleep efficiency and overweight, and poor sleep efficiency and overweight for hypertension were 1.79 (1.08 to 2.98), 2.99 (1.99 to 4.49), and 4.15 (2.56 to 6.71), respectively.

Conclusions:
Poor sleep efficiency was associated with increased prevalence of hypertension even in individuals with non-overweight, and additionally the risk of poor sleep efficiency for prevalent hypertension in individuals with overweight was relatively higher than that in individuals with non-overweight.
Abstract P272: The Association Between Sleep Apnea and Left Ventricular Structure and Function: The ECHO-SOL Ancillary Study
Authors: Ogilvie Rachel P , Genuardi Michael V , Patel Sanjay R , Magnani Jared W , Redline Susan , Daviglus Martha L , Shah Neomi , Ramos Alberto R , Cai Jianwen , Hurwitz Barry E , Kansal Mayank , Rodriguez Carlos J
Published: March 2019

Background:
Obstructive sleep apnea (OSA) initiates a range of pathophysiologic mechanisms which may promote cardiac disease, but few studies have examined the association of OSA with global longitudinal strain (GLS) and diastolic function, especially among middle aged and older Hispanics/Latinos in the United States.

Methods:
We examined cross-sectional data from adults aged 18-64 in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014), a representative subsample of the parent study. OSA was assessed using an ARES Unicorder sleep apnea monitor for one night; the apnea-hypopnea index (AHI) was obtained. Echocardiographic measures evaluated left ventricular (LV) structure (LV mass index [LVMI], left atrial volume index), systolic function (ejection fraction, GLS) and diastolic function (E’ and E/e’ ratio). Potential confounders included age, sex, ethnicity, and body mass index. Multivariable linear regression was used to model the association between AHI and the echocardiographic outcomes. All analyses accounted for the complex survey design.

Results:
Among 1,506 participants (median age 55.0, interquartile range 49.0, 62.0, 58.3% female) with both sleep and echo data, 17.9% had an AHI ≥15 and 3.2% had an ejection fraction <50%. Each 10-unit higher AHI was associated with 1.4 (95% CI 0.3, 2.5) g/m2 greater LVMI, 0.1 (0.0, 0.3) worse GLS, 0.2 (0.1, 0.3) lower E’, and 0.3 (0.1, 0.5) greater E/E’ ratio. There were no associations between AHI and left atrial volume index or ejection fraction.

Conclusion:
OSA was associated with poorer LV GLS and diastolic function indices, but associations with structure and ejection fraction were less consistent. Subclinical LV dysfunction may precede the onset of symptomatic disease in this at-risk population. Further studies are needed to determine the longitudinal association of OSA and cardiac remodeling.
Abstract P273: The Association of Obstructive Sleep Apnea on Cardiac Parasympathetic Responses During Stress Testing: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Castro-Diehl Cecilia , Redline Susan , Sloan Richard , Reis Geovanini Glaucylara , Wang Xu , Kwon Younghoon , Shea Steven
Published: March 2019

Introduction:
Obstructive sleep apnea (OSA) may lead to abnormalities in the balance between sympathetic and parasympathetic activity at night; variation in daytime activity and responses to stress are less understood.

Hypothesis:
OSA is associated with reduced parasympathetic response from stress challenges.

Method:
In the Multi-Ethnic Study of Atherosclerosis (MESA) cohort (mean age 68yrs), 413 participants underwent in-home polysomnography. OSA severity was characterized by apnea-hypopnea index (AHI) as mild (5≤AHI<15), moderate (15≤AHI<30), severe (AHI≥30), or no OSA (AHI <5 events/h) (referent). We examined High Frequency (HF)-heart rate variability (HRV), an index of cardiac parasympathetic modulation, during a standardized daytime stress challenge protocol: a baseline period followed by two mental stress tasks, the modified Stroop color-word conflict and an arithmetic task, each followed by a recovery period. We used linear mixed effects model with HF-HRV as outcome.

Results:
Participants with mild OSA (but not those with moderate or severe OSA) had lower levels of HF-HRV than those with no OSA (–0.36 log msec
2
, 95% CI –0.70, –0.02,
P
<0.05) at baseline. Those with severe OSA had a smaller increase in HF-HRV during recovery than the no OSA group (–0.34% change, 95% CI –0.63, –0.06,
P
<0.05) (
Table 1A
). Because OSA related cardiovascular disease may vary by age, a sensitivity analysis separately examining participants ≥65 and < 65 yo suggested that those ≥65 years with mild and moderate OSA had greater HF-HRV reactivity to the tasks than those with no OSA, and those <65 years with mild, moderate and severe OSA had a smaller increase in HF-HRV during recovery than those without OSA (
p
-interaction=NS)
(Table 1B).

