bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P205: Behavioral Characteristics Associated with Biomarkers of Metabolic Syndrome Among Overweight/Obese Children in Korea
Authors: Ham Ok-Kyung , Kang Youjeong , Im Eun-Ok
Published: July 2021

Introduction:
Obesity rates have increased twofold among children in Korea over the past decade, posing a significant public health concern. Researchers have reported that 27% of overweight/obese children in Korea have metabolic syndrome (MS). However, there are no studies that elucidate factors influencing MS among children that could provide directions for future interventions for this specific population of children.

Purpose:
The purpose was to examine behavioral and socioeconomic factors that were associated with biomarkers of MS among overweight/obese Korean children to provide information for the development of tailored education for prevention of MS.

Methods:
A cross-sectional study was conducted with a convenience sample of 75 overweight/obese children recruited from four elementary schools in South Korea. The instrument included exercise frequency, eating behavior, sleep hours, stress, and screen time. Anthropometric measurements included weight, height, and waist circumference. Physiological variables included blood pressure (BP), fasting blood sugar (FBS), total cholesterol, triglyceride, and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. The data were analyzed using descriptive and inferential statistics including chi-square tests and analysis of covariance (ANCOVA) with age as a covariate.

Results:
The mean age of the children was 10.6 years (SD=1.01, range 8-13), and 56.8% were boys. Thirty percent were identified as having MS with three or more risk factors (BP ≥ 130/80 mmHg, HDL cholesterol< 40 mg/dL, triglyceride >120 mg/dL, FBS > 100 mg/dL, and > 90
th
percentile value for waist circumference). MS was associated with family income, and children from more affluent families were more likely to have MS (
p
< 0.05). Children with higher stress were more likely to have elevated systolic BP; children who frequently consumed fast food were more likely to have lower total cholesterol; and children who usually ate a late dinner were more likely to have higher LDL cholesterol compared to their counterparts (
p
< 0.05). Screen time, exercise frequency, and sleep duration were not significant (
p
> 0.05). Among socioeconomic factors, mother’s employment status and education level were not significant (
p
> 0.05). However, children who had fathers with at least college level education were more likely to have elevated diastolic BP, and those from more affluent families were more likely to have elevated systolic BP compared to their counterparts (
p
< 0.05).

Conclusion:
Eating behavior, stress, and family socioeconomic factors were associated with MS and deviation in biomarkers among overweight/obese children. This needs to be incorporated into future development of education programs for this specific population at risk.
Abstract P213: Habitual Coffee Intake, Blood Pressure and Risk of Stroke: a Meta-analysis of Prospective Studies
Authors: Strazzullo Pasquale , D'Elia Lanfranco , Cairella Giulia , Garbagnati Francesca , Rossi Giovanni , Scalfi Luca
Published: July 2021

Background:
Prospective cohort studies estimated the predictive role of exposure to coffee consumption and risk of hypertension (HP) or cerebrovascular disease, with contrasting results. Therefore, we carried out a meta-analysis to assess the relation between habitual coffee intake and risk of HP and stroke in the general population.

Methods:
We performed a systematic search for prospective studies published without language restrictions between 1966 and July 2013. Inclusion criteria were: original article, prospective design, adult general population study, assessment of coffee intake as baseline exposure, assessment of HP or stroke as outcome, and follow-up of at least 2 years. To evaluate risks of HP and stroke, relative risks and 95% confidence intervals for “low-moderate” (2-3 cups/d), “high”(4-6) and “very high”(>6) compared with “reference” (0-1) coffee intake categories were extracted and pooled using a random effect model. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed.

Results:
Four studies for HP (171,460 participants and 39,851 HP diagnoses) and 10 for stroke (969,656 participants with 12,990 events) met the inclusion criteria. Coffee intake was assessed by dietary questionnaire. In pooled analyses, “low-moderate” and “high” coffee intake were both inversely associated with the risk of stroke (RR=0.84, 95% C.I. 0.78 to 0.91 and 0.83, 0.72 to 0.96, respectively) but not with risk of HP. “Very high” coffee intake was not significantly associated with either risk of stroke or of HP. There was significant heterogeneity between studies, while some evidence of publication bias was detected only in the analysis of HP risk. Sub-group analysis suggested an influence of gender and of geographic location, and meta-regression analysis detected age at baseline and length of follow-up as further sources of heterogeneity. Decaffeinated coffee consumption was not related to risk of stroke or HP.

Conclusions:
This meta-analysis of the available prospective studies showed that habitual coffee intake is not associated with higher risk of HP in the general population and that moderate-high coffee consumption is inversely associated with risk of stroke. A protective effect of coffee consumption towards cerebrovascular disease might be exerted through mechanisms independent of changes in blood pressure.
Abstract P216: Fatty Liver Index and Stroke Risk: the Reasons for Geographic and Racial Differences in Stroke Study
Authors: Alexander Kristine S , Zakai Neil A , Lidofsky Steven D , Callas Peter W , Judd Suzanne E , Tracy Russell P , Cushman Mary
Published: July 2021

Background:
Nonalcoholic fatty liver disease (NAFLD) is a common condition driven by the obesity epidemic. It is associated with cardiometabolic risk factors including diabetes, obesity, and hyperlipidemia, but also cardiovascular disease events, independent of these factors. No prospective studies have investigated the association of NAFLD with stroke risk.

Hypothesis:
NAFLD is associated with the risk of stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) case-cohort study.

