bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P392: Association Between Blood Pressure Variability and Subclinical Measures of Cardiovascular Disease in Desk Workers
Authors: Paley Joshua , Gordon Benjamin , Alansare Abdullah , Barone Gibbs Bethany
Published: March 2023

Introduction:
Previous research has demonstrated that variability in resting blood pressure (BP) across arms, measurements, or days may be associated with an increased risk for cardiovascular disease (CVD) and mortality. Yet, the extent to which BP variability increases cardiovascular risk and the mechanisms explaining this association are unclear. This study evaluated associations between BP variability with subclinical pathways of CVD development (arterial stiffness (pulse wave velocity [PWV]) and cardiac autonomic function (heart rate variability [HRV]) in desk workers.

Hypothesis:
Higher BP variability will be associated with higher PWV and lower (worse) HRV

Methods:
This secondary analysis of baseline data from the Effect of Reducing Sedentary on Blood Pressure randomized controlled trial included 265 sedentary and inactive desk workers (mean age 44.9±11.6 years; 82.0% white; 57.9% female) with elevated-to-stage 2 hypertension and who were not using antihypertensive medication. Sequential BP measurements determined the arm with the higher systolic BP by using an oscillometric device (Omron HEM-907XL). BP was then measured at least twice from the arm with the higher systolic BP at the first (visit-1) and second (visit-2) visits, occurring ≤30 days apart. Systolic BP variability metrics included inter-arm (first measurements between arms at visit-1), intra-arm (first two measurements on the arm with higher systolic BP at visit-1), and inter-visit (average BP from repeated measurements on the same arm across visits-1 and -2). Subclinical measures of CVD included resting carotid- femoral(cfPWV) and carotid-radial(crPWV) PWV (Complier Analyse) and the log transformed standard deviation of normal R-R intervals (SDNN) and the root mean square of the successive differences (RMSSD) HRV measures (Polar Electro). Adjusted linear regression estimated the associations between subclinical measures of CVD and BP variability metrics; Metrics were operationalized into three categories: differences of 0-5 mmHg, 6-10 mmHg, and 11 or more mmHg.

Results:
The prevalence of having 6 mmHg or more difference for the inter-arm, intra-arm, and inter-visit systolic BP was 43%, 38%, and 53%, respectively. PWV and HRV were not different across categories of inter-arm systolic BP variability or inter-visit systolic BP variability (all p>0.05). However, a same-day intra-arm difference in systolic BP of 6-10 mmHg within visit-1 was associated with higher cfPWV (β=0.42 m/s, (95% CI: 0.07, 0.77) as compared to those with an intra-arm difference of 0-5 mmHg.

Conclusion:
These data suggest that higher systolic BP variability in the same arm within visit, but not variability across arms or between visits, may be associated with higher aortic stiffness in desk workers with untreated elevated-to-stage 2 hypertension.
Abstract P393: AHA Life’s Essential 8 and Incident Hypertension Among US Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos
Authors: Tremblay Julien , Bello Natalie A , Mesa Robert A , Schneiderman Neil , Rundek Tatjana , Testai Fernando , Pirzada Amber , Daviglus Martha L , Perreira Krista , Gallo Linda , Penedo Frank , Sotres-Alvarez Daniela , Wassertheil-Smoller Sylvia , Elfassy Tali
Published: March 2023

Background:
The American Heart Association’s Life Essential 8 (LE8) are a set of eight simple health metrics used to define cardiovascular (CV) health and promote healthy behaviors. Our objectives are to: 1) describe for the first time, LE8 among Hispanics/Latinos of diverse backgrounds and 2) determine the association between LE8 and incident hypertension, a leading risk factor for CV disease.

Methods:
The Hispanic Community Health Study/Study of Latinos is a population-based study of diverse Hispanics/Latinos aged 18-74 years from four US communities. Participants were examined in 2008-2011 (visit 1) and 2014-2017 (visit 2). At visit 1, information on behavioral factors (diet, smoking status, physical activity, sleep duration) and clinical factors (BMI, blood pressure, cholesterol, fasting glucose, and medication use) were measured and used to estimate a LE8 score (range: 0 to 100%) for 14,772 participants with complete information. Ideal cardiovascular health (ICH) was defined by LE8 ≥ 80%. Hypertension was defined as systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg, or self-reported use of antihypertensive medications. We estimated ICH and described LE8 score according to Hispanic/Latino background group. Among the 5,667 participants free from hypertension at visit 1, we used Poisson regression models to determine the association between LE8 and incident hypertension at visit 2 including time between visits as an offset. Models were adjusted for age, sex, Hispanic/Latino background, income, education, nativity, health insurance, and marital status. All analyses accounted for the complex survey design of the study.

Results:
Among diverse US Hispanics/Latinos with a mean age of 41, 21.6% (SE: 0.7) had ICH. Mean LE8 score (68.2, SE: 0.3) varied by Hispanic/Latino background (p<0.05). Compared with Mexican background, (mean: 72.6, SE: 0.3), LE8 was significantly lower (less favorable) in all other Hispanic/Latino background groups: mean score of 62.2 (SE: 0.4) among Puerto Ricans; 62.3 (SE: 0.5) among Cubans; 69.3 (SE: 0.4) among Central Americans, 70.2 (SE: 0.5) among Dominicans; and 70.2 (SE: 0.7) among South Americans. Among Hispanics/Latinos without hypertension at Visit 1, each 10% decrement in LE8 score was associated with 23% increased risk of hypertension over approximately six years (incident density ratio: 1.23, 95% CI: 1.16, 1.30).

