bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9767: History of Gallstones and the Risk of Coronary Heart Disease: Prospective Cohorts and Systematic Review
Authors: Zheng Yan , Xu Min , Li Yanping , Rimm Eric , Hu Frank , Wirth Janine , Albert Christine , Rexrode Kathryn , Manson JoAnn , Qi Lu
Published: March 2022

Introduction:
Recent evidence suggests that gut microbiota functions like a metabolically active ‘organ’ and influences cardiovascular risk. Gallstone patients are characterized by gut microbiota dysbiosis and distorted metabolism; however, the relation between gallstones and coronary heart disease (CHD) is less well established.

Methods:
We examined the association between a history of gallstones and risk of CHD in 3 large prospective cohorts, and conducted a meta-analysis of published data with our result. A prospective study of 225,430 women and 44,637 men without CHD at baseline from the Nurses’ Health Study (NHS) (112,509 women; 1980-2010), NHS II (112,921 women; 1989-2011) and the Health Professionals Follow-up Study (HPFS) (44,637 men; 1986-2010). Other prospective cohort studies on a history of gallstones and risk of CHD were identified in searches of PUBMED and EMBASE up to March 2015.

Results:
After adjustment for potential confounders, the hazard ratio (HR) for the participants with a gallstone history as compared with those without was 1.16 (95% confidence interval [CI] 1.10-1.22) for NHS, 1.33 (95% CI 1.17-1.51) for NHS II and 1.11 (95% CI 1.03-1.20) for HPFS (all: p-value < 0.01). The associations appeared to be stronger in individuals with BMI<30kg/m2 than ≥30kg/m2. Based on a meta-analysis of seven cohort studies including 356,105 participants and 27,790 incident cases of CHD, a history of gallstone disease was associated with a 25% (95% CI 13%-37%) increase in risk of CHD.

Conclusions:
Findings from prospective cohort studies consistently support a history of gallstones as an independent predictor of CHD risk.
Abstract 9773: Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion
Authors: El Haddad Danielle
Published: March 2022

Objectives:
We evaluated outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion and assessed the procedure’s safety in patients with thrombocytopenia.

Background:
Pericardial effusion is common in cancer patients. The optimal therapeutic approach is not well defined and in practice depends on patient characteristics and local hospital expertise. Percutaneous pericardiocentesis is less invasive than surgery, but its effectiveness and safety are not well documented.

Methods:
Cancer patients who underwent percutaneous pericardiocentesis for pericardial effusion between November 2009 and October 2014 at MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed.

Results:
Of 1645 cancer patients referred for pericardial effusion, 212 (13%) underwent percutaneous pericardiocentesis; procedure was successful in 99% of the cases, and there were no procedure-related deaths. Four patients had major procedure-related bleeding necessitating blood transfusions and/or surgical intervention. Procedure-related bleeding did not differ between patients with normal platelet counts and thrombocytopenic patients. Effusion recurred in 26 (12%) patients. Patients with catheter drainage for 3-5 days had the lowest recurrence rate (10%). Median overall survival was 143 days (95% CI, 95-221). Age>65 years, lung cancer, platelet count <20,000/μL, and malignant pericardial fluid were independently associated with poor prognosis. In lung cancer, but not breast cancer, median survival was shorter in patients with malignant effusions than in those with nonmalignant effusions.

Conclusion:
Percutaneous pericardiocentesis with extended catheter drainage, as primary treatment for pericardial effusion in cancer patients, is safe and effective, including in those with thrombocytopenia. Malignant pericardial effusion significantly shortens the survival outcome of lung cancer patients, but not breast cancer patients.
Abstract 9865: A Validated, Simplified Risk Model for Predicting 6-Month Mortality in Infective Endocarditis
Authors: Park Larry , Chu Vivian , Peterson Gail , Skoutelis Athanasios , Lejko-Zupa Tatjana , Bouza Emilio , Tebini Alessandro , Tattevin Pierre , Habib Gilbert , Tan Ren , Gonzalez Javier , Altclas Javier , Edathodu Jameela , Fortes Claudio Q , Siciliano Rinaldo F , Pachirat Orathai , Kanj Souha , Wang Andrew ,   for the International Collaboration on Endocarditis
Published: March 2022

Introduction:
Infective endocarditis (IE) is a disease with high in-hospital and longer term mortality.

Hypothesis:
A validated risk model of prognostic variables may improve clinical risk stratification.

Methods:
Using a large, multinational, prospective registry of definite IE (International Collaboration on Endocarditis-Prospective Cohort Study, 2000-2006, n=4066), a model to predict 6-month survival was developed by Cox proportional hazard modeling with inverse probability weighting for surgery treatment and internally validated by bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1582).

Results:
Six-month mortality was 964/4066 (23.7%) in ICE-PCS and 346/1582 (21.9%) in ICE-PLUS cohorts. Surgery during the index hospitalization was performed in 49.5% and 56.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell’s C statistic=0.715). In the validation model, these variables had similar hazard ratios (Harrell’s C statistic=0.682), with a similar, independent benefit of surgery (HR=0.74 [95% CI, 0.62-0.89]). Both models differentiated quintiles of risk for 6-month mortality. A simplified risk model was developed by weight-adjustment of these variables.

