bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P171: Hemoglobin A1c and Incident Albuminuria Among Individuals Without Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Carson April P , Muntner Paul , Carnethon Mercedes R , Gross Myron D , Lewis Cora E
Published: July 2021

Background:
Higher hemoglobin A1c (HbA1c) has been associated with an increased risk of reduced estimated glomerular filtration rate <60 mls/min/1.73m2 among individuals without diabetes. However, it is unclear whether higher HbA1c in the non-diabetic glycemic range also is associated with an increased risk of albuminuria. This study investigated the association of HbA1c with incident albuminuria in a biracial cohort of middle-aged men and women without a history of diabetes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Methods: The CARDIA Study is a prospective cohort study of 5,115 African-American and white adults, age 18-30 years at baseline (1985-86), from four field centers in the United States: Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. Participants with prevalent diabetes (defined as fasting glucose ≥126 mg/dL, 2-hour post-challenge glucose ≥ 200 mg/dL, HbA1c ≥ 6.5%, or used diabetes medications) or albuminuria (defined as a race- and sex-adjusted urine albumin-to-creatinine ratio ≥ 25 mg/g) at the year 20 examination (2005-06; baseline for this analysis) were excluded. This study included 2174 participants who had HbA1c measured at the year 20 examination and had urine albumin and creatinine measured at the year 25 examination (2010-11). Poisson regression with robust error variances was used to obtain risk ratios (RR) and 95% confidence intervals (CI) for the association of HbA1c, both as a continuous variable and dichotomous variable using its prediabetes cut-point, with albuminuria in unadjusted models and models adjusted for socio-demographics and cardiovascular risk factors. Results: During the follow-up period, 103 (4.7%) participants developed incident albuminuria. In unadjusted analyses, each 1% increase in HbA1c was associated with incident albuminuria (RR=2.55, 95% CI=1.48, 4.39). This association was attenuated and not statistically significant after adjustment for age, race, sex, and education (RR=1.68, 95% CI=0.98, 2.88) and further adjustment for cardiovascular risk factors (RR=1.42, 95% CI=0.81, 2.50). Additionally, individuals with HbA1c in the prediabetes range (5.7%-6.4%) had an increased risk of albuminuria (RR=1.59, 95% CI=1.04, 2.43) compared with those with HbA1c in the normal glycemic range (<5.7%) in the unadjusted model. However, this association was attenuated after adjustment for socio-demographics (RR=1.11, 95% CI=0.71, 1.72) and cardiovascular risk factors (RR=0.98, 95% CI=0.61, 1.55). Conclusions: After taking into account socio-demographics and traditional cardiovascular risk factors, HbA1c was not associated with incident albuminuria among individuals without diabetes.
Abstract P188: “False Positive” Stress Testing: Does Endothelial Vascular Dysfunction Explain ST-Segment Depression in the Absence of Clinical Coronary Artery Disease in Women?
Authors: Agrawal Shilpa , Mehta Puja , Sedlak Tara , Hobel Zachary , Shufelt Chrisandra , Jones Erika , Kligfield Paul , Mortara David , Laks Michael , Bairey Merz Noel
Published: July 2021

Background:
Current guidelines do not endorse exercise electrocardiography (Ex-ECG) screening in asymptomatic adults due to poor diagnostic accuracy for clinical coronary artery disease (CAD), however Ex-ECG combined with other variables paradoxically has strong prognostic accuracy for cardiovascular mortality. Ex-ECG ST segment depression “false positive” results are common in women, who have higher rates of vascular dysfunction such as Raynaud’s and migraines compared to men. We hypothesized that ST segment depression indicates endothelial vascular dysfunction, which is known to predict an adverse prognosis. To test this hypothesis, we evaluated the relationship between Ex-ECG and peripheral endothelial vascular function in asymptomatic women.

Methods:
Asymptomatic women with no cardiac risk factors and normal resting ECG underwent maximal Bruce protocol Ex-ECG testing (GE Healthcare). Computer-generated Ex-ECG ST segment values were independently verified by 2 cardiologists. Based on established methods, endothelial vascular function was assessed by calculating reactive hyperemia index (RHI) using peripheral vascular testing (Endopat, Itamar). As established previously, RHI <1.68 is abnormal and indicates endothelial vascular dysfunction.

Results:
Among 35 women, mean age 54±8 years and BMI 24±4, there were 5 (14%) women with abnormal RHI. Women with abnormal RHI had a greater (more abnormal) ST/HR slope, a trend toward greater peak ST depression, and achieved lower METs than women with normal RHI (Table 1).

Conclusion:
Among asymptomatic women, endothelial vascular dysfunction was associated with abnormal Ex-ECG results characterized by greater ST/HR slope, greater ST depression, and lower exercise capacity. These findings suggest that “false positive” ST-segment depression in the absence of clinical CAD in women may be explained by endothelial vascular dysfunction. Our study further suggests that endothelial vascular dysfunction may explain the Ex-ECG diagnostic/prognostic paradox.
Abstract P189: Cardiovascular Risk Factors in Adolescence and Young Adulthood Predict Carotid Intima-Media Thickness in Early and Middle Adult Life
Authors: Fyfe-Johnson Amber L , Steinberger Julia , Sinaiko Alan R , Alonso Alvaro , Dengel Donald R , Jacobs David R
Published: July 2021

Introduction:
Cardiovascular (CV) risk factors measured in childhood and adulthood are positively associated with increased carotid intima-media thickness (cIMT) later in life. In particular, body mass index (BMI), systolic blood pressure (SBP), and lipids are implicated. However, questions remain regarding prediction of cIMT from adolescent and young adult CV risk factors.

