bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P283: Healthy Food Marketing Can Potentially Increase Consumption of Fruit and Vegetables in New York City Neighborhoods
Authors: Li Yan , Siscovick David S , Zhang Donglan , Pagán José A
Published: July 2021

Introduction:
Consumption of fruit and vegetables is associated with a lower risk of obesity, diabetes, hypertension, and cardiovascular disease
.
While five or more servings of fruits and vegetables are recommended, only 50% of residents of New York City (NYC) consume two or more servings a day. While food marketing can change individual dietary behaviors, there is limited evidence on the extent to which healthy food marketing strategies—such as community-based and mass-media campaigns—influence fruit and vegetable consumption at the neighborhood level. Agent-based modeling (ABM) has the potential to provide new insights on how healthy food marketing may impact dietary behaviors by simulating interventions, consumption decisions, and interactions among people in different contexts.

Hypothesis:
Healthy food marketing significantly increases consumption of fruit and vegetables in NYC neighborhoods. The impact of healthy food marketing varies across different neighborhoods depending on population characteristics and the local food environment.

Methods:
We developed an ABM that takes into account individual and neighborhood-level factors (e.g., age, gender, education, food environment) and influences of social networks (peers, friends, and family) to predict dietary behaviors of individuals at the neighborhood level. Model parameters were estimated from the Food Attitudes and Behaviors Survey, United States Census data, and previous studies. Healthy food marketing can strengthen positive social norms with regard to dietary behaviors. We simulated two hypothetical healthy food marketing interventions that could improve the influence of positive social norms by 5% and 10%, respectively. We predicted the impact of these interventions on the proportion of the population who consume two or more servings of fruits and vegetables across 34 NYC neighborhoods (defined by the United Hospital Fund) in three years. We validated our model using data from the NYC Community Health Survey.

Results:
The simulation results suggested that the healthy food marketing interventions have the potential to increase the proportion of the population who consume two or more servings of fruits and vegetables over three years: for a 5% improvement on positive social norms, the increase in the proportion was 0.58% - 8.97% by neighborhood; and for a 10% improvement on positive social norms, 2.68% - 13.94% by neighborhood. Exploratory analyses suggested that among population characteristics, a high proportion of population without a high school diploma was associated with lower effectiveness of healthy food marketing in increasing consumption of fruits and vegetables.

Conclusions:
Healthy food marketing may increase consumption of fruits and vegetables in NYC, but more attention to the mechanisms that account for the lower increase in neighborhoods with low educational attainment is needed.
Abstract P292: Age at Menarche, Weight Change From Young Adulthood to Middle Age, and Adult Adiposity: Evidence From The Hong Kong Women’s Health Study
Authors: Xie Yao Jie , Ho Suzanne C.
Published: July 2021

Background:
Previous studies have shown that early menarche is associated with elevated adiposity in adulthood. This relationship was not well-examined in Hong Kong Chinese women. The purposes of this study were: 1) to examine the associations between age at menarche and adult body mass index (BMI) and adiposity; 2) to determine whether weight change from age 18 to middle age modifies the relationship between early menarche and adult adiposity.

Methods:
A life-course epidemiology study named “Hong Kong Women’s Health Study” was conducted among Chinese female nurses in Hong Kong. Three rounds of mail surveys were implemented and 1253 nurses aged 35 to 65 years were involved in this study. Age at menarche, height, weight at age 18, current weight, waist circumference and other variables were collected by a self-administered questionnaire. Weight change was calculated as current weight minus weight at age 18. The self-reported anthropometric variables have been validated in a pilot study.

Results:
The mean age at menarche was 12.5±1.4 years. Nearly one fourth (23.9%) of the women had early menarche (≤11 years). The mean weight change was 5.8±6.8 kg. Women with early menarche had higher body weight at age 18 (51.6 kg vs. 48.6 kg, p<0.001) but lesser weight change from age 18 to current (5.0 kg vs. 6.0 kg, p<0.05) than those without early menarche. Using regression analyses, after adjustment for age, height, and physical activity, one year increase in age at menarche was associated with 0.21 kg/m2 decrease in BMI (95% CI: -0.33 to -0.09, p<0.001); early menarche was significantly associated with overweight/obesity (OR=1.64, 95% CI: 1.23 to 2.19, p<0.01) and central adiposity (OR=1.73, 95% CI: 1.29 to 2.32, p<0.001). All these associations were strengthened after further adjustment of weight change (all p<0.01). In the stratified analysis, the ORs were 1.49 and 1.68 for overweight/obesity and central adiposity in weight gain group (gained weight > 1 kg), and 2.85 and 1.69 in weight loss group (lost weight > 1 kg), respectively (all p<0.05).

Conclusions:
Our study indicated that early menarche predicted greater BMI and elevated adiposity in adulthood. This association could not be eliminated by weight change status, even if the women had reduced body weight from young adulthood to middle age.
Abstract P301: Adipocytokines and Vitamin D in a Biracial Sample of Young Metabolically Healthy Obese and Metabolically Abnormal Obese Women
Authors: Camhi Sarah M , You Tongjian , Hayman Laura L , Must Aviva , Lichtenstein Alice H
Published: July 2021

Purpose:
Adipocytokines and vitamin D (vitD) concentrations may contribute to cardiometabolic risk profiles in obese populations. To address this potential relationship we assessed levels of adipocytokines and vitD concentrations between young metabolically healthy obese (MHO) and metabolically abnormal obese (MAO) black and white women.

