bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P243: Psychosocial Strengths in Childhood Reduce Cardiometabolic Risk in Midlife: Longitudinal Findings From the 1958 British Birth Cohort
Authors: Boehm Julia K , Kubzansky Laura
Published: March 2020

Introduction:
Reaching middle age with even one cardiovascular risk factor increases risk for morbidity and mortality. Yet once cardiovascular risk factors are in place, repairing or improving them can be difficult. One alternative is to promote healthy cardiovascular functioning during childhood. Although evidence indicates that adversity and psychological distress in childhood increase cardiovascular risk in adulthood, less research has examined
protective
childhood factors that enhance cardiovascular functioning and reduce risk over time. This research investigated if psychosocial strengths in childhood - such as positive emotions, optimism, purpose, satisfaction, and social connections - were associated with midlife cardiometabolic risk.

Hypothesis:
We hypothesized children with more versus fewer psychosocial strengths would have lower cardiometabolic risk in middle age.

Methods:
Data came from individuals in the 1958 British Birth Cohort, who have been repeatedly assessed from birth through adulthood. A subset of 11 year olds wrote an essay imagining their lives at age 25. Two trained judges rated 5,463 essays for the extent to which 9 psychosocial strengths were present (1=not at all; 7=very). The average rating across judges was calculated for each strength. All strengths were then averaged together for an overall score (α=.82). A cardiometabolic risk score was derived at age 45 from clinically-assessed systolic and diastolic blood pressure, resting heart rate, high-density lipoprotein cholesterol (reversed), total cholesterol, triglycerides, glycosylated hemoglobin, fibrinogen, and C-reactive protein. Each biomarker was standardized and then summed (higher numbers indicated more cardiometabolic risk). Missing values were multiply imputed, then linear regression analyses determined associations between psychosocial strengths and cardiometabolic risk.

Results:
In unadjusted models, having more psychosocial strengths was significantly associated with lower cardiometabolic risk (b=-.42, se=.08, p<.0001). After adjusting for sex and financial hardship in childhood, the association was maintained (b=-.20, se=.08, p=.009). However, adding childhood cognitive ability and essay word count (b=-.09, se=.08, p=.24), as well as childhood health-related variables (heart complaints, height, weight) and adulthood cardiovascular medication use (b=-.10, se=.07, p=.18), attenuated the association.

Conclusions:
Children with more psychosocial strengths tended to have reduced cardiometabolic risk in midlife. These associations were accounted for by other child attributes that may cluster with psychosocial strengths. With a primordial prevention framework and innovative methods to assess childhood psychosocial strengths, this study contributes to growing evidence about factors in early life that may reduce cardiometabolic risk across the lifespan.
Abstract P245: Impact of Depressive and Anxiety Symptoms on All Cause Mortality Among Andean Hispanics: Result From the PREVENCION Study
Authors: Chirinos Diana , Aguayo Liliana , Vargas Emily , Carnethon Mercedes R , Medina Lezama Josefina
Published: March 2020

Introduction:
Depressive/anxiety symptoms are associated with mortality among patients with established cardiovascular disease (CVD). These symptoms are also associated with higher burden of CVD risk factors. Few studies have examined whether the association between psychological symptoms and mortality is independent of CVD risk factors in community-based samples, and no study to date has focused on Andean Hispanic adults. In this study, we examined the association between depressive/anxiety symptoms and 10-year all-cause mortality among community-based Andean Hispanic adults, after adjusting for demographic and CVD risk factors.

Hypothesis:
Depressive/anxiety symptoms are independently associated with 10-year all-cause mortality among Andean Hispanic adults.

Methods:
Participants included 551 adults (57.7% female, mean baseline age=50.9 years [SD=16.8]) enrolled in the Peruvian Study of Cardiovascular Disease (PREVENCION). Depressive/anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale. Cox proportional-hazards models were used to examine associations between depressive/anxiety symptoms and all-cause mortality.

Results:
Mean depressive and anxiety symptom scores were 5.7 (SD=3.5) and 7.6 (3.6), respectively. There were 42 events (7.6%) reported at the 10-year follow-up. In unadjusted models, depressive symptoms were significantly associated with all-cause mortality (HR=1.25, 95% Confidence Intervals [CI]=1.14-1.37). After controlling for demographic factors and CVD risk factors (Figure 1), depressive symptoms remained significantly associated with all-cause mortality (HR=1.18, 95% CI=1.06-1.31). No associations were found between anxiety symptoms and all-cause mortality in unadjusted or adjusted models.

Conclusion:
Depressive symptoms were associated with 10-year all-cause mortality among Andean Hispanic adults even after adjusting for demographic and CVD risk factors. Future studies should examine associations with cause-specific mortality.
Abstract P254: Daytime Napping is Associated With Incident Stroke in Community
Authors: Jin Xuting , Yan Bin , Li Ruohan , Gao Ya , Zhang Jingjing , Li Jiamei , Wang Gang
Published: March 2020

Introduction:
There are conflicting reports regarding whether daytime napping is a risk factor for cardiovascular events. The purpose of this study was to investigate the relationship between daytime napping and incident stroke within a community-based cohort study.

Hypothesis:
We assessed the hypothesis that the duration and the frequency of daytime napping may be associated with incident stroke.