Methods:
The REGARDS study recruited 30,239 participants from the contiguous U.S., in order to study the reasons for regional and racial differences in stroke mortality. The REGARDS case-cohort study consists of 569 cases of incident stroke with 5.4 years follow up and a cohort random sample of 1,104. The Fatty Liver Index (FLI) was used a surrogate marker for NAFLD. It is calculated as e
X
/(1 + e
X
) x 100, where x = 0.953*log(triglycerides) + 0.139*BMI + 0.718*log(γ-glutamyltransferase) + 0.053*waist circumference - 15.745. An FLI >60 is considered a positive score, 20-60 an intermediate score, and <20 a negative score. After excluding 68 participants who reported heavy alcohol consumption and 87 with baseline stroke, Cox proportional hazards models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of stroke for FLI category, adjusting for age, race, sex, and the Framingham stroke risk factors and stratified by body mass index (BMI).

Results:
In the cohort sample, 44% of participants had NAFLD based on the FLI and 19% had a negative score. Compared to those without NAFLD, individuals with a positive score were more likely to be male (51% vs. 28%), have hypertension (69% vs. 40%), dyslipidemia (68% vs. 37%) diabetes (35% vs. 8%), and higher BMI (mean 33.7 vs. 23.0 kg/m
2
; all p<0.001). No participant with BMI < 20 kg/m
2
had NAFLD by FLI. NAFLD was not associated with risk of stroke in a model adjusted for age, race and sex; HR 1.00 (95% CI 0.69-1.46), or a model further adjusted for Framingham stroke risk factors; HR 0.71 (95% CI 0.45-1.11). Stratifying by BMI group (20-30 kg/m
2
), there was no association between NAFLD and stroke risk in those with BMI 20-<25 or 25-30 kg/m
2
. We were unable to analyze NAFLD in the BMI >30 group, due to low number of negative scores. When analyzed as a continuous variable among those with BMI 30 kg/m
2
, the HRs for a 10 unit higher FLI score were 0.92 (95% CI 0.84-1.01) and 1.17 (95% CI 0.97-1.42), respectively, adjusted for age, sex, race, and stroke risk factors.

Discussion:
NAFLD, as determined by a positive FLI score, was not associated with risk of stroke although FLI score was borderline associated with stroke risk in those with a BMI >30. Results raise the possibility that NAFLD represents end organ damage from an adverse metabolic profile, and is not a mediator of stroke risk.
Abstract P217: Coagulation Factor IX Levels and Risk of Stroke and Coronary Heart Disease: The REasons for Geographic And Racial Differences in Stroke Study (REGARDS)
Authors: Olson Nels C , Cushman Mary , Judd Suzanne , Kissela Brett , Safford Monika M , Rosendaal Frits R , Howard George , Zakai Neil A
Published: July 2021

Introduction:
The role of coagulation in coronary heart disease (CHD) and stroke remains controversial. We examined the association of levels of coagulation factor IX (FIX) with incident CHD and ischemic stroke in REGARDS.

Methods:
REGARDS recruited 30,239 participants in their homes across the contiguous U.S. between 2003-07; by design 41% were black, 55% female, and 56% lived in the southeast. Levels of FIX were measured in participants with incident CHD (n=654), incident stroke (n=646), and in a cohort random sample (n=1,104). Cox models were used to calculate the hazard ratio (HR) per standard deviation (SD) higher FIX level for incident CHD and stroke adjusting for traditional cardiovascular disease (CVD) risk factors, and testing a race by FIX interaction term. Participants with hemorrhagic stroke were excluded from the stroke analyses (n=73).

Results:
Levels of FIX were higher with increasing age, black race, female gender, diabetes, hypertension, dyslipidemia, and among those living in the southeastern U.S. (all p<0.0001). As shown in the table, FIX levels (per 1 SD higher) were associated with CHD, but not stroke, after adjustment for CVD risk factors. When stratified by race, the association with CHD was stronger in blacks than whites (p-interaction = 0.08) with no association for stroke in either blacks or whites (p-interaction 0.71). Analyses of FIX by quintiles did not alter the results.

Discussion:
Levels of coagulation factor IX were significantly associated with incident CHD, but not stroke in blacks but not whites, after adjustment for CVD risk factors. These data suggest that higher levels of FIX are a risk factor for CHD in blacks but not whites, and may indicate different roles for hemostasis in vascular disease risk by race and by vascular disease type.
Abstract P222: Serum fibroblast growth factor-23 and risk of incident stroke: The Atherosclerosis Risk in Communities Study (ARIC)
Authors: Lutsey Pamela L , Selvin Elizabeth , Misialek Jeffrey R , Michos Erin D , Rebholz Casey M , Gottesman Rebecca F , Eckfeldt John H , Alonso Alvaro
Published: July 2021

Background:
Fibroblast growth factor-23 (FGF23), a hormone involved in phosphorous regulation and vitamin D metabolism, has been associated with risk of coronary heart disease and heart failure and is a potential target for intervention. FGF23 may influence stroke risk through several pathways: suboptimal vitamin D levels, impaired kidney function, endothelial dysfunction, and/or inflammation. We tested whether elevated FGF23 is associated with increased risk of incident stroke, independent of traditional stroke risk factors and kidney function.

Methods:
Biologically active intact FGF23 was measured in stored samples collected at baseline, in 1990-1992, from 12,432 stroke-free ARIC participants. Participants were followed through 2010. Incident stroke events (both ischemic and hemorrhagic) were identified during follow-up and adjudicated using medical chart review. Multivariable Cox proportional hazards regression models were used to evaluate the independent association of baseline serum FGF23 with risk of incident stroke.

