bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP68: Effects of Macronutrients on Serum Short Chain Fatty Acids (SCFA): Results From the Optimal Macro-Nutrient Intake to Prevent Heart Disease (OmniHeart) Trial
Authors: Mueller Noel T
Published: March 2019

Introduction:
Emerging evidence links greater concentrations of serum SCFA, derived from microbial fermentation of indigestible fiber in the colon, with better cardiometabolic health. The OmniHeart trial tested the effects of 3 diets that differed in % kcal of carbohydrate, protein, and unsaturated fat; each diet was high in fiber (~30g/day) and isocaloric.

Hypothesis:
All 3 diets, being high in fiber, would increase SCFAs, but there will be differences between diets.

Methods:
The OmniHeart trial is a randomized crossover trial that enrolled 158 men and women, aged 30 years or older, with systolic blood pressure 120–159 mm Hg, diastolic blood pressure < 100 mm Hg. Participants consumed each of 3 different isocaloric diets for 6 weeks in random order: a carbohydrate (CARB)-rich diet (similar to DASH); a protein (PROT)-rich diet with protein predominantly from plant sources; and a diet rich in monounsaturated fat (UNSAT). Fasting serum was collected from participants at baseline, while they consumed their own diet, and at the end of each diet intervention period. SCFAs were measured in stored serum with LC-MS/MS (Metabolon Method TAM148)and normalized by log transformation. We fitted a linear regression model using generalized estimating equations to examine mean change in log-transformed SCFAs from baseline in each diet and between diets.

Results:
Compared to baseline diet, all 3 diets increased acetic acid; CARB and UNSAT diets decreased propionic acid; and the PROT diet increased butyric acid (
Figure 1, top panels
). PROT increased acetic acid more than CARB, but no differently than UNSAT. PROT increased propionic acid compared to both CARB and UNSAT (
Figure 1, bottom panels
).

Conclusion:
All 3 high-fiber OmniHeart diets affected microbiota-derived serum SCFA concentrations with some notable differences between diets. Future research is needed to determine whether changes in SCFA mediate the relationship of dietary change and cardiometabolic disease risk factors.
Abstract MP71: Female Community Health Volunteer-Led Lifestyle Intervention is a Highly Cost-Effective, Low-Cost and Scalable Solution for Blood Pressure Control in Nepal
Authors: Neupane Dinesh , Krishnan Anirudh , Kallestrup Per , Karki Arjun , Olsen Michael H , Finkelstein Eric A
Published: March 2019

Introduction:
Cardiovascular disease (CVD) has become the leading cause of death worldwide, accounting for 32% of global deaths in 2016. Hypertension, which can be mitigated through diet, exercise and adherence to medication, is the greatest risk factor for CVD. However, public spending on CVD prevention remains low in many low- and middle-income countries partly due to a lack of evidence of low-cost, scalable, cost-effective and evidence-based CVD prevention programs. The goal of this study was to quantify the scalability and cost effectiveness of an evidence-based community-based hypertension management study (COBIN) in Nepal.

Hypothesis:
A community health worker-led BP monitoring and lifestyle counseling intervention is a cost-effective solution to achieving greater BP control in Nepal.

Methods:
We conducted a cost-effectiveness (CE) and budget impact (BI) analysis of a community health worker-led hypertension prevention and management intervention in Nepal that has previously been shown to reduce BP. Costs were retrospectively collected to estimate per capita and total costs of a national scale-up focusing on three scenarios: (A) hypertensives only; (B) prehypertensives and hypertensives; and (C) all adults aged 25-65 years. The primary CE measure was incremental cost per CVD disability-adjusted life year (DALY) averted. Both CE and BI analyses were conducted for each scenario. One-way sensitivity analyses were conducted to assess the impact of uncertainty in key parameter values on the primary CE measure.

Results:
The first-year BI was estimated to be an average of US$0.88 per participant: a total of US$2,698,181, US$5,667,503, and US$10,832,403 in scenarios A, B, and C respectively. In subsequent years costs are roughly half as much. In the base-case CE analysis, scenarios A, B, and C resulted in an incremental cost-effectiveness ratio (ICER) of US$185, US$340, and US$303/DALY respectively. One-way sensitivity analyses around the base-case analysis for scenario C show that the ICER was most sensitive to uncertainty in the estimate of SBP reduction among normotensives, varying the ICER between US$225 and US$465/DALY.

Conclusions:
The program is highly cost effective in all three scenarios compared to the WHO threshold of US$835/DALY for Nepal. This work presents the first evidence from Nepal that a community-based hypertension prevention and management program can be a cost-effective, low-cost, and scalable solution to control blood pressure nationwide.
Abstract MP72: The Effects of Antihypertensive Class on Falls, Syncope, and Orthostatic Hypotension in Older Adults: the ALLHAT Trial
Authors: Juraschek Stephen P , Simpson Lara M , Davis Barry R , Beach Jennifer L , Ishak Anthony , Mukamal Kenneth J
Published: March 2019

Background:
Hypertension treatment is believed to contribute to falls, syncope, and orthostatic hypotension (OH), common events among older adults. Whether choice of antihypertensive agent influences the incidence of these adverse outcomes is unknown.

Hypothesis:
Chlorthalidone and atenolol are associated with higher risk of fall, syncope, and OH, compared with amlodipine or lisinopril.

