bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P212: Adherence Trends to a Remotely Supervised Weight Loss and Exercise Training Intervention to Improve Rheumatoid Arthritis Cardiovascular Risk
Authors: Collins Katherine A , Ross Leanna M , Sudnick Alyssa M , Andonian Brian J , Huffman Kim M
Published: May 2024

Introduction:
Individuals with rheumatoid arthritis (RA) have an increased risk for cardiometabolic disease. By improving traditional markers of cardiometabolic health, interventions that induce weight loss and increase physical activity may also reduce RA-related cardiometabolic disease risk. However, to achieve these health benefits, an individual must adhere to such interventions. To understand whether sustained behavioral modification is feasible for individuals with RA, assessing adherence to prescribed intervention components is needed.

Hypothesis:
We hypothesized that adherence to a daily step goal would be greater than adherence to more intensive intervention components.

Methods:
Older adults with RA and overweight/obesity (n = 20) were randomized and completed 16 weeks of “usual care” Counseling Health as Treatment (CHAT) or remotely Supervised Weight loss and Exercise Training (SWET). The SWET program consisted of caloric restriction (7% weight loss goal), aerobic training (AT; 150 minutes/week), and resistance training (RT; twice weekly). Both groups were given a daily goal of 6,000 steps. Pearson correlation analyses assessed for a relationship between baseline measures and average daily step count.

Results:
Participants were on average 66.7 ± 5.4 years old, Caucasian (65.0%), men (80.0%), with obesity (body mass index: 32.4 ± 2.9 kg/m
2
). For SWET and CHAT, respectively, average daily step adherence was 117.8% (7065.6 ± 2117.0 steps/day) and 118.2% (7093.4 ± 2965.4 steps/day) (Figure 1A). Average adherence to SWET-only components was 84.0 ± 0.5% for AT, 83.0 ± 0.2% for RT, and 93.9 ± 0.1% for weigh-ins (Figure 1B). Step count adherence was unrelated to baseline measures.

Conclusions:
Step count adherence 1) was similar in both groups despite the intervention delivery strategy, and 2) exceeded other more intensive SWET intervention components (i.e., AT and RT). Findings highlight step counts as an achievable and sustainable RA exercise goal.
Abstract P231: Are Resiliency and Religiosity/Spirituality Associated With Better Sleep Outcomes in Midlife Latinas?
Authors: Harris Latesha K , Perreira Krista M , Cazales Andrea , Long Christian , Cortés Yamnia I
Published: May 2024

Background:
The disproportionate cardiovascular disease (CVD) burden among Latinas is not completely explained. An important health behavior in CVD prevention is sleep. In the United States (U.S.), Latinas experience unique sociocultural stressors that may impact sleep, particularly in midlife. Yet, little is known about protective factors such as resiliency and religiosity/spirituality among midlife Latinas.

Aims:
To assess the relation of resiliency and religiosity/spirituality with sleep disturbances in midlife Latinas.

Methods:
We conducted a cross-sectional analysis using baseline data from 49 participants in a pilot study to reduce CVD risk in midlife Latinas. Participants were Latinas aged 40-60 years who were perimenopausal or early postmenopausal, free of CVD, with no menopause hormone therapy use in the prior three months. Women were recruited from community settings. The frequency of sleep disturbances (trouble falling asleep, waking early, or nocturnal awakenings) over the past two weeks was assessed, and a sum score was created (0-16). The 6-item Brief Resilience Scale was used to assess the perceived ability to “bounce back” or recover from hardship. Religiosity/spirituality was determined by self-report (how important is religion/spirituality to you). Multivariable linear regression models were performed at p<0.15, adjusting for sociodemographic.

Results:
Participants were on average aged 47.1±4.5 years, 47% had less than a high school education, and 98% were born outside of the continental U.S. Sixty-nine percent of women experienced trouble falling asleep. The mean sleep score was 6.9±4.6. In adjusted models, we found an inverse relationship between resiliency and sleep (ß[SE]= -0.33[0.13],p=0.01). Religiosity/spirituality was not related to sleep disturbances (ß[SE]= 1.15[1.60],p=0.48).

Conclusions:
In this analysis of midlife Latinas, higher resiliency was associated with poorer sleep. Findings suggest that the ability to “bounce back” after hardship and religiosity/spirituality may not buffer the negative impact of stress on sleep. Further research is necessary with objective sleep measures to identify protective factors for sleep disturbances that may subsequently improve CVD risk in midlife Latinas.
Abstract P263: Cardiometabolic Multimorbidity Among Rural Low-Wage Workers Participating in a Worksite-Based Health Assessment
Authors: Burch Ashley , Lee Elisabeth , Shackelford Paul , Bolin Paul
Published: May 2024

Introduction:
Multimorbidity or the co-occurrence of two or more chronic conditions, is common among adults in the US and cardiometabolic multimorbidity is becoming progressively more common. Non-medical factors, such as lower educational attainment and poverty can increase a person’s risk of having cardiometabolic multimorbidity. The burden of cardiometabolic multimorbidity and its association with self-perceived health among a sample of rural, low-wage workers has not been established.

Methods:
Between December 2020 and August 2023, we partnered with 34 business to conduct worksite-based health screening clinics. Participants completed questionnaires, including the EQ-5D, and a physical assessment. Disease screenings included diabetes, obesity, and hypertension.