Conclusions:
Our results showed reduced HRV at baseline and a decrease of the parasympathetic cardiac modulation with stress challenge associated with OSA severity. Findings were different according to age groups. Assessment of HRV may help identify individuals with OSA-related physiological abnormality.
Abstract P274: Association Between Atrial Fibrillation and Central Sleep Apnea in Older Japanese-American Men
Authors: Anzai Tagayasu , Grandinetti Andrew , Katz Alan , Masaki Kamal
Published: March 2019

Introduction:
Several studies have indicated that central sleep apnea (CSA) is associated with atrial fibrillation (AF) in older populations. However, there are few studies of this association in older Asian populations.

Hypothesis:
The hypothesis being tested is that there is an association between AF and CSA in older Japanese-American men.

Methods:
The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. We did a cross- sectional analysis using data from the 1999- 2000 7th exam cycle. Participants were 718 Japanese-American men between 79 and 97 years old, who had overnight polysomnography (PSG) conducted in their homes using criteria established by the large multicenter Sleep Heart Health Study. Obstructive Apnea-Hypopnea Index (OAHI) was the measure of the number of obstructive apneas and hypopneas with >4% oxygen desaturation. Additionally, the Central Apnea Index (CAI) was the measure of the number of central apneas. Obstructive sleep apnea (OSA) was categorized as none (OAHI <5), mild (OAHI 5-14), moderate (OAHI 15-29) and severe (OAHI 30 or more). CSA was defined by CAI of 5 or more. Cheyne-Stokes Breathing (CSB) was defined as a minimum consecutive 10-minute period of a crescendo-decrescendo respiratory pattern associated with CSA. A board-certified physician confirmed AF by single lead electrocardiography of PSG.

Results:
The mean age of participants was 83.2±0.2 years. The prevalence of AF was 5.5% (39 of 709). The prevalence proportions of severe OSA, CSA, and CSB were 20.5% (145 of 709), 6.3% (43 of 681) and 3.2%, (22 of 681) respectively. In multivariable-adjusted logistic regression models, CSA and CSB were significantly associated with AF prevalence [Odds Ratio (OR) 4.78; 95% Confidential interval (CI), 1.91-11.95] and [OR 5.48; 95% CI, 1.70-17.66], respectively. In contrast, OSA was not significantly associated with AF prevalence (severe OSA [OR 1.17; 95% CI, 0.44-3.11], moderate OSA [OR 0.72; 95% CI, 0.26-2.05], mild OSA [OR 0.97; 95% CI, 0.39-2.44]).

Conclusion:
There is an association of AF prevalence with CSA and CSB in older Japanese-American Men. In older Japanese men, screening for CSA and CSB might be important to prevent AF.
Abstract P278: Patterns of Eating Associated With Sleep Duration, Insomnia, Daytime Sleepiness, and Overall Sleep Quality Among Individuals of Mexican Descent at the US-Mexico Border
Authors: Grandner Michael , Okuagu Ashley , Granados Karla , Olivier Kayla , Alfonso-Miller Pamela
Published: March 2019

Introduction:
Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group.

Methods:
Data were collected from N=100 adults (age 18-60, 53% female) of Mexican descent in the city of Nogales, AZ (66% not born in the US, 33% 1
st
-generation). Surveys were presented in English or Spanish. Eating Patterns were assessed with the 3-Factor Eating Questionnaire (3FEQ), which resulted in a total score and subscales for “cognitive restraint,” “uncontrolled eating, “and “emotional eating.” Insomnia was assessed with the Insomnia Severity Index (ISI), Sleepiness with the Epworth Sleepiness Scale (ESS), Sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the Sleep Timing Questionnaire (STQ). Covariates included age, sex, and immigrant status.

Results:
See Table. Eating patterns associated with insomnia, sleep quality, sleepiness, and weekend (but not weekday) sleep duration. Regarding subscale scores, relationships were generally seen between sleep and emotional eating and unrestricted eating, and not cognitive restraint.

Conclusions:
Several different aspects of sleep quality were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanics/Latinos.
Abstract P279: Marijuana Use, Multiple Sleep Characteristics, and Hypertension Among White, Black, and Hispanic Adults in the United States
Authors: Gaston Symielle A , Jackson Chandra L
Published: March 2019

Introduction:
Prior studies have found an association between marijuana use and hypertension. However, few consider the role of sleep as an explanatory factor or race/ethnicity as a moderator. Our objective was to investigate associations between marijuana use, sleep characteristics, and hypertension in a multiethnic population.

Hypothesis:
We hypothesized that the marijuana use and sleep association would vary by race/ethnicity and sleep would partially explain associations between marijuana use and hypertension.

Methods:
We used National Comorbidity Survey-Replication cross-sectional data (2001-2003) from white, black, and Hispanic participants aged ≥18 years who reported no current abuse of cocaine or prescription drugs. Participants self-reported marijuana use, multiple sleep characteristics (insomnia symptoms, early awakening, daytime sleepiness), and a physician’s diagnosis of hypertension (yes vs. no). Using Poisson regression with robust variance and sampling weights, we estimated the prevalence of poor sleep characteristics among participants who reported current or former use to never use adjusting for age, sex, and race/ethnicity. Sleep characteristics were added to adjusted models for associations between use and hypertension. Race/ethnicity*marijuana use interaction terms were tested for all models.