Methods:
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized clinical trial that compared the effects of first-step therapy with amlodipine, lisinopril, or chlorthalidone on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). We linked participants to CMS and VA claims to determine the incidence of fall, syncope, OH, or a composite outcome (any of fall, syncope, or OH), using Cox regression. The association of baseline or 1-month add-on atenolol use with outcomes was determined via Cox models adjusted for age, sex, race, and randomized drug assignment.

Results:
Among 23,964 participants (mean age 70.4 ± 6.7 years, 43% women, 31% black), 927 participants took atenolol at baseline. Over a mean follow-up of 4.9 years, there were 267 fall, 755 syncope, 249 OH, and 1,157 composite claims with no significant differences in the cumulative incidence of events across randomized drug assignments (
Figure
). Compared with chlorthalidone, amlodipine and lisinopril were not associated with falls (HR [95%CI]: 1.36 [0.90-2.05] and 0.80 [0.47-1.36], respectively), syncope (0.96 [0.77-1.21] and 1.07 [0.85-1.34], respectively), OH (0.98 [0.66-1.45] and 1.24 [0.87-1.76], respectively), or the composite outcome (1.01 [0.84-1.21] and 1.07 [0.92-1.22], respectively). Similarly, atenolol use was not associated with any of the 3 individual or composite claims.

Conclusions:
Choice of antihypertensive agent has no effect on risk of fall, syncope, or OH in older adults. This observation should simplify the choice of initiating antihypertensive therapy in this population.
Abstract P004: Activity-Aware Medication Prompting and Bluetooth Pillbox Usability and Acceptability With Adults
Authors: Ardo Jessica C , Guijarro Diana , Ghasemzadeh Hassan G , Evangelista Lorraine S
Published: March 2019

Purpose/Aims:
To examine usability (e.g., efficiency, learnability) and acceptability (e.g., user experience, perceived control) of the activity-aware medication prompting application and pillbox in a sample of adults at risk of CVD.

Background:
Medication adherence has been identified as one potentially modifiable factor that contributes to increased morbidity and remains a great challenge for many adults at risk of CVD due to decreased knowledge of medication self-management. Novel strategies have been proposed to improve medication adherence. However, medication adherence outcomes have primarily been tracked using self-report and therefore success with these interventions varies widely. It is important to measure and take into account end users’ perceptions of usability and acceptability of these technologies as they are being developed.

Methods:
A software algorithm was developed and tested in adults at risk of CVD (N=12) to recognize daily behavior contexts using machine learning combined with automated activity discovery. Participants were given the pillbox device to use for 8 weeks, from which medication adherence rates were monitored. Usability and acceptability of the platform were assessed at study completion using a Usability Survey and open-ended questions.

Results:
Participants (33.3 % male; mean age 55.00, ±10.57) reported moderate to high levels of usefulness and acceptability (see Table). Participants claimed that the platform and pillbox devices were useful, user-friendly and easy to learn and understand, but did not feel that it helped them understand their illness, influence a change in health habits or impact their feelings of control.

Implications:
This study highlights the importance of seeking end-user feedback in the development of intelligent technologies. Participants’ perceptions of usability and acceptability are warranted to ensure that these applications will achieve their intended aim of improving medication adherence and ultimately human health and health care delivery.
Abstract P011: Hypoglycemia Unawareness is Associated With Impaired Cognition Among Older Adults With Type 1 Diabetes: the Study of Longevity in Diabetes
Authors: Lacy Mary E , Gilsanz Paola , Schnaider-Beeri Michal , Karter Andrew J , Quesenberry Charles P , Whitmer Rachel A
Published: March 2019

Introduction:
Severe hypoglycemia is common among those with type 1 diabetes (T1D). Hypoglycemia unawareness (HU) in T1D increases the risk of severe hypoglycemia more than five-fold. Prior work has established an association between severe hypoglycemia and impaired cognition. However, it is unknown if HU is associated with impaired cognition.

Hypothesis:
We hypothesized that HU would be associated with impaired cognition in a large cohort of older adults with T1D.

Methods:
We examined the association between HU and cognitive function using baseline data collected on 544 older adults with T1D from the Study of Longevity in Diabetes (SOLID). Self-reported HU was assessed using the 8-item Clarke Hypoglycemia Awareness Questionnaire, which captures frequency of hypoglycemia and awareness of symptoms. Participants with responses indicating ‘reduced awareness’ on ≥4 of the 8 items were categorized as having reduced awareness. Cognitive tests assessed four cognitive domains identified via factor analysis (language, executive function, episodic memory, attention). All cognitive test scores were standardized. Using generalized linear regression, we examined the association between HU and cognition on each of the four cognitive domains and on global cognition (average of scores on the 4 domains) in models adjusted for age and age, sex, education, race/ethnicity, and diabetes duration.

Results:
Overall, 27% of participants (n=149) had reduced hypoglycemia awareness. In fully adjusted models, compared to those with normal awareness, those with reduced hypoglycemia awareness had significantly lower scores on measures of language and global cognition; however, executive function, episodic memory and simple attention did not differ by HU status.

Conclusions:
Our results suggest that, among older adults with type 1 diabetes, HU may be associated with poorer cognition, specifically through language-related processes.
Abstract P015: Biomarkers Representing Key Aging-related Biological Pathways Are Associated With Subclinical Atherosclerosis: the Framingham Study
Authors: Castro-Diehl Cecilia , Ehrbar Rachel Q. , Vasan Ramachandran S. , Xanthakis Vanessa
Published: March 2019

Background:
Increased oxidative stress, telomere attrition, endothelial dysfunction and alterations in insulin-like growth factor-1 are key molecular mechanisms of aging. We hypothesized that biomarkers representing these aging-related biological pathways are associated with measures of subclinical atherosclerosis.