Conclusions:
Six-month mortality after IE is approximately 25% and predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality. A simplified risk model may be used to identify specific risk sub-groups in IE.
Abstract 9903: Baseline Left Atrial Abnormality by Electrocardiogram Predicts Incident Stroke in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy
Authors: Okin Peter M , Kamel Hooman , Kjeldsen Sverre E , Devereux Richard B
Published: March 2022

Background:
Recent findings in population-based studies suggest that abnormal P-wave terminal force in lead V
1
(PTFV
1
), a marker of left atrial (LA) abnormalities such as fibrosis, dilatation and elevated filling pressures, is associated with incident ischemic stroke, even in the absence of atrial fibrillation (AF). However, whether PTFV
1
predicts incident stroke in hypertensive patients during aggressive blood pressure (BP) lowering has not been examined.

Methods:
Risk of incident stroke was examined in relation to abnormal PTFV
1
on a baseline ECG in 1879 hypertensive patients aged 60 or younger with ECG left ventricular hypertrophy (LVH), no history of AF, in sinus rhythm on their baseline ECG with no incident AF during follow-up, who were randomly assigned to losartan- or atenolol-based treatment. Patients >60 years old were not included because of a highly significant interaction between PTFV
1
and age in Cox analyses. Abnormal PTFV
1
was defined by the presence of a negative terminal P wave in lead V
1
with amplitude x duration ≥4000 V*ms.

Results:
During mean follow-up of 4.8±0.9 years, 45 patients (2.4%) experienced a definite stroke. A higher incidence of stroke occurred in those with abnormal than normal baseline PTFV
1
: incidence rate per 1000 person-years, 7.8, 95% CI, 5.2-11.4 vs 3.4; 95% CI, 2.2-5.2; p=0.004. In univariate Cox models, abnormal PTFV
1
was associated with a > 2-fold increased risk of incident stroke (HR 2.31, 95% CI 1.28-4.16, p=0.005). In multivariable Cox regression models that adjusted for other significant predictors of incident stroke in this population (gender, history of stroke or transient ischemic attack, ischemic heart disease or diabetes, baseline creatinine and in-treatment systolic BP), abnormal PTFV
1
remained associated with a > 2-fold increased risk of incident stroke (HR, 2.06; 95% CI, 1.14-3.74, p=0.017).

Conclusions:
Abnormal PTFV
1,
a marker of LA abnormality, was strongly associated with incident stroke in hypertensive patients, independent of in-treatment systolic BP and other predictors of incident stroke. This association, in the absence of detectable AF, suggests that an underlying atrial cardiopathy may cause LA thromboembolism and a subsequent stroke without necessarily manifesting with AF.
Abstract 9923: Feasibility of New Real-Time 3-Dimensional Echocardiographic Imaging in a Mitral Valve Stenosis Model: A Comparison With 2D Imaging
Authors: Gadd Kayla , Tam Lydia , Ashraf Muhammad , Lei Hao Chuan , Streiff Cole , Zhu Meihua , Sahn David J
Published: March 2022

Introduction:
This study investigated the feasibility and accuracy of real-time three-dimensional echocardiography (RT3DE) in assessing the severity of simulated mitral stenosis in a pumped porcine heart model.

Hypothesis:
RT3DE is accurate for assessing mitral stenosis.

Methods:
Eight porcine hearts were used to simulate mitral stenosis. Four different sized inner-diameter tubes (9,11,13 and 15mm) were used to create stenotic mitral valve orifice areas. These tubes were inserted into vinyl tubing which was then connected to a pulsatile pump. A balloon was secured to the end of the tubing entering the left ventricle, and the model was sutured at the mitral annulus. The heart was submerged in a water tank and the pump set at 60 bpm with stroke volumes ranging from 30-70 mL in 10 mL increments. At each increment, images were acquired in 2D echo and RT3DE using a GE Vivid 7 ultrasound system. Data were analyzed using GE EchoPAC PC.

Results:
A comparison of true area and measured orifice areas were analyzed for both 2D echo and RT3DE. Linear regression analysis showed excellent correlation 2D and RT3DE acquired areas and true areas (2D: r
2
=0.9; RT3DE: r
2
=0.9). It was found that while RT3DE presented significantly similar mean values for all areas tested (P<0.05), 2D-measured areas were consistently larger than expected values (P<0.05).

Conclusions:
RT3DE has the potential to be an accurate, noninvasive diagnostic tool in clinical cardiology that overcomes imaging limitations present in 2D echo.
Abstract 9949: NADH/NAD+ Sensitive Protein Hyper-acetylation Links Mitochondrial Dysfunction to Cardiac Susceptibility to Stress
Authors: Lee Chi Fung , Garcia-Menendez Lorena , Choi Yongseon , Roe Nathan D , Chavez Juan D , Bruce Jim E , Edgar J S , Goo Young Ah , Goodlett David R , Tian Rong
Published: March 2022