Methods:
Participants without previous stroke were enrolled in the present prospective study from the Sleep Heart Health Study (registration number, NCT00005275). Daytime napping were assessed with a self-reported Sleep Habits Questionnaire. Duration of daytime napping was divided into the following categories: no naps, 0-30 min, 31-60 min, or >60 min. Frequency of naps were categorised as: no naps, 1-2 times/week, 3-4 times/week, 5-6 times/week, or daily. After combining nap duration and frequency, participants were further divided into groups with regular long naps (≥5 times per week and >30 min), regular short naps (≥5 times per week and ≤30 min), irregular naps or no naps. Subsequently, participants were followed up until the first stroke occurred between the date of the completed questionnaire and the final censoring date. Cox regression analysis was used to estimate the relationship between daytime napping and incident stroke.

Results:
The present study enrolled 4757 participants, of which 220 participants (4.6%) experienced incident stroke during an average follow-up of 10.6 years. There was a higher rate of stroke among participants taking longer and more frequent naps than others. Multivariate Cox regression analysis indicated that, when compared with participants with no naps, those with a nap duration of ≥60 min or of 31-60 min had a higher risk of stroke (HR, 2.182; 95% CI, 1.443-3.301; HR, 1.594; 95% CI, 1.003-2.531, respectively). Moreover, there was an increased risk of stroke among participants taking daily daytime naps (HR, 1.563; 95% CI, 1.059-2.307) or napping 5-6 times per week (HR, 1.548; 95% CI, 1.026-2.335) than those with no naps. And after combining nap duration and frequency, regular long naps and regular short naps were also associated with higher risk of incident stroke (HR, 1.903; 95% CI, 1.182-3.065; HR, 1.451; 95% CI, 1.010-2.084, respectively).

Conclusions:
In conclusion, daytime napping of long duration and high frequency may increase the risk of incident stroke in community. Modification of sleep habits may improve the life quality among those elderly community-based population.
Abstract P274: Kidney Filtration Markers and the Risk of Clinical Outcomes in Individuals With Type 2 Diabetes in the Advance Trial
Authors: Kim Hyunju , Wang Dan , Chalmers John , Woodward Mark , Selvin Elizabeth , Rebholz Casey M
Published: March 2020

Introduction:
Creatinine-based estimated glomerular filtration rate (eGFR) is biased in the setting of obesity and other conditions. Alternative kidney filtration markers may be particularly useful in adults with diabetes, but few studies examined the risk of clinical outcomes associated with filtration markers in adults with type 2 diabetes.

Objective:
We evaluated whether baseline levels and change in eGFR based on creatinine (Cr), cystatin C (Cys), and B
2
-microglobulin (B2M) were associated with the risk of clinical outcomes among individuals with type 2 diabetes.

Methods:
In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, Cr, Cys, and B2M were measured in 7,217 participants at baseline and a random sample of 640 participants at the 1 year visit. We categorized baseline eGFR
Cr
, eGFR
Cys
, eGFR
B2M
, and the average across the 3 eGFR estimates (eGFR
avg
) into quarters, and examined associations with major macrovascular and microvascular events together, and separately, and all-cause mortality using Cox regression models, adjusting for established risk factors. We also examined associations with continuous eGFR decline and increase (per 30%).

Results:
Over a median follow-up of 5 years, 1,313 combined major macrovascular (n=748) and microvascular events (n=637), and 743 deaths occurred. Lower levels of eGFR based on all three filtration markers individually and combined were associated with 1.5 to 2.2 times higher risk of combined major macrovascular and microvascular events, with similar patterns for other outcomes (
Table
). Per 30% decline in eGFR
Cys
and eGFR
avg
were associated with a >2-fold higher risk of all clinical outcomes, after additional adjustment of baseline eGFR.

Conclusions:
In adults with type 2 diabetes, baseline levels of eGFR based on alternative filtration markers and per 30% decline in eGFR
Cys
and eGFR
avg
were consistently associated with all clinical outcomes.
Abstract P282: A Simple Clinical Scoring System Using Readily Available Clinical Measures for Prediction of Non-alcoholic Fatty Liver Disease: Evidence From the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Rodriguez Luis A , Shiboski Stephen , Bradshaw Patrick , Fernandez Alicia , Herrington David M , Ding Jingzhong , Bradley Ryan D , Kanaya Alka M
Published: March 2020

Background:
Many patients have risk factors for non-alcoholic fatty liver disease (NAFLD), the leading cause of liver disease in the US. Screening all patients with risk factors for NAFLD using ultrasound or computed tomography (CT) is not always possible. We present a practical scoring tool for predicting presence of NAFLD based on common anthropometric measurements, clinical parameters and patient characteristics.

Methods:
We used cross-sectional data from 6,194 white, African American, Hispanic, and Chinese American participants from the Multi-Ethnic Study of Atherosclerosis, ages 45-85 years. Liver fat attenuation was measured by CT scans (
<
40 Hounsfield units identifies hepatic steatosis). We selected risk factors that are routinely available in clinical practice. We used random forest-derived variable importance to select 9 final predictors among 18 candidates. These were used to develop a logistic regression-based score predicting occurrence of NAFLD in a random 2/3 derivation subset of the sample. Calibration and discrimination performance was assessed in the remaining 1/3 validation sample using goodness of fit measures, area under the receiver operating characteristic curve (AUC) and Brier scores.