Methods and Results:
We evaluated up to 2,314 Framingham Offspring Study participants attending routine examination cycles (mean age 58 yrs, 55% women) with available biomarkers of key aging-related pathways: leukocyte telomere length [expressed by terminal restriction fragment; TRF]; urinary concentrations of creatinine corrected isoprostanes [an index of systemic oxidative stress]; circulating concentrations of insulin-like growth factor [IGF-1]; and asymmetrical dimethylarginine [ADMA; a marker of endothelial dysfunction]. We related each biomarker as independent variable to the presence of subclinical atherosclerosis (dependent variable) defined as presence of coronary artery calcium (CAC modeled as [ln(CAC+1)]), and carotid intimo-medial thickness (IMT; defined as the average of standardized values of common carotid and internal carotid artery IMT) using multivariable linear regression models adjusting for age, sex, body mass index, systolic blood pressure, diabetes, smoking status, hypertension, and total cholesterol/HDL. In multivariable-adjusted models, higher ADMA levels were associated with higher CAC values (β
ADMA
per 1-SD increase 0.25; 95% confidence interval [CI] [0.09,0.41]). Shorter TRF length and lower IGF-1 values were associated with higher IMT values (β
TRF
-0.08; 95%CI [-0.14, -0.01] and β
IGF-1
-0.04; 95%CI [-0.08, -0.01]). Levels of isoprostanes were not associated with either CAC or IMT.

Conclusions:
We observed differential patterns of associations between aging-related biomarkers and measures of subclinical atherosclerosis. Additional studies are warranted to elucidate the molecular mechanisms that underlie these association patterns.
Abstract P016: Lifestyle Factors Substantially Contributed to Urban-Rural Disparity in All-Cause Mortality Among the Oldest-Old in China
Authors: Xiong Shangzhi , Li Yaxi , Yan Lijing
Published: March 2019

Introduction:
With rapid population aging, the number of the oldest old population (≥ 80 years old) will increase dramatically in the coming decades in China. In this population, previous studies have demonstrated large health disparities between urban and rural China. Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we aim to assess the hypothesis that individual-level lifestyle factors contribute to the disparity in all-cause mortality of the oldest old between urban and rural China.

Methods:
The CLHLS study sampled 862 randomly selected counties and districts in 22 of the 34 provinces in China. Our study included a total of 32,999 oldest old residents (13,767 urban, 19,232 rural) from seven waves of the CLHLS: 1998, 2000, 2002, 2005, 2008, 2011-12, and 2014. Five lifestyle factors were examined: smoking, drinking, diet (fruits, vegetables, fish, eggs, salted vegetables, sugar, tea, garlic, meat, and beans), physical activity, and leisure activity (housework, fieldwork, reading, petting, majong, gardening, and watching television). All-cause mortality was ascertained through death registry and information from next of kin with a median follow up of 2.3 years (range: 1-16.5 years). We used Cox Proportional Hazard Models to examine the urban-rural disparity of all-cause mortality: the basic model including residence (rural/urban) and demographic variables (age, gender, education, occupation, marriage, co-residence, and ethnic), five separate models including each lifestyle factor and all variables in the basic model, and a model with all lifestyle factors added to the basic model.

Results:
There were significant differences between urban and rural participants in their smoking, drinking, physical activity, diet, and leisure activities (
P
<0.005 for all). All seven Cox Regression models showed large urban-rural disparities in mortality. The basic model showed that rural mortality was 11.2% higher than urban (95% Confidence Interval: 8.2, 14.3). Adjusting for diet, physical activity, and leisure activities, separately reduced the disparity by 10.3%, 25.3%, and 34.7% respectively. Adjusting for smoking and drinking did not cause substantial changes to the disparity. When put together in the same model, these five lifestyle factors collectively reduced the disparity by 37.5%.

Conclusions:
In conclusion, lifestyle factors, especially diet, physical activity, and leisure activities, contributed substantially to the urban-rural disparity in all-cause mortality of the oldest old in China. Interventions and policies targeting lifestyle factors are expected to reduce the disparity in China among the oldest old population.
Abstract P020: Novel Serum Metabolites Associate With Grip Strength Among Bogalusa Heart Study Participants
Authors: Nierenberg Jovia L , He Jiang , Li Changwei , Gu Xiaoying , Li Shengxu , Bazzano Lydia A , Chen Wei , Kinchen Jason , Kelly Tanika N
Published: March 2019

Introduction:
Hand grip strength is a simple and non-invasive measure for frailty and pre-frailty in aging populations. It has been shown to predict cardiovascular disease events, disability, fracture risk, and all-cause mortality. However, the biological pathways underlying frailty remain largely unknown.

Hypothesis:
Serum metabolites may associate with grip strength, among a middle aged biracial population.

Methods:
Untargeted ultrahigh performance liquid chromatography-tandem mass spectroscopy was used to detect and quantify serum metabolites among 825 white and 436 African-American participants of the Bogalusa Heart Study. Grip strength was measured in kg, and was averaged between both hands. We used race stratified and combined multivariate adjusted linear regression to examine associations between single metabolites and grip strength (mean: 35.14 kg, standard deviation: 11.85 kg), adjusted for age, sex, body mass index, kidney function, education, cigarette smoking, alcohol drinking, and race (in combined analyses). Significant metabolites were identified as those achieving Bonferroni corrected significance (P<4.16х10
-5
) in one race group and the entire cohort, with a similar trend observed in the other race group.