Mitochondrial dysfunction is a recognized player in heart failure progression although the underlying molecular mechanisms are largely unknown. Using a mouse model with Complex I-deficiency (cardiac Ndufs4-KO, cKO), we had shown that impairment of mitochondrial function led to increases in NADH/NAD+ ratio and inhibition of sirtuin activity. The resultant mitochondrial lysine acetylation (LysAc) sensitized the mitochondrial permeability transition pore (mPTP) opening and exacerbated heart failure progression. Here, we show that elevation of cardiac NAD+ levels pharmacologically or genetically normalized LysAc levels and rescued cardiac dysfunction in cKO mice under stresses. Furthermore, pressure overload in control mice also led to increases in cardiac NADH/NAD+ ratio, mitochondrial LysAc levels and mPTP sensitivity. All of them were normalized by increasing cardiac NAD+ levels. Together with the elevated LysAc levels in human failing hearts, these data support the roles of LysAc in human heart failure progression. Interestingly, proteomics analysis revealed increased LysAc of proteins in the mitochondria as well as in the cytosol and nucleus from cKO hearts without changes in the total protein amount. We identified LysAc of mitochondrial malate aspartate shuttle (MAS) as a mechanism for communicating elevated NADH/NAD+ ratio in the mitochondria to the cytosol, resulting in hyperacetylation of non-mitochondrial proteins. Furthermore, increased LysAc sensitized the mPTP to stress by promoting the binding of cyclophilin D (CypD) to the ATP synthase complex via increased interaction with oligomycin-sensitive conferring protein (OSCP). In silico docking calculation revealed an interaction interface between CypD and OSCP in ATP synthase complex, and their interaction can be facilitated via acetylation of the specific lysine residues identified by the acetylome analysis. This study unveils novel mechanisms by which mitochondrial dysfunction modulates protein modification and the propensity to cardiac dysfunction during stress. The results also identify NADH/NAD+ ratio as a therapeutic target for the progression of heart failure.
Abstract 9972: Do Risk Models Accurately Predict the Coronary Artery Bypass Graft Mortality Risk in Patients of Southeast Asian Origin?
Authors: Liang Sai , Lim Yan Zheng Daniel , Ma Ronald , Yow Ka Shing , Eng Jolane , Li Bowen , Lee Chuen Neng , Kofidis Theodoros , Teoh Kristine , Ooi Oon Cheong , Luo Hai Dong
Published: March 2022

Introduction:
Cardiac surgery risk models have been developed based on predominantly Caucasian populations. This study is conducted to validate and evaluate these models for Southeast Asian patients.

Methods:
We analyzed a prospectively collected dataset of 1769 patients who underwent isolated CABG between 2009 and 2013 in an academic medical center: National University Heart Center, Singapore. Patients were scored by six risk models (Additive EuroSCORE, Logistic EuroSCORE, EuroSCORE II, Society of Thoracic Surgeons (STS), Northern New England Cardiovascular Disease Study Group, and Parsonnet). Discriminatory power was compared using ROC and C-statistics. Goodness of fit test was used to assess model calibration.

Results:
The overall observed mortality was 2.48% (n=44). C-statistics showed fair discriminatory power for all six risk scores, with STS (C-statistic 0.774, 95% CI 0.697 - 0.851) and EuroSCORE II (C-statistic 0.766, 95% CI 0.690 - 0.843) having the highest values. The optimal thresholds using Youden’s method were: STS threshold 1.33%, sensitivity 79.55%, specificity 68.04%; EuroSCORE II threshold 5.23%, sensitivity 54.55%, specificity 86.14%. Calibration testing revealed that only the STS (p=0.156) and EuroSCORE II (p=0.352) had a good fit with our data. However, EuroSCORE II and STS over-predict and under-predict mortality in high risk patients respectively.

Conclusion:
The STS and EuroSCORE II have the best predictive value for patients of Southeast Asian origin and can provide our surgeons with a suitable benchmark for outcome tracking. Inaccurate predictions for high-risk patients may be improved with recalibration.
Abstract 9992: Rhythm Control Versus Rate Control and Clinical Outcomes in Patients With Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)
Authors: Noheria Amit , Shrader Peter , Piccini Jonathan P , Fonarow Gregg C , Kowey Peter R , Mahaffey Kenneth W , Naccarelli Gerald , Noseworthy Peter A , Reiffel James A , Steinberg Benjamin A , Thomas Laine E , Peterson Eric D , Gersh Bernard J
Published: March 2022

Introduction:
Randomized trials have not demonstrated significant differences in stroke, heart failure or mortality between rhythm and rate control strategies for management of atrial fibrillation (AF). The comparative outcomes in contemporary clinical practice are not well described. The objective of this study was to evaluate outcomes in clinical practice with rhythm control versus rate control strategy.

Methods:
Patients managed with a rhythm control strategy targeting maintenance of sinus rhythm were retrospectively compared with a strategy of rate control alone in a AF registry across various US practice settings. Unadjusted and adjusted (inverse-propensity weighted) outcomes were estimated.

Results:
The overall study population (n=6988) had a median age of 74 (25th, 75th percentile 65, 81) years, 56% were males, 77% had first detected or paroxysmal AF and 89% had CHA2DS2-VASc score ≥2. In unadjusted analyses, rhythm control was associated with lower all-cause death, cardiovascular death, first stroke/non-central nervous system systemic embolization/transient ischemic attack, or first major bleeding event (all p<0.05); however, rhythm control was associated with more cardiovascular hospitalizations (HR 1.24, 95% CI 1.10-1.39, p=0.0003; Figure).

Conclusion:
Among patients with AF in clinical practice, rhythm control was not superior to rate control strategy for outcomes of stroke, heart failure, or mortality, but was associated with more cardiovascular hospitalizations.
Abstract 05: Associations of Objectively-measured Sedentary Time And Physical Activity with Meeting Cardiovascular Risk Factor Control Goals in U.S. Hispanic/Latino Adults with Diabetes: The Hispanic Community Health Study/Study of Latinos (hchs/sol)
Authors: Qi Qibin , Wang Xueyin , Strizich Garrett , Sotres-Alvarez Daniela , Buelna Christina , Gallo Linda , Gellman Marc , Mossavar-Rahmani Yasmin , O’Brien Matthew , Stoutenberg Mark , Wang Tao , Aviles-Santa Larissa , Kaplan Robert
Published: March 2022

Background:
Cardiovascular risk factor (RF) control is a cornerstone of diabetes management. Little is known about whether objectively-measured sedentary time and physical activity are associated with meeting RF goals in individuals with diabetes.

