bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P141: Dairy Consumption and Risk of Type 2 Diabetes: 3 Cohorts of US Adults and An Updated Meta-Analysis
Authors: Chen Mu , Sun Qi , Giovannucci Edward , Willett Walter , Mozaffarian Dariush , Hu Frank B
Published: July 2021

Introduction:
The relation between consumption of different types of dairy foods and risk of type 2 diabetes (T2D) remains uncertain.

Hypothesis:
We hypothesized that total dairy intake is not associated with incident T2D but some specific types of dairy foods may be associated with reduced risk of T2D in US adults.

Methods:
We followed 41,705 men in Health Professionals Follow-Up Study (1986-2010), 67,812 women in Nurses’ Health Study (1980-2010), and 86,158 women in the Nurses’ Health Study II (1991-2009). Diet was assessed by validated food-frequency questionnaires, and data were updated every 4 yrs. Incident T2D was confirmed by a validated supplementary questionnaire. Analyses were performed by using Cox regression models and fixed-effect meta-analyses were conducted to summarize the estimates of association if no significant heterogeneities were shown otherwise random-effect models were used.

Results:
During 4,054,783 person-years of follow-up, we documented 14,372 incident T2D cases. After adjustment for age, BMI, and other lifestyle and dietary risk factors, total dairy consumption was not associated with T2D risk and the pooled HR (95% CI) for each 1 serving/d increase in total dairy was 0.99 (0.98, 1.01). Among different types of dairy products, yogurt was consistently associated with lower T2D risk in all three cohorts, with a pooled HR of 0.83 (0.76, 0.91) for each 1 serving/d increment. Other types of dairy foods such as milk and cheese were not significantly associated with T2D. The results were confirmed by a meta-analysis of 13 prospective cohorts (543,438 participants and 39,555 diabetes cases): the RRs (95% CIs) were 0.98 (0.96, 1.01) and 0.83 (0.73, 0.95) for 400g total dairy/d and for 200g yogurt/d, respectively.

Conclusion:
These results suggest that intake of yogurt is associated with a reduced risk of T2D, whereas other dairy foods are not associated with incidence of T2D.
Abstract P155: The Impact of Drinking Patterns on Differences in the Alcohol-Mortality Relationship between Blacks and Whites in the United States
Authors: Jackson Chandra L , Hu Frank B , Kawachi Ichiro , Williams David R , Mukamal Kenneth J , Rimm Eric B
Published: July 2021

Background:
Moderate alcohol consumption appears to confer survival benefits, but previous studies suggest that blacks may not experience such benefits due to, for example, differences in genetic polymorphisms in ethanol metabolizing genes or societal/behavioral factors related to type and pattern of consumption. Investigating potential Black-White differences in the alcohol-mortality relationship may also help illuminate if apparent benefits of moderate alcohol consumption are confounded by lifestyle and socioeconomic characteristics. Few studies, however, have included a sufficient number of blacks.

Objective:
To investigate Black-White differences in the relationship between alcohol consumption and all-cause mortality.

Methods:
We pooled cross-sectional surveys of nationally representative samples of 145,143 adults in the National Health Interview Survey from 1997-2002 with mortality follow-up through 2006. Usual drinking days/week and level of alcohol consumed/day were based on self-report. Race-sex specific Cox regression analyses were used to adjust for marital status, education, physical activity, smoking status, and other potential confounders.

Results:
Over 9 years of follow-up, there were 13,366 deaths: 11,221 in whites and 2,145 in blacks. Participants who consumed 1 drink/day on 3-7 days/week had the lowest age-adjusted mortality rates (MR)/1,000 person years among white men (MR: 66.5 [95%CI: 57.7-75.3]) and women (MR: 34.3 [95%CI: 27.1-41.5]). Two drinks/day on ≤2 days/week in black men (MR: 101.9 [95%CI: 69.3-134.5]) and 1 drink/day ≤2 days/week in black women (MR: 60.0 [95%CI: 41.8-78.1]) was associated with the lowest MR. Compared to never drinkers after accounting for important covariates, the lowest relative risk of mortality for white men (HR=0.55 [95%CI: 0.42-0.74]) was found among those who consumed 2 drinks between 3 to 7 days/week, and white women (HR=0.39 [95%CI: 0.26-0.59]) consuming 1 drink/day on 3 to 7 days/week had the lowest mortality risk. Black women (HR=0.44 [95%CI: 0.27-0.72]) consuming 1 drink on ≤2 days/week had the lowest mortality risk, and black men (HR=0.52 [95%CI: 0.26-1.01]) who consumed 2 drinks ≤2 days/week had the lowest risk of total mortality.

Conclusions:
Light-to-moderate drinking patterns of alcohol consumption were associated with lowest all-cause mortality among white and black men and women although the apparent nadir varied by race and sex. Further research investigating racial differences in drinking patterns and health outcomes is warranted.
Abstract P187: Intake of Plant Sterols from Natural Sources and Risk of Cardiovascular Disease in the EPIC-NL Population
Authors: Ras Rouyanne T , van der Schouw Yvonne T , Trautwein Elke A , Sioen Isabelle , Verschuren W. Monique M , Boer Jolanda M , Dalmeijer Geertje W , Huybrechts Inge , Zock Peter L , Beulens Joline W
Published: July 2021

Background:
Plant sterols (PS) are known to lower low-density lipoprotein (LDL-)cholesterol, which is an established risk factor for cardiovascular disease (CVD). Whether a high intake of PS indeed reduces the risk of CVD is unknown. This study aimed to investigate the relations of dietary intake of naturally occurring PS with blood lipids and CVD risk.