Results:
NAFLD prevalence was 6.2% in the overall sample (n=6,194). The table shows the 9 predictors with beta coefficients, OR (95% CI) and points. Using the point-based system, the derivation set achieved an AUC of 0.84 (95% CI, 0.84 to 0.86), and the validation set an AUC of 0.81 (0.78 to 0.85). The Hosmer-Lemeshow goodness-of-fit test had a p=0.15, and the Brier score was 0.06 for the validation set, indicating that our validation model was well calibrated with acceptable prediction performance. At
>
27 points, sensitivity was 83%, specificity 66% and Youden’s index was 0.49.

Conclusions:
Our NAFLD point system is a simple but highly predictive score system that can allow clinicians to identify individuals at high risk of NAFLD. Future studies should evaluate prediction performance in an external dataset.
Abstract P285: Sociodemographic and Metabolic Risk Characteristics Associated with Metabolic Weight Categories in the Women's Health Initiative
Authors: Cordola Hsu Amber R , Ames Susan L , Xie Bin , Peterson Darleen V , Garcia Lorena , Going Scott B , Wong Nathan D , Anton-Culver Hoda
Published: March 2020

Introduction:
To identify sociodemographic and metabolic correlates of weight categories in postmenopausal women.

Hypothesis:
We assessed the hypothesis that postmenopausal women with metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO) were more likely to have adverse risk factors as compared to those with metabolically healthy normal weight (MHNW).

Methods:
The Women’s Health Initiative (WHI) enrolled 161,808 postmenopausal women ages 50-79. We included those free of cardiovascular disease (CVD) and with CVD risk factors and biomarkers (n=19,412). Normal weight was defined as a body-mass index (BMI) ≥18.5 and <25 kg/m
2
and waist circumference (WC) <88 cm and overweight/obesity as a BMI
>
25 kg/m
2
or WC
>
88 cm. Metabolically healthy was based on <2 and metabolically unhealthy
>
2 traits: triglycerides
>
150 mg/dl, systolic blood pressure (BP)
>
130 mmHg or diastolic BP
>
85 mmHg or antihypertensives or diuretics, fasting glucose
>
100 mg/dl or diabetes medication, and HDL-cholesterol <50 mg/dl. Multinomial logistic regression with generalized link logit function provided the odds ratio (ORs) of MHNW, MUHNW, MHO and MUHO.

Results:
The table shows the ORs of risk factors and biomarkers. Among the 19,412 participants, 2,369 (12.2%) had prevalent diabetes and a mean age of 63.3 ± 0.05 (SEM). Advanced age was associated with a greater odds of MUHNW and a lower odds of MHO as compared to the MHNW after adjusting for covariates. African-Americans were associated with a decreased likelihood of MUHNW and MUHO, while Hispanics were associated with a decreased likelihood of MHO and MUHO as compared to MHNW. Low-income had a greater odds of MUHNW, yet high-income had a lower odds of MHO or MUHO. Total cholesterol, insulin and C-reactive protein were associated with a greater odds of MUHNW, MUHO or MHO.

Conclusions:
Advanced age, ethnicity, income and biomarkers are important indicators of metabolic weight categories among postmenopausal women.
Abstract P286: Sex-differences In The Prevalence Of Low Clinical Cardiovascular Health From Childhood To Middle-age
Authors: Aguayo Liliana , Krefman Amy , Reges Orna , Davis Matthew M , Labarthe Darwin R , Greenland Philip , Juonala Markus , Kähönen Mika , Lehtimäki Terho , Day R. Sue , Bazzano Lydia A , Van Horn Linda , Alonso Camilo F , Webber Larry S. , Pahkala Katja , Laitinen Tomi T. , Raitakari Olli T , Lloyd-jones Donald M , Allen Norrina B
Published: March 2020

Introduction:
This study examines sex differences in the prevalence of low clinical cardiovascular health (CVH) scores from ages 8-50 years old.

Methods:
Five cardiovascular cohorts (Bogalusa, Young Finns, HB!, CARDIA, and STRIP) were used to create a pooled cohort spanning from ages 8 to 50 years old. The American Heart Association criteria for poor, intermediate and ideal levels for 4 CVH factors (blood pressure, BMI, cholesterol, and glucose) were summed to calculate a clinical CVH score (range 0-8; higher being more ideal). Sex differences in the prevalence rates of low clinical CVH by age group (defined as a score ≤3) were estimated using logistic regression models.

Results:
Sex differences were examined among 9,386 participants with data on clinical CVH (56% female, 66% White and average follow-up time of 23 yrs). The prevalence of low clinical CVH increased for both men and women with age from 0.72% at age 8-14 yrs to 15% at 45-50 yrs of age in women and from 0.44% at ages 8-14 yrs to over 23% at ages 45-50 yrs in men. There were no significant sex differences in the prevalence of low clinical CVH at younger ages (8-20 years old, p>0.05). Between the ages of 21-26 years old, males were 2 times more likely to have low clinical CVH than women (odds ratio [OR] 2.2, 95% confidence interval [CI], 1.4-3.4). Sex differences in the prevalence of low clinical CVH persisted through adulthood and with only a slight decrease by ages 45-50 years old (OR 1.6, 95%CI 1.4-1.9).