Methods:
We examined cross-sectional associations of sedentary behaviors and moderate-to-vigorous physical activity (MVPA) with meeting RF goals in 1,699 adults who self-reported diagnosed diabetes from the HCHS/SOL, a population-based cohort of US Hispanics/Latinos conducted between 2008 and 2011. Sedentary time and MVPA were assessed by Actical accelerometers for 7 days. Five RF goals were defined: HbA1c <7.0%; systolic/diastolic blood pressure <140/80 mmHg; triglycerides <150 mg/dL; LDL-cholesterol <100mg/dL; HDL-cholesterol >40/50 mg/dL for men/women.

Results:
The mean time spent in sedentary behaviors and MVPA was 12.5 hrs/day and 17.2 mins/day, respectively. Adults with diabetes meeting greater number of RF goals spent, on average, less time in sedentary behaviors, and the odds of meeting ≥ 3 RF goals, relative to meeting zero RF goal, was 3.31 (95% CI 1.27, 7.68) times by comparing the lowest and highest tertiles of sedentary time (Figure 1). Specifically, after adjustment for potentially confounding variables and MVPA, less sedentary time was associated with increased odds of meeting HbA1c (OR for the lowest vs highest tertile of sedentary time =1.81 [1.20, 2.72]; P for trend =0.005) and triglyceride (OR =2.07 [1.34, 3.20]; P for trend =0.001) goals. MVPA was not associated with meeting any RF goals (all P for trend >0.21). Associations between sedentary time and meeting RF goals were consistent among adults meeting or not meeting MVPA recommendations.

Conclusions:
US Hispanics/Latino adults with diabetes who spend less sedentary time were more likely to meet RF goals, particularly HbA1c and triglyceride goals, regardless of MVPA. Our findings further emphasize the importance of reducing sedentary behaviors beyond increasing exercise in individuals with diabetes.
Abstract 11: Neighborhood Social Cohesion and Meeting Physical Activity Guidelines: Does the Association Differ by Race/Ethnicity?
Authors: Yi Stella , Trinh-Shevrin Chau , Yen Irene H , Kwon Simona C
Published: March 2022

Introduction:
Neighborhood social cohesion is associated with physical activity (PA), but prior studies have used local population samples and presented results in aggregate across racial/ethnic groups.

Hypothesis:
Neighborhood social cohesion is associated with PA in a large, nationally representative dataset and may be modified by race/ethnicity.

Methods:
Data from the National Health Interview Survey (NHIS) 2013-14 survey waves were combined (n=64,754). NHIS 2013-14 included four questions on neighborhood social cohesion - participants rated agreement/disagreement with the following statements (scale: 1-strongly disagree, 2-disagree, 3-agree, 4-strongly agree): 1) people in this neighborhood help each other out; 2) there are people I can count on in this neighborhood; 3) people in this neighborhood can be trusted; and 4) this is a close-knit neighborhood. A neighborhood cohesion score was constructed by summing the responses to the questions (range: 4 to 16). The primary outcome of meeting aerobic PA guidelines (150 minutes/week of moderate or 75 minutes/week of vigorous PA) was calculated using self-reported moderate or vigorous minutes/week. Multivariable regression models for meeting PA guidelines were run, adjusting for age, race/ethnicity, sex, education, income, nativity (U.S.- or foreign-born), and English proficiency; additional models were run with neighborhood cohesion as a binary variable (above/below median) to assess potential effect modification by race/ethnicity. All data were analyzed using complex survey weighting in STATA 12.1 and SUDAAN 10.0.

Results:
About half of U.S. adults reported meeting PA guidelines (49.6). Neighborhood social cohesion was fairly high, with a median value of 12 (IQR: 11-15) and was higher in those 65+ years of age, and with higher education, income and length of time living in one’s neighborhood. In adjusted analyses, a one-unit increase in neighborhood social cohesion was associated with an increased odds of meeting PA guidelines (OR:1.04 (1.03, 1.05), p<0.001). Neighborhood social cohesion and PA was associated in whites and Hispanics (OR:1.30 (1.20, 1.42), p<0.001; OR: 1.18 (1.03, 1.34), p<0.001, respectively), and not in blacks or Asian American subgroups (Chinese, Filipino and Asian Indians).

Conclusions:
Neighborhood social cohesion was associated with meeting PA guidelines in this nationally representative sample of U.S. adults. However this association appears to be driven by whites and Hispanics. While neighborhood characteristics may be an important aspect of public health planning and epidemiologic inquiry, additional studies are needed to further investigate which neighborhood factors affect ability to meet PA guidelines for blacks and Asian Americans.
Abstract 20: Fatty Liver is Associated with Greater Incidence of Cardiovascular Risk Factors
Authors: Ma Jiantao , Hwang Shih-Jen , Hoffmann Udo , Fox Caroline S , Long Michelle T
Published: March 2022

Introduction:
Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk for cardiovascular (CV) related-death. Prior studies have demonstrated a cross-sectional association between NAFLD and CV risk factors including hypertension, hyperlipidemia, and insulin resistance. Little is known about the relationship between NAFLD and incident CV risk factors in the American adult population. We hypothesized that, independent of overall adiposity, NAFLD is associated with incident CV risk factors.

Methods:
We conducted a longitudinal study of 1,645 Framingham Heart Study Third Generation Cohort participants (median age 44.0 years, 46.1% women) who attended examination 1 (2002-2005) and examination 2 (2008-2011) and participated in the multi-detector computed tomography (MDCT) sub-study (2002-2005). The median follow up duration was 6.2 years. We excluded participants with heavy alcohol use or with prevalent myocardial infarction and stroke at baseline. Liver fat was assessed using MDCT at the baseline examination. Odds ratios (OR) of incident CV risk factors per standard deviation increase of liver fat were estimated using logistic regression models with adjustment for multiple baseline covariates including BMI.

