bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP28: Filtration Markers, Cardiovascular Disease and All-cause Mortality in Kidney Transplant Recipients: The FAVORIT Trial
Authors: Foster Meredith C , Weiner Daniel E , Bostom Andrew G , Carpenter Myra A , Inker Lesley A , Jarolim Petr , Kusek John W , Pfeffer Marc A , Rao Madhumathi , Levey Andrew S
Published: March 2022

Background:
Cardiovascular disease (CVD) is common in kidney transplant recipients (KTRs). The level of kidney function (glomerular filtration rate [GFR]) estimated from serum creatinine has been shown to be independently associated with CVD outcomes in a wide range of populations, including KTRs. In other populations, CVD outcomes are more strongly associated with the alternative filtration markers serum cystatin C and beta-2-microglobulin (B2M) than creatinine, but this has not been evaluated in KTRs.

Methods:
We performed a case-cohort study of participants of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial, a randomized, double blind clinical trial of homocysteine lowering with B vitamins in KTRs. Study participants were enrolled from 2002-07 from centers in the US, Canada & Brazil; we studied a 15% random subcohort of eligible baseline participants (N=508; mean age 52 years, 38% women) and all additional eligible adjudicated CVD (CVD death, myocardial infarction, resuscitated sudden death, stroke, N=211) and all-cause mortality (N=314) events that occurred through June 2009. Filtration markers measured at baseline were expressed as estimated GFR using established CKD-EPI equations (eGFRcr, eGFRcys & eGFRB2M). Associations of eGFRcr, eGFRcys & eGFRB2M with CVD and mortality were evaluated with weighted Cox proportional hazard regression to account for the case-cohort design.

Results:
In multivariable adjusted models eGFRcr was not significantly associated with CVD or all-cause mortality. In contrast, both lower eGFRcys and eGFRB2M were associated with increased risk of CVD and all-cause mortality (Figure). Findings were similar when eGFR was treated as a continuous variable.

Conclusion:
Similar to non-transplant cohorts, cystatin C and B2M have stronger risk associations for CVD and all-cause mortality compared to creatinine in KTRs. These findings likely reflect differences in their non-GFR determinants; future work is needed to evaluate non-GFR determinants in KTRs.
Abstract MP35: Relation of Left Ventricular Structure to Incident Heart Failure in African Americans: The Jackson Cohort of the Atherosclerosis Risk in Communities Study
Authors: Azeem Amir , Beard Walter L , Musani Solomon , Butler Kenneth R , Mosley Thomas H , Fox Ervin R
Published: March 2022

Introduction:
Studies in non-Hispanic whites suggest that early adaptive changes in cardiac structure due to hypertension may influence the development of heart failure (HF). The predictive value of left ventricular (LV) structure to incident acute decompensated HF (ADHF) has not been well-studied in African Americans (AA) despite the higher incidence of HF in this group.

Hypothesis:
We hypothesized that incidence of ADHF in AA varies according to cardiac structures and LV geometry type.

Methods:
The study sample included 1,737 participants who attended the third examination cycle of the Jackson cohort of ARIC between 1993 and1995 and underwent echocardiography, anthropometry and phlebotomy for glucose and lipids. Left atrial size, aortic root diameter (AOD), LV wall thicknesses and chamber dimensions, LV mass, LV mass index, LV hypertrophy (LVH) and LV geometric patterns [normal geometry, concentric hypertrophy, eccentric hypertrophy (EH), concentric remodeling] were determined by echocardiography. Cutoff for LVH was defined as above the 80th percentile of LV mass index. HF data was available up to December 31, 2011. In the primary analyses we adjusted for age, sex, smoking, diabetes, body mass index, systolic blood pressure, and use of hypertension medications in the multivariable model.

Results:
Over a follow-up period of approximately 18 years, 188 participants developed ADHF. Incident ADHF was significantly related to AOD [HR 1.42 (1.03, 1.97)], LV internal diameter in diastole (cm) [HR 1.60 (1.24, 2.05)], LV mass [HR 1.003 (1.002, 1.005)], LVM index [HR 1.01 (1.004, 1.02) and LVH [HR 1.62 (1.16, 2.27)]. In terms of LV geometry, EH was significantly related to incident ADHF in the multivariable model [HR 2.94 (1.70-5.10)].

Conclusion:
In our large community-based sample of AAs, we observed that AOD, LV internal diameter in diastole, LV mass, LV mass index, LVH and EH geometry were significantly related to long-term incidence of ADHF independent of standard risk factors. These findings suggest echocardiography may be helpful in risk stratifying members of this high risk population for ADHF.
Abstract MP42: Subfractions of High-density Lipoprotein Cholesterol and Carotid Intima-media Thickness
Authors: Tiozzo Eduard , Gardener Hannah , Hudson Barry I , Dong Chuanhui , Della-Morte David , Crisby Milita , Goldberg Ronald B , Elkind Mitchell S , Cheung Ying K , Wright Clinton B , Sacco Ralph L , Rundek Tatjana , Desvarieux Moise
Published: March 2022

Background and Purpose:
Recent drug trials have challenged the “HDL-cholesterol anti-atherosclerotic hypothesis”, suggesting that total levels of HDL-C may not be best target for intervention. HDL-cholesterol (HDL-C) subfractions may be better markers of vascular risk than total levels of HDL-C. The objective of this cross-sectional study was to investigate the relation between HDL2-C and HDL3-C fractions and carotid intima-media thickness (cIMT) in the population-based Northern Manhattan Study.