Results:
Over a median follow-up of 19 years, 766 participants (median age 56, 24% black) developed incident stroke. A significant association of baseline FGF23 with incident stroke was only observed in the highest quintile of serum FGF23. Compared to those in the lowest quintile of FGF23, those in the highest quintile were at 37% greater risk of incident stroke (Table), after adjustment for demographics, behaviors, and body mass index. Additional adjustment for cardiovascular risk factors and eGFR categories completely attenuated the association. There was no evidence of interaction by age, sex, race, or eGFR category.

Conclusions:
Elevated levels of serum FGF23 were associated with modestly increased risk of incident stroke in this large, biracial, community-based cohort in minimally-adjusted models, however this association was not independent of cardiovascular risk factors and kidney function.
Abstract P225: Association Between Perfluoralkyl Acids and Self-Reported Stroke or Cerebral Vascular Accident
Authors: Frisbee Stephanie J
Published: July 2021

PFCs are a class of man-made compounds developed after WWII for use as plasticizers, wetting agents, and as emulsifiers during industrial manufacturing processes. Several lines of research suggest a direct and indirect role for PFCs in stroke and stroke outcome, including: detection in human brain tissue and cerebrospinal fluid and relationships to conditions known to affect stroke, including: homocysteine and blood pressure, thyroid function; immune function, and hypercholesterolemia. The C8 Health Project resulted from a pre-trial settlement of the class action lawsuit filed after PFOA was found to have infiltrated several local drinking water supplies along the mid-Ohio River valley. Final enrollment totaled 69,030 participants. We tested the hypothesis that PFCs were associated with self-reported stroke or cerebral vascular accident. The primary independent variables of interest were the serum concentrations (ng/mL) of 7 different PFCs (PFHxA, PFHS, PFHpA, PFOA, PFOS, PFNA, PFDA), partitioned into age and gender-specific quintiles. Covariates included in this analyses were: demographic; lifestyle / modifiable risk factors; and medical risk factors. We did not include race as a covariate (≥97% of C8 Health Project participants self-identified as white). The primary dependent variable of interest was self-reported stroke or cerebral vascular accident. In univariate analysis (ANOVA), PFHpA and PFOS levels were higher in participants with Stroke/CVA, but PFNA was lower in participants with Stroke/CVA. Results from logistic regression analysis are presented. For four of seven chemicals included in the analysis, there were statistically significant associations with prevalent Stroke/CVA. PFHxA was associated with increased prevalence of Stroke/CVA, whereas PFHS, PFOS, and PFNA were associated with a decreased prevalence of Stroke/CVA. Thus, results from this preliminary analysis support an associations between PFCs and prevalent Stroke/CVA that warrant further, more rigorous investigation.
Abstract P227: Diabetes Mellitus and Venous Thromboembolism: A Systematic Review and Meta-analysis
Authors: Bell Elizabeth J , Folsom Aaron R , Lutsey Pamela L , Selvin Elizabeth , Cushman Mary , Zakai Neil A , Alonso Alvaro
Published: July 2021

Introduction:
Reported associations of diabetes with venous thromboembolism (VTE) are inconsistent. We conducted a systematic review and meta-analysis to quantify the association between diabetes mellitus (type 1 or 2) and VTE (deep vein thrombosis or pulmonary embolism).

Methods:
A systematic review of observational studies was conducted using PubMed, Web of Science, and CINAHL through Dec 31, 2012. Additional studies were identified by contacting experts and through manual review of reference lists of review articles and articles eligible for the present study. We abstracted information on relative risk (RR) estimates and pooled these data using a random-effects model. We queried authors of papers that did not adjust for important confounders to request controlled RR estimates.

Results:
We identified 10 studies (N participants: 240,940; 7 cohort, 3 case-control: Heit, Lidegaard, and Poulter) which provided RRs adjusted for age and BMI (Figure), and 8 additional studies which did not adjust for these confounders (N participants = 150,205). The pooled RR for the association of diabetes with VTE in the 10 studies was 1.18 (95% CI, 1.03-1.34). The test for heterogeneity was not significant (I
2
= 23.8%, p = 0.22). Amongst the 10 studies, smaller studies tended to have lower RR estimates: Both the Begg and Egger tests were significant (p = 0.02 and 0.01, respectively). The other 8 studies showed evidence of significant between-study heterogeneity (I
2
= 75.5%, p <0.0001), making a pooled estimate inappropriate.

Conclusions:
Diabetes is associated with an 18% increased risk of VTE in observational studies after accounting for age and obesity. Possible explanations for the association of diabetes with VTE include increased hypercoagulability or vascular damage caused by the metabolic derangements of diabetes or increased exposure to VTE risk factors in individuals with diabetes. Further research is needed to elucidate the mechanisms of this association and whether improved control of diabetes is associated with reduced VTE risk.
Abstract P228: Distribution of Multisite Atherosclerosis in Persons with Metabolic Syndrome & Diabetes: The Multi-Ethnic Study of Atherosclerosis
Authors: Evans Marcella A , Allison Matthew A , Bertoni Alain G , Budoff Matthew J , Criqui Michael H , Malik Shaista , Ouyang Pamela , Polak Joseph F , Wong Nathan D
Published: July 2021

Background:
The extent of atherosclerosis across multiple vascular beds in persons with metabolic syndrome (Mets) and diabetes (DM) has not been documented. We hypothesized a greater presence/extent of multisite atherosclerosis in MetS and DM, vs. neither.