Methods:
Project Health included 46 overweight/obese young women (BMI ≥25 kg/m2, age=19-35 years, 61% Black). Women were classified as MHO (<2 abnormal cardiometabolic risk factors) or MAO (≥2 abnormal cardiometabolic risk factors) based on: blood pressure ≥130/85 mmHg; triglycerides ≥150 mg/dL; HDL-C <50 mg/dL; glucose ≥100 mg/dL; CRP ≥90th %tile; HOMA-IR ≥90th %tile). Serum levels of high sensitivity C-reactive protein (CRP) were measured by an immunoturbidimetric assay; levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) by an electrochemiluminescence immunoassay; adiponectin by an enzyme-linked immunosorbent assay; and 25-hydroxyvitamin D (vitD) by a radioimmunoassay. Total body fat was measured by dual x-ray absorptiometry. Pearson correlations were used to test the associations between body fat and serum measures. T-tests and linear regression (adjusting for race and body fat) were used to examine differences between MHO and MAO.

Results:
Compared to MAO (n=9, 20%), MHO (n=37; 80%) had significantly lower BMI values (MHO: 30.5±3.5; MAO: 34.3±3.9 kg/m2, p=0.004), but there was no significant difference in body fat (mean in total sample: 45.3±6.2%). CRP concentration was significantly associated with higher body fat (%) in MAO (r=0.78, p=0.007), but this relationship was not significant in MHO. IL-6, TNF-α and vitD were not significantly correlated with percent body fat in either MHO or MAO. Compared to MHO, MAO had significantly higher CRP levels (log mg/L MHO: 0.82±1.2 vs. MAO 1.8±0.9, p=0.01); and significantly lower adiponectin levels (log ng/mL MHO: 9.7±0.5 vs. MAO 9.0±0.3; p=0.0004). These differences remained significant after adjusting for race and body fat. There were no significant differences between MHO and MAO for IL-6, TNF-α or VitD levels.

Conclusion:
Compared to MHO, young women who are MAO have higher levels of CRP and lower levels of adiponectin even after controlling for potential confounders. Our findings suggest that chronic inflammation may play an important role in the mechanism of abnormal cardiometabolic risk as it differentiates young MHO and MAO women.
Abstract P321: Insulin Resistance is Associated with Incident Coronary Heart Disease but Not Stroke Among African Americans: The Jackson Heart Study
Authors: Effoe Valery S , Wagenknecht Lynne E , Echouffo-Tcheugui Justin B , Chen Haiying , Joseph Joshua J , Kalyani Rita R , Bell Ronny A , Wu Wen-Chih H , Casanova Ramon , Bertoni Alain G
Published: July 2021

Background:
The association between the homeostasis model assessment for insulin resistance (HOMA-IR) and CVD varies by race/ethnicity and is often non-existent or weaker in African Americans (AAs). Triglyceride levels (110-149 mg/dl) below the current metabolic syndrome threshold are associated with insulin resistance in AAs, suggesting that the McAuley index (MA
index
), based on insulin and triglycerides, may predict CHD and stroke better than HOMA-IR. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of AAs.

Methods:
Insulin resistance was estimated for 3565 participants without diabetes and CVD at baseline using the MA
index
(exp [2.63-0.28 In(insulin in mU/l) - 0.31 In(triglycerides in mmol/l)]) and its association with incident CHD and stroke (composite outcome) was compared against that of the HOMA-IR index. A lower MA
index
and higher HOMA-IR are indicative of insulin resistance. Cox regression analysis was used to estimate adjusted hazard ratios (HR) for incident CHD and stroke, individually and as a composite.

Results:
There were 158 events (89 CHD-only, 58 stroke-only, and 11 CHD/stroke) over a median follow-up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the MA
index
(HR 0.80; 95% CI: 0.67 - 0.96), with no attenuation following further control for CHD and stroke risk factors. When considered individually, the MA
index
was associated with CHD (HR 0.71, 95% CI: 0.55 - 0.92), but not stroke (HR 0.96, 95% CI: 0.74 - 1.25) risk. The log(HOMA-IR)-CHD association was comparable to that observed with the MA
index
(Table 1). For both indices, an association was present in men, but not in women (P
interaction
= 0.01 and 0.2 for log(HOMA-IR) and MA
index
, respectively).

Conclusions:
The performance of the MA
index
in predicting CHD and stroke risk in AAs is comparable to the widely used HOMA-IR index. Our findings suggest a role of insulin resistance in CHD but not stroke risk in this population.
Abstract 04: Racial Disparities in Cardiovascular Health Behaviors are Partially Explained by Socioeconomic, Psychosocial and Environmental Factors: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Whitaker Kara M , Jacobs David R , Kershaw Kiarri N , Booth John N , Goff David C , Lloyd-Jones Donald M , Demmer Ryan T , Kiefe Catarina I
Published: July 2021

Introduction:
There are known racial differences in cardiovascular health behaviors, including smoking, physical activity, and diet quality. A better understanding of factors that explain these differences may suggest novel intervention targets for reducing disparities in cardiovascular disease.

Objective:
To examine whether socioeconomic, psychosocial and environmental factors mediate racial differences in health behaviors.

