bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P186: Does Lipoprotein (a) Level Have a Predictive Value in Reintervention After Iliofemoral Vein Stenting?
Authors: Li Keva , Min Andrew , Bai Halbert , Storch Jason , Chen Jenny , Ting Windsor
Published: May 2024

Background:
Lipoprotein (a), Lp(a), is associated with cardiovascular complications and atherothrombosis in arteries. However, the effects of Lp(a) in venous disease are unknown and uninvestigated.

Hypothesis:
Utilizing a patient population with iliofemoral stenosis from external compression (May-Thurner Syndrome) of which 30% had a prior deep vein thrombosis (DVT), we hypothesize that elevated Lp(a) levels may be associated with an increased risk of major reoperations after intravascular vein stenting (IVS) when compared to patients with non-elevated Lp(a) levels.

Methods:
In this study, 584 patients who underwent IVS for chronic iliofemoral stenosis between 2011 and 2019 were retrospectively studied. Patients with acute DVT, any prior IVS, or no Lp(a) results were excluded. Patients were stratified into two groups according to Lp(a) levels: non-elevated Lp(a) <50 mg/dL (N=472 patients), and elevated Lp(a) ≥50 mg/dL (N=112). Statistical analysis of demographics, clinical outcomes, and venous clinical severity score (VCSS) included paired t-tests and chi-squared tests. Kaplan-Meier curves and Cox proportional hazard models assessed the relationship of Lp(a) with time to major reoperation requiring venography and/or intravascular ultrasound (IVUS).

Results:
Patients with elevated Lp(a) levels were more likely to be Black (14% vs. 2.3%; p <0.001), hypertensive (56% vs. 44%; p = 0.025), higher preop VCSS pain (2.0 vs. 1.6; P<0.01), and greater number of reoperations (2.1 vs. 1.7; p = 0.037), specifically major reoperations (54% vs. 21%; p = 0.012) than those with non-elevated Lp(a) levels. Both non-elevated and elevated Lp(a) demonstrated comparable changes in composite VCSS scores during post-op, 1, 2, and 3-year follow-up (p = 0.12, 0.3, 0.4, and 0.5, respectively). However, multivariate analysis, controlling for demographic variables and comorbidities, showed no significant association between elevated Lp(a) and major reoperation (HR: 1.3; 95% CI: 0.84-2.00; p = 0.2). A statistically significant interaction was found between Lp(a) and hypertension status (p = 0.003). Compared with the reference group (Lp(a)) <50 mg/dL and no hypertension), those with Lp(a) ≥50 mg/dL and hypertension demonstrated a statistically significant increase in risk for reoperation (p = 0.01).

Conclusion:
This study found that elevated Lp(a) levels were not associated with major reoperations in patients undergoing IVS for chronic iliofemoral stenosis. While Lp(a) levels have a significant impact in arterial disease, this study suggested that Lp(a) may have a lesser influence in venous disease. As such, the utility of Lp(a) as a predictive biomarker in venous disease may be limited.
Abstract P187: Associations of Body Composition, Inflammation, and Lipids: The Multi-Ethnic Study of Atherosclerosis
Authors: Mirzai Saeid , Rikhi Rishi , Chevli Parag A , Gabani Mohanad , Howard Annie Green , Brinkley Tina E , Mongraw-Chaffin Morgana , Herrington David M , Kitzman Dalane W , Allison Matthew A , Shapiro Michael D
Published: May 2024

Background:
Prior evidence has linked inflammation with myopenic obesity (MO), a high cardiometabolic risk body composition phenotype characterized by low muscle and high fat mass. Inflammation may also alter lipid metabolism. This study aimed to examine the association between MO and lipids and whether inflammation is one potential mediator of their complex relationship.

Methods:
We conducted a cross-sectional analysis of 1,421 Multi-Ethnic Study of Atherosclerosis participants with abdominal computed tomography body composition, lipid, and inflammatory marker measurements. The ratio of total skeletal muscle area to total adipose tissue area (SM/AT) at L3-4 was used to identify MO (lowest sex-stratified tertiles of <0.52 in men and <0.44 in women). Principal component analysis was used to reduce six inflammatory markers by patterns of covariation. Parallel mediation analysis was conducted to examine whether the inflammatory components mediated the relationship between SM/AT and lipids, acknowledging the limitations of cross-sectional data.

Results:
The sample’s mean age was 64±10 years, 52.4% were female, and 42.1% were Caucasian. Participants with MO (n=474), compared to those without (n=947), had lower high-density lipoprotein cholesterol (HDL-C; 49±13 vs. 54±16, p<0.001), higher remnant cholesterol (RC; 28±13 vs. 24±13, p<0.001), and similar low-density lipoprotein cholesterol (LDL-C; 110±32 vs. 113±30, p=0.073). All inflammatory markers were higher in MO (p≤0.002). Parallel mediation analysis showed significant direct effects between SM/AT and both HDL-C and RC, which were mediated by component 1 but not component 2. There was no significant direct or indirect effect between SM/AT and LDL-C (Table 1).