Methods:
We analyzed four vascular beds (coronary (CA), abdominal aorta (AA), carotid, peripheral vascular) in subjects without cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis, who had complete data on these measures. Multisite atherosclerosis was defined as the presence/extent of CA calcium, AA calcium, carotid intimal medial thickness (disease ≥1mm) and borderline/abnormal (<1 or ≥1.3) ankle brachial index. We then created a composite score summing the continuous gender-stratified standardized z-scores for each measure. ANOVA compared least squares means across disease states; logistic regression gave odds of being in the top quartile of the composite score distribution. We adjusted for non-MetS risk factors (age, gender, ethnicity, smoking, LDL-C, lipid medications, family history).

Results:
Of 1,771 subjects (mean age 64, 50% male, 40% Caucasian, 25% Hispanic, 21% African American, 14% Chinese), 25% had MetS and 13% DM. Persons with DM or Mets had a greater number of sites positive for atherosclerosis (
figure
). Adjusted mean composite scores increased across disease groups (neither disease 0.24, MetS 0.88, DM 1.38, p<0.001 between groups). Adjusted logistic regression showed that the odds of being in the top quartile of the composite score were higher for those with DM OR=4.42 [2.21-8.83] p<0.001 and MetS OR=2.72 [1.63-4.56] p<0.001, vs. neither condition.

Conclusions:
Those with MetS or DM have an increased prevalence and extent of multisite atherosclerosis. Whether disease in one vascular bed should prompt further evaluation, and how this relates to future CVD events, requires further investigation. Our findings support the concept that atherosclerosis in those with MetS or DM is more likely to be systemic vs. site-specific.
Abstract P232: Worse Cardiometabolic Health in African Immigrants than African-Americans: Reconsideration of the Healthy Immigrant Effect
Authors: Sumner Anne E , O'Connor Michelle Y , Thoreson Caroline K , Ricks Madia , Courville Amber B , Thomas Francine , Yao Jianhua , Katzmarzyk Peter T
Published: July 2021

In decades past, African immigrants were considered to have better cardiometabolic health than African Americans. Whether this health advantage continues to exist in the 21st century is unknown. To explore differences in markers of cardiometabolic health, oral glucose tolerance tests, blood pressure (BP), visceral adipose tissue (VAT) volume and the waist circumference (WC) which predicts insulin resistance were compared in 210 men (134 African immigrants, 76 African Americans, mean age 36±9y (mean±SD), range 20-64y) who self-identified as healthy. Insulin resistance was defined by the lowest quartile of the insulin sensitivity index (SI≤2•28mU/L-1.min-1). Receiver operating characteristic curves and the Youden Index were used to identify the WC which optimally predicts insulin resistance. BMI was lower in African immigrants than African Americans (27.4±3.9 vs. 29.3±5.5kg/m2, P<0.01). Adjusting for BMI, WC did not differ between groups (93±5 vs. 94±5cm, P=0.55); but African immigrants had more visceral adipose tissue (VAT) (P<0.001) higher BP (P≤0.01), higher fasting glucose (P≤0.001) and 2h glucose (P<0.001) as well as a higher prevalence of previously undiagnosed diabetes (7% (9 of 134) vs. 0% (0 of 76), P<0.01) and pre-diabetes (35% (47 of 134) vs. 22% (17 of 76), P<0.01). Degree of insulin resistance did not differ in African immigrants and African Americans (4.17±2.88 vs. 4.24±2.61 (mU/L)-1 .min-1, P=0.88). Yet, the WC which optimally predicted insulin resistance was lower in African immigrants than African Americans, specifically 92 cm and 102 cm, respectively. As African immigrants had higher VAT, BP and glucose levels than African Americans, the healthy immigrant effect may no longer be a valid concept. As insulin resistance occurred at a lower WC in African immigrants than African Americans, lower BMI in African immigrants does not appear to provide protection from cardiometabolic risk.
Abstract P238: Marijuana Use and Incident Diabetes: Results from the Coronary Artery Risk Development in Young Adults Study
Authors: Bancks Michael P , Pletcher Mark J , Kertesz Stefan G , Sidney Steve , Jamal Rana S , Schreiner Pamela J
Published: July 2021

