bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4957: Racial Differences in Waitlist Mortality in Children Listed for Heart Transplant in the United States in the Current Era
Authors: Singh Tajinder P , Gauvreau Kimberlee , Thiagarajan Ravi , Piercy Gary , Almond Christopher
Published: July 2021

Disparities in access and utilization of solid organ transplantation in racial minorities are well known in adults but not children. We assessed racial differences in waitlist mortality in children listed for heart transplant (HT) in the United States (US) in the current era. Data from the United Network of Organ Sharing for all US children<18 years of age listed for primary HT during 1999 –2006 were analyzed. Clinical variables were defined at the time of listing. Race was defined as reported by HT centers. Multivariable Cox proportional hazards modeling was used to determine the relationship between race and waitlist mortality. Of 3299 listed children, 1913 (58%) were White, 657 (20%) were Black, 519 (16%) were Hispanic, 109 (3%) were Asian and the remaining 101 (3%) were defined as “Other”. The racial groups were similar with respect to distribution of listing status, percent patients on hemodynamic support and those with pre-formed antibodies >10%. Black and Hispanic children lived in areas with lower median household income ($33,352, $37,516, and $43,077 for Black, Hispanic and White children respectively, P<0.001) and were more likely to have Medicaid insurance compared to White children (58%, 59% and 24% respectively, P<0.001). Waitlist mortality was 14% for White, 19% for Black, 21% for Hispanic, 17% for Asian and 27% for “Other” children. After controlling for age, cardiac diagnosis, listing status, hemodyamic support and creatinine clearance, Black (hazard ratio HR 1.6, 95% confidence interval CI 1.3–1.9, P<0.001), Hispanic (HR 1.5, CI 1.2–1.9, P=0.001), Asian (HR, 2.1, CI 1.3–3.3, P=0.003) and “Other” children (HR 2.3, CI 1.5–3.4, P<0.001) were all at higher risk for waitlist mortality compared to White children. After adjusting additionally for insurance and area household income, the risk of death remained higher for all nonwhite races (HR 1.4 for Black, 1.4 for Hispanic, 2.3 for Asian and 2.2 for “Other” children, P<0.01 for all). Nonwhite children listed for heart transplant have higher waitlist mortality compared to White children after controlling for clinical risk factors. Socioeconomic variables explain only a small fraction of this increased risk.
Abstract 5636: Major Depression is Associated with Decreased Coronary Flow Reserve Detected by Positron Emission Tomography
Authors: Vaccarino Viola , Bremner J D , Votaw John , Faber Tracy , Veledar Emir , Murrah Nancy V , Jones Linda , Dai Jun , Zhao Jinying , Su Shaoyong , Goldberg Jack
Published: July 2021

Introduction.
Major depressive disorder (MDD) is associated with coronary heart disease, but the underlying mechanisms are unclear. Coronary flow reserve (CFR) in response to adenosine is an index of coronary microvascular dysfunction which predisposes to myocardial ischemia. We examined the relationship between MDD and CFR in a genetically informative sample.

Methods.
We studied 141 twin pairs drawn from the Vietnam Era Twin Registry who were born between 1946 and 1956 (mean age 54). For all twins, a lifetime history of MDD was determined with the Structured Clinical Interview for Psychiatry Disorders; 53 pairs were discordant for MDD and 88 pairs were free of MDD. Standard cardiovascular risk factors were obtained by interview and examination. We performed myocardial perfusion imaging and blood flow quantitation with [13N] ammonia positron emission tomography at rest and after adenosine stress. A perfusion defect score summed the number and severity of defects across 20 myocardial regions. CFR was measured as the ratio of maximum flow to baseline flow at rest. Mixed-effect and GEE models were used to conduct matched-pair analyses.

Results.
There was no difference in the distribution of abnormal scans, in summed rest or stress defect scores, and in heart rate/blood pressure responses to adenosine between twins with and without MDD. Among the DZ twin pairs discordant for MDD, the mean CFR was lower in twins with MDD than their brothers without MDD (2.36 ± 0.66 vs 2.75 ± 0.90; p=0.03); no significant difference in mean CFR was found in MZ discordant pairs (2.90±0.78 vs 2.64±0.64, p=0.13). The zygosity by MDD interaction was significant (p=0.01). Results did not change substantially after adjusting for cardiovascular disease risk factors and antidepressant use (adjusted interaction p=0.007). There were no differences in myocardial perfusion comparing twins in discordant pairs with twins in healthy pairs.

Conclusions.
MDD is associated with lower CFR in spite of no differences in visible perfusion defects, suggesting microvascular dysfunction. This association is largely due to shared genetic liability between depression and CFR, suggesting a common underlying pathophysiological process linking depression and coronary microvascular dysfunction.

This research has received full or partial funding support from the American Heart Association, AHA National Center.
Abstract 5664: Left Atrial Strain In Patients With Atrial Fibrillation: Relationship To Fibrosis By Delayed Enhancement-MRI
Authors: Kuppahally Suman S , Oakes Robert S , Fish Eric N , Kholmovski Eugene , Vijayakumar Sathya , DiBella Edward V , MacLeod Rob S , Litwin Sheldon E , Marrouche Nassir F
Published: July 2021

Introduction:
The extent of left atrial (LA) wall fibrosis detected by delayed enhancement (DE)-cardiac MRI prior to catheter ablation of atrial fibrillation (AF) appears to predict procedural success. However, it is currently unknown how the degree of fibrosis affects atrial mechanical function.

Methods:
Prior to catheter ablation of AF, 31 patients underwent DE-CMRI and 2-dimensional transthoracic echocardiography. 3D segmentation of LA was performed and the degree of fibrosis was determined using a semi-automated quantification algorithm. Longitudinal mid-septal and mid-lateral LA wall velocity, strain and strain rate were measured during ventricular systole from the apical 4-chamber view by velocity vector imaging.