Hypothesis:
CV risk factors are positively associated with young adult and early middle age cIMT thickening, both cross-sectionally and longitudinally.

Methods:
CV risk factors (BMI, SBP, metabolic syndrome [MetS, mean of CV risk factor z-scores]) were measured in two pediatric cohort studies. The Insulin Study measured CV risk factors in 305 adolescents at mean ages 15 and 22 years, with cIMT measured at mean age 22 years. The Prevention of High Blood Pressure in Children Study measured CV risk factors in 444 individuals at mean ages 24 and 38 years, with cIMT measured at mean age 38 years. Predictors were categorized into quartiles; cIMT was measured by ultrasonography. Linear regression models were used to predict cIMT and adjust for potential confounding variables. Differences between risk factor quartile 4 and quartile 1 (Q4-Q1) were used in analyses, with a
p
-test for trend based on continuous predictors.

Results:
Positive cross sectional associations were found between CV risk factors at ages 24 and 38 and cIMT at 38 (Table). Positive longitudinal associations were found between BMI (Q4-Q1: 0.024 mm, p=0.0001) and MetS score (Q4-Q1: 0.019 mm, p=0.004) at age 15 and cIMT at age 22, and between BMI (Q4-Q1: 0.045 mm, p=0.01) and MetS score (Q4-Q1: 0.048 mm, p<0.0001) at age 24 and cIMT at age 38 (Table). SBP at ages 24 and 38 was predictive of cIMT at age 38.

Conclusions:
These findings suggest that CV risk factors beginning in adolescence predict cIMT thickening in young adulthood, and this predictive association continues into middle age. This supports early identification of CV risk, and initiation of preventive strategies to reduce early CV disease.
Abstract P195: Hypertension is Associated With an Abnormal Pressor Response to Voluntary Apnea
Authors: Jouett Noah , Mason Ryan , Niv Dorene , Watenpaugh Donald E , Smith Michael L
Published: July 2021

Background:
Cardiovascular diseases are commonly associated with elevated sympathetic nerve activity (SNA). Previously, we have shown that the blood pressure response to a voluntary apnea is closely correlated with the SNA response in patients with sleep disordered breathing (SDB) and thus may serve as an index of SNA responsiveness. In the current study, we hypothesized that the pressor response to apnea is 1) reduced with effective treatment of SDB in SDB patients, and 2) that it is exaggerated in hypertensive patients (HTN) when compared to healthy control subjects.

Methods:
22 OSA patients (14 treated and 8 untreated), 19 treated hypertensive patients and 23 healthy normotensive control subjects were recruited from the UNTHSC Primary Care Center and Sleep Consultants of Texas. Subjects completed a medical history questionnaire and Epworth Sleepiness survey. Blood pressure was measured by standard auscultatory assessment in the seated position. Baseline blood pressure was obtained in triplicate during quiet rest. Then after practicing a voluntary breath hold, subjects repeated three voluntary 20-second breath holds each beginning at end-expiration. Comparisons were made 1) between treated and untreated SDB patients, and 2) between HTN patients and healthy control subjects using a Student t test.

Results:
Importantly, as in prior studies the pressor response to apnea was not different from zero in the healthy control subjects (-1.0 ± 4.2 mmHg, p>0.05). In the SDB patients, the pressor response was significantly greater than zero in both treated (11.4 ± 3.9 mm Hg) and untreated (24.5 ± 9.8 mm Hg) SDB patients (p<0.001), and was significantly reduced in the treated SDB patients (p<0.001). In addition, the pressor response was significantly greater in the HTN patients (10.5 ± 5.3 mmHg, p<0.001) compared to the healthy control subjects.

Conclusions:
These data support our hypotheses that the pressor response to voluntary apnea is exaggerated in both untreated SDB and treated HTN patients and that effective treatment of SDB reduces this response, but does not normalize the response. These data suggest that the pressor response to apnea may be a simple physiologic index of exaggerated sympathetic responsiveness.
Abstract P208: Comparison of Hypertension and Treatment Prevalence Across Geographic Regions in Three National Surveys
Authors: Thompson-Paul Angela M , Baumgardner Jason L , Gillespie Cathleen , Fang Jing , Loustalot Fleetwood
Published: July 2021

Background:
Geographic disparities have been reported in prevalence, awareness, and treatment of hypertension. Several community-based national surveillance systems assess hypertension allowing for comparison of estimates. The objectives of this study were to compare hypertension estimates across surveys and to examine geographic differences in the findings.

Methods:
Using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010, the National Health Interview Survey (NHIS) 2008, and the Behavioral Risk Factor Surveillance Survey (BRFSS) 2009, we calculated prevalence estimates of measured hypertension (an average systolic BP ≥140 mm Hg or an average diastolic BP ≥90 mm Hg or self-reported current use of BP-lowering medication), self-reported hypertension (having ever been told that one has hypertension), and treatment, nationally and regionally.

Results:
Nationally, 30.5% of adults have hypertension with higher prevalence in the Midwest (33.0%) and South (32.6%) and lower prevalence in the West (26.0%) and Northeast (28.0%) (NHANES). In all surveys, self-reported hypertension was highest in the South (range: 31.1% [NHIS] - 32.8% [NHANES],) and lowest in the West (range: 23.6% [NHIS] - 27.0% [BRFSS]). In all surveys and all regions, more than two-thirds of participants who were aware of their high blood pressure reported receiving treatment. Treatment prevalence was lowest in the West (range: 69.7% [NHIS] - 74.5% [BRFSS]), highest in the South in NHIS (77.5%) and BRFSS (81.4%), and highest in the Northeast in NHANES (78.3%).