Results:
Six novel associated metabolites were identified, comprised of amino acid (polyamine), carbohydrate (aminosugar), and nucleotide (purine metabolism, adenine containing, and pyrimidine metabolism, cytidine or uracil containing) subpathways (
Table
). Participants with higher levels of these metabolites had lower grip strength.

Conclusions:
This analysis identified novel metabolites associated with grip strength, providing insight into the biological pathways of frailty.
Abstract P023: Predictors of Oral Anticoagulation Resumption Among Atrial Fibrillation Patients Surviving an Intracranial Hemorrhage
Authors: Chen Nemin , Newman Terri , He Meiqi , Hernandez Inmaculada
Published: March 2019

Background:
The clinical benefit of resuming oral anticoagulation (OAC) in atrial fibrillation (AF) patients who have survived an intracranial hemorrhage (ICH) remains unclear. It is important to understand what patient characteristics affect whether patients are restarted on OAC after an ICH.

Hypothesis:
We hypothesized that younger patients, those without chronic kidney disease, and at high stroke risk would be more likely to restart OAC.

Methods:
Using claims data from a 5% random sample of Medicare beneficiaries, we selected patients with a diagnosis of non-valvular AF who experienced an ICH while using OAC (n=4,822). The primary outcome was OAC resumption at 12 weeks after ICH. Among patients who restarted OAC, we further evaluated the likelihood of resuming warfarin versus direct oral anticoagulants (DOACs). We constructed multivariate logistic regression to evaluate the association between a comprehensive list of demographics and clinical characteristics (list in table) and OAC resumption.

Results:
Among the 4,822 patients, 1,766 (37%) restarted OAC during the first 12 weeks. Among them, 280 (16%) started direct oral anticoagulants, and 1,486 (84%) started warfarin. Younger patients, those eligible for Medicaid, with a previous ischemic stroke and higher CHA
2
DS
2
-VASc score were more likely to restart OAC (Table). Among participants who resumed OAC in 12 weeks, patients with a history of ischemic stroke were less likely to use DOACs; however, those with a higher risk of bleeding, measured by HAS-BLED score, were more likely to use them.

Conclusion:
Around 35% of AF patients who survived an ICH restarted OAC within 12 weeks of the ICH, and, among them, most used warfarin. Although a history of ischemic stroke increased the odds of OAC resumption, it decreased the odds of using DOACs.
Abstract P030: Association of Ideal Cardiovascular Health and Plasminogen Activator Inhibitor-1 From Early Adulthood to Middle Age: the Coronary Artery Risk Development in Young Adults Study
Authors: Lee Lauren Y , Vaughan Douglas E , Colangelo Laura , Lloyd-Jones Donald M , Khan Sadiya S
Published: March 2019

Background:
Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease (CVD). Therefore identification of biomarkers that may mediate risk between CVH and CVD may offer novel approaches in CVD prevention. One potential biomarker is plasminogen activator inhibitor-1 (PAI-1), which has been associated with increased risk of CVD. The aim of this study is to assess the relationship between CVH scores and PAI-1 levels from young adulthood to mid-life.

Methods:
Plasma PAI-1 levels were measured in a subset of randomly selected participants (n=1200) from the Coronary Artery Risk Development in Young Adults (CARDIA) study at year 7 (Y7) and Y20. Among them, 911 participants at Y7 and 830 participants at Y20 had available data on CVH status. We calculated CVH scores (range 0-14) and categorized as low (0-7), moderate (8-11), and high (12-14). We performed multivariable linear regression to study the association of CVH and PAI-1 at Y7 and Y20 after adjustment for age, sex, race, education, and center.

Results:
At Y7, participants (mean age 32.3±3.5 years) had a mean CVH score of 11.1 (±1.8) and mean PAI-1 level of 20.0 ng/mL (±21.2) with an adjusted correlation coefficient of -0.29 (p<0.0001)
(TABLE)
. By Y20, mean CVH score of the participants had declined to 10.1 (±2.3) and mean PAI-1 level had increased to 36.2 ng/mL (±37.1) with an adjusted correlation coefficient of -0.46 (p<0.0001). Among participants with high, moderate, and low CVH, PAI-1 levels were higher at Y20 compared to Y7 (high: 14.7 to 18.0 ng/mL, moderate: 23.9 to 36.9 ng/mL, low: 27.3 to 64.6 ng/mL). At both Y7 and Y20, mean level of PAI-1 was significantly higher in participants with moderate or low CVH (compared with high CVH).

Conclusion:
Higher CVH score is associated with lower plasma levels of PAI-1 from young adulthood to mid-life. PAI-1 levels increased among all CVH categories with aging; however, participants with high CVH had the smallest increase in PAI-1 and PAI-1 levels remained lower than even young adults with moderate or low CVH.
Abstract P032: Soluble CD14 Level is a Coronary Heart Disease Risk Factor in Younger-aged Black Adults of the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study
Authors: Olson Nels C , Koh Insu , Reiner Alex P , Judd Suzanne E , Irvin Marguerite R , Howard George , Zakai Neil A , Cushman Mary
Published: March 2019

Introduction:
CD14 plays an important role in the innate immune response and promotes inflammation. Soluble CD14 (sCD14) is produced during an acute phase response and following cleavage from immune cell surfaces upon activation. Higher sCD14 may be a risk factor for cardiovascular disease, however prospective studies evaluating sCD14 with incident coronary heart disease (CHD) events are limited. We examined the association of sCD14 levels with incident CHD in black and white REGARDS participants.

