bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P346: Cohort Identification to Harness the Electronic Health Record for Cardiovascular Disease Prediction
Authors: Manemann Sheila M , St Sauver Jennifer , Olson Janet E , Larson Nicholas B , Takahashi Paul Y , Roger Veronique L , Decker Paul A , Killian Jill M , Bielinski Suzette J
Published: March 2020

Background:
Current cardiovascular disease (CVD) risk scores are derived from research cohorts and are particularly inaccurate in women, older adults, and those with missing data. To overcome these limitations, we aimed to develop a cohort to capitalize on the depth and breadth of clinical data within electronic health record (EHR) systems in order to develop next-generation sex-specific risk prediction scores for incident CVD.

Methods:
All individuals 30 years of age or older residing in Olmsted County, Minnesota on 1/1/2006 were identified. We developed and validated algorithms to define a variety of risk factors, thus building a comprehensive risk profile for each patient. Outcomes including myocardial infarction (MI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), and CVD death were ascertained through 9/30/2017.

Results:
We identified 73,069 individuals without CVD (Table). We retrieved a total of 14,962,762 lab results; 14,534,466 diagnoses; 17,062,601 services/procedures; 1,236,998 outpatient prescriptions; 1,079,065 heart rate measurements; and 1,320,115 blood pressure measurements. The median number of blood pressure and heart rate measurements ascertained per individuals were 11 and 9, respectively. The five most prevalent conditions were: hypertension, hyperlipidemia, arthritis, depression, and cardiac arrhythmias. During follow-up 1,455 MIs, 1,581 PCI, 652 CABG, and 2,161 CVD-related deaths occurred.

Conclusions:
We developed a cohort with comprehensive risk profiles and follow-up for each patient. Using sophisticated machine learning approaches, this electronic cohort will be utilized to develop next-generation sex-specific CVD risk prediction scores. These approaches will allow us to address several challenges with use of EHR data including the ability to 1) deal with missing values, 2) assess and utilize a large number of variables without over-fitting, 3) allow non-linear relationships, and 4) use time-to-event data.
Abstract P354: Percent of Americans Meeting Food Group Recommendations and Top Food Sources of Key Nutrients in the American Diet
Authors: Smith Jessica D , Zhu Yong , Vanage Vipra , Jain Neha , Holschuh Norton
Published: March 2020

The 2015-2020 Dietary Guidelines for Americans recommends consumption of a healthy dietary pattern that includes nutrient-dense vegetables, fruits, whole grains, dairy, protein foods, and oils. However, many Americans are falling short on consuming the recommended amount of these food groups and greater disparities may exist within certain sociodemographic groups.

Objectives:
The objectives of this study were to determine where Americans were falling short in intake of food groups when stratified by sociodemographic characteristics and to determine which foods in the American diet were the top sources of whole grains and nutrients of public health concern (calcium, vitamin D, potassium, fiber and iron [for women and adolescent girls of childbearing age]).

Methods:
Data on consumption of food groups for Americans 2 years and older (excluding pregnant and lactating women; n=7,814) were taken from the Food Patterns Equivalent Database (FPED) 2015-2016. Usual intake of food groups was calculated based on 2 24-hr recalls using the National Cancer Institute method and National Health and Nutrition Examination Survey (NHANES) study weights. Top food sources of nutrients in the diet were calculated using NHANES 2015-2016 day 1 24-hr dietary recall data and foods were grouped according to the What We Eat in America categorization.

Results:
Over half of Americans 2 years and older met the intake recommendations for protein foods, oils, and total grains; however, far fewer met the recommendations for vegetables (12%), fruits (15%), whole grains (1%), or dairy (8%) intake. Patterns were similar across age groups although children and older adults were generally more likely to meet recommendations than adolescents and younger adults. Compared to men and boys, women and girls were more likely to meet recommendations for vegetables (14% vs 9%) and fruits (17% vs. 13%), and less likely to meet recommendations for total grains (50% vs 62%), dairy (5% vs 12%) and protein foods (43% vs 62%). The percent meeting recommendations for fruits, vegetables, whole grains and dairy remained low across racial/ethnic groups. Milk, ready-to-eat cereals, pizza, sandwiches, and breads were among the top sources of whole grains and the nutrients of public health concern for children. For adults, key foods included breads, ready-to-eat cereals, milk, and Mexican mixed dishes.

Conclusion:
Shifts in dietary patterns are needed to meet current recommendations across all age, gender, and racial/ethnic groups in the U.S. Increasing the intake of key foods such as milk, ready-to-eat cereal, bread and mixed dishes may help Americans increase intake of under-consumed food groups and nutrients.
Abstract P362: Metabolomic Markers of Southern Dietary Patterns in the Jackson Heart Study
Authors: Rebholz Casey M , Gao Yan , Talegawkar Sameera , Tucker Katherine L , Colantonio Lisandro , Muntner Paul , Gerszten Robert E , Wilson James
Published: March 2020

Background:
Diet is an important modifiable risk factor for hypertension and other chronic diseases. New biomarkers are needed for the objective assessment of dietary intake. The aim was to investigate metabolites associated with Southern dietary patterns.