Methods:
We evaluated 988 stroke-free participants (mean age 66±8 years; 60% women; 66% Hispanic, and 34% Non-Hispanic) with available data on HDL-C subfractions using precipitation method and cIMT assessed by a high-resolution carotid ultrasound. The associations between HDL-C subfractions and cIMT were analyzed by multiple linear regression models.

Results:
The mean HDL2-C was 14 ± 8 mg/dl, HDL3-C 32 ± 8 mg/dl, and the mean total HDL-C was 46 ±14 mg/dl. The mean cIMT was 0.90 ± 0.08 mm. After controlling for demographics and vascular risk factors, HDL2-C and total HDL-C were inversely associated with cIMT (per 2SDs, beta= -0.012, p=0.03 and beta= -0.012, p=0.04, respectively). The same inverse association was more pronounced among those with diabetes (per 2SDs, HDL2-C: beta= -0.036, p=0.04; HDL-C: beta= -0.032, p=0.04). HDL3-C was inversely associated with cIMT but the association was not significant (per 2SDs, beta= -0.008, p=0.13) after adjustment.

Conclusions:
HDL2-C had greater effect on cIMT then HDL3-C in this urban population. This effect was especially pronounced among individuals with diabetes. More research in needed to determine anti-atherosclerotic effects of HDL-C subfractions and clinical relevance of raising their levels.
Abstract MP55: Systemic Arterial Compliance Predicts All-cause Mortality and Cardiovascular Mortality: The Rancho Bernardo Study
Authors: Daka Bledar , Langer Robert D , Allison Matthew , Lindblad Ulf , Dandolu Vani , Barrett-Connor Elizabeth
Published: March 2022

Objective:
To investigate the association between peripherally measured arterial compliance and cardiovascular and total mortality in an elderly cohort.

Background:
There is limited evidence that systemic indices of elasticity and stiffness in the carotid and femoral arteries can predict incident cardiovascular disease (CVD) events. Little is known about the associations between systemic arterial compliance and CVD events.

Methods:
Between 1997 and 1999, 849 community dwelling participants in the Rancho Bernardo Study (mean age 74, 39% male, 4.2% with type 2 diabetes) underwent noninvasive pulse wave measurements. Systemic and brachial artery compliance were estimated using the PulseMetric device applying an algorithm previously validated by angiography. Data on cardiovascular risk factors and fasting blood samples were obtained at the same visit as the compliance measurements, as well as at a follow-up visit conducted within one year. CVD and overall mortality were recorded through January 2013. Kaplan-Meier survival curves for quartiles of systemic and brachial artery compliance were constructed. Cox proportional hazards models were used to examine the associations of systemic and brachial artery compliance with all-cause and CVD mortality. Multivariable models were used to assess interactions and to estimate the role of potential confounders. Stratified models were constructed when interactions of p<0.15 were found.

Results:
During a mean follow-up of 10 years (SD=3.9), 324 deaths occurred, 114 of which were attributed to CVD. Kaplan-Meier curves suggested an increasing probability for survival with increasing quartiles of arterial systemic compliance (p < 0.001). In the fully adjusted Cox proportional hazard model, a 1-SD increment in systemic compliance was associated with a 39% lower risk of mortality (HR = 0.61, 95% CI: 0.47-0.79) and a 37% lower risk for CVD mortality (HR = 0.63, 95% CI 0.41-0.96). A significant interaction by sex was found (p=0.01). Specifically, among women, the association between systemic arterial compliance and mortality was stronger in the fully adjusted model (HR = 0.59, 95% CI 0.42-0.83) than in men (HR = 0.70, 95% CI 0.50-0.96). Similar sex-specific associations were found for CVD mortality, but those were not statistically significant (HR in women = 0.60, 95% CI 0.38-1.08; HR in men = 0.64, 95% CI 0.35-1.17). Brachial artery compliance was not significantly associated with the considered events (all-cause mortality: HR 0.86, CI 0.66-1.14; CVD mortality: HR 0.99, CI 0.59-1.63).

Conclusions:
In an elderly cohort, systemic arterial compliance, but not brachial artery compliance, was significantly associated with total and CVD mortality, and the relationships were stronger in women. Non-invasive measurement of systemic compliance may be useful in predicting mortality risk in older, community-dwelling adults.
Abstract MP61: Dairy Products Such as Milk are Associated with a Lower Risk of Hypertension in Singapore Chinese
Authors: Talaei Pashiri Mohammad , Pan An , Yuan Jian-Min , Koh Woon-Puay
Published: March 2022

Introductions:
Dairy products are rich sources of calcium. Epidemiologic evidence from Western populations suggests that intake of dairy products and calcium may reduce risk of hypertension. However, there are few reports from Asian populations which generally have lower consumption of dairy products and calcium than their Western counterparts.

Hypothesis:
The association between intake of calcium and dairy products and risk of developing hypertension was evaluated in a prospective cohort study.