Methods:
The study included 35,597 Dutch men and women, aged 20-70 years, participating in the European Prospective Investigation into Cancer (EPIC-NL) study. Intakes of PS were estimated with a validated food frequency questionnaire (correlation of 0.59 for energy adjusted PS intake against 12 24-hour recalls). Occurrence of CVD was determined through linkage with registries. Blood lipids were measured at baseline. Associations with cardiovascular endpoints were analyzed prospectively using Cox proportional hazard models; this was done for total CVD, total coronary heart disease (CHD) and myocardial infarction (MI). Associations with blood lipids were analyzed cross-sectionally using regression models in a random sample of the baseline cohort (n=2417).

Results:
Average energy-adjusted PS intake was 295.8 ±49 mg/d (mean ±SD) and ranged from 231.3 ±22.0 to 366.0 ±34.9 mg/d between the lowest and highest quintiles. During follow-up, 3047 CVD cases were documented, including 1807 cases of CHD and 606 cases of MI. Adjusted for CVD risk factors, lifestyle and dietary factors, naturally occurring PS intake was not associated with risk of CVD, CHD or MI (P-value trend >0.05). However, PS intake was associated with a lower risk of CHD in the second (HR: 0.83; 95%CI: 0.72; 0.97) and third (0.84; 0.72; 0.98) quintiles vs. the lowest quintile of PS intake, but not in the fourth (0.90; 0.76-1.06) and fifth quintile (0.84; 0.70-1.01). Higher PS intake was associated with lower total cholesterol (-0.06 mmol/L; P-value 0.038) and lower LDL-cholesterol (-0.07 mmol/L; P-value 0.007) per 50 mg/d incremental PS intake. These associations were stronger in men than in women.

Conclusions:
In this population with a relatively narrow and low range of naturally occurring PS intake, PS intake was not associated with a reduced cardiovascular risk, although total- and LDL-cholesterol concentrations were lower in people with higher intakes of PS. Future studies should preferably investigate the association between PS intake and CVD risk in populations with higher PS intakes
.
Abstract P190: Validity and Reproducibility of a Food Frequency Questionnaire to Assess Compliance to a Cardioprotective Mediterranean Diet
Authors: Cantin Jennifer , Lacroix Sébastien , Latour Élise , Lambert Jean , Lalongé Julie , Faraj May , Nigam Anil
Published: July 2021

Background:
The cardioprotective effects of the Mediterranean diet have been well established in epidemiological studies. More recently, it has been shown to improve the cardiometabolic risk profile and endothelial function, as well as reduce markers of vascular inflammation, independent of weight loss. Since cardiovascular disease is the second cause of death in the Canadian and North American populations, randomized clinical trials evaluating the efficacy of the Mediterranean diet in high-risk primary and secondary prevention are warranted. In order to conduct such studies, validated dietary assessment methods specific to population and food habits are needed. Therefore, the aim of our study was to assess the reproducibility and the relative validity of a quantitative food frequency questionnaire (FFQ) to be used in clinical trials at the Montreal Heart Institute’s Prevention Center.

Methods:
Fifty (50) participants (54% (27 of 50) women) aged 19 to 86 years with and without coronary disease were recruited, and randomized in 3 groups in a crossover design where the sequence of administration of questionnaires differed in each group. The FFQ includes 157 food items and was designed to measure food intake over one month. It was administered twice 3 to 5 weeks apart to assess reproducibility and was compared to a 12-day dietary record carried out over a 1-month period to assess validity. Participants were asked not to modify their diet for the duration of the study. FFQs were self-administered and reviewed by a registered dietician. All questionnaires were analyzed using The Food Processor software.

Results:
Reproducibility (n = 49) assessed by the intraclass correlation coefficient (ICC) revealed good (ICC > 0.5) to very good (ICC > 0.7) correlations for energy and all nutrients (except vitamin A) with ICCs ranging from 0.48 (95% confidence interval (CI), 0.23 to 0.67) for vitamin A to 0.91 (95% CI, 0.85 to 0.95) for alcohol (mean 0.68). Preliminary results for validity (n = 15) revealed very good significant correlations for EPA, DHA, selenium and alcohol and good significant correlation for energy, total fat, saturated fatty acids, monounsaturated fatty acids, oleic acid, linolenic acid, trans fat, vitamin B3, vitamin D, iron and magnesium.

Conclusions:
Our FFQ demonstrates good to very good reproducibility. Furthermore, the FFQ appears valid for evaluating adherence to a Mediterranean diet, notably because it provides very good estimates of marine omega-3 fatty acid (EPA, DHA) intake. These results support the eventual use of our FFQ in clinical trials on the Mediterranean diet. Complete sample analysis will be available in March 2014.
Abstract P200: The Circadian Pattern of Cardiac Autonomic Modulation and its Correlates in Adolescents- Penn State Child Cohort (PSCC) Study
Authors: Rodriguez-Colon Sol M , He Fan , Bixler Edward O , Fernandez-Mendoza Julio , Calhoun Susan , Liao Duanping
Published: July 2021

Objective:
To examine the circadian pattern of cardiac autonomic modulation (CAM) and its correlates in a population-based sample of adolescents.

Methods:
We used the data from 400 adolescents who completed the follow up exam in the PSCC study. CAM was assessed by heart rate variability (HRV) analysis of beat-to-beat normal R-R intervals from a 24-hour (7:00 PM to 7:00 PM) ECG, on a 30-minute basis (48 segments/person). The HRV indices included frequency domain: [high and low frequency powers (HF, LF), and LF/HF ratio] and time domain: [standard deviation of normal RRs (SDNN), and the square root of the mean squared difference of successive normal RRs (RMSSD), and heart rate (HR)]. We used a cosine periodic model to estimate each participant’s circadian parameters: mean (M), amplitude (Â), and crescent time (θ). We then used mixed-effects models to calculate group level circadian pattern as the overall M, Â of the oscillation, and θ of the highest oscillation.