Conclusions:
Sex differences in the prevalence of low clinical CVH change over the lifetime. In childhood the prevalence of low clinical CVH is similar. By young adulthood, men are more than twice more likely to have low clinical CVH than women; that sex difference is maintained throughout middle age. Understanding the reasons for the growing sex differences in the prevalence of low clinical CVH with age may help to identify targets for primordial prevention, especially prevention strategies to target young men.
Abstract P287: The Rising Trend of Hypertension in Pediatric and Adolescent Patients
Authors: Aguilar Rodrigo , Mansoor Kanaan , Higginbotham Zachary , McCorkle Colin , Saunders Elizabeth
Published: March 2020

Background:
A concerning trend in society today is the development of lifelong diseases, such as hypertension, at an early age. The sequelae of prolonged uncontrolled hypertension are devastating and include the development of vascular disease, kidney disease, and ultimately increased mortality among other things. Though it is thought that today’s children are affected by chronic conditions such as hypertension more frequently than in previous generations, this has not been thoroughly analyzed. This study aimed to evaluate incidence of hypertension, as well as mortality rates in patients with a diagnosis of hypertension in 2 different hospitalized patient populations, children ages 0-12 and adolescents ages 13-18 over the course of a 7-year period from 2005-2012.

Methods:
An NIS database was queried from 2005-2012. Exclusion criteria included patients greater than >18 years old and patients with secondary causes of hypertension, as this study was looking at essential hypertension only. Analysis was performed via chi square or t test with SAS 9.4, all values were significant when p<0.05.

Results:
As per our analysis, the incidence of hypertension in the pediatric populations had a decline in 2006, but since then it has been on the rise while hypertension in the adolescent age group showed a consistent upward trend. Furthermore, our data also revealed that the incidence of hypertension was highest in the Caucasian race in comparison to the other races, with a p-value of < 0.001. Lastly, the likelihood of mortality in hospitalized pediatric populations with a diagnosis of hypertension was 2.03 while in adolescents it was 0.84 with a p value of <0.001.

Discussion:
It is thought that the increase in incidence of hypertension in these patient populations could potentially be due to the high sodium, high fat, and low fiber diets of most American citizens. It is well documented that obesity is an epidemic in the youth of America and we believe an analysis of the correlation between hypertension and obesity in these patient populations is warranted, as it is possible that dietary modification in these patients could result in a lower incidence of hypertension, and thus lower mortality and morbidity rates.
Abstract P304: Introduction of a Longitudinal Cohort Study to Evaluate the Prevalence and Incidence of Cardiovascular Risk Factors and Diseases in Haiti and Their Associated Poverty-related Social Determinants
Authors: Victor Jean Joscar , Rivera Vanessa , Pierre Lookens , Preval Fabyola , Joseph Inddy , Raynold Jean Baptiste , Exantus Serfine , Tilus Rosie , Benedict Charles , Smith Caleigh , Tymejczyk Olga , Nash Denis , Fitzgerald Daniel , Pape Jean W , Safford Monika M , McNairy Margaret
Published: March 2020

Background:
Cardiovascular disease is the leading cause of mortality among Haitian adults, having surpassed HIV in the last decade. The natural history of CVD in Haitians including the age of onset, incidence, and role of major risk factors and social determinants is urgently needed to develop prevention and treatment interventions.

Objective:
This study fills this gap by establishing the first population-representative longitudinal cohort of adults in metropolitan Port-au-Prince to estimate the prevalence and incidence of cardiovascular risk factors, diseases, and associated poverty-related determinants.

Methods:
The cohort will include 3,000 adults ≥ 18 years, followed for 2-3.5 years, using multistage random sampling from census blocks. Randomly-generated GPS locations were selected in proportion to the estimated population of each block. Community health workers identify one household systematically at each location, collect household information and measure blood pressure during a single visit. Two adults who live in each household are randomly selected to participate in the longitudinal study. Data is collected at baseline and every six months on risk factors (hypertension, diabetes, obesity, dyslipidemia, kidney disease, poor diet, smoking, physical inactivity, and inflammation) and diseases (myocardial infarction, heart failure, stroke and CVD mortality) using AHA definitions. We also measure stress, social isolation, depression, food insecurity and blood lead exposure. Blood, urine, and stool samples are biobanked at enrollment. We report the first 7 months of prevalence data.

Results:
A total of 585 households (response rate 97%) were surveyed with 566 participants enrolled (51% response rate). The majority of participants are women (73%) with median age 38.5 years with 30% 18-30 years. Over 90% live in extreme poverty (<$2/day) and 26% are unemployed. Prevalence rates of risk factors include 31.5% HTN (15.6% Stage I, 11.11% Stage II, 4.79% history of HTN), 4.4% active smokers, 20.7% obesity (BMI > 30 kg/m
2
), and 5.1% diabetes. Heart failure was the most common CVD (9.8%), followed by angina/MI (5.6%), and stroke (3.3%).

Impact:
This study will provide invaluable insights into the epidemiology of CVD in Haiti. The study also builds a platform for comparison research with existing US CVD cohorts. Our goal is to translate findings from this study into pragmatic prevention and treatment interventions to fight the CVD epidemic in Haiti and in Haitian immigrants in the US.
Abstract P310: Contribution of AHA Life’s Simple 7 to Sex Differences in the Incidence of Coronary Heart Disease and Stroke
Authors: Huang Tianyi , Rimm Eric , Rich-Edwards Janet , Hu Frank , Rexrode Kathryn M
Published: March 2020

Background:
Substantial sex differences exist in the incidence of cardiovascular disease (CVD), with women at lower risk for coronary heart disease (CHD) but higher risk for stroke compared with men. However, the underlying reasons remain poorly understood, and no study to date has quantified the contribution of conventional cardiovascular risk factors to these sex differences.