Conclusion:
Participants with MO exhibited elevated levels of inflammation and unfavorable lipid profiles. Two inflammatory components were identified, one of which (IL-6, CRP, fibrinogen, and leptin) partially mediated the relationship of SM/AT with HDL-C and RC.
Abstract P188: The Triglyceride-Glucose Index in Africans is an Important Marker of Both an Atherogenic Lipid Profile and Insulin Resistance
Authors: Aravindakshan Pramodkumar T , Worthy Charlita C , Huefner Eliza A , Sayed Mariam S , Hurston Jamaiica S , DuBose Christopher W , Jagannathan Ram , Sumner Anne E
Published: May 2024

Background:
Type 2 diabetes (T2D) and cardiovascular disease (CVD) are rapidly increasing in Africa. Both are linked to insulin resistance (IR). Measuring insulin levels and entering the values into formulas such as the Matsuda Sensitivity Index are classic ways to measure IR. But due to cost and technological issues, the insulin assay is unavailable in most clinics in African countries. However, the Triglyceride-Glucose Index (TyG) may be an inexpensive, readily available alternative and could have the added benefit of indicating dyslipidemia. As the value of TyG in Africans is uncertain, we assessed in African-born Blacks living in America, the ability of the TyG index to (a) predict IR, (b) the optimal cut-off for TyG to predict IR, and (c) differences in the strength of the correlations between five lipid parameters which are closely linked to IR, specifically HDL-C, HDL-size, LDL-C, LDL-size and LDL-particle number, and both the TyG and Matsuda Index.

Methods:
OGTTs and fasting lipid profiles were performed in 589 African-born Blacks living in America (Male: 64%, Age: 39±11y, (mean±SD) (range 20 -69y); BMI 27.9±4.5 kg/m
2
(range 19.5-41.9 kg/m
2
)). The formula for TyG was: ln(fasting glucose * fasting TG)/2. IR was defined by the threshold of the lowest quartile of the population distribution of the Matsuda Index (≤2.89). Area under the receiver operating characteristic (AUC-ROC) curve was used to determine the ability of TyG to predict IR. Youden Index was used to identify the optimal cut-off.

Results:
T2D, preT2D and normal glucose tolerance occurred in 7% (40/589), 32% (188/589) and 62% (361/589), respectively. AUC-ROC curve for TyG to predict IR was 0.76 (95% CI: 0.71, 0.80). The optimal cut-off was: 4.3. Lipid correlations are provided in the table and were significantly stronger between each lipid parameter and TyG than with the Matstuda Index.

Conclusions:
TyG is an effective marker of IR in Africans and due to stronger correlations with atherogenic lipids may be a better predictor of CVD than the Matsuda Index.
Abstract P192: Association Between Time-Restricted Eating and All-Cause and Cause-Specific Mortality
Authors: Chen Meng , Zhong Victor W
Published: May 2024

Introduction:
Time-restricted eating (TRE) has gained popularity as a dietary intervention that limits daily food consumption to a 4- to 12-hour window. Most short-term randomized controlled trials reported that TRE improved cardiometabolic risk profiles. However, whether TRE is associated with long-term hard endpoints remains unknown.

Hypothesis:
We assessed the hypothesis that TRE is associated with a reduced risk of all-cause and cause-specific mortality.

Methods:
Participants aged at least 20 years who completed two valid 24-hour dietary recalls and reported usual intake in both recalls were included from the National Health and Nutrition Examination Survey in 2003-2018. Mortality status as of December 2019 was obtained through linkage to the National Death Index. An eating occasion required consuming more than 5 kcal of foods or beverages. Eating duration between the last and first eating occasion was calculated for each day. The average duration of two recall days defined typical eating duration which was then categorized as <8, 8-<10, 10-<12, 12-16 (reference group; mean duration in US adults), and >16 hours. Multivariable Cox proportional hazards models were employed to estimate the association of eating duration with all-cause and cause-specific mortality in the overall sample and among adults with cardiovascular disease or cancer. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were derived.

Results:
Among 20,078 adults included, the weighted mean (SE) age was 48.5 (0.3) years, 50.0% were men, and 73.3% were non-Hispanic White. During a median follow-up of 8.0 years (IQR, 4.2-11.8), 2797 all-cause deaths occurred, including 840 cardiovascular deaths and 643 cancer deaths. Compared with eating duration of 12-16 hours, eating duration <8 hours was significantly associated with an increased risk of cardiovascular mortality (HR, 1.96 [95% CI, 1.23-3.13]); this association was also observed in adults with cardiovascular disease (HR, 2.06 [95% CI, 1.12-3.81]) and adults with cancer (HR, 2.72 [95% CI, 1.28-5.80]). Other eating durations were not associated with cardiovascular mortality, except for eating duration of 8-<10 hours in people with cardiovascular disease (HR, 1.64 [95% CI, 1.02-2.63]). No significant associations were found between eating duration and all-cause or cancer mortality in the overall sample and diseased subsamples, except that eating duration >16 hours was associated with a lower risk of cancer mortality in people with cancer (HR, 0.46; [95% CI, 0.22-0.95]).

Conclusions:
In US adults, TRE with eating duration <8 hours was significantly associated with a higher risk of cardiovascular mortality in the general population as well as in people with cardiovascular disease or cancer. These findings do not support long-term use of 16:8 TRE for preventing cardiovascular death.
Abstract P200: Mediterranean Diet and Metabolic Syndrome in Adolescents: An Analysis From the National Health and Nutrition Examination Survey 2015-2020
Authors: Hastert Mary , GORCZYCA Anna
Published: May 2024

Background:
The Mediterranean Diet (MD) is an evidence-based dietary approach emphasizing fruits, vegetables, whole grains, seafood, and olive oil. While it’s demonstrated efficacy in enhancing cardiometabolic health in adults, it’s received minimal evaluation in adolescents with metabolic syndrome (MetS).

Hypothesis:
We hypothesized that higher consumption of MD foods was associated with better metabolic health in a nationally representative sample of U.S. adolescents.