Results:
Among 3,928 participants, mean age±SE was 45±0.49 years, 79% were white, 11% black, and 10% Hispanic. Current users were younger (32±0.49 years), more likely to report black (17%) or Hispanic (13%) race/ethnicity and insomnia symptoms (31%), and less likely to report hypertension (12%) compared to former (40.6±0.45 years, 9.6% black, 9.9% Hispanic, 26% insomnia, 20% hypertension) and never (51.1±0.79 years, 10% black, 9.9% Hispanic, 22% insomnia, 29% hypertension) users. Estimates were similar across marijuana use categories for early awakening (16%) and daytime sleepiness (34%). Former and current marijuana use was associated with 22% (whites) to 38% (blacks) and 33% (Hispanics) to 85% (blacks, prevalence ratio (PR)=1.85 [95% confidence interval: 1.06-3.23]) higher prevalence of insomnia symptoms as well as 32% (blacks) to 49% (whites) and 46% (blacks) to 77% (whites, PR=1.77 [1.29-2.44]) higher prevalence of early awakening (p
race/ethnicity*marijuana use
<0.05). Across all races/ethnicities, marijuana use was similarly associated with higher prevalence of daytime sleepiness (PR
former
=1.17 [1.03-1.33], PR
current
=1.20 [1.00-1.43]). Former marijuana use was associated with higher prevalence of hypertension only among blacks (PR=1.46 [1.04-2.05]) and sleep characteristics explained approximately 2% of this association on average.

Conclusions:
Marijuana use was associated with poor sleep and relationships varied by race/ethnicity, but relationships between marijuana use and hypertension were not explained by sleep.
Abstract P282: Sub-Optimal Sleep Duration is Independently Associated With Morbid Obesity in the United States
Authors: Aneni Ehimen , Valero-Elizondo Javier , Osondu Chukwuemeka U , Brandt Eric J , Nasir Khurram
Published: March 2019

Introduction:
Extremes of sleep duration and morbid obesity are independent risk factors for cardiovascular disease (CVD). There are only a few studies that have examined the relationship between the two and even less have studied their association in a national cohort.

Methods:
We utilized the National Health Interview Survey (2013-2017) for this study. We assessed the cross-sectional association between habitual self-reported sleep duration (in hours) and obesity groups. We also conducted subgroup analysis to show the trends in sleep duration among subgroups with morbid obesity (BMI ≥35kg/m
2
)

Results:
After exclusion of 1,897 persons who reported sleeping more than 12 hours in a day, there were 154,872 participants in the study representing a population of 227.9 million US adults annually. The prevalence of moderate (BMI 35 -39.9kg/m
2
) and severe obesity (BMI ≥ 40kg/m
2
) was 7.1% and 8.1% respectively. The prevalence of morbid obesity was highest among blacks, females and persons aged 40 - 64 years (21.5%, 17.5% and 17.3% respectively). There was a U-shaped distribution in the prevalence of moderate and severe obesity with increase in sleep duration. The lowest prevalence was seen among persons who slept 7-<9hours. Females, blacks and persons aged 40 - 64years had a higher prevalence of severe obesity at every subgroup of sleep duration. Across sleep duration, Asians and Hispanics demonstrated a clear U-shaped trend for severe, but not moderate obesity. In multivariate analysis controlling for demographics, CVD risk factors and comorbidities, sleeping less than 7 hours was independently associated with moderate and severe obesity, while sleeping 9 or more hours was associated with severe obesity. The above findings are depicted in attached figure.

Conclusion:
Compared to 7-<9 hours of sleep, shorter and longer (sub-optimal) sleep duration, was independently associated with morbid obesity. The relationship between sleep and morbid obesity differs by race and requires further exploration.
Abstract P284: The Chemotherapeutic Agent Docetaxel Disrupts Mitochondrial Energetics in 3D Human Bioengineered Myobundles
Authors: Torres Alcalde Maria J , Zang Xu , Slentz Dorothy H , Koves Timothy R , Truskey George A , Muoio Deborah M
Published: March 2019