Methods:
This study was based on the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese men and women aged 45-74 years at enrolment in 1993-1998 living in Singapore. The analysis included 37,124 participants who had no history of cancer, physician-diagnosed hypertension, and cardiovascular disease at recruitment. Diet at baseline was assessed using a validated 165-item semi-quantitative food-frequency questionnaire. The incident hypertension was defined as physician-diagnosed hypertension that the study subject reported during two follow-up interviews during 1999-2004 and 2006-2010, respectively. Cox proportional hazard regression method was used to calculate hazard ratios (HRs) and 95% confidence interval (CI) for incident hypertension associated with intake of calcium and dairy products with adjustment for potential confounders.

Results:
During 354,226 person-years of follow-up, we identified 13,148 new cases of hypertension. Milk accounted for about 80% of all dairy products consumed in this population. Among all study subjects, 67% (n=24,832) hardly drank milk, 9% (n=3,236) drank at least monthly, 9% (n=3,394) drank at least weekly, and 15% (n=5,662) drank daily. Non-dairy calcium intake contributed up to 76% of total calcium intake. Compared to non-drinkers, those who drank milk daily had a statistically significant 7% lower risk of hypertension (HR 0.93; 95% CI 0.89-0.98,
P
-trend=0.005) after controlling for other potential lifestyle and diet risk factors and supplement usage. The intake of all dairy food was inversely associated with risk of hypertension in a dose-dependent manner: the HR (95% CI) for the second, third, and fourth quartile was 0.96 (0.92-1.02), 0.98 (0.93-1.03) and 0.93 (0.88-0.98), respectively, compared with the lowest quartile (
P
-trend=0.005). While total calcium intake was inversely associated with hypertension risk (HR comparing extreme quartiles 0.93; 95% CI 0.88-0.98;
P
-trend=0.002) there was a null association between non-dairy calcium intake and hypertension risk (HR comparing extreme quartiles 1.00; 95% CI 0.92-1.08;
P
-trend=0.89).

Conclusions:
Consumption of milk and other dairy products may offer beneficial effect on reducing risk of hypertension in Chinese population. This beneficial effect might be independent of calcium in the dairy food.
Abstract MP72: Geographic and Demographic Patterns of Rheumatic Heart Disease in Western Kenya
Authors: Lumsden Rebecca , Akwanalo Constantine , O’Meara Wendy P , Bloomfield Gerald S
Published: March 2022

Introduction:
Rheumatic heart disease (RHD) remains a leading cause of cardiovascular mortality in sub-Saharan Africa. Identifying geographic “hot spots” and high risk populations are crucial for the development of RHD prevention and screening strategies in high burden areas.

Objectives:
We aimed to identify demographic patterns and geographic variation in RHD prevalence in western Kenya.

Methods:
We conducted a retrospective chart review of all patients <50 years old (n=937) attending adult cardiology clinic at a national referral hospital in western Kenya. Demographic information, residential location and cardiac history were collected. We mapped the spatial distribution of cardiac disease rates and analyzed the effect of distance from the hospital on RHD status using multivariable logistic regression.

Results:
Two-thirds (64%) of all patients <50 years old had RHD. RHD patients were younger (26 vs. 33 years, p<0.001) and more often female (69% vs. 59%, p=0.002) than non-RHD patients. Patients of Nilote ethnicity had over twice the odds of RHD than non-Nilotes (OR 2.5, 95%CI 1.7-3.7). Global clustering of disease rates exists within 200km of the hospital with significant clustering of the RHD and non-RHD rate difference seen surrounding the hospital in the (Moran’s I: 0.3, p=0.001) (Figure). Clustering was attenuated after controlling for age, gender, ethnicity and distance from the hospital. There was an interaction between ethnicity and distance to the hospital such that the odds of RHD increased with further distance for Nilotes, but the odds of RHD in non-Nilotes decreased with further distance.

Conclusion:
Most adult cardiology patients treated at a national referral hospital in western Kenya have RHD. Young females of Nilote ethnicity are commonly affected. Ethnicity and distance to the hospital interdependently affect the odds of RHD, and geographic clustering of disease rates may reflect this relationship. Future studies in this area should consider the impact of ethnic predisposition to RHD.
Abstract MP77: Glucose Peaks and Risk of Dementia Among Persons with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rawlings Andreea , Sharrett A. Richey , Mosley Thomas , Ballew Shoshana , Deal Jennifer , Steffes Michael , Selvin Elizabeth
Published: March 2022

Introduction:
The risk of dementia increases with increasing levels of hemoglobin A1c (HbA1c), a measure of average blood glucose. However the association between glucose peaks and dementia in persons with diabetes is unclear. 1,5-anhydroglucitol (1,5-AG) is a novel biomarker of glucose peaks, with low levels reflecting blood glucose concentrations that exceed the renal filtration threshold (~180 mg/dl) over the prior 7-10 days.

Hypothesis:
Glucose peaks, indicated by low levels of 1,5-AG, will be associated with higher risk of dementia, independent of HbA1c and other dementia risk factors.

Methods:
We conducted a prospective analysis of 1568 participants with diabetes from visit 2 (1990-1992) of the ARIC Study. Diabetes was defined based on self-reported physician diagnosis, diabetes medication use, or HbA1c ≥ 6.5%. Community surveillance of hospitalizations was used to identify incident dementia. Cases were defined as the first occurrence of a hospitalization with an ICD-9 code for dementia appearing in any position in the hospital discharge record. We used Cox regression to examine the association between 1,5-AG (modeled linearly) and incident dementia, adjusted for demographic and clinical risk factors, including HbA1c.