Results:
A total of 1128 individuals (45.1% Black, 56.7% male) were screened and included in this report. On a scale from 0 (poor health) to 100 (best health) the mean self-reported health was 78.4. On-site lab results identified 104 (9.2%) participants with an indicator of diabetes (HbA1c≥6.5), 575 participants were obese (51.0%), and 450 had a systolic blood pressure ≥ 140 (39.9%). Cardiometabolic multimorbidity was found in over a quarter of participants (28.3%, see figure). Self-perceived health differed among multimorbidity clusters. Participants with the lowest self-perceived health included those who screened positive for all three conditions (diabetes, obesity, and hypertension) (68.9), followed by those who screened positive for
both
diabetes and obesity (72.4), and those with only obesity (76.3). Participants without any positive screens had the highest health score (81.5).

Conclusion:
Of the 1128 individuals screened, over a quarter of participants screened positive for cardiometabolic multimorbidity. An additional 40.3% of the sample screened positive for
one
of the chronic conditions. Self-perceived health was associated with cardiometabolic multimorbidity; obesity appears to be an important factor in this relationship.
Abstract P264: HDL-C Variability and Peripheral Artery Disease
Authors: Chu Pao Hsien H , Tung Ying-Chang
Published: May 2024

Background:
Growing evidence has recognized the clinical implications of lipid variability in relation to cardiovascular disease and adverse outcomes. However, data on the association between lipid variability and the risk of incident peripheral artery disease (PAD) remain scarce compared to other manifestations like coronary artery disease and stroke.

Methods:
We conducted a study using data from the Chang Gung Research Database in Taiwan. A total of 93,948 patients diagnosed with hyperlipidemia between 2007 and 2013 who had at least one lipid measurement annually for four consecutive years were included in this study. Lipid levels, including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides, as well as their visit-to-visit variability (average real variability, ARV), were calculated over the four-year period. Patients were followed up until December 31, 2019, for the development of incident PAD.

Results:
During a mean follow-up of 5.9 years, 2,735 (2.5%) of the patients had incident PAD. The mean levels of the four lipids were all significantly associated with the development of incident PAD. However, only HDL-C ARV showed a significant association with an increased risk of incident PAD, independent of traditional risk factors for atherosclerosis and lipid-lowering therapy (adjusted hazard ratio: 1.13; 95% confidence interval: 1.004-1.27 for the comparison between patients in the highest and lowest quartile of HDL-C ARV; P for trend = 0.002). A sensitivity analysis using the variability independent of the mean as the HDL-C variability index confirmed this association. The study result was consistent across all subgroups analyzed.

Conclusions:
In this multi-institutional database analysis, visit-to-visit variability in HDL-C was significantly associated with the risk of incident PAD, independent of traditional risk factors for atherosclerosis, mean lipid levels, and the use of lipid-lowering therapy. Absolute levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were all significantly associated with the development of incident PAD. Visit-to-visit variability in HDL-C was significantly linked to the risk of incident PAD, irrespective of traditional atherosclerosis risk factors, mean lipid levels, and lipid-lowering therapy use.
Abstract P267: Associations of Urinary Zinc With Incident Peripheral Arterial Disease and Amputation in the Strong Heart Study
Authors: Howlett Claire , Ravalli Filippo , Bhatt Kishan , Martinez-Morata Irene , Fabsitz Richard , Tellez-Plaza Maria , Umans Jason G , Goessler Walter , Grau-Perez Maria , Devereux Richard B , Navas-Acien Ana
Published: May 2024

Background:
Urinary zinc has been associated with cardiometabolic endpoints including diabetes and peripheral artery disease (PAD), but evidence from prospective studies is limited.

Objective:
Our goal was to evaluate the prospective association between urinary zinc levels and incident PAD and amputation events in a large population-based cohort of American Indian adults in the US, the Strong Heart Study (SHS) cohort.

Methods:
A total of 2,049 PAD-free and 2,184 amputation-free participants at the baseline examination (1989-91) were included (mean 56 years, 61% female). The median (IQR) urinary zinc levels were 538 (388, 765) μg/g creatinine among PAD-free participants and 547 (396, 784) μg/g creatinine among amputation-free participants. PAD (defined as ankle brachial index <0.9 or >1.4) and amputation events were collected through the second (1993-1995) and third (1997-1999) SHS examination visits. We used logistic regression models to evaluate the progressively adjusted odds ratios (ORs) of PAD and amputation by increasing quantile of urinary zinc.

Results:
Over the two prospective study visits, 345 participants developed PAD and 23 underwent amputation. After adjustment for CVD risk factors including age, sex, location, body mass index, smoking and alcohol use status, cholesterol levels, estimated glomerular filtration rate, hypertension and diabetes, the ORs per IQR change in urine zinc levels were 1.16 (95% CI: 0.98, 1.38) for PAD, and 1.74 (95% CI: 1.04, 2.92) for amputation. Further adjusting the models for plasma fasting glucose reduced the magnitude of the association between high urinary zinc levels on PAD (OR: 1.09, 95% CI: 0.91, 1.31) and amputation (OR: 1.32, 95% CI: 0.72, 2.44).