Results
: There was greater percent of fibrosis as LA maximum (R = 0.4, p = 0.05) and minimum (R=0.52, p = 0.008) volumes increased. Figure

shows examples of DE-CMRI and strain curves (C) for two patients: Patient 1(A) with mild fibrosis and patient 2 (B) with extensive fibrosis. Patient 1 shows much larger strain than patient 2. Larger LA volumes correlated inversely with maximal LA mid-lateral systolic wall strain (p < 0.005). The percent fibrosis also correlated inversely with maximal LA mid-lateral systolic wall strain (R=0.56, p < 0.005) and the systolic strain rate (R = 0.58, p = 0.002).

Conclusion:
LA strain and strain rate can be assessed using standard echocardiographic gray scale images. LA strain is related to both atrial volumes and fibrosis, which are markers of atrial disease progression. This relationship may represent changes in the properties of LA substrate. These novel imaging approaches may be helpful in predicting outcomes in patients with AF.
Abstract 5684: Long-Term Outcomes after Catheter Ablation of Atrial Flutter: A Meta-Analysis
Authors: Perez Francisco J , Schubert Christine M , Parvez Babar , Pathak Vishesh , Ellenbogen Kenneth A , Wood Mark A
Published: July 2021

Clinical outcomes after catheter ablation of atrial flutter (AFL) vary widely in reported literature. The puropose of this study was to analyze long-term outcomes after cathteter ablation of AFL using meta-analys. Meta-analysis was performed of articles published from 1988 – 2007 with outcomes after catheter ablation of cavotricuspid isthmus (CTI) dependent AFL. The analysis included 110 studies comprising 7946 patients (79% male, 59.8±0.5 years, 43% left atrial enlargement, 49% heart disease, 16±12 months follow up). The acute success rate was 97% (95% CI 95–98%) with cooled (8 –10mm tip or irrigated) radiofrequency catheters and 95% (94 –96%) when bidirectional CTI block was the endpoint. Recurrence rate of AFL was 4% (3– 6%) with cooled catheters. Use of bidirectional CTI block as ablation endpoint decreased AFL reccurrence to 8% (^−10%) versus 18% (14 –22%) without CTI as endpoint. AFL recurrence rate did not increase over time. Mortality was 3% (2– 4%) during follow up. The overall occurrence rate of atrial fibrillation (AF) after AFL ablation was 25% (21–29%). In patients with AF prior to ablation, AF occurred in 46% (41–51%) compared to 16% (11–22%) without AF prior to ablation. Five years after ablation, the AF rates were similar in those with and without AF prior to ablation (Figure

). Antiarrhythmic drug use post ablation was 28% (22–36%). The long term use of coumadin was not described. AF is common after AFL ablation and may limit the clinical utility of this procedure. 28% of patients require antiarrhythmic drugs after AFL ablation. AF before ablation may indicate a more advanced electrical disease.
Abstract 5717: Cardiovascular Abnormalities and Outcomes in a Large Williams Syndrome Cohort
Authors: Collins Ronnie T , Kaplan Paige , Rome Jonathan J
Published: July 2021

Background:
Williams syndrome (WS) is a congenital developmental disorder caused by microdeletion of approximately 28 genes on chromosome 7q11.23, affecting the vascular, connective tissue, and central nervous systems of 1 in 8,000 live births. Previous reports have reported high frequencies of cardiovascular abnormalities (CVA) in small cohorts of patients with WS.

Methods:
A retrospective review was undertaken of patients (pts) with WS evaluated at the Children’s Hospital of Philadelphia from 1/1/1980 through 12/31/2007. WS was diagnosed by the clinical phenotype assessed by an experienced medical geneticist and/or by fluorescence in situ hybridization. Congenital CVA were diagnosed by echocardiography and/or cardiac catheterization. Freedom from intervention was determined using Kaplan-Meier analysis.

Results:
Two hundred and seventy two pts were identified and constituted the study group. Pts presented to our center at 5.2 ± 8.2 yrs with an average length of follow-up of 8.2 ± 7.8 yrs (0 – 43 yrs). Congenital CVA were present in 220/272 (81%) pts. The commonest lesions were supravalvar (SV) aortic stenosis (AS) in 120/272 (44%) and branch pulmonary stenosis (PS) in 84/272 (31%); 44/272 (16%) had both. Other common lesions included mitral valve prolapse and regurgitation in 32/272 (12%), VSD in 30/272 (11%), and SVPS in 29/272 (11%). A number of other CVA occurred with frequencies less than 10%. Surgical or catheter-based interventions were performed in 55/220 (25%) pts with CVA. SVAS most commonly required intervention (28/120 pts, 23%). Branch PS was second with 13/84 (15%). Freedom from intervention in all pts with CVA was 91, 78, 75, 69, and 66% at 1, 5, 10, 20, and 40 years, respectively. Death occurred in 7 pts with an average of 1 death per 345 pt-yrs.

Conclusion:
Though CVA are common in WS, in this, the largest cohort ever reported analyzing CVA and outcomes, SVAS and branch PS occur less frequently than previously reported. In WS pts with CVA, interventions are commonly required and usually occur by 5 years of age. Most WS pts do not require intervention on long-term follow-up and overall mortality in these pts is low.
Abstract 5773: Reduced Left Ventricular Vortex Formation Ability Despite Preserved Ejection Fraction in Low-Flow, Low-Gradient Severe Aortic Stenosis
Authors: Lee Li Ching , Lim Sher Lynn , Tan Huay Cheem , Chia Boon Lock , Poh Kian Keong
Published: July 2021

Background and Aim
: Low-flow, low-gradient (LFLG) severe aortic stenosis (AS) despite preserved left ventricular (LV) ejection fraction (EF) has been associated with more advanced stage of the disease, lower cardiac output (CO) and higher systemic afterload. We aim to characterize the LV performance determinants, including its vortex formation (VF) ability.