Results:
At baseline, the mean age was 58 years, 58% were female, 54% were white, and mean HbA1c was 8.1%. Over a median follow-up of 18 years, 158 participants had a hospitalization with an ICD-9 code of dementia. Each unit decrease in 1,5-AG increased the risk of dementia by 4% (HR=1.04, p-value=0.03, Figure). Associations were similar when 1,5-AG was modeled using linear splines.

Conclusions:
Short-term glucose peaks were associated with higher risk of dementia among adults with diabetes, independent of HbA1c and other dementia risk factors. More studies are needed to determine if targeting glucose peaks, in addition to average glucose, among persons with diabetes can reduce the risk of dementia.
Abstract MP90: Identifying Risk Profiles for Sedentary Behavior in Youth Using Recursive Partitioning Based on Individual, Familial, and Neighborhood Environment Factors
Authors: Barnett Tracie A , Contreras Gisele , Van Hulst Andraea , Mathieu Marie-Eve , Henderson Melanie
Published: March 2022

Background:
Being sedentary is an established risk factor for obesity and related cardiometabolic complications, independently of physical activity (PA) levels. We used recursive partitioning analysis (RPA) to identify unique combinations of individual, familial, and neighborhood factors that increased the likelihood of being very sedentary.

Methods:
Baseline data were collected in 2005-2008 for 512 Quebec youth (aged 8-10 years) with a history of parental obesity (QUALITY study). Sedentary behavior and PA were assessed by accelerometry (Actigraph). Children with ≥10h of valid wear time on at least 4 days were retained for analysis. Children were categorized as being very sedentary if they accumulated at least 300 minutes/day of ≤100 counts/min on average. Fifteen variables were submitted to the recursive partitioning process in order to identify sub-groups by likelihood of being very sedentary. MLR was used to estimate likelihood of being very sedentary across subgroups, controlling for the child’s age, sex, household income, and PA level. Indicator variables were used, retaining the lowest risk group as the reference.

Results:
Data were complete for 445/512 participants. Six variables were retained to construct the classification tree. A total of 7 subgroups were identified, with proportions very sedentary equal to 5%, 22%, 31%, 26%, 33%, 40%, and 77%, respectively. The 7 risk subgroups, in order of increasing likelihood of being very sedentary, comprised children who: (1) met MVPA guidelines (engaged in at least 60 min/day of MVPA), (2) did not meet MVPA guidelines, but resided in lower poverty areas, (3) did not meet MVPA guidelines, resided in higher poverty areas, but with a higher park area ratio; (4) did not meet MVPA guidelines, resided in higher poverty areas, had a lower park area ratio, but did not have an obese father; (5) did not meet MVPA guidelines, resided in higher poverty areas, had a lower park area ratio, had an obese father, but lived in more urban areas; (6) same as subgroup (5) but living in less urban areas and not exceeding 2 hours/day of screentime on weekends; and finally (7) same as subgroup (6) but exceeding 2 hours per day of screentime on weekends. In multivariable logistic regressions, compared to subgroup 1, groups 2 to 7 were significantly more likely to be very sedentary, after controlling for age, sex and household income. However, after further controlling for minutes of MVPA, only children in group 7 remained significantly more likely to be categorized as very sedentary (OR: 7.3, 95% CI: 1.3-45.1).

Conclusion:
The relationship between physical activity and sedentary behaviour is complex.

Specific combinations of factors appear particularly conducive to engaging in excessive sedentary behaviour, with weekend screen time possibly being the most salient individual contributor.
Abstract MP97: Physical Inactivity is a Strong Risk Factor for Stroke in the Oldest Old Findings From the Northern Manhattan Study
Authors: Willey Joshua Z , Park Moon Yeseon , Marquez Chensy E , Sacco Ralph L , Wright Clinton B , Elkind Mitchell S , Cheung Yuen K
Published: March 2022

Introduction:
The fastest growing segment of the population is those over age 80, in whom there is the highest incidence of stroke. Few clinical trials, however, have targeted this population, and management of risk factors is complicated by higher rates of side effects and polypharmacy. We aimed to characterize whether the risk factors for stroke are different in those age >80 versus <80 in a multi-ethnic prospective cohort study.

Methods:
The study sample derives from the Northern Manhattan Study (n=3298), a prospective cohort study among an urban dwelling multi-ethnic population. At enrollment risk factors were assessed by self-report, physical examination, and laboratory data. Leisure-time physical activity (LTPA) was assessed by validated questionnaire and categorized as none versus any. Participants are followed annually for incident stroke which is adjudicated by study neurologists after review of all records and imaging. We fit Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association of cardiovascular disease risk factors (LTPA, reported alcohol use, fasting HDL-C and LDL-C, history of diabetes, hypertension, heart disease, and tobacco use) with risk of stroke. Multi-variable models also included two-way interaction terms between the primary exposures and age (<80 and ≥80) and stratified models are presented if p-interaction < 0.05.

