bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P327: Risk Factors for Prehypertension in the Community
Authors: Rafalson Lisa , Donahue Richard P , Stranges Saverio
Published: July 2021

Background:
Prehypertension is an increasingly highly prevalent condition in the general population, and is associated with an increased risk for coronary heart disease and stroke. However, evidence from population-based studies of the risk factors for prehypertension is scant. We sought to examine the predictors of progression from normotension to prehypertension in a community-based population from Western New York.

Methods:
We conducted a longitudinal analysis, over six years of follow-up, among 569 men and women (51.8 years, 96% White, 70% female) who were free of prehypertension, hypertension, cardiovascular disease and type 2 diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Incident prehypertension at follow-up was defined as systolic blood pressure of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg.

Results:
In bivariate analyses, there were several correlates of incident prehypertension, including age, BMI and waist circumference, impaired fasting glucose (IFG), uric acid, and baseline blood pressure levels. After multivariate adjustment, IFG at baseline odds ratio (OR):1.69, 95%CI:1.06-2.67) and weight gain since age 25 (OR: 1.28, 1.11-1.58 per 10 lb. increase) were the strongest significant predictors of prehypertension at follow-up. Neither waist circumference nor current BMI were predictor variables in models when they were substituted for weight gain.

Conclusions:
Results from this study suggest early dysregulation of glucose metabolism and weight gain over the lifespan are likely to represent important risk factors for prehypertension in the general population.
Abstract P350: Completion of Cardiac Rehabilitation Reduces Hospital Admission Rates in Long Term Follow-up
Authors: Sobolev Maria , Prince David Z , Gao Ju , Taub Cynthia
Published: July 2021

Introduction:
Cardiac rehabilitation (CR) improves exercise tolerance, quality of life, and mortality among patients with heart disease in short term follow-up. Less is known regarding the sustained benefits attributable to CR after 1 year.

Hypothesis:
CR attendees have decreased morbidity, represented by lower admission rates.

Methods:
A database of patients referred to CR between May 2001 and January 2011 was constructed. Data on gender, race, age, and attendance was collected. Completion of CR was designated as 36 sessions. Participants attending 1 to 35 sessions were excluded. All cause hospitalization was recorded from the date of primary cardiac diagnosis. Data was analyzed using a t-test to compare hospitalization rates between participants and non-participants. Baseline admission rates were compared.

Results:
162 participants competed CR, 84 (52%) of minority race, 98 (60%) males, 95 (59%) were 65 or older. There were 229 non-participants, 147 (64%) of minority race, 147 (64%) males, 77 (34%) were 65 or older. Mean follow up time was 6 years. Completion of CR resulted in lower mean hospitalization rates (1.19 vs. 2.93, p = 0.001) in all groups: Caucasians 0.92 vs. 2.99 (p = 0.005), minorities 1.44 vs. 2.89 (p = 0.035), males 1.32 vs. 2.89 (p = 0.011), females 1.00 vs. 3.02 (p = 0.003), age 65 or older 0.96 vs. 3.96 (p = <0.001). There was no difference in baseline mean hospitalization rates between participants and non-participants when comparing race or gender: non-participant Caucasians 2.99 vs. minorities 2.89 (p = 0.895), participant Caucasians 0.92 vs. minorities 1.44 (p = 0.246), non-participant males 2.87 vs. females 3.02 (p = 0.834), participant males 1.32 vs. females 1.00 (p=0.489). There was no difference in baseline mean hospitalization rates when comparing participants younger than 65 with 65 or older (1.52 vs. 0.96, p = 0.212). Non-participants 65 or older had significantly higher hospitalization rates than younger non-participants (3.96 vs. 2.33, p = 0.027).

Conclusions:
Long term follow-up of CR participants demonstrated a sustained morbidity benefit. Previous studies were limited to 1 year follow-up. Race, gender, and age did not influence morbidity, although participants older than 65 may have an additional morbidity reduction.
Abstract P353: Survival after Acute Coronary Syndrome in the Community
Authors: McNallan Sheila M , Gerber Yariv , Weston Susan A , Killian Jill , Dunlay Shannon M , Chamberlain Alanna M , Bell Malcolm R , Jaffe Allan S , Kors Jan , Roger Veronique L
Published: July 2021

Background:
Contemporary data on survival after incident acute coronary syndrome (ACS), including both myocardial infarction (MI) and unstable angina (UA), are limited.

Objective:
To describe survival after incident ACS, to determine if it differs by ACS type (MI or UA) and to determine whether it has improved over time.

Methods:
Olmsted County, MN residents hospitalized between 1/1/2005-12/31/2010 were screened for incident ACS. ACS was defined as either MI validated by standard epidemiological criteria or UA validated by the Braunwald classification. Patients were followed for death from any cause. Cox proportional hazards regression was used to determine whether survival differed by ACS type, while adjusting for year of diagnosis, age, sex and comorbidities.

Results:
Among 1,160 incident ACS cases (mean±SD age 66.9±14.8, 60% male), 35% were UA and 65% were MI. After a mean (SD) follow up of 3.7 (2.1) years, 274 deaths occurred. The 3-year Kaplan-Meier survival estimate for MI was 79.6% (95% CI: 76.7%-82.6%) and for UA was 84.9% (95% CI: 81.3%-88.6%) (log-rank p=0.011). The association of ACS type with survival differed by age (p=0.056). After adjustment for year of diagnosis, sex and comorbidities, no difference in survival was observed between ACS types among those aged <60 (HR for MI vs. UA: 0.64, 95% 0.29-1.42). By contrast, among patients aged 60-79, those with an MI had 2 times the risk of death compared to those with UA (HR: 2.04, 95% CI: 1.24-3.37). Patients aged 80 or older who had an MI had a 40% increased risk of death compared to patients of the same age who had UA (HR: 1.42, 95% CI: 1.02-1.98). There was no difference in survival over time (HR for 2010 vs. 2005: 0.91, 95% CI: 0.61-1.36).