Results:
The mean age was 16.9 yrs (SD=2.2), with 54% male and 77% white. The mean BMI percentile is 61, with 16% were obese (BMI percentile ≥ 95). Overall, the parasympathetic modulation gradually increases from late afternoon throughout the evening, and reaches the peak amplitude around 3:00 AM, at which it gradually decrease throughout most of the daytime until late afternoon. The age, sex and race showed varying differences on the CAM circadian parameters. In contrast, obesity in adolescents had adverse effects on all three circadian parameters. Using HF (a reliable index of parasympathetic modulation) as an example, the circadian pattern of the entire sample, and stratified by obesity are shown in Figure 1.

Conclusion:
Circadian pattern of CAM can be quantified by three cosine parameters (M, Â, and θ). Obesity in adolescents is already associated with a CAM profile indicative of sympathetic overflow and reduced parasympathetic modulation, at all levels of the CAM circadian rhythm.
Abstract P206: Estimation of Directly Quantified Visceral Adipose Tissue Using Cardiometabolic Biomarkers
Authors: Powell-Wiley Tiffany M , Hasan Josh , Krishnamoorthy Parasuram , Weiner Elizabeth , Dave Jenny , Doveikis Julia , Rose Shawn , Playford Martin , Yao Jack , Mehta Nehal
Published: July 2021

Background:
Visceral adipose tissue (VAT) has been linked to increased cardiovascular (CV) risk. Furthermore, there is limited data on how anthropometric measures and known markers of cardiometabolic disease (CMD) relate to the presence of VAT. Therefore, the aim of this study was to define how CMD biomarkers relate to directly-quantified volume-based measures of VAT using computed tomography (CT) scan measurements in a well-phenotyped sample of patients from an ongoing cohort study of inflammation and CMD.

Methods and Results:
We evaluated the relationship between directly measured VAT, anthropometric measures [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR)] and CMD biomarkers [lipoproteins, lipoprotein particle size, high sensitivity C-reactive protein (hsCRP), insulin resistance markers] in a longitudinal study of CV risk predictors in chronic inflammation (NCT: NCT01778569). Patients underwent blood testing and CT to measure the sum of visceral adipose tissue between the diaphragm and the inferior border of the urinary bladder (slice 50-150 SumVAT) during a single baseline visit in 2012-2013 (N=42), resulting in a validated, volume-based measurement of VAT. Linear regression modeling was used to understand the relationship between VAT, anthropometric measures and CMD biomarkers. Those with higher levels of visceral adiposity were more likely to be male (p=0.05) and have higher BMI. Adjusting for age, sex, race, physical activity, smoking, and CV risk factors, HDL, hsCRP, insulin, and HOMA-IR were independent predictors of 50-150 SumVAT (Table).

Conclusions:
Markers of lipid metabolism, inflammation, and insulin resistance serve as independent predictors of visceral adiposity and may be useful surrogates to estimate VAT when volume-based CT measures are not possible. Therefore, these biomarkers may be used to evaluate cardio-metabolic risk in areas with limited access to imaging for defining visceral adiposity, particularly community-based settings.
Abstract P212: Blood pressure lowering and clinical outcomes in patients with acute ischemic stroke: China Antihypertensive Trial in Acute Ischemic Stroke (CATIS)
Authors: He Jiang , Zhang Yonghong , Xu Tan , Zhao Qi , Chen Chung-Shiuan , Tong Weijun , Mills Katherine , Chen Jing ,   CATIS Investigators
Published: July 2021

Introduction:
Observational studies have reported that a decrease in blood pressure (BP) within the first several days after stroke onset was associated with poorer, better, or no difference in adverse clinical outcomes among patients with acute ischemic stroke.

Hypothesis:
We investigated the association of immediate BP lowering in acute ischemic stroke patients with major clinical outcomes at 14 days or hospital discharge and at a 3 month follow-up visit.

Methods:
CATIS is a randomized clinical trial conducted in 4,071 Chinese patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment or control. The primary outcome was a combination of death and major disability (a modified Rankin score ≥3) at 14 days or hospital discharge or at the 3 month follow-up visit. Multiple logistic regression analysis was used to adjust for baseline age, gender, SBP, NIHSS score, time of stroke onset, history of antihypertensive treatment, and intervention assignment.

Results:
Compared to patients with a >0-10% reduction in systolic BP within the first 24 hours after admission, the multivariable-adjusted odds ratios (95% confidence interval [CI]) for patients with ≤0%, 11-20%, and ≥21% reduction in SBP were 1.40 (1.08, 1.82), 1.00 (0.81, 1.23), and 0.98 (0.73, 1.30) at 14 days or hospital discharge; and 1.31 (1.00, 1.71), 0.82 (0.66, 1.02), and 0.78 (0.58, 1.05) at 3 months follow-up. Compared to patients with a BP 130-139/85-89 mmHg at 7 days after admission, the multivariable-adjusted odds ratios (95% CI) for patents with BP <130/85, 140-159/90-99, and ≥160/100 mmHg were 1.07 (0.82, 1.38), 1.09 (0.89, 1.34), and 1.58 (1.18, 2.11) at 14 days or hospital discharge, and 0.89 (0.67, 1.17), 1.10 (0.89, 1.36), and 1.50 (1.11, 2.03) at 3 months follow-up, respectively.