Taxanes (i.e. docetaxel, (TAX)) comprise the first line-treatment for breast cancer (BC), mostly in combination with anthracyclines like doxorubicin (DOX). The efficacy of these drugs as antineoplastic agents has helped to boost 10-year survival rates to > 90%, leading to a fast-growing population of over 3 million BC survivors in the US. However, epidemiological evidence shows that the highly abrasive nature of these therapies can give rise to a vicious cycle of metabolic decline and physical inactivity that compromises quality of life and increases risk of numerous musculoskeletal and cardio-metabolic disorders including arthritis, sarcopenic obesity, cardiovascular disease and type 2 diabetes. Major side effects of TAX include peripheral neuropathy, arthralgia, myalgia and muscle weakness. Taxanes act primarily by stabilizing microtubules (MTs), which causes cell cycle arrest. Importantly, MT dynamics can also impact mitochondrial function. For example, the MT protein unit, tubulin, can bind to the outer mitochondrial protein channel, VDAC, and thereby affect ATP transport to the cytosol. Herein, we sought to test the hypothesis that TAX exacerbates DOX-induced mitochondrial dysfunction, which is thought to underlie anthracyclines’ cardiotoxicity. To this end, we leveraged a newly developed 3-D bioengineered model of human muscle organoids (myobundles), derived from primary human skeletal muscle progenitor cells (HSkM), to study mechanisms of TAX-induced myotoxicity and its interactions with DOX. Preliminary findings in primary HSkM cells exposed to 3 daily x 3 h treatments with TAX (1 - 100 nM) +/- 10 nM DOX caused a robust ~10-fold acetylation of a-tubulin at lysine 40 (AcK40), reflecting marked stabilization of MTs. TAX treatment decreased basal and ATP-linked respiration (JO
2
) up to 30 % (p<0.05), in a dose-dependent manner. However, maximal uncoupled JO
2
(+FCCP) remained unchanged, suggesting TAX disrupts mitochondrial thermodynamics and energy transfer, rather than maximal oxidative phosphorylation capacity. Exposure of 3D myobundles to a TAX+/-DOX regimen that mimicked human pharmacokinetics post-infusion led to a 30-fold increase (p<0.005) in AcK40 a-tubulin. TAX alone induced a biphasic JO
2
response to ADP (KM
ADP
2- and 4-fold higher, p<0.05), but when combined with DOX there was a 50 % loss in maximal JO
2
(p<0.005) with no changes in KM
ADP
. We hypothesize that the TAX-driven stabilization of MTs leads to detrimental MT-mitochondria interactions that disrupt ATP/ADP transfer between cellular compartments, exacerbating DOX toxicity and ultimately impairing muscle function. The present findings provide novel insights into the mechanisms of TAX-induced myotoxicities, which is of paramount importance for developing therapeutic strategies to improve cardiovascular health and quality of life of long-term breast cancer survivors.
Abstract P291: Racial/Ethnic Differences in the Shopping Behaviors and Fruit and Vegetable Consumption of Low-Income Farmers Market Incentive Program Users in Illinois
Authors: Singleton Chelsea R , Kessee Nicollette , Chatman Corey , Spreen Connie
Published: March 2019

Introduction:
Studies have shown that low-income populations in the US often consume fewer servings of fruits and vegetables (FVs) per day compared to higher income populations. Farmers market incentive programs provide monetary incentives to Supplemental Nutrition Assistance Program (SNAP) participants to support their procurement of fresh FVs. Information on the racial/ethnic differences in FV consumption among SNAP participants who utilize farmers market incentive programs is scarce. This research aimed to address this need by examining racial/ethnic differences in the farmers market shopping behaviors and frequency of FV consumption among users of the Link Match program in Illinois. We hypothesized that Non-Hispanic Black program users will consume FVs less frequently than Non-Hispanic White users.

Methods:
A cross-sectional evaluation of 328 Link Match users (39.6% Non-Hispanic White; 45.4% Non-Hispanic Black; and 15.0% Other) was conducted during the 2016 and 2017 farmers market seasons in Illinois. Information on user demographics, farmers market shopping behaviors, and frequency of FV consumption in the prior month was collected. Chi-square and ANOVA tests were used to assess racial/ethnic differences in farmers market shopping behaviors. Multivariable-adjusted logistic regression models were used to examine the association between race/ethnicity and daily consumption of FVs among program users.

Results:
A significantly higher percentage of Non-Hispanic Black Link Match users reported being an infrequent farmers market user (i.e., shopping ≤ once a month) compared to Non-Hispanic White and Other users (p = 0.01). After adjusting for covariates (i.e., demographics, market location), Non-Hispanic Black users had lower odds of consuming fruit daily (OR: 0.44; 95% CI: 0.22-0.86) compared to Non-Hispanic White users. Other users had lower odds of consuming vegetables daily (OR: 0.30; 95% CI: 0.12-0.71) compared to Non-Hispanic White users.

Conclusions:
Significant racial/ethnic differences in shopping behaviors and FV consumption were observed among Link Match users in Illinois. Future research should examine the nutritional and health implications of these differences.
Abstract P296: Almond Consumption in Cardiovascular Disease: Markov Model and Health Economic Evaluation
Authors: Wang Jifan , Lee-Bravatti Michelle A , Raman Gowri , Avendano Esther E , Johnson Elizabeth J
Published: March 2019

Background:
Heart disease is the leading cause of death in the United States, with over 630,000 deaths in 2015 and over 140,000 stroke-related deaths in the same year. Our recent meta-analysis found lower LDL levels with almond intake. According to the US Food and Drug Administration, 1.5 oz. of any tree nut intake may reduce the risk of cardiovascular disease (CVD). The objective of this study was to use Markov models to examine the cost-effectiveness of almond consumption in preventing CVD.