Conclusions:
Similar estimates showing regional differences in measured and self-reported hypertension and treatment were found across all three national surveys. In addition, low treatment has been identified in regions with low prevalence. As recognized in many national initiatives (e.g., Million Hearts), improving hypertension treatment and control requires multi-level interventions across community and clinical settings.
Abstract P215: Associations of Yerba Mate Tea Drinking With Blood Lipids, Apolipoproteins, and C-Reactive Protein Among South American Adults
Authors: Elorriaga Natalia , Poggio Rosana , Gutierrez Laura , Irazola Vilma E , Defago Maria D , Corrmick Gabriela , Danaei Goodarz , Mozaffarian Dariush , Rubinstein Adolfo L
Published: July 2021

Background:
Yerba mate tea, made from tree leaves of Ilex paraguariensis, is a widely consumed beverage in South America. Animal studies have reported improvement in serum lipids parameters and reduction in cholesterol content and size of aortic lesions with consumption of ilex paraguariensis extracts, that contain potentially bioactive saponin, phenolic compounds and methilxanthines. Few studies have been conducted in humans, mostly pilot studies. Evidence on the association between mate tea consumption and lipid profile, Apolipoprotein (Apo) AI, Apo B and C-reactive protein (CRP) in humans are sparse. We assessed these associations among adults from Argentina, Chile and Uruguay.

Methods:
CESCAS I (Center of Excellence in Cardiovascular Health of South America Study I) study is an observational population-based prospective cohort study of 7,600 participants from general population of four cities in the three countries. We conducted a cross-sectional analysis in a randomly selected subsample of 988 subjects aged 35 to 74 years. Participants with previous cardiovascular events or receiving lipid-lowering agents were excluded. Mate consumption and other dietary habits were assessed using a previously validated 126-item food frequency questionnaire. Multivariable linear regression models were used to examine the associations between Apo AI, B, CRP, and other lipids by tertiles (T) of mate tea consumption. The models adjusted for age, smoking status, body mass index, physical activity, alcohol intake, ‘prudent’ or ‘Western’ diet-pattern scores (identified by principal component analysis), added sugar to the mate, and presence of diabetes.

Results:
The sample included 418 men and 570 women. The proportion of mate drinkers (at least once a month during last year) were 40% in Temuco (Chile), 84% in Canelones (Uruguay), 89% in Marcos Paz and 91% in Bariloche (Argentina). Median mate intake across tertiles was 0, 590 and 1875ml/day in men and 0, 625 and 1875ml/day in women, respectively. Higher mate consumption (T3 vs. T1) was independently associated with higher levels of Apo AI in both men (5.1mg/L, 95% CI, 0.1 to 10.1) and women (6.7mg/L, 95% CI, 1.5 to 11.9). In men higher mate consumption was also associated with lower levels of triglycerides (-49mg/dL, 95% CI, -11 to -86) and in women with slightly lower Apo B/AI ratio (-0.05, 95% CI, -0.001 to -0.06). Differences in total cholesterol, HDL cholesterol, LDL cholesterol, Apo B, and CRP were not statistically significant.

Conclusions:
Among generally healthy adults, higher consumption of mate during the past 12 months was associated with higher levels of APO-A1 in both men and women, and with lower triglycerides levels in men.
Abstract P234: Cardiovascular Risk Prediction With Minimal Physiologic Variables
Authors: Safford Monika M , Colantonio Lisandro , Richman Joshua
Published: July 2021

Introduction:
Cardiovascular risk prediction relies on physiologic parameters, limiting the utility of tools such as the Pooled Cohort Risk Equation (PCRE) for self-administration outside clinical contexts. Tools that can be widely administered in places such as stores or pharmacies that offer blood pressure (BP) assessment could increase detection of high risk individuals and motivate care seeking. We developed a risk prediction approach that relies only on BP and otherwise self-reported variables and compared it with the PCRE.

Methods:
We identified 16,833 in the REasons for Geographic AND Racial Differences in Stroke (REGARDS) study without coronary heart disease (CHD) and <80 years of age at baseline. CHD and stroke were expert adjudicated. Data included variables required to calculate the PCRE, as well as variables for the BP-self-report models (sociodemographics, medical history, and items assessed by validated questionnaires [e.g., Short Form-12]). We developed two predictive models for the composite endpoint of incident CHD or stroke using 1) survival trees (Tree) and 2) generalized additive models (GAM). For 5 iterations the cohort was randomly partitioned into equal training and testing subsets. Tree models and GAM were fit using the training subset and predicted risks calculated for the testing subset using the PCRE, Tree and GAM methods. C-statistics were calculated overall and stratified by age dichotomized at 65 for each model.

Results:
For the overall cohort, the mean C-statistics over the 5 iterations were PCRE: 0.69 (Range 0.65-0.74); GAM BP-self-report: 0.70 (0.67-0.72); Tree BP-self-report: 0.59 (0.55-0.66). For participants aged over 65 years the GAM had the highest mean of 0.64 vs. 0.58 (PCRE) and 0.54 (Tree). See Figure.