Conclusions:
These data indicate that a lack of BP reduction in the first 24 hours of hospitalization and higher BP levels at 7 days after admission predict increased risk of death and major disability at 14 days or hospital discharge and at 3 months follow-up.
Abstract P246: Obstructive Sleep Apnea and Particulate Matter Exposure
Authors: McLaughlin Mary Ann , Iyengar Rupa L , Janneck Jessica , Beebe Heather N , Sanghavi Sarah , Sawit Simonette T , Crowley Laura E , Woodward Mark , Maceda Cynara
Published: July 2021

Background:
Recent studies have found a high prevalence of obstructive sleep apnea (OSA) among responders of the World Trade Center (WTC) disaster. Exposure to particulate matter (PM) causing upper airway inflammation is considered a significant contributing factor in the pathogenesis of OSA. The Berlin Questionnaire (BQ) is a widely used questionnaire to screen for OSA with published sensitivity up to 86% and specificity of 87% for OSA risk. We aim to investigate whether a relationship exists between OSA risk using the BQ and exposure to PM using the Wisnevsky exposure score.

Methodology:
We evaluated 808 participants in the WTC-CHEST Program from January 2011 to September 2013. High risk for OSA was identified as 2 or more positive categories in the BQ. The subjects were categorized into four exposure groups: very high, high, intermediate and low (Wisnevsky exposure score). Chi-square and Binary Logistic Regression analyses were performed to determine if there was a significant relationship between OSA risk and PM exposure.

Results:
High risk for OSA is associated with PM exposure in the study population (p=0.002). Using a binary logistic regression adjusting for gender and age, high risk for OSA was still found to be significantly associated with PM exposure (p = 0.022).

Conclusion:
Prior investigations have demonstrated a link between PM exposure and pulmonary disease, digestive disorders and PTSD. These results provide strong evidence for the association of PM exposure and OSA. In fact, PM exposure in this cohort of WTC first responders is one of the most significant contributors to increased OSA risk. Assessment of both OSA risk and exposure to PM are important as both have been linked to an increase in cardiovascular risk.
Abstract P257: Common Genetic Variations in the Vitamin D Pathway in Relation to Blood Pressure
Authors: Wang Lu , Chu Audrey , Buring Julie E , Ridker Paul M , Chasman Daniel I , Sesso Howard D
Published: July 2021

Background:
Vitamin D is involved in the regulation of blood pressure (BP) through multiple mechanisms. Genetic variation may influence the effect of vitamin D on BP, but data from epidemiologic studies remain limited.

Methods:
We conducted a comprehensive genetic association study to investigate the variants in an expanded vitamin D metabolism and signaling pathway in relation to BP. Analyses were conducted in the Women’s Genome Health Study (WGHS) with genome-wide genotype data among 23,294 women of European ancestry and in the International Consortium of Blood Pressure (ICBP) with published genome-wide meta-analysis results from 69,395 men and women of European ancestry.

Results:
Analyses were conducted in three stages. First, among 5 candidate single-nucleotide polymorphisms (SNPs) in the vitamin D related genes that were previously found associated with BP, none was associated with systolic (SBP) or diastolic BP (DBP) in the WGHS or ICBP. Second, in an expanded set of 61 SNPs involved in vitamin D metabolism and signaling pathway, rs1507023 (in
RBFOX1
) and rs2296241 (in
CYP24A1
) showed nominally significant associations with SBP, DBP, mean arterial pressure (MAP), or pulse pressure (PP) in the WGHS, but the associations were no longer significant after correction for multiple hypothesis testing. Similarly, nominally significant associations found in the ICBP were also not significant after multiple testing corrections. Third
,
among 24 candidate genes across the vitamin D pathway, associations with BP traits that meet gene-wide significance level (gene-based empirical p<0.05) were found in the WGHS for
NCOA3
(rs2235734),
RXRA
(rs875444),
DHCR7
(rs1790370),
VDR
(rs2544037), and
NCOR2
(rs1243733 and rs1147289). Similar gene-wide significant associations (gene-based p<0.05) with SBP or DBP were found in the ICBP for
NCOR1
,
TP53BP1
and
TYRP1
. After further correction for number of genes in the pathway, however, only the association of
TYRP1
with SBP in the ICBP reached significance threshold. Further, the WGHS observed associations were not replicated in the ICBP, and vice versa.

Conclusions:
Our study in large samples of Caucasian population did not replicate several previously observed associations of candidate SNPs in the vitamin D pathway with BP. However, we found suggestive evidence for associations of other vitamin D pathway gene variants with BP traits. Future studies are needed to replicate our findings.
Abstract P283: Disparities in Long-term Risk of Cardiovascular Disease by Sexual Orientation and Race/Ethnicity: the National Longitudinal Study of Adolescent Health
Authors: Clark Cari J , Borowsky Iris W , Alonso Alvaro , Spencer Rachael A , Everson-Rose Susan A
Published: July 2021

Background:
Risk of cardiovascular disease (CVD) may be higher in sexual minorities, but epidemiologic evidence is sparse. We used a nationally representative sample of young adults to examine sex-specific disparities in global CVD risk by sexual orientation and race/ethnicity.

Methods:
Data were from National Longitudinal Study of Adolescent Health subjects who participated in wave 4 (2008-09) and who had valid weights and non-missing data (7087 women; 6340 men). Age, race/ethnicity, sexual orientation, education, financial stress, and CVD risk factors (body mass index, smoking, diabetes, systolic blood pressure, and use of antihypertensive medication) were collected via an in-home interview. We calculated the 30-Year risk for total CVD using a Framingham-based prediction model. Sex-specific differences in 30-year risk of CVD by sexual orientation were calculated with weighted linear models adjusted for age, race/ethnicity, education, and financial distress. Sex-specific interactions between race/ethnicity and sexual orientation were tested.