Conclusions:
High urinary zinc levels were prospectively associated with PAD and amputation events, an association that appears to be partly related to lack of glycemic control. Further research is needed to better understand the complex relationship between urinary zinc, glycemic control and CVD.
Abstract P271: Greater Long-Term Non-High Density Lipoprotein Cholesterol Variability From Childhood is Associated With Poorer Midlife Cognitive Function: The Bogalusa Heart Study
Authors: Kang Soo Jung , De Anda-Duran Ileana , Fernandez Alonso Camilo , JIN XUANYI , Carmichael Owen , Bazzano Lydia A
Published: May 2024

Background:
Exposure to elevated plasma non-high density lipoprotein cholesterol (non-HDL-C) levels during adulthood has been associated with higher risk of cardiovascular events. However, whether long term non-HDL-C variability from childhood impacts midlife cognitive function (CF) is unclear.

Hypothesis:
We hypothesized that higher long-term non-HDL-C variability from childhood would be associated with worse midlife CF measures.

Aim:
We aimed to identify the effect of long term lipid variability from childhood on midlife CF.

Methods:
We studied 1,249 midlife participants of the Bogalusa Heart Study (age at baseline: mean 9.5 years+/- standard deviation(SD)3.5 years; age at midlife: mean 48.2 years+/- SD 5.2 years; 59.8 % women(747 of 1249), 34.3% Black(428 of 1249)) with ≥3 lipid measurements across follow up. Non-HDL-C levels were obtained as total cholesterol - HDL cholesterol. Visit-to visit non-HDL-C variability from childhood was estimated by the deviation from age predicted values (DEV), and residual SD (RSD). Non-HDL-C measurements were fitted in random-effects models stratified by race and sex, to produce individual growth curves. DEV and RSD were measured as the mean and SD of the residuals of observed and predicted non-HDL levels. Midlife CF was measured by 10 neuropsychological (NP) tests. NP test results were categorized into 3 distinct NP profiles (optimal, average, and mixed-low) using cluster analysis. Associations between non-HDL-C and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status and the mean of non-HDL-C measurements from childhood to midlife. DEV and RSD were standardized to z-scores before conducting regression analysis. Interactions according to race and sex were performed.

Results:
The odds of having a mixed-low CF compared to optimal increased by 31.1% (95% CI 1.075, 1.599) for every 1 SD increase in DEV, and by 30.5% (95% CI 1.069, 1.591) for every 1 SD increase in RSD, respectively, adjusted for education status and mean non-HDL-C levels. Neither race or sex were found to modify the associations of DEV nor RSD on CF.

Conclusions:
Higher long-term non-HDL-C variability was linked to poorer midlife CF. Further studies are needed to identify the impact of long-term non-HDL-C variability in the association of cardiometabolic risk factors and midlife CF.
Abstract P287: Incorporating Behavioral and Social Determinants of Health Variables Into a Machine Learning Model Predicting Cardiometabolic Disease
Authors: Salvia Meg , Mattie Heather , Austin S. Bryn , Hu Frank B , Mattei Josiemer
Published: May 2024

Introduction:
Machine learning models hold potential for improved cardiometabolic disease prediction and more efficacious prevention and intervention efforts. Current models are limited by use of cross-sectional datasets and variables (features) consisting of diagnostic criteria (such as blood glucose or hemoglobin A1c in type 2 diabetes models) and overlook health behaviors and social determinants of health (HB-SDH).

Hypothesis:
Machine learning models built with HB-SDH variables will accurately predict type 2 diabetes.

Methods:
We used data from 2,493 participants without diabetes in the Adolescent to Adult Health study (mean age = 15.5 years at baseline (1994), 40.9% male) who contributed blood samples and anthropometric measures in wave 4 (2008) or 5 (2016-2018). We used an 80/20 split to form separate training and test datasets; the training dataset was used to build random forest and XGBoost models, and performance with respect to classifying diabetes was evaluated in the test dataset. We first built a model using 15 demographic and biomarker features as a comparator for our second model, which included 34 HB-SDH features measured during adulthood but no biomarkers.

Results:
Five-hundred sixteen participants developed type 2 diabetes. In XGBoost, the comparator model was found to predict diabetes with 92.6% accuracy (95% CI: 89.8%, 94.8%) and area under the curve (AUC) = 0.8165. The HB-SDH model had 88.7% accuracy (95% CI: 85.4, 91.4%) and AUC = 0.7631. Using random forest, the comparator model had 93.0% accuracy (95% CI: 90.3, 95.2%) and AUC = 0.8376, while the HB-SDH model had 89.8% (95% CI: 88.6, 92.4%) accuracy and AUC = 0.7650. The top 10 variables in ascertaining classifications in the random forest model included self-reported general health, waist circumference, self-reported anxiety diagnosis, self-reported hypertension diagnosis, income, BMI, education level, change in weight, financial scarcity, and experienced stigma, while in the XGBoost model these were self-reported general health, experienced stigma, financial scarcity, self-reported anxiety diagnosis, experienced weight stigma, waist circumference, income, self-reported hypertension diagnosis, sugar-sweetened beverage intake, and BMI.