Results:
The prevalence of NAFLD was 16.6% in the present sample. In multivariable-adjusted models, liver fat was not associated with incident metabolic syndrome (OR 1.10, 95%CI: 0.88, 1.37), hypertriglyceridemia (OR 0.93, 95%CI: 0.75, 1.16), low high-density lipoprotein (OR 1.21, 95%CI: 0.88, 1.66), or prediabetes (OR 1.15, 95%CI: 0.95, 1.40). However, per standard deviation increase of liver fat, we observed a greater risk of incident hypertension (OR 1.22, 95%CI: 1.02-1.46, P-value=0.03) and incident type 2 diabetes (OR 1.45, 95%CI: 1.15-1.84, P-value=0.002). The association with liver fat and incident type 2 diabetes remained after additional adjustment for visceral adipose tissue volume (OR 1.42, 95%CI: 1.10-1.82, P-value=0.006).

Conclusions:
The present study demonstrates that higher level of liver fat is associated with increased incidence of hypertension and type 2 diabetes over 6 years. Future studies are needed to determine if interventions targeting individuals with NAFLD may reduce incident CV risk factors burden.
Abstract 27: Is Butter Back? A Systematic Review and Meta-analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality
Authors: Pimpin Laura , Wu Jason , Haskelberg Hila , Del Gobbo Liana , Mozaffarian Dariush
Published: March 2022

Introduction:
Dietary guidelines recommend avoiding foods high in saturated fat. Yet, emerging evidence suggests potential cardiometabolic benefits of dairy products and dairy fat. Evidence on the role of butter, with high saturated dairy fat content, for total mortality, CVD, and diabetes remains unclear.

Objective:
To systematically investigate the prospective association of butter consumption with all-cause mortality, CVD, and type 2 diabetes.

Methods:
We searched 9 databases from inception to May 2015 without restriction on publication year, setting, or language, using keywords related to butter intake and outcomes of interest. We included prospective cohorts or randomized clinical trials providing estimates of effects of butter intake on mortality, CVD (including CHD or stroke), or diabetes in general adult populations. Inclusion decisions and data extractions were performed independently and in duplicate, including on study and participant characteristics, exposure and outcome definitions and assessments, analysis methods, and adjusted risk estimates and uncertainty of prospective multivariate associations. Study quality was evaluated by a modified Newcastle-Ottawa score. Findings were pooled by random and fixed effects meta-analysis, with heterogeneity assessed by the I2 statistic and publication bias by Egger’s test and funnel plots.

Results:
We identified 9 publications including 15 country-specific cohorts, with 636,151 unique participants, 6.5 million person-years of follow-up, and 28,271 total deaths, 9,783 cases of incident CVD, and 23,954 cases of incident diabetes. Quality ratings were high for all studies. Butter consumption was weakly associated with all-cause mortality (N=9 country-specific cohorts; per 14 g (1 tablespoon)/day: RR=1.01, 95%CI=1.00, 1.03, P=0.045); was not significantly associated with any CVD (N=4; RR=1.00, 95%CI=0.98, 1.02; P=0.79), CHD (N=3; RR=0.99, 95%CI=0.96, 1.03; P=0.605), or stroke (N=3; RR=1.00, 95%CI=0.98, 1.03; P=0.79), and was inversely associated with incidence of diabetes (N=11; RR=0.96, 95%CI=0.93, 0.99; P=0.02). We did not identify evidence for heterogeneity nor publication bias.

Conclusions:
This systematic review and meta-analysis identified a weak association of butter intake with total mortality, no association with CVD, and a modest protective association with diabetes. The studies identified indicate that many global cohorts have not reported on these associations; if publication bias exists, it would likely be for unpublished reports with null findings, rather than significant associations. In sum, these results suggest relatively neutral effects of butter consumption on major health outcomes, with a possible modest benefit for diabetes.
Abstract 39: Estimated Risk of Coronary Heart Disease Associated with the Replacement of Various Foods with Vegetables in Two Large Prospective Cohorts
Authors: Bertoia Monica L , Mukamal Kenneth J , Overvad Kim , Hu Frank B , Willett Walter C , Rimm Eric B
Published: March 2022

Introduction:
Previous studies show that higher fruit and vegetable intake is associated with a lower risk of coronary heart disease (CHD), but the magnitude of this association may vary depending on what foods are replaced. In a typical meal, vegetables may replace grains or protein sources but the potential benefits of replacing specific foods with vegetables have not been quantified.

Hypothesis:
The replacement of refined grains and red or processed meat with vegetables will be associated with a lower risk of CHD.

Methods:
We identified incident cases of nonfatal myocardial infarction or fatal CHD in 41,983 men participating in the Health Professionals Follow-up Study and 77,347 women participating in the Nurses’ Health Study from 1986 to 2012 who were free of cardiovascular disease at baseline. Participants self-reported their usual diet at baseline and every four years over 26 years of follow-up. We used substitution models to estimate hazard ratios (HR) for total CHD, adjusting for age, total calories, smoking, alcohol, family history of MI, physical activity, aspirin use, BMI, and history of hypertension, high cholesterol, and diabetes. We pooled results using a meta-analysis with fixed effects.