Marijuana use is common in the United States, but the cardiometabolic effects of marijuana use are unclear, specifically the association with incident diabetes. We examined the association between self-reported marijuana use and incident diabetes in the CARDIA Study, including 3,506 men and women aged 18-30 at the time of enrollment (1985-1986). In order to establish antecedent marijuana use, we classified marijuana use at enrollment and at exams 2, 5, and 7 (years later), and then followed individuals free of diabetes at year 7 for incident events. Marijuana use was modeled in three categories: never users (20% of the population), ever-past use (44% of the population), and ever-recent use (36% of the population). From 1992-2011, we observed 396 incident cases of diabetes ascertained at each exam via fasting glucose values (≥126 mg/dL), oral glucose tolerance test results (≥200 mg/dL), percentage of glycated hemoglobin (HbA1c ≥6.5%), or use of diabetes medications. Cox regression was used to estimate hazard ratios (HR) for incident diabetes according to marijuana use category, after adjustment for age, sex, race, smoking status, alcohol consumption, education, study center, body mass index, systolic blood pressure, LDL- and HDL-cholesterol, caloric intake, physical activity, and other illicit drug use. Results from crude analysis suggested decreased risk of incident diabetes for both ever-past (HR=0.81; 95% CI = 0.62 - 1.04) and ever-recent (HR=0.86; 95% CI = 0.66 - 1.13) marijuana use when compared to never users. In the multivariable model, neither ever-past (HR=1.03; 95% CI = 0.78 - 1.36) or ever-recent (HR=0.97; 95% CI = 0.70 - 1.36) marijuana use was associated with incident diabetes when compared to never users. The findings were not materially different after excluding the first three years of follow up. Marijuana use in young adulthood was not associated with incident diabetes in middle age.
Abstract P244: Urinary Triclosan Concentrations Are Associated with Body Mass Index and Waist Circumference in US Population, NHANES 2003-2010
Authors: Li Shengxu , Zhu Yun , Wang Guangdi , Yun Miaoying , McLachlan John A , Chen Wei , He Jiang , Whelton Paul K , Zhao Jinying
Published: July 2021

Introduction:
Triclosan, an antibacterial and antifungal agent, is widely used in personal care and household products such as toothpaste. Its effect on human health, however, has not been well investigated. No study has examined the potential consequences of triclosan exposure on obesity traits.

Objective:
To examine whether triclosan exposure is associated with obesity traits.

Methods:
This study included 3,659 children (1,884 boys and 1,775 girls, 6-20 years old) and 6,566 adults (3,251 men and 3,315 women, 20 years and older) with detectable levels of urinary triclosan from the 2003-2010 National Health and Nutrition Examination Surveys (NHANES) database. Urinary triclosan concentrations were measured by automated solid-phase extraction coupled to isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. The association of triclosan levels with body mass index (BMI) or waist circumference was examined using multiple linear regression, adjusted for age, race, education, household income, alcohol intake, and cotinine where appropriate. All data analyses were performed using SAS version 9.3 (SAS Institute Inc, Cary, North Carolina), while taking into account sample weights and design variables.

Results:
Urinary triclosan concentrations were 4.2 μg/g creatinine (95% confidence interval, CI: 3.3-5.3 μg/g creatinine) in boys, 5.1 μg/g creatinine (95% CI: 3.8-6.9 μg/g creatinine) in girls, 9.2 μg/g creatinine (95% CI: 7.4-11.4 μg/g creatinine) in men, and 11.9 μg/g creatinine (95% CI: 9.6-14.8 μg/g creatinine) in women. From the bottom to the top quartile of urinary triclosan concentrations, there was a decreasing trend of BMI in all groups: 22.02±0.33 (multivariable-adjusted mean ± standard error), 21.55±0.28, 21.31±0.27, and 21.16±0.34 kg/m2, p for trend=0.05 in boys; 22.13±0.37, 21.87±0.34, 21.42±0.35, and 20.64±0.23 kg/m2, p for trend=0.009 in girls, 29.24±0.29, 29.07±0.27, 28.73±0.26, and 28.20±0.34 kg/m2, p for trend=0.03 in men; and 29.37±0.40, 28.47±0.43, 29.06±0.39, and 27.07±0.30 kg/m2; p for trend=0.0007 in women. Similar trends were observed for waist circumferences in the four groups (p for trend=0.003-0.04).

Conclusion:
Triclosan exposure is inversely associated with BMI and waist circumference, independent of multiple risk factors. The biological mechanisms linking triclosan exposure to obesity await further investigation although it is likely that triclosan is an endocrine disrupting chemical.
Abstract P245: Dry Air Triggers Paroxysmal Atrial Fibrillation in Patients with Implantable Cardioverter Defibrillators
Authors: Nguyen Jennifer , Link Mark S , Luttmann-Gibson Heike , Laden Francine , Schwartz Joel , Wessler Benjamin , Mittleman Murray A , Gold Diane R , Dockery Douglas W
Published: July 2021

Introduction:
Atrial fibrillation (AF) is responsible for substantial morbidity and mortality, yet little is known about the environmental factors that may trigger AF episodes. Weather has been proposed as a potential precipitant of paroxysmal AF.

Hypothesis:
We assessed the hypothesis that changes in outdoor ambient temperature and outdoor absolute humidity may trigger paroxysmal AF in the following 24 hours.

Methods:
Patients with dual chamber implantable cardioverter defibrillators (ICDs) living in eastern Massachusetts were enrolled between September 2006 and March 2010 from the Tufts Medical Center Cardiac Arrhythmia Clinic (Boston, Massachusetts) and followed prospectively for episodes of paroxysmal AF lasting at least 30 seconds. Arrhythmias documented by the ICD were reviewed and interpreted by an electrophysiologist masked to exposure. The date and time of AF episodes were linked to hourly weather data measured at Boston Logan International Airport. We examined the hypothesis using a time-stratified case-crossover analysis matched on calendar month, day of week and time of day and adjusted for air pollution and barometric pressure. To reduce the possibility of over-representation of clustered events and to reflect the averaging time of the exposure, incident AF episodes were included in the analysis if at least 24 hours had passed since the previous AF episode.