Conclusions:
Machine learning models built with behavioral and social determinants of health variables perform comparably to models with biomarkers and identify salient features for diabetes risk. The features that factored into classification performance were similar between random forest and XGBoost models. In this population, HB-SDH of relevance included socioeconomic indicators, sugary beverages, anxiety, and experiencing stigma, in addition to adiposity and hypertension. This finding needs to be replicated in diverse cohorts that may experience different HB-SDH.
Abstract P300: Evaluation of Organizational Behavior in a Rural Cardiology Clinic
Authors: Al Tibi Ghaith , Islam Rakin , Forkan Taskin , Ahmed Saad , Miller Samuel , Chronos Nicolas
Published: May 2024

Introduction:
In the healthcare industry, organizational behavior plays a pivotal role in patient care and staff well-being. Exploring these dynamics in a rural setting may add the unique factors of community engagement, resource allocation, and staffing limitations. Taking steps to understand how these concepts manifest can improve the effectiveness of healthcare delivery and form positive work environments that benefit both patients and providers.

Research Question:
How do healthcare staff at a rural cardiology clinic operate in the context of organizational behavior?

Goal:
The goal is to understand the organizational behavior in a rural clinic to optimize healthcare delivery and tackle operational-related challenges.

Methods:
Conducted in 2022 during the COVID-19 pandemic, this study employed a mixed-methods approach featuring interviews with staff at the rural Georgia cardiology clinic of Lake Country Medical Group (LCMG) and a five-point Likert scale survey of twenty-three questions developed from qualitative data gathered through the interviews. The survey queried organizational behavior concepts such as job satisfaction, communication, and leadership, with answers being graded on a scale of 1 being “strongly disagree” to 5 being “strongly agree.” Descriptive statistics were used to analyze survey responses.

Results:
Twenty LCMG staff responded to the survey. Key survey results were analyzed according to organizational behavior categories (Figure 1). Qualitative data from interviews described operational inefficiencies and day-to-day challenges including scheduling issues, billing difficulties, and deficient recordkeeping perpetuated by “siloed” teams at the clinic.

Conclusion:
LCMG faces some operational challenges that can be ameliorated by organizational behavior approaches. Solutions oriented around enhancing synchronous work, cross-training, and stress-reduction could improve staff well-being and ultimately lead to improved patient care.
Abstract P325: Perceptions of Primary Care Quality and Hypertension Control in the Eastern Caribbean
Authors: Wambugu Vivien , Steel Sydney A , Galusha Deron , Nunez-Smith Marcella , Oladele Carol R
Published: May 2024

Introduction:
The Caribbean region has high rates of uncontrolled hypertension, a condition that is predominantly managed in primary care. Though evidence shows patient perceptions of quality of care are associated with health outcomes, there is a paucity of research in the Caribbean. This study aimed to fill evidence gaps on the relationship between perceived quality of care and hypertension management in the Caribbean.

Objective:
To understand the role of quality-of-care perceptions in hypertension control in the Eastern Caribbean.

Hypothesis:
We assessed the hypothesis that individuals with higher perceived quality of primary care are more likely to achieve blood pressure control.

Methods:
We conducted a cross-sectional analysis of baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECHORN) (N=2961). ECHORN is an ongoing longitudinal study of adults conducted across four island sites. Participants completed a self-reported health survey, clinical examination, and laboratory testing. Participants who were aware of their hypertension status and reported a clinic visit within the past year were included in this study. The main exposure, perceived quality of care (QOC), was measured by asking participants to rate the quality of their healthcare. Likert responses were used and categorized as poor/fair, good, and very good in analyses. The outcome, hypertension control, was defined by JNC-7 guidelines and used as a binary variable. Pearson and Mantel-Haenszel Chi-Square tests were used for analysis.

Results:
The final analysis included 470 participants. Forty-six percent of participants had controlled hypertension, and 54% did not. Younger persons and those with higher educational attainment were more likely to have controlled hypertension. Twenty-four percent ranked QOC as poor/fair, 47% as good, and 29% as very good. Forty-one percent of those who rated QOC as poor/fair, 44 percent of those who rated QOC as good, and 53 percent of those who rated QOC as very good had their hypertension controlled. Mantel-Haenszel Chi-Square results showed a statistically significant positive linear trend in the relationship between QOC and hypertension control.

Conclusion:
This study demonstrated a positive relationship between higher perceived QOC and hypertension control in the Eastern Caribbean. Due to the burden of hypertension and the lack of region-specific literature on quality of care, further research is warranted to explore dimensions of QOC that most influence hypertension control.
Abstract P326: Patient Predictors of Antihypertensive Medications Prescription Classes Revealed by the All of Us Research Project (AOURP) Registry
Authors: Yu Jingzhi , Gauen Abigail , Zmora Rachel , Petito Lucia , Kho Abel , Allen Norrina B
Published: May 2024