Methods:
Decision trees with Markov models were developed for consuming 1.5 oz. almond per day versus no almond and myocardial infarction (MI) and stroke, respectively. We set 20 cycles for Markov models with a 1-year time frame for each cycle. Half-cycle correction was applied in the models. In the MI model, people who survived after having MI were considered as having chronic heart disease; in the stroke model, any type of stroke was included. Quality-adjusted life years at each stage were used as the effectiveness. We derived the parameters from published literature and public sources.

Results:
Consuming almonds had more effectiveness although it led to more cost. It was not preferred for either MI or stroke. When setting the willingness-to-pay as $50,000, the annual net monetary benefit (NMB) in the MI model was $954,542 for consuming almonds and $958,482 for not consuming almonds; the NMB in the stroke model was $945,096 and $947,414 for the almond and the non-almond, respectively.

Conclusion:
Consuming 1.5 oz. almond per day may not be cost-effective enough in terms of preventing MI and stroke. Further studies are required to evaluate the overall effect of almond on CVD.
Abstract P300: Cluster Analysis of Discrepancies Between Self-Reported and Investigator-Assessed Biomeasures of Cardiovascular Disease Risk
Authors: Lee Sohye , Lindquist Ruth
Published: March 2019

Introduction:
Hypertension and obesity are major cardiovascular disease (CVD) risk factors that affect huge numbers of Americans. Although hypertension and obesity are largely preventable and manageable, national statistics evidence that these CVD risks are not effectively managed. Patterns of personal under-estimates of individual risk, i.e., discrepancies between one’s perceived health (self-reported biomeasures) relative to actual health (investigator-assessed biomeasures) may contribute to delays in seeking care that could result in CVD risk detection and management.

Hypothesis:
We hypothesized that personal patterns of awareness reflecting a higher degree of self-reported underestimation of biomeasures of CVD risk would reveal personal profiles of greater CVD risk.

Methods:
Adults, aged 18 and over were recruited at a large community event. Self-reported systolic and diastolic blood pressure (SBP, DBP; mmHg), weight (lb.) were collected before objective investigator-obtained assessments of SBP, DBP, and weight. K-means (non-hierarchical) cluster analysis was used to divide data into clusters. The z-score of mean differences between self-reported and measured SBP, DBP, and weight were included in the cluster analysis. ANOVA was used to examine differences in variables among clusters.

Results:
A total of 61 subjects were eligible and included in the cluster analysis. The mean age of the sample was 55.2 yrs (range 21 to 73; SD: 12.9) and mostly female (63.9%). Mean SBP, DBP, and weight were 133.8, 77.6, and 176.8, respectively. Three clusters from k-means cluster analysis were identified. Cluster 1 (n=22) had moderate discrepancies, with mean differences in SBP, DBP, weight of 14.0, 3.2, -0.5, respectively. Cluster 2 (n=17) had low discrepancies, with mean differences in SBP, DBP, weight: 3.0, -2.6, 7.1, respectively. Cluster 3 (n=22) showed high discrepancies, with mean differences in SBP, DBP, weight of 27.2, 10.5, 4.5, respectively. There were significant mean differences between Cluster 2 (low discrepancies) and Cluster 3 (high discrepancies) in investigator-obtained SBP and DBP (p<0.01, p<0.05, respectively).

Conclusions:
A wide range of accuracy in personal awareness of biomeasures of risk was uncovered with patterns of discrepancy ranging from low to high; those having a pattern of greatest inaccuracy had significantly higher SBP and DBP (key risk factors for CVD) than those with least inaccuracy. These data highlight the importance of regular objective screening of biomeasures and suggests that relying on personal awareness or self-report of biomeasures is ineffective. The greater discrepancy between self-perceived and investigator-assessed numbers was associated with greater blood pressure-related CVD risks underscoring the potential benefit of arming individuals with information to “know their numbers.”
Abstract P302: Hand Osteoarthritis is associated With Subclinical Cardiovascular Disease in Mexican Women
Authors: Flores-Mariñelarena Rodrigo R , Flores-Torres Mario H , Lopez-Ridaura Ruy , Lajous Martín , Cantú-Brito Carlos , Catzin-Kuhlmann Andres
Published: March 2019

Introduction:
Osteoarthritis is a growingly common joint disorder affecting older adults. It is characterized by chronic low-grade inflammation, a phenomenon by itself considered a cardiovascular risk factor. However, data on its potential impact on cardiovascular disease (CVD) is scarce. Assessing hand osteoarthritis (HOA) might be advantageous when studying CVD as this particular location might be less affected by traditional cardiovascular risk factors such as overweight and physical activity.

Hypothesis:
HOA is associated with subclinical CVD.