Methods
: Echocardiography was performed in 61 consecutive patients with severe AS (aortic valve area index (AVAI) ≤ 0.6 cm
2
/m
2
) and preserved LVEF (≥ 50%). In addition to biplane LV measurements, AS severity indices and Tei index were measured. Hemodynamic indices (including systemic vascular resistance (SVR) and valvulo-arterial impedance (VAI)) were calculated. VF index (VFI) was obtained from 4 X (1-β)/πX α
3
X LVEF where β is the fraction of total transmitral diastolic stroke volume (SVol) contributed by atrial contraction (assessed by time velocity integral of the mitral E and A waves) and α is the end diastolic volume (EDV)
1/3
divided by mitral annular diameter during early diastole. Patients were categorized by their LV SVol index (SVI). LFLG group consisted of SVI < 45ml/m
2
.

Results
: Mean VFI was 2.67±1.1; AVAI, 0.50±0.09 cm
2
/m
2
. Though AVAI was slightly lower in LFLG, dimensionless index and aortic valve resistance were similar and associated with no difference in LV mass and volume between the 2 groups. VFI was significantly reduced in the LFLG, 2.37±0.9 vs 3.12±1.3 (
P
=0.01), However other LV functional parameters including Tei index and LVEF were similar (Table

). LFLG was associated with higher SVR and VAI (Table

). In LFLG, the only significant correlates of VFI were SVR (r=0.38), VAI (0.37) and stroke work index (0.36); all
P
s<0.05. VFI did not correlate to these parameters in the non-LFLG group.

Conclusion
: In LFLG severe AS, increased afterload and suboptimal LV vortex formation ability contribute to lower CO/SV. VFI provides useful insights in understanding this relatively new entity.

Comparison of echocardiographic and haemodynamic data in LFLG and non-LFLG groups
Abstract 006: Relationship of Sedentary Behavior and Physical Inactivity to Incident Coronary Heart Disease: Results from the Women's Health Initiative
Authors: Chomistek Andrea K , Lu Bing , Sands Megan , Going Scott B , Garcia Lorena , Allison Matthew A , Stefanick Marcia L , Sims Stacy T , LaMonte Michael J , Johnson Karen C , Manson JoAnn E , Eaton Charles B
Published: July 2021

Background:
Sedentary behavior, such as prolonged sitting, is becoming recognized as a distinct construct that may not merely reflect lack of leisure-time physical activity (PA), usually defined as physical inactivity. Our objective was to examine the independent and joint associations of sedentary time and physical inactivity with risk of incident coronary heart disease (CHD) in women.

Methods:
This study included 84,798 post-menopausal women, aged 50-79 and free of CHD at baseline, participating in the Women's Health Initiative Observational Study. At baseline, participants reported information on sedentary behavior, defined as hours of sitting and lying per day, and usual PA, defined as energy expenditure from recreational activity including walking, mild, moderate and strenuous PA. Participants were followed from the baseline visit through September 2010 for first occurrence of CHD (MI and CHD death). Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CHD according to tertiles of sedentary time (hrs/day) and physical activity (MET-hrs/wk).

Results:
Sedentary time ≥10 hrs/day was associated with increased CHD risk (HR=1.13, 95% CI 1.04,1.23) in age-adjusted models, but was non-significant in multivariable-adjusted models (HR=1.08, 95% CI 0.99,1.17). In multivariable-adjusted models, the HR of CHD comparing moderate (5.1 - 16.25 MET-hrs/wk) and low (≤ 5 MET-hrs/wk) levels of PA to high (>16.25 MET-hrs/wk) levels were 1.10 (95%CI 1.01,1.21) and 1.21 (95%CI 1.11,1.32), respectively (P for trend <.0001). When we cross-classified women by sedentary time and PA (P for interaction = 0.91), CHD risk was significantly increased only in women with low PA regardless of their sedentary behavior, with the greatest risk seen in women reporting low PA and ≥10 hrs/day of sedentary time.

Conclusion:
Physical inactivity is associated with increased CHD risk in a dose-response manner, whereas sedentary behavior was only modestly associated with CHD risk in this analysis.

Physical Activity (MET-hours/week)

Sedentary Time (hours/day)
High (> 16.25)
Moderate (5.1 - 16.25)
Low (≤ 5)

≤6
1.00 (Referent)
1.12 (0.96, 1.30)
1.17 (1.01, 1.36)

6.1-9.9
0.96 (0.82, 1.13)
1.09 (0.94, 1.27)
1.18 (1.02, 1.38)

≥10
1.08 (0.92, 1.27)
1.14 (0.99, 1.32)
1.32(1.15, 1.51)

The multivariable model includes age, race, education, income, marital status, smoking, family history of MI, depression, alcohol intake, and history of diabetes, hypertension, or hypercholesterolemia
Abstract 023: The Effect of Dietary Protein on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials
Authors: Rebholz Casey M , Friedman Eleanor E , Powers Lindsey J , Arroyave Whitney D , He Jiang , Kelly Tanika N
Published: July 2021