Methods:
We prospectively followed 71,342 women from the Nurses’ Health Study and 36,499 men from the Health Professionals Follow-up Study (1986-2012) without CVD history at baseline who had complete data on Life’s Simple 7 (LS7), including smoking, diet quality, physical activity, body mass index (BMI), hypertension, hypercholesterolemia and diabetes. Time-varying Cox proportional hazards regression was used to estimate hazard ratios (HRs) for CHD and stroke comparing men versus women adjusted for age. Impact of LS7 on sex differences was evaluated by change in the sex HR estimate after further adjustment for LS7. We assessed effect modification by sex for the associations between individual components of LS7 and risk of CHD and stroke.

Results:
The age-adjusted HR (95% CI) comparing men versus women was 2.21 (2.10, 2.32) for CHD and 0.74 (0.69, 0.80) for stroke. Rates of achieving LS7 goals were in general worse among women compared to men (age-standardized mean LS7 score: 3.7 versus 4.1). Smoking, diabetes, hypertension and hypercholesterolemia were more strongly associated with CHD risk in women than in men (p-interaction<0.01), whereas the associations with BMI, diet quality and physical activity were similar by sex (p-interaction>0.23). For example, every 5 pack-years of smoking was associated with 19% higher CHD risk in women (95% CI: 1.17, 1.21) and 8% higher risk in men (95% CI: 1.06, 1.10). The HR (95% CI) associated with diabetes was 2.63 (2.40, 2.88) in women and 1.32 (1.15, 1.50) in men. By contrast, while most risk factors showed stronger associations with stroke risk in women than in men, only the difference for smoking reached statistical significance (p-interaction=0.009). After adjustment for LS7, the HR (95% CI) by sex increased to 2.61 (2.47, 2.75) for CHD and was attenuated to 0.83 (0.76, 0.89) for stroke.

Conclusion:
Lower LS7 achievement and stronger associations of LS7 with CVD outcomes in women than in men appeared to explain some of the sex difference in stroke risk but not CHD risk on the risk ratio scale. Ongoing work is exploring the impact of LS7 on sex differences on the absolute risk difference scale.
Abstract P317: Sex and Age Differences in a typical Chief Complains for Heart Failure in Emergency Department Visits
Authors: Meyer Michelle L , Bush Montika , Bischof Jason J , Waller Anna E , Platts-Mills Timothy F
Published: March 2020

Background:
Around 1 million United States emergency department (ED) visits per year are due to exacerbation of heart failure (HF) symptoms, with ~80% of those patients admitted to the hospital. However, sex and age differences in HF symptom presentation in the ED have not been thoroughly investigated.

Objectives:
To describe sex and age differences in chief complaints of ED patients with a HF diagnosis.

Methods:
We included patients ≥18 years old with an ED diagnosis of HF in NC DETECT, a statewide syndromic surveillance system. We defined a HF diagnosis using ICD-9-CM and ICD-10-CM codes from ED visits between 2010 and 2016. We classified the ED chief complaints into categories by symptom groups (e.g. respiratory complaint includes hypoxia, respiratory distress, breathing difficulties). Chief complaint categories are not mutually exclusive. We calculated frequencies of chief complaint categories for ED visits by sex and age (18-44 (n=55,216), 45-64 (n=260,397), ≥65 (n=578,313) years old) and evaluated for a 10% standardized difference between groups.

Results:
There were 422,720 patients with 893,950 total unique visits (1.6 average visits/person). Of these visits, 55.0% were by women and 59.5% patients were admitted. Overall, the top chief complaint categories were dyspnea (19.1%), chest pain (13.5%), and respiratory complaints (13.4%), and were similar by sex and by ED disposition (admitted or discharged) and sex. When stratified by sex and age group, in those 18-44 years old, women had more reports of nausea/vomiting (6.7%) compared with men (4.1%) and headache (4.2%) compared with men (2.0%). In those 45-64 and ≥65 years old, chief complaint categories were similar between women and men. When stratified by age group alone, reports of chest pain decreased with age (21.4% in 18-44, 17.7% in 45-64, and 10.8% in ≥65 year olds), whereas reports of balance issues (1.2% in 18-44, 2.4% in 45-64, and 6.0% in ≥65 year olds), weakness (1.7% in 18-44, 2.7% in 45-64, and 5.5% in ≥65 year olds), and confusion (0.8% in 18-44, 2.1% in 45-64, and 4.5% in ≥65 year olds) increased with age. Compared to those ≥65 years old, those 18-44 years old had fewer respiratory complaints (10.0% vs. 13.9%), but more reports of headache (3.2% vs. 0.8%) and nausea/vomiting (5.5% vs. 3.2%).

Conclusion:
In a state-wide population of ED patients with HF diagnoses, sex differences in chief complaint categories that are less obvious symptoms of HF were observed for those 18-44 years old, with women reporting more nausea/vomiting and headache compared to men. Chief complaint categories that are less obvious symptoms of HF were more common among patients 18-44 (nausea/vomiting, headache) and ≥65 (balance issues, confusion, weakness) years old. Characterizing the variation of symptoms of HF patients in the ED may help inform the identification of ED patients with HF and the outpatient management of HF-related symptoms.
Abstract P319: Racial Differences and Temporal Trends in Obesity Among Patients Hospitalized With Acute Decompensated Heart Failure With Preserved Ejection Fraction: The ARIC Study Community Surveillance
Authors: Caughey Melissa C , Vaduganathan Muthiah , Arora Sameer , Qamar Arman , Mentz Robert J , Chang Patricia , Russell Stuart D , Shah Sanjiv J , Rosamond Wayne D , Pandey Ambarish
Published: March 2020

Introduction:
Obesity is disproportionately prevalent in black populations and strongly associated with heart failure with preserved ejection fraction (HFpEF). An “obesity paradox” or lower mortality risk with obesity, has been reported in HFpEF populations. Whether racial differences exist in the temporal trends and outcomes of obesity is uncertain.