Methods:
A secondary analysis was conducted using data from the National Health and Nutrition Examination Surveys 2015-2020 (pre-COVID) in adolescents (12-19 years) with ≥ 2 valid 24-hour dietary recalls, complete fasting data for all components of the International Diabetes Foundations definition of MetS risk factors, and no known diabetes. Consumption of MD foods was evaluated using the validated, literature-based MD intake score (Medi-Lite, 0-16 score, excluding alcohol). MetS was evaluated using a continuous MetS score (cMetS) and separated into quartiles [Q1, metabolically unhealthy (cMetS score 1.83 ± 1.64) vs. Q4, metabolically healthy (cMetS score -4.16 ± 0.89)]. Correlation of Medi-Lite scores with cMetS scores and quartile groups controlled for energy intake, age, sex, and BMI were assessed via Pearson correlation and odds ratios, respectively.

Results:
The primary analyses included 886 adolescents (~15 years, 49% female, 70% non-Hispanic, body mass index ~25 kg/m
2
) with a mean cMetS score of -1.40 ± 2.39. In the total sample, overall consumption of the MD was low (mean score 6.95 ± 1.83) and cMetS scores were not associated with Medi-Lite scores (r = -0.05,
p
= 0.21). There was a significant between-group difference for Medi-Lite scores between quartiles (F = 1.69, p = 0.05). In the metabolically healthy group, there was a positive trend towards between cMetS score and Medi-Lite score (r = 0.15, p = 0.06). No correlation was found between cMetS and Medi-Lite scores in the metabolically unhealthy group (r = -0.04, p = 0.59). Metabolically healthy adolescents had higher odds of consuming the MD compared to metabolically unhealthy adolescents (OR 2.012, 95% CI 1.44 to 2.81,
p
< 0.001).

Conclusion:
In conclusion, U.S. adolescents had an overall low consumption of MD foods. Metabolically healthy adolescents consumed more MD foods compared to metabolically unhealthy adolescents. Future research should evaluate a MD lifestyle intervention as a treatment option for adolescents with MetS.
Abstract P211: Burden and Temporal Trend of Peripheral Artery Disease in the United States and Its Attributable Risk Factors From 1990-2019: An Insights From the Global Burden of Disease Study 2019
Authors: Cortorreal Javier Rafael , Parisapogu Anusha , Alziadin Nmair , Thota Anjani Kumar , Dadhania Khush , Gadamidi Vinay Kumar , VEMPARALA Priyatha , PATEL Juhi , Desai Hardik Dineshbhai
Published: May 2024

Background:
Peripheral Artery Disease (PAD) ranks as the 10th primary cause of mortality and the 11th for disability among all cardiovascular diseases in the U.S.

Method:
We employed the Global Burden of Disease 2019 framework. PAD non-fatal health outcomes were analyzed using the DisMod MR 2.1 (Bayesian meta-regression tool) and determined fatal health outcome with the cause of death ensemble model (CODEm), segmented by age, gender, year, and location from 1990-2019 across the U.S.

Results:
The annual percentage change (APC) revealed a 26% (9.9-12.4 million) increase in overall prevalence and incidence, a significant 152% (5,757-14,527) rise in deaths, and a 98% (119,253-236,031) uptick in DALYs during 1990-2019. Notably, while the age-standardized incidence rate dipped by 28% (267-193), death and DALY rates climbed by 33% (1.7-2.27) and 11% (36-39) respectively. Delaware witnessed the highest APC in deaths 118% (2.33-5.08) per 100,000, trailed by Colorado with a 58% (35-55) rise in DALYs. Individuals under 70 experienced a 118% (1052-2294) surge in APC for deaths and a 28% (458,357-588,135) increase in incidence. In absolute numbers, males bore a heavier PAD burden, yet females exhibited elevated age-standardized rates from 1990-2019.

Conclusion:
The study underscores a concerning rise in PAD in the U.S. from 1990-2019, accounted for 1.52% deaths of all cardiovascular related casualties in 2019. Delaware and Colorado have notably high increases in PAD-related outcomes. From both a clinical and public health perspective, addressing high fasting plasma glucose and sodium-rich diets is crucial, as they stand as leading risk factors in PAD's burgeoning prevalence.
Abstract P216: Physical Fitness and Incidence of Metabolic Syndrome Before Midlife in Military Young Adults: A Cohort Study
Authors: Lin Gen-Min
Published: May 2024

Background:
Cardiorespiratory fitness (CRF) could reduce the risk of metabolic syndrome (MetS), while the association of muscular endurance capacity (MEC) with incident MetS before midlife was rarely investigated.

Methods:
A total of 2,890 military men and women, aged 18-39 years, free of baseline MetS were followed for new-onset MetS from baseline (2014) through the end of 2020 in Taiwan. All subjects received annual health examinations for an assessment of MetS. Physical fitness was evaluated by CRF (estimated VO
2
max (mL/kg/min), from a 3000-m run) and MEC (2-min push-up numbers), respectively. MetS was defined based on the International Diabetes Federation criteria. The CRF and MEC were divided by tertiles, respectively against the subjects free of MetS for the Kaplan-Meiner survival analysis. Multivariable Cox regression model with adjustments for baseline demographics, body mass index, and physical activity was used to determine the associations of CRF and MEC (continuous variables) with incident MetS. Subgroup analyses within major MetS components were performed.

Results:
During a median follow-up of 5.8 years, there were 673 (23.3%) incident MetS. The Kaplan-Meiner Curves are shown in Figure 1. Greater CRF and MEC were associated with a lower risk of MetS [HRs and 95% CI: 0.956 (0.926-0.988) and 0.992 (0.985-0.999), respectively]. In the subgroup analyses, there were no heterogeneities within groups, e.g., body mass index, except that the associations for incident MetS were significantly lower in subjects with serum triglycerides <150 mg/dL [HRs: 0.943 (0.900-0.987) and 0.989 (0.981-0.997), respectively] than those with hypertriglyceridemia (both p for interaction =0.01).