Results:
The mean age was 69 years and 562 (17%) were age ≥80 years. Physical inactivity was common (41%) and did not differ by age. Subjects were followed for a median of 14 years, and there were 391 total strokes. We found a statistically significant interaction of age ≥80 on the risk of stroke with physical inactivity (p=0.02), diabetes (p=0.04), hypertension (p=0.005), and LDL-C (p=0.03). In stratified models no LTPA versus any (adjusted HR 1.61, 95%CI 1.06-2.43) was associated with an increased risk of stroke among those age ≥80 but not in those younger; LDL-C, hypertension and diabetes were mainly associated with risk of stroke in those below age 80.

Conclusion:
Lack of leisure-time physical activity is a potentially modifiable stroke risk factor and was more notable than hypertension, diabetes or dyslipidemia among those older than age 80. Improving activity may reduce the risk of stroke in this segment of the population.
Abstract MP98: Circulating Phospholipid n-3 Polyunsaturated Fatty Acids and Incident Atherothrombotic and Cardioembolic Ischemic Stroke in 3 Large US Cohorts
Authors: Saber Hamidreza , Yakoob Mohammad Y , Shi Peilin , Longstreth Will , Rimm Eric B , Lemaitre Rozenn N , Siscovick David , Rexrode Kathryn , Willett Walter C , Mozaffarian Dariush
Published: March 2022

Introduction:
The associations of individual seafood n-3 polyunsaturated fatty acids with incident ischemic stroke, and its subtypes (atherothrombotic and cardioembolic stroke), are not well-established. Individual n-3 fatty acids, which are best assessed by circulating biomarkers, may also have differential effects on atherothrombotic vs. cardioembolic stroke.

Objective:
To prospectively investigate the relationship of circulating eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke.

Methods:
We measured circulating phospholipid fatty acids (erythrocyte or plasma) at baseline in the Cardiovascular Health Study (CHS), Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). Ischemic stroke was prospectively adjudicated and classified into atherothrombotic (large and small vessel infarctions) or cardioembolic (cardiac mural thrombi, valvular heart disease, atrial fibrillation, other sources) stroke by imaging studies and medical records. Risk was assessed using conditional logistic regression (for prospective nested case-control studies: NHS, HPFS) or Cox proportional hazards model (full cohort: CHS). Findings were pooled by fixed-effects meta-analysis.

Results:
A total of 953 incident ischemic strokes were identified that included 408 atherothrombotic and 256 cardioembolic strokes, during mean follow-up of 11.4 (CHS) and 8.3 (NHS,HPFS) years (the remaining 289 ischemic strokes could not be sub-classified). After adjustment for age, race, sex, smoking, physical activity, alcohol intake, family history of MI and diabetes, menopausal status, BMI, aspirin use and intakes of fruits, vegetables, and meats, lower risk of total ischemic stroke was seen with DPA (highest vs. lowest-quartiles, pooled HR=0.74, 95%CI=0.58-0.92) and DHA (0.80, 0.64-1.00), but not EPA (0.94, 0.77-1.19). Among stroke subtypes, DHA was associated with substantially lower risk of atherothrombotic (0.53, 0.34-0.83), but not cardioembolic stroke; and DPA with substantially lower risk of cardioembolic (0.58, 0.37-0.92), but not atherothrombotic stroke. Findings in each individual cohort were similar to the pooled results.

Conclusions:
In 3 US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke, and DPA, with cardioembolic stroke. EPA was not associated with ischemic stroke. These novel findings highlight the importance of separately evaluating ischemic stroke subtypes as well as specific individual fatty acids, and suggest differential pathways of benefit for DHA, DPA, and EPA.
Abstract P001: Early Loss of Ideal LDL in Multi-Ethnic Populations: Why Focusing on Young Adults is Needed to Achieve the AHA 2020 Goals
Authors: Engeda Joseph , Holliday Katelyn , Hardy Shakia , Chakladar Sujatro , Heiss Gerardo , Avery Christy
Published: March 2022

Introduction:
Ideal low density lipoprotein (LDL) levels are associated with lower cardiovascular disease morbidity and mortality and the National Cholesterol Education Program has identified LDL as the primary target for cholesterol lowering treatment. The prevalence of poor LDL has decreased since the 1970’s, however 27% of U.S. adults still have poor LDL levels. Few studies have characterized the transitions from ideal to intermediate to poor LDL levels in different life epochs and in minorities using contemporary data.

Methods:
Cross-sectional 2007-2012 National Health and Nutrition Examination Survey (NHANES) data (N = 11,140) and 2008-2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL) data (N = 15,262) were used to estimate the age-, race-, and sex- specific prevalence of ideal (<100 mg/dL untreated), intermediate (100-140 mg/dL or treated to goal), or poor (>140 mg/dL) among European American (EA), African American (AA) and Hispanic/Latino (HL) adults ≥20 years of age. We then used these data and novel Markov-type models to estimate race/ethnic- and sex-specific net transition probabilities between ideal, intermediate, and poor LDL.