Methods:
We studied 3,028 Black or White CARDIA participants who were enrolled at age 18-30 years in 1985-86 and completed the 30 year follow-up visit in 2015-2016. Health behaviors included smoking (current, former ≤ 12 months, never smoker/quit >12 months), physical activity (inactive, active but not meeting guidelines, meeting guidelines), and a surrogate for healthy eating using fast food and sugar-sweetened beverage consumption (frequency per week ≥ 2, some but < 2, none). Each behavior was assigned a value of 0 for poor, 1 for intermediate or 2 for ideal and summed to calculate an overall health behavior score for each participant (range 0-6). The race difference (β) in health behavior score was estimated using linear regression. Formal mediation analyses computed the proportion of the total effect of race on health behavior score explained by socioeconomic, psychosocial, and environmental factors (see
Table
footnote).

Results:
Blacks had a lower health behavior score than Whites in crude analyses (mean difference: -1.04, p<0.001). After adjustment for sex, age and field center, socioeconomic factors mediated 50.5% of the association between race and the health behavior score, psychosocial factors 26.8% and environmental factors 9.0% (p<0.05 for all). Joint associations mediated 58.1% of the race-health behavior score association.

Conclusions:
Observed racial differences in the health behavior score are predominately mediated by socioeconomic factors, which appear to play a stronger explanatory role than psychosocial and environmental factors.
Abstract 10: Metabolically Healthy Obesity Over 25 Years in the Coronary Artery Risk Development in Young Adults (CARDIA) Study: Race and Sex Differences
Authors: Camhi Sarah M , Must Aviva , Gona Philimon N , Hankinson Arlene , Odegaard Andrew , Reis Jared , Gunderson Erica P , Jacobs David R , Carnethon Mercedes
Published: July 2021

Background:
Obesity is heterogeneous condition with phenotypic variation. Metabolically healthy obese (MHO) may represent an unstable phenotype which changes over time. MHO duration, or the length of time in MHO, is not well characterized. The purpose is to quantify MHO duration over 25 years and explore possible race/sex differences.

Methods:
Young adults (baseline ages 18-30 yrs) from CARDIA were included if they were non-obese at baseline, developed obesity (BMI ≥30kg/m
2
) at any follow-up exam (yrs 7, 10, 15, 20 and 25), and had complete data for metabolic status, age, race and sex (n=702). MHO was defined as obese (BMI ≥30 kg/m
2
) and having either 0 or 1 risk factor of the following: ≥SBP/DBP 130/85 mmHg; glucose ≥100 mg/dL; triglycerides (≥150 mg/dL); and HDL-C (men <40, women <50 mg/dL). Obese individuals with ≥2 risk factors were classified as metabolically unhealthy obese (MUO). MHO duration (yrs) and obesity duration (yrs) were estimated for subsequent time-points; and a duration sum was calculated for the follow-up period. For two time-points in which a person remained MHO and obese, a duration for that period was assigned. If they transitioned to MUO or non-obese, then the midpoint of the time period was estimated as MHO duration (yrs). MHO duration was also expressed as the percentage (%) of the total obesity duration. Multivariable adjusted ANCOVA was used to compare MHO duration (%) between race and sex groups (black men, white men, black women and white women), adjusting for baseline age, baseline BMI status (normal weight or overweight).

Results:
The eligible CARDIA sample was 55% black, 71% women and had a mean (± SD) baseline age of 25.0 ± 3.7 yrs. Duration of obesity was 12.3 ± 6.8 yrs, MHO duration (yrs) was 6.2 ± 5.4 yrs (range: 0 years to 19 yrs), and MHO duration (%) was 51.9 ± 34.8%. After adjusting for age and baseline BMI, MHO duration (%, mean ± SE) was significantly higher in women compared to men within race (black women n=292: 56.3 ± 2.0% vs. black men n=91: 43.3 ± 3.6%, p=0.001; white women n=206: 56.1 ± 2.4% vs. white men n=113: 39.7 ± 3.2%, p <0.0001). No significant differences were found between race groups within gender (black men vs. white men or black women vs. white women).

Conclusion:
MHO status is a transient phenotype accounting for only approximately half of obesity duration. Women have longer MHO duration compared to men, but differences by race were not apparent. Future research is needed to explore possible modifiable predictors and/or determinants of longer MHO duration in order to maintain a healthy cardiometabolic phenotype, even in the presence of obesity.
Abstract 17: Association of Race and Sex with Cardiovascular Disease and Non-Cardiovascular Disease Mortality: The REasons for Geographic and Racial Differences in Stroke study
Authors: Tajeu Gabriel S , Safford Monika M , Howard George , Tanner Rikki M , Muntner Paul
Published: July 2021

Introduction:
Black Americans have higher rates of cardiovascular disease (CVD) mortality compared with whites. Differences in sociodemographic, psychosocial, CVD, and other risk factors may explain increased mortality risk.

Methods:
We analyzed data from 29,015 REasons for Geographic and Racial Differences in Stroke study participants to determine factors that may explain the higher hazard ratio for CVD and non-CVD mortality in blacks compared with whites. Cause of death was adjudicated by trained investigators. Within age-sex sub-groups, we used Cox proportional hazards regression with progressive adjustment to estimate black:white hazard ratios.