Methods:
REGARDS enrolled 30,239 participants from across the contiguous U.S. in 2003-07. The cohort was 55% female and 41% black by design. In a nested case-cohort study, sCD14 levels were measured by ELISA in 612 participants with incident CHD and 856 in a cohort random sample; all were free of CHD at baseline. Using Cox proportional hazards models we calculated the hazards ratio (HR) of CHD for increasing sCD14, and studied interactions of sCD14 with age, sex, or race.

Results:
In models adjusted for Framingham risk factors, interaction terms for sCD14-by-race (p-interaction=0.02) and sCD14-by-age (p-interaction=0.02) were statistically significant but not for sCD14-by-sex (p=0.21). Stratified by race and age, each 1-SD higher sCD14 (442 ng/mL) was associated with an increased CHD risk in blacks but not whites (Table). Relationships were stronger in younger than older black participants. SCD14 was not significantly associated with CHD risk among white participants, but there was a trend for stronger relationships at younger ages.

Conclusions:
Higher sCD14 is associated with risk of CHD in blacks with greater risk at younger ages. These findings suggest sCD14 may be an important CHD risk factor among younger black adults.
Abstract P037: Independent and Joint Associations of 25-Hydroxy Vitamin D and Parathyroid Hormone Levels With Cardiometabolic Biomarkers Among American White and Black Postmenopausal Women
Authors: Xia Jin , Tu Wanzhu , Manson JoAnn E , Nan Hongmei , Shadyab Aladdin H , Bea Jennifer W , Cheng Ting-Yuan D , Hou Lifang , Song Yiqing
Published: March 2019

Introduction:
Despite evidence of racial disparities in independent relationships of 25-hydroxyvitamin D (25[OH]D) and parathyroid hormone (PTH) status with cardiovascular risk, little is known about their joint associations with intermediate cardiovascular biomarkers.

Hypothesis
We hypothesized that there are White-Black differences in the direction and shape of the associations of total 25(OH)D and PTH with cardiovascular biomarkers of insulin resistance, beta cell function, systemic inflammation, and renal function among postmenopausal women.

Methods:
A random subcohort of 2,800 American White (n=1,500) and Black (n=1,300) postmenopausal women without cardiovascular disease (CVD) at baseline was selected from the Women’s Health Initiative Observational Study (N=93,676). We assessed plasma total 25(OH)D, PTH, high-sensitive C-reactive protein (hs-CRP), as well as creatinine-based glomerular filtration rate (GFR). Fasting glucose and insulin were measured to derive the homeostasis model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-B). Weighted linear regression analyses were performed to assess independent and joint associations after adjusting for age, race/ethnicity, clinical center, education, body mass index, season of blood draw, smoking status, physical activity, alcohol consumption, postmenopausal hormone therapy use, and family history of CVD.

Results:
Total 25(OH)D levels were inversely associated with HOMA-IR among White women only (5.6% decrease per 1 SD increase in 25[OH]D; P for linear trend = 0.001). This association persisted among White women with PTH ≤65 pg/mL (5.9% decrease per 1 SD increase in 25[OH]D; P for linear trend = 0.001). While there was a linear trend towards higher 25(OH)D levels associated with lower GFR levels among White women with PTH ≤65 pg/mL (P for linear trend = 0.045), we found a non-linear relationship between total 25(OH)D and GFR among Black women with PTH >65 pg/mL (P for non-linearity = 0.001).

Conclusions:
Higher levels of total 25(OH)D, independently and jointly with PTH, were associated with lower HOMA-IR in White postmenopausal women. The shapes of the associations between total 25(OH)D and GFR markedly differed between White and Black women after accounting for PTH, suggesting potential racial disparities in vitamin D/PTH mechanisms underlying cardiovascular health.
Abstract P039: Change in Blood Pressure and Glucose Are Major Determinants of Increasing Carotid IMT in Young Adults
Authors: Gao Zhiqian , Dolan Lawrance , Kimball Thomas , Urbina Elaine
Published: March 2019

Increased carotid intima-media thickness (cIMT) is associated with CV events in adults and thicker cIMT is found in youth with CV risk factors including obesity. Which risk factors have the most direct effect upon cIMT in youth and whether obesity has direct or indirect effects is not known. We used structural equation modeling to elucidate direct and indirect pathways through which obesity and other risk factors were associated with increase in cIMT. Demographics, anthropometrics, laboratory and carotid ultrasound data were collected on 426 participants aged 17.5 at baseline (32% type 2 diabetes) and after 5 years of follow-up. Latent change score variables were defined by baseline and follow-up measurements. Latent baseline and follow-up cIMT, glucose variables were defined for each cIMT segmemt (common, bulb and internal), HbA1c, and fasting glucose. SAS 9.4 CALIS procedure was used for analyses with maximal likelihood estimation. Comparative fit index (CFI >0.9) and root mean squared error of approximation (RMSEA <0.1) were considered good model fit. At follow up, there were increases in BMI, MAP, LDL, TG, HDL, CRP and fasting glucose, decrease in fasting insulin and HbA1c (all p≤0.05). There was no increase in common, but significant increase in bulb (0.031 mm) and internal (0.027 mm) cIMT (all p ≤0.001). Significant direct effects on changes of cIMT were baseline MAP (β 0.23) and BMI z-score (β 0.16) plus change in glucose (β 0.37) and age (β 0.37; all p≤0.05). Change in MAP showed a trend in the model (β 0.14, p=0.10). BMI also had significant indirect effect (b 0.17) while non-HDL demonstrated no significant effect. We conclude that baseline adiposity drives increasing BP and glucose in high risk youth leading to accelerated accumulation of carotid atherosclerosis. Prevention of acquisition of obesity is critical in slowing development of CV disease. NIH R01 HL105591 (Urbina) and UL1 TR001425.
Abstract P042: Metabolic Syndrome Prevalence and Risk Factors Among Adult Asian Americans
Authors: Zhu Lin , Lu Wenyue , Lee Minsun , Ma Grace X
Published: March 2019