Results:
Of 200 patients enrolled, 49 experienced at least one AF episode (n = 328 episodes). After excluding events with missing exposure or covariate information, analyses were confined to 230 AF episodes among 47 patients. The 47 patients with paroxysmal AF were followed for an average of 1.9 years, and 32 (68%) were male, 45 (96%) were Caucasian, the mean age was 67 years, 24 (51%) had a history of prior AF episodes, 27 (57%) had a pre-implantation ejection fraction < 35%, and 29 (62%) received the ICD for primary prophylaxis. Outdoor temperature in the previous 24 hours was not associated with AF (odds ratio (OR) = 1.13; 95% confidence interval (CI): 0.89, 1.43, p = 0.32, per interquartile range (IQR) decrease of 6.3°C). Lower absolute humidity in the previous 24 hours was associated with a higher risk of AF onset (OR = 1.33; 95% CI: 1.02, 1.74, p = 0.04, per IQR decrease of 3.5 g/m
3
); this risk increased slightly for the previous 3 hours (OR = 1.39; 95% CI: 1.06, 1.82, p = 0.02, per IQR decrease of 3.7 g/m
3
).

Conclusions:
In conclusion, drier air was associated with a transiently higher risk of paroxysmal AF in the following 24 hours among patients with dual chamber ICDs.
Abstract P251: Epigenome-Wide Study of Erythrocyte Fatty Acids in the Genetics of Lipid Lowering Drugs and Diet Network
Authors: Aslibekyan Stella , Hidalgo Bertha , Irvin Marguerite M , Sha Jin , Tiwari Hemant K , Zhi Degui , Ordovas Jose M , Absher Devin M , Arnett Donna K
Published: July 2021

Introduction:
Dietary fatty acids have a role in many physiological mechanisms that influence cardiovascular health. An emerging body of evidence suggests that dietary fats may interact with genetic variants in regulating tissue levels of fatty acids, thus impacting disease risk. Epigenetic changes such as DNA methylation are a promising mechanism underlying such interactions. However, no studies to date have investigated the relationship between DNA methylation and tissue fatty acids at the genome-wide level.

Methods:
We have performed the first epigenome-wide association study (EWAS) of erythrocyte concentrations of polyunsaturated, monounsaturated, saturated, and trans fatty acids in 958 participants of the Genetics of Diet and Lipid Lowering Drugs Network (GOLDN). We assayed the methylation status of approximately 450,000 CpG sites in CD4+ T-cells. To investigate the associations between methylation of each CpG site and red blood cell fatty acids, we fit linear mixed models adjusted for age, sex, cell purity, and family structure.

Results:
The strongest association was observed between the methylation status of a CpG site in PDE4D, previously linked to systemic inflammation and stroke, and red blood cell trans fatty acids (P=4x10-7). In the analysis of polyunsaturated fatty acids, we found inverse associations with the methylation status of two CpG sites in BRSK2 (P=9x10-6 and P=1x10-5 respectively), as well as with a CpG site located in a “gene desert” on chromosome 14 proximally to VRK1 (P=5x10-7). BRSK2 encodes a kinase previously shown to control epigenetic programs that determine T-cell function. The top hits for monounsaturated and saturated fatty acids were located in ATL2 (P=1x10-6) and FGD2 (P=1x10-5), respectively.

Conclusions:
We present preliminary evidence of cross-sectional association between the methylation status of several biologically relevant genomic regions and erythrocyte concentrations of polyunsaturated, trans, monounsaturated, and saturated fatty acids. Upon successful validation, these findings further current understanding of gene-fatty acid interactions in human health and disease.
Abstract P258: Traditional Risk Factors and a Genetic Risk Score Are Associated with Age of First Acute Coronary Syndrome
Authors: Labos Christopher , Wang Leo Rui , Pilote Louise , Bogaty Peter , Brophy James M , Engert James C , Thanassoulis George
Published: July 2021

Background:
Early onset myocardial infarction (MI) is frequently attributed to genetic factors that may accelerate the atherosclerotic process. However, early MI may also occur due to a high burden of traditional risk factors. We sought to examine the association between traditional risk factors as well as a genetic risk score on the age of a first acute coronary syndrome (ACS).

Methods and Results:
We included 460 participants (mean age 59 +/- 12 years, 22.4% female) with a first ACS enrolled in the Recurrence and Inflammation in the Acute Coronary Syndromes (RISCA) cohort. Participants were genotyped for 30 single nucleotide polymorphisms identified from prior myocardial infarction genome-wide association studies to construct a multilocus genetic risk score (GRS). Linear regression models were fit to estimate the association between traditional risk factors (TRFs) and the GRS with age of first ACS. Several TRFs were significantly associated with earlier age of first ACS (all β coefficients in years; p<0.05 for all) : male sex [β=-6.9 (95%CI -9.7,-4.1)], current cigarette smoking [β=-8.1 (95% confidence interval [CI] -10.0, -6.1)], overweight (BMI>25) [β=-2.6 (95%CI -4.8, -0.3)] and obesity (BMI>30) [β=-5.24 (95%CI -7.9, -2.6)]. Use of hormone replacement therapy [β=-4.3 (95%CI -8.4, -0.3) ] and aspirin use were also associated with age of first ACS [β=3.7 (95%CI 0.3, 7.0)]. After multivariable adjustment for TRFs, a one standard deviation increment in the GRS was associated with a 1.0 (95%CI 0.1-2.0) year earlier age of first ACS.