Conclusion:
Both CRF and MEC were inversely associated with incident MetS in military young adults, which was obviously observed in those without hypertriglyceridemia. This cohort study suggests that obtaining greater physical fitness and lower serum triglycerides are important preventive measures to reduce the risk of MetS before midlife.
Abstract P222: Prolonged Sitting Time Was Associated With Central Obesity-Related Parameters Among Hong Kong Chinese Women: A Cross-Sectional Study
Authors: Zhang Yan , Xie Yao Jie , Deng Yunyang
Published: May 2024

Introduction:
The evidence concerning the association between sitting time and central obesity in Hong Kong Chinese women was still scarce.

Hypothesis:
Prolonged sitting time was positively associated with increased waist circumference (WC), hip circumference, and trunk body fat percentage; and also larger waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) among Hong Kong Chinese women.

Methods:
Data were extracted from a cohort study named “Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women”. The baseline data (2019-2021) were used for analysis. Sitting time and physical activity level were measured by the International Physical Activity Questionnaire short form. Body weight, height, WC, hip circumference, and trunk body fat percentage were measured according to standard protocol. The WHR and WHtR were then calculated. Central obesity was defined as WC ≥80.0 cm. Subgroup analysis were conducted based on age (≥60 and <60 years) and whether participants met the recommended physical activity guidelines (≥75 minutes/week of vigorous physical activity or ≥150 minutes/week of moderate-intensity physical activity).

Results:
A total of 3,280 Hong Kong Chinese women aged 56.46±8.30 years were included. The overall prevalence of central obesity was 32.26% (1,058 of 3,280). Participants with central obesity had a longer sitting time compared to those without (8.01±3.27 vs. 7.60±3.25 hours/day,
P
=0.001). After adjusting for age, education, living alone or with family members, drink, smoking, and physical activity, each additional hour of daily sitting time was significantly correlated with 0.678 unit increase in hip circumference (
P
<0.001), 0.003 unit increase in WHR (
P
=0.004), 0.004 unit increase in WHtR (
P
=0.002), and 5.485 unit increase in trunk body fat percentage (
P
<0.001). With a one-unit augment in sitting time, the odds of being central obesity was 1.187-fold higher (
95% CI=
1.108-1.587,
P
<0.001). In subgroup analysis, the sitting time-central obesity association was significant in women aged ≥60 years (
OR
=1.192,
95% CI=
1.085-1.309,
P
<0.001). Whereas, such positive association existed both in women who did not meet the physical activity guidelines (
OR
=1.413,
95% CI
=1.011-1.977,
P
=0.043, 8+ vs. <8 hours/day) and those who adhered to the guidelines (
OR
=1.326,
95% CI
=1.108-1.587,
P
=0.002, 8+ vs. <8 hours/day).

Conclusions:
Longer sitting time exhibited a positive relationship with central obesity-related indices in terms of WC, hip circumference, trunk body fat percentage, WHR and WHtR. The significant association between sitting time and central obesity was only observed in older women, but it remained consistent and robust regardless of whether the subjects followed the recommended physical activity guidelines.
Abstract P228: Baseline Characteristics of a Pilot Randomized Controlled Trial of a Self-Management Program for Depressed Black Women at Risk for Hypertension
Authors: Church Emma , Maniglia Taylor , Sajatovic Martha , Briggs Farren Basil Shaw , Kelley Erika , Conklin Danette , Rahman Mahboob , Harwell Carla , Conroy Carla , Levin Jennifer B
Published: May 2024

Introduction:
Black women have the highest prevalence of hypertension (HTN) compared to other racial/ethnic groups. Depression impacts women on a 2:1 ratio and increases cardiovascular risk. Black women are less likely to receive evidence-based care for depression and face barriers to engaging in healthy behaviors. In the current descriptive analysis, we examined baseline data from an ongoing pilot randomized controlled trial aimed to assess the efficacy of a group self-management program to decrease depression and HTN risk.

Hypotheses:
We assessed the hypothesis that a well-characterized sample of 30 depressed Black women would have high levels of physical and psychosocial risk factors for cardiovascular disease, low levels of treatment engagement, and that depression severity would correlate with experience of discrimination, stress, and perceived lack of social support.

Methods:
Inclusion criteria were Black women between the age of 18-49 with moderate depression (PHQ-9 of ≥10) and at least one risk factor for HTN. Social determinants of health (SDOH), discrimination, stress, and social support were assessed using validated measures.

Results:
The sample consisted of 30 Black females; mean age=34.27, SD= 8.60, and mean years of education=13.97, SD=1.79. Mean depression=15.10, SD=3.16, 33.33% endorsed thoughts of self-harm, and 36.67% reported currently receiving treatment for depression. Of those, 72.7% were in therapy and 54.5% were taking medication. Forty percent reported a history of physical abuse and 36.7% reported a history of sexual abuse. Salient cardiovascular risk factors included mean BMI=37.47, SD=5.84 (29/30 met BMI>30 criteria), 26.67% smoker, 6% diabetes, 13% high cholesterol, and 46.67% other chronic health conditions. Mean discrimination score was 27.23, SD=10.96 indicating moderate exposure to discrimination and 75% identified race as the main source of discrimination. Additionally, 26.67% scored above the threshold on violence as measured by a SDOH screener and perceived stress averaged in the moderate range. Depression severity was significantly correlated with discrimination (
r
=.43,
p
<.05), stress, (
r
=.55,
p
<.01) and trended with social support (
r
=-.39,
p
=.076).