Results:
Overall, 41.0% of participants were black, and 54.9% were women. Over a mean follow-up of 7.1 years (maximum 12.3 years), 5,299 participants died (1,797 CVD and 3,502 non-CVD deaths). Among participants < 65 years of age, the age and region adjusted black:white hazard ratio for CVD mortality was 2.28 (95% CI: 1.68-3.10) and 2.32 (95% CI: 1.80-3.00) for women and men, respectively, and for participants ≥ 65 was 1.54 (95% CI: 1.30-1.82) and 1.35 (95% CI: 1.16-1.57) for women and men, respectively (
Table
). The higher black:white hazard ratios for CVD mortality were no longer statistically significant after multivariable adjustment, with the largest attenuation occurring with sociodemographic and CVD risk factor adjustment. Among participants < 65 years of age, the age and region adjusted black:white hazard ratios for non-CVD mortality were 1.51 (95% CI: 1.24-1.85) and 1.76 (95% CI: 1.46-2.13) for women and men, respectively, and for participants ≥ 65 was 1.12 (95% CI: 1.00-1.26) and 1.34 (95% CI: 1.20-1.49) for women and men, respectively. The higher black:white hazard ratios for non-CVD mortality were attenuated after adjustment for sociodemographics.

Conclusions:
Black:white differences are larger for CVD than non-CVD causes of death. The increased CVD mortality for blacks compared with whites is primarily explained by sociodemographic and CVD risk factors.
Abstract 31: Cardiovascular Health at Young and Middle Ages and Dementia in Older Age - The Chicago Heart Association Detection Project in Industry Study
Authors: Vu Thanh Huyen T , Lloyd-Jones Donald M , Schiman Cuiping , Liu Lei , Zhao Lihui , Liu Kiang , Shih Ya-Chen Tina , Fries James F , Daviglus Martha L , Allen Norrina B
Published: July 2021

Background:
Data are sparse regarding the association of cardiovascular health (CVH) in younger/middle age with the diagnosis of dementia later in life.

Methods:
We used linked data from the Chicago Heart Association Detection Project in Industry Study assessed in 1967-73 with fee-for-service Medicare claims and National Death Index data from 1991-2010. Participants were ≤65 years old in 1991 and Medicare eligible during 1991-2010. Baseline CVD risk factors included blood pressure, cholesterol, BMI, smoking, and diabetes. Participants were classified into four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. ICD-9 codes were used to identify date of first dementia diagnosis. We used competing Cox models to estimate hazards for dementia in Medicare data after age 65 with competing event of all-cause mortality prior to dementia diagnosis. Covariates included baseline age, race, sex, and education attainment.

Results:
This study included 4,273 females and 8,381 males, 10.3% Black, baseline ages 18-48. Dementia was diagnosed in 5.1% of study participants. The prevalence of dementia diagnosis increased with increasing CVH burden from 3.4% to 6.4%. During 1991-2010 in Medicare, the average time from age 65 to the first dementia diagnosis was 7.7 years. Greater CVH in younger age was associated with a reduced risk of being diagnosed with dementia in later life. Hazards ratios of experiencing dementia in those with baseline favorable levels, 0 RF high, and 1 only high RF were lower by 36%, 29%, and 28% respectively as compared to those with 2+ high-risk factors (see Table - Model 1). Similar trends were observed when deaths were treated as competing events although the association was attenuated (Model 2). Patterns were similar when stratified by sex or race.

Conclusions:
Having a favorable CVH profile at younger age is associated with lower risk of dementia in older age. Improvements in CVH in younger age may translate to increased independence and quality of life later in life.
Abstract 38: Glucose Levels and Brain Gray Matter Volume in Middle-aged Adults: Findings From the Coronary Artery Risk Development in Young Adults CARDIA Study
Authors: Elbejjani Martine , Bryan R Nick , Schreiner Pamela J , Jacobs David R , Lewis Cora E , Sidney Stephen , Reis Jared , Lee Ju-Mi , Launer Lenore J
Published: July 2021

Background:
Type II diabetes has been widely linked to a higher risk of dementia. Some studies have also shown relationships between diabetes and magnetic resonance imaging (MRI) markers of exacerbated brain aging and neurocognitive pathology, such as gray matter (GM) volume atrophy. However, data on the earlier impacts of glucose levels on GM volume in younger subjects are scarce.

Objective:
We assessed the cross-sectional relationship of fasting glucose levels and GM volume measured at middle-age.

Methods:
Data come from the brain MRI sample of the CARDIA study, a bi-racial community-dwelling cohort of middle-aged adults (n=709, mean age=50 (SD=3.5)). We used multivariable linear regression models and adjusted for potential confounders, including several cardiovascular and metabolic factors (hypertension, body mass index, smoking, history of vascular disease, and hypercholesterolemia).

Results:
Higher fasting glucose levels were associated with smaller total GM volume (-1 mL (95%CI= -0.16, -0.04) smaller GM volume per each 1 mg/dL increase in glucose levels). In analyses exploring the normal (<100 mg/dL), pre-diabetic (≥100, <126 mg/dL), and diabetic glucose ranges (≥126 mg/dL), we found that subjects with diabetic glucose levels had -14 mL smaller GM (95%CI= -21.50, -5.61; p=0.001) than subjects with normal glucose levels; subjects with pre-diabetic levels were not significantly different from those with normal levels (p for trend for the glucose-range categories =0.08).