Conclusion:
Only one in five Hispanics/Latinos had ICH and LE8 varied substantially across Hispanic/Latino background group. Improvements in other components of CV health may result in lower risk of developing hypertension.
Abstract P394: Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Medicaid and Medicare Recipients
Authors: Smith Kayla M , Winterstein Almut G , Gurka Matthew J , Walsh Marta , Keshwani Shailina , Libby Anne , Hogan William , Pepine Carl J , Cooper-Dehoff Rhonda M , Smith Steven M
Published: March 2023

Introduction:
Early treatment for hypertension (HTN) portends better outcomes. However, few real-world studies have assessed initial antiHTN regimens and how they differ by baseline blood pressure (BP). We sought to compare initial treatment patterns, stratified by BP, between Medicaid and Medicare recipients.

Methods:
We performed a cross-sectional study of adults with newly-treated HTN in the One Florida+ Consortium(2012-2020) who had linked claims-EHR data from the treatment initiation visit. Eligible patients were Floridians with Medicaid or Medicare aged ≥18 years, with diagnosed HTN, who filled ≥1 first-line antiHTN class with no evidence of anti HTN fills during the year prior (in which continuous insurance enrollment was required). Baseline BP was categorized per current HTN guidelines, and logistic regression was used to estimate age-adjusted odds of combination vs. monotherapy, per 10 mmHg increase in systolic BP (SBP) or diastolic BP (DBP).

Results:
We included 2,902 patients (47% Medicaid, 53% Medicare); mean age was 44 (Medicaid) and 67 yrs(Medicare); 60% (64% and 56%, respectively) were women and 42% (57% and 29%, respectively) were Black. Initial antiHTN classes were similar comparing cohorts: ACEI, ARB and thiazide initiation varied little by BP category, in contrast to CCBs and β-blockers (Figure, panels A-B). In age-adjusted analyses, use of initial combination therapy was 40% more likely (OR, 1.40; 95% CI, 1.11, 1.76) among Medicare recipients and inversely related to BP category (panels C-D) among Medicare patients, in which each 10mmHg greater SBP (OR, 0.93; 95% CI, 0.88, 0.97) and DBP (OR 0.82; 95% CI, 0.75, 0.90) had lower odds of combination therapy. Among Medicaid recipients, only SBP associated with combination therapy (OR1.11; 95% CI, 1.03, 1.20).

Conclusions:
We observed similar initial class patterns among Medicaid & Medicare recipients across baseline BP, but differential use of combination therapy was less likely at higher baseline BP in Medicare recipients, which contrasts current guidance.
Abstract P396: A Culturally Tailored Mobile Health Lifestyle Intervention Improves Cardiovascular Health Among African Americans With Preexisting Risk Factors
Authors: Lalika Mathias , Jenkins Sarah , Hayes Sharonne N , Jones Clarence , Burke Lora E , Cooper Lisa A , Patten Christi , Brewer LaPrincess C
Published: March 2023

Background:
African-American (AA) adults have a higher prevalence of cardiovascular (CV) risk factors, leading to higher CV disease mortality than White adults. Prior findings of our mobile health (mHealth) lifestyle intervention (FAITH! App) demonstrated efficacy in promoting ideal cardiovascular health (CVH) in AAs.

Hypothesis:
We hypothesized that the intervention group with preexisting CV risk factors would have a greater increase in LS7 scores than the control group with the same risk factors following use of the FAITH! App.

Methods:
A cluster randomized controlled trial was conducted among AAs from 16 churches in Minnesota. The intervention included culturally relevant, LS7-focused education modules, diet/physical activity self-monitoring and a group sharing board. A subgroup of participants with ≥1 diagnosis of overweight/obesity, hyperlipidemia, hypertension (HTN) or diabetes was examined. The primary outcome was change in LS7 score—a measure of CVH ranging from poor to ideal (range 0-14 points)—at 6 months post-intervention.

Results:
Forty-nine participants (75.5% female) were included in the intervention (n=20; mean age [SD]: 58.8 [9.5]) or control (n=29, mean age [SD]: 52.5 [10.7]) groups (Table 1). There was no significant difference in the CV risk factor prevalence between the two groups. There was a greater increase in LS7 score in the intervention vs. control group across all CV risk factors, with significant differences among those with overweight/obesity (1.77, p<.0001) and with 2+ or 3+ CV risk factors (1.00, p=.03; 1.09, p=.04). Compared to the control group, the increase in the percentage of participants with ideal LS7 scores in the intervention group was higher among those with overweight/obesity, HTN, diabetes and 3+ CV risk factors.

Conclusions:
Our culturally tailored mHealth lifestyle intervention was associated with notable increases in LS7 scores among AAs with preexisting CV risk factors, suggesting its efficacy in improving CVH among this population.
Abstract P403:
In Situ
Physiological and Behavioral Monitoring With Digital Sensors for Cerebrovascular Disease: A Scoping Review
Authors: Zawada Stephanie J , Aissa Naser H , Athreya Arjun P , Pollock Benjamin D , Erickson Bradley J , Demaerschalk Bart M
Published: March 2023

Background:
Cerebrovascular disease is a life-threatening neurological event and a leading cause of long-term disability and death worldwide. Early detection of characteristic behavioral and physiological changes associated with cerebrovascular disease is critical to improving patient outcomes and quality of life measures. The growing prevalence of remote monitoring tools, from wearable devices to smartphone applications, that facilitate
in situ
observation of patients and the environments of daily life holds promise for more timely recognition and possible prevention of cerebrovascular accidents (CVA) like stroke.