Conclusion:
In conclusion, given the high rates of CVD risk factors, multiple psychosocial stressors, and low rates of treatment engagement, to improve cardiovascular health in Black women, we must be aware of and address a more comprehensive set of socio-emotional risk factors. Self-management interventions that simultaneously provide social support, address mental health needs, and are led by peers are likely to increase engagement and improve health outcomes.
Abstract P233: Leveraging Community-Engaged Research Methods to Improve Recruitment and Retention of Midlife Black Women in Cardiovascular Research
Authors: Jones Holly J , Bakas Tamilyn , Kovacic Melinda Butsch
Published: May 2024

Introduction:
Midlife Black women (ages 45-64) are more likely to die of a cardiovascular disease (CVD)-related cause compared to White women of the same age and less likely to be optimally controlled for upstream chronic conditions like hypertension or dyslipidemia. Black women are also 58% less likely than White women to identify heart disease as their greatest health risk. Recruitment and retention of Black women in research trials has been historically difficult, contributing to the paucity of interventions designed to address the unique sociocultural factors that contribute to the existing health disparities. The Midlife Black Women’s Stress Reduction and Wellness intervention (B-SWELL) was created to lower stress and increase CVD awareness and adoption of healthy lifestyle behaviors to lower CVD risk in midlife Black women. Hypothesis We hypothesized that a theoretically based intervention co-developed with midlife Black women from the community would yield a culturally appropriate and appealing intervention, resulting in high retention, low attrition, and high satisfaction.

Methods:
Mixed methods and community-engaged methods were used in the preliminary research that supported the B-SWELL feasibility trial. Each step (i.e., conceptualization, development, intervention design and delivery) was viewed through a Black Feminist lens, giving voice to midlife Black women. The B-SWELL materials and content were co-developed with an existing community research advisory board (C-RAB) and midlife Black women from the community to produce a culturally tailored and targeted product that was rated highly by experts. A randomized feasibility study was conducted. Recruitment was led by the C-RAB and other community partners. Satisfaction was measured using a 9-item tool ranging from 1 (strongly disagree) to 5 (strongly agree) and a maximum score of 45. Narrative feedback responses were also obtained.

Results:
Recruitment (N=52) was completed within 30 days and attrition was low (8%). Four participants withdrew prior to the start of the feasibility trial. The remaining 48 participants completed the trial, and none were lost to follow up. Participant satisfaction ratings were high with a mean of 41. Narrative feedback responses were positive. Participant responses indicated an increase in CVD awareness and motivation to adopt healthier behaviors:
“Sisterhood is very important to Black women's health." “Never too late in your life to make changes and better choices.” “I need to be a cheerleader and I need to be checked on as well".

Conclusions:
Theoretically based interventions that employ community-engaged methods have potential to increase recruitment and retention of midlife Black women in research studies. We recommend integration of community-engaged methods at each level of development and for delivery of interventions targeted to at-risk subpopulations like midlife Black women.
Abstract P238: A Multinational Analysis of Perceptions of Non-Communicable Diseases
Authors: Rios Duarte Jorge A , Mendivil Carlos O , Pena-Silva Ricardo A
Published: May 2024

Introduction:
Understanding perceptions of non-communicable diseases (NCDs) is pivotal for enhancing primary prevention programs and health literacy.

Objective:
To assess perceptions and attitudes toward NCDs in five distinct countries.

Methods:
A cross-sectional study was conducted using the "Measuring Public Perceptions of Noncommunicable Diseases" survey by Gallup (2022). The sample encompassed 7,029 participants from the United States, Colombia, Jordan, Tanzania, and India, selected through probability-based sampling. The survey involved 15 sociodemographic variables and 97 questions related to knowledge, perceptions, and attitudes toward NCDs. We focused our analysis on cardiometabolic diseases and cancer.

Results:
Over 89% of respondents across all countries considered NCDs to be harmful, although perceptions were lower in India and Jordan, particularly for diabetes and stroke. Gender-based differences were notable in these countries; women in India and men in Jordan were less likely to view stroke as harmful. Support for public policies varied by country; participants from Jordan showed greater support for alcohol taxes, whereas India demonstrated lower support for tobacco control. Cancer was generally perceived as highly harmful, but along with stroke showed the least perceived empowerment for risk reduction. Television was the preferred source of health information, and high levels of trust were placed in healthcare personnel across countries. Individuals with higher education and income were more aware of the detrimental impacts of NCDs and felt more empowered to mitigate them, and older participants showed a diminished perception of their harm (Table 1).

Conclusion:
The data highlights varied perceptions of harm and empowerment across countries, affecting receptivity to different public policies such as taxation and advertising restrictions. Understanding these disparities is crucial for crafting efficient healthcare interventions tailored to specific populations.
Abstract P239: Association of Presence of Non-Specific Physical Complaints With Future Development of Cardiovascular Disease in Middle-Aged Japanese Workers: Finding From the Aichi Workers Cohort Study
Authors: Song Zean , Li Yuanying , Nakano Yoshihisa , Hong Young-Jae , Akter Tahmina , Hamrah Mohammad Hassan , Nuamah Hanson Gabriel , Fukuda Chisato , Tajima Rina , Lin Jingyi , Shi Zhiling , Hibino Mizuho , Endale Baruck Tegegn , He Yupeng , Matsunaga Masaaki , Ota Atsuhiko , Tamakoshi Koji , Yatsuya Hiroshi
Published: May 2024

Introduction:
Stress responses to work-related stressors often manifest in non-specific physical complaints, by monitoring it may provide early indications of underlying health issues.