Conclusion:
Among individuals with a first ACS, a GRS composed of 30 SNPs is associated with a younger age of presentation. Although common genetic predisposition modestly contributes to earlier ACS, a heavy burden of traditional risk factors is strongly associated with markedly earlier ACS.
Abstract P276: Metabolic Profiles of Biological Aging in American Indians: The Strong Heart Family Study
Authors: Zhu Yun , He Jiang , Lin Jue , Matsuguchi Tet , Blackburn Elizabeth , Lee Elisa T , Howard Barbara V , Zhao Jinying
Published: July 2021

Background:
Telomere length is an emerging biomarker for cellular senescence or biological aging. Short leukocyte telomere length (LTL) has been associated with a wide range of age-related metabolic disorders such as diabetes and cardiovascular disease. Telomere attrition induces profound metabolic dysfunction in animal models, but no study has examined the metabolic profiles of biological aging assessed by telomere length in human.

Objective:
To identify metabolic profiles of leukocyte telomere length in American Indians participating in the Strong Heart Family Study (SHFS, 2001-2003).

Methods:
This study included 432 SHFS participants free of cardiovascular disease and type 2 diabetes. LTL was measured by quantitative polymerase chain reaction (qPCR). Plasma metabolites were detected using an untargeted metabolomics approach by high-resolution liquid chromatography-mass spectrometry (LC/MS). The association of leukocyte telomere length with concentration of each metabolite was examined using generalized estimating equation (GEE), adjusting for age, sex, study center, body mass index, fasting glucose and fasting insulin. Multiple testing was corrected by Bonferroni correction (significance level 2.8х10-6).

Results:
After adjusting for covariates and multiple testing, three metabolites including cytosine, selenophosphate and pentyl propanoate, were significantly associated with LTL. Of these, cytosine was positively associated with LTL (β=0.0476, 95% CI, 0.0474 to 0.0478, P=1.90х10-7), and selenophosphate (β =-0.1522, 95% CI, -0.1525 to -0.1519, P=2.48х10-8) and pentyl propanoate (β =-0.0644, 95% CI, -0.0683 to -0.0606, P=1.08х10-8) were negatively associated with LTL. Multivariate analysis demonstrated that participants with longer (top telomere tertile) and shorter (bottom telomere tertile) LTL can be clearly separated by partial least square discriminant analysis (PLS-DA) using these three metabolites. Multiple unknown compounds were also independently associated with LTL.

Conclusions:
This study, for the first time, identifies metabolites and metabolic profiles associated with interindividual variability in leukocyte telomere length, independent of potential confounders. Our findings provide novel insights into understanding of telomere biology and metabolic mechanisms underlying age-related disorders.
Abstract P284: Social Engagement and Cardiovascular Risk Behaviors: The Multi-Ethnic Study of Atherosclerosis
Authors: Samuel Laura J , Dennison Himmelfarb Cheryl R , Seeman Teresa E , Echeverria Sandra E , Szklo Moyses , Diez-Roux Ana V
Published: July 2021

Although social engagement is important to health behaviors, prior studies mostly considered only one of multiple different dimensions of it, with inconsistent results. Presence of countervailing or interacting influences of different types of social engagement may account for prior conflicting findings. This study identifies which dimensions of social engagement are associated with risk behaviors of smoking, low levels of physical activity, and a diet poor of fruit and vegetable intake.

Cross-sectional data from 5004 participants, aged 45-84 from the Multi-Ethnic Study of Atherosclerosis was used. Social support was measured using the ENRICHD Social Support Instrument, loneliness with a three item instrument derived from the revised University of California at Los Angeles Loneliness Scale, and neighborhood social cohesion with the instrument from the Project on Human Development in Chicago Neighborhoods. Prevalence ratios of behaviors associated with standardized social engagement variables were modeled with Poisson regression, using robust standard errors.

In unadjusted analyses, higher social support and neighborhood social cohesion were associated with slightly lower prevalence of smoking (prevalence ratio, PR=0.82, 95% CI: 0.77-0.87, and PR=0.91, 95% CI: 0.84-0.98, respectively) and slightly higher likelihood of achieving recommended levels of physical activity (PR=1.04, 95% CI: 1.02-1.07, and PR=1.05, 95% CI: 1.03-1.07, respectively). Higher loneliness was associated with slightly higher prevalence of smoking (PR=1.17, 95% CI: 1.10-1.24) and slightly less physical activity (PR=0.95, 95% CI: 0.93-0.98
)
. Associations of social support and loneliness with smoking, and associations of social support and neighborhood cohesion with physical activity, persisted after adjusting for individual characteristics. After further adjusting for all dimensions of social engagement, only neighborhood social cohesion remained associated with very slightly higher probability of achieving recommended physical activity levels (PR=1.03, 95% CI: 1.01, 1.05), and only social support remained associated with lower prevalence of smoking (PR=0.87, 95% CI: 0.81, 0.94) and higher probability of quitting, amongst those who had ever smoked (PR=1.03, 95% CI: 1.01, 1.06). Social support interacted with loneliness (p for interaction=0.001), such that these associations were present only amongst non-lonely individuals (PR=0.77, 95% CI: 0.69, 0.86). In fully adjusted models, no associations were found for fruit and vegetable intake.

This study is among the first to simultaneously investigate several dimensions of social engagement and their interactions in relation to risk behaviors. Social support is more consistently associated with smoking than other dimensions of social engagement and this association appears to be modified by loneliness.
Abstract P285: Psychosocial Factors are Associated with Blood Pressure Progression among African Americans in the Jackson Heart Study
Authors: Ford Cassandra D , Sims Mario , Higginbotham John C , Crowther Martha R , Wyatt Sharon B , Musani Solomon K , Payne Thomas J , Parton Jason
Published: July 2021

Background:
African Americans (AA) have a higher risk of hypertension than other race/ethnic groups. Research that examines the associations of psychosocial factors with longitudinal changes in blood pressure (BP) and incident hypertension among AA is limited. Using Jackson Heart Study (JHS) data, we hypothesized that negative affect and stress are positively associated with BP progression and incident hypertension among AA.