Methods:
Hospitalizations for acute decompensated heart failure (ADHF) were sampled from 2005-2014 by the ARIC Study Community Surveillance and classified by physician review. BMI was calculated using the admission height and weight. Associations between obesity and 1-year all-cause mortality were analyzed with multivariable Cox regression.

Results:
There were 10,147 weighted hospitalizations for ADHF with ejection fraction ≥50% (64% female, 74% white). Overall, black patients had a higher mean BMI than white patients (34 vs. 30 kg/m
2
;
P
<0.0001), and a greater prevalence of obesity (56% vs. 43%;
P
<0.0001). Mean BMI and obesity steadily increased from 2005-2014 for white patients (Trends:
P
= 0.003 and
P
= 0.002) while remaining stable for black patients. Within BMI groups (18.5-24, 25-30, 30-35, 35-40, and ≥40 kg/m
2
) a U-shaped mortality risk was observed, with the lowest risk among patients with a BMI of 30-35 kg/m
2
(
Figure
). When defining obesity by a BMI cutpoint ≥30 kg/m
2
, the “obesity paradox” was apparent in 2005-2009 for white obese vs. non-obese patients (HR = 0.58, 95% CI: 0.38 - 0.80), but attenuated by 2010-2014 (HR = 1.11; 95% CI: 0.80 - 1.48);
P
for interaction =0.006. Among black patients, there was no survival benefit for a BMI ≥30 kg/m
2
in 2005-2009 (HR = 1.15; 95% CI; 0.65 - 2.02) or 2010-2014 (HR = 1.06; 95% CI: 0.68 - 1.66).

Conclusion:
In this decade-long community surveillance of HFpEF patients hospitalized with ADHF, obesity and mean BMI were stable for black patients but steadily increased for white patients. A BMI ≥30 kg/m
2
was initially associated with better survival among white patients but the association dissipated as obesity and mean BMI increased over time.
Abstract P327: Inflammation Associates With Lower Myocardial Function Among Antiretroviral-Treated Persons Living With HIV in South Africa
Authors: Peterson Tess E , Ntsekhe Mpiko , Shuldiner Scott , Wong Lye-Yeng , Wolfson Julian , Jermy Stephen , Saad Hadil , Mbalabu Lumbamba Ackim Justin , Singh Achita , Shey Muki , Meintjes Graeme , Ntusi Ntobeko , Baker Jason
Published: March 2020

Introduction:
HIV-associated inflammation contributes to higher CVD risk among persons living with HIV (PLWH). Heart failure (HF) is a prominent CVD manifestation in sub-Saharan Africa where HIV prevalence is high. Systolic dysfunction is a well-known complication of untreated, advanced HIV disease, but it is unknown if ongoing inflammation contributes to myocardial dysfunction during antiretroviral therapy (ART). We evaluated myocardial function via cardiac magnetic resonance (CMR) and studied associations with inflammatory biomarkers among ART-treated PLWH residing in Khayelitsha township near Cape Town, South Africa.

Methods:
CMR images were ascertained via a large bore 3T Siemens Skyra MRI scanner using standardized protocols. Biomarkers were measured from stored plasma using immunoassays and were log
2
-transformed for analyses. Linear regression was used to evaluate cross-sectional associations between CMR parameters and biomarker concentrations, adjusted for age, sex, current smoking, and hypertension.

Results:
Among 133 ART-treated PLWH without known CVD, 64% (85) were female, 99% (132) were Black African, 29% (39) were smokers, 92% (123) had undetectable HIV viral load, mean (SD) age was 50 (9) years, and current and nadir CD4+ count were 535 (270) and 271 (213) cells/μL, respectively. Higher TNFR1, TNF-α, and IFN-γ were associated with lower left ventricular ejection fraction (p=0.03, 0.05, and 0.03, respectively) and systolic global circumferential strain (p=0.01, 0.04, and 0.02) (
Table
). Higher TNFR1 was also associated with lower diastolic strain rate in circumferential (p=0.02), longitudinal (p=0.05), and radial (p=0.01) planes.

Conclusion:
These data suggest inflammation may contribute to lower myocardial function among ART-treated PLWH prior to development of clinical HF. The magnitude of this effect was modest, but potential long-term effects on myocardial tissue remodeling and subsequent HF risk warrant further investigation among a growing ART-treated population in South Africa.
Abstract P330: Assessment Of The Prevalence Of Arterial Hypertension Depending On Environmental Living Conditions
Authors: Glova Svetlana , Shlyk Sergey
Published: March 2020

Materials and methods:
A one-stage population-based epidemiological study of a random sample of 3446 people stratified by age and sex from an unorganized population of Rostov-on-Don was performed. In order to determine the association of hypertension and environmental comfort, all the subjects, depending on the environmental comfort of living, were divided into 2 groups, which were formed on the basis of the "Map of environmental comfort of living in the city of Rostov-on-Don", developed by V.V. Privalenko. The total environmental pollution was determined by the dust load, the content of heavy metals and other toxicants in atmospheric deposition, the degree of soil pollution with heavy metals and oil products, the level of occurrence (flooding) and the scale of groundwater pollution, and the noise level. The 1st group included residents living in regions with low to moderate pollution levels; in the 2nd group - with strong and very strong pollution. The duration of residence of respondents in an area with a certain environmental comfort of living was at least 5 years. Statistical processing of the data was carried out using the program Statistica 6.0.