Conclusion:
A predictive statistical model using only self-reported data and systolic BP can have similar predictive performance to the PCRE, with potential marginal improvement noted for subjects over age 65 years.
Abstract P241: 2013 AHA/ACC/TOS and 1998 NHLBI Clinical Guidelines for the Management of Overweight and Obesity Predict Higher Cardiovascular Disease Risk in Adults Recommended versus Not Recommended for Weight Loss Treatment: the Atherosclerosis Risk in Communities Study
Authors: Stevens June , Erber-Oakkar Eva , Cui Zhaohui , Cai Jianwen , Wormser David , Virani Salim S
Published: July 2021

Introduction:
In 2013, AHA/ACC/TOS released an algorithm to assist primary care providers in the identification of patients who should be considered for weight loss treatment to promote the prevention and treatment of cardiovascular disease (CVD). This guidance updated the recommendations released in 1998 by NHLBI. We know of no studies that have compared risk of incident CVD in adults recommended or not recommended for treatment by these two guidelines.

Hypothesis:
We hypothesized that adults recommended for weight loss treatment by the 1998 and 2013 algorithms have higher CVD risk than those not recommended for treatment. Additional analyses explored sources of differences in the algorithms as predictors of CVD risk.

Methods:
The ARIC study included 13,020 African American and White adults aged 45-64 years. Baseline data collected in 1987-1989 on BMI, waist circumference and other CVD risk factors in participants were used to form treatment groups that differed between the algorithms in regard to the choice, definition and number of risk factors. We calculated hazard ratios (HR) for first CVD event defined as ischemic stroke, fatal and non-fatal myocardial infarction (MI), silent MI and coronary revascularization procedures. Covariates included age, gender, ethnicity and study center.

Results:
At baseline, mean BMI was 28 kg/m2 (SD 5.3). During a median follow-up of 19.8 years, 2,698 incident CVD outcomes were recorded. The 1998 and 2013 algorithms recommended weight loss for 58% and 63% of participants, respectively, with 13% discrepant. The HR for CVD in adults recommended vs not recommended for treatment were 1.85 (95% CI: 1.69, 2.00) for the 1998 algorithm and 1.59 (95% CI: 1.47, 1.72) for the 2013 algorithm. The higher HR for the 1998 algorithm was driven in part by the inclusion of three risk factors (age, smoking and family history of premature CHD) not included in the 2013 algorithm (1998 HR reduced from 1.85 to 1.78 (95% CI: 1.65, 1.93) when those risk factors omitted). In the 2013, but not the 1998 algorithm, all overweight adults with a large waist circumference or pre-diabetes as their only risk factor were included in the treated group, but the HR’s for those subgroups were not elevated. The 2013 HR changed from 1.59 to 1.77 (95% CI: 1.63, 1.93) when those criteria were omitted.

Conclusions:
Both algorithms identified patients for weight loss treatment who were at elevated CVD risk, and the difference in the HR’s associated with the algorithms can be explained by differences in the specification of risk factors.
Abstract P249: A Behavioral Weight Loss Intervention is Effective for Change in CVD Risk Factors in Young Adults: The IDEA Study
Authors: Jakicic John M , Davis Kelliann K , Barone Gibbs Bethany , Helsel Diane , King Wendy C , Rickman Amy D , Rogers Renee J , Wahed Abdus , Belle Steven H
Published: July 2021

Introduction:
Few studies have examined behavioral weight loss interventions with respect to change in cardiovascular disease risk factors in young adults (aged 18 to 35 years).

Hypothesis:
We tested the hypothesis that a 6 month behavioral weight loss intervention resulted in significant improvements in selective cardiovascular disease risk factors in young adults.

Methods:
Data are presented as median [25
th
, 75
th
percentiles]. 470 participants (age: 30.9 [27.8, 33.7] years); BMI: 31.2 [28.4, 34.3] kg/m
2
) were enrolled in a 6 month behavioral weight loss intervention that included weekly group sessions and prescribed an energy restricted diet and moderate-to-vigorous physical activity. Assessments included weight using a standardized protocol, resting blood pressure, and fasting lipids, glucose, and insulin. Statistical significance of change was according to tests of symmetry or the Wilcoxon matched pairs signed ranks test.

Results:
The primary outcome (weight) was available for 424 of the 470 participants (90.2%). Weight significantly decreased (-7.8 kg [-12.2, -3.7]) (p<0.0001). Systolic (-4.0 mmHg [-8.5, 0.5] and diastolic blood pressure (-3.0 mmHg [-6.5, 1.0]) decreased (p<0.0001). Total cholesterol (-13 mg/dl [-28.0, 2.0]), LDL cholesterol (-9.5 mg/dl [-21.7, 2.0]), triglycerides (-8.5 mg/dl [-44.0, 9.0]), glucose (-4.0 mg/dl [-8.0, 1.0]), and insulin (-2.6 mIU/L [-5.9, 0.7]) decreased (p<0.0001, n=416). There was not a significant change in HDL cholesterol (p=0.72).

Conclusions:
In conclusion, after 6 months, weight loss was observed in young adults assigned to this behavioral intervention that focused on physical activity and diet modification. They tended to also have improved cardiovascular disease risk factors. This may demonstrate an approach to reducing cardiovascular disease risk in young adults.

Supported by NIH (U01HL096770) and AHA (12BGIA9410032)
Abstract P258: Prevalence of Obesity and Estimated Medical and Work Loss Costs Attributable to High BMI: The Baptist Health South Florida Employee Study
Authors: Nasir Khurram , Veledar Emir , Osondu Chukwuemeka , Aneni Ehimen , Ogunmoroti Oluseye , Das Sankalp , Rouseff Maribeth , Tran Thinh , Parris Don , Holzwarth Leah , Guzman Henry , Feldman Theodore , Ozner Michael , Fialkow Jonathan , Fernandez Bernie , Ziffer Jack , Agatston Arthur
Published: July 2021

BACKGROUND:
Obesity is strongly related to chronic health problems and concomitant increased healthcare costs for employers. The aim of the study is to explore the distribution of obesity categories and estimate associated health costs among self-insured employees of Baptist Health South Florida (BHSF), a large not-for-profit health care organization.