Conclusions:
Survival did not differ between UA and MI patients younger than 60, however among patients 60 or older, survival was worse among those with an MI. Survival after ACS did not change over the study period.
Abstract P359: Cardiovascular Risk Factor and Diseases in the Italian Adult Population: The National Health Examination Surveys 2008-2012
Authors: Donfrancesco Chiara , Palmieri Luigi , Lo Noce Cinzia , Dima Francesco , De Curtis Amalia , De Sanctis Caiola Patrizia , Vanuzzo Diego , Giampaoli Simona
Published: July 2021

Background:
From 2008 to 2012 an Health Examination Survey (HES)-Osservatorio Epidemiologico Cardiovascolare (OEC) has been implemented in Italy with the aim of assessing cardiovascular (CV) risk factors, prevalence of risk conditions and CV diseases for the Italian adult population.

Methods:
Random samples of general population stratified by age and sex were examined in all Italian regions (participation rate 56%). Risk factor were collected using standardized procedures and methods; biochemical tests were assayed in a central laboratory; a questionnaire investigates behaviours and CVD history; a ECG read in Minnesota code was used to define previous myocardial infarction. Comparisons between men and women were assessed using t-test for means and chi-squared test for prevalence.

Results:
Data of 4371 men and 4339 women ages 35-79 years were analysed. Majority of risk factors mean levels resulted higher in men than in women: systolic blood pressure (SBP) was 134 mmHg and 129 mmHg (p<0.0001), diastolic (DBP) was 84 mmHg and 79 mmHg (p<0.0001), fasting plasma glucose was 103 mg/dl and 95 mg/dl (p<0.0001), triglycerides was 135 mg/dl and 108 mg/dl (p<0.0001), respectively; as well as many CV risk conditions: smoking habit was 21% in men and 18% in women (p<0.0001), diabetes was 14% in men and 9% in women (p<0.0001) (28% of diabetic unaware both in men and women), 56% of men and 43% of women have SBP>=140 mmHg or DBP>=90 mmHg or in treatment (p<0.0001), 65% of men and 70% of women have total cholesterol (TC) >=200 mg/dl or in treatment for (p<0.0001), 48% of men and 33% of women are in overweight (BMI 25-29 kg/m
2
) (p<0.0001). TC, LDL and HDL cholesterol resulted lower in men than in women: 209 mg/dl and 218 (44) (p<0.0001), 131 (38) mg/dl and 134 mg/dl (p<0.0001), 51 mg/dl and 62 mg/dl (p<0.0001), respectively. As well as prevalence of physical inactivity during leisure time: 31% in men and 43% in women (p<0.0001). Prevalence of obesity (BMI>=30 kg/m
2
) resulted similar in men and women: 25% and 27% respectively (p=0.0818). Prevalence of myocardial infarction was 2.1% in men and 0.7% in women (p<0.0001), prevalence of by-pass or angioplasty surgery was 5.1% and 1.0% (p<0.0001), prevalence of angina pectoris was 3.2% and in 4.8% (p<0.0001), respectively.

Conclusions:
At present obesity and smoking are still a priority in public health. In combination with other information sources, the OEC can contribute greatly to plan community actions and health services at national and regional level.
Abstract P368: Risk Factor Interventions are Effective for Preventing Cardiovascular Events in HIV-Infected Patients on Antiretroviral Therapy: A Systematic Review and Meta-analysis
Authors: Nduka Chidozie , Ngianga-Bakwin Kandala , Suri Gaurav , Stranges Saverio
Published: July 2021

Introduction:
The declining rate of HIV-related deaths has become rather slow in recent times, largely because of the rising incidence of cardiovascular events associated with the disease and its long-term treatment with anti-retroviral drugs. While conclusive evidences support the effectiveness of cardiovascular risk factor interventions in the general population, there is a dearth of such evidence of clinical effectiveness in certain high-risk subgroups, particularly HIV-infected patients on antiretroviral treatment.

Objective:
To evaluate the clinical effectiveness of risk factor interventions in preventing cardiovascular disease in HIV-positive patients on antiretroviral treatment (ART) and summarize the effect size.

Design and methods:
Systematic review of randomized controlled trials investigating the effects of interventions in modifying ART-associated risk factors for cardiovascular disease. Trials were eligible for inclusion if they were published in the last 12 years [2000 to June 2012] and participants were HIV-positive, on ART and having more than one ART-associated cardiovascular risk factor.

Results:
In total, 2,071 HIV-positive participants from 10 randomized trials were included in the review. The interventions evaluated comprised lifestyle modification, lipid-lowering treatment and smoking cessation. Overall, the main results showed significant improvements in total cholesterol [P<0.0001], LDL cholesterol [P<0.0001], HDL cholesterol [P<0.002], triglycerides [P<0.001], apolipoprotein B levels [P=0.036], adiposity [<0.001], anthropometry [P<0.001], insulin sensitivity [P<0.05], HbA1c levels [P<0.001], FBG levels [P=0.017], adiponectin levels [P<0.05], dietary intake [P<0.001], smoking abstinence [P<0.0001] and Framingham score [P=0.03].

The results also showed improvements in systolic [from 145.6±14.5 mmHg to 122.8±5.2 mmHg] and diastolic blood pressure [from 84.7±1.7 mmHg to 80.1±3.8 mmHg]; however, there was no improvement in carotid intima-media thickness [P=0.61] or inflammatory biomarkers [P=0.973 to 0.110].