Results:
We confirmed 4,220 incident CHD events among men and 3,199 among women. In fully adjusted models, combining men and women, replacing one serving/day of starchy vegetables (peas, corn, and potatoes) with one serving/day of non-starchy vegetables was associated with a 21% lower risk of CHD. Replacing one serving/day of refined grains with one serving/day of non-starchy vegetables was associated with a 4% lower risk of CHD, and replacing one serving/day of processed meats or unprocessed red meat with one serving/day of non-starchy vegetables was associated with a 23% lower risk of CHD.

Conclusions:
Consuming vegetables, especially non-starchy vegetables, in place of less healthy refined grains and red and processed meats, was associated with a lower risk of CHD.
Abstract MP02: Ideal Cardiovascular Health Through Young Adulthood and Brain Structure in Midlife: The Coronary Artery Risk Development in Young Adults Study
Authors: Bancks Michael P , Allen Norrina , Dubey Prachi , Launer Lenore , Lloyd-Jones Donald , Reis Jared , Sidney Steve , Yano Yuichiro , Schreiner Pamela
Published: March 2022

Introduction:
Cardiovascular health (CVH) status is associated with better cognitive function; however the cardiovascular profile integral in maintaining sound structural brain health is unclear. The purpose of this study was to assess CVH status in relation to brain structure.

Methods:
Ideal cardiovascular health, defined by the American Heart Association Life’s Simple 7, was determined on 710 men and women 18-30 years of age at enrollment (1985-1986) at CARDIA exam years 0, 7, and 25. We examined the cross-sectional association between ideal cardiovascular health, at each of the 3 exams, and brain MRI measures of normal tissue of the total brain, gray matter, white matter, and volume (cm
3
) of abnormal tissue of white matter at exam year 25. Strata of CVH were determined according to the sum total of metrics meeting ideal criteria (0-2, 3, 4, and 5-7 total metrics meeting ideal criteria). Markov Chain Monte Carlo multiple imputation (m=10) was used to impute missing data on CVH and potential confounders. Meta-analysis multiple imputation linear and logistic regression analyses were used. Multivariable models adjusted for total intracranial volume, age, sex, race, education, study center, alcohol consumption, APOE ε allele, and use of blood pressure lowering and cholesterol lowering medication.

Results:
The percent of individuals with ≥ 5 ideal cardiovascular health metrics declined from exam year 0 through 25 (52% to 18%) while the percent of individuals with ≤ 2 ideal cardiovascular health metrics increased over time (4% to 33%). After adjustment, better CVH status in year 0 and year 7 was associated with roughly 10 cm
3
and 7 cm
3
greater volumes in white matter by year 25, respectively. Multivariable models are presented in the table below.

Conclusion:
Throughout younger adulthood, better CVH was associated with normal white matter volume in middle adulthood, but not with normal brain and gray matter volumes or abnormal white matter. Maintenance of better CVH through young adulthood may be beneficial to brain structure in midlife.
Abstract MP10: Racial Differences in Blood Pressure Components Associated with Incident Cardiovascular Disease in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Yano Yuichiro , Reis Jared , Goff David , Jacobs David , Sidney Stephen , Liu Kiang , Greenland Philip , Tedla Yacob , Ning Hongyan , Lloyd-Jones Donald
Published: March 2022

Introduction:
Diastolic blood pressure (DBP) instead of systolic BP (SBP) or pulse pressure (PP) has been suggested as an important predictor for cardiovascular disease (CVD) events in those <50 years of age. Observations in those ages 18 to 30 years are sparse, and racial differences are also unknown.

Methods:
Using data from the Coronary Artery Risk Development in Young Adults (CARDIA), which recruited healthy black and white young adults ages 18 to 30 years (n=4880) in 1985-1986, we assessed the associations between distinct BP components (SBP, DBP, mean arterial pressure [MAP], and PP) and incident CVD, defined as a composite endpoint of CVD deaths, myocardial infarction, angina, stroke, and heart failure.

Results:
The mean SBP, DBP, and PP at baseline (mean age 25 years) were 112, 69, and 43 mmHg in blacks (n=2473) and 109, 68, and 41 mmHg in whites (n=2407), respectively. Over 25 years of follow-up (100,291 person-years), 210 CVD events (140 events in blacks) occurred before the age of 55. Results from Cox proportional hazards models suggest that SBP was superior to DBP for predicting incident CVD in blacks, while DBP was superior to SBP in whites (Table). In blacks, CVD risk associated with higher PP was significant in models including MAP. Significant interactions were found between race and PP (P=0.02) but not SBP (P=0.14) and DBP (P=0.38) in association with incident CVD risk.

Conclusions:
In this long-term follow-up study, SBP outperformed DBP for predicting incident CVD in young blacks, while DBP outperformed SBP in young whites. In blacks, higher PP, representing large arterial stiffness, was associated with CVD risk. These racial differences may be attributable to earlier development of arterial stiffness in blacks compared with whites.
Abstract MP13: Perceived Environmental Supports and Barriers are Associated with Physical Activity Behaviors During Pregnancy
Authors: Bower Julie K , Bollinger Claire E , Foraker Randi E , Hood Darryl B
Published: March 2022

Background:
In the absence of contraindications, current guidelines recommend ≥ 150 minutes/week of moderate-intensity aerobic activity for women during pregnancy for the prevention of excess weight gain, metabolic abnormalities (e.g., gestational diabetes), and the general health of both mother and offspring. In the U.S., approximately 20% of pregnant women meet this recommendation. The perceived quality of the built environment may play an important role in supporting or hindering active living during pregnancy. Thus, this study examined the association of environmental supports for physical activity (PA) with PA behaviors in a population of pregnant women.