Results:
Mean age was 28.9 ± .2 years; 93% (n=5912) of male participants were heterosexual, 4% (n=258) were bisexual, and 2% (n=170) were gay. 80% (n=5713) of female participants were heterosexual, 18% (n=1243) were bisexual, and 2% (n=131) were lesbian. Average 30-year risk of CVD was 17.2 ± .5% in men and 9.0 ± .3% in women. Differences in CVD risk by sexual orientation were not detectable for men (p=.59). Compared to heterosexual women, bisexual and lesbian women had a .9% (95% CI: .3, 1.4) and 2.0% (95% CI: .7, 3.2) higher risk of CVD, respectively. In race/ethnicity stratified models (interaction p-value=.01), an increased risk among sexual minorities, especially lesbians, was detectable except among Hispanic women (Figure).

Conclusion:
Disparities in global CVD risk were observed by sexual orientation for women and persisted across most racial/ethnic groups. Sexual orientation may be a marker of increased risk of CVD but more research on contributing factors is needed.
Abstract P287: Weight misperception and health-related quality of life in Appalachian adolescents
Authors: Southerland Jodi L , Wang Liang , Dalton William T , Slawson Deborah L
Published: July 2021

Objective:
Weight misperception (overestimation and underestimation) has been linked to health behaviors and overestimation in particular has been associated with higher psychological distress. Less is known about the relation between weight misperceptions and health-related quality of life (HRQoL) particularly among adolescents in Southern Appalachia.

Hypothesis:
We assessed the hypothesis that weight misperception would be associated with poorer HRQoL outcomes.

Methods:
Waves 1 (n=544) and 2 (n=965) baseline data collected between 2011-2012 were used from the
Team Up for Healthy Living
Project, a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention among Appalachian school children. BMI percentiles for age and sex were calculated using measured height and weight. Participants were classified into 3 groups: (1) accurate weight perception (perceived weight corresponds with actual weight), (2) underestimators (perceived weight less than actual weight), and (3) overestimators (perceived weight more than actual weight). HRQoL was assessed using the 23-item Pediatric QoL Inventory 4.0 (PedsQL
TM
). Multiple linear regression was performed with adjustment for age, gender, race/ethnicity and BMI to examine associations between weight misperception and HRQoL.

Results:
In total, 393 students (26.7%) underestimated their weight and 67 overestimated their weight (4.6%). Univariate analyses showed that compared to accurate perception, underestimation was associated with higher HRQoL in the following areas: total HRQoL score, physical health, psychosocial health, and emotional and social domains (all p<0.05); and overestimation was associated with a lower total HRQoL score and physical health, as well as emotional functioning (all p<0.05). After adjusting for covariates, compared to accurate perception, underestimation was associated with a higher total HRQoL score (β=2.73, P=0.002), physical health (β=3.09, P=0.001), and psychosocial health (β=2.62, P=0.008), as well as emotional (β=3.23, P=0.011) and social (β=2.79, P=0.011) functioning.

Conclusion:
Contrary to the hypothesized relationship, underestimation was associated with higher HRQoL across all domains except for school functioning among Appalachian adolescents; whereas, overestimation was not associated with HRQoL. Better understanding of these associations will be beneficial in developing interventions to improve adolescents’ health in Appalachia.
Abstract P300: Cardiovascular Risk Inequality in Subjects with Chronic Kidney Disease by Age, Race and Ethnicity in the United States
Authors: Liu Longjian
Published: July 2021

Objectives:
Adults with chronic kidney disease (CKD) carry an extraordinarily excess risk for cardiovascular disease (CVD). The present study aimed to test two hypotheses: (1) Non-Hispanic black (NHB) with CKD have significantly higher CVD risk profiles than non-Hispanic white (NHW). (2) This difference significantly contributes to the excess risk of CVD in NHB versus NHW.

Methods:
A total of 3,939 participants aged 21-74 years old in the baseline Chronic Renal Insufficiency Cohort Study, a multiethnic population-based study supported by the National Institute of Diabetes and Digestive and Kidney Diseases, were analyzed. CKD was classified using estimate glomerular filtration rate. A sum weighted CVDRisk score was developed from multiple CVD risk factors. Differences in CVDRisk score by race/ethnicity were tested using quantile regression (QR), a novel data mining approach to identify distribution of risk factors and outcomes.

Results:
The prevalence of CVD was 30.7 and 38.2% in NHW and NHB with CKD (p<0.001). The means (SD) of CVDRisk score were 12.6 (5.7) in NHW and 14.6 (6.4) in NHB (p<0.001). QR analysis indicated that NHB had significantly higher CVDRisk score in all quantile (Qs) of CVDRisk score than NHW. This race/ethnicity difference was even worse among younger NHB (aged <65). An estimated 32% of the excess CVD prevalence for NHB versus NHW may be attributable to a higher CVDRisk score in those aged<65 years old.

Conclusion:
The study highlights an excess and disproportionate distribution of CVD risk factor profile in subjects with CKD for NHB versus NHW. An estimated one third of the excess CVD prevalence in younger NHB with CKD could be explained by their higher CVD risk factor profiles.
Abstract P311: Impact Of Income Level On The Care Of Senile Aortic Stenosis Under Universal Health Coverage
Authors: Lee Seitetsu , Hashimoto Hideki , Yasunaga Hideo , Horiguchi Hiromasa , Kohro Takahide , Iimuro Satoshi , Koide Daisuke , Komuro Issei , Yamazaki Tsutomu
Published: July 2021

Background:
Population aging results in increased volume of aortic stenosis (AS) patients. Although, income is an independent factor of operative mortality for patients undergoing aortic valve surgery in the US, it remains unknown to date whether individual income affects treatment decision to undergo surgery and survivorship after surgery under the universal health coverage in Japan.