Results:
When analyzing the frequency of prevalence of AH depending on the environmental comfort of the area of residence, it was found that in people living in environmentally comfortable areas, AH was detected in 639 people (42.86%). At the same time, among the population of Rostov-on-Don living in ecologically uncomfortable areas, hypertension was registered in 396 people (49.26%), which is significantly higher than the prevalence of hypertension in group I (p = 0.003). Analysis of associations of hypertension in the population of Rostov-on-Don and the environmental comfort of the area of residence revealed that in the group of people who lived in ecologically uncomfortable areas, the prevalence of hypertension was significantly higher than in the group of people with environmentally comfortable living conditions: odds ratio = 1.30 (95% confidence interval 1.09-1.54; p = 0.003). When analyzing the average levels of blood pressure depending on the area of residence, it was found that the level of SBP in people living in areas with environmentally uncomfortable conditions is significantly higher (p <0.001) than in people living in environmentally comfortable areas: for men - 140.91 ± 0.8 mmHg and 136.0 ± 0.4 mm Hg, and in women - 133.42 ± 0.5 mm Hg. and 128.2 ± 0.6 mm Hg, respectively.

Findings:
The prevalence of hypertension among Rostov-on-Don residents living in environmentally uncomfortable areas is significantly higher (p<0.001) than in environmentally comfortable areas (49.26% and 42.86%, respectively).
Abstract P332: Urine Uromodulin Does Not Alter the Relationship Between Salt Intake and Blood Pressure: The DASH-Sodium Trial
Authors: Bakhoum Christine , Anderson Cheryl A , Juraschek Stephen , Rebholz Casey M , Appel Lawrence J , Miller Edgar R , Parikh Chirag , Obeid Wassim , Rifkin Dena E , Ix Joachim H , Garimella Pranav S
Published: March 2020

Introduction:
Genome-wide association studies have revealed susceptibility variants for hypertension in the
UMOD
gene. The encoded protein, uromodulin, modulates NKCC2 transporter in the thick ascending limb of the loop of Henle, and its overexpression in murine models leads to salt-induced hypertension.

Hypothesis:
Individuals with higher levels of urine uromodulin will have a greater increase in systolic blood pressure compared to those with lower uromodulin levels.

Methods:
We used data from 157 subjects in the control diet of the DASH-Sodium trial assigned to 30 days of low (1500 mg/d), medium (2400 mg/d), and high salt (3300 mg/d) diets in random order. Blood pressure was measured at baseline and at 5 visits during the last 9 days of each feeding period. We evaluated the association of urine uromodulin with change in systolic blood pressure between diets, as measured by the average at the end of each feeding period, using multivariable linear regression.

Results:
Baseline urine uromodulin stratified by tertiles was less than or equal to 17.64, 17.65 - 31.97, and greater than or equal to 31.98 μg/mL (overall mean 30.0 μg/mL, SEM 1.85 μg/mL). Across the tertiles, there were no significant differences in systolic blood pressure (SBP) at baseline, nor was there a differential effect of sodium diet on SBP across tertiles (low to high p = 0.81, Figure). After adjusting for age, sex, BMI, and race, uromodulin levels were not significantly associated with SBP change from low to high sodium diet (β = -0.68 per 10 μg/mL increase in urine uromodulin, p = 0.28).

Conclusion:
In a randomized trial of different levels of salt intake, higher urine uromodulin levels were not associated with a greater increase in blood pressure in response to high salt intake. Further human studies are needed to evaluate the findings seen in animal models, where the expression of higher levels of urine uromodulin has been associated with salt sensitive hypertension.
Abstract P333: National Trends in the Quality of Office Blood Pressure Measurements, 2014-2019
Authors: Foti Kathryn , Appel Lawrence J , Matsushita Kunihiro , Coresh Josef , Alexander G Caleb , Selvin Elizabeth
Published: March 2020

Introduction:
Clinical practice guidelines emphasize the importance of accurate blood pressure measurement and recording to diagnose and treat hypertension. Trends in terminal digit preference (typically manifest by a terminal digit of ‘0’) have not been examined nationally. The growing use of automated blood pressure devices may have reduced terminal digit preference and improved accuracy over time.

Objective:
To evaluate trends in terminal digit preference in office blood pressure measurements among adults with hypertension by patient and provider characteristics.

Methods:
We used IQVIA National Disease and Therapeutic Index (NDTI) data from January 2014 through June 2019. The NDTI is designed to be nationally-representative of all patient visits to office-based physicians and uses a two-stage stratified sampling design to sample ~4,000 physicians per quarter who report information on all patient visits on 2 random workdays. We included all hypertension treatment visits (~60M/year) among adults aged ≥18. We examined trends in the proportion of hypertension treatment visits with recorded systolic (SBP) and diastolic (DBP) blood pressure measurements with a terminal digit ‘0’. The expected percent of blood pressures with ‘0’ is 10% for automated and 20% for manual readings.