METHODS:
Distribution of BMI categories was determined among individuals participating in a voluntary health risk assessment (HRA) available to employees eligible for health benefits. The potential estimates of obesity related costs to BHSF were imputed using CDC's Obesity Cost Calculator based on data from NHIS and MEPS (http://www.cdc.gov/leanworks/costcalculator/disclaimer.html).

RESULTS:
Overall 9996 (aged 43.1±12.1 years, 75% females, 75% Hispanic, 35% hypertensive, 4% diabetic) employees participated in 2013 annual HRA and wellness fair. The age-adjusted mean BMI was 29.3 (95% CI, 29.1-29.5) for men and 28.3 (95% CI, 28.15-28.45) kg/m2 for women. The table describes distribution of BMI categories according to gender and age groups. The age-adjusted prevalence of obesity (BMI>30 kg/m2) was 36% (95% CI, 34%-37%) among men and 32% (95% CI, 31%-33 %) among women. In BHSF employee population, 6% (n=581) were classified as morbidly obese (BMI>=40) and 7% (n=748) individuals met criteria for bariatric surgery. Total annual estimated cost attributable to high BMI (>25) were $8.05 million (74% medical and 26% work lost) of which 41% were contributed by 14% employees with BMI>35. The average attributable cost per high BMI employee ranged from $598 among those with BMI 25-29.9 to $2695 with BMI>=40.

CONCLUSIONS:
One third of employees (predominantly female and Hispanic) in a large health care organization (BHSF) were obese. Given the significant financial burden imposed by obesity large self-insured organizations like BHSF have a lot to gain by introducing evidence-driven weight reduction programs, and tracking the success of these programs in the workforce.
Abstract P266: The Local Food Environment and Obesity: A Systematic Review
Authors: Cobb Laura K , Appel Lawrence J , Franco Manuel , Jones-Smith Jessica C , Anderson Cheryl A
Published: July 2021

Introduction:
Numerous studies have explored the relationship of the local food environment and obesity. However, results have been inconsistent, and existing literature reviews have not taken into account study quality or the heterogeneity of measures of the local food environment.

Methods:
We used systematic keyword searches in Pubmed and Scopus to identify studies conducted in the US and Canada that assessed the relationship of obesity to the local availability of supermarkets, grocery stores, convenience stores, fast food restaurants or indices combining these measures. We developed a quality metric based on study design, exposure and outcome measurement and analysis, and then assigned each study a score.

Results:
We identified 71 studies representing 65 cohorts. Overall, study quality was low; 60 studies were cross-sectional. The approach to measuring local food environments varied: fast food availability was measured 31 ways in 44 studies. Associations between food outlet availability and obesity were predominantly null. In adults, we saw a trend among the non-null associations toward inverse associations between supermarket availability and obesity (22 inverse, 4 direct, 67 null) and direct associations between fast food and obesity (29 direct, 6 inverse, 71 null). In children, we saw robust direct associations between fast food availability and obesity in lower income populations only (12 direct, 7 null). In adults, indices made up of multiple types of outlets had resulted in the most consistent associations with obesity (18 expected, 23 null). Limiting analyses to higher quality studies did not affect results.

Conclusions:
We found limited evidence for associations between the local food environment and obesity. Quality issues, however, make causal inference difficult. Absent compelling direct evidence linking local food environments to obesity, policy makers will need to rely on other types of evidence as they address the environmental changes that contribute to the steep increase in obesity in the US.
Abstract P278: Prevalence, Patterns and Correlates of Physical Activity Among the Adult Population of Four Cities in the Southern Cone of Latin America: Results from the CESCAS I study
Authors: Poggio Rosana , Matta María G , Serón Pamela , Gutierrez Laura , Irazola Vilma , Rubinstein Adolfo
Published: July 2021

Introduction:
In the Southern Cone of Latin America physical inactivity has become the fifth most important determinant of death. There is no published data describing and comparing physical activity (PA) patterns among different cities in this region.

METHODS:
CESCAS I is an observational, prospective cohort study entailing a probabilistic sample of 7524 representing the general adult population in four middle-size cities of the Southern Cone of Latin America. PA was assessed through the transcultural adapted questionnaire from the International Physical Activity Questionnaire long form. The indicator of PA intensity was expressed continuously, in metabolic equivalent task (MET) per minutes per week. We expressed the total PA score per week as “Total MET-minutes/week” constituted by the sum of Walking, Moderate and Vigorous MET minutes/week scores. Insufficient PA was defined as < Total 600 MET-minutes/week. Analyses were based on weighted data taking into account individual probabilities of inclusion and calibrated on national census data. Multiple linear regressions were conducted as secondary analyses to model for the predictors of low PA. RESULTS: Thirty-five percent of the population is insufficiently active, showing the highest prevalences in Temuco (42.0%), women (41.3%), and “retired or unemployed” status (44.4%). Considering the overall population, women spend one third of energy compared to men (median 989 vs. 2763 MET-minutes/week respectively) mainly because only 12.9% of women performed vigorous activities compared to 39.9% in men. Among those subjects who reported performing vigorous activities, the energy expended by women was much lower than that expended by men (median 2384 vs. 5567 MET-minutes/week, respectively). When the overall population by domain was analyzed, the highest energy expenditure was seen in occupational at the expense of the manual labor category (2856 and 4588 MET-minutes/week for women and men respectively). Analyzing those who reported expending some energy in occupational, we found that men expended more than double the energy compared to women at the expense of vigorous activities (7055 vs. 2803 MET-minutes/week, respectively). In the multivariable analysis insufficient PA was strongly related with the categories retired or unemployed (OR 2.22; 1.87- 2.64), office or clerical work (OR 1.96; 1.60- 2.40), being women (OR 1.56; 1.36- 1.78), obesity (OR 1.47; 1.24- 1.74) and college or university education (OR 1.29; 1.07- 1.56).