Results:
At age 20 the prevalence of ideal LDL ranged from 44% (HL men) to 64% (EA women).Variation in the loss of ideal LDL was also observed by race/ethnicity and gender. For example, among EA men aged 20, a net 4.6% (95% CI: 3.9%-5.3%) transitioned from ideal to intermediate LDL levels by age 21, net transitions that were 30% higher than net transitions estimated for EA women aged 20, for whom a net 3.3% (95% CI: 2.3%-4.3%) transitioned from ideal to intermediate LDL levels by age 21. Movement from ideal to intermediate LDL levels in adulthood also peaked at earlier ages among men (EA=27, AA=28, and HL= 31) than among women (EA=36, AA=35, and HL=45), with the largest transitions occurring among EA men [net transition probability of 5.6% (95% CI: 4.6%-6.6%)]. In addition, net transition patterns favored movement from intermediate to poor LDL levels across the life course, with adult net transitions peaking at age 20 among EA and AA men and approximately 10 years later among EA women, AA women, and HL men. Net transitions peaked at the latest ages among HL women [age 36, net transition probability = 2.7% (95% CI: 2.4%-3.1%)].

Conclusions:
Loss of ideal LDL begins early in life and shows divergent patterns by gender and race. Difficulties re-attaining ideal LDL once classified as intermediate or poor support interventions that promote ideal LDL levels in younger ages, especially in men.
Abstract P021: Hemoglobin A1c (HbA1c) and the Risk of Ischemic Stroke Among Women
Authors: Adebamowo Sally N , Pai Jennifer K , Jiménez Monik C , Rexrode Kathryn M
Published: March 2022

Background:
Poor glucose control as indicated by elevated levels of hemoglobin A1c (HbA1c) among those with diabetes is a risk factor for stroke; however, whether HbA1c is independently associated with risk of stroke among those without diabetes remains unclear.

Methods:
Among 32,826 participants in the Nurses’ Health Study who provided blood samples in 1989-1990, ischemic strokes were identified and confirmed by medical records through 2010. Participants with a history of diabetes or HbA1c ≥ 6.5% at baseline were excluded from the analyses. We conducted a nested case-control analysis of 378 cases, matched to controls (1:1) on age, menopausal status, use of postmenopausal hormones, ancestry, date of blood draw, fasting status and smoking status. The study population was categorized into quartiles based on the baseline HbA1c distribution among the controls Conditional and unconditional logistic regression models were used to estimate the multivariable adjusted (alcohol intake, body mass index [BMI], physical activity, aspirin use, C-reactive protein [CRP] levels, history of hypertension, coronary heart disease [CHD] and total/high density lipoprotein cholesterol) association of HbA1c and the risk of ischemic stroke; results were similar, thus we present results for unconditional analyses.

Results:
The mean age at baseline was 60.8 years and the median time to stroke was 9.0 years. In univariate analyses, median HbA1c levels did not differ between stroke cases compared to controls (median of 5.5 for both groups; p-value=0.91). The relative risk (RR) of ischemic stroke was 0.91 (95% confidence interval (CI), 0.57 - 1.45), p-trend = 0.55, among those in the highest quartile compared to the lowest. There was no evidence of effective modification of the association between HbA1c and ischemic stroke by age, BMI, smoking, hypertension or CRP.

Conclusions:
In this population of women without diabetes at baseline, HbA1c was not significantly associated with increased risk of total ischemic stroke.
Abstract P026: Associations of Biomarkers of Endothelial Dysfunction with Hyperglycemia and Insulin Resistance in Hispanic/Latino Youths: Results From the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth)
Authors: Parrinello Christina M , Carnethon Mercedes R , Gallo Linda C , Kaplan Robert C , Isasi Carmen R
Published: March 2022

Background:
Endothelial dysfunction may contribute to the long-term development of diabetes and cardiovascular disease (CVD). However, little is known about the correlates of biomarkers of endothelial dysfunction in youths, which is significant because early markers of endothelial damage might signal high future CVD risk and could be reversible.

Methods:
We included 1,318 participants from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) (2012-14) aged 8-16 years with complete data who were fasting ≥8 hours. We calculated unadjusted Pearson correlations for e-selectin and PAI-1, biomarkers of endothelial dysfunction, with sociodemographic and clinical variables. We conducted multivariable logistic regression and used predictive margins to obtain prevalence ratios (PRs) and 95% CIs for the association of quartiles of e-selectin and PAI-1, separately and in combination with one another, with fasting glucose≥100 mg/dL, HbA1c≥5.7%, and HOMA-IR≥2.6.

Results:
Higher levels of e-selectin and PAI-1 were associated with higher body mass index, systolic blood pressure, and dyslipidemia (P<0.05 for all). After adjustment for sociodemographic and clinical variables, higher levels of PAI-1 were associated with elevated fasting glucose and HOMA-IR, and higher levels of e-selectin were associated with elevated HOMA-IR (
Figure
). Associations were relatively unchanged when including both e-selectin and PAI-1 in the same model. Adjusted PR and 95% CI for Q4 of e-selectin with HOMA-IR was 1.36 (1.13, 1.60); and for Q4 of PAI-1 with fasting glucose and HOMA-IR were 2.50 (1.16, 3.85) and 1.59 (1.26, 1.91), respectively.

Conclusions:
Biomarkers of endothelial dysfunction were independently associated with insulin resistance in Hispanic/Latino youths. Since the endothelium may help regulate insulin secretion, these biomarkers may be useful in risk stratification and prediction of diabetes and CVD in this population.
Abstract P030: Long-term Pharmacotherapy for Elevated Low Density Lipoprotein Levels in Children: A Retrospective Analysis
Authors: John Collin C , Regier Michael , Lilly Christa , Aly Shahenda
Published: March 2022

Background:
There is limited research detailing LDL trends over the long term in children on various lipid lowering medications.