Methods:
We used available dietary and metabolomics data from 1,042 Jackson Heart Study participants, a population of African-American men and women in Jackson, Mississippi, to determine metabolites associated with Southern dietary patterns. Three dietary patterns were empirically derived using factor analysis: meat and fast food, fish and vegetables, and starchy foods. Multivariate regression models were adjusted for age, sex, education, smoking status, physical activity, alcohol consumption, multi-vitamin use, kidney function, body mass index, and batch. We randomly selected two subsets of the study population: 2/3 sample for discovery (n=683) and 1/3 sample for validation (n=359). False discovery rate (FDR) was used to account for multiple comparisons in the analysis of the discovery sample and α=0.05 was used to assess statistical significance in the validation sample.

Results:
Among the 357 metabolites analyzed, one was associated with the meat and fast food dietary pattern (proline betaine), ten were associated with the fish and vegetables dietary patterns [1,7-dimethyluric acid, caffeine, C22:6 lysophosphatidylethanolamine (LPE), C38:6 phosphatidylethanolamine (PE), C38:7 phosphatidylcholine plasmologen, C38:7 PE plasmalogen, N-acetylornithine, NH4 C38:5 diacylglycerol or triacylglycerol fragment, pantothenate, and pantothenic acid], and none were associated with the starchy foods dietary pattern (all FDR<0.05). Two metabolites remained statistically significantly associated with dietary patterns in the validation sample: proline betaine and meat and fast food (β: -0.16, 95% CI: -0.30, -0.01, p=0.03) and C22:6 LPE and fish and vegetables (β: 0.12, 95% CI: 0.01, 0.23, p=0.03).

Conclusion:
Two potential biomarkers (proline betaine and C22:6 LPE) were discovered and replicated in association with dietary patterns detected in a Southern U.S. African-American population.
Abstract P383: Trends in Selected Chronic Conditions and Behavioral Risk Factors Among Women of Reproductive Age: Behavioral Risk Factor Surveillance System, 2011-2017
Authors: Hayes Donald K , Ko Jean Y , Robbins Cheryl L
Published: March 2020

Introduction:
Chronic disease causes significant morbidity and mortality across the lifespan. Public health approaches that reduce or prevent risk factors along with effective management of chronic diseases can improve health. This study describes trends of chronic conditions and related risk factors among reproductive aged women.

Methods:
Data from the 2011-2017 Behavioral Risk Factor Surveillance System, a representative state-based telephone survey of health behavior in US adults, were analyzed among 265,544 women of reproductive age, 18-44 years. We estimated adjusted prevalence ratios (APR) using predicted marginals to assess trends over time for 12 chronic conditions and related risk factors accounting for age, race/ethnicity, education, and health care coverage.

Results:
From 2011-2017, estimates of the following decreased: smoking (20.7%—15.9%;
P-value
<0.001), gestational diabetes (3.1%—2.7%; 0.003), and high cholesterol (19.0%—16.7%, 2011-2015; <0.001). Whereas the estimates increased for depression (20.4%—24.9%; <0.001), and obesity (24.6%—27.6%; <0.001). There were no differences over time for heavy alcohol consumption, binge drinking, diabetes, pregnancy-related high blood pressure, or high blood pressure. In the adjusted analysis, WRA were more likely to report asthma (APR=1.06; 95%CI=1.01—1.11), physical inactivity (1.08; 1.04—1.12), obesity (1.15; 1.11—1.19), and depression (1.29; 1.25—1.34) in 2017 compared to 2011. They were less likely to report high cholesterol (0.89; 0.85—0.94; 2011-2015), smoking (0.86; 0.82—0.89); and gestational diabetes (0.84; 0.75—0.94).

Conclusions:
Future research should examine why some chronic conditions and related risk factors improved while others worsened. That research may support the development of targeted interventions to promote improvements and reverse the worsening trends in chronic disease and related risk factors, potentially preventing adverse reproductive and long-term health outcomes among women of reproductive age.
Abstract P385: Pregnancy Care Must Do More to Meet Women's Social Needs: A Systematic Review of Interventions Addressing the Social Determinants of Health
Authors: Reyes Ana , Dahdouh Rabih , Akanyirige Precious , Estrada Araceli , Young Maria R , Simon Melissa A
Published: March 2020

Introduction:
Consistent evidence has shown that the social determinants of health (SDoH) play an important role in shaping overall health. As health systems become more focused on improving the health of populations, there is an urgent need for interventions that address upstream factors such as the social determinants of health. Such interventions have not been widely studied and even less work exists in the realm of maternal health. But as maternal and infant mortality remain critical issues, there is great opportunity for the study and development of interventions to address social needs in pregnancy care.

Hypothesis:
We assessed the hypothesis that most existing interventions addressing the social needs of pregnant women would focus only on identifying social risks, while fewer would connect patients with resources in the community. We expected that most studies would not provide evaluations of effectiveness.

Methods:
We conducted a database search of MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science to capture literature published between January 1970 and April 2019. A team of reviewers screened titles and abstracts for interventions that were issued in a clinical setting and addressed at least one SDoH as defined by the World Health Organization.

Results:
Preliminary results revealed 25 studies. All consisted of some form of risk screening and four included a referral process. Interventions addressing intimate partner violence were most numerous followed by psychosocial factors and cigarette smoking. Financial needs were assessed in one study. Eight studies included an evaluation process. Staff carrying out the interventions were primarily research staff, nurse practitioners or nurse midwives.