Objective:
The goal of this scoping review is to examine and establish categories of innovation with digital sensors that monitor physiological and behavioral variables
in situ
to augment the current screening and diagnostic processes for patients with cerebrovascular disease.

Methods:
Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist, a robust search strategy for spanning multiple databases from 2012 to September 30, 2022, excluding review articles, articles including interventions, and articles not published in English, was implemented. Among the databases searched were Web of Science; Scopus; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; and Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily.

Results:
This search strategy aggregated 689 articles, of which 101 (14.7%) articles met the inclusion criteria for this scoping review. Articles were divided into two categories based on their focus: physiological and behavioral. Articles with a physiological focus were sorted into one of nine subcategories according to the signal(s) monitored: motor function, heart rhythm, heart rate, kinematic analysis, physical activity, blood pressure, sensory deficit, electrodermal activity, and intracranial pressure. Articles focusing on behavioral variables were sorted into two subcategories: mood and fatigue. Most studies used an ECG-enabled smartwatch, like an Apple Watch 3, or passive smartphone sensors.

Conclusions:
This scoping review identified disparate methods and conclusions associated with the use of digital sensors for
in situ
physiological and behavioral monitoring of cerebrovascular disease patients. While most articles evaluated pilot validation and feasibility trials, the lack of randomized controlled trials is a critical literature gap specific to this evolving research area.
Abstract P408: Association Between South Asian Ethnicity and Clinical Characteristics of Patients Undergoing Cardiac Catheterization
Authors: Visaria Aayush , Yanamala Naveena , Moon Seung Jae , Dave Payal , Sharma Ranita
Published: March 2023

Background:
We sought to describe differences in the characteristics of coronary interventions in U.S. South Asians (SA), an ethnicity at high risk for CAD, as compared to other races/ethnicities in New Jersey.

Methods:
In this single-center, retrospective cohort study of 8,850 patients from 2019-2021 undergoing coronary interventions (elective or acute), SAs were identified by 2 expert adjudicators. We used multivariable linear regression to estimate differences in mean age of coronary intervention by race/ethnicity (SA, non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, Other Asian, Other/unspecified). Among a subset of 7,288 patients, we used logistic regression to estimate odds of premature CAD (age<50y for overall cohort, <45y for male, <55y for female) and odds of multi-vessel disease (MVD; >2 vessels with ≥70% stenosis), adjusted for confounders (Table).

Results:
Among 8,850 patients (mean age 68y; 34% female; 5,011 [58%] NHW, 1,054 [12%] SA), 8.6% had premature CAD, 38% had acute coronary syndrome, and 20% had MVD. SA males, on average, were 5.1y younger and SA females were 3.9y younger, than NHW (male: SA, 63y [SD,12], 67[11] for NHW; female: SA, 67[11], NHW, 70[12]. p<0.001). Compared to NHW, SAs had 4.0x higher odds (male: 4.6x, female: 2.1x), NHB had 2.6x higher odds (M: 2.7x, F: 2.3x), other Asians had 2.1x higher odds (M: 2.3x, F: 1.3x), and Hispanics had 4.5x higher odds (M: 5.4x, F: 2.5x) of premature CAD (Table). SAs also had 47% higher odds of MVD than NHW (male: 45%, female: 47%), while NHB and Hispanics had 46% and 24% lower odds, respectively (Table). Findings were similar when restricting the cohort to patients requiring acute intervention (SA vs. NHW; OR [95% CI]. premature CAD, 3.73[2.44,5.71]; MVD, 1.54[1.12,2.11]).

Conclusion:
Independent of CAD risk factors, NJ SA males and females undergoing coronary intervention have more than 4 times and 2 times the likelihood of premature CAD, respectively, and more than 1.4 times the likelihood of multi-vessel disease compared to NHW.
Abstract P411: Low Serum Magnesium Predicts Higher Troponin and Lower Ejection Fraction in Acute Coronary Syndrome
Authors: Bardia Nikky , Shah Nupur , Riad Mariam , Ur Rahman Mustafeez , Mulyala Rajasekhar , Parks Alexis , Malozzi Christopher , Awan G. Mustafa , Omar Bassam A
Published: March 2023

Background:
Low Magnesium levels not only increase the risk of arrhythmias, but are also associated with increased myocardial damage in experimental animal models. The role of Mg levels and Mg supplementation on clinical outcomes after acute coronary syndrome (ACS) in human studies, however, remains controversial.

Objective:
To determine if low serum Mg levels in patients admitted with an ACS are associated with higher peak troponin I levels and lower left ventricular ejection fraction (EF), both of which are indicators of extensive myocardial damage and are independent markers of poor outcomes.

Methods:
Data were collected from University Medical Center’s computer system. Clinical lab defines low Mg as a level below 1.8 mg/dL. A total of 369 patients with ACS were identified; 86 had low Mg, and 283 had normal Mg. Data collected included age, gender, revascularization status, serum Mg, peak troponin I, peak CKMB, and EF. Data was analyzed using Student’s t-test.