Objectives:
This study sought to assess factors associated with stability of LDL levels in children on long-term pharmacotherapy and their ability to reach the current recommended LDL goal of 130 mg/dL or less while on pharmacotherapy.

Methods:
Medical records of children seen in a university pediatric cholesterol clinic between 1998 and 2012 who were treated with a statin, ezetimibe, or both were reviewed. Aggregate data were obtained to determine the number of children who were able to reach an LDL level of 130 mg/dL or less while on pharmacotherapy. Kaplan-Meier curve and proportional hazard regression analysis were used to examine the propensity for LDL levels to stabilize over time while on pharmacotherapy as well as factors affecting this propensity.

Results:
76 patients who contributed 864 total visits met inclusion criteria. 56 of 76 patients developed a stable LDL with median time to stability of 28 months on pharmacotherapy. Younger age of first visit was associated with development of LDL stability (9.8 years for stable LDL vs. 13.3 years for nonstable LDL; p= 0.004). Titration to higher statin doses and/or higher potency statins was also associated with higher propensity for LDL stabilization. There was no significant difference between patients who were taking a statin, ezetimibe, or both in terms of their propensity to stabilize even when stratifying for presence of probable familial hypercholesterolemia (p=0.579). 36 of 76 patients were able to reach an LDL of 130 mg/dL or less, with only 11 of 38 patients with probable familial hypercholesterolemia (>190 mg/dL baseline LDL) reaching this goal.

Conclusion:
A majority of children in a university pediatric cholesterol clinic were able to reach a stable LDL level on pharmacotherapy after a median 28 month interval. On the other hand, the majority of children had difficulty reaching the current recommended goal LDL of 130 mg/dL or less, even after aggressive titration of medication. This was specifically true for those with probable familial hypercholesterolemia. Further research is needed to assess the utility of goal-directed therapy in children with regards to cardiovascular outcomes.
Abstract P045: Public Attitudes to Government Intervention to Improve Children’s Diets
Authors: Berry Narelle M , Carter Patricia , Nolan Rebecca , Dal Grande Eleonora , Booth Sue
Published: March 2022

Introduction:

Globally the prevalence of overweight and obesity in children is increasing. For effective population level dietary intervention comprehensive packages, including policy action across food environments, food supply chains and behaviour change communication are required to ensure that it is easy for both adults and children to make healthy food choices. The World Health Organization has called on governments to implement recommendations on the marketing of foods and beverages to children. Public support of government intervention is likely to influence government action in this area: thus this study aimed to explore public attitudes to government intervention in the area of unhealthy food marketing to children and related matters.

Methods:
Data for this study were collected using a computer-assisted telephone interview. Households were randomly selected and the person aged ≥18 years with the most recent birthday was selected for interview. Respondents were asked to report their agreement on a five point Likert scale ranging from strongly agree to strongly disagree on questions relating to the role of government in: regulating food advertising to children, educating parents on healthy eating, and in requiring manufacturers to make food healthier, and their opinion on current food advertising practices. Data are presented as the proportion of respondents who agreed/strongly agreed with each statement.

Results:
A total of 3911 adults responded to this survey (2008: n=1910, 2011: n=2001) and overall there was high agreement with most survey statements: 87.0% of respondents strongly agreed/agreed that governments should regulate the way food or drink is marketed to children; 92.9% strongly agreed/agreed that governments should help educate families on healthy eating; 85.7% strongly agreed/agreed that governments should require manufacturers to make children’s food healthier; and 75.9% strongly agreed/agreed that there is too much advertising of unhealthy food during children’s television viewing time. When asked how governments should intervene, 60.8% of respondents strongly agreed/agreed on a total ban on advertising unhealthy foods and 86.4% strongly agreed/agreed on a ban on advertising of unhealthy food at times when children watch television.

Conclusions:

The results of this study demonstrate that there is high public support for governments to intervene to decrease unhealthy food marketing to children. Despite this, governments have been reluctant to act and more effort is needed to harness public opinion to influence and inform policy development.
Abstract P049: Cognitive Function and Brain Structure and Risk for Incident Diabetes: The Atherosclerosis Risk in Communities Study
Authors: Bancks Michael P , Alonso Alvaro , Gottesman Rebecca , Mosley Thomas , Selvin Elizabeth , Pankow James
Published: March 2022

Introduction:
Diabetes is an established risk factor for accelerated brain aging; however recent epidemiological studies suggest individuals with lower levels of cognitive functioning may be at increased risk for developing diabetes.

Hypothesis:
We hypothesized that lower baseline levels of cognitive function and MRI measures of brain pathology are associated with increased risk of diabetes.

Methods:
We used data on 11,503 adult men and women with cognitive function assessment (ARIC visit 2, 1990-1992) and 1,383 individuals who completed brain MRI (ARIC visit 3, 1993-1995) and were followed through 2012. Cognitive function was calculated as the average of z-scores from three unique neuropsychological tests. Board-certified radiologists adjudicated severity of sulcal size, ventricular size, and white matter hyperintensity (WMH) from brain MRI to a 10-point visual matching scale. Incident diabetes was ascertained at ARIC visits 3, 4 (1996-1998), and 5 (2010-2012) [self-report of diabetes medication use, self-report of a physician diagnosis, fasting glucose ≥ 126 mg/dL (≥ 7.0 mmol/L) or by non-fasting glucose ≥ 200 mg/dL (≥ 11.1 mmol/L)] and at annual telephone follow-up calls by self-report of physician diagnosis or diabetes medication use. Cox proportional hazards regression analysis was used to estimate hazard ratios (HR) for incident diabetes according to 1 standard deviation (SD) increment of cognitive function and severity of each brain MRI measure. Minimally adjusted models included age, sex, race, and field center. More fully adjusted models included other potentially relevant characteristics and diabetes risk factors.