Metabolic Syndrome (MetS) is a disease entity characterized by a constellation of interconnected physiological, biochemical, clinical, and metabolic factors that directly increase the risk of cardiovascular atherosclerotic diseases, and diabetes mellitus type 2. Limited evidence of MetS found excess risk in Asian Americans. Despite lower body mass index (BMI), Asian Americans have higher MetS rate than Caucasians at every BMI level. Although there is the increasing burden of diabetes, hypertension, and obesity in Asian American populations in the US, no national estimates of MetS prevalence are available. This study used the National Health and Nutrition Examination Survey (NHANES) 2015-2016 data to examine the prevalence of MetS, and identify sociodemographic and lifestyle risk factors among Asian Americans. The analysis sample consist of 281 Asian Americans over the age of 18, including 134 women (47.69%) and 147 men (52.31%). The average age was 44. About one third of the sample (24.20%, 68 out of 281) were obese, with a BMI of 27.5 or higher. Chi-square test was used to examine the bivariate relationship, while logistic regression was used to examine the multivariate relationship between MetS and risk factors. We used the International Diabetes Federation (IDF) criteria to decide MetS. Sociodemographic factors included age, gender, marital status, household income, employment status, nativity status, and years lived in the US. Lifestyle factors included smoking, alcohol use, sleep duration, and recreational physical activity.One third of the sample (31.32%, 88/281) met the IDF criteria of MetS. The rate was lower in those who were under- or normal weight (10.38%, 11/106), and higher in those who were overweight (30.84%, 33/107) or obese (64.71%, 44/68). Furthermore, a higher likelihood of having MetS was associated older age (40 or over versus 18-39), having lived in the US for over 5 years, lower household income, and low recreational physical activity. Age, household income, and physical activity reminded independent and significant predictors in multivariate regression model. To the best of our knowledge, this is the first study one to use a nationally representative sample to examine the MetS prevalence and risk factors among adult Asian Americans, a population that faces increasing cardiovascular burden yet remained understudied. The findings of this study provided critical epidemiological reference data for further investigation. Because only a subsample took part in the physical examination, biomarker data were only available for these participants, hence the limited sample size. The authors intend to conduct analyses with a combined sample from multiple release cycles of NHANES to achieve a larger sample size, and use multiple imputation to increase sample size. We will also conduct subgroup analysis by detailed Asian ethnic groups, BMI level, gender, and age group.
Abstract P047: Circulating Testosterone and Sex Hormone-Binding Globulin Concentrations and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality in US Women
Authors: Li Jun , Hu Jie , Huang Tianyi , Hankinson Susan E , Hu Frank B , Manson JoAnn E , Rexrode Kathryn M , Tworoger Shelley S
Published: March 2019

Introduction:
It remains unclear whether circulating testosterone and sex hormone-binding globulin (SHBG) are associated with cardiometabolic disease risk and mortality.

Hypothesis:
Higher SHBG and lower testosterone levels are associated with reduced risk of incident type 2 diabetes (T2D), cardiovascular disease (CVD), and all-cause mortality in women.

Methods:
Baseline testosterone and SHBG measures were available on 11,314 women from the Nurses’ Health Study I and II, who were part of 9 separate nested case-control studies and were free of CVD, T2D, and cancer at study baseline. Total testosterone was assayed by a radioimmunoassay or liquid chromatography tandem mass spectrometry; SHBG was measured by an immunoassay. Free testosterone was calculated based on a standard clinical formula. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regressions, adjusted for study design characteristics, established risk factors and confounders including menopausal statues, hormone therapy, and continuous body mass index.

Results:
During up to 22 years of follow-up (215,120 person-years), 891 incident T2D cases, 1,089 CVD cases (fatal myocardial infarction, nonfatal coronary heart disease, and fatal/nonfatal stroke), and 1,818 deaths occurred. In multivariable analyses, circulating SHBG levels were inversely associated with incident T2D (comparing the highest to lowest quartiles, HR [95% CI]: 0.34 [0.24-0.47];
P
trend
<0.001) and all-cause mortality (HR: 0.78 [0.65-0.95];
P
trend
=0.03). Total testosterone was inversely associated with T2D (HR: 0.71 [0.53-0.96];
P
trend
=0.04), while free testosterone was positively associated with T2D (HR: 1.99 [1.44-2.75];
P
trend
<0.001) and all-cause mortality (HR: 1.22 [1.00-1.48];
P
trend
=0.02). No association was observed between SHBG, nor free or total testosterone and CVD.