Results:
Patients admitted with ACS had significantly higher troponin levels of 32.1 ng/mL when Mg level was < 1.8 mg/dL, compared to 25.9 ng/mL when Mg level was ≥ 1.8 mg/dL (6.2 ng/mL higher; P < 0.05). EF was significantly lower at 45.6% with Mg level of < 1.8 mg/dL, compared to 49.8% with Mg level of ≥ 1.8 mg/dL (4.2% lower; P < 0.05). Peak CKMB, age, gender, and revascularization status were not significantly different between the two groups.

Discussion:
In our cohort of patient admitted with ACS, we demonstrated a significant correlation between lower Mg levels and troponin level elevation, in addition to lower EF, indicating more extensive myocardial damage, which portends poor cardiovascular outcomes. Even though the role of Mg supplementation in the setting of ACS has been equivocal in the literature, it is likely, based on our findings, that maintaining normal Mg levels in patients at risk of ACS may translate into better outcomes if these patients present with an ACS. Further studies would be needed to examine this hypothesis and shed light on the potential mechanism behind our observations.
Abstract P416: Higher Quality Diet is Associated With Lower Serum Levels of NT-proBNP
Authors: Yang Ping , Rooney Mary R , Wallace Amelia S , Kim Hyunju , Echouffo Tcheugui Justin B , McEvoy John William , Ndumele Chiadi E , Christenson Robert H , Selvin Elizabeth , Rebholz Casey M
Published: March 2023

Introduction:
N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is widely used as a diagnostic biomarker for heart failure. Higher diet quality is associated with lower risk of cardiovascular disease. However, the association between diet and subclinical cardiovascular disease, as assessed by biomarker concentrations, is less well-studied.

Hypothesis:
We hypothesized that higher diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), would be associated with lower serum levels of NT-proBNP.

Methods:
We included 9,782 adults from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality, and was categorized into sex-specific quintiles. Weighted multivariable linear regression models were used to estimate associations between the overall HEI-2015 score as well as its 13 components and log-transformed NT-proBNP.

Results:
Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, persons in the highest HEI-2015 quintile had a 10.0% lower NT-proBNP level compared to those in the lowest HEI-2015 quintile (95% CI: -17.7% to -2.6%). There was a dose-response relationship between HEI-2015 and NT-proBNP (
Figure
). For each 1-unit higher sodium and added sugars score, NT-proBNP was lower by 7.7% and 6.8% respectively (95% CI: -13.8 % to -2.2%, and 95% CI: -13.1% to -0.9% respectively).

Conclusion:
Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.
Abstract P418: Dietary Glutamine and Glutamate in Relation to Cardiovascular Disease and Mortality in Adults With Type 2 Diabetes
Authors: Chen Zhangling , Hu Yang , Hu Frank , Manson Joann E , Rimm Eric B , Doria Alessandro , Sun Qi
Published: March 2023

Background:
The potential health effects of dietary glutamine and glutamate have been studied in healthy populations, but evidence among individuals with type 2 diabetes (T2D) who have altered macronutrient metabolism and elevated cardiovascular disease (CVD) risk is limited.

Objectives:
We aimed to examine dietary glutamine and glutamate in relation to subsequent risk of CVD, including coronary heart disease and stroke, and all-cause and cause-specific mortality among individuals with T2D.

Methods:
We prospectively followed 15,040 men and women with T2D at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014, Health Professionals Follow-Up Study: 1986-2018). Diet was repeatedly assessed using validated food frequency questionnaires every 2-4 years since baseline. Associations of energy-adjusted glutamine and glutamate intake, as well as their ratio, with CVD risk and mortality were assessed using Cox proportional hazards models with adjustments for demographics, dietary and lifestyle factors, and medical history.

Results:
During 196,955 and 225,371person-years of follow-up in participants with T2D, there were 2,927 incident CVD cases and 4,898 deaths, respectively. Higher intake of glutamine was associated with lower risk of incident CVD, total mortality and CVD mortality: comparing extreme quintiles, the HRs (95%CIs) were 0.88 (0.77, 0.99), 0.85 (0.77, 0.94), and 0.82 (0.69, 0.98), respectively (all

P
trend

<0.05). In contrast, higher intake of glutamate was associated with higher risk of incident CVD, total mortality, and CVD mortality; the HRs were 1.30 (1.15, 1.46), 1.19 (1.08, 1.31), and 1.42 (1.21, 1.67), respectively (all

P
trend

<0.05). Furthermore, comparing extreme quintiles, higher dietary glutamine-to-glutamate ratio was associated with lower risk of CVD incidence (0.84 (0.75, 0.95)), total mortality (0.83 (0.76, 0.91)), and CVD mortality (0.69 (0.59, 0.80)). In addition, compared with participants without increment in glutamine-to-glutamate ratio from pre- to post-diabetes diagnosis, those who increased the ratio had a 15% (3%, 25%) lower CVD mortality.

Conclusions:
In patients with T2D, dietary glutamine and glutamate demonstrated divergent associations with CVD incidence and mortality, and higher dietary glutamine-to-glutamate ratio was significantly associated with lower CVD incidence and mortality. These data suggest a potential critical role of these two amino acids in the etiology of cardiometabolic diseases and early deaths also among adults with T2D.
Abstract P420: The Interaction Between the Community Food Environment and Cooking Skills in Relation to Diet-Related Outcomes
Authors: Siddiqui Noreen Z , Matias de Pinho Maria Gabriela , Rutters Femke , Beulens Joline , Mackenbach Joreintje
Published: March 2023

Introduction:
What people eat is dependent on their food environment. However, individuals with better cooking skills may be less dependent on what is available in their food environment.