Lifestyle modifications such as weight loss, increasing physical activity, and reducing alcohol consumption and salt intake have been consistently shown to decrease blood pressure. Less well understood is whether increased dietary protein intake may also reduce blood pressure and the risk of hypertension. We conducted a meta-analysis of randomized controlled trials to assess the hypothesis that increased dietary protein intake decreases systolic and diastolic blood pressure in adults. MEDLINE, EMBASE, Cochrane Library, Web of Science, a registry of soy research trials, bibliography review, and expert consultation were the sources of English and non-English articles published before April 2011. Search terms included randomized controlled trial, blood pressure, dietary proteins, dietary supplements, casein, soy, and meat. Forty randomized controlled trials including 3,277 participants in which amount or source of protein was the only difference between the intervention and comparison groups and that examined blood pressure were included. Using a standardized protocol and data extraction form, two investigators independently abstracted data on study design, participant characteristics, intervention, and treatment outcomes. Net effects of protein on blood pressure were pooled across trials and weighted by the inverse of the variance using random-effects models. Compared to carbohydrate, dietary protein was associated with significant decreases in mean systolic and diastolic blood pressure (95% confidence intervals) of -1.75 (-2.31, -1.19) and -1.16 (-1.60, -0.72) mmHg, respectively (all P<0.001). Blood pressure lowering effects of both vegetable and animal sources of protein were observed with significant decreases of -2.22 (-3.18, -1.26) and -2.54 (-3.55, -1.53) mmHg for systolic blood pressure, respectively (all P<0.001), and -1.25 (-2.12, -0.39) and -0.95 (-1.72, -0.19) mmHg for diastolic blood pressure, respectively (P=0.005 and 0.01, respectively). Blood pressure reduction was not significantly different when vegetable protein was compared directly to animal protein. In conclusion, dietary protein intake reduces systolic and diastolic blood pressure in adults. Replacement of carbohydrate intake with protein intake, from either vegetable or animal sources, could be an important strategy for helping to curb the growing pandemic of hypertension and related cardiovascular disease morbidity and mortality. Future research is indicated to assess potential differential effects of protein on blood pressure according to hypertension status.
Abstract 025: Multidetector Computed Tomography Adipose Tissue Depots and Incident Cardiovascular Disease
Authors: Britton Kathryn A , Massaro Joseph M , Murabito Joanne M , Hoffmann Udo , Fox Caroline S
Published: July 2021

Introduction:
Ectopic fat depots may play a role in obesity-mediated cardiovascular disease (CVD). We tested the association of several distinct fat depots and incident CVD in an asymptomatic community-based sample.

Methods:
Participants from the Framingham Heart Study (n=3086, 49% women, mean age 50.2 years, free of CVD at baseline) underwent volumetric assessment of multiple fat depots using multidetector computed tomography from 2002–2005, and were followed longitudinally for CVD events. Fat depots included subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), pericardial adipose tissue, intra-thoracic adipose tissue and thoracic periaortic adipose tissue (TAT). Adipose volumes were standardized within sex to a mean of 0 and a standard deviation of 1. Cardiovascular events included coronary heart disease (myocardial infarction, coronary insufficiency or angina), cerebrovascular disease (stroke or transient ischemic attack), intermittent claudication, heart failure or CVD death. Using Cox proportional hazards regression models, we examined the association of each fat depot with the risk of CVD after adjustment for age, sex, systolic blood pressure, hypertension treatment, diabetes, total cholesterol, high-density lipoprotein cholesterol, smoking, and then additionally for BMI. We additionally examined the association of pericardial fat and incident coronary heart disease.

Results:
During a mean follow-up of 4.7 years, 90 CVD events occurred. After multivariable adjustment, VAT, VAT/SAT ratio, intra-thoracic fat and TAT were significantly associated with incident CVD events. The hazard ratios (95% confidence intervals) per each standard deviation higher were 1.37 (1.10–1.71, p=0.006 [VAT]), 1.30 (1.05–1.60, p=0.02 [VAT/SAT ratio]), 1.28 (1.03–1.59, p=0.03 [intra-thoracic fat]), and 1.30 (1.03–1.67, p=0.03 [TAT]), respectively. We observed no association between BMI (HR 1.15, 0.92–1.43, p=0.21), SAT (HR 1.13, 0.90–1.42, p=0.28) or pericardial fat (HR 1.14, 0.95–1.37, p=0.15) and incident CVD. After additional adjustment for BMI, VAT, VAT/SAT ratio and TAT remained significantly associated with incident CVD events [HR 1.44 (1.08–1.92, p=0.01 [VAT]), 1.34 (1.08–1.65, p=0.007 [VAT/SAT ratio]), and 1.31 (1.03–1.67, p=0.03 [TAT])], respectively. Pericardial fat was also not associated with incident coronary heart disease, even when limiting our events to myocardial infarction or coronary heart disease death (HR 0.97, p=0.81).

Conclusion:
Several distinct ectopic fat depots, including VAT, VAT/SAT ratio, intra-thoracic fat, and TAT, but not generalized obesity, are significantly associated with CVD events after adjustment for risk factors in our community-based sample. These findings support the growing recognition of several potentially pathogenic ectopic fat depots.
Abstract 027: Effectiveness of a 2-phase Color-coded Food and Beverage Intervention among Minority and Low-income Employees
Authors: Levy Douglas E , Riis Jason , Sonnenberg Lillian , Barraclough Susan , Thorndike Anne N
Published: July 2021

Background:
Effective strategies are needed to address obesity, particularly among minority and low-income individuals. Simple point-of-purchase interventions have the potential to improve nutrition choices of a diverse population.

Methods:
We tested the effectiveness of a 2-phase food labeling and choice architecture intervention among different racial and socioeconomic groups in 4,642 employees who were regular patrons at a large hospital cafeteria in Boston, MA. After collecting baseline sales data for 3 months, we implemented Phase 1 to label all items green (healthy), yellow (less healthy), or red (unhealthy). In Phase 2, we manipulated “choice architecture,” making green-labeled items more accessible and red-labeled items less accessible. We calculated the proportion of items purchased by an employee labeled green or red during each 3-month period (baseline, Phase 1, Phase 2) and assessed person-level changes. We linked employee cash register data to human resources files to determine demographics, including race/ethnicity (self-reported) and job type (measure of socioeconomic status). We tested the interaction between intervention phase and race or job type to determine differences in intervention effects across subgroups. We calculated average calories and price per beverage during each phase.