Hypertension (HTN) treatment guidelines recommend five general classes (ACEi, ARB, CCB, diuretics, beta-blockers) of medications with minimal guidance regarding specific classes for different types of patients. Understanding heterogeneity in HTN treatment and demographic and clinical traits of individuals receiving different medication classes may provide insights into outcome disparities and enable the development of more tailored treatment recommendations. Using EHR data from the national All of Us Research Project (AOURP) registry, we examined patient predictors of first-line HTN medication class usage. From the AOURP we selected: 1) patients aged 18+ and diagnosed with new-onset HTN between 2010 and 2021 which is determined by having no HTN medication prescription prior to diagnosis date; 2) patients not pregnant within a year before and after the HTN diagnosis. We restricted our analyses to individuals receiving routine care within the EHR database as defined by having at least one in-person visit in the year prior to the first HTN diagnosis and prescribed with a single class of HTN medications within a year of their HTN diagnosis. We performed multivariate regression analysis on the outcome of whether a certain class of first-line medication was prescribed another class. Our covariates include age, sex, race/ethnicity, comorbidities (diabetes, CVD, CKD), and household income. All reported odds ratios below have a p-value of less than 0.05. Among 5,521 AOURP participants, ACEi was the most prescribed class (29%), followed by CCB (23%), Diuretic (22%), Beta-blocker (17%), and ARB (9%). We found ACEi were more likely to prescribed for females (OR: 0.74) while diuretics were less likely to be prescribed for males (OR: 1.45). We found CCB (OR: 2.73) and diuretics (OR: 1.54) were more likely to be prescribed for Blacks than their White counterparts. We also found that ACEi (OR: 2.75) were more likely prescribed for diabetics. In terms of household income, we found that ARB (OR: 1.67) were prescribed more frequently for those in higher income brackets (<$25,000 vs $100,000+) compared to other classes of medication. This corresponds to the fact that ARB are relatively newer and more expensive class of HTN medications. Our findings show that although there are levels of clinical equipoise in terms of prescribed medication classes among the general population, evidence-based guidance on personalized antihypertension treatments may be needed.
Abstract P327: Examination of Cardiometabolic Health Status, Obesity, and Brain Health in Community-Dwelling Older Adults
Authors: Alphin Kathryn H , Lockhart Samuel N , Suerken Cynthia , Gaussoin Sarah , Brinkley Tina E
Published: May 2024

Introduction:
Mid-life and late-life obesity have been associated with changes in brain structure and function, though the exact nature of this dynamic relationship is not well understood.

Purpose:
To determine whether associations between measures of obesity and neuroimaging biomarkers are independent of cardiometabolic health status in older adults.

Methods:
Adults 55 and older were recruited into the Clinical Core of the Wake Forest Alzheimer’s Disease Research Center (ADRC) between 2016 and 2023 and underwent standard evaluation in accordance with the National Alzheimer’s Coordinating Center protocols. Body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) were measured to assess obesity. Cardiometabolic health was determined by the presence of impaired glucose tolerance (IGT) and hypertension (HTN). Brain MRI scans were conducted to assess cerebral blood flow (CBF) in white matter (WM) and gray matter (GM), WM microstructure using neurite orientation dispersion and density imaging (NODDI) of free water (FW), total brain volume (GM+WM), and temporal lobe cortical thickness. Linear regression was used to examine associations between anthropometric and neuroimaging measures, controlling for demographics (age, gender, race, education) in model 1 and demographics plus cardiometabolic health (HTN and IGT) in model 2.

Results:
A total of 647 Clinical Core participants with anthropometric, MRI, cardiometabolic, and demographic data available were analyzed. Mean age of participants was 70.1±8.2 years, 19% were African American, 48% had adjudicated cognitive impairment (35% mild cognitive impairment, 13% dementia), 76% had HTN, and 69% had IGT. BMI (p<0.001), WC (p<0.001), and WHR (p=0.006) were positively associated with WM CBF in models 1 and 2. BMI (p=0.039) was also positively associated with GM CBF in model 2. All three obesity measures were positively associated with NODDI FW in model 1: BMI (p=0.006), WC (p=0.007), and WHR (p=0.039), and WHR was negatively associated with total brain volume (p=0.043). However, these associations were attenuated after further adjustment. Cortical thickness was not significantly associated with obesity in any model.

Conclusion:
These results demonstrate that, among community-dwelling older adults, having higher BMI, WHR, and WC is associated with higher WM CBF even after adjusting for demographics, HTN and IGT, suggesting that obesity may be a risk factor for impaired brain perfusion in late life.
Abstract P335: Predictors of Cognitive Resilience in Those With and Without High White Matter Hyperintensity Burden: A Post-Hoc Analysis of Systolic Blood Pressure Intervention Trial Memory & Cognition in Decreased Hypertension (SPRINT MIND)
Authors: Stulberg Eric , Zheutlin Alexander , de Havenon Adam H
Published: May 2024

Introduction:
Little is known if predictors of cognitive resilience (CR) differ between adults with or without large white matter hyperintensity burdens. In the current analysis of cross-sectional baseline SPRINT MIND data, we a) determined bivariate associations of sociodemographic, vascular-metabolic, and neurodegenerative biomarkers with CR and b) delineated variables that maximized predictive fit of CR among participants with the highest and lowest white matter hyperintensity volumes (WMHv).

Methods:
We included SPRINT MIND participants with baseline available plasma biomarker concentrations & Montreal Cognitive Assessment (MoCA) scores. We then created two analytic samples: those with the highest tertile of WMHv (N = 186) and those with the lowest tertile (N=134). We defined CR two ways: as a MoCA score a) >25 or b) >22. We determined the association between sociodemographic, vascular-metabolic, and serum neurodegenerative variables, as well as WMHv with CR using logistic regressions to generate unadjusted odds ratios (OR) & 95% confidence intervals (CI). Multivariate lasso regressions were then used to determine which variables optimized predictive fit of CR, and R
2
values were calculated.

Results:
In participants with the lowest tertile of WMHv , the median age was 66 years, 45.5% were female and 63% were Non-Hispanic white. In participants with the highest tertile of WMHv, the median age was 73 years, 45.7% were female and 66% were Non-Hispanic white.
.
CR defined as MoCA scores > 25 & >22 was present in 37.3% and 64.9% in those with the lowest tertile of WMHv and 28.5% & 56.5% in those with the highest tertile, respectively. Higher education and self-reported race generally had the strongest ORs in all analyses (Table 1 excerpt). Only age and education level were included in all four predictive models after lasso shrinkage. The R
2
values for all lasso regressions were <0.25.