Conclusions:
In conclusion, more must be done to connect pregnant women with social resources. As unmet social needs put women at higher risk for poor outcomes in pregnancy, action should be taken to more seamlessly integrate social needs interventions into clinical workflows. Focus should expand beyond traditional social risk screening to capture a wider range of needs including financial stability, housing, and transportation. These are particularly important during pregnancy because adequate prenatal care requires women to be more engaged with the health care system than they would to maintain baseline health.
Abstract P393: Current and Future Perceptions of Well-being are Associated With General Health Status in Adults: Results From the Gallup National Health and Well-being Index, 2018
Authors: Shay Christina M , Poudel Remy , Stitzel Kimberly , Khan Yosef
Published: March 2020

Background:
Growing evidence exists indicate that subjective perceptions of well-being (i.e. life satisfaction) are favorably associated with overall health status. Few reports are available that explore this association in nationally representative samples of US adults.

Methods:
Data from were collected from 115,929 US adults (18+ y) from all 50 states via dual mail and web-based sampling through the 2018 Gallup National Health and Well-Being Survey. Well-being was assessed by asking individuals to place themselves on a 10-step ladder with ‘worst possible life’ representing the lowest rung and ‘best possible life’ the top rung; ratings were collected for both their current life and their life in 5 years. Based on both current and future life ratings, individuals were categorized as thriving, struggling, or suffering. General health status was assessed based 5 options (excellent to poor).

Results:
Significant positive trends were observed between current and future levels of life satisfaction with ratings of general health status after accounting for age, sex, education, an income (p<0.001 and p<0.001, respectively) (Figure 1). Similarly, the proportion of adults categorized as “Thriving” was higher across more favorable levels of general health status.

Conclusions:
Level of well-being assessed by subjective rating of life satisfaction is strongly, positively, and independently associated with perception of general health status in a large sample of US adults. These results may demonstrate the strong influence of well-being on the preservation of health, however, further prospective examination of these associations are warranted.
Abstract P416: An Externally Validated and Highly Sensitive Artificial Intelligence-driven Integrated Genetic-epigenetic DNA Test for Incident Coronary Heart Disease Prediction
Authors: Dogan Meesha , Philibert Robert
Published: March 2020

Despite being largely preventable, every year, coronary heart disease (CHD) affects millions of Americans. Currently, primary prevention of CHD starts with an understanding of several risk factors (e.g. age, gender, diabetes) that are aggregated to derive an incident CHD risk score using risk calculators such as the Framingham Risk Score (FRS) and ASCVD Pooled Cohort Equation (PCE). Unfortunately, this approach involves multiple tests and its lack in sensitivity could result in ineffective treatment recommendations to patients for the prevention of CHD. As an alternative, we have developed and independently validated a single, simpler, AI-driven, digital PCR (dPCR)-based integrated genetic-epigenetic DNA test that can more sensitively estimate the 3-year incident CHD risk for both men and women. Our technology accounts for the inherited and acquired (lifestyle/environment) risks for CHD through three genetic (SNP) and three epigenetic (DNA methylation) biomarkers, respectively, and can be performed on DNA from blood or saliva. The incident CHD risk prediction model was developed using genome-wide DNA methylation and genotype data from the Framingham Heart Study (FHS) Offspring cohort (n=1172 in training set, n=512 in test set) and was validated in an Intermountain Healthcare (IM) cohort (n=80 in validation set, n=79 in test set). The final prediction model is an ensemble of SVM, Random Forest and Logistic Regression models, and its performance in the FHS and IM test sets is summarized in Table 1. The FRS and PCE risk calculators were implemented on all FHS and IM cohort data. A clinically implementable version of this tool as part of its translation into a Laboratory Developed Test incorporates standard Taqman assays for genotyping and custom dPCR assays for DNA methylation quantification. The strong correlation between our dPCR assay values and the Illumina array values are shown in Figure 1, indicating successful dPCR assay translation. We are also extending this tool to include more ethnically diverse cohorts.
Abstract P420: Alcohol Consumption and Longitudinal Changes in Magnetic Resonance Imaging-defined Brain Abnormalities: The Cardiovascular Health Study
Authors: Costanzo Simona , Bartz Traci M , de Gaetano Giovanni , Di Castelnuovo Augusto F , Iacoviello Licia , Longstreth W T , Rimm Eric B , Siscovick David S , Mukamal Kenneth J
Published: March 2020

Introduction:
Alcohol intake has been related with a complex group of associations with brain structure in cross-sectional analyses, but to our knowledge, its prospective relationship with structural brain abnormalities detected by MRI has never been reported.

Hypothesis:
We hypothesized that consumers of 1-<7 drinks/week would have slower progression of leukoaraiosis (white matter abnormalities) but more rapid progression of brain atrophy than longer-term abstainers.

Methods:
As part of the Cardiovascular Health Study, 1 996 adults aged ≥65 years underwent MRI scanning in 1991-94 and again in 1997-99, having excluded 120 participants with a history of cerebrovascular disease before the initial scan. Alcohol consumption was assessed at each annual visit by self-reported intake of wine, beer and liquor. A 10-point white matter grade (WMG) and ventricular grade (VG) were assessed in a standardized and blinded manner in both scans; hippocampal and total brain volumes were also quantified on the second scan. We estimated the associations of alcohol intake in categories (as reported closest to the date of initial scan), with MRI findings at follow-up with multinomial ordered logistic regression (WMG ≤ 3
ref
and ≥ 4; VG ≤ 3
ref
, =4 and ≥5) using inverse probability weighting to account for attrition.