Results:
Employees were white (73%), black (10%), Latino (7%), and Asian (10%). At baseline, black and Latino employees purchased higher proportions of red items compared to white employees (33%, 28%, and 18%, respectively, p<0.001) and lower proportions of green (33%, 38%, and 48%, p<0.001). Purchases by Asian employees did not differ from white employees. Adjusting for demographics, labeling decreased all employees’ purchases of red items (-11.2%, 95% CI -13.6% to -8.9%) and increased green purchases (6.6%, 95% CI 5.2% to 7.9%). The greatest effect was for red beverages (-23.8%, 95% CI -28.1 to -19.6). Choice architecture further decreased red purchases after labeling. Intervention effects were similar across all race and job types (p>0.05 for tests of interaction between race or job type and intervention phase). At baseline, average calories per beverage purchased by black and Latino employees was higher than for white employees (126, 113, and 87 calories, respectively, p<0.001). During the 2-phase intervention, mean calories per beverage decreased similarly for all racial groups and job types (-15 calories, 95% CI -18 to -13), but the mean cost per beverage did not change.

Conclusions:
Despite racial and socioeconomic differences in purchasing of healthy foods at baseline, a simple color-coded labeling and choice architecture intervention improved food and beverage choices among employees from all backgrounds.
Abstract 029: The Automated Self-Administered 24-Hour Dietary Recall (ASA24): A Research Resource from the National Cancer Institute (NCI)
Authors: Subar Amy F , Kirkpatrick Sharon I , Mittl Beth , Zimmerman Thea P , Thompson Frances E , Bingley Christopher , Willis Gordon B , Islam Noemi G , Baranowski Tom , McNutt Suzanne , Potischman Nancy A
Published: July 2021

Introduction:
Extensive evidence has demonstrated that 24-hour dietary recalls (24HRs) provide high-quality dietary intake data with minimal bias, making them the preferred tool for nutrition monitoring and, potentially, for studying diet and disease associations. Traditional 24HRs, however, are expensive and impractical for large-scale research because they rely on trained interviewers, and require multiple administrations to estimate usual intakes. To address these challenges, NCI developed ASA24.

System:
The ASA24 system is a publicly available web-based software tool that enables automated and self-administered 24HRs for epidemiologic, intervention, behavioral, or clinical research. ASA24 consists of a Respondent application used by participants to enter recall data and a Researcher application used by researchers to manage study logistics and obtain nutrient and food level data. The format and design of the Respondent application are modeled on USDA’s interviewer-administered Automated Multiple Pass Method (AMPM) 24HR, which uses multi-level food probes to assess food types and amounts. A Beta version of ASA24, released in 2009, has been used by over 100 researchers to collect over 20,000 recalls. Version 1 of ASA24, released in September 2011, offers improved functionality, features, and usability. Respondents report their intakes using a list of foods and beverages from USDA’s most current Food and Nutrient Database for Dietary Studies (FNDDS 4.1). Multiple images are shown to help respondents estimate portion size. ASA24 allows respondents to: 1) find foods and beverages by browsing or searching, 2) move or copy a food or beverage to a different meal, edit a meal, adjust reported amounts, or correct double reports, 3) review a final list of the day’s intake, and 4) access help. Resulting data files include food codes, nutrients, and MyPyramid food group equivalents for each day and each food, as well as variables to calculate Healthy Eating Index scores. Additional optional modules querying location of meals, who one ate with, TV/computer use during meals, and supplement intake are available, as well as a Spanish language version.

Evaluation:
ASA24 will be compared to traditional interviewer-administered recalls in a large sample of adults and within a smaller feeding study. The measurement error structure of ASA24 will be evaluated against doubly-labeled water and multiple 24-hour urinary nitrogen collections in three large on-going cohorts (NCI’s AARP Diet and Health Study, and Harvard’s Nurses Health Study and Health Professionals Follow-up Study).

Conclusion:
ASA24 has the potential to improve dietary assessment by enhancing the feasibility and cost-effectiveness of collecting high-quality dietary data.
Abstract 031: An Innovative Home Care Delivery Model Reduces The Rate Of Dropouts Found With Traditional Cardiac Rehabilitation
Authors: Ding Hang , Varnfield Marlien , Lee Chi-Keung , VanVeen Johanna , Arnold Desre , Keightley Anita , Walters Darren , Karunanithi Mohan
Published: July 2021

Introduction:
Despite recognized benefits of cardiac rehabilitation (CR), utilization of traditional centre based CR programs has been poor (16–19% of eligible patients) in Australia and USA. To address this issue, an innovative home care model (CAP), based on smart phone technologies, was developed by the Australian e-Health Research Centre and Queensland Health. The aims of this study were to assess perceived barriers of dropouts in traditional CR (TC) and observe the efficacy of the CAP in overcoming these barriers through a randomized control trial.

Method:
Following consent, 120 patients from the Metro North Health Services District, Queensland, were randomised to the CAP (n=60) and control, TC (n=60) CR groups. Dropout rates were observed between the two groups and their perceived barriers were analysed through questionnaires and categorized according to: 1) life demands (work and family commitments), 2) facilitating factors (difficulties in transportation and/or parking), 3) group preference (exercise in groups), 4) medical reasons (deterioration in health), 5) technical difficulties, 6) lack of motivation, 7) lack of need for CR (due to improvement in health) and 8) other reasons. The dropout rates were analysed by the two sided Fisher’s exact test in SPSSvs16.