Hypothesis:
We hypothesized that there is a significant association between non-specific physical complaints and the subsequent incidence of cardiovascular diseases (CVD) in middle-aged Japanese.

Methods:
A cohort of 4820 Japanese workers (3876 male, 944 female) ages 35 to 65 years were followed from 2007 to 2019 for CVD incidence (stroke and acute coronary artery diseases). Non-specific physical complaints were assessed as a domain of stress response in the 57-item brief job stress questionnaire and consisted of 11 items: felt dizzy; experienced joint pains; experienced headaches; had stiff neck or shoulders; had lower back pain; had eyestrain; had heart palpitations or shortness of breath; had stomach or intestine problems; lost appetite; had diarrhea or constipation; couldn’t sleep well. Each item had four possible responses from never, sometimes, often, to always, corresponding scores of which are 1, 2, 3, and 4, respectively. The presence of non-specific physical complaints was defined as a sum score of 27-44 for males and 30-44 for females according to the recommended standard values. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) of non-specific physical complaints for CVD were estimated and adjusted for age, sex, smoking status, alcohol consumption, regular exercise, sleep duration, body mass index, systolic blood pressure, total cholesterol, and histories of hypertension, hyperlipidemia, and diabetes.

Results:
During a median of 10.4 years of follow-up, 90 CVD cases were identified. The presence of non-specific physical complaints was significantly associated with the incidence of CVD independent of confounding variables (HR: 2.04, 95% CI: 1.02-4.07).

Conclusion:
The present study revealed that the presence of non-specific physical complaints was associated with a higher risk of developing CVD.
Abstract P242: The Effects of Wellness Coaching on Lowering Stroke Risk Factors in a Wisconsin Native American Population
Authors: Akin Louden , Wilbrand Stephanie M , Hess Timothy , Riesenberg Amanda , Maybock Jenna , Vandenberg Connie , Blohowiak Carrie , Kennard Jay , Danforth Debra , Dempsey Robert J , Mitchell Carol
Published: May 2024

Objective:
Native Americans are disproportionally affected by obesity, diabetes and stroke. This study tests the hypothesis that weight loss and change in BMI are related to coaching participation in the first 52 weeks of a two-year study.

Methods:
Participants of the “Stroke Prevention in the Wisconsin Native American Population” study age ≥55 years with three or more stroke risk factors were assigned to a High Risk-Intensive Coaching arm (n=49); informed consent was obtained for all participants. These participants engaged in routine wellness coaching visits centered around lifestyle modification in an effort to reduce risk factors for stroke. Data analysis was performed with SPSS (SPSS, IBM Corporation, Armonk, NY, US) and R (RStudio, PBC, Boston, MA, US). Continuous variables are reported with median and interquartile range (IQR). A participation score (total coaching sessions attended ÷ 52 weeks) was calculated for each participant and total weight loss for the first 52 weeks was also calculated (baseline weight in pounds - the weight in pounds at the last coaching session closest to week 52), (n=49). The Wilcoxon Signed Rank test was used to test the hypothesis that weight loss or change in BMI was significantly different than baseline. A smoothing spline was used to assess a potential dose-response relationship between participation score and weight loss and change in BMI.

Results:
Of the 49 participants examined, 36 were female and 13 were male, with a median age of 66 (IQR =10.0) years. Risk factors observed at baseline included smoking (n=11, 22.4%), median BMI of 31.6 lb/in
2
(IQR=7.7), and median physical activity of 90 minutes per week (IQR=210.0). Biometric measures were also recorded at baseline, with a median systolic blood pressure of 149 mmHg (IQR=26.0) and median diastolic of 80 mmHg (IQR=14.0), median total cholesterol of 156 mg/dL (IQR=57.0), median LDL of 87 mg/dL (IQR=57.0), median HDL of 46 mg/dL (IQR=16.0), median non-HDL of 110 mg/dL (IQR=61.0), and median hemoglobin A1C of 6.5 mg/dL (IQR=1.2). Participation score median of 0.33 (IQR=0.375) range 0.06-0.87. Weight loss median 3.6 (IQR=9.45) range -41 to 35 pounds. A spline analysis found a significant dose-response relationship between participation score in the first 52 weeks of the study and weight loss (r
2
=0.199 deviance 23%, p=0.006) and BMI (r
2
=0.145, deviance 16.7%, p=0.010).

Conclusion:
Preliminary results suggest that participation in a wellness coaching program may be associated with weight loss and change in BMI in this study population. Future work will continue to examine how coaching is related to weight loss and change in BMI in a larger cohort and with a wider age range.
Abstract P245: Association Between Individual Socioeconomic Status and Discharge Dispositions to Home or Rehabilitation Following Incident Stroke Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Li Ning , Abner Erin L , Koton Silvia , Mathews Lena M , Matsushita Kunihiro , Kucharska-Newton Anna
Published: May 2024

Background:
The contribution of socioeconomic status (SES) to discharge destination in stroke survivors is not known.

Hypothesis:
Discharge to home, as compared to inpatient rehabilitation, will be greater among stroke survivors with low, as compared to high SES.