Conclusion:
Education level may be associated with CR irrespective of WMHv. However, a large variation of CR remains unaccounted for.
Abstract P352: Association of General and Exertional Fatigue Subtype With Pre-Clinical Heart Failure Stage in Community Dwelling Older Adults in the Atherosclerosis Risk in Communities Study
Authors: Pavlovic Noelle , Abshire Saylor Martha , Dennison Himmelfarb Cheryl R , Commodore-Mensah Yvonne , Shah Amil M , Matsushita Kuni , Ndumele Chiadi E
Published: May 2024

Background:
General and exertional fatigue are prevalent in heart failure (HF), can co-occur, and are associated with adverse outcomes. However, little is known about general and exertional fatigue in pre-clinical HF stages (stage A or B HF).

Methods:
In this cross-sectional analysis, we included participants at ARIC study visit 5 with stage A HF (risk factors for HF) or B HF (echocardiographic abnormalities or cardiac biomarker elevations). Using general fatigue (Patient Reported Outcomes Measurement Information System (PROMIS) fatigue scale) and exertional fatigue (Medical Research Council breathlessness scale) scores, we cross-categorized individuals into 4 fatigue subtypes: fatigue-free; high general fatigue only; high exertional fatigue only; high general/high exertional fatigue. The absence of a fatigue type was defined as a score of “none-mild”, and high severity as a score of “moderate-severe”. We examined the independent association of HF stage with fatigue subtype using multinomial logistic regression.

Results:
Our sample (N=4,269) was 59% female, 80% White, with a mean age of 75 years. Prevalence of any type of fatigue was 28% (n=1,179). Those with stage B had a higher prevalence of all fatigue types compared to stage A: high general fatigue only (10.2% vs 8.1%), high exertional fatigue only (12.6% vs 9.1%) and high general/high exertional fatigue (6.9% vs 4.7%). Compared to those with stage A, those with stage B had higher odds of having high general fatigue only (adjusted Odds Ratio (aOR) = 1.3 (95%CI = 1.0, 1.7)), high exertional fatigue only (aOR = 1.4 (1.1, 1.8)), and high general/high exertional fatigue (aOR = 1.6 (1.1, 2.2)) compared to being fatigue-free. Further adjustment for cardiometabolic risk factors attenuated these associations (Table).

Conclusions:
General and exertional fatigue are more prevalent in those with subclinical HF and these associations may be linked to cardiometabolic profiles. Prevention and management of risk factors may reduce the burden of fatigue in this population.
Abstract P362: Differences in Cardiovascular Health, Physical Activity Determinants, and Desired Intervention Components in Individuals With a History of Hypertensive Disorders of Pregnancy by Activity Level
Authors: Borrowman Jaclyn D , Story Willaim , Carr Lucas , Pierce Gary L , Barone Gibbs Bethany , Whitaker Kara M
Published: May 2024

Introduction:
Hypertensive Disorders of Pregnancy (HDP) affects ~16% of pregnancies and is associated with a 2- to 4-fold greater risk of cardiovascular disease (CVD). Physical activity (PA) is a known modifiable risk factor for CVD; however, little is known about the CVD risk factors potentially related to postpartum PA after HDP. More research is also needed examining specific behavioral determinants influencing postpartum PA and a postpartum PA intervention would be desired.

Purpose:
To assess differences in CVD risk factors, behavioral determinants of PA, and desired PA intervention components among postpartum individuals with HDP, stratified by PA level.

Hypothesis:
Inactive individuals will have more CVD risk factors, different behavioral determinants and desired PA intervention components compared to active individuals after HDP.

Methods:
Individuals residing in Iowa who were <1 year postpartum and experienced a HDP were recruited to complete online surveys assessing demographics, PA, CVD risk factors, behavioral determinants of PA (e.g., barriers and facilitators of PA), and desired PA intervention components. Individuals were classified as active or inactive using the 2018 PA guidelines for Americans.

Results:
Participants (N=72) were 30±6 years old, mostly white (84%), and 54% were sufficiently active. Inactive individuals were more likely to be diagnosed with hypertension after delivery, had lower CVD knowledge, and were 2.9 times less likely to identify facilitators of PA compared to active individuals (Table; p<0.05). All indicated interest in a postpartum PA intervention, with inactive individuals expressing greater interest in information on postpartum PA safety, PA while breastfeeding, and social media interventions compared to active individuals (Table; p<0.05). Preferred communication included text, email, and video call.

Conclusions:
Development of PA interventions after HDP should consider the unique needs of individuals across current postpartum activity levels.
Abstract P365: Systematic Review of Self-Management Interventions for Black Women With Cardiovascular Risk Factors
Authors: Church Emma , Kelley Erika , Maniglia Taylor , Kohli Rhea , Sajatovic Martha , Levin Jennifer B
Published: May 2024

Background:
Cardiovascular disease (CVD) is the leading cause of death among Black women, and when compared to their non-Hispanic White counterparts, they are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review assessed the efficacy of self-management interventions for Black women with CVD risk factors.