Results:
We observed a U-shaped association with WMG, with significantly lower risk among participants consuming 1-<7 drinks/week (OR 0.38; 95% CI 0.17-0.82, table) than long-term abstainers (P
quadtrend
= 0.01). For VG, the association was inverse (P
trend
= 0.06), with significantly less progression among drinkers of 1-<7 drinks/week than long-term abstainers (OR 0.62; 95% CI 0.40-0.97). We identified no significant associations of alcohol intake with quantitative mean hippocampal or total brain volumes at the second scan.

Conclusions:
Compared with long-term abstention, consumption of 1-<7 drinks/week of alcohol was generally associated with less progression of leukoaraiosis and some measures of brain atrophy in older adults.
Abstract P432: Racial Differences In Endothelial Function And Insulin Sensitivity
Authors: Couch Catharine , Bush Nikki , Dudenbostel Tanja , Gower Barbara
Published: March 2020

Racial disparities in health outcomes continue to be a significant public health concern and African Americans (AA) are disproportionately burdened by several risk factors for cardiovascular disease. Endothelial dysfunction has been shown to be a predictor of CVD and metabolic factors, including insulin resistance, are associated with endothelial dysfunction. Compared to EA, AA have impaired endothelial function and are more insulin resistant (less insulin sensitive). However, it remains unclear how insulin resistance may contribute to endothelial dysfunction in AA and EA. The purpose of the present study was to evaluate the relationship between insulin sensitivity and endothelial function in AA and EA. It was hypothesized that insulin sensitivity would be associated with endothelial function in both AA and EA.

Skeletal muscle insulin sensitivity was measured by hyperinsulinemic-euglycemic glucose clamp technique in 112 lean, overweight, and obese AA and EA adults without diabetes. Insulin was infused at 120 mU/m
2
/min for 3 hours and an infusion of 20% dextrose was adjusted to maintain blood glucose at the fasting level. Insulin sensitivity (10
-4
.dL.kg
-1
.min
-1
/(μU/mL)) was defined as M/(G x ΔI), where M is steady state glucose infusion rate, G is steady state serum glucose concentration, and ΔI is the difference between basal and steady state serum insulin concentrations. M was adjusted for total lean body mass which was measured by dual-energy X-ray absorptiometry (DXA).

Endothelial function was assessed by percent change in flow-mediated brachial artery dilatation (FMD). Changes in brachial artery diameter during reactive hyperemia were measured using ultrasound. Increased blood flow was induced via blood pressure cuff around the forearm, with a 5-minute inflation at 50 mmHg above the subject’s systolic blood pressure. Brachial arterial flow was determined using a pulsed-Doppler signal at baseline and 10-15 seconds after cuff release. Arterial diameter was measured at end-diastolic phase from super-VHS recordings. For reactive hyperemia response, measurements with the 5 largest diameters were averaged and the percent increase from baseline was determined as FMD.

A total of 55 AA and 57 EA were included in the analysis. Mean insulin sensitivity was 4.89 in AA and 7.97 in EA (p < .0001) and mean FMD was 10.69 in AA and 10.14 in EA (p = .595). Linear regression analysis indicated a significant relationship between insulin sensitivity and endothelial function in AA but not in EA (p= .005 and p= .5, respectively). These results suggest that insulin sensitivity may play a role in determining endothelial function in AA.
Abstract P452: Urinary Metal Levels After Repeated Chelation With Edetate Disodium: Additional Evidence in Support of Metals as Cardiovascular Risk Factors
Authors: Navas-Acien Ana , Alam Zenith , Domingo-Relloso Arce , Ujueta Francisco , LAMAS Gervasio A
Published: March 2020

Background:
Epidemiologic evidence supports lead and cadmium as CVD risk factors. In the Trial to Assess Chelation Therapy (TACT), edetate disodium infusions lowered CVD risk in patients with a prior myocardial infarction. The impact of repeated chelation on established biomarkers of metal body burden, post-chelation lead and pre-chelation urine cadmium, is unknown.

Objective:
To assess metals in urine samples collected at the first and at 10 or more infusions with edetate disodium. We hypothesized that post-chelation urine lead and pre-chelation urine cadmium would be lower after 10 infusions compared to the first infusion. Other metals were exploratory.

Methods:
13 patients with coronary artery disease (CAD) received a median of 3 g of edetate disodium over 3h per infusion and a median of 51 infusions (range 22-61). We collected pre and post-chelation urine samples at infusions 1 and ≥10. Metals were analyzed with ICPMS and controlled for urine dilution. Pre and post-chelation geometric means (GM) of urine metals at the ≥10 vs. first infusion were compared using paired T-tests.

Results:
Mean (SD) age was 75 (11) years, 77% participants were men, 46% were past smokers, 92% had diabetes, and 92% had peripheral artery disease. Comparing infusions ≥10 to 1 (Table), the GM (μg/g creatinine) dropped from 0.45 to 0.03 (94% reduction; p=0.005) for pre-chelation lead and from 14.80 to 2.91 (80% reduction; p=0.04) for post-chelation lead. For pre and post-chelation cadmium, the corresponding figures were 0.34 to 0.12 (64% reduction; p=0.17) and 2.81 to 2.35 (16% reduction; p=0.48), respectively.