Results:
Mean follow-up for the cognitive function analysis was 16.7 years and 14.2 years for the MRI analyses. Summary statistics and hazard estimates are presented in the Table (below).

Conclusion:
Measures of brain atrophy were associated with an increased incidence of diabetes in more fully adjusted models, but cognitive function and other measures of brain structure were not.
Abstract P053: Glycated Hemoglobin in Relation to Incident Diabetes and Cardiovascular Disease in Non-diabetic Adults
Authors: Metcalf Patricia A , Kyle Cam , Kenealy Tim , Wells Susan , Jackson Rod T
Published: March 2022

Introduction:
We compared the utility of glycated hemoglobin (HbA1c) and oral glucose tolerance (oGTT) in non-diabetic patients for identifying incident diabetes, all-cause mortality, cardiovascular disease (CVD) mortality, all-CVD events, coronary heart disease (CHD) events, ischaemic stroke events and diabetes microvascular complications.

Hypothesis:
HbA1c will provide the similar information to an oGTT.

Methods:
Data from a New Zealand community setting were prospectively linked to hospitalization, mortality, pharmaceutical and laboratory test results data. After applying exclusion criteria (prior laboratory diagnosis or history of drug treatment for diabetes or hospitalisation for diabetes or CVD event), there were 31,148 adults who had an HbA1c and 2-hr 75g oGTT. HbA1c was measured by ion-exchange high-performance liquid chromatography, and glucose using a commercial enzymatic method. We compared glycaemic measures and outcomes using multivariable Cox proportional hazards regression.

Results:
The median follow-up time was 4 years (range 0 to 13). The mean age was 57.6 years and 53.0% were male. After adjusting for other glycaemic measures (fasting glucose, 2-hr glucose and/or HbA1c where relevant) in addition to age, sex and ethnicity, the hazard ratios for incident diabetes, and diabetes complications of retinopathy, nephropathy and neuropathy were highest for 2-hr postchallenge glucose levels, followed by HbA1c and lastly by fasting plasma glucose. However, all-cause mortality was significantly associated with HbA1c concentrations only. CHD events were most strongly associated with HbA1c, followed by 2-hr glucose and circulatory complications showed stronger associations with HbA1c.

Conclusion:
HbA1c showed stronger associations with adverse outcomes compared to fasting glucose and provides a convenient alternative to an oGTT.
Abstract P056: Diabetes Education for Stroke Inpatients is Incomplete and Differs by Stroke Severity, Age, and Substance Abuse History
Authors: Baraban Elizabeth , Lucas Lindsey , Lowenkopf Theodore
Published: March 2022

Introduction:
Diabetes is a well-established risk factor for stroke and other vascular disease. Consequently, diabetes management is important for prevention of primary and secondary vascular events. Hospitals offer diabetes education, but it is unknown if the appropriate patients are receiving the necessary information. The objective of this study was to determine the factors associated with receiving diabetes management teaching among patients presenting to a hospital with an ischemic stroke (ISC) or Transient Ischemic Attack (TIA) who have a concurrent new diabetes diagnosis.

Methods:
Data from 20 hospitals in a multi-state healthcare system stroke registry from 2002 to May 2015 were used. ISC or TIA patients with a new, in-hospital diagnosis of diabetes were included. Patients on comfort care, transferred to an outside facility from the emergency department, discharged to hospice or expired were excluded. Associations between receiving diabetes management education and demography, insurance, medical history, BMI, functional status, and stroke severity of the patient were examined using a generalized linear mixed model with a logit link.

Results:
Data from 336 newly diagnosed diabetes patients were used in the analyses. Of those, 269 (80.1%) received diabetes management education, while 67 (19.9%) did not. Patients with a medical history of drug or alcohol abuse were 79% less likely to receive diabetes management training than those without a history (adjusted odds ratio [AOR] = 0.215, p=.014). Patients who were overweight or obese weight were over three times more likely to receive diabetes management education than patients who were of normal weight or underweight (AOR = 2.92, p=.003). For every one-point increase of the NIH Stroke Scale score, the likelihood of receiving education decreased by 6% (AOR=.913, p=.005), and with each additional five years of age the likelihood of receiving education decreased by 14% (AOR=.861, p=.017). Gender, insurance type, discharge status, and medical histories of atrial fibrillation, CAD/prior MI, previous strokes, previous TIA, hypertension, family history of stroke were not significant predictors.

Conclusions:
Almost 20% of patients with newly diagnosed diabetes did not receive diabetes management education. While education was appropriately targeted to overweight and obese patients, these results indicate that patients with a history of drug and alcohol abuse, those who are normal or under-weight and those with more severe strokes were underserved. More work needs to be done to ensure that stroke patients are receiving appropriate education to prevent subsequent cerebrovascular events.