Hypothesis:
We assessed the hypothesis that the relation of the food environment around home and work with frequency of home cooking, diet quality, and body mass index (BMI) was modified by the level of cooking skills among Dutch adults.

Methods:
Our study included 1461 Dutch adults aged 18-65 years, who participated in a cross-sectional survey. Availability of restaurants and food stores was determined by their count in a 1000m buffer around home and work. Frequency of home cooking was categorized into <6 days and 6-7 times a week. A validated Dutch healthy diet index (0-150 points) was used to determine dietary quality. BMI was based on self-reported height and weight. Cooking skills (score 1-5) were assessed using a validated questionnaire and added to the models as interaction term. Linear and logistic regression models were adjusted for age, sex, energy intake, education, income, household size, and urbanization.

Results:
Neither the count of restaurants nor food stores was associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with higher diet quality (β: 0.58 (95% CI: 0.04, 1.13)). This association was not found for count of restaurants (β: 0.04 (95% CI: -0.02, 0.11)). A 10-unit higher count of restaurants was associated with a lower BMI (β: -0.02 (95% CI: -0.04, -0.004) but not with frequency of home cooking (OR: 1.00 (95% CI: 0.99, 1.01) or diet quality (β: 0.04 (95% CI: -0.02, 0.11). Better cooking skills were associated with higher odds of home cooking 6-7 days a week compared to <6 days a week (OR: 1.81 (95% CI 1.55, 2.12) and higher diet quality (β: 4.31 (95% CI: 3.12, 5.49)), but not with BMI (β: 0.06 (95% CI: -0.25, 0.37)). No significant effect modification between the food environment and cooking skills in relation to any of the outcomes was observed (P-for-interaction >0.1).

Conclusions:
In conclusion, being exposed to food stores was associated with a higher diet quality and being exposed to restaurants was associated with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and a better diet quality, but did not modify the observed associations with the food environment.
Abstract P422: Diminished Returns: Racial/Ethnic Differences in Diet Quality Vary by Education Level
Authors: Singleton Chelsea R , Peralta Garcia Ana Lucia , Bell Caryn
Published: March 2023

Introduction:
Poor diet is a major modifiable risk factor for cardiovascular disease. Educational attainment is highly correlated with healthy dietary behavior; as education level increases, diet quality also increases. Nevertheless, a recent study reported that Black adults with a high education level consume lower amounts of healthy foods (e.g., fruits, vegetables, whole grains) compared to White adults with a high education level. These findings are concerning because they suggest that certain individual or structural factors may produce diminished returns on educational investment among Black-identifying people. The literature on this topic is scarce. To address this gap, this study examined racial/ethnic differences in diet quality by education level among U.S. adults.

Hypothesis:
Black adults with ≥ bachelor’s degree will have lower diet quality than White adults with the same education level.

Methods:
We analyzed cross-sectional data on 19,591 adults (age ≥ 20) who participated in the National Health & Nutrition Examination Survey from 2011-2018. We calculated Healthy Eating Index (HEI)-2015 total scores using the participant’s 24-hour recall data. HEI-2015 (scale: 0-100) reflects how well an individual’s food and beverage intake aligns with the
2015-2020 Dietary Guidelines for Americans
. We ran stratified linear regression models to identify racial/ethnic differences in HEI-2015 total score within each category of educational attainment: < high school, high school or equivalent, some college/associate’s degree, ≥ bachelor’s degree. All models were adjusted for age, sex, marital status, poverty level, and household size.

Results:
Regression models revealed that Asian adults, on average, had significantly higher HEI-2015 total scores compared to White adults at every education level (p<0.0001 in all models). Hispanic adults had significantly higher scores than White adults in every educational category except ≥ bachelor’s degree where there was no difference. There was no difference in HEI-2015 total score between Black and White adults at every education level except ≥ bachelor’s degree. Black adults with a bachelor’s degree, on average, had a lower HEI-2015 total score (β = -1.69; SE: 0.79; p=0.03) compared to White adults with the same education level. Additional sex-specific analyses revealed that this disparity existed mainly between Black and White women with ≥ bachelor’s degree (β = -2.26; SE: 1.11; p=0.04).

Conclusion:
This study found that racial/ethnic differences in diet quality do vary by education level. As hypothesized, there is a Black-White disparity in diet quality among adults with higher education levels. Additional research is need to explore the individual and structural factors associated with this disparity.
Abstract P423: Adding Salt to Foods is Associated With the Risk of Incident Chronic Kidney Diseases
Authors: Tang Rui , Kou Minghao , Wang Xuan , Ma Hao , Li Xiang , Heianza Yoriko , Qi Lu
Published: March 2023

Introduction:
We recently found the frequency of adding salt to foods could reflect a person’s long-term salt taste preference and intake and was related to the risk of cardiovascular diseases. Whether adding salt to foods is related to chronic kidney disease (CKD) remains unknown.

Hypothesis:
We assessed the hypothesis that the frequency of adding salt to foods was associated with incident CKD risk in a general population of adults.

Methods:
A total of 465,288 participants initially free of CKD at baseline from the UK Biobank cohort with completed information on adding salt were analyzed in this study. Incident CKD cases were identified by ICD-10 codes and OPCS-4 codes. Cox proportional hazard models were used to estimate the association between the frequency of adding salt to foods and incident CKD.