Methods:
We cross-sectionally assessed the relationship between HOA and CVD in 1,803 women from the Mexican Teachers’ Cohort, excluding those with history of myocardial infarction, cerebrovascular disease, and rheumatoid arthritis. From 2012 to 2016, a subsample of the MTC participants from Mexico City and the states of Nuevo LeÓn, Chiapas, and YucatÅn were invited for clinical examinations in which standardized neurologists measured their carotid intima-media thickness (IMT) with ultrasound and a standardized HOA questionnaire was applied. HOA was defined as having ≥45 years, hand joint pain, and morning stiffness that lasts no longer than 30 minutes. Subclinical CVD was assessed through log-transformed IMT, and carotid atherosclerosis (CAS) was defined as mean right or left carotid IMT ≥0.8 mm or the presence of atherosclerotic plaque. Multivariable linear and logistic regression analyses were used to evaluate the association between HOA and IMT and CAS adjusting for age, state, smoking, alcohol consumption, diabetes, hypertension and body mass index.

Results:
Among participants with a mean age of 51 years (±4), 18.4% met the criteria for HOA, and the prevalence of CAS was 23.1%. After multivariable adjustment, women diagnosed with HOA had 1.6% (95%CI 0.2, 3.1) higher mean IMT than those without the joint disease. Similarly, women with HOA had 35% (95%CI 1.01, 1.81) higher odds of CAS. Sensitivity analyses using a less stringent definition of OA (pain regardless of stiffness), as well as incapacitating pain, did not have a significant association with CAS.

Conclusion:
Among middle-aged women, HOA was associated with subclinical CVD. This relation might be due to low-grade chronic inflammation, but further research is needed to clarify the underlying mechanisms, the role of screening for HAO as part of cardiovascular risk profiling, and the value of potential interventions such as anti-inflammatory drugs.
Abstract P304: Underuse of Cardiovascular Medications in Individuals With Lower Extremity Peripheral Artery Disease: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Hua Simin , Isasi Carmen R , Kizer Jorge R , Matsushita Kunihiro , Allison Matthew A , Qi Qibin , Ponce Sonia G , Tarraf Wassim , Daviglus Martha , Kaplan Robert
Published: March 2019

Introduction:
The underuse of cardiovascular therapies among individuals with lower extremity peripheral artery disease (PAD) has been reported. However, little is known about this in the Hispanic/Latinos, who may have limited access to health care and worse clinical outcomes than non-Hispanics.

Methods:
We studied the cross-sectional use of cardiovascular therapies including antiplatelet, lipid-lowering and antihypertensive medications among 826 HCHS/SOL participants who reported a PAD diagnosis by a physician. We studied the factors that may be associated with use of cardiovascular medications, including demographic, socioeconomic factors, acculturation, access to health care and comorbidities. Survey Poisson regression was used to generate the prevalence ratios. Factors in age-adjusted models with P≤0.10 were included in multivariate regression.

Results:
A total of 723 participants with medical history of PAD were free of coronary heart disease (CHD, mean age=53) while 103 patients had concurrent CHD (mean age=56). The overall age-adjusted prevalence of antiplatelet, lipid-lowering and antihypertensive medications were 31%, 26% and 34%, respectively. Individuals of Mexican background had low health insurance coverage (42%) and low use of antiplatelet (20%), statin (17%) and antihypertensive (47% among hypertensive individuals) medications. More advanced age, number of doctor visits (2+ vs 0-1) in the past year and number of cardiovascular risk factors (2+ vs 0-1) were significantly associated with using cardiovascular medications in adjusted models. Compared with those with PAD alone, individuals with PAD and concurrent CHD were more likely to use antiplatelet (PR=1.44, 95% CI 1.13-1.82) and statin (PR=1.56 [1.17-2.07]) treatment in the multivariate analysis.

Conclusions:
We found underuse of cardiovascular medications among Hispanic/Latino individuals with medical history of PAD. More efforts should be directed in eliminating treatment disparities in this important race-ethnic group.
Abstract P306: Proportion of Community-dwelling Older Adults Potentially Benefiting From the Detection of Peripheral Arterial Disease (PAD) With Ankle-Brachial Index: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Feng Yijing , Ballew Shoshana , Kalbaugh Corey A , Meyer Michelle L , Tanaka Hirofumi , Heiss Gerardo , Allison Mathew , Salameh Maya , Coresh Josef , Matsushita Kunihiro
Published: March 2019

Background:
The value of detecting PAD using the ankle-brachial index (ABI) among asymptomatic adults is controversial. However, the detection of PAD can help informing cardiovascular preventive therapy (e.g., statin and aspirin) and identifying PAD as a potential cause of reduced leg function which may be improved by exercise therapy. No previous studies have quantified the proportion of community-dwelling older adults who may benefit from PAD detection from these perspectives.

Methods:
In 4375 ARIC participants aged 66-90 between 2011-2013 without previously diagnosed PAD, we assessed the proportion of participants with newly detected PAD based on ABI who were not taking statin or aspirin and had reduced leg function (defined as the Short Physical Performance Battery score ≤9). Subsequently, we explored factors associated with higher odds of potentially benefitting from the detection of PAD (i.e., not taking statin/aspirin or having reduced leg function despite the presence of PAD) using logistic regression models. ABI ≤0.9 was the primary definition of PAD, but according to recent guidelines we secondarily explored ABI ≤1.0 or >1.4.