Conclusion:
In conclusion, this review presents evidence suggesting that cardiovascular risk factor interventions are effective in HIV-infected persons on ART. However, cardiovascular screening programs targeting people living with HIV and primary studies assessing the effectiveness (clinical and cost) of multiple risk factor interventions in this sub-group are needed.
Abstract P373: Cardiac Depolarization and Repolarization Changes with Mental Stress are Associated with Mental Stress- Induced Ischemia
Authors: Pimple Pratik M , Shah Amit , Ramadan Ronnie , Soliman Elsayed Z , Bremner Doug , Quyyumi Arshed , Vaccarino Viola
Published: July 2021

Introduction:
QRS duration and frontal QRS/T angle are simple and easily available electrocardiographic measures of cardiac depolarization and repolarization that predict cardiovascular disease (CVD) events and mortality. Such measures may be indicative of cardiac structural disease, ischemia, or primary conduction abnormalities. Mental stress-induced myocardial ischemia (MSI) is also associated with increased CVD risk, but the underlying mechanisms are unknown. We hypothesized that MSI is associated with stress-induced abnormalities in cardiac depolarization and repolarization, QRS duration and frontal QRS/T angle.

Methods:
We compared QRS duration & frontal QRS/T angle during mental stress between coronary artery disease (CAD) patients who were MSI positive (MSI+) and CAD patients who were MSI negative (MSI-). For each MSI+ case (n=22), one or two MSI- controls were matched for age, gender and race- ethnicity (n=41). QRS duration and frontal QRS/T angle were automatically computed by a 12-lead ECG (GE MAC 5000). QRS/T angle was calculated as absolute minimal difference between the frontal R and T axes in patients with QRS duration < 120 ms (n= 50). Mental stress was induced via speech stressor, and nuclear 99m-Tc-sestamibi gated Single-Photon Emission Computed Tomography (SPECT) was used to assess MSI.

Results:
Mean age was 65 years, 20 patients were black, and 55 were males. The two groups were similar in terms of demographics and past medical history. Both MSI+ and MSI- groups had similar QRS duration at baseline, but MSI+ patients had an adjusted 3.1 ms higher increase in QRS duration with mental stress than MSI- patients (95% CI: 0.5 to 5.7), after adjusting for CVD risk factors, hemodynamic changes during mental stress (blood pressure, heart rate), and baseline QRS duration. MSI+ patients had an adjusted 28.2 degrees larger QRS/T angle at baseline (95% CI: 2.5 to 53.9) compared to MSI- patients, but did not differ with regards to change in QRS/T angle with mental stress. However, among those with normal baseline conduction (QRS<100 ms, n=36), MSI+ patients had an adjusted 17.8 degrees larger change in QRS/T angle with mental stress compared to MSI- patients (95% CI: 3.1 to 32.4). In patients with mildly abnormal conduction (QRS duration between 100 and 119 ms, n=14), no differences were found, p=0.059 for QRS duration x MSI interaction.

Conclusion:
CAD patients exhibit changes in cardiac depolarization and repolarization during acute mental stress. Those with MSI have greater baseline QRS/T angle and larger changes in QRS/T angle and QRS duration with mental stress. These findings may help to explain the pathophysiology linking mental stress and CVD, as well as the increased risk in patients with MSI.
Abstract P378: Behavior Patterns over 20 Years and their Relationship to Subclinical Atherosclerosis
Authors: Siddique Juned , Colangelo Laura A , Reis Jared P , Spring Bonnie , Moller Arlen C , Lloyd-Jones Donald , Liu Kiang
Published: July 2021

Background:
While individual health risk behaviors are independently associated with CVD and mortality, these behaviors frequently co-occur. Less is known about combinations of behaviors and their relationship to subclinical atherosclerosis.

Objective:
To identify patterns of behavior from young adulthood through middle age and whether these patterns are associated with developing coronary artery calcification (CAC) and carotid intima-media thickening (IMT) over 20 years

Methods:
Our sample consists of all participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study who completed the Year 20 exam (n = 3538). We assessed five healthy lifestyle factors at Years 0, 7, and 20: BMI (<25 kg/m
2
), alcohol intake (women: ≤ 15 g/day; men: ≤ 30 g/day), diet (best 40% of cohort by race and sex: high in potassium, calcium, & fiber; low in saturated fatty acids), physical activity (> 300 exercise units), not a cigarette smoker (Yes/No). We applied Latent class analysis (LCA) to these 15 binary variables in order to identify a discrete set of participant groups characterized by the presence or absence of behaviors. We then regressed CAC and IMT thickening on our identified groups to determine those behavioral patterns that are associated with subclinical atherosclerosis. Regression models controlled for age, race, and gender. Missing values were replaced prior to analyses using imputation.

Results:
We identified six distinct behavioral patterns primarily characterized by combinations of the presence or absence of being overweight, smoking, and/or healthy diet and physical activity (HDiet&PA; see table). Odds of CAC and IMT thickening were highest among the two smoking groups. Normal-weight non-smokers had the lowest odds of CAC and the least IMT thickening.

Conclusions:
We identified combinations of behaviors through young adulthood associated with varying burden of subclinical atherosclerosis in middle age. These data may suggest potential targets for primordial and primary prevention.
Abstract P394: Impact of Caffeinated Versus Decaffeinated Energy Shots on Blood Pressure
Authors: Shah Sachin A , Kurtz Abby , Leong Jessica , Dargush Anthony E
Published: July 2021

Introduction:
Energy drinks are commonly used to boost cognitive performance. However, this is paralleled with a significant increase in systolic and diastolic blood pressures. No studies have evaluated these changes with energy “shots” and whether these effects are driven solely by the caffeine component in energy drinks or a multitude of ingredients remains unknown. The purpose of this study was to determine if the effects of regular (caffeinated) 5-Hour Energy® shot differ from that of decaffeinated 5-Hour Energy® (decaf) shot as assessed by changes in systolic (SBP) and diastolic blood pressure (DBP).