Conclusions:
TACT treatment may decrease total body burden of lead, further supporting lead is a modifiable CVD risk factor. Data are insufficient to inform on changes in the burden of cadmium or other metals. Ongoing, larger studies will assess the effect of repeated chelation on toxic metal burden and incident cardiovascular disease.
Abstract P461: Genome-wide Analysis in Sedentary Adults of Non-completion of a Controlled Exercise Intervention
Authors: Jiang Rong , Huffman Kim M , Hauser Elizabeth , Hubal Monica , Slentz Cris , Johnson Johanna , Babyak Michael , Williams Redford , Siegler Ilene C , Kraus William E
Published: March 2020

A wide range of health benefits of exercise have been documented in clinical lifestyle medicine. However, many individuals fail to complete or maintain an exercise program. We hypothesized that this behavior has biological underpinnings. Thus, we conducted analyses of multi-omic data obtained from genomic, transcriptomic and metabolomic data specific to subjects (n=603) initiating a well-characterized exercise training trial (STRRIDE-Study of a Targeted Risk Reduction Intervention through Defined Exercise) to understand the biology of non-completion. GWAS detected the strongest evidence of association with non-completion was at SNP rs722069 (P = 2.2 х 10
-7
, OR=2.23, T/C, risk allele =C) on chromosome 16, with other 8 SNPs in a linkage disequilibrium block (pairwise R
2
> 0.74). These SNPs were eQTLs of the
EARS2, COG7
and
DCTN5
genes in skeletal muscle tissue in GTEx portal. In a subset of the STRRIDE sample, the C allele of rs722069 was associated with lower pre-exercise skeletal muscle expression of
EARS2
(P < 0.016) using Affymetrix platform (n=37). This was further replicated (P=0.017) in another set of skeletal muscle expression data using the Illumina gene expression array (n=67). The C allele was associated with lower pre-exercise skeletal muscle concentrations of C2- and C3-acylcarnitines (P < 0.03) - the incomplete oxidation products of fatty acid and amino acid metabolism. Lower
EARS2
skeletal muscle expression was also related to the lower C2- and C3-acylcarnitine concentrations in skeletal muscle (
P
< 0.05) before exercise. Rs722069 variants were not related to maximal oxygen uptake and insulin sensitivity in the individuals completing the exercise intervention. The tests of glucose and lipids levels associated with the genetic variants in this LD block are ongoing. To further understand the systemic genetics and biology of non-completion,
in silico
functional analysis for the genes in this region such as
UBFD1, NDUFAB1, PALB2
is also under way. Our results imply that non-completion is genetically moderated through differential gene expression and metabolic pathways in skeletal muscle. Impaired mitochondrial energetics in skeletal muscle may be partly responsible for non-completion. Individual genetic traits may allow development of a biomarker-approach to identify individuals that would benefit from more intensive counseling to maintain exercise programs.
Abstract P464: Progression of Obesity and Physical Inactivity in Chilean Medical and Dentistry Schools Students. A Call for Action
Authors: Sandoval Daniela , Bello Franco , Bravo Miguel , Romero Tomas E
Published: March 2020

Background:
In Chile obesity has increased (25.1% to 34%), and sedentary lifestyle has remained at 86.7% since 2010 to 2017 despite National programs and campaigns for improvements. It is unknown the prevalence of these and other lifestyle factors in students of medical careers, the expected future promotors of healthy lifestyles throughout their work.

Objectives:
To determine prevalence of obesity, physical inactivity, emotional stress, smoking and use of alcohol in first year students at University of Chile Faculties of Medicine and Dentistry at admission and throughout their first academic year.

Methods:
In a longitudinal randomized sample of 253 students (186 females) who completed the study, weight, height, waist circumference, waist circumference-weight ratio, BMI, food consumption, smoking (Glover-Nilsson Test) alcohol use (AUDIT), perceived stress level (PSS), and physical activity (GPAQ) at the first week, 3 and 6 months after their admission were measured. Cochran Test for dichotomic variables and Friedman test for non-parametric variables were used.

Results:
Average age was 19.1 ± 0.95 years, and blood pressure (first week) 117.2 ± 14.9 / 68.8 ± 8.7 mm/Hg. All the other results are listed in Table 1. Significant increasing prevalence of obesity (general and abdominal, 6.3% to 10.3%) and physical inactivity (< 600 MET/min/week, 16.6% to 22.9%), and poor eating habits with similar sex trends were found. High level PSS persisted throughout the study. Smoking in 17.8 % the first week without significant changes and harmful alcohol consumption declined significantly since admission (10.7 to 5.1%).

Conclusions:
Progressive obesity and physical inactivity, persistent highly perceived stress, poor eating habits, prevalence of smoking and harmful consumption of alcohol in first year medical students are of concern. Inclusion of lifestyle counseling in the curriculum and revision of its priorities and structure should be considered. A longer follow-up in a larger student cohort is being planned.
Abstract P480: The Distinct Role of Occupational Therapy in Addressing the Self-care Management Needs of Patients With Heart Failure
Authors: Bennett Amber , Nxumalo Kristin , Pike Whitney , Carroll Olivia
Published: March 2020

Introduction:
Hospitalizations for heart failure (HF) are the highest single Medicare expenditure. This cost primarily results from readmissions linked to failed self-care. Evidence suggests that effective self-care routines are equivalent to medication in preventing HF exacerbation and hospitalization. Occupational therapists (OT) are well suited to address HF self-care needs by facilitating self-efficacy and adapting patients’ routines, roles and habits. A recent study determined that OT is the only hospital spending category associated with lower HF readmission rates.