Methods:
Using the Japanese Diagnosis Procedure Combination database, we extracted a total of 16079 isolated AS patients aged ≥ 65 years hospitalized between July 2010 and March 2012. Individual income was represented by patients’ residential mean household income. Income was categorized into quartiles with approximately equal numbers of patients. First, decision over undergoing valve surgery was regressed on income level with adjustments for hospital volume, regional medical supplying factor and patients’ individual variables. Moreover, survivorship was regressed on income level with adjustment for types of surgery and combined surgery besides the abovementioned variables.

Results:
Of the 16079 AS patients, 6803 underwent aortic valve surgery. In the multivariable regression analysis for decision over undergoing surgery, the odds ratios for the 2nd, 3rd, 4th quartiles with reference to the 1st quartile of income were 0.79[95% CI: 0.61-1.02], 0.90[0.69-1.17], 0.99[0.77-1.28], respectively. In the multivariable regression analysis for post-operative mortality, the odds ratios for the 2nd, 3rd, 4th quartiles were 1.47 [0.47-4.6], 1.10 [0.30-3.70] and 1.50 [0.50-4.60], respectively. Hospital volume was significantly associated with higher likelihood of surgical intervention and lower post-operative mortality.

Conclusions:
Under universal health coverage in Japan, treatment decision for surgical intervention and postoperative survivorship of aortic valve surgery was equal regardless of patients’ income levels, while hospital volumes exerted a significant influence on the treatment choice and the outcome of the surgery.
Abstract P320: Discordance of Framingham Risk Score and Reynolds Risk Score to Global Vascular Risk Score: Results from the Hispanic Community Health Study/Study of Latinos
Authors: Jung Molly , Medina Hector M , Daviglus Martha , DelRios Marina , Garcia Mario , González Hector M , Kaplan Robert C , Pina Ileana L , Sorlie Paul , Sotres-Alvarez Daniela , Wright Clinton B
Published: July 2021

Introduction:
The Framingham Risk Score (FRS) is a coronary heart disease (CHD) risk model established using an ethnically homogeneous population that predicts 10-year hard CHD events, myocardial infarction (MI) and coronary death. The Reynolds Risk Score (RRS) and Global Vascular Risk Score (GVRS) are validated CHD risk models that, in addition to hard CHD events, predict stroke and other CHD outcomes. In addition to major CHD risk factors, RRS adds systemic inflammation and family history of MI as GVRS adds behavioral and anthropometric measures. This study aims to compare agreement of RRS and GVRS with FRS among Hispanic/Latino adults and to describe discordance in RRS and GVRS with FRS categories, by socio-demographic characteristics.

Methods:
HCHS/SOL is a population-based cohort study of Hispanics/Latinos in four US communities. The analytic sample includes 6,058 non-diabetic participants 45-74 years of age with no past history of CHD and stroke who underwent comprehensive baseline examination. 10-year hard CHD risk score was calculated; participants were categorized as low (<10%), moderate (10-<20%), and high (≥20%) risk. Kappa scores were calculated to compare agreement of RRS and GVRS with FRS. Socio-demographic characteristics of concordance and discordance were characterized overall; multinomial logistic regression models was used to examine age-sex-adjusted likelihood of in discordance by these factors.

Results:
Mean age of the participants was 55 (SE=0.15) years, 54.3% were women, 41% had family history of CHD, and 90% were foreign born. Overall, 4,805 (74%) had low FRS, 1,143 (24%) had moderate FRS, and 110 (2%) had high FRS. There was poor agreement between RRS and FRS (Kappa=0.16, P<0.01) and fair agreement between GVRS and FRS (Kappa=0.36, P<0.01). In age-sex-adjusted analyses, RRS and GVRS were both more likely to classify persons of moderate and high risk who are between the ages of 60-74; GVRS classified more moderate and high risk women than the FRS. RRS and GVRS discordance with FRS was not associated with nativity and length of time in US.

Conclusion:
Significant discordance was observed between RRS and GVRS compared to FRS. Among Hispanic/Latino adults, use of RRS or GVRS may be more inclusive in classifying older age adults and women at high 10-year CHD risk.
Abstract P334: Distribution of Coronary Artery Calcium Score in a Multi-Ethnic Admixed Population: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Authors: Bittencourt Marcio S , Pereira Alexandre C , Staniak Henrique L , Santos Itamar S , Sharovsky Rodolfo , Gomez Luz M , Blaha Michael J , Bensenor Isabela M , Lotufo Paulo A
Published: July 2021

Introduction:
Coronary artery calcium (CAC) is a marker of coronary atherosclerosis burden and is a strong predictor of cardiovascular events and overall mortality, especially in White populations. The distribution of CAC has been determined for a number of predominantly White populations; however, the distribution in ethnically admixed groups has not been well established. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort with 15, 105 participants with an ethnic diversity (White, 52.2%; Brown, 28.2%; Black,16.1%; Asian, 2.5% and Native, 1.0%) is an unique opportunity to explore CAC scores differences among admixed populations.

Hypothesis:
to compare CAC scores obtained from an admixed population in Brazil with the results from the Multi Ethnic Study of Atherosclerosis (MESA).

Methods:
From the 15105 participants of ELSA-Brasil, a prospective study that enrolled civil servants aged 35 to 74 years, CAC scoring was performed on 3,400 individuals at the Sao Paulo site. Similar to previous studies, individuals with self-reported cardiovascular diseases or treated diabetes were excluded from the analysis. The final population included 2,753 individuals (men = 54%; median age = 48 years). Percentiles of CAC distribution were estimated using a two-part local regression fitting model, adapted to zero-inflated data and then compared to MESA CAC percentiles. Testing of the predictive role of age (years), sex, and ethnicity was done modeling a zero-inflated distribution for continuous data.