Methods:
This was a randomized, double-blind, crossover study conducted at a university campus. Healthy subjects, between 18-40 years of age with a blood pressure less than 140/90 and not on any medications were eligible for inclusion. Participants were randomized into either the regular 5-Hour Energy® drink or the decaf 5-Hour Energy® drink study arms with blood pressure recorded at baseline, 1, 3 and 5 hours. Following a washout period of at least 6 days, the same was performed giving the alternate study drink. Additionally, heart rate, adverse events and energy score (1-5 scale) were also assessed.

Results:
Ten males and 10 females were enrolled in the study with 90% (18 of 20) being of Asian race. Average age was 23.3±2.7 years, weighing 149.1±31.7 pounds with SBP of 114±11.3 mmHg and DBP of 69.5±7.6 mmHg. Baseline coffee consumption was less than 2 cups per week in 11 subjects and at least 1 cup per day in the remainder. The maximum SBP increase from baseline in the regular arm was 7.8±6.5 mmHg versus 2.8±5.6 mmHg in the decaf arm (p = 0.046). Maximum DBP increase was 6.3±3.7mmHg and 1.0±5.4 mmHg (p = 0.003) in the regular and decaf arms, respectively. Significant increases in systolic and diastolic pressures were evident at 1 and 3 hours post consumption (p ≤ 0.027) but not at 5 hours. Maximum heart rate or energy levels between the two groups were not significantly different (p ≥ 0.436). In subgroup analysis, regular energy drinks invoked a significantly higher increase in systolic and diastolic blood pressures (p ≤ 0.003) 1 hour post consumption in caffeine naïve subjects (n=11).

Conclusion:
Regular energy drinks available in the form of a “shot” increase both systolic and diastolic blood pressures by approximately 5mmHg. This effect appears to be exaggerated in caffeine naïve subjects.
Abstract P422: Dissociation between Changes in Cardiorespiratory Fitness and Cardiometabolic Risk Profile in Response to Exercise in Abdominally Obese Adults
Authors: Brennan Andrea , Lam Miu , Hudson Robert , Ross Robert
Published: July 2021

Cardiorespiratory fitness (CRF) is a strong, independent predictor of morbidity and mortality. Although the majority of adults who increase daily physical activity experience an increase in CRF (VO2 peak), about 10-15% of participants do not increase CRF despite participating in a standardized exercise program. In this study we sought to determine whether exercise combined with a healthy diet was associated with a corresponding improvement in cardiometabolic risk factors despite the absence of change in CRF. We studied 59 sedentary, abdominally obese (waist circumference: 104.6 ± 8.5cm) adults who participated in 3 (women) or 4 (men) months of supervised aerobic exercise. CRF was measured using a standard treadmill test. Cardiometabolic risk factors included fasting triglycerides, total cholesterol, HDL-C, LDL-C, insulin, glucose, systolic and diastolic blood pressure. Participants were asked to exercise 7 days per week for the time required to expend 500 kcals per session for women, and 700 kcals for men. The intensity of exercise was self-selected and ranged between 65-90% of VO2 peak. Men and women were combined for all analyses. To examine the relationship between corresponding changes in cardiometabolic risk factors and CRF, participants were divided into tertiles based on mean change in CRF. A linear trend test was used to characterize the change in cardiometabolic risk factors across CRF change tertiles. The volume (energy expenditure (kcal)) and intensity (%VO2 peak) of exercise performed across tertiles of change in CRF was not different (P>0.10). As expected a significant linear trend across tertiles was observed for change in CRF (P<0.001), however, the mean change in CRF within the lowest tertile was not significant (P>0.10). Without exception, no linear trend was observed for the change in cardiometabolic risk factors across tertiles of change in CRF (P>0.10). This was also true for change in waist circumference and visceral fat (P>0.10). Regression analysis using the total sample confirmed that, with the exception of glucose, the change score for each cardiometabolic risk factor was not related to the change in CRF (P>0.10). Our findings suggest that in abdominally obese adults, improvement in cardiometabolic risk profile is not associated with change in CRF and that increasing physical activity combined with a healthful diet is associated with substantial health benefit in the absence of change in CRF.
Abstract P433: Associations of CD4+ T Lymphocyte Subpopulations with Insulin Levels and Type 2 Diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Olson Nels C , Doyle Margaret F , Psaty Bruce M , De Boer Ian , Jenny Nancy S , Kronmal Richard A , Tracy Russell P
Published: July 2021

Background:
Chronic inflammation is a characteristic feature of insulin resistance (IR) and type 2 diabetes (T2D). Elevated circulating levels of pro-inflammatory cytokines, such as interleukin-1 beta (IL-1β) and interleukin-6 (IL-6), are predictive of disease onset suggesting contributions of adaptive immune responses in the etiology of T2D. Therefore, we hypothesized that increased populations of CD4
+
effector/memory (EM) and T helper 1 (Th1) cells, and decreased populations of CD4
+
naive cells, would be associated with high insulin levels and an increased risk of T2D.