Hypothesis:
Occupational therapy has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care.

Methods:
The OT department launched a HF self-care management program as part of process improvement initiatives at an AHA-recognized teaching hospital. An assessment battery was developed which included the following: The Self-Care of Heart Failure Index (SCHFI) v.6.2, Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, and the Montreal Cognitive Assessment. Administration of the OT HF assessment battery to a pilot group of 12 inpatients revealed factors that affect patient adoption and adherence to beneficial self-care management routines. Based on assessment battery data, an outpatient OT program was established. Eleven outpatients were enrolled and completed 3-6 hours of OT treatment. The SCHFI was administered at program evaluation and completion to measure self-care maintenance and confidence. To expand service access, a telehealth self-care program was introduced and a single patient case study was assessed to determine the feasibility and effectiveness of the virtual format.

Results:
Assessment battery data enabled the development of outpatient treatment modules focusing on symptom monitoring, medication management, low sodium diet, activity tolerance and psychosocial strategies. All outpatients who completed the modules demonstrated improved self-care maintenance (ranging from 16-53 points) and half demonstrated improved self-care confidence (ranging from 6-39 points). The patient assessed after completing the telehealth program demonstrated improved self-care maintenance (70 points) and self-care confidence (28 points).

Conclusions:
In conclusion, OT has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. The utilization of a standardized OT HF assessment battery is effective in determining the needs of this population and for guiding the implementation of targeted individualized treatment. Outpatient and telehealth delivery of OT programming is effective in improving self-care for people with HF.
Abstract P482: Long-term Health and Cost Impact of the 2017 American College of Cardiology/American Heart Association (2017 Acc/aha) Hypertension Guidelines for Low-risk Adults
Authors: Wei Pengxiao C , Penko Joanne , Coxson Pamela , Bellows Brandon , Machen Leah , Moran Andrew E , Bibbins-Domingo Kirsten
Published: March 2020

Introduction:
The 2017 ACC/AHA guidelines redefined stage 1 hypertension to include blood pressure 130-139 mmHg/80-89 mmHg and recommended non-pharmacologic interventions (e.g., DASH diet, physical activity) for those with stage 1 hypertension and a low 10-year risk of cardiovascular disease (CVD). The cost-effectiveness of achieving target blood pressure in this low risk population in the clinical setting (via identification, diagnosis, and counseling on diet and exercise) has not been assessed.

Methods:
We used the Cardiovascular Disease Policy Model (CVDPM), a dynamic state-transition model of CVD in US adults to simulate achieving blood pressure control in low-risk adults aged 35-64 years with untreated stage 1 hypertension based on the 2017 ACC/AHA guidelines. Outcomes included incident CVD (coronary heart disease and stroke), CVD healthcare costs (2018 dollars), and quality-adjusted life years (QALYs) over 10 years. We projected outcomes assuming all low-risk young adults achieve control. We then varied the degree to which patients would change behaviors following diagnosis, using low uptake (20%) and high uptake (70%) estimates sourced from literature. We tested the sensitivity of health gains to decrements in QALYs associated with receiving a diagnosis using estimates from the Global Burden of Disease.

Results:
An estimated 7.0 million men and 6.6 million women age 35-64 years would be newly diagnosed with stage 1 hypertension and indicated for non-pharmacologic interventions according to 2017 ACC/AHA. Achieving targets of <130/80 mmHg is projected to prevent 63,200 incident CVD events and 4,800 CVD deaths and lower CVD related healthcare costs by $3.6 billion (2018 USD) over 10 years compared to no BP change. Assuming less than complete control (because of variable uptake of non-pharmacologic interventions) resulted in lower rates of CVD prevention (low uptake - 13,900 events prevented and $0.8 billion lower costs; high uptake 41,000 events prevented and $2.3 billion lower costs). In all scenarios, the magnitude of QALYs gained from preventing CVD was highly sensitive to decrements associated with anxiety from receiving a diagnosis.

Conclusions:
Achieving 2017 ACC/AHA stage 1 hypertension goals in newly diagnosed low-risk adults would result in substantial CVD benefit and reductions in CVD-related healthcare costs. . If these goals are to be achieved in the clinical setting, gains are likely to be offset by degree of uptake of counseling regarding non-pharmacologic interventions and anxiety related to a new diagnosis of hypertension.
Abstract P486: Association Of Psychiatric History With Hypertension Among Adults Who Presented For Bariatric Surgery
Authors: Tajeu Gabriel S , Wu Jingwei , Tewksbury Colleen , Spitzer Jacqueline C , Gadegbeku Crystal A , Sarwer David
Published: March 2020

Introduction:
Poor psychological health is common among adults with extreme obesity (body mass index (BMI)
>
40 kg/m
2
). While prior studies report an association between psychological conditions (i.e., depression) and risk of hypertension, less is known about this association among adults with extreme obesity. Additionally, the association between other forms of poor psychological health (i.e., anxiety) and hypertension among this population have yet to be studied.