CONCLUSIONS:
At least one third of the population did not reach the recommended PA levels necessary for promoting health and preventing diseases. Intervention strategies to promote leisure-time physical activity should be considered a health priority, especially in women.
Abstract P283: Association of Cardiorespiratory Fitness and Adiposity with Inflammatory Biomarkers in Young Adults
Authors: Park Eunduck , Meininger Janet C , Kang Duck-Hee , Gabriel Kelley P
Published: July 2021

Introduction:
Low grade systemic inflammation plays a key role in the pathogenesis of atherosclerosis. There is evidence that higher cardiorespiratory fitness (CRF) is associated with lower levels of inflammatory biomarkers. However, it remains uncertain whether the negative association between CRF and inflammatory biomarkers is due to CRF itself or results from lower levels of adiposity. Moreover, adiposity, including central adiposity, has not been examined as a moderator of the association between CRF and inflammatory biomarkers in young adults.

Hypotheses:
1. Higher level of CRF will be associated with lower levels of inflammatory biomarkers after adjusting for levels of adiposity and confounders. 2. Adjusting for confounders, there will be a significant interaction effect between adiposity (BMI, waist circumference (WC)) and CRF in relation to inflammatory biomarker levels.

Methods:
A cross-sectional study was conducted in Houston, TX. A sample of 88 asymptomatic young adults aged 20-34 years without diagnosed diseases was accessed. CRF was assessed by a submaximal treadmill walking test. Adiposity was measured using BMI and WC. The inflammatory biomarkers (hs-CRP, IL-6 and TNF-α) were assayed and were log
10
-transformed. A separate multiple regression analysis was conducted with each of inflammatory biomarker as dependent variables for hypothesis one. Analysis of covariance was used for hypothesis two. Confounding variables tested were sex, ethnicity, oral contraceptive use, and education level.

Results:
Hypothesis 1: CRF was not associated with log
10
hs-CRP after adjustment for BMI (or WC) and confounders. CRF was not associated with log
10
IL-6 after adjustment for BMI and confounders. However, CRF was negatively associated with log
10
IL-6 after adjustment for WC and confounders (Model adjusted R
2
=.273,
p
< .0001;
β
= -.341, t = -1.995,
p
=.049). Hypothesis 2: CRF х BMI (or WC) interaction was not associated with log
10
hs-CRP after adjustment for confounders. CRF х BMI interaction was not associated with log
10
IL-6 after adjustment for confounders. However, CRF х WC interaction was negatively associated with log
10
IL-6 after adjustment for confounders (Model adjusted R
2
= .258,
p
< .0001; partial eta
2
=.056, F = 4.730,
p
= .033). There were no associations of CRF, adiposity, and log
10
TNF-α.

Conclusions:
In young adults, higher level of CRF is associated with lower level of IL-6 after adjustment for central adiposity and confounders. Further, there is a significant interaction between CRF and WC in relation to IL-6 after adjustment for confounders. Higher levels of CRF may play an important role for lowering some inflammatory biomarkers in central adiposity.
Abstract P295: Oxidative Stress Biomarkers and Incidence of Post-Operative Atrial Fibrillation in the OPERA Trial
Authors: Wu Jason H , Marchioli Roberto , Latini Roberto , Masson Serge , Silletta Maria G , Sellke Frank W , Libby Peter , Milne Ginger L , Mozaffarian Dariush
Published: July 2021

Background:
Post-operative atrial fibrillation (PoAF) commonly complicates cardiac surgery. Animal studies point to oxidative stress as a key mechanism triggering PoAF, and yet, the extent to which oxidative stress might relate to PoAF risk in humans remains speculative.

Methods and Results:
We assessed the association of validated oxidative stress biomarkers (F
2
-Isoprostanes, F
2
-IsoP, Isofurans, IsoF, and F
3
-Isoprostanes, F
3
-IsoP) in plasma and urine, with incident PoAF among 551 cardiac surgery patients. Biomarkers were measured using standardized methods at baseline, the end of surgery, and post-op day 2. PoAF lasting ≥ 30seconds was confirmed by rhythm strip or ECG, and centrally adjudicated. Outcomes were assessed until hospital discharge or post-operative day 10, whichever occurred first. Urine level of each oxidative stress biomarkers demonstrated a rise at the end of surgery (2-3 fold over baseline,
P
<0.001), which subsequently fell and were comparable to baseline by post-op day 2. In contrast, plasma levels remained relatively stable throughout. Urine F
2
-iso and IsoF at the end of surgery were 20% and 50% higher in subjects who developed PoAF (
P
≤ 0.009). Baseline biomarker levels did not associate significantly with PoAF, whereas end of surgery and post-op day 2 Isop and IsoF did associate with PoAF. For example, the end of surgery extreme quartile multivariate adjusted odds ratio (95% CI) for urine IsoF and F
3
-IsoP were 1.95 (1.05-3.62;
P
for trend = 0.01) and 2.10 (1.04-2.25,
P
for trend = 0.04), respectively. Analyses using restricted cubic splines suggested continuous (monotonic) associations of biomarkers of oxidative stress at the end of surgery and post-op day 2 with incident PoAF (
Figure
) There was little evidence that associations of IsoP and IsoF with PoAF varied by demographic, surgery type, and medication use (
P
≥ 0.29 for each).