Conclusions:
Lower circulating levels of SHBG and higher levels of free testosterone were associated with increased risk of T2D and all-cause mortality, but not CVD, in women.
Abstract P048: Early Cardiometabolic Risk: The Prevalence of Compensatory Hyperinsulinemia in U.S. Populations
Authors: Cistola David P , Bonilla Liliana , Campbell Erin B
Published: March 2019

Introduction:
Metabolic syndrome (MetS) and prediabetes (PreD) identify individuals at increased cardiometabolic risk. However, by the time those conditions develop, a significant decline in beta-cell insulin secretion has already occurred. The earliest stage in the pathogenesis of type 2 diabetes includes compensatory hyperinsulinemia, the robust response of intact beta cells to peripheral insulin resistance. This state of early metabolic dysregulation is not detected by conventional glucose and lipid screening.

Hypothesis:
The U.S. prevalence of compensatory hyperinsulinemia is high.

Methods:
Population-weighted data from the 2013-2014 cohort of the U.S. National Health and Nutrition Examination Survey (NHANES) were analyzed. The inclusion criteria were ages 12 and up, and the exclusion criteria were type 2 diabetes (fasting glucose ≥ 125 mg/dL, HbA1c ≥ 6.5 or 2-Hr glucose from OGTT ≥ 200 mg/dL), fasting triglycerides ≥ 885 mg/dL (familial hypertriglyceridemia), pregnancy or missing lab values. After population weighting, the 2,128 subjects sampled represented 198,424,653 non-diabetic individuals, approximately 62% of the U.S. population.

Results:
The subjects were categorized into four groups: NN: no MetS or PreD, no hyperinsulinemia; NY: no MetS or PreD with hyperinsulinemia; YN: MetS and/or PreD, no hyperinsulinemia; and YY: MetS and/or PreD with hyperinsulinemia. Hyperinsulinemia was defined as fasting insulin ≥ 12.2 μIU/ml based on prior calibration against the euglycemic clamp. The NY group represented compensatory hyperinsulinemia (CH). The 2013-2014 prevalence of CH was 11.2% of the non-diabetic U.S. population (95% CI: 11.17, 11.18). This group represented ~20% of the total at-risk subjects, defined as the sum of the NY, YN and YY groups. The prevalence of CH was highest in the
youngest
age groups and declined with age: 21.1% (21.08, 21.12) for ages 12-19, 13.2% (13.22,13.24) for ages 20-39, 7.7% (7.74, 7.75) for ages 40-59, 6.4% (6.34, 6.36) for ages 60-79, and 2.6% (2.63, 2.66) for ages 80 and up. The CH prevalence was higher in females vs. males: 12.7% (12.72, 12.73) vs. 9.6% (9.60, 9.61). In addition, CH prevalence was highest among Mexican Americans (17.0%; 16.98, 17.01) and other Hispanics (18.2%; 18.22, 18.27), followed by non-Hispanic blacks (12.3%; 12.29, 12.31), Native American/mixed race/other (10.8%; 10.79, 18.84), non-Hispanic whites (9.8%; 9.79, 9.80) and Asians (6.3%; 6.26, 6.29).

Conclusion:
The prevalence of compensatory hyperinsulinemia is high, especially in adolescents and young adults. These findings highlight a target population for early screening and intervention strategies to improve diabetes prevention outcomes.
Abstract P050: Competing Health Priorities Lead Young Women to Worry Little About Heart Disease
Authors: Gooding Holly C , Brown Courtney A , Revette Anna C , Liu Jingyi , Stamoulis Catherine , de Ferranti Sarah D
Published: March 2019

Introduction:
The American Heart Association (AHA) Go Red for Women campaign has substantially improved heart disease awareness among adult women. Little is known about how younger women in adolescence and young adulthood (AYA) perceive their risk of heart disease during this key time in the life course for primordial prevention.

Methods:
We used an explanatory sequential mixed method design consisting of the AHA National Women’s Health Study survey and follow-up focus groups. We surveyed a random convenience sample of 331 AYA women ages 15-24 years presenting for care at an urban academic medical center and a community health center. Survey results guided development of a qualitative guide used during eight online, semi-structured focus groups with 32 young women. We report descriptive statistics performed using Matlab (Mathworks, Inc.) and thematic analyses conducted to synthesize data from the online focus groups using NVivo 11.

Results:
Only 10% [n=33] of AYA identified heart disease as the leading cause of death in women. Very few identified it as the top health concern for women of all ages [16 (4.8%)] or women in their age group [3 (0.9%)]. Most young women surveyed worried little [131 (39.6%)] or not at all [123 (37.2%)] about getting heart disease. In contrast, mood disorders were the most commonly noted top health concern for women of all ages [66 (19.9%)] and women in their age group [59 (17.8%)] and many AYA [142 (42.9%)] worried a lot about getting depression or anxiety. AYA discussed age (“I feel like those are things I associate with older people like 40”), competing health priorities (“because we’re so pressured just to grow up and more focused on pregnancies or depression or our weight”), and lack of perceived risk (“I like to think that I’m conscious of what I eat and drink”) as personal reasons for not worrying about heart disease. At the end of the focus group discussions, AYA women expressed being more motivated to both learn about heart health and to perform heart healthy behaviors (“I am definitely more motivated because I wasn’t aware that it was the number one kill[er] so I will definitely make sure to start working out”). Many group participants also noted the importance of receiving heart health information as well as personalized risk information from doctors.