Hypothesis:
Self-management interventions that target more than one health practice, when administered to Black women with CVD risk factors, will decrease CVD risk and improve clinical outcomes.

Methods:
Searches were run on PubMed, Cochrane, CINAHL, and PsycINFO databases based on the following inclusion criteria: papers written from September 22, 2018; English language; US studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices (individual or group, in-person or remotely delivered, or person-person synchronous); primary prevention; comorbid conditions without a cardiovascular event; at least one patient level outcome (self-reported or biological); Black women at least 18 years of age only. Data extraction included participant demographics; intervention characteristics; self-management/health behavior domains; research design; and study outcomes.

Results:
Of the 1041 abstracts screened (262 duplicates removed), 87 full-text articles were screened, and 11 papers from 10 unique trials (N= 1,635) were chosen for inclusion. Intervention durations ranged from 5-weeks to 12-months, with a frequency of intervention dose ranging from daily contact to bi-weekly meetings. Of the 10 unique trials, the majority targeted physical activity (n=8), nutrition (n=5), weight loss (n=3), health knowledge (n=2), and BP control (n=2). Interventions were mostly offered in groups (n=9), and some included individual components (n=2). Nine of the eleven papers reported statistically significant improvements in CVD risk factors including weight loss (n=6), physical activity (n=2), BP control (n=2), waist circumference (n=1), and depression (n=1). Few papers (N=1) addressed mental health, and none addressed other social determinants of health.

Conclusions:
Evidence to date indicates that self-management interventions are not only feasible but also appear to improve CVD risk factors and clinical outcomes in Black women with CVD risk. Future research should assess best practices for the implementation of culturally informed CVD risk prevention programs in underserved populations. Further intervention development should focus on the influence that social determinants of health such as discrimination, stress, and mental health may have on self-management and CVD risk in this population.
Abstract P390: Cardiometabolic Disease Prevalence Are Inconsistent by Racial Group Across Three National United States Datasets From 2015 to 2021
Authors: Thakkar Zeel , Wu Yan , Khan Mohammed A , Qi Xinran , Hung George , Kikuta Nicholas T , Srinivasan Malathi , Huang Robert J , Jamal Armaan , Kim Gloria , Palaniappan Latha , Bacong Adrian
Published: May 2024

Introduction:
The United States uses the National Health Interview Survey (NHIS), Behavioral Risk Factor Surveillance System (BRFSS), and National Health and Nutrition Examination Survey (NHANES) to inform disease trends and preventative research. However, the consistency in prevalence of cardiometabolic disorders in these datasets by race is understudied. We examined differences in the crude and age/sex adjusted prevalence of self-reported doctor diagnosis of myocardial infarction (MI), stroke (CVA), coronary heart disease (CHD), any cardiovascular disease (CVD), and diabetes (DM) by racial group across the datasets.

Methods:
We harmonized available NHIS (N = 179,593), BRFSS (N = 2,592,050), and NHANES (N = 12,506) datasets of adults aged ≥ 30 from 2015-2021. We first calculated crude prevalence by race and survey. We then used multivariable logistic regression to calculate age and sex adjusted prevalence by race and survey, accounting for survey weights.

Results:
The majority of participants were female (52.3%) and 53.6 years old (SD=14.4). Crude prevalence was most similar within a given race group for CVA (Table). Prevalence across surveys varied up to 4.6% by race and was most variable on average for DM. For each race group, prevalence estimates were generally higher in BRFSS than NHIS. Prevalence estimates varied most in people of Other/Multiple race. Racial differences in DM were significant in all datasets (p<0.001). Results were similar after adjustment for age and sex.

Conclusion:
While prevalence estimates for our national datasets are consistent for the NH-White population, estimates are less consistent for other racial groups. Additional work is needed to ensure consistency of cardiometabolic surveillance both nationally and among minoritized groups.
Abstract P392: Cardiovascular-Kidney-Metabolic Syndrome Burden and Disparities in the 2011-2020 National Health and Nutrition Examination Survey
Authors: Ogungbe Oluwabunmi V , Aryee Ebenezer K , Turkson-Ocran Ruth-Alma , Ndumele Chiadi E , Commodore-Mensah Yvonne
Published: May 2024

Background:
Cardiovascular-kidney-metabolic (CKM) health is a new concept that reflects the interconnectedness of metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). The differences in poor CKM health by race/ethnicity in the US population have not been completely elucidated.

Objective:
To examine racial/ethnic differences in CKM stages among persons in the United States using large, nationally representative data.

Methods:
We cross-sectionally examined ≥18 years from the 2011-2020 National Health and Nutrition Examination Survey (NHANES). The outcome of interest was CKM syndrome, which we defined as the presence of at least one metabolic risk factor, CKD, or clinical CVD, and categorized into stage 0, stage 1, stage 2-3, and stage 4; each category was computed as a binary outcome. Our exposure was self-reported race/ethnicity, categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or non-Hispanic Asian adults. Survey-weighted multivariable logistic regression was used to estimate racial/ethnic differences across CKM stages, adjusted for age, sex, and socioeconomic status.