Methods:
T cell subpopulations were measured in peripheral blood by flow cytometry, using CD4
+
CD45RO
+
, CD4
+
CD45RA
+
, CD4
+
IFN-γ
+
, and CD4
+
IL4
+
as markers for EM, naive, Th1, and Th2 cells, respectively. Data for each subpopulation were reported as a percent of total CD4
+
cells. Associations were explored with components of the metabolic syndrome, insulin measures, and type 2 diabetes in a random subset (
n
=917) of the Multi-Ethnic Study of Atherosclerosis (MESA). T2D was defined by fasting glucose ≥126 mg/dL or use of glucose-lowering medications (
n
=151). All variables were measured at Exam 4 (2005-2007), except for insulin which was measured at Exam 5 (2010-2012), and inflammatory biomarkers measured at Exam 1 (2000-2002).

Results:
Naive cells were inversely, and EM, and Th1 cells positively associated with insulin levels in minimally adjusted (age, gender, race/ethnicity) linear regression analyses that modeled insulin as the dependent variable. No significant associations were observed with Th2 cells. After further adjustment for the metabolic- and cardiovascular disease (CVD)-related variables, waist circumference, systolic blood pressure (BP), use of anti-hypertensive medication, smoking status, total- and HDL-cholesterol, use of lipid lowering medication, and IL-6, the association of insulin with Th1 cells, but not naive or EM cells, remained significant [β= 6.4 mU/L (± 1.69 mU/L) per standard deviation (SD) increase in Th1 cells (8.3%); p=0.0002]. Adjusting for body mass index (BMI) in place of waist circumference did not alter interpretation of the results. In standardized logistic regression models including cell subpopulations and metabolic- and CVD-related variables (as above) as the independent variables, naive cells were inversely associated with prevalent T2D [odds ratio (95% confidence interval)=0.78 (0.61-0.99)].

Conclusion:
Increased populations of Th1 cells and decreased populations of CD4
+
naive cells are associated with insulin levels and T2D, respectively, independent of measures of adiposity. These cross-sectional findings suggest that excess immune activation and Th1 bias, as reflected by these differences, may contribute to the etiology of IR and T2D.
Abstract P434: The Relationship Between Level of Glycemic Control and First Manifestation of Coronary Artery Disease (CAD) Differs by Sex in Type 1 Diabetes (T1D)
Authors: Miller Rachel G , Costacou Tina , Orchard Trevor J
Published: July 2021

The nature of the association between glycemic control and CAD in T1D is unclear. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset T1D has not demonstrated a consistent relationship between glycemic control and incidence of CAD, with neither baseline HbA1c nor average HbA1c over follow-up reliably predicting CAD. However, it is possible that glycemic control may influence the type of first CAD event observed. As CAD often manifests differently in men and women, our objective was to examine whether the manifestation of CAD differs by glycemic control up to the time of the CAD event separately by sex.

Data are from 604 (304 men, 300 women) participants in the Pittsburgh EDC Study of childhood-onset (<17 years old) type 1 diabetes without prevalent CAD at baseline and represent 20 years of follow-up for CAD incidence ascertainment. Participants were first assessed 1986-1989 (mean age, 28 and duration, 19 years), with 8 subsequent exams occurring approximately every 2 years thereafter. First CAD event was divided into 5 categories: fatal event/CAD death, nonfatal myocardial infarction (MI), revascularization/stenosis >=50%, ischemia (Minnesota codes 1.3, 4.1, 4.3, 5.1, 5.3, 7.1), or angina. The average HbA1c from baseline until CAD event or last follow-up for noncases was calculated (median # HbA1c measures=4); the median average HbA1c was 8.7%. This value was used as a cut point to divide the cohort into 2 groups: persons with HbA1c≥8.7% at all study visits prior to CAD incidence (80 men, 60 women) versus all others (224 men, 240 women).

In women, the 20-year incidence of CAD was 40% (n=24) and 24.6% (n=59) in the consistently high HbA1c group and all others, respectively (p=0.02). In men, CAD incidence was 38.8% (n=31) and 28.6% (n=64) in the high HbA1c group and all others, respectively (p=0.09). Of the CAD cases, nonfatal MI was a significantly more frequent first event in the consistently high HbA1c group compared to all others in both men (48.4% v 21.9%, p=0.009) and women (37.5% v 15.3%, p=0.04). Angina was a significantly less frequent first event in the consistently high HbA1c group in women (25% v 52.5% in all others, p=0.02), but no significant difference in angina incidence by HbA1c group was observed in men. Fatal CAD was a marginally more frequent first event in the high HbA1c group in women (16.7% v 3.4%, p=0.06), but did not differ by HbA1c in men. No differences for revascularization or ischemia as first events were seen by HbA1c group in either sex.

These results suggest that, in T1D, glycemic control may influence the manner of CAD manifestation, in particular nonfatal MI and angina, and that this effect may differ by sex. Particularly, there may be a need for more aggressive monitoring and treatment of CAD risk factors in women with high HbA1c, as they may be at higher risk of fatal events.
Abstract P438: Cardiovascular Health in Adolescents with Type 1 Diabetes: The SEARCH CVD Study
Authors: Alman Amy , Talton Jennifer , D'Agostino Ralph , Mayer-Davis Elizabeth , Dolan Lawrence , Urbina Elaine , Marcovina Santica , Wadwa R. Paul , Daniels Stephen , Hamman Richard , Dabelea Dana
Published: July 2021

In 2010, the American Heart Association (AHA) identified national goals for ideal cardiovascular health (ICH). Type 1 diabetes (T1D) significantly increases the risk of cardiovascular disease (CVD), and adolescents with T1D are a group particularly relevant for focus on ICH. The purpose of this study was to examine the prevalence of ICH in a population of adolescents with T1D and to examine the association of ICH with measures of CV function [arterial stiffness (AS) measured using pulse-wave velocity (PWV), augmentation index (AIX) and brachial distensibility (BD)], and structure [carotid intima-media thickness (cIMT; bulb, common carotid (CC), and internal carotid (IC))].