Conclusions:
Younger women are unaware that heart disease is the leading cause of death in women and express little worry about their future risk. As the antecedents of heart disease begin in childhood and adolescence, these findings demonstrate a major unmet need. Campaigns to promote heart healthy behaviors in young women should directly address low perceived risk, the importance of lifetime risk, and competing health priorities with both young women and their health care providers.
Abstract P052: Not Only Velocity but Also Variability in Body Mass Index in Childhood Are Associated With HOMA-IR at Adulthood: 30 Years Follow-up Kangwha
Authors: Lee Su Jin , Lee Jung Hyun , Kim Hyeon Chang , Suh Il
Published: March 2019

Introduction:
Recent studies have reported that childhood obesity increased the risk of adult metabolic disorders. Moreover, the variability and rapid increase in body mass index (BMI) during childhood have been revealed as risk factors for adult obesity. Although obesity increases metabolic disorders through induction of insulin resistance, it has not been studied whether the rate of change and variability of BMI during childhood are independently associated with insulin resistance at adulthood.

Hypothesis:
We assessed the hypothesis that rate of change and variability of BMI during childhood would affect insulin resistance at adulthood.

Method:
The study cohort consisted of 284 Kangwha study participants (aged 25 - 38 years at follow-up) who had been screened at least four times during childhood (aged 6 - 19 years) and also had no diabetes at adulthood. The average follow-up period was 21.5 years. BMI Z-score was measured by considering the growth curve in Korea, and rate of change (velocity) in BMI during childhood for each individual was assessed by mixed models; BMI residual standard deviation (RSD) during childhood was calculated as a measure of variability. Outcome variable was homeostatic model assessment of insulin resistance (HOMA-IR) at adulthood follow-up.

Results:
The mean age of the participants 13.3 (SD 1.4) years and mean BMI was 18.6 (SD 2.3) at childhood. One SD increase in rate of change in BMI z-score (
β
= 0.32,
p
-value <0.001) and in RSD of BMI (
β
= 0.31,
p
-value <0.001) during childhood were positively and independently associated with HOMA-IR. Stratified by sex, adult HOMA-IR was also positively associated with the velocity (
β
= 0.36,
p
= 0.001 in men, and
β
= 0.38,
p
= 0.001 in women) and variability (
β
= 0.25,
p
= 0.03 in men;
β
= 0.27,
p
= 0.002 in women) of BMI during childhood.

Conclusions:
BMI velocity and variability during childhood appear to be independent risk factors for adult HOMA-IR. Our findings suggest prevention of rapid weight gain and body weight regulation during childhood would be important factors to reduce insulin resistance at adulthood related with metabolic disorders.
Abstract P053: The Frequency of High Glycemic Load Meals is Predictive of Cardiovascular Risk Factors in Children at Risk for Obesity After 2 Years
Authors: Suissa Karine , Benedetti Andrea , Henderson Mélanie , Gray-Donald Katherine , Paradis Gilles
Published: March 2019

Introduction:
Consuming a daily diet of high glycemic load (GL) carbohydrates has potential long-term effects on obesity and cardiovascular health. However, it is possible that the GL of certain meals (breakfast, lunch and supper) have different effects. Few studies have examined the effect of meal-specific GL and frequency of high GL meals on adiposity and cardiovascular health in children. We hypothesized that the number of high GL meals per day, and secondarily, the meal-specific GL, would predict cardiovascular risk factors in children after two years of follow-up.

Methods:
We used data from the QUALITY cohort which recruited 630 children, ages 8-10 years at baseline with at least one obese parent. Three separate 24-hour dietary recalls were administered by a dietitian at baseline and individual meal-specific GL scores were calculated using the International table of GI. CV risk factors measured at 2 years of follow-up included continuous values of BMI z-score, percent fat mass, triglycerides, LDL and HDL cholesterol, and systolic (SBP) and diastolic (DBP) blood pressure obtained through direct measurement (blood pressure, blood lipids, anthropometrics) or questionnaires (socio-economic characteristics). Linear regressions between meal-specific GL categorized as high (
2
33) vs. low (<33) and CV risk factors were estimated, adjusting for important confounders, including underreporting, as well as anthropometric, socio-economic and dietary factors. Secondary analysis consisted of linear regression with number of high GL meals as an ordinal exposure variable.

Results:
Mean age at baseline was 9.6 years, with 33% of children overweight or obese. Breakfast, lunch and supper glycemic load were positively associated with each other. A higher number of high GL meals was positively associated with BMI z-score (β=0.18, 95%CI: 0.06, 0.30), percent fat mass (β=1.74, 95%CI: 0.52, 2.96) and triglycerides (β=0.08, 95%CI: 0.03, 0.14) and negatively associated with HDL (β=-0.04, 95%CI: -0.07, -0.01). Our secondary analysis revealed that High breakfast GL was positively associated with increased triglycerides (β=0.14, 95%CI: 0.05, 0.23) after 2 years but not adiposity, HDL, LDL and blood pressure. High GL lunch (β=0.27, 95%CI: 0.08, 0.46) and supper (β=0.22, 95%CI: 0.02, 0.41) were associated with higher BMI z-score after 2 years.

Conclusion:
In conclusion, consuming more than one high GL meal per day is associated with greater BMI and unhealthy lipid profile after 2 years.