Results:
During a median follow-up of 11.8 years, we documented 22,031 incident events of CKD. A higher frequency of adding salt to foods was significantly related to a higher CKD risk after adjustment for sex, age, race, body mass index (BMI), Townsend deprivation index, smoking, drinking, regular physical activity, high cholesterol, cardiovascular diseases (CVD), diabetes at baseline. Compared with the “never/rarely” group, the adjusted HRs (95% CI) of “sometimes”, “usually”, and “always” groups were 1.03 (0.99, 1.07), 1.07 (1.02, 1.11), 1.12 (1.06, 1.19), respectively (
P
-trend<0.001). In addition, we found that estimated glomerular filtration rate (eGFR), BMI and physical activity significantly modified the associations, which were more pronounced in participants with higher level of eGFR, and lower level of BMI or physical activity (P-interaction=0.003, 0.004 and 0.02, respectively).

Conclusion:
Our findings for the first time indicate that a higher frequency of adding salt to foods is associated with a higher CKD risk in the general population.
Abstract P428: Evaluating a Personalized Low Sodium Diet Intervention for Blood Pressure Control in Hypertensive Patients: A Pilot Study
Authors: Ko Jisook , An Kyungeh , Wang Jing , Chung Misook L
Published: March 2023

Introduction:
Although many clinical trials tested the effects of a low sodium diet (LSD) on high blood pressure (HBP) management, adherence to an LSD remains challenging. Considerable barriers to adherence to diet modification have been examined, and heterogenous responses to an LSD evolved. We tested the intra-individual response to an LSD to develop an individualized dietary intervention to optimize HBP management. The purpose of this pilot study was to determine the effectiveness of a personalized low-sodium diet (P-LSD), enhanced by mobile health technology for real-time dietary assessment and at-home BP monitoring in hypertensive adults.

Methods:
A total of 24 hypertensive patients (60.4±10.7 years) were randomly assigned to either PLSD (n=16) or usual care control groups (n=8). Participants in P-LSD went through individual sessions via video conferencing to discuss LSD regimens, patients’ food choices, and BP tracks on mobile apps. The Control group followed their usual care for HBP management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, SBP, and DBP were measured at the baseline and at 8 weeks. The preliminary effects of P-LSD were tested by paired t-test and analysis of covariance (ANCOVA).

Results:
Dietary sodium intake (
t
= 3.82), SBP (
t
= 3.95), and DBP (
t
= 3.54) were significantly declined overtime in the P-LSD group (Ps<0.01) but not in control group (Ps>0.05). There were significant differences between the control and intervention groups in changes of dietary sodium intake (F=18.6, p<0.001) and SBP over time (F=4.84, p<0.05) before and after the intervention. No statistically significant difference was revealed in DBP between the two groups before the intervention (p=0.20).

Conclusion:
The PLSD appears to be effective on the adherence to an LSD and BP control in hypertensive patients. Future studies with larger sample sizes are warranted to examine the long-term effects of PLSD on outcomes.
Abstract P429: Adiposity: Full or Partial Mediator of the Association of Diet With Blood Pressure?
Authors: Williams Amaris , Joseph Joshua J
Published: March 2023

Background:
Recently published results suggest body mass index (BMI) fully mediates the association of Dietary Approaches to Stop Hypertension (DASH) diet score with hypertension in women from the United Kingdom. The DASH diet has been shown to reduce systolic and diastolic blood pressure (SBP & DBP) while keeping BMI constant in United-States-(US)-based trials. Thus, we quantified the mediation of adiposity in the association of DASH diet with SBP and DBP in a US nationally representative sample.

Methods:
Using National Health and Nutrition Examination Survey (NHANES) data, years 2011-2018, the association of DASH score (scale: 8 - 40) with SBP and DBP was quantified with and without BMI or waist circumference (WC) in models adjusted for age, sex, education, income, and physical activity. Percent mediation was calculated from all sets of models.

Results:
The included sample (n=11,662) was aged 20 years or older (median 41 years), was not taking blood pressure medication, and was weighted to be representative of the US population. For SBP, in models without BMI or WC, a one-point higher DASH score was associated with a -0.21 mmHg lower SBP in the adjusted base model (p < 0.001). With the addition of BMI to the adjusted base model, the effect estimate was -0.12 mmHg (p = 0.005) for DASH score. With the addition of WC to the base model, the effect estimate was -0.13 mmHg (p=0.006) for DASH score. Thus, BMI and WC mediated 34% and 41% of the association between DASH and SBP in adjusted models, respectively. For DBP, in models without BMI or WC, a one-point higher DASH score was associated with a -0.15 mmHg lower DBP in the adjusted model (p < 0.001). With the addition of BMI to the base model, the effect estimate was -0.10 mmHg (p = 0.004). With the addition of WC to the base model, the effect estimate was -0.11 mmHg (p = 0.003) for DASH score. Thus, BMI and WC mediated 29% and 52% of the association between DASH and DBP in adjusted models, respectively.