We used data from the retrospective cohort component of the SEARCH CVD study, which followed youth with T1D for approximately 6 years. Data collected at baseline (mean age 15 years) include diet, smoking, physical activity, BMI, cholesterol, blood pressure, and fasting plasma glucose. Measures of PWV, AIX, BD, and cIMT were obtained at follow-up (mean age 20 years, diabetes duration 10 years). Complete data were available on 182 subjects. Multiple linear regression models were fit to examine the association between the Number of metrics that met the ICH goal (NICH; range 0 to 7) and the subclinical CVD outcomes.

The prevalence of the ICH metrics is shown in Table 1. Prevalence of ICH ranges from none meeting the healthy diet to nearly all being never smokers (88%). While most youth met 3 or 4 goals, only 5% met 5 and none met all 7 criteria. Increasing NICH at baseline was associated with lower AS [lower PWV (β= -0.02, p=0.035), higher BD (β= 0.03, p=0.042)] and lower cIMT of the CC (β= -0.02, p=0.023), adjusted for age, sex, race, hemoglobin A1c, triglycerides, and diabetes duration.

In conclusion, youth with T1D are not meeting ICH goals. Meeting more ICH goals was associated with better CV health as indicated by lower AS and cIMT thickness. Measures targeted at increasing ICH in adolescents with T1D are needed in order to reduce the burden of CVD in this high risk population.
Abstract 05: Longer Duration of Obesity Beginning in Young Adulthood is Associated with Greater Left Ventricular Mass and Worse Left Ventricular Function in Middle-Age: The CARDIA Study
Authors: Reis Jared P , Allen Norrina B , Barone-Gibbs Bethany , Lee Joyce M , Lewis Cora E , Lima Joao , Lloyd-Jones Donald , Loria Catherine M , Powell-Wiley Tiffany M , Wei Gina , Liu Kiang
Published: July 2021

Background:
As a result of the obesity epidemic, individuals are becoming obese at a younger age than in previous generations. Yet, few studies have determined the consequences of a longer duration of obesity. The present study examined whether the duration of obesity beginning early in adulthood is associated with left ventricular (LV) structure and function in middle-age.

Methods:
We studied 2,545 white and black adults aged 18-30 years without obesity [body mass index (BMI) <30 kg/m
2
] at baseline in 1985-86 or clinically apparent heart disease through year 25 (2010-11) in the multicenter, community-based CARDIA study. Duration of obesity (years with BMI ≥30.0 kg/m
2
) was calculated using repeat measurements of BMI performed 2, 5, 7, 10, 15, 20, and 25 years after baseline. Outcomes included LV mass and ejection fraction from an echocardiogram performed during the 25-year follow-up examination.

Results:
During follow-up, 994 participants became obese (39.1%); mean duration of obesity was 14.1 years. After adjustment for demographic and behavioral covariates, including year 25 BMI, a longer duration of obesity was associated with a greater LV mass and a lower ejection fraction (Table, model 1). Further adjustment for intermediate clinical covariates, including antihypertensive medication use, systolic blood pressure, heart rate, and diabetes only modestly attenuated these associations (Table, model 2). These associations were similar across white and black men and women (p-interaction>0.10, for all).

Conclusions:
Longer duration of obesity from young adulthood to middle-age was associated with significantly greater LV mass and marginally lower LV function in midlife, independent of concurrent BMI.
Abstract 34: Serum Dietary Antioxidants in Young Adulthood and Incident Cardiovascular Disease in Middle Age: The CARDIA Study
Authors: Odegaard Andrew O , Jacobs David R , Steffen Lyn M , Van Horn Linda , Shikany James M , Gross Myron D
Published: July 2021

Introduction:
Serum levels of carotenoids and tocopherols are objective measures of dietary intakes, including fruits and vegetables (carotenoids and the carotenoid index), nuts/seeds and vegetable oils (α-tocopherol (α-toc)), and oils, margarines, salad dressing and other related foods (γ-tocopherol (γ-toc)). Little research has examined these serum measures in young adulthood as predictors of the incidence of cardiovascular disease (CVD) in middle age.

Hypothesis:
Circulating carotenoids and tocopherols in young adulthood are inversely associated with incident CVD during middle-age.

Methods:
Participants from the Coronary Artery Risk Development in Young Adults study (CARDIA, N=5,115) with serum measures of carotenoids and tocopherols at year 0 of the study and concurrent risk factor data were included in the analysis (N=4,810, mean age 25). CVD events (n=167, coronary heart disease, stroke, and heart failure, adjudicated based on medical records) were ascertained over 25 years of follow up. Multivariable Poisson regression (PROC Genmod) was used to estimate the incidence density of CVD over 25 years according to quintiles of the carotenoid index (sum of 4 variables, defined in Table), α-toc and γ-toc with adjustment for demographic, lifestyle, and clinical covariates.

Results:
There was a strong inverse association between higher levels of the carotenoid index and incidence of CVD, a suggestive inverse association between higher levels of α-toc and incident CVD, and a positive association between γ-toc and incident CVD (Table). The carotenoid, lycopene, did not predict incident CVD.

Conclusions:
The results for the carotenoids and α-tocopherol underscore how a nutrient rich, plant based dietary pattern in young adulthood may inversely associate with CVD events through middle age. The divergent γ-toc results may reflect the kinetics of its metabolism, a poorer dietary pattern, or higher intake of a food from the food supply (e.g. margarine in 1985-6) that may increase risk.
Abstract 39: Added Sugar Intake and Lipids Profile Among US Adolescents: NHANES 2005-2010
Authors: Zhang Zefeng , Gillespie Cathleen , Hu Frank , Yang Quanhe
Published: July 2021

Background:
Studies suggest that higher consumption of added sugar is associated with cardiovascular risk factors in adolescents. However, these studies were subject to measurement error due to the lack of adjustment for day-to-day variability.