Results:
There were 236 (5.4%) participants with an ABI ≤0.9, among which 119 were not taking statin or aspirin and 151 had reduced leg function (77 having both conditions), leading to 193 (4.4%) participants potentially benefitting from PAD detection with ABI. The corresponding proportion was 12.4% (544) when abnormal ABI was defined as ≤1.0 or >1.4. Older age (per 10 years), black race, and current smoking were strongly associated with higher odds of potentially benefitting from detection of PAD (adjusted odds ratio >2.5). The proportion of benefitting from PAD detection was especially high in current smokers followed by blacks (proportions shown in Figure1).

Conclusions:
Up to 12.4% of community-dwelling older adults may benefit from PAD detection with ABI. The proportion are especially high among current smokers and black race, with implications on targeted ABI assessment for detecting PAD.
Abstract P309: The High Risk of Venous Thromboembolism in Black Americans
Authors: Tran H. Nicole , Udaltsova Natalia , Siu Stanton , Darbinian Jeanne , Klatsky Arthur L
Published: March 2019

Background:
Reports suggest a higher risk of venous thromboembolism (VTE) in Black persons compared to Whites. The major clinical presentations of VTE, pulmonary embolism (PE) and deep venous thrombosis (DVT) are considered parts of the same pathological process and generally share the same risk factors. Sparse data raise the possibility of additional Black/White disparity in clinical VTE presentation; specifically, larger proportions of presentation with PE in Blacks than Whites and vice versa with DVT in Whites compared to Blacks. We present here relevant data from a new study with 4,674 VTE subjects.

Hypothesis:
The Black/White disparity in VTE may be concentrated in greater risk of Blacks for PE.

Methods:
We studied composite VTE risk in 61,459 members of a comprehensive health plan, who had supplied self-classified ethnicity data on prior health examinations between 1978 and 1985 and remained plan members in 1996, when out-patient diagnoses were added to electronic health records. Subjects were 28% Black, (n = 17,442), and 53% White (n = 32,557). From 1996 through 2015, at least one diagnosis of VTE was made during an outpatient visit or hospitalization for 4,675 persons (1,554 Black and 2,576 White). With Whites as referent we performed logistic regressions with 5 covariates. Models stratified by race were performed to explore traits of specific VTE codes and circumstances of diagnosis (hospitalization, out-patient, etc.).

Results:
The table shows HRs (95% CI) of Blacks vs Whites. Increased VTE risk of Blacks in each sex was entirely concentrated in subjects with PE and with hospitalization diagnoses. Among covariates sex, education, and smoking were unrelated to VTE risk while BMI was directly associated; results were similar in Whites, Blacks and race-stratified models within the diagnosis code and location of diagnosis groups.

Conclusion:
Compared to Whites, Black persons have an unexplained increased risk of PE but not of DVT.
Abstract P315: Beneficial Associations Between Breastfeeding and Cardiopulmonary Fitness: A Life Course Study
Authors: Ferreira Isabel , Lim Tracy L , Boreham Colin A
Published: March 2019

In contrast to associations with other cardiometabolic risk factors, the extent to which breastfeeding is associated with cardiorespiratory fitness (CRF) is unclear. Moreover, whether any such association persists throughout the life course has never been investigated before.

We have therefore examined the associations between breastfeeding (yes/no, duration) and CRF as estimated from field and laboratory tests and expressed by the level of VO
2
max from late childhood, through adolescence to young adulthood in 892 (50.8% female) participants in the Northern Ireland Young Hearts Project. This is a population-based cohort study conducted in a region with very low rates of breastfeeding within the UK and the western world. Longitudinal data were analyzed with weighted generalized estimating equations, to correct estimates for selective attrition bias (with inverse probability of attrition weights). All estimates were adjusted for the participants age, sex, socio-economic status and important perinatal confounders (birthweight z-scores, gestational age, maternal age and parity, and mode of delivery).

Participants’ mean levels of CRF were 45.6±4.9, 43.9±6.9 and 32.8±9.7 mL/kg/min at the ages of 12, 15 and 22 years, respectively. On average, and as compared with participants who were never breastfed (n=746), those who were breastfed (n=146) had significantly higher levels of CRF, from childhood to adulthood: 1.23 mL/min/kg (95%CI: 0.22, 2.24). Further adjustments for potential mediators, i.e. participants’ lifestyle risk factors (physical activity, smoking alcohol and dietary habits) and body size (height) and composition (fat and fat-free masses) during growth, did not appreciably attenuate this association: 1.14 mL/min/kg (95%CI: 0.29, 1.99). Analyses by duration of breastfeeding did not reveal increasing benefits with increasing duration, however: +1.10 and +1.20 mL/kg/min if <=3 and >3 months vs. none, respectively. There were no significant interactions between breastfeeding and participants’ sex or age at the time of CRF assessments, indicating that the decreases in CRF were similar across the different breastfeeding groups, with those who were not breastfed displaying consistently lower levels throughout the longitudinal period. Finally, those who were breastfed had lower lifelong risk of poor CRF as defined according to age and sex-specific reference values of VO
2
max: RR=0.70 (0.49, 0.97) and RR=0.73 (0.51, 0.99) in models adjusted for confounders and potential mediators, respectively.