Results:
Patients’ ages (Mean±SD) between the CAP (59±12 yrs) and TC (59±9 yrs) groups were similar. Dropouts for the TC were mainly due to Categories 1 and 2 (C1
TC
=21.7%, C2
TC
=21.7%); and they were reduced significantly (p<0.05) for CAP (C1
CAP
=5.0%, C2
CAP
=3.3%). No significant difference was found for the remaining categories between the two groups. Category 7 was not responsible for any dropouts in either of the groups.

Conclusion:
The study demonstrates that both competing life demands and facilitating factors were the key barriers to patient dropouts from traditional CR programs, despite patients’ recognition of need to participate in the CR programs. The CAP was able to overcome these two barriers, and hence improve the rate of utilization of CR programs.
Abstract 045: Race-Sex Differences in Risk for Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Safford Monika M , Muntner Paul , Gamboa Christopher , Prineas Ronald , Brown Todd , Durant Raegan , Howard George , Howard Virginia , Cushman Mary , Glasser Stephen
Published: July 2021

National death certificate data suggest that racial disparities in acute coronary heart disease (CHD) mortality widened over the past decade for both men and women. To better understand this disparity, we examined black:white race-sex differences in overall, fatal and nonfatal acute CHD incidence in a large national biracial cohort. REGARDS is following 30,239 community-dwellers age ≥;45 years recruited between 2003-7 from 48 states. Recruitment was designed to balance race and sex; the final sample was 55% female and 41% black. Participants are telephoned every 6 months for CVD endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin, and expert adjudication following national consensus recommendations. Acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. Among participants free of CHD at baseline, we examined black:white hazards for incident overall acute CHD, and, separately, fatal and nonfatal acute CHD for men and women through 2008, adjusting incrementally for sampling, sociodemographics and CHD risk factors. The study sample numbered 24,431 with mean age 64.1 (SD±9.3). Over a mean follow-up of 3.4 (maximum 5.9) years, 48.7% (55/113) of black men, 33.0% (38/115) of black women, 23.0% (46/200) of white men and 24.1% (21/87) of white women died at their presentation of acute CHD. Black:white hazard ratios for overall, fatal and nonfatal acute CHD from incrementally adjusted models stratified on sex are presented in the Table. Black men and women had over twice the age-adjusted hazard of incident fatal acute CHD compared to whites, not entirely explained by excess risk factor burden among blacks. Although socio-economic and CHD risk factors among blacks continue to be major contributors to fatal incident acute CHD, known risk factors did not fully explain the disparity between black and white men; causes of the elevated risk among black men need to be better understood if widening CHD mortality disparities are to be reversed.
Abstract MP006: Plasma and Erythrocyte Biomarkers of Dairy Fat Intake and Risk of Coronary Heart Disease in Men
Authors: Malik Vasanti S , Wu Hongyu , Hu Frank B , Sun Qi
Published: July 2021

Introduction:
Intake of dairy products have been postulated to be associated with risk of coronary heart disease (CHD) because of their high saturated fat content, however studies examining this relation have yielded inconsistent results. Given the widespread consumption of dairy products, further evaluation of this controversial topic using biological markers of dairy fat intake is warranted.

Objective:
To evaluate plasma and erythrocyte odd chain fatty acids and certain trans isomers as biomarkers of dairy fat intake and assess their relation to risk of CHD in US men.

Methods:
We conducted a case-control study nested within the Health Professionals Follow-up study among 18,140 men who provided blood samples between 1993 and 1994. From baseline to 2008, four hundred and fifty-nine cases of CHD were ascertained and matched with 879 controls for age, smoking, fasting status and date of blood draw. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (95% CI) for CHD.

Results:
Among controls, we identified certain fatty acids that were significantly correlated with dairy fat intake: the correlation coefficients between average dairy fat intake in 1986–1994 and 15:0, 17:0, 19:0, 23:0 and trans 16:1n−7 were 0.27, 0.24, 0.10, 0.22 and 0.31 respectively for plasma and 0.25, 0.21, 0.05, 0.21 and 0.30 respectively for erythrocytes. In multivariate analyses controlling for matching factors and other diet and lifestyle risk factors, men with higher plasma concentrations of 15:0 had a significantly greater risk of CHD (RR: 1.61, 95% CI: 1.07, 2.43, p trend: 0.02, comparing extreme tertiles of plasma 15:0). Associations with other biomarkers were not significant in multivariate analyses and associations were generally weaker in erythrocytes.

Conclusions:
These data confirm that certain odd chain fatty acids and trans 16:1n−7 may be used as biomarkers of dairy fat intake and suggest that a high intake of dairy fat is associated with an elevated risk of CHD.
Abstract MP010: Body Mass Index and Stroke Incidence in Japanese Elderly Men
Authors: Tanno Kozo , Kuribayashi Toru , Ohsawa Masaki , Onoda Toshiyuki , Itai Kazuyoshi , Sakata Kiyomi , Nakamura Motoyuki , Omama Shinichi , Ogasawara Kuniaki , Ishibashi Yasuhiro , Okayama Akira
Published: July 2021

Objective:
To examine the association between body mass index (BMI) and incident stroke in Japanese elderly men.

Methods:
A total of 4743 men and aged 65 years and over (mean age, 72 years) who had no history of stroke or myocardial infarction were followed up prospectively for 5.4 years. Stroke events were identified by accessing the Iwate Stroke Registry. Participants were classified into 6 groups according to BMI (kg/m
2
): less than 18.5, 18.5–20.9, 21.0–22.9, 23.0–24.9 (reference), 25.0–27.4, and 27.5 and over. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for ischemic stroke and hemorrhagic stroke according to BMI were estimated with adjustments for age, systolic blood pressure levels, total cholesterol levels, HDL cholesterol levels, HbA1c levels, current smoking, regular drinking and regular exercise using Cox’s regression.