Methods:
The study population included ARIC Study participants, enrolled in fee-for-service Medicare, aged 66 years or older, with incident ischemic or hemorrhagic stroke (1992-2017). Black participants from the Minneapolis and Washington County study centers were excluded due to low numbers. Individual SES was estimated from median household income and education. Discharge disposition was ascertained from CMS Medicare inpatient records. Logistic regression models with inverse probability of treatment weighting were used to estimate the effect of exposures, accounting for age, sex, race, study center, comorbidity, and stroke severity. The Elixhauser Comorbidity Index was used to as a measure of comorbidity burden. Stroke severity was estimated from discharge diagnosis and procedure codes obtained from Medicare hospitalization records.

Results:
Of a total 710 ARIC stroke survivors (mean age at discharge 76 (SD: 6.2) years, 30.1% (214 of 710) Black, 57.5% (408 of 710) women), 50.7% (360 of 710) were discharged home. Compared to high income, low and moderate income was associated with lower adjusted odds of discharge to home among White participants (AOR:0.8, 95% CI: 0.68-0.93) and AOR: 0.63, 95% CI: 0.57-0.69), respectively) and higher odds discharge to home among Black participants (AOR: 1.36, 95% CI: 1.07-1.73 and AOR: 1.43, 95% CI: 1.11-1.83, respectively). Low income was also associated with higher odds of discharge home among women. Adjustment for stroke severity and comorbidity did not attenuate estimates. No significant association between education and discharge disposition was observed.

Conclusions:
Low and moderate median household income is statistically significantly associated with discharge home among Black and female stroke survivors.
Abstract P250: Vascular Contributions to Alzheimer's Disease
Authors: Chaudhuri Soumilee , Liu Shiwei , Huang Yen-Ning , Park Tamina , Rosewood Thea , Cho Min Young , Nho Kwangsik , Saykin Andrew
Published: May 2024

Introduction:
Alzheimer’s disease (AD) is a debilitating neurodegenerative disorder that affects over 50 million people worldwide. The role of vascular risk factors have been described as a contributor to and a major comorbidity of AD pathogenesis; yet there is discordant evidence of this complex relationship between cardiovascular diseases (CVD) and its risk factors (like hypertension, hyperlipidemia, obesity, etc.) with AD pathophysiology and cognitive decline. AD associated Genome-wide association studies (GWAS) and derived polygenic risk scores (AD PRS) have uncovered some significant common genetic variants relating to CVD risk factors; however, we are still yet to unravel the comprehensive impact of these vascular genetic contributions to AD pathogenesis and cognitive decline.

Method:
In this study, we used 1800 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort spanning the full spectrum of clinical and pathological diagnoses of the AD spectrum, as our target dataset used for polygenic risk score calculation. Thereafter, we obtained GWAS summary statistics for cumulative cardiovascular risk by searching the Polygenic Score (PGS) GWAS Catalog using CVD as the ‘mapped trait” and then calculated cardiovascular-based PRS using HRS-based imputed GWAS data of the ADNI cohort. We conducted association analysis using a multivariate linear regression model with appropriate covariates (age, sex, APOE, education, etc.) between CVD-related polygenic risk score (CVD-PRS) with the different clinical AD diagnoses groups (Cognitively Normal/CN, Significant Memory Concerns/SMC, Mild Cognitive Impairment/MCI, Alzheimer's Disease/AD). We also performed association analysis of this CVD-PRS with white matter hyperintensity (WMHI) values, a vascular biomarker, at baseline using a linear regression model. Furthermore, we extended our analyses of CVD-related PRS with cognitive performance at baseline using composite scores for memory (MEM) and executive functioning (EF).

Results and Conclusion:
We found significantly strong correlation of CVD-related PRS with only certain AD Diagnoses groups (Significant Memory Concerns: SMC and Alzheimer's: AD) in the AD continuum. Additionally, we found strong associations (p < 0.05) of this cardiovascular based- polygenic risk score with baseline memory as well as White Matter Hyperintensity (WMH) in our sample, specifically the group with a clinical diagnosis of AD. Furthermore, we are performing longitudinal association analysis of CVD-related PRS with longitudinal cognitive decline using a linear mixed effects model. Our findings will help us understand 1) how a cumulative CVD-related PRS associates with different AD diagnoses subgroups as well as vascular biomarkers for AD and 2) how CVD-related PRS associates with cognitive performance and longitudinal cognitive decline.
Abstract P251: Circulating Immune Cell Phenotypes Are Associated With Inflammatory Biomarkers in the Framingham Heart Study Offspring Cohort
Authors: Chen Jiachen , Doyle Margaret , Ragab Ahmed , Cao Yumeng , Murabito Joanne , Lunetta Kathryn
Published: May 2024

Age-related changes in circulating immune cells have been associated with inflammation and immunosenescence, increasing susceptibility to cardiovascular disease. This study investigated the association between circulating immune cell phenotypes and inflammatory biomarkers in the Framingham Heart Study Offspring cohort. Participants (N=865, 52% female, mean age 62) were immunophenotyped using peripheral blood mononuclear cells with 37 immune cell phenotypes and 6 composite ratio measures, including T cells, B cells, NK cells, and monocytes. The inflammatory biomarkers were profiled in plasma samples using the OLINK Proteomics inflammation panel. Pairwise cross-sectional associations between 43 circulating immune cell phenotypes and 68 protein biomarkers were investigated using linear mixed-effect models accommodating familial correlations and adjusting for covariates (sex, age, number of apolipoprotein E (
APOE)
ε2 and ε4 alleles, and cytomegalovirus levels), with FDR ≤0.05 to declare significant associations. Age-stratified analyses were performed to explore effect modification. CD8 T naïve cells (CD8Tn) were negatively associated with several proteins (
Figure
). Significant associations were also observed for CD4 T cell subtypes including higher levels of CD4 T helper cells associated with lower Flt3L and TNFRSF9, higher levels of CD4 T central memory (Tcm) and CD4 T effector (Teff) cells associated with lower TNFB, and higher CD4 Teff associated with lower CD40 levels. Among associations identified in the full sample, we observed a large proportion of associations between CD4 T cell subtypes and CD8 Tn in the older age group (>60 years) but not the younger age group. Our results suggest that people tend to have more inflammation-associated immune responses during aging. Future studies are needed to improve understanding of the contribution of these inflammation-immune cell associations to cardiovascular disease.
Abstract P260: Association of Hearing Impairment and Physical Functioning Among Chinese Adults Aged 60 Years or Older: Evidence From the China Health and Retirement Longitudinal Study (CHARLS)
Authors: Zhou Huiyuan , He Zhengting , Ding Xiong , Hao Jie , Zhang Xian , Yan Lijing L
Published: May 2024