Methods:
The JHS is an observational, community-based study of cardiovascular disease (CVD) in AA. Our sample consisted of 1,668 normotensive participants at baseline (2000-2004) (mean age 47±12; 61% women). We investigated sex-pooled associations of negative affect (cynical distrust, anger in, anger out and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact and negative life events) with BP progression (an increase by one BP stage as defined by JNC VII), incident hypertension and longitudinal changes in systolic and diastolic BP by examination 2 (2005-2008). Poisson regression analysis was utilized to examine the prevalence ratios (PR 95% CI) of BP tracking with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES) and hypertension risk factors.

Results:
Men had higher cynical distrust scores than women (p<.0001). Women had higher anger out, depressive symptoms and perceived stress scores than men (p<.05). Fifty six percent of the sample (934 cases) had BP progression from 2000 to 2008. After adjustment for age and sex, a high anger-out score was associated with a 20% increased prevalence of BP progression compared to a low anger-out score (PR 1.20, 95%CI 1.05,1.36). This association attenuated after adjustment for hypertension risk factors and became non-significant. High depressive symptoms score was associated with BP progression in the age, sex and SES-adjusted model (PR, 1.14 95%CI 1.00,1.30), but not in the fully-adjusted models. High WSI-event scores were associated with BP progression in the fully-adjusted model (PR, 1.21 95% CI 1.04,1.40). Psychosocial factors were not associated with incident hypertension.

Conclusions:
Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred. Further research is needed to better understand the pathway between exposure to negative affect and stress and BP progression among AA.

Keywords:
psychosocial, hypertension, health disparities, African Americans, Jackson Heart Study

Category:
Hypertension
Abstract P293: Post-Traumatic Stress Disorder, Exposure to Particular Matter and its Cardiovascular Implications
Authors: Iyengar Rupa L , Maceda Cynara , O'Boyle Jacqueline , Beebe Heather , Yakunina Yuliya , Sawit Simonette T , Crowley Laura E , Woodward Mark , McLaughlin Mary Ann
Published: July 2021

Background:
Exposure to particulate matter (PM) is a risk factor for cardiovascular disease (CVD). It is likely that different mechanisms, including inflammatory processes, are responsible for acute and chronic toxic effects. First responders during the World Trade Center (WTC) tragedy have been exposed to PM. Post-Traumatic Stress Disorder (PTSD) is well-established in the WTC cohort. High sensitivity C-reactive protein (hsCRP) is a marker of inflammtion and is indicative of increased CVD risk. In this abstract we aim to investigate the relationship between PTSD and PM exposure and its impact on CVD.

Methods:
We evaluated 816 participants in the World Trade Center-CHEST Program from January 2011 to September 2013. PTSD was defined as self-reported diagnosis and/or a score of above 50 on the PTSD questionnaire. Using the Wisnevsky’s exposure score, participants were classified into four exposure groups, very high, high, intermediate and low. Chi-square analysis, independent t-test, and linear regressions were performed to determine if there was any significant relationship between PTSD, Exposure and CVD.

Results:
Participants with very high or high exposure score were more likely to have PTSD (p=0.001). Those with PTSD had higher hsCRP which were trending to significance (p=0.053). When adjusted further for CVD risk and exposure, hsCRP was significantly related to PTSD (p = 0.044).

Conclusions:
PTSD is significantly related to PM exposure in this cohort of WTC responders. PTSD is a condition that not only affects level of function on a psychological level but can also have an impact on CVD health. PTSD and PM exposure should be considered when assessing CVD risk.
Abstract P297: Repeated Measures of Albuminuria in the Rancho Bernardo Study: 1992-2005
Authors: Jassal Simerjot K , Bergstrom Jaclyn , Ix Joachim , Rifkin Dena , Barrett-Connor Elizabeth
Published: July 2021

Albuminuria is an early, non-invasive marker of kidney injury, and an independent, potentially modifiable, risk factor for cardiovascular disease. Between 1992-96, 1764 community-dwelling men and women 31-98 (mean 71) years old were assessed for albuminuria using spot urine albumin/creatinine ratio (ACR). Median (interquartile range) ACR was 12 (7-20) mg/g. ACR was repeated in 1997-99 (n=926; ACR 12 [7-20]), 1999-2002 (n=977; ACR 16 [9-32]) and 2003-05 (n=755; ACR 11 [6-20]) (Figure). In analyses limited to 977 participants with ACR measured at 1992-96 and 1999-2002 visits, mean 6.6 (range 4.5-9.5) years later, median change in ACR was 4 (-1-17) mg/g; ACR doubled or greater in 36%, halved or less in 10%, and was unchanged in 54%. Table shows change in ACR by baseline characteristics. Using logistic regression, only sex was associated with doubling of ACR (vs. less than doubling); OR 1.42 (95% CI 1.08-1.87, p=0.01) for women; age, blood pressure, and diabetes were not; none of these were associated with halving of ACR. Further studies of predictors of albuminuria may inform future interventions to modify albuminuria and mitigate kidney and cardiovascular risk.