Methods:
Participants (n=281) were recruited from a large academic medical center in an urban environment who were scheduled for bariatric surgery. Informed consent was obtained from all participants. Hypertension diagnosis (yes/no) was identified from the electronic medical record of the participants within eight weeks of psychological assessment. Psychiatric diagnoses were assessed by structured clinical interview and included major depression, bipolar disorder, alcohol use disorder, substance use disorder, post-traumatic stress syndrome (PTSD), anxiety, and eating disorders. Prevalence of hypertension by psychiatric diagnosis was compared using chi-square tests. Multivariable adjusted odds ratios (aOR) for the association between poor psychological health and hypertension were calculated using logistic regression. Regression models were adjusted for age, BMI, gender, race, marital status, education, and employment status. In order to avoid collinearity, each psychiatric diagnosis was included in its own model.

Results:
The mean age of participants was 41.5 (SD=11.0) and BMI was 45.9 kg/m
2
(SD=6.2). The majority (61.2%) of participants were black and 86.5% were women. Across the sample, 42.6% of participants were married, 75.5% had more than a high school education, and 77.9% were employed. Hypertension prevalence was 44.8%. Approximately 64.4% of participants had at least one lifetime psychiatric diagnosis. Prevalence of individual lifetime diagnosis was 41.6% for major depressive disorder, 41.0% for affective/bipolar disorder, 23.2% for alcohol use disorder, 16.8% for substance use disorder, 13.6% for PTSD, 10.4% for anxiety, and 3.2% for eating disorders. Unadjusted prevalence of hypertension was higher among participants with a diagnosis of anxiety (65.4% vs. 43.3%; p=0.03) compared to those without diagnosis. Multivariable adjusted odds of hypertension were higher among participants with a diagnosis of anxiety (aOR=6.28; 95% CI: 2.07-19.04; p-value=0.001) compared to those without.

Conclusions:
Among a diverse sample of patients with extreme obesity who presented for bariatric surgery, a lifetime diagnosis of anxiety, but not other commonly seen psychiatric diagnoses, was associated with increased odds of hypertension.
Abstract P488: Discrimination and Hypertension Risk Among African Americans in The Jackson Heart Study
Authors: Forde Allana T , Sims Mario , Muntner Paul , Lewis Tené , Onwuka Amanda , Moore Kari , Diez Roux Ana V
Published: March 2020

Background:
African Americans have a higher risk for hypertension compared to other racial or ethnic groups in the United States. One possible explanation for this health disparity is perceived discrimination. Few studies have prospectively examined the association between discrimination and the incidence of hypertension.

Methods:
We examined the associations of everyday, lifetime, and stress from lifetime discrimination with incident hypertension and whether these associations differed by sex, discrimination attribution (i.e. the main reason for the discrimination event), and coping responses to discrimination among African Americans enrolled in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000-2004). Participants completed two follow-up study visits from 2005-2008 and 2009-2013. We used interval-censored Cox regression to estimate associations of discrimination with incident hypertension (antihypertensive medication use; and/or systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure ≥ 90 mm Hg at follow-up visits 2 or 3) after adjustment for confounding variables.

Results:
Overall, 52% (954 of 1845) of participants developed hypertension over the follow-up period. After adjustment for age, sex, education and hypertension risk factors (body mass index, alcohol use, smoking, diet and physical activity), medium versus low levels of lifetime discrimination (hazard ratio-HR: 1.45, 95% confidence interval-CI: 1.15-1.82) and high versus low levels of lifetime discrimination (HR: 1.35, CI: 1.08-1.68) were associated with a higher incidence of hypertension. High versus low stress from lifetime discrimination was associated with hypertension risk after adjustment for demographics (HR: 1.20, CI: 1.02-1.41), but the association was attenuated after adjustment for hypertension risk factors (HR: 1.14, CI: 0.97-1.35). Lifetime discrimination and stress from discrimination were associated with an increased hypertension risk among females, but not males. No interactions with age, attribution or coping were present for any type of discrimination.

Conclusions:
Findings from this study support an association between lifetime discrimination and incident hypertension in African Americans.
Abstract P497: Association Between Accelerometer-estimated Physical Activity Intensity and Heart Rate Variability: Mediation by Glycemic Measures and Triglycerides (from The Cardia Study)
Authors: Pope Zachary C , Gabriel Kelley P , Whitaker Kara M , Chen Lin Y , Schreiner Pamela J , Jacobs David R , Sternfeld Barbara , Carr Jeffrey , Lloyd-Jones Donald M , Pereira Mark A
Published: March 2020

Introduction:
We estimated cross-sectional associations between accelerometer-estimated light (LPA), moderate (MPA), and vigorous (VPA) intensity physical activity (PA) and heart rate variability (HRV), and tested mediation of these associations by glycemic control indices, blood lipids, and blood pressure.

Hypothesis:
PA is positively and independently associated with higher (improved) HRV. Glycemic measures are partial physiological mediators of these associations.

Methods:
Data were from 1,668 participants (X
-age
= 46 ± 4 yrs, 58% F, 40% black) in Year 20 (2005-06) of the Coronary Artery Risk Development in Young Adults (CARDIA) Fitness Study. The ActiGraph 7164 estimated participants’ mean min/d of LPA, MPA, and VPA over 7d. Three sequential 10-sec 12-lead ECG strips provided standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Physiological mediators included fasting glucose and insulin as well as 2-hr oral glucose tolerance (OGTT), fasting triglycerides (TG), HDL-C, and systolic blood pressure (BP). Multiple linear regression, controlling for demographic and lifestyle confounders, assessed independent associations of PA with SDNN and rMSSD HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV associations attributable to physiological mediators.