Results:
During the follow-up, 171 ischemic and 58 hemorrhagic strokes occurred. Compared to men with BMI of 23.0–24.9, men with BMI of 25.0–27.4 and BMI of 27.5 and over had 1.6- and 1.9-fold higher risks for ischemic stroke, respectively, and men with BMI of less than 18.5 and 18.5–21.9 had 4.1- and 2.5-fold higher risks for hemorrhagic stroke, respectively. (See
Table
)

Conclusion:
The findings suggest that low BMI (less than 21) is an independent risk factor for hemorrhagic stroke and that high BMI (25 and over) is an independent risk factor for ischemic stroke in Japanese elderly men.

Table

Multivariate HRs (95% CIs) for stroke according to BMI in Japanese eldery men

BMI (kg/m
2
)

Less than 18.5
18.5–20.9
21.0–22.9
23.0–24.9
25.0–27.4
27.5 and over

No. of subjects
138
725
1126
1283
1018
453

Ischemic stroke

No. of cases
3
29
41
33
42
23

Incidence rate
4.32
7.49
6.75
4.81
7.72
9.66

HR (95% CI)
0.82 (0.25–2.72)
1.45 (0.86–2.43)
1.38 (0.87–2.19)
1 (reference)
1.58 (1.00–2.51)
1.92 (1.12–3.30)

Hemorrhagic stroke

No. of cases
4
15
12
10
11
6

Incidence rate
5.66
3.81
1.94
1.44
1.99
2.45

HR (95% CI)
4.10 (1.24–13.6)
2.53 (1.10–5.82)
1.32 (0.57–3.08)
1 (reference)
1.40 (0.59–3.31)
1.62 (0.58–4.52)

Incidence rate was defined as number of cases per 1000 person-years.
Abstract MP016: Innovation in Exercise: Increasing Capacity of Sedentary Obese Women with Cooling
Authors: Sims Stacy T , Tsai Sandra , Stefanick Marcia L
Published: July 2021

Background:
Barriers to physical activity for obese women include overheating, sweating, fatigue, exhaustion, and rapid heart rate. Adipose tissue acts as a thermal insulator, promoting a greater heat load on the nonfat tissues, reducing heat tolerance; exercise causes a rise in body temperature with an inability to dissipate heat contributing to reduced exercise tolerance. With difficulties of thermoregulation in the sedentary obese population, the aspect of attenuating the discomfort thus associated may encourage continuation of exercise. A heat sink applied to palmar surfaces extracts heat and cools the venous blood, reducing thermal strain by enhancing the volume of cooled venous return. We hypothesized that palmar cooling using a rapid thermal exchange device (RTX) during exercise would attenuate the thermal discomfort of exercise of sedentary obese women, improving exercise tolerance.

Methods:
To examine whether palmar cooling would impact exercise tolerance in obese women, 24 healthy women aged 30–45 years, with no history of long term structured exercise, a body mass of 120–135% above ideal and/or BMI between 30 and 34.9 were recruited. Women were randomized into a cooling (RXT with 16°C water circulating) or a control (RTX with 37°C water circulating) group and attended 3 exercise sessions a week for 3-months (12 weeks). Each session was comprised of 10 min body weight exercises, 25–45 min treadmill walking at 70–85% HRR with the RTX device, and 10 min of core strengthening exercises. The performance marker was a 1.5 mi walk for time; conducted on the first and last days of the intervention. Mixed models were used to model each of the outcomes as a function of thermal strain, time and treatment with covariates of speed, heart rate, distance, and the interaction of the main effects included in the model.

Results:
Groups were matched at baseline for key variables (time for 1.5 mile walk test, resting and exercising heart rate [HR], blood pressure [BP], waist circumference [WC], body weight, body mass index [BMI]). Among the cooling group, time to complete the 1.5mile walk test was significantly faster (31.6 ± 2.3 vs. 24.6 ± 2.5 min, pre vs. post,
P<
0.01). A greater average exercising HR was observed (136 vs. 154 bpm, pre vs. post,
P
<0.001), with a significant reduction in WC (41.8 ± 3.1 vs. 39.1 ± 2.2 inches, pre vs. post,
P<
0.01) and resting BP (139/84 ± 124/70 mmHg, pre vs. post,
P <
0.025). There were no significant differences observed in the control group.

Conclusion:
Results indicate that exercise tolerance in obese women improved with cooling during exercise, more so than those women who did not have cooling. An improvement in blood pressure, heart rate, waist circumference, and overall aerobic fitness was observed. These findings suggest that by reducing thermal discomfort during exercise, tolerance increases, thus improving cardiovascular parameters of obese women.
Abstract MP020: Long-term, Visit-to-visit Blood Pressure Variability and the Risk of Total Mortality, MI, and Stroke in the Cardiovascular Health Study
Authors: Suchy-Dicey Astrid , Wallace Erin , Elkind Mitchell , Aguilar Maria , Gottesman Rebecca , Voorman Arend , Rice Kenneth , Kronmal Richard , Longstreth W.T. , Psaty Bruce
Published: July 2021

Introduction:
Recent reports have linked visit-to-visit blood pressure (BP) variability to risk of mortality and stroke, independent of the effect of mean BP level. We sought to confirm these findings in the Cardiovascular Health Study (CHS), a cohort study of cardiovascular risk factors.

Hypothesis:
Variability in visit-to-visit SBP, defined as intraindividual SBP SD, is directly associated with risk of mortality, myocardial infarction (MI), and stroke, independent of intraindividual SBP mean and trend over time.