Conclusion:
Results suggest that important relationships between glucose levels and smaller GM can already be detected at middle-age. These associations were particularly pronounced in the diabetic glucose ranges. Findings strengthen the links between vascular factors and brain health and emphasize the importance of studying the earlier stages of these links to improve our understanding of the course of brain diseases and to identify optimal time-windows for prevention and treatment strategies.
Abstract 44: Cardiorespiratory Fitness Decreases Stroke Incidence in Hypertensive Veterans
Authors: Kokkinos Peter , Faselis Charles , Narayan Puneet , Myers Jonathan , Karasik Pamela , Moore Hans
Published: July 2021

Introduction:
Stroke incidence is significantly higher in hypertensive patients compared to normotensive subjects. Cardiorespiratory fitness (CRF) is associated with a more favorable cardiovascular health. The CRF-stroke incidence association in hypertensive patients has not been fully explored.

Hypothesis:
We assessed the hypothesis that CRF is inversely and independently associated with stroke incidence in hypertensive patients.

Methods:
From 1985 to 2014, we identified 12,933 hypertensive patients (mean age: 60±11 years) with a normal response to an exercise tolerance test and no prior history of stroke. We established five fitness categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-Fit (4.1±1.0 METs; n=2,516); Low-Fit (5.6±1.0; n=2,772); Moderate-Fit (7.0±1.0 METs; n=2,803); Fit (8.4±1.3 METs; n=3,282); and High-Fit (11.4±2.0 METs; n=1,560). A multivariable Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of stroke across fitness categories. The model was adjusted for age, resting blood pressure, BMI, atrial fibrillation, gender, race, other cardiac risk factors, alcohol dependence and medications. The Least-fit category was used as the reference group.

Results:
During follow-up (median=11.4 years; 152,408 person-years), 694 individuals (4.5 events per 1,000 person-years) developed stroke. The risk for stroke was 5% lower for each 1-MET increase in exercise capacity (HR=0.95, CI: 0.92-0.98; p<0.001). When considering fitness categories, stroke risk was lower by 28% (HR=0.72; CI: 0.57-0.90) for the Moderate-Fit and Fit individuals (HR=0.72; CI: 0.58-0.89) and 33% for High-Fit individuals (HR= 0.67; CI: 0.50-0.88).

Conclusions:
Increased CRF was inversely related to stroke incidence in hypertensive patients. The association was independent and graded.
Abstract MP012: Plasma Galectin-3 Levels and Subsequent Risk of Incident Chronic Kidney Disease
Authors: Rebholz Casey M , Selvin Elizabeth , Liang Menglu , Ballantyne Christie M , Hoogeveen Ron C , Grams Morgan E , Coresh Josef
Published: July 2021

Introduction:
Galectin-3 is a 35 kDa β-galactoside-binding lectin which has been proposed as a novel biomarker of heart failure primarily due to its involvement in myocardial fibrosis. Elevated levels of galectin-3 may be associated with fibrosis of other organs, such as the kidney, and increase the risk of developing kidney disease.

Methods:
Using Cox proportional hazards regression, we prospectively analyzed Atherosclerosis Risk in Communities (ARIC) study participants with measurements of plasma galectin-3 levels at baseline (visit 4, 1996-98) and without prevalent kidney disease or heart failure (N=9,647). Incident chronic kidney disease was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m
2
accompanied by 25% eGFR decline, chronic kidney disease-related hospitalization or death, or end-stage renal disease between baseline and December 31, 2013.

Results:
2,105 participants (22%) developed incident chronic kidney disease over a median follow-up of 16 years. The mean (standard deviation) plasma level of galectin-3 was 14.7 (4.4) ng/mL. At baseline, galectin-3 was cross-sectionally associated with eGFR (r = -0.31) and urine albumin-to-creatinine ratio (UACR) (r = 0.19). After adjusting for demographics and kidney disease risk factors, there was a significant, graded, and positive association between galectin-3 and incident chronic kidney disease (quartile 4 vs. 1 HR: 1.84, 95% CI: 1.62, 2.09, p for trend <0.001). The association between galectin-3 and incident chronic kidney disease was attenuated but remained significant after accounting for eGFR and UACR (quartile 4 vs. 1 HR: 1.58, 95% CI: 1.39, 1.80, p for trend <0.001). The association was similar by diabetes status (p for interaction = 0.33) and stronger among those with hypertension (p for interaction = 0.004).

Conclusion:
In this community-based population, higher plasma galectin-3 levels were associated with elevated risk of developing incident chronic kidney disease, particularly among those with hypertension.
Abstract MP036: Prevalence of American Heart Association Heart Failure Stages in African-American and White Middle Aged Adults: The CARDIA Study
Authors: Gidding Samuel S , Lloyd-Jones Donald , Lima Joao , Ambale-Venkatesh Bharat , Shah Sanjiv , Shah Ravi , Lewis Cora E , Jacobs David R , Allen Norrina
Published: July 2021

Background:
Symptomatic heart failure is increasingly recognized as a chronic and lethal condition with antecedents, earlier in life, including hypertension, obesity, and diabetes. The American Heart Association (AHA) has developed a four stage heart failure staging classification system. At the year 30 examination (and prior examinations) of the Coronary Artery Risk Determinants in Young Adulthood (CARDIA) data has been collected on a population-based cohort of 48-60 year old black and white men and women.

Methods:
Data on demographics and attributes for classification into a heart failure stage were retrieved from the CARDIA database. Participants were then assigned to No Risk, stage A (asymptomatic but with risk factors (hypertension, obesity, diabetes, atherosclerotic disease, metabolic syndrome, cancer), stage B (asymptomatic but prevalent cardiac structural abnormality or prevalent heart disease(prior myocardial infarction, LV hypertrophy, low LV ejection fraction, asymptomatic valve disease), or stage C/D (symptomatic, merged).