Results:
Participants averaged 360.2 ± 83.8, 33.0 ± 22.0, and 2.7 ± 6.2 min/d of LPA, MPA, and VPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. VPA was associated with both HRV metrics (SDNN: std = .06 [.03, .10]; rMSSD: std = .08, [.05, .12]) and LPA with rMSSD only (std = .05, [.01, .08]). Fasting glucose and insulin mediated between 11.6%-20.7% of the association of VPA and LPA with HRV (Table). Triglycerides also mediated these associations (range: 9.6%-13.4%; Table).

Conclusions:
Accelerometer-estimated VPA and LPA were positively associated with higher HRV. These associations may be due most to glycemia and insulinemia.
Abstract P511: Adherence to the Dietary Portfolio is Associated With Lower Cardiovascular Disease Risk in the Women's Health Initiative Study
Authors: Glenn Andrea J , Lo Kenneth , Boucher Beatrice A , Vitolins Mara Z , Manson Joann E , Snetselaar Linda G , Kendall Cyril W , Jenkins David J , Liu Simin , Sievenpiper John L
Published: March 2020

Introduction:
The Dietary Portfolio is a plant-based dietary pattern of a combination of recognized cholesterol-lowering foods and has been shown to lower a number of cardiovascular disease (CVD) risk factors, including low-density lipoprotein cholesterol, blood pressure and C-reactive protein. However, no studies have assessed if following the Portfolio results in fewer CVD events.

Hypothesis:
Higher adherence to the Portfolio will be associated with fewer CVD events.

Methods:
We included 125,389 postmenopausal women from the Women’s Health Initiative Observational Study and Clinical Trials (from 1993 to 2017) who were free of CVD at baseline. Adherence to the Portfolio was assessed using an a priori diet index based on 6 food categories (high in plant protein [soy & pulses], nuts, viscous fiber, plant sterols and monounsaturated fat, and low in saturated fat) that were found to lower CVD risk factors in the Portfolio trials. Adjusted hazard ratios (HRs) and 95% confidence intervals [CIs] for CVD were calculated using Cox regressions. We adjusted for CVD risk & lifestyle factors and potential confounders (see Table 1).

Results:
During 1,826,176 person-years of follow-up, we documented 11,370 total CVD cases, including 5,739 coronary heart disease (CHD) cases, 4,451 stroke cases, 1,946 heart failure (HF) cases and 935 atrial fibrillation (AF) cases. Comparing the highest to the lowest quartile in the fully adjusted model, higher adherence to the Portfolio was associated with a reduced risk of total CVD (HR=0.89 [95% CI 0.84-0.95]), CHD (0.87 [0.79-0.95]) and HF (0.83 [0.70-0.98]). No association was found with stroke (0.97 [0.87-1.08]) and AF (1.09 [0.87-1.38]).

Conclusions:
In postmenopausal women, higher adherence to the Portfolio was inversely associated with total CVD, CHD and HF but not stroke or AF. These findings suggest that the Portfolio may assist with CVD, CHD and HF prevention and warrants further investigation.

Table 1: Association of the Dietary Portfolio and risk of CVD in Postmenopausal Women
Abstract P512: Red Meat Intake and Risk of Coronary Heart Disease Among US Men
Authors: Al-Shaar Laila , Satija Ambika , Wang Dong , Rimm Eric , Smith-Warner Stephanie A , Stampfer Meir J , Hu Frank , Willett Walter
Published: March 2020

Background:
The relation of red meat to risk of coronary heart disease (CHD) is of great interest, but this is likely to depend on the foods to which red meat is compared.

Objective:
We investigated the associations between total, processed and unprocessed red meat consumption and CHD risk and also estimated the effects of substituting other protein sources for red meat.

Methods:
We prospectively followed 43,259 men in the Health Professionals Follow up Study (1986-2012) who had no known history of cancer or cardiovascular disease. Diet was assessed by a standardized and validated food frequency questionnaire that was updated every 4 years. Multivariate Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of CHD risk across categories of red meat consumption. Substitution analyses were done by comparing coefficients in models including alternative foods as continuous variables.

Results:
During 932,968 person-years of follow-up, we documented 4,148 incident CHD cases of which 1,680 were fatal CHD cases. After multivariate adjustment for dietary and nondietary risk factors, both total and processed red meat intake were associated with a modestly higher risk of CHD (HR for a one serving/day increment: 1.08; 95% CI, 1.01-1.14 for total and HR=1.13; 95% CI, 1.03-1.22 for processed red meat). Substitutions of 1-serving per day of other foods (including nuts, legumes, soy, whole grains, low- and high-fat dairy) for 1-serving per day of total red meat were associated with a 10%-47% lower CHD risk. Stronger inverse associations were observed between some of these substitutions for red meat and risk of fatal CHD [substituting nuts (-17%, -27% to -6%) or whole grains (-48%, -60% to -32%), and were more pronounced when replacing processed red meat.

Conclusions:
Our results suggest that red meat consumption, particularly processed red meat, is associated with higher risk of CHD. Substituting high-quality plant foods such as legumes, nuts, soy, and whole grains for red meat may substantially lower CHD risk.