Methods:
Participants from CHS were eligible if they attended their first five annual clinic visits and did not have stroke, MI, or death by the 5th visit (N=3513). Follow-up started at the 5th visit and extended through June 2008. Analyses were further restricted to subjects who used no antihypertensive medications during the entire 5-year baseline period (non-users, n=1570) and subjects who used the same antihypertensive regimen during that time (users, n=978). Intraindividual SBP variables were defined using each subject’s 5-visit BPs. Cox proportional hazards models estimated adjusted hazard ratios (HR) per standard deviation (SD) increase in intraindividual SD (iSD) SBP or intraindividual mean (iMean) SBP. Results were stratified on medication use or non-use.

Results:
Participants’ mean age was 71 years, 42% were men, and 95% were white. Mean(SD) of iSD SBP was 9.8(4.6) mmHg for anti-hypertensive medications non-users and 12.0(6.0) mmHg for users. iMean SBP was significantly associated with all 3 outcomes among non-users and with stroke among users (table). iSD SBP was significantly associated with mortality in all participants and with MI among non-users; associations for stroke were not significant.

Conclusion:
Long-term visit-to-visit SBP variability may be an important determinant of MI and mortality risk in the elderly. Results for stroke are not consistent with other, previous reports. More research is needed to determine the clinical implications.
Abstract MP022: B-Type Natriuretic Peptide is Associated with Higher Blood Pressure: Results from the Multi-Ethnic Study of Atherosclerosis
Authors: Marney Annis M , Kronmal Richard , Lakoski Susan , Siskovick David , Criqui Michael , Daniels Lori , Cushman Mary
Published: July 2021

B-type natriuretic peptide (BNP) predicts cardiovascular morbidity and mortality in the general population. Its relationship with blood pressure in ambulatory populations is not well established. We hypothesized that BNP concentrations would be positively associated with blood pressure in the Multi-Ethnic Study of Atherosclerosis (MESA). MESA is an epidemiological study of 6,814 men and women from 4 ethnic groups (45-84 years) without known cardiovascular disease. N-terminal pro-BNP was measured at baseline in 6,213 subjects. We used linear regression with systolic blood pressure (SBP) as the outcome and log (natural) BNP (lnBNP), use of BP medications, body mass index (BMI), age, sex, and race as predictors. For every 1 standard deviation higher lnBNP, SBP was 4 mmHg higher (
table
). The regression coefficient for lnBNP was larger (p=0.001) in those on vs not on BP medications (figure). We conclude BNP was significantly associated with SBP in this population. Whether BNP changes with SBP over time is unknown.

Table:

Multivariable Linear Regression of SBP

Predictor

Standardized Coeff.

Std Error

95% CI

Antihypertensive medication

6.5
0.56

5.39-7.60
*

lnBNP

4.0

0.31

3.38-4.58
*

BMI

3.1
0.28

2.60-3.69
*

Age

5.6
0.29

5.03-6.17
*

Sex

1.7
0.53

0.69-2.77
†

Chinese vs Caucasian

5.1
0.83

3.48-6.73
*

African-American vs Caucasian

7.5
0.67

6.22-8.85
*

Hispanic vs Caucasian

3.9
0.66

2.57-5.17
*

*
P
<0.001, †
P
=0.001 Figure: Lowess smoother for relationship of standardized ln(BNP) and SBP (mm/hg)
Abstract MP023: Novel Patterns of Circulating Fatty Acids and Risk of Cardiovascular Disease: the Cardiovascular Health Study
Authors: Imamura Fumiaki , Lemaitre Rozenn N , King Irena B , Song Xiaoling , Lichtenstein Alice H , Matthan Nirupa R , Herrington David M , Siscovick David S , Mozaffarian Dariush
Published: July 2021

Background:
Circulating fatty acids (FA) reflect complex interrelations of diet and metabolism. Few studies have evaluated circulating FA as patterns related to cardiovascular diseases (CVD).

Methods:
We applied principal component analysis (PCA) to 39 plasma phospholipid FA measured in 2,972 older adults (mean age=72.1) at baseline (1992) in the Cardiovascular Health Study, and derived FA patterns. We evaluated prospective associations of identified FA patterns with 14-year incidence of CVD, adjudicated by centralized committee, using multivariate Cox proportional hazards corrected for regression dilution bias. The CHS-derived FA patterns were evaluated in a separate cohort for associations with angiographically-defined atherosclerosis progression over 3.5 years in 1,912 coronary segments of 228 postmenopausal women (mean age=65.4) with established CHD, including FA in phospholipids, triglycerides, and cholesteryl esters.

Results:
Three distinct patterns were identified, that we characterized as having higher trans FA (TFA pattern), de novo lipogenesis FA (DNL pattern), and dairy and long-chain monounsaturated FA (dairy-LCMUFA pattern). During 32,265 person-years, 780 CVD events occurred, including 512 CHD and 346 stroke. The TFA pattern was associated with higher CVD risk (HR for quintiles 5 vs. 1=2.47 [95% CI 1.35–4.51]; p trend=0.006) (Figure), primarily due to stroke (HR=4.68 [1.85–11.8]; p trend=0.003) but not CHD (HR=1.08 [0.50–2.32]; p trend=0.6). The DNL and dairy-LCMUFA patterns were not associated with CVD, or with CHD or stroke examined separately (p>0.1). In the second cohort, the TFA pattern, but not the other 2 patterns, in all lipid compartments was positively associated with progression of coronary stenosis (p trend<0.05).

Conclusions:
Our results suggest PCA can derive informative FA patterns for assessing disease risk. A pattern mainly reflecting higher trans FA levels is linked to higher risk of stroke in older adults, and coronary stenosis progression in women with CHD.