Results:
The Table shows the prevalence of each heart failure stage by race and gender and for the CARDIA cohort examined in Y30 without missing data. Almost half the cohort is at risk (Stage A) and about a fifth has heart failure associated co-morbidities (Stage B). Only about a fifth of African-Americans have no heart failure risk while about two fifths of whites have no risk, mostly secondary to higher prevalence of obesity and diabetes (p < 0.01). There is a higher prevalence of stage C/D in African-Americans.

Conclusion:
Heart failure prevention should begin in young adulthood, particularly in African-Americans.
Abstract MP039: Association Between Estimated 24-hour Urinary Sodium and Potassium Excretion and Blood Pressure in a Japanese Cohort: a Repeated Measure Analysis
Authors: Nguyen Trang , Miura Katsuyuki , Tanaka Sachiko , Tanaka Taichiro , Nakamura Yasuyuki , Kadota Aya , Tamaki Junko , Takebayashi Toru , Okamura Tonomori , Ueshima Hirotsugu ,   HIPOP-OHP Rsch Group
Published: July 2021

Background:
While measurement of sodium (Na) and potassium (K) from the collection of urine over a 24-hour period are associated with blood pressure, relationships with 24-hour urinary excretion estimates from more conveniently collected spot urine samples are less clear.

Objectives:
The purpose of this report is to examine the association of estimated 24-hour excretion of Na, K and their ratio from annually repeated spot urine samples with systolic (SBP) and diastolic (DBP) blood pressures.

Methods:
Data include 4,958 normotensive Japanese aged 19 to 55 years who participated in annual physical examinations over a 5-year period in the High-Risk and Population Strategy for Occupational Health Promotion Study (1999-2004). At each examination, spot urine samples were collected in the morning and blood pressure was measured following standardized procedures. 24-hour urinary excretion of Na and K were estimated from spot urine specimens using the formula of Tanaka. Adjustments were made for potential confounding from demographic, lifestyle education, body mass index, smoking, alcohol consumption and physical activity. Mixed-effects regression models were used to examine the association of the estimated 24-hour excretion of Na, K, and the sodium-to-potassium (Na:K) ratio with SBP and DBP over the 5-year period of study.

Results:
A one standard deviation (SD) increase in the estimated 24-hour excretion of Na (36.6 mmol/day) was associated with a 1.3 mm Hg higher SBP and a 0.8 mm Hg higher DBP (P<.001). The association between Na and SBP was greater in men (1.4 mm Hg per SD) than in women (0.9 mm Hg per SD, P=.003 for interaction) and increased with age (1.0 mm Hg per SD at <35 years of age, 1.2 mm Hg per SD at 35 to 45 years of age, and 1.8 mm Hg per SD at >45 years of age, P<.001 for interaction). Estimated 24-hour excretion of K was inversely associated with blood pressure where a one SD increase (8.9 mmol/day) was associated with a 1.1 mm Hg lower SBP and 0.7 mm Hg lower DBP (P<.001). Unlike the estimated 24-hour excretion of Na, interactions between K and age or sex were absent. Estimated 24-hour Na:K ratio were positively associated with SBP and DBP, with greater effects in men than in women and increasing positive associations with age (P<.01 for each interaction).

Conclusions:
Estimated 24-hour excretion of Na, K, and the Na:K ratio from spot urine samples have significant associations with blood pressure. Findings suggest that the less costly and more convenient collection of spot urine samples for estimating excretion of Na, K, and their ratio over a 24-hour period may be an efficient way of monitoring these electrolytes in large population-based samples.
Abstract MP047: Abdominal Skeletal Muscle Density is Significantly Associated With Selected Measures of Adiposity Associated Inflammation: the Multi-Ethnic Study of Atherosclerosis
Authors: Van Hollebeke Rachel , Cushman Mary , Allison Matthew A
Published: July 2021

Background:
Excess adiposity is associated with higher levels of certain inflammatory markers that have been linked to cardiometabolic disease. Lean skeletal muscle is the largest regulator of glucose metabolism but few population-based studies have examined the associations between muscle and inflammation. Therefore, we studied the relationships between abdominal muscle mass [area] and density with selected measures of adiposity-associated inflammation.

Methods:
Nearly 2,000 subjects enrolled in the Multi-Ethnic Study of Atherosclerosis underwent computed tomography (CT) of the abdomen and had venous fasting blood drawn concomitantly. The CT scans were interrogated for visceral and subcutaneous fat, as well as lean muscle areas and densities in the rectus abdominus, obliques, paraspinus and psoas muscle groups. We then categorized the muscle in locomotion (psoas) and stabilization groups (rectus, obliques and paraspinus). The blood samples were assayed for interleukin-6, resistin, C-reactive protein, and tumor necrosis factor - alpha. Multivariable linear regression was used to determine the independent associations between muscle area and density with each of the aforementioned adipokines.