Methods:
The study included 155 pregnant women in the Ohio State University Wexner Medical Center that self-reported PA behaviors during the third trimester (27+ weeks). Participants also rated 26 perceived environmental supports and barriers for PA in four domains: outdoor recreation supports, access to a safe walking environment, neighborhood and community supports, and public recreation facilities; the total environmental quality score ranged from 0 (worst) to 26 (best). Logistic regression was used to examine the association of the total and subscale scores with achievement of ≥150 minutes of moderate-to-vigorous physical activity (MVPA) during the pregnancy, maintenance of pre-pregnancy PA level, and change in moderate PA from the 1st through 3rd trimester.

Results:
The study included women between the ages of 20-46 years that were between 27-40 weeks pregnant. The mean age was 32 years (SD=4.3 years). Fifty percent of the study population reported achieving ≥150 minutes per week of MVPA. Women with access to a safe walking environment were more likely to maintain or increase their PA during pregnancy [adjusted OR (aOR) per 1-point increase in PA score = 1.61, 95% CI: 1.14-2.28, p<0.01]; a safe walking environment was characterized by perceptions of physically active neighbors, lack of concern about unattended pets, safe and well-maintained sidewalks, and adequate street lighting. Participants that reported better access to public recreational facilities were also more likely to maintain or increase moderate PA levels throughout their pregnancy (aOR = 1.24, 95% CI: 1.05 - 1.47, p<0.05).

Conclusions:
Perceived access to a safe environment and neighborhood public recreation facilities are strongly associated with achievement and maintenance of recommended PA throughout pregnancy. Interventions at the individual-level have been shown to promote PA during pregnancy. Combining these efforts with community-level interventions that enhance the built environment to include access to safe outdoor space for leisure and recreational facilities may also positively impact the metabolic health of expectant mothers.
Abstract MP15: Physical Activity is Inversely Associated with Calcified Atherosclerotic Plaque in the Coronary Arteries: The NHLBI Family Heart Study
Authors: Imran Tasnim F , Patel Yash , Ellison R C , Heiss Gerardo , Hunt Steven C , Carr J. Jeffrey , Arnett Donna K , Pankow James , Gaziano J. Michael , Djoussé Luc
Published: March 2022

Background:
Physical activity is integral to the primary prevention of cardiovascular diseases. However, studies have reported mixed findings on the association between physical activity and coronary artery calcification (CAC).

Hypothesis:
Our primary hypothesis is that physical activity is inversely associated with prevalent CAC.

Methods:
In a cross-sectional design, we studied 2,971 participants of the NHLBI Family Heart Study without a history of MI, CABG or PTCA. A standardized questionnaire was used to ascertain the number of blocks walked daily to compute block metabolic equivalent hours per week. CAC was measured by cardiac CT, and we defined prevalent CAC using an Agatston score of at least 100. Generalized estimating equations were used to calculate adjusted prevalence ratios of CAC.

Results:
Mean age was 55 (±12.7) years and 60.3% of participants were women. Compared to 0-4 blocks/d, prevalence ratios for CAC after adjusting for age, sex, race, BMI, hyperlipidemia, hypertension, diabetes, smoking, and alcohol abuse were 0.73, 95% CI: 0.55-0.97 for >4-8 blocks/d, 0.72, 95% CI: 0.58-0.89 for >8-20 blocks/d, and 0.82, 95% CI: 0.62-1.1 for >20 blocks/d, p for trend 0.02. Corresponding values for total block activity were 0.84, 95% CI: 0.53-1.30 for 1-4 met-hrs/wk, 0.50, 95% CI: 0.31- 0.81 for >4-7 met-hrs/wk, 0.68, 95% CI: 0.47-1.00 for >7-14 met-hrs/wk, and 0.54, 95% CI: 0.33-0.88 for >14-22 met-hrs/wk, p for trend 0.04 (Table 1). In a secondary analysis stratified by BMI (<25 and ≥25 kg/m2), the results remained statistically significant for those with BMI ≥ 25 (p=0.01). The number of participants with BMI < 25 was too small for analysis. The inverse association persisted when we repeated the main analyses using CAC cutoffs of 150 and 200, but not 50.

Conclusion:
The Family Heart Study data are consistent with an inverse association of mild to moderate physical activity with coronary artery calcification in adult men and women.
Abstract MP18: Hand Grip Strength is Inversely Related to Arterial Stiffness in 136,856 UK Adults: The UK Biobank Project
Authors: Kim Youngwon , Wijndaele Katrien , Wareham Nick , Brage Soren
Published: March 2022

Introduction:
Fitness is an important determinant of cardiovascular health in adults. Arterial stiffness has been shown to be a useful prognostic index of cardiovascular events. However, little is known about the relationships of muscular strength with arterial stiffness.

Hypothesis:
Muscular strength is inversely related to arterial stiffness index.

Methods:
We utilized baseline data collected from the UK Biobank project, an ongoing UK national cohort study of 502,656 adults. Of 169,835 adults that undertook arterial stiffness tests, 136,854 (aged 40-70yrs; 52.4% females) with all essential variables were included for cross-sectional analyses. Maximal hand grip strength was measured once in each hand via a Jamar J00105 hydraulic hand dynamometer (Lafayette Instrument, USA). Values from both hands were averaged, and then divided by body weight to normalize grip strength for body size. Arterial stiffness was assessed using the pulse waveform measured by photo-plethysmography of the index finger (PulseTrace PCA2, Carefusion, USA). Arterial stiffness index (m/s) was calculated by dividing participants’ height (m) by the difference in time (s) between the first systolic peak and early diastolic peak in the waveforms. Quantile regression was performed to examine cross-sectional associations of grip strength with 5 different percentiles of arterial stiffness index: 10th, 30th, 50th, 70th and 90th. The analyses were adjusted for age, gender, percent body fat, ethnicity, smoking status, employment, household income, deprivation index, self-rated health status, medication use, alcohol consumption, parental history of cardiovascular events, assessment centers, self-reported sedentary time and moderate-to-vigorous physical activity time. Analyses were also stratified by gender, age groups and weight status.