Hypothesis:
We hypothesized that higher usual percent of calories from added sugar is associated with dyslipidemia.

Methods:
We analyzed data on 3322 adolescents aged 12-19 years who were not on low fat/low cholesterol diet or on sugar free/low sugar diet from the 2005-2010 National Health and Nutrition Examination Surveys. We estimated the usual percent of calories from added sugar from the diet accounting for measurement error. Multivariable linear regression was used to examine the associations between the percent of calories from added sugar with lipids profile.

Results:
The average usual percent of calories from added sugar was 17.5%. Ninety-one percent and 11% adolescents had usual percent ≥10% and ≥25%, respectively. After adjustment for potential confounders (age, sex, race/ethnicity, body mass index, parental educational attainment, smoking status, physical activity, 2010 Health Eating Index score except sugar component, and total calorie intake), usual percent of calories from added sugar was inversely associated with high-density lipoprotein and positively associated with triglycerides and the ratio of total cholesterol to high-density lipoprotein. Among the lowest and the highest quintiles of intake, high-density lipoprotein were 52.4 mg/dL (95% CI: 50.9 to 53.9) and 49.0 (95% CI: 47.9 to 50.2) (P trend = 0.003), triglycerides were 80.2 mg/dL (95% CI: 70.5 to 90.0) and 100.4 mg/dL (95% CI: 86.7 to 114.2) (P trend = 0.028), and the ratio of total cholesterol to high-density lipoprotein were 3.16 (95% CI: 2.8 to 3.6) and 3.49 (95% CI: 3.0 to 4.0) (P trend =0.006), respectively. The patterns of association were largely consistent across gender, race/ethnicity, and body mass index (normal vs. overweight/obese) subgroups, except in non-Hispanic black and Mexican American, in which the magnitude of the association tended to be smaller. Sensitivity analysis showed that, when intake data from the 1
st
24-hour dietary recall was used, the association remained significant but attenuated substantially. No association was found for total cholesterol and low-density lipoprotein.

Conclusions:
Overwhelming majority of US adolescents consumed more added sugar than recommended for heart health. Increased intake of added sugar is associated with several measures of dyslipidemia, and reduction of added sugar consumption among adolescents might reduce the risk of developing cardiovascular disease in adults.
Abstract 51: Baseline Depressive Symptoms are Associated with Incident Hypertension in Postmenopausal Hispanic Women: Results from the Women’s Health Initiative
Authors: Lopez Lenny , Zambrana Ruth E , Dinwiddie Gniesha Y , Ray Roberta M , Wassertheil- Smoller Sylvia
Published: July 2021

Background:
Hispanic women have higher rates of depressive symptoms compared to other racial/ethnic groups. Depression has been associated with incident hypertension in multiple prior studies with mixed results. However, prior studies were limited by small numbers of Hispanic women, short followup and limited information on possible confounders.

Methods:
We evaluated baseline depression and incident hypertension at three years follow-up among 4,680 postmenopausal Hispanic women enrolled in the Women’s Health Initiative observational study and clinical trial. Depression was measured at baseline using the Burnam 8-item scale (combines 6 items from the Center for Epidemiological Studies Depression Scale and 2 items from the Diagnostic Interview Schedule). This scale assesses both current depressive symptoms and past depression history. Women with a calculated Burnam score ≥ 0.06 were considered to have symptoms of depression. Multinomial logistic regression was used to estimate odds of hypertension at baseline in relation to depression. We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between depression and incident hypertension at three years of follow-up. All models were adjusted for multiple demographic, clinical, and behavioral covariates.

Results:
Of 4, 680 Hispanic women, 32% met current depression criteria at baseline. In an age-adjusted model, women with depression were more likely to be hypertensive (OR=1.25; 95% CI 1.04-1.51), although results were attenuated when adjusting for multiple covariates. Further adjustment for antidepressant use at baseline made no important differences to the estimates. Depression at baseline in normotensive Hispanic women was associated with incident hypertension at year 3 follow-up (OR=1.29; 95% CI 1.02-1.63) after adjustment for age, education, insurance, body mass index, diabetes status, hypercholesterolemia, family history of diabetes and cardiovascular disease, and participant history of CVD. Further adjustment for behavior covariates (smoking, physical activity and alcohol intake) did not attenuate the association significantly.

Conclusion:
In the largest study to date of older Hispanic women, baseline depression is associated with incident hypertension at three years of followup. Early detection and management of depression in older Hispanic women is essential to preventing cardiovascular sequelae.
Abstract MP04: Determinants of attaining and maintaining a low cardiovascular risk profile - the Doetinchem Cohort Study
Authors: Hulsegge Gerben , Daviglus Martha L , van der Schouw Yvonne T , Smit Henriëtte A , Verschuren W M
Published: July 2021

Introduction:
Increasing the proportion of adults who attain and maintain low cardiovascular risk profile is essential in the prevention of cardiovascular disease (CVD). It is unknown which factors are associated with attaining and maintaining a low risk profile. We investigate the association of 6 demographic, 4 lifestyle, 3 CVD history, and 4 psychosocial determinants with 1) attaining and 2) maintaining a low risk profile.

Method:
CVD risk factors and determinants were measured at baseline (1987-1991) and 5-year intervals until 2013 among 6,390 adults initially aged 20-59. Participants were categorized into low risk (i.e., ideal levels of blood pressure, cholesterol, and body mass index, not smoking and no diabetes) and medium or high risk profile. Those with low risk profile maintained or lost their low risk status, whereas those with medium/high risk profiles maintained that risk profile or attained a low risk profile during 5 years follow-up. Determinants of change in risk profiles were examined using modified Poisson regression to obtain risk ratios (RR) and 95% confidence intervals (95%CI) and generalized estimating equations to combine multiple 5-year comparisons.