Results:
Among 27,662 adults, mean age was 47±16 years, 52% female, and 94% had stage 1 CKM or worse. In the fully adjusted models, Black and Hispanic adults had a significantly higher likelihood of CKM syndrome across all CKM stages compared to White adults, while Asian adults had lower odds of CKM (
Table
). Compared to White adults, the odds of stage 2-3 CKM was 2.67 (95%CI: 1.83-3.90) among Black adults and 1.58 (95%CI: 1.14-2.19) among Hispanic adults. Similarly, the odds of stage 4 CKM was 1.70 (95%CI: 1.14-2.53) among Black and Hispanic adults.

Conclusion:
Racial/ethnic disparities were evident across CKM stages and most pronounced for Black and Hispanic persons. These results underscore the disproportionate burden of CKM faced by Black and Hispanic populations and highlight the need for concerted efforts to address these unequal risks.
Abstract P401: Association of Healthy Lifestyle Score With Metabolic Syndrome in Hong Kong Chinese Women: An Age-Matched Nested Case-Control Study
Authors: Xie Yao Jie , Deng Yunyang , Sun Qi , Yang Lin , Hao Chun
Published: May 2024

Introduction:
Limited studies explored the combined effect of lifestyles on metabolic syndrome (MetS), especially in Hong Kong Chinese people.

Hypothesis:
We assessed the hypothesis that a combination of seven lifestyles, expressed as a healthy lifestyle score (HLS), was inversely associated with MetS.

Methods:
A nested case-control study was conducted in a cohort named Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK). We recruited 4,221 women aged ≥30 years at baseline (2019-2021) and followed up with 3,435 subjects at the second-round survey until September 2023. The MetS was diagnosed based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) (2005 version). Women who developed MetS between baseline and second-round survey and had no hypertension, diabetes, hyperlipemia, myocardial infarction, stroke, or cancers at baseline were selected as cases. Age-matched controls were selected using a 1:1 ratio. Seven lifestyles were included in the HLS, each was assigned 0 or 1 point. The 1-point criteria were: smoking (never smoker), physical activity (vigorous physical activity ≥75 min/week), sleep (Pittsburgh Sleep Quality Index ≤5), stress (Perceived Stress Scale-10 ≤13), fatigue (≤ the median of a 10-point Likert scale), diet (≥ the median of a healthy diet score), and alcohol (<20g/day). The overall score ranged from 0 to 7, where a higher score indicated better health. Leave-one-out test was performed by excluding the seven items from the HLS one at a time. A weighted HLS was generated based on the coefficient of each component in multivariable analysis.

Results:
A total of 123 MetS patients (aged 56.6±7.5 years) and 123 controls (aged 56.9±7.8 years) were included. The number of MetS cases and total subjects for the lowest (0-2 points), middle (3-4 points), and highest (5-7 points) HLS groups were 40/64 (62.5%), 51/107 (47.7%), and 32/75 (42.7%), respectively. Compared to the lowest HLS group, the ORs (95% CIs) for the highest HLS group in univariable and multivariable analysis were 0.45 (0.23, 0.88) (P=0.021) and 0.46 (0.23, 0.94) (P=0.032), respectively. Among the seven components, smoking was the strongest contributor, followed by physical activity and diet. The results were consistent in the leave-one-out test and weighted HLS.

Conclusions:
Higher HLS was associated with lower MetS risk in Hong Kong Chinese women. The combined healthy lifestyles could benefit the prevention of MetS.
Abstract P408: Plasma Metabolomic Profile of Dyslipidemia in Childhood: Genetics of Glucose Regulation in Gestation and Growth (Gen3G) Study
Authors: Semnani-Azad Zhila , Perron Patrice , Bouchard Luigi , Hivert Marie-France
Published: May 2024

Objective:
Dyslipidemia is a major risk factor for atherosclerosis development. Evidence suggests atherosclerotic plaque accumulation can begin in childhood and lead to adverse cardiovascular events into adulthood. The use of metabolomics to identify metabolites specific to dyslipidemia may provide insights into the pathogenesis of cardiovascular-related outcomes. Thus, our aim was to identify metabolite networks associated with dyslipidemia in childhood.

Methods:
We used cross-sectional data from 326 children (median age of 5.2 years) from Gen3G, a prospective pre-birth cohort. We evaluated 1,038 plasma metabolites (798 annotated and 240 unannotated). Lipid measures included total cholesterol, non-HDL, LDL, triglyceride, and HDL. Using the AHA and the American Academy of Pediatrics guidelines, we identified normal and borderline/high classifications for each lipid. We applied weighted-correlation network analysis to find highly correlated metabolite networks. Spearman’s partial correlations were applied to assess the associations of lipids with metabolite networks, adjusting for age and sex, with false discovery rate correction.

Results:
We identified a green module of 120 metabolites, mainly comprised of lipids, that showed positive correlations with total cholesterol, non-HDL, and LDL classified as borderline/high vs normal (ρ
adjusted
= 0.28 to 0.40) and as continuous measures (ρ
adjusted
= 0.32 to 0.63), while HDL (borderline/high vs normal) was inversely associated (
Figure
). In this module, sphingomyelin (d18:2/16:0, d18:1/16:1)* and sphingomyelin (d18:2/23:0, d18:1/23:1, d17:1/24:1)* appeared to be driving the associations. Also, the blue and yellow modules showed inverse correlations (mainly driven by 10-nonadecenoate (19:1n9) and 3-hydroxyhexanoate, respectively), while the brown module showed positive correlations with triglyceride (driven by 1-palmitoyl-GPC (16:0)).

Conclusions:
A unique network of metabolites was associated with dyslipidemia in childhood.