Results:
One unit increase in grip strength was significantly associated with reductions in arterial stiffness index by 0.68m/s (confidence interval [CI]: 0.54, 0.83), 1.25m/s (CI: 1.08, 1.42), 1.31m/s (CI: 1.13, 1.49), 1.23m/s (CI: 1.00, 1.45) and 1.32m/s (CI: 0.93, 1.71) at the 10th, 30th, 50th, 70th and 90th percentile of arterial stiffness index, respectively. However, stratified analyses revealed stronger negative associations at higher percentiles of the arterial stiffness index in females versus males, younger (<65yrs) versus older individuals and normal versus overweight/obese individuals.

Conclusions:
Hand grip strength was inversely associated with arterial stiffness index; the relationships were, in general, stronger at the upper tail of the arterial stiffness index distribution. Additional research is needed to understand biological mechanisms through which various genetic and lifestyle factors improve muscular strength, as well as causal relationships between muscular strength and arterial stiffness.
Abstract MP22: The Association of Dietary Intake Biomarkers with Rapid Kidney Function Decline: The CARDIA (Coronary Artery Risk Development in Young Adults) Study
Authors: Hirahatake Kristin , Odegaard Andrew , Gross Myron , Peralta Carmen , Bibbins-Domingo Kirsten , Shlipak Michael , Mattix-Kramer Holly , Jacobs David
Published: March 2022

Introduction:
Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease. Evidence linking dietary intake to CKD is largely focused on management, rather than prevention of CKD. To provide evidence that addresses this gap we analyzed data from CARDIA using objective biomarkers of dietary intake (serum carotenoids and ascorbic acid marking fruit and vegetable intake, tocopherols marking nuts/seeds and oil intake) and serum cystatin C as a measure of kidney filtration.

Hypothesis:
Higher levels of serum carotenoids, tocopherols and plasma ascorbic acid are inversely associated with rapid kidney function decline.

Methods:
We analyzed data of subjects from the CARDIA study (N=2,210) with blood measures of dietary biomarkers at year 15 (2000-2001, black and white men and women aged 33-45y), concurrent clinical risk factor data, and measures of cystatin-C at years 15 and 20. GFRcys (ml/min/1.73m
2
) was estimated from the CKD-EPI (CKD Epidemiology Collaboration) equation for calibrated cystatin C at years 15 and 20. Only subjects with GFRcys > 60 ml/min/1.73m
2
at year 15 were analyzed. Rapid decline was defined as >15% decline in GFRcys over 5 years (or >3% decline per year). Multivariable logistic regression was used to estimate the Odds Ratio of incident rapid decline over 5 years by quartile of the dietary biomarkers and adjusted for demographic, lifestyle and clinical measures.

Results:
From year 15 to 20, 15.3% (339 of 2,210) of subjects experienced rapid kidney function decline. There was a strong inverse association after adjustment (P=0.016) between higher levels of the carotenoid index and incidence of rapid decline, but no association with any other measure. There was no evidence that the associations differed by diabetes or hypertension status.

Conclusions:
These results underscore how a nutrient rich, plant based dietary pattern in early middle-age inversely associates with subsequent rapid kidney function decline and provide insight for dietary recommendations related to CKD prevention.
Abstract MP27: Comparative Prognostic Performance of Different Definitions of Prediabetes in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Warren Bethany , Pankow James S , Woodward Mark , Selvin Elizabeth
Published: March 2022

Introduction:
Discordance among definitions of prediabetes has been well documented, however less is known about which definitions are most indicative of long-term risk of clinical outcomes.

Hypothesis:
Prediabetes defined by Hemoglobin A1c (HbA1c) will be more strongly associated with risk of future outcomes than prediabetes defined by fasting glucose (FG) or 2-hour glucose.

Methods:
We included 10,692 ARIC participants who attended visit 2 (1990-92), when HbA1c and FG were measured, and 6,521 participants who attended visit 4 (1996-98), when FG and 2-hour glucose were measured, without prevalent diabetes, cardiovascular disease, heart failure, or chronic kidney disease at the relevant baseline. Participants were followed for up to 20 years for all-cause mortality and incident diabetes, cardiovascular disease/heart failure, and chronic kidney disease. Cox proportional hazards models were used to estimate adjusted hazard ratios of incident events for each prediabetes definition compared to normal glycemic levels. Seemingly unrelated regression was used to compare prediabetes definitions.

Results:
Prediabetes defined by FG and 2-hour glucose were similarly associated with risk of all-cause mortality, cardiovascular disease/heart failure, and chronic kidney disease (all p-values > 0.1). Prediabetes defined by FG was more strongly associated with risk of diabetes than the 2-hour glucose definition (p < 0.01). Prediabetes defined by HbA1c was more strongly associated with risk of all-cause mortality, diabetes, cardiovascular disease/heart failure, and chronic kidney disease than with prediabetes defined by FG (all p-values < 0.001; Table).

Conclusion:
The HbA1c-based definition of prediabetes was more strongly associated with all-cause mortality, and incident cardiovascular disease/heart failure, and chronic kidney disease as compared to FG or 2-hour glucose-based definitions. Screening with HbA1c to identify persons with prediabetes identifies a group of persons at high risk for clinical outcomes.