Introduction:
Hearing impairment is a common treatable condition and a risk factor for various adverse health outcomes. Prior evidence associated hearing impairment with physical functioning declines in older adults of Western countries, but longitudinal evidence on such association is limited among Chinese older adults.

Method:
We pooled the first three waves of CHARLS (2011, 2013, and 2015) together as a longitudinal dataset with repeated measurements. For each participant, self-reported hearing status was collected at each wave and categorized as normal hearing or impaired hearing (reported fair or poor hearing). Physical functioning was assessed by Short Physical Performance Battery (SPPB), including gait speed, duration to complete five chair stands and balance test. Each SPPB component was assigned a score from 1 to 4 corresponding from the lowest to highest quartile. The SPPB score ranged from 1 to 12, with higher scores representing better physical functioning. We used a series of linear mixed-effects models with participant-level random intercepts and slopes to assess the association of hearing impairment with physical functioning, adjusting for demographics, socioeconomics, and comorbidities.

Results:
A total of 8,894 participants aged 60 or above at baseline were included, with a median age of 68 years. At baseline, the impaired hearing group were estimated to be 0.21 (0.11, 0.31) lower in average SPPB score, 0.02 (0.01, 0.03) lower in average gait speed, and 1.04 (1.02, 1.05) times longer in average duration to complete the chair stand test as compared to the normal hearing group (
Table
). Statistically significant differences in average rate of longitudinal changes were not observed for either outcome.

Conclusion:
Baseline hearing impairment was associated with poorer physical functioning among Chinese older adults, but no significant association with longitudinal changes was observed. This finding emphasizes the necessity of monitoring hearing status among the Chinese elderly population.
Abstract P277: Adherence to Time-Restricted Eating, Plasma Metabolomic Signatures, and Risk of Coronary Heart Disease
Authors: Heianza Yoriko , Sun Qi , Drotz Emily M , DiMatteo Oona J , Rexrode Kathryn M , Alotaibi Mona , Jain Mohit , Manson JoAnn E , Qi Lu
Published: May 2024

Introduction:
Early time-restricted eating (TRE) has been recently suggested as an effective dietary intervention strategy to improve risk factors of coronary heart disease (CHD), whereas late TRE may be related to poor cardiometabolic health. Metabolomic pathways linking the adherence to habitual TREs depending on the time of the day and CHD risk are unknown.

Hypothesis:
We tested whether adherence to early or late TRE was related to distinct metabolomic signatures (including those in pathways of energy/purine pyrimidine metabolism, lipids, carbohydrates, and acylcarnitines). We then tested whether TRE-related plasma metabolites were associated with the risk of incident CHD among women without prior CHD.

Methods:
This study included 674 women without cardiovascular disease who completed 7-day food records and measurements of untargeted plasma metabolomics in a sub-study of the Nurses’ Health Studies (NHS/NHSII). TRE was indicated by 4-12 hours of daily eating window. The adherence to TRE was assessed by summing up the TRE days in a week (0-7 days). We analyzed two TRE habits: early TRE (starting before 9 a.m./ending no later than 9 p.m.) and late TRE (beginning after 9 a.m.). Separately, plasma metabolites were measured in a prospective nested case-control of 762 incident cases of CHD and 762 matched controls identified over 10-14 years of follow-up in the NHS. A metabolomic risk score for predicting adherence to late TRE (MRS-TRE
late
) was created based on metabolites selected through the elastic net procedure with a 10-fold cross-validation.

Results:
Adherence to late TRE was positively associated with greater adiposity, insulin/proinsulin, uric acid, and medium-chain fatty acids/acylcarnitines; the late TRE habit was inversely related to metabolites in the TCA cycle/pyruvate metabolism and specific PC species (

P
FDR

<0.05). On the other hand, metabolites in lipid pathways (including diglyceride DG 38:5) and glucose were inversely related to the adherence to early TRE. Individual levels of late-TRE-related metabolites in energy/phosphatidylcholine /acylcarnitine pathways were significantly associated with an increased risk of CHD. Every 1 SD increment of MRS-TRE
late
, based on 21 metabolites in various metabolic pathways, was associated with a relative risk (RR) of 1.24 (95% CI: 1.11, 1.38) for CHD in a model adjusted for matching factors, and a RR of 1.15 (1.02, 1.29) after adjusting for covariates, such as demographic factors, diet quality, alcohol, lifestyle factors, and BMI. Women in the top tertile of MRS-TRE
late
had a 1.44-fold (1.10, 1.89) increased risk of CHD as compared to those in the lowest tertile after adjusting for the covariates.

Conclusions:
TRE habit, depending on the timing, was related to distinct metabolomic pathways, and adherence to late TRE may be associated with metabolic reliance linked to the risk of incident CHD among women.