Conclusion:
Adiposity is a partial mediator of the association of DASH score with SBP and DBP. The mechanisms that explain the greater mediation of WC than BMI in the association of DASH score with SBP and DBP require further elucidation. The effect of the DASH diet on blood pressure may have multiple mechanistic pathways: one that works through adiposity and others that work through non-adiposity-based mechanisms including higher potassium consumption and lower sodium consumption.
Abstract P430: Role of Cystatin C-based Estimated Glomerular Filtration Rate for Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation
Authors: Shin Jung-Im , Xu Yunwen , Ballew Shoshana , Bosi Alessandro , Hjemdahl Paul , Grams Morgan , Coresh Josef , Inker Lesley , carrero juan jesus
Published: March 2023

Introduction:
Renal dose adjustment is imperative to appropriate direct oral anticoagulant (DOAC) prescribing among patients with atrial fibrillation (AF). Serum creatinine is routinely used to estimate GFR (eGFRcr) in clinical practice, but eGFRcr may be less accurate in certain settings. It is unknown whether other kidney function biomarkers, like cystatin C, is helpful to guide DOAC dosing.

Hypothesis:
Appropriate DOAC dosing by eGFRcr but supratherapeutic dosing by cystatin C-based eGFR (eGFRcys) is associated with bleeding, compared to appropriate dosing by both eGFRcr and eGFRcys.

Methods:
We conducted observational study from the SCREAM project, a healthcare utilization cohort of Stockholm, Sweden, during 2006-2018. We identified patients with AF on DOACs who had creatinine and cystatin C measured on the same day. We calculated eGFRcr with the 2021 Chronic Kidney Disease (CKD)-EPI and eGFRcys with 2012 CKD-EPI cystatin C equations. We estimated defined daily dose consumed per day and considered <0.8 as a reduced dose. We separately classified supratherapeutic, subtherapeutic, and appropriate dosing by eGFRcr and eGFRcys, and examined the bleeding risk using Cox regression.

Results:
Among 5427 AF patients on DOACs, mean age (SD) was 76 (9) years and 43% were women. Compared to eGFRcr, eGFRcys identified more patients with CKD (61% for eGFRcys <60 ml/min/1.73 m
2
vs. 35% for eGFRcr <60 ml/min/1.73 m
2
), as well as more patients with supratherapeutic dosing (7.9 vs. 2.4%). Among 3064 patients who were classified as appropriate dosing by eGFRcr, 312 (10.2%) were reclassified as supratherapeutic dosing by eGFRcys and had a higher risk of bleeding (hazard ratio=1.58, 95% CI: 1.03-2.42), compared with those who were classified as appropriate dosing by both eGFRcr and eGFRcys (
Table
).

Conclusions:
Appropriate DOAC dosing by eGFRcr but supratherapeutic dosing by eGFRcys was associated with a higher risk of bleeding. The findings suggest that eGFRcys may inform decisions on DOAC dosing.
Abstract P432: Statin Initiation for Primary Prevention and Dose Intensity According to Age in the Women’s Health Initiative
Authors: Bancks Michael , Gaussoin Sarah A , Beavers Dan , Bress Adam S , Gillette Chris , Haring Bernhard , Liu Longjian , Maron David J , Reynolds Lindsay M , Shadyab Aladdin H , Vitolins Mara Z
Published: March 2023

Introduction:
Over 50% of US adults older than 75 live free of atherosclerotic cardiovascular disease (ASCVD) and diabetes (DM), yet data on incident statin use among this population are lacking. Our objective was to assess statin initiation by age among the Women’s Health Initiative cohort free of ASCVD and DM at baseline (1993).

Hypothesis:
Statin initiation is higher at older ages and differs by race/ethnicity.

Methods:
Exclusions were statin use at baseline, known ASCVD, DM, and no follow-up after baseline. Self-reported medication use was assessed in 1996 and 2008. Specific statin and dose prescribed at the time of initiation were identified using National Drug Codes and determined statin intensity, defined by the ACC/AHA guidelines. We estimated the adjusted association between age group (<65, 65-74, and ≥75) and statin initiation and assessed for heterogeneity by race/ethnicity. We also assessed statin dose at the time of initiation.

Results:
Over 12 years of follow-up, 27% of 99,631 women free of ASCVD and DM at baseline initiated a statin; initiation was lower with older age (Table). This association remained after adjustment for ASCVD risk factors and did not differ by race/ethnicity (p for interaction >0.5). Moderate intensity dose was most common at statin initiation overall, and moderate and high intensity dose were both lower with older age.

Conclusion:
Of women free of ASCVD and DM, women older than 75 were least likely to start a statin and most likely to start low intensity statin therapy at initiation than younger women. We identified a potential clinical gap for investigation: whether lower overall use of statins and lower intensity statin therapy among older women are associated with preventable ASCVD.
Abstract P433: Predictors of Self-Reported Medication Non-Adherence in Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Yin Christina , Windham B Gwen , Kucharska-Newton Anna , Couper David , Lutsey Pamela L , Ballew Shoshana , Shin Jung-Im
Published: March 2023

Introduction:
Medication non-adherence increases the risk of hospitalization and mortality in older adults. Evidence from previous studies was not conclusive due to small sample size or lack of adjustment for potential confounders. This study aims to investigate the prevalence and predictors of medication non-adherence in older adults, considering both individual-level and neighborhood-level factors.

Methods:
We studied participants (aged 66-90 years) who were on at least one medication at visit 5 (2011-2013) of the ARIC Study. Potential predictors included demographic factors, individual-level and neighborhood-level socioeconomic factors, behavioral factors, depressive symptoms, and cognitive function. We estimated the prevalence of self-reported medication adherence using the Morisky Green Levine medication adherence questionnaire and considered intermediate and low as medication non-adherence. We used multivariable logistic regression to identify independent predictors of medication non-adherence, further adjusting for race-center, insurance types, comorbidities, and number of medications.