Results:
The mean age was 64.7 years and 49% were female. Forty percent were non-Hispanic White, 26% were Hispanic/ Latino American, 21% were African American, 13% were Chinese American. The mean BMI was 28.0 kg/m
2
and 30% were obese (BMI > 30 kg/m
2
). With adjustment for age, gender, race, dyslipidemia, diabetes, hypertension, eGFR, coronary artery calcium, physical activity, sedentary behavior, selected adipokines and both subcutaneous and visceral fat, a 1-SD increment in the mean densities for total abdominal muscle, total stabilization muscle and total locomotive muscle were each significantly associated with lower levels of interleukin-6 (-15%, -15% and -9%, p < 0.01 for all) and resistin (-0.11, -0.11 and -0.07 ng/mL, p < 0.02 for all), but not CRP or TNF-alpha. These associations remained significant after additional adjustment for muscle area in the corresponding muscle group. Conversely, the areas of the muscle variables were not independently associated with any of the adipokines, especially after adjustment for muscle density. There were no significant interactions between ethnicity and both muscle area and density for any of the adipokines.

Conclusions:
Higher densities of several muscle groups in the abdomen are significantly associated with lower interleukin-6 and resistin levels, independent of the muscle area in these groups. Techniques that either enhance or maintain muscle density levels may reduce the risk of cardiometabolic diseases linked to adverse levels of inflammation.
Abstract MP060: Contributors to the Geographic Disparity in Stroke Incidence in the United States: Results From the Reasons for Geographic and Racial Disparities in Stroke Cohort
Authors: Howard George , Labarthe Darwin R , Howard Virginia J , Judd Suzanne E , Moy Claudia S , Kissela Brett M , Cushman Mary
Published: July 2021

Introduction:
Geographic disparities in US stroke risk have recently been confirmed by REGARDS, but contributors to this are unknown. Higher prevalence of risk factors (RF) and lower socioeconomic status (SES) may contribute to this geographic disparity. For a RF/SES to contribute to this disparity it must
both
: 1) have a large geographic difference in prevalence, and 2) be powerfully associated with stroke risk.

Methods:
The 1,623 counties of residence of 24,863 REGARDS participants were placed in quartiles of Vital Statistics stroke mortality. Logistic regression assessed the geographic difference in prevalence of each RF/SES by quartile of stroke mortality. Proportional hazards was used to calculate HR stroke for each RF/SES. Mediation analysis then estimated the proportion of increased stroke incidence in counties with high stroke mortality explained by each RF/SES.

Results:
Higher county-level stroke mortality was significantly associated with low neighborhood SES (nSES), and more weakly associated with low education and presence of RFs (left column of table). Over 8-years follow-up there were 1,194 stroke events. Hypertension, diabetes and heart disease were all more strongly associated with higher stroke risk (HR ≥1.59) than nSES (HR = 1.21) (center column of table). The large differences in nSES between regions overcame the somewhat weaker association of nSES with stroke risk, since nSES was the largest single contributor to the geographic disparity in stroke incidence, accounting for 20.5% of the disparity (95% CI: 7.1 - 34.0) (right column in table). In multivariable analysis nSES, hypertension and diabetes collectively mediated27% of the geographic disparity (95% CI: 20.0% - 34.0%), but the association with county-level mortality remained significant (p = 0.006).

Conclusion:
Lower nSES played the largest role in explaining the county-level geographic disparity in stroke incidence in REGARDS, however, 73% of the excess risk of stroke incidence was not explained by any studied factors.
Abstract MP067: Reducing US Cardiovascular Disease Disparities Through Dietary Policy
Authors: Pearson-Stuttard Jonathan , Bandosz Piotr , Rehm Colin D , Penalvo Jose , Whitsel Laurie , Gaziano Tom , Conrad Zach , Wilde Parke , Micha Renata , Lloyd-Williams Ffion , Capewell Simon , Mozaffarian Dariush , O’Flaherty Martin
Published: July 2021

Quantifying reductions in US cardiovascular deaths and disparities by different diet policies

Background:
Large disparities exist in US dietary habits and cardiovascular disease (CVD) mortality. While economic incentives have demonstrated success in improving dietary choices, the quantitative impact of different dietary policies on CVD disparities is not well-established

Methods:
Using a US IMPACT Food Policy Model and probabilistic sensitivity analyses, we estimated and compared the reductions in CVD mortality and disparities in the US population potentially achievable from 2015 to 2030 with specific dietary policy scenarios

a) a national mass media campaign (Media campaign) aimed to increase consumption of fruits and vegetables (F&V) or reduce sugar sweetened beverages (SSBs),

b) national fiscal policies to tax SSB and increase price by 10% and subsidize F&V to reduce prices by 10%; and

c) a targeted policy, to subsidize F&V to reduce prices by 30% among Supplemental Nutrition Assistance Programme (SNAP) participants only.

We also evaluated a combined multi-component approach, combining each of the above policies.

Results:
Among individual policy options, a national 10% F&V subsidy was estimated to be most effective, resulting in approximately 150,500 (95% CI, 142,700-157,900) CVD deaths potentially prevented or postponed (DPPs) by 2030. This far exceed the approximately 35,100 (32,000-37,900) DPPs from a 30% F&V subsidy targeting SNAP participants, or some 23,000 (21,700-24,600) DPPs from a 1-year Media campaign or approximately 21,400 (19,500-23,600) DPPs from a 10% SSB tax.

Neither the Media campaign nor individual national economic policies would significantly reduce CVD disparities. However, the SNAP-targeted intervention would significantly reduce CVD disparities between SNAP participants and SNAP-ineligible individuals, by approximately 7% (10 DPPs per 100,000 population).