Results:
For the discrete part of CAC modelling, age, sex and ethnicity were predictors of CAC prevalence (CAC>0). For the ELSA-Brasil sample, increasing age (OR=1.14, p<0.001), male sex (OR: 3.61, p<0.001), and White ethnicity (OR=1.46 (against Blacks), p=0.02) were significantly associated with increased odds of having CAC>0. Different from expected, for the continuous part of CAC modelling, only age (p=0.02) was significantly associated with increased CAC values. Compared to MESA percentiles, the participants or ELSA-Brasil presented, overall, lower CAC values.

Conclusions:
Among this sample of apparently healthy Brazilian adults, we did observe significant differences in CAC prevalence by ethnicity, sex, and age. In contrast with MESA, the difference regarding the amount of CAC between men and women were smaller, suggesting an increased risk of Brazilian women compared to US women.
Abstract P337: The Metabolic Syndrome and Subclinical Atherosclerosis:The Study of Women's Health Across the Nation
Authors: Asubonteng Julius O , White Jessica , Thurston Rebecca , Mulukutla Suresh , Wisniewski Stephen , Barinas-Mitchell Emma , Selzer Faith
Published: July 2021

Objective:
The metabolic syndrome (MetS) and subclinical CVD measures are associated with a higher risk of future cardiovascular disease (CVD) events. Furthermore, individuals with MetS have a greater burden of subclinical CVD, such as the presence of carotid plaque (CP) and larger adventitial diameter (AD). Midlife women proceeding through the menopausal transition are vulnerable to developing MetS and are also at greater risk of CVD, a risk that varies by race/ethnicity. We hypothesized that there are racial/ethnic differences in the association between MetS and measures of subclinical atherosclerosis.

Methods:
Participants from 6 sites of the Study of Women’s Health Across the Nation (SWAN) were analyzed if they were free of clinical CVD and had measures of CP and AD at the 12th annual visit. Women were identified as having MetS if they met the criteria defined by the International Diabetes Federation (IDF). Multivariable logistic and linear regression models were used to investigate the relationship of MetS with CP and AD overall and separately within each race/ethnicity group. Study site, age, height, LDL-C, smoking status, menopausal status, hormone use, and education level were included as covariates. Further analysis adjusted for inflammatory and metabolic biomarkers.

Results:
The 1454 women were, on average, 59.6 years old 43.5% had evidence of MetS, and 85.8% were postmenopausal. The race/ethnicity breakdown was 51.1% White, 30.3% Black, 12.7% Chinese, and 5.8% Hispanic. Overall, MetS was associated with the presence of CP and higher AD after adjusting for covariates (OR (95%): 1.65 (1.31, 2.08); β (SE): 0.344(0.035) mm, p< .0001, respectively). In race-specific models, MetS was significantly associated with AD in White, Black, Hispanic, and Chinese participants, adjusting for covariates (β (SE): 0.305 (0.043) p<.0001; 0.401(0.077) p<.0001; 0.466 (0.147) p= 0.0023; 0.291 (0.098) p = 0.0035; respectively). MetS was significantly associated with CP in White participants only (OR (95%): 1.89 (1.39, 2.57)). When high-sensitivity C-reactive protein and insulin resistance were included in the model, MetS remained significantly associated with AD in Black (0.327(0.86), p = 0.0002) and White (0.212(0.051) p<.0001) participants, and MetS remained significantly associated with CP in Whites participants (1.55 (1.08, 2.23)).

Conclusion:
MetS is associated with subclinical atherosclerosis, and the association varies by race/ethnicity in midlife women. This variation may help explain differences in incidence rates of CVD events between racial/ethnic groups.
Abstract P339: Angina and Silent Myocardial Infarction are Associated with Isolated Small Vessel Peripheral Artery Disease in Community-Dwelling Older Adults: The Rancho Bernardo Study
Authors: Hughes-Austin Jan M , Criqui Michael H , Barrett-Connor Elizabeth
Published: July 2021

Background:
Classic CVD risk factors associated with isolated small vessel peripheral artery disease (iSV-PAD) include older age, male sex, longer smoking duration, and higher LDL cholesterol levels. These CVD risk factors have been linked to atherosclerosis in several vascular beds and to cardiac ischemia. It is not known whether iSV-PAD shares these same links, especially in community-dwelling older adults. Thus, in the Rancho Bernardo (RB) Study, we investigated whether iSV-PAD was associated with measures of atherosclerosis and cardiac ischemia.

Methods:
Among 965 RB Study participants with complete measures of ankle-brachial index (ABI), toe-brachial index (TBI), and measures of cardiac ischemia [self-reported angina, major Q wave on electrocardiogram (ECG), and any ECG abnormality], we evaluated associations between cardiac ischemia and iSV-PAD. In a subset of 387 RB participants free of diagnosed CVD, we evaluated associations between measures of atherosclerosis [coronary artery calcium (CAC) (Agatston scores and calcium volume) and internal carotid intima-media thickness (cIMT)] with iSV-PAD. Isolated SV-PAD was defined by bilateral normal ABI (1.0-1.4) with bilateral TBI < 0.7. Associations of measures of atherosclerosis and cardiac ischemia with iSV-PAD were evaluated using logistic regression in staged models, adjusted for age, sex, anthropometrics, lifestyle, comorbidities, and medications.