In conclusion, breastfeeding may have lifelong beneficial effects on CRF and thereby cardiovascular health. These findings may have important public health and clinical implications and should reinforce breastfeeding promotion policies, particularly where uptake rates remain low. The mechanisms through which breastfeeding affect CRF need to be further explored though.
Abstract P316: A Longitudinal Assessment of Exercise Participation From Mid- to Late-Life: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Schilsky Samantha , Palta Priya , Porter Anna , Heiss Gerardo , Evenson Kelly
Published: March 2019

Background:
Physical activity is a modifiable behavior with cumulative health benefits across the lifespan. Most studies of adult exercise patterns have been cross-sectional and limited to non-US populations. Describing longitudinal changes in exercise from mid- to late-life can provide insight into targeted exercise recommendations for middle-aged and older adults.

Objective:
In the biracial ARIC Study (n=15792), we report trends in the type and duration of exercise among adults aged 45-64 years who were followed for over 20 years. We further examined exercise patterns in a subset of adults who reported engaging in exercise at each ARIC visit (n=1254).

Methods:
Individuals self-reported type and duration of up to 4 exercises participated in the past year at four visits. Participant’s total minutes/week of exercise was estimated as a composite of the 4 exercises. Type of exercise was categorized as defined in Table 1. Participants were identified as having engaged in <30 minutes or ≥30 minutes/week for each exercise category.

Results:
Overall, 9,866 adults (female n=5,288; Black n=1,874) reported engaging in exercise at baseline (Table 1). Adults who reported exercise participation at all visits (n=1254; female n=658; Black n=163) had, on average, increased and then decreased their exercise duration from visits 1 to 6. Consistently active adults participated in exercises for a longer duration over time, while among the whole cohort, duration decreased. Walking was the most frequently reported exercise overall for the whole and consistently active cohort. The number of consistently active adults who walked for at least 30 minutes/week increased from 704 to 790 at visits 1 and 6, respectively

Conclusion:
Exercise patterns differed for adults reporting participation in exercise at a minimum at visit 1 compared to consistently active adults. Further exploration of predictors (i.e. retirement or health status) of exercise change should be examined to guide recommendations that aim to optimize energy expenditure in adulthood.
Abstract P317: Bidirectional Associations Between Accelerometer-Measured Sedentary Time, Physical Activity, and Weight Over 10 Years in the CARDIA Study
Authors: Barone Gibbs Bethany , Aaby David , Siddique Juned , Reis Jared , Whitaker Kara , Sternfeld Barbara , Pettee Gabriel Kelley
Published: March 2019

Introduction:
Though a pattern of high sedentary time (ST) with low light-intensity (LPA) and moderate-to-vigorous intensity PA (MVPA) is associated with weight gain, other data suggest excess weight may precede this behavioral profile in the causal pathway.

Objective:
To investigate bidirectional associations between activity patterns and weight over 10 years.

Methods:
Analysis included 886 CARDIA participants (aged 38-50 years, 62% female, 38% black) with weight and accelerometry (≥4 d with ≥10 hr/d) at the year 20 (ActiGraph 7164; 2005-6) and year 30 (ActiGraph wGT3X-BT; 2015-6) exams. Accelerometer data were harmonized and expressed as counts per minute (cpm) and time-dependent (min/d) intensity categories (ST, LPA, MVPA). Linear regression models were constructed to estimate adjusted associations of baseline (Y20) activity with 10-y change in weight and vice versa. Model 2 further adjusted for concurrent 10-y change in the independent variable. When intensity categories were the independent variables, regression coefficients estimated the effect of replacing ST with LPA or MVPA, adjusted for accelerometer wear time.

Results:
Over the 10-y follow-up, weight increased by a mean 2.55 ± 8.05 kg; mean total activity (cpm) decreased by -50 ± 153 cpm. Higher baseline cpm and MVPA were associated with a reduced 10-y weight gain (Model 1); further adjustment for concurrent changes in activity (Model 2) strengthened associations such that both baseline LPA and MVPA were each related to reduced 10-y weight gain (
Table
). Conversely, higher baseline weight was associated with unfavorable changes in activity profile such that ST increased and cpm, LPA, and MVPA decreased over the 10-y follow-up (Model 1); results were similar after adjustment for concurrent weight change (Model 2;
Table
).

Conclusions:
Poor activity profiles and body weight were bidirectionally related. Interventions that work simultaneously to replace ST with LPA and MVPA while also using other methods to address excess weight may be optimal.