Results:
Among 5304 participants (mean age of 75.5 [SD 5.1] years, 21.6% Black, and 58.2% female), 2.3% and 37.1% reported low and intermediate medication adherence, respectively. After adjustment, age 66-74 (odds ratio [OR]= 1.23 [95% CI, 1.10-1.38]), current drinker (1.31 [1.10-1.55]), lack of physical activity (PA) (1.18 [1.01-1.37] for intermediate PA; 1.38 [1.21-1.58] for low PA), and depressive symptoms (2.30 [1.82-2.91]) were significant predictors of medication non-adherence (
Table
). Education and ADI were not associated with medication non-adherence.

Conclusions:
We found that almost 40% of older adults have medication non-adherence. Unhealthy lifestyle factors and depressive symptoms were associated with medication non-adherence. Education and neighborhood-level SES were not. Depression is an important modifiable factor to improve medication adherence in older adults.
Abstract P435: Proton Pump Inhibitor Use and Risk of Incident Primary Cardiovascular Disease: A Systematic Review and Meta-Analysis
Authors: Soliman Ahmed I , Wactawski-Wende Jean , Millen Amy E , Eaton Charles B , Gray Shelly L , Lamonte Michael J
Published: March 2023

Background:
The risk of secondary cardiovascular events associated with proton pump inhibitor (PPI) use and their interaction with thienopyridine antiplatelets such as clopidogrel is well established. Recent evidence from
in-vitro
and animal studies suggests PPIs may impact cardiovascular disease (CVD) irrespective of antiplatelet use. However, whether PPI use is associated with primary cardiovascular events in humans remains uncertain.

Methods:
Systematic searches were conducted in the MEDLINE and EMBASE databases from their inception to September 2022. Inclusion criteria included studies that examined participants free from cardiovascular disease at baseline who were followed over time to assess any of the following outcomes according to PPI use: incident myocardial infarction (MI), incident ischemic stroke (IS), or CVD mortality. Hazard ratios (HR) and their 95% confidence intervals (CI) were abstracted, combined estimates and heterogeneity (I
2
) were calculated using the random-effects model in RevMan 5.4 software.

Results:
A total of 15 observational studies met the inclusion criteria, 2,272,479 participants were studied for MI, 2,689,943 for IS, and 1,591,428 for CVD mortality. The mean age of participants ranged from 49.3 to 82.2 years. Compared to non-use, PPI use was associated with 30% higher risk of incident MI (HR: 1.30, 95%CI: 1.10-1.53, I
2
=91%) and 15% higher risk of CVD mortality (HR: 1.15, 95%CI: 1.05-1.26, I
2
=56%). However, there was no statistically significant association with incident IS (HR: 1.05, 95%CI: 0.91-1.22, I
2
=96%).

Conclusion:
The meta-analysis results from published studies suggests PPI use is associated with higher risk of incident MI and CVD mortality. However, these findings should be interpreted with caution given the considerable heterogeneity among published studies and the possibility of residual confounding. More studies are needed to address these limitations and determine the validity of these associations.
Abstract P436: Objective Physical Activity and Orthostatic Hypotension in Older Adults: The STURDY Trial
Authors: Kwon Sohyeon , Juraschek Stephen P , Wanigatunga Amal A , Mitchell Christine M , Michos Erin D , Miller Edgar R , Appel Lawrence J , Schrack Jennifer A
Published: March 2023

Introduction:
Orthostatic hypotension (OH) is prevalent in older adults and associated with poor health outcomes. Physical activity (PA) may attenuate the risk of OH, but evidence of the association between daily volume and patterns of objectively measured PA and OH is lacking.

Hypothesis:
Lower daily volume and higher fragmentation of PA are associated with greater risk of OH.

Methods:
We included 196 participants (age ≥70) of the Study To Understand Fall Reduction and Vitamin D in You (STURDY) trial who wore an accelerometer for 7 days at their baseline visit and completed a supine-to-standing OH assessment at 2-year follow-up. We defined OH as a 20 mm Hg drop in systolic blood pressure or 10 mm Hg drop in diastolic blood pressure 3 minutes after changing from supine to standing position. Using accelerometry, daily total activity counts (TAC; counts/day) and time spent active (mins/day) were used to measure volume of daily PA. Active-to-sedentary transition probability (ASTP) was calculated as the reciprocal of the average PA bout duration to measure PA fragmentation. Multivariable robust Poisson regression estimated the risk ratio between baseline PA and OH after 2-years of follow up.

Results:
Among 196 participants, 12.2% of participants had OH after 2-years of follow up; 62.2% were male, and mean baseline age was 76.4 (SD=5.2). In this prospective analyses, lower daily activity (lowest vs highest tertile of TAC: RR = 6.49, 95% CI: 2.15-19.58; lowest vs highest tertile of time spent active: RR= 4.30, 95% CI:1.55-11.92) and higher fragmentation (highest vs lowest tertile of ASTP: RR = 5.36, 95% CI: 1.57-18.34) of PA were associated with higher risk of OH after 2 years
(Figure)
.

Conclusions:
Both lower daily activity volume and higher fragmentation of PA were associated with increased risk of OH in older adults over follow-up. Longitudinal studies to assess whether changes in PA volume or fragmentation alter the risk of OH should be explored.