Results:
More likely to have iSV-PAD were participants who ever had angina (OR=2.1, 95% CI: 1.04-4.2) or had major Q wave on ECG (OR=4.2, 95% CI: 1.1-15.5). There were too few to stratify by sex. No statistically significant associations were observed for measures of atherosclerosis with iSV-PAD. (Figure 1)

Conclusion:
Strong associations of cardiac ischemia, coupled with null associations of atherosclerosis, with iSV-PAD suggest that iSV-PAD may indicate vascular pathology different from atherosclerosis. Further investigation of endothelial dysfunction and iSV-PAD may elucidate underlying pathology.
Abstract P352: Is Brain Natriuretic Peptide or Pro- Brain Natriuretic Peptide of value for Early Cardiovascular Disease Risk Stratification in asymptomatic Subjects?
Authors: El Shahawy Mahfouz , El Shahawy Omar Y , Entcheva Miglena O
Published: July 2021

Introduction:
There has been much discussion in recent years about the use of Brain natriuretic peptide (BNP) or Pro-brain natriuretic peptide (Pro-BNP) for cardiovascular disease (CVD) risk stratification. The purpose of this study is to assess the association between the presence of abnormal BNP/pro BNP with Left ventricular Hypertrophy (LVH) in asymptomatic subjects with or without hypertension and their value for early CVD risk stratification.

Methods:
We evaluated 2230 subjects aged 23-80 years, who underwent screening for CVD risk using Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS). ECVDRS consists of 10 non-invasive tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (BP PME), Carotid Intima Media Thickness (CIMT), abdominal aorta ultrasound, retinal photography, microalbuminuria, electrocardiogram (ECG), left ventricular ultrasound, and BNP/Pro-BNP.

Results:
Among the 2230 asymptomatic participants, we analyzed 933 who were treated by at least one or more cardiovascular medication for Diabetes, Hypertension (HTN) or Hyperlipidemia.

Our hypothesis was that asymptomatic subjects with LVH have a significantly higher BNP/ProBNP values than those without LVH independent of HTN management. We used 3 Chi-square tests to test the independence between the two groups (with or without LVH) regarding their BNP/ProBNP status for the whole sample and further stratified by their HTN control.

The findings in three tests were highly significant; the proportion of abnormal LVH was 0.17 and 0.39 respectively with normal vs elevated BNP/ProBNP for the whole sample, χ
2
(1, N = 933) = 36.693, p < 0.001. When we stratified by HTN control, with uncontrolled HTN the proportion of abnormal LVH was 0.25 and 0.46 respectively with the normal vs elevated BNP/ProBNP, χ
2
(1, N = 271) = 11.983, p =0.0005. Among participants with controlled HTN the proportion of abnormal LVH was 0.15 and 0.33 respectively with normal vs elevated BNP/ProBNP, χ
2
(1, N = 662) = 18.257, p < 0.001.

Conclusions:
Abnormal BNP/pro-BNP levels are significantly associated with abnormal LVH findings in asymptomatic subjects independent of their HTN control. Thus, ProBNP/BNP could be considered an important follow up test for early detection of serious CV structural abnormality like LVH during the management of patients with HTN regardless of the degree of their HTN control. This finding may justify a more aggressive treatment approach and close monitoring with BNP/ProBNP as a possible screener for CVD manifestations like LVH in HTN patients.
Abstract P381: Impact Of Switching From Different Treatment Regimens To A Fixed-dose Combination Pill (Polypill) In Patients With Cardiovascular Disease Or Similarly High Risk
Authors: Lafeber Melvin , Spiering Wilko , Grobbee Diederick E , Bots Michiel L , Webster Ruth , Thom Simon , Rodgers Anthony
Published: July 2021

Aims:
Cardiovascular fixed-dose combination (FDC) pills, or polypills, may help address the large treatment gaps that exist among patients with cardiovascular disease or similarly high risk. Initiation of polypill-based care in this group typically entails switching from current separately taken medications. Given the heterogeneity in usual care, there is interest in the impact of polypill treatment across different prior medication regimens.

Methods:
This abstract describes effects of a polypill-based treatment strategy, according to baseline anti platelet, statin and blood pressure (BP)-lowering therapy, in a randomized clinical trial among 2004 participants from India and Europe. The main eligibility criteria were established cardiovascular disease or estimated five year cardiovascular risk of ≥15%. Participants were randomly assigned to a polypill-based treatment strategy or usual care. In the polypill group, physicians could use a polypill that contained aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Baseline medication was reviewed and coded into categories. Statin therapy was defined as less potent than the polypill if estimated LDL-cholesterol reduction was 40%. Estimated cardiovascular risk reduction was calculated by combining risk factor changes with results seen in meta-analyses of previous randomized trials.

Results:
The effect of the polypill at twelve months was relatable to baseline statin usage, with LDL differences of -0.37, -0.22, -0.14 and -0.07 mmol/L compared to continuing usual care among patients taking no statin, less potent, equipotent and more potent statin at baseline, respectively. Similarly there were differences in systolic BP of -5.4, -6.2, -3.3 and -1.8 mmHg among patients taking 0, 1, 2 or ≥3 BP-lowering agents. Among patients taking more potent statins at baseline, there was no significant difference in LDL-cholesterol but there were benefits for BP and aspirin adherence. Similarly, among patients taking ≥3 BP-lowering agents, there were no differences in BP, but benefits for LDL-cholesterol and aspirin adherence. As a result, there were estimated cardiovascular relative risk reductions across all subgroups defined by baseline medication usage.

Conclusion:
Adherence benefits from switching to a polypill resulted in risk factor changes that were at least as good as usual care, even when usual care involved more potent regimens. More importantly, switching to a polypill-based strategy resulted in estimated cardiovascular relative risk reductions across a wide range of usual care patterns of antiplatelet, statin and BP-lowering therapy prescribing.