Conclusions:
Elevated end of surgery and post-op day 2 oxidative stress as assessed by IsoP and IsoF relate independently to higher risk of PoAF.
Abstract P303: Low Albumin and Risk of Type 2 Diabetes
Authors: Rafalson Lisa , Cornelius Leeann , LaMonte Michael , Donahue Richard P
Published: July 2021

Type 2 diabetes (T2DM) is a burdensome, costly and debilitating disease that causes premature morbidity and mortality. Recent evidence suggests that T2DM is in part an inflammatory disease. It is well known that serum albumin is a negative acute phase reactant, yet few studies have examined the association between albumin and risk of T2DM. The purpose of this analysis was to prospectively examine the association between serum albumin and incident type 2 diabetes in middle-aged and older adults from a defined population. The Western New York Health Study enrolled apparently healthy participants ages 35-79 yrs from Niagara and Erie counties, NY. For this report, at baseline (1996-2001) all participants from the Western New York Health Study had fasting plasma glucose <110 mg/dl. At follow-up, six years later each case (n=61) was matched with up to three controls (n=158) on gender, race/ethnicity, the year of study enrollment, and baseline fasting glucose <110 mg/dl or 110-125 mg/dl. Diabetes at follow-up was defined as: 1) fasting plasma glucose > 125 mg/dl; 2) random glucose >199 mg/dl; or 3) a physician diagnosis and receiving antidiabetic medication. Conditional logistic regression was used to estimate the odds ratio (95% CI) of developing type 2 diabetes by tertile of baseline albumin adjusted for the matching criteria and additional covariates including BMI, smoking and physical activity. Mean age was 58 years; 60% women; 93% White. Multivariate analyses indicated that cases had lower baseline albumin concentrations (OR = 0.41, 95%CI: 0.17, 0.99 (p=0.04; lowest tertile vs highest) (p trend < 0.05). Further analyses indicated that this relation was independent of hs-CRP and IL-6. Stratification by smoking status did not alter the findings. The results of this analysis support the hypothesis that individuals with lower albumin concentrations were more likely to develop type 2 diabetes than those with higher levels.
Abstract P308: The Association of Vitamin K Intake and Status With the Metabolic Syndrome: A 10 Year Follow-Up Study
Authors: Dam Veerle , Dalmeijer Geertje W , Vermeer Cees , van der Schouw Yvonne T , Beulens Joline W
Published: July 2021

Background:
The Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities and is associated with increased risk of type 2 diabetes, cardiovascular diseases and all-cause mortality. Vitamin K intake (phylloquinone/menaquinones) and vitamin K status are associated with several components of MetS, but the association with MetS has hardly been studied to date.

Objective:
To examine whether dietary intake and/or status of vitamin K are associated with occurrence of MetS and its components.

Design:
This study comprised of two cohorts, one of 402 women and one of 400 men (40-80 years). At follow-up 625 participants were still alive and willing to participate. Data were analyzed both cross-sectionally and longitudinally with Poisson and linear regression analyses adjusted for lifestyle and dietary factors. Baseline phylloquinone and menaquinone intake were measured with a validated food frequency questionnaire and dephospho-uncarborxylated matrix Gla protein was used as a marker for vitamin K status.

Results:
At baseline 285 (35.6%) participants had MetS and 172 (35.7%) at follow-up. Cross-sectionally, a high intake of menaquinones was associated (P
trend
=0.03) with a lower prevalence of MetS with a prevalence ratio (PR) of 0.70 (95%CI: 0.51-0.96) for the highest versus the lowest tertile. A high vitamin K status was also associated (P
trend
=0.02) with a reduced prevalence of MetS in cross-sectional analyses (PR
T3 vs. T1
=0.73; 0.54-0.98) At follow-up, the highest tertiles of menaquinone intake (PR=0.62; 0.40-0.95) and vitamin K status (PR=0.61; 0.40-0.92) were associated (P
trend
<0.02) with a lower occurrence of MetS. These associations were mainly driven by relations with lower triglyceride concentrations for menaquinones and lower waist circumference in women for vitamin K status. Phylloquinone intake was not associated with MetS prevalence.

Conclusion:
This study shows that a high intake of menaquinones and high vitamin K status are associated with a lower prevalence of MetS. This is mainly driven by the associations of high menaquinones intake with lower triglycerides concentrations and high vitamin K status with lower waist circumference in women.
Abstract P317: Association of Dietary Insulin Index, Insulin Load With Risk of Coronary Heart Disease Among Us Men and Women
Authors: Li Shanshan , Rimm Eric B , Hu Frank B , Sampson Laura , Franz Mary , Willett Walter C
Published: July 2021