The combined policy approach would save more lives than any single policy studied (approximately 215,500 DPPs by 2030) while also significantly reducing disparities by approximately 5% (7 DPPs per 100,000 population).

Conclusions:
Fiscal strategies targeting diet could reduce CVD burdens. A national 10% F&V subsidy would save by far the most lives, while a SNAP-targeted 30% F&V subsidy would most reduce disparities.

A combined policy would have the greatest overall impact on both mortality and disparities.
Abstract MP068: Dietary Fatty Acids and Coronary Heart Disease in Mortality in the Alpha Omega Cohort
Authors: Mölenberg Famke J , de Goede Janette , Wanders Anne J , Zock Peter L , Kromhout Daan , Geleijnse Johanna M
Published: July 2021

Background:
Replacement of saturated fatty acids (SFA) with polyunsaturated fatty acids (PUFA) is associated with a lower risk of coronary heart disease (CHD) in the general population. Whether this is also the case for CHD patients is not yet clear. In this observational study of Dutch CHD patients, we examined the risk of CHD mortality for the exchange of SFA with total unsaturated fatty acids (UFA), PUFA and
cis
-monounsaturated fatty acids (MUFA).

Methods:
We included 4146 post-myocardial infarction patients aged 60-80 (78% male; Alpha Omega Cohort) in whom diet was assessed at baseline (2002-2006) by a validated 203-item food-frequency questionnaire. Cause-specific mortality was monitored until January 2013. Iso-caloric replacement of SFA with (subgroups of) UFA in relation to CHD mortality was studied in quintiles and continuously per 5 energy percent (en%), using Cox regression models. Hazard ratios (HR, 95%-CI) were obtained after adjustment for age, sex, BMI, smoking, education, physical activity, cardiovascular drugs (anticoagulants, antihypertensives, statins), diabetes, and dietary factors, i.e. total energy, protein (en%), carbohydrates (en%), trans fatty acids (en%), dietary fiber (g/d) and dietary cholesterol (mg/d). The model for PUFA also included MUFA as a covariate, and
vice versa
.

Results:
During a median follow-up of 7.3 years, there were 888 deaths including 249 CHD deaths. SFA replacement was inversely associated with CHD mortality when comparing extreme quintiles of intake, which was statistically significant for total UFA (HR: 0.44; 95% CI: 0.21-0.92;
P
= 0.03) and non-significant for PUFA (0.58, 0.31-1.09) and MUFA (0.81, 0.45-1.49). When expressed per 5 en% (Figure), replacing SFA with either UFA, PUFA or MUFA was associated with a more than 30% lower risk of CHD mortality. Findings were similar when confined to statin users.

Conclusion:
In well-treated CHD patients, replacement of SFA by UFA is associated with a lower CHD mortality risk.
Abstract MP073: Sleep Patterns and Depression in a Diverse Sample of Women from the AHA Go Red for Women Strategically Focused Research Network (SFRN)
Authors: Aggarwal Brooke , Liao Ming
Published: July 2021

Background:
Depression has been linked to increased risk of cardiovascular disease (CVD) through biological mechanisms and altered lifestyle behaviors, possibly including short and/or long sleep duration. However the relation between specific sleep components and depressive symptoms, and interaction by race/ethnicity has not been fully defined. The purpose of this study was to determine if sleep patterns including short sleep duration, poor sleep quality, and insomnia were associated with depressive symptoms in a free-living ethnically diverse population of adult women, and if they varied by racial/ethnic status.

Methods:
English or Spanish speaking females between the ages of 20-79 y, participating in an observational cohort study as part of the American Heart Association Go Red for Women SFRN, were included (n=50, 56% (28 of 50) non-white, mean age = 41 ±18y). Sleep patterns were assessed using the Pittsburgh Sleep Quality Index (PSQI), a validated instrument used to measure the quality and duration of sleep in adults. Presence of insomnia was measured using the Insomnia Severity Index (ISI). Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Linear and logistic regression models were used to evaluate cross-sectional associations between sleep patterns and depression overall, and by race/ethnicity.

Results:
Overall, nearly one-fifth of participants had depressive symptoms (BDI II score ≤13), 18% (9 of 50) had short sleep duration (<6 hours per night), 38% (19 of 50) had poor quality sleep (PSQI score ≥5), and 40% (20 of 50) had some level of insomnia (ISI score ≥8). Mean BDI-II scores among women who slept <6 versus ≥6 hours were significantly greater (16 versus 5, p=.0003). Higher depression scores were associated with shorter sleep duration (p=.001), poorer sleep quality (p=.03), and higher insomnia severity (p<.0001) overall. There was no association between depression and long sleep (≥8 hours). When stratified by race/ethnicity, depression was significantly associated with poor sleep quality among minority women in multivariable models adjusted for demographic confounders (OR=1.42, 95% CI=1.03-1.95), but not among non-Hispanic white women. Depression was also significantly associated with insomnia severity (p<.001), and sleep duration (p=.03) among minority women only, in multivariable adjusted models stratified by race/ethnicity.

Conclusions:
In this diverse sample of women, sleep problems were highly prevalent. Poor sleep quality, insomnia, and short sleep duration (but not long sleep) were associated with greater depressive symptoms among minority women but not whites. These preliminary data suggest that minority women with short sleep duration may be at heightened CVD risk from depression. Future research should determine if interventions designed to improve sleep result in decreased depressive symptoms and reduced CVD risk.