Results:
A small proportion of participants (3%) with medium/high risk profile attained a low risk profile during the following 5 years. Compared to those who maintained a medium/high risk profile, one unit increment in Mediterranean (healthy) diet score was associated with 9% (RR: 1.09, 95%CI: 1.02-1.16) and being physically active compared to being inactive with a 104% (RR: 2.04, 95%CI: 1.05-4.00) higher likelihood to attain a low risk profile. Older age (RR: 0.66), male gender (RR: 0.46), low (RR: 0.55) and intermediate (RR: 0.77) education, low education of partner (RR: 0.70), and being a homemaker (RR: 0.73) were significantly associated with lower chance to attain low risk status. Of those having a low risk profile, 40% maintained that low risk profile over 5 years. For those with low risk profile, only older age (RR: 0.93) and low educational level (RR: 0.80) were significantly inversely associated with maintaining low risk profile.

Conclusion:
Low education level had an unfavorable impact on changes in risk profiles. This underscores the need to target preventive efforts at individuals with low education in the prevention of CVD. A healthy diet and physical activity were the only modifiable risk factors that were favorably associated with attaining low risk profile.
Abstract MP16: The Validity of Predictive Equations for 24-Hour Urine Sodium Excretion Among Older Adults and Those with Hypertension: The MESA and CARDIA Urinary Sodium Study
Authors: Allen Norrina B , Zhao Lihui , Loria Catherine , Van Horn Linda , Wang Chia-Yih , Pfieffer Christine , Cogswell Mary , Wright Jacqueline , Liu Kiang
Published: July 2021

Background:
Excess dietary sodium (Na) intake is linked to adverse cardiovascular health; the population distribution of urinary sodium (UNa) values in the US is unknown. We examined the population distribution of UNa and the validity of existing equations predicting 24-h Na excretion from a single spot urine sample among older adults with and without hypertension.

Methods:
Demographic, anthropometric, lab, and diet data along with 24-h urine collections were obtained from 555 MESA and CARDIA participants aged 45-79y. One third provided a second 24-h urine collection. Four timed voids (morning, afternoon, evening, and overnight) and the 24-h collection were analyzed for Na, creatinine, potassium and chloride concentrations. We examined the distribution of 24-h excretion of each analyte overall and by gender-race subgroups and hypertensive (HTN) status. We then examined the mean differences (bias) and confidence intervals between measured 24-h UNa excretion and the predicted from spot urine using 4 published equations by specimen timing, race-gender subgroups, and HTN status.

Results:
Using preliminary data from 265 participants with completed laboratory analysis, 55% female, 61% Black, and 60% had HTN. Mean 24-h Na excretion was 4234 ± 1920 mg for white men, 2706 ± 1136 mg for white women, 3463 ± 1691 mg for Black men and 3415 ± 1635 mg for Black women and did not significantly differ by hypertensive status. Mean bias in predicting 24-h Na excretion overall ranged from -268 (95% CI: -443.5, -91.8) to 1045 (849.3, 1240.4) mg/d. (Table)

Conclusion:
Among this group of older adults and those with hypertension, the mean 24-h UNa excretion levels for all race-gender groups exceeded current recommendations of 2,300 mg/d, with significant variation by race and gender. All of the four published equations under or overestimated mean 24-h Na excretion when using a single, timed spot urine sample but using evening samples appeared to produce the least bias. These preliminary findings are tentative until confirmed with the full dataset.
Abstract MP24: Urinary Potassium Excretion and Risk of Developing Hypertension
Authors: Kieneker Lyanne M , Gansevoort Ron T , Feskens Edith J , Geleijnse Johanna M , Navis Gerjan , Bakker Stephan J , Joosten Michel M
Published: July 2021

Background:
Potassium supplementation lowers blood pressure (BP) in randomized controlled trials, but the long-term effect of dietary potassium intake on risk of hypertension has not yet been established.

Objective:
To examine the association of 24h urinary excretions of potassium, reflecting dietary uptake, with risk of hypertension.

Methods:
We used data from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, community-based, observational cohort of Dutch men and women aged 28-75 years. Potassium excretion was measured at baseline (1997-98) and during follow-up (2001-03) in two consecutive 24h urine specimens. Risk of hypertension (defined as BP ≥140/90 mmHg, or initiation of BP-lowering drugs) was studied in 5,511 normotensive subjects not using BP-lowering drugs at baseline. We used Cox proportional hazards regression analysis with time-dependent covariates.

Results:
Baseline median potassium excretion was 72 mmol/24h (Q1-Q3: 57-85 mmol/24h). During a median follow-up of 7.6 years (Q1-Q3: 5.0-9.3 years), 1172 subjects developed hypertension. We observed a nonlinear association between potassium excretion and risk of hypertension (P=0.005;
Figure
). This association was in such a way that the lowest sex-specific tertile of potassium excretion (men: <68 mmol/24h; women: <58 mmol/24h) had an increased risk of hypertension (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.08-1.37) after adjustment for age and sex, compared to the upper two tertiles. Further adjustment for body mass index, smoking status, alcohol intake, parental history of hypertension (HR, 1.25; 95% CI, 1.11-1.41), and additionally for 24h urinary excretions of sodium, magnesium, and calcium (HR, 1.23; 95% CI, 1.08-1.40) did not materially affect the association.

Conclusions:
In this population-based cohort, low potassium excretion was associated with an increased risk of developing hypertension.

Figure: Association between 24h urinary potassium excretion and risk of hypertension.