Results:
There was a decrease in the percent of visits with SBP (43.0% to 37.4%) or DBP (44.3% to 38.1%) recordings ending in zero (
Table
). The decrease in percent of SBPs with a terminal zero was similar by patient and provider characteristics, though the percentage of SBPs with a terminal ‘0’ was consistently higher among patients aged ≥60, when SBP ≥140 mmHg, and among cardiologists.

Conclusions:
Terminal digit preference is common indicating systematic error in blood pressure measurement and recording, despite some improvement over time. This may lead to under- and overtreatment of patients with hypertension. Improving the quality of blood pressure measurement is central to improving hypertension diagnosis and control in clinical practice.
Abstract P337: Lifetime Burden of Traditional Cardiovascular Disease Risk Factors and Incidence of Cancer: The Bogalusa Heart Study
Authors: Razavi Alexander C , Kelly Tanika N , He Jiang , Fernandez Camilo , Ferguson Tekada , Wu Xiaocheng , Barshop Rupert , Maniscalco Lauren , Krousel-Wood Marie A , Whelton Seamus P , Blumenthal Roger S , Bazzano Lydia A
Published: March 2020

Introduction:
Cardiovascular disease (CVD) and cancer remain the leading causes of death globally. While these diseases have traditionally been regarded as separate entities, recent evidence points towards shared biological pathways, underlying a need to study CVD and cancer conjointly. We examined the association between CVD risk factors and the incidence of cancer over the life course in a biracial community-based cohort.

Methods:
The analysis included 1,368 participants of the Bogalusa Heart Study who had at least 3 measurements of CVD risk factors throughout life (57.6% women, 32.8% black, baseline age=10.5
+
3.6 years, median follow-up=38.2 years). CVD risk factors assessed included systolic and diastolic blood pressure, LDL-C, HDL-C, plasma glucose, serum triglycerides, and body mass index (BMI). Cancer cases were ascertained via the Louisiana Tumor Registry. Cox proportional hazards regression assessed the association between CVD risk factors and cancer incidence, adjusting for race, sex, smoking, and blood pressure-, lipid-, and glucose-lowering medications.

Results:
There were 88 incident cases of cancer, with breast (22.7%), cervical (11.4%), and prostate (9.1%) being the most highly represented cancers. BMI (kg/m
2
) had the most robust association with incident cancer (HR=5.83, 95% CI: 2.24, 15.19; p=3.0x10
-4
). We observed a strong association between annualized change in blood pressure per mmHg and hazard of all cancers (for systolic, HR=2.24, 95% CI: 1.50, 3.35; p<0.0001 and diastolic, HR=4.86, 95% CI: 2.86, 8.27; p<0.0001). Race and sex significantly modified the relationship of incident cancer with lipids and blood pressure, respectively (
Figure
).

Conclusion:
Subclinical increases in adiposity and blood pressure associate with an increased cancer risk, while HDL-C inversely associates with cancer risk, more consistently in women versus men and in blacks versus whites. Control of CVD risk factors beginning in childhood may lead to improved overall cancer prevention in the general population.
Abstract P339: Association Between Cardiometabolic Syndrome And Cancer: Systematic Review
Authors: Saxena Anshul , Rubens Muni , Ramamoorthy Venkataraghavan , Das Sankalp , Bhatt Chintan B , Salami Joseph A , McGranaghan Peter , Shehadeh Nancy , Veledar Emir
Published: March 2020

Introduction:
Cardiometabolic syndrome consists of a cluster of metabolic dysfunctions such as impaired glucose tolerance, insulin resistance, dyslipidemia, central adiposity, and hypertension. According to the latest estimates, globally, nearly 25% of all adults have cardiometabolic syndrome. Both cardiometabolic syndrome and cancer pathophysiology commonly involve inflammation and oxidative stress. The objective of this systematic review was to evaluate existing evidences that support the association between cardiometabolic syndrome and risk of developing cancer.

Methods:
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus for relevant articles published from the database inception until October 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for this review. Using the Oxford Center for Evidence-Based Medicine guidelines individual studies were evaluated. A total of 59 articles were included in this study.

Results:
Our review showed that cardiometabolic syndrome was associated with increased risk for colorectal, hepatic, endometrial, breast, and bladder cancers. These associations showed variations for sex and geographical locations. For example, the associations were stronger for pancreatic and rectal cancers among women. The strength of these associations was also stronger for sex specific cancers such as breast and endometrial cancers. Studies on European populations showed that these associations were stronger for colorectal cancer among women. However, one study showed that presence of cardiometabolic syndrome contributed protective effects to prostate cancer among American men. In general, strongest associations were found for colorectal cancer among both men and women and hepatic cancer among men. Among cardiometabolic factors, impaired glucose tolerance and central adiposity were the greatest contributors towards increased risk for cancers.

Conclusion:
Given these results, there should be greater focus on primary prevention to identify and treat cardiometabolic risk factors. In addition, patients with greater cardiometabolic risk factors should be screened earlier and more frequently for cancers. A number of gender and geographical gaps identified in this review could be targeted for improvements as per the goals of 2030 sustainable development initiatives. Future studies should consider cardiometabolic syndrome and cancer together and develop effective interventions for decreasing the incidence and morbidity associated with both the conditions.