Introduction:
Dietary insulin index and insulin load were developed to quantify the insulinogenice effects of various foods to capture the postprandial insulin response elicited by carbohydrate, protein and fat intake. However, the association between dietary insulin index, dietary insulin load with risk of coronary heart disease is unknown. Methods: Based on the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS), two large prospective cohort studies of US women and men, we included 76,277 women and 42,689 men into our study with dietary information measured every 4 years. We excluded participants with a baseline history of cardiovascular disease, type 2 diabetes, or cancer. Multivariate Cox proportional hazard models were used, adjusting for major risk factors for coronary heart diseases. We modeled dietary insulin index and insulin load using simple update, cumulative average, continue updating and stop updating after intermediate outcomes. Results: The multivariate adjusted hazard ratio (HR) and 95% confidence intervals comparing the highest vs. the lowest quintile of dietary insulin index was 1.08 (95% CI: 0.95-1.23; p for trend=0.66) for women, and 1.07 (95% CI: 0.98-1.17; p for trend =0.02) for men. For dietary insulin load, the adjusted HR was 1.1 (95% CI: 0.97-1.25; p for trend=0.50) for women and 1.05 (95%CI: 0.96-1.14; p for trend=0.10) for men. Results were similar across different analytic methods. Conclusion: In this cohort of US women and men, we did not observe a strong positive between dietary insulin index or dietary load and risk of coronary heart diseases.
Abstract P328: Estimating the Population Distribution of Usual 24-Hour Sodium Excretion From Timed-Spot Urine Specimens Among Adults 18-39 Years
Authors: Wang Chia-Yih , Carriquiry Alicia L , Chen Te-Ching , Loria Catherine M , Pfeiffer Christine M , Liu Kiang , Sempos Christopher T , Perrine Cria G , Cogswell Mary E
Published: July 2021

Introduction:
National efforts toward reducing population sodium intake necessitate developing a feasible and valid monitoring method, especially for the distribution tails given about 90% of the US population consumes more sodium than recommended.

Objective:
We developed and tested the validity of a statistical approach using one or two timed-spot urines to estimate population distribution of usual 24-hour sodium excretion.

Methods:
A convenience sample of 407 adults, 18-39 years of age, (54% female, 48% black) collected urine for a 24-hour period, placing each void in a separate container. Of these, 133 repeated the procedure 4-11 days later. Four timed-spot specimens (morning, afternoon, evening, and overnight) were selected from each 24-hour collection. We developed gender-specific equations using Fuller’s error-in-the-equation measurement error model to calibrate total sodium excreted in each of the one-spot (e.g., morning) and combined two-spot (e.g., morning + afternoon) urines to 24-hour sodium excretion. The calibrated sodium excretions were used to estimate the population distribution of usual 24-hour sodium excretion. Participants were then randomly assigned to modeling (n=160) or validation (n=247) groups to examine the bias in estimated population percentiles.

Results:
Median bias in predicting the 5
th
, 25
th
, 50
th
, 75
th
, and 95
th
population percentiles of usual 24-hour sodium excretion with one-spot urine ranged from -367 to 284 mg (-7.7 to 12.2% of the observed usual excretions) for men and -604 to 486 mg (-14.6 to 23.7%) for women, and with two-spot urines from -338 to 263 mg (-6.9 to 10.4%) and -166 to 153 mg (-4.1 to 8.1%), respectively. Four of the six two-spot urine combinations produced no significant bias in predicting selected percentiles.

Conclusions:
Our approach to estimate the population distribution of usual 24-hour sodium excretion using calibrated spot urine sodium accounted for day-to-day variation and covariance between measurement errors, and produced percentile estimates with relatively low biases across low to high sodium levels. This may provide a low-burden, low-cost alternative to 24-hour collections in monitoring population sodium intake among healthy young adults and merits further investigation in other population subgroups.
Abstract P347: Risk of Incident Coronary Heart Disease Events in Men Compared to Women by Menopause Type and Race
Authors: Kim Catherine , Cushman Mary , Khodneva Yulia , Lisabeth Lynda D , Judd Suzanne , Kleindorfer Dawn O , Howard Virginia J , Safford Monika M
Published: July 2021

Introduction:
Men have greater risk of coronary heart disease (CHD) compared to women. It is unclear whether type of menopause affects this sex difference and if the impact is similar in blacks and whites. Moreover, women and their physicians may consider CHD risk when considering whether elective hysterectomy and/or bilateral salpingo-oophorectomy (BSO) are performed.

Hypotheses:
Women who undergo natural menopause, menopause due to BSO, and menopause due to hysterectomy alone have different risks of non-fatal CHD and acute CHD death compared to men.

Methods:
Participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007 without CHD at baseline (n=23,086), with follow-up through December 2011. Cox proportional hazard models were used to calculate the hazard of incident CHD events in men vs. women by menopause type, stratified by black vs. white race. The main outcome measure was adjudicated incident CHD events, defined as nonfatal CHD (definite or probably myocardial infarction) and acute CHD death.

Results:
Over a median 6.0 years of follow-up, 892 incident CHD events occurred. Cox regression models adjusted for age, age at last menstrual period < 45 years, region, education level, income, CHD risk factors (total cholesterol, high-density lipoprotein, smoking, systolic blood pressure, diabetes, albumin to creatinine ratio, physical activity, C-reactive protein, body mass index and waist circumference), and use of anti-hypertensive medications, statins, and estrogen therapy. Associations of menopause with non-fatal events differed by race (p for interaction=0.03). Among white women, natural menopause (hazard ratio [HR] 0.45, 95% CI 0.31, 0.66) and surgical menopause (HR 0.65, 95% CI 0.42, 0.99) were associated with a reduced hazard of non-fatal events compared to white men. Among black women, natural menopause was marginally significantly associated with lower hazard of non-fatal events compared to men (HR 0.69, 95% CI 0.47, 1.03) but surgical menopause was not (HR 0.81, 95% CI 0.51, 1.29). For acute CHD death, women had lower risk than men regardless of their menopause type and race.

Conclusions and Relevance:
Sex differences in the risk of incident CHD events were larger among whites than blacks and varied by type of menopause. Women consistently had a lower risk of incident CHD death than men, but the magnitude of sex differences was greater in whites than blacks for non-fatal events regardless of menopause type. Menopause type was not associated with large differences in the hazard for CHD risk.