bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P084: Cardiovascular Disease Burden in African Americans: The Jackson Heart Study
Authors: Min Yuan-I , Anugu Pramod , Butler Kenneth , Correa Adolfo , Hartley Tara , Mwasongwe Stanford , Norwood Arnita , Sims Mario , Wallace Valerie , Wang Wei , Winters Karen
Published: March 2022

Background:
African Americans (AA) bear an excess burden of CVD compared to Whites. This burden persists when socioeconomic status (SES) and other known CVD risk factors are considered. One limitation to studies of Black-White disparities in CVD is that population subgroups with lower SES may be over-represented among AA compared to Whites. We aimed to quantify CVD burden in the Jackson Heart Study (JHS), an exclusively AA cohort with a balanced representation of SES.

Methods:
Baseline distributions of SES indicators in 5,301 JHS participants were compared to the US 2000 Census data. Baseline prevalence of myocardial infarction (MI), stroke and hypertension were compared to the National Health and Nutrition Examination Survey (NHANES) data collected during a comparable time period as the JHS baseline exam (2000-2004) (population reference including all races). Indirect standardization methods based on population age and sex specific prevalence were used to calculate the expected prevalence of MI, stroke and hypertension in the JHS. Standardized prevalence ratios (SPR) was calculated by dividing the observed by the expected prevalence. An SPR greater than 1 indicates excess burden.

Results:
Compared to national data, JHS participants were more likely to have some college education (61% vs. 52%) or a bachelor’s degree (32% vs. 24%), were more likely to hold management or professional occupations (36% vs. 34%), but had somewhat lower income, which could be in part due to a higher proportion (64%) of women in the JHS cohort. The observed baseline prevalence of MI, stroke and hypertension in JHS was 5.5%, 4.4% and 60.1%. The SPR for MI, stroke and hypertension were 1.05 (95% CI 0.88, 1.25), 1.39 (95% CI 1.12, 1.69) and 1.51 (1.42, 1.60) for men. The corresponding values for women were 1.61 (95% CI 1.37, 1.89), 1.33 (95% CI 1.12, 1.57) and 1.43 (95% CI 1.37, 1.50). Further analyses evaluating CVD risk factors (smoking, weight, physical activity, serum cholesterol, blood pressure and diabetes) found excess burden in overweight/obesity, physical inactivity, elevated blood pressure (≥140/90 mmHg), and diabetes among JHS participants compared to the population reference.

Conclusions:
We found an excess burden for stroke and hypertension in men, and an excess burden for MI, stroke and hypertension in women in the JHS. We also found an excess burden for CVD risk factors in the JHS cohort. Despite comparable SES between JHS and US population, we found an excess burden of CVD and CVD risk factors in this AA cohort.
Abstract P092: Association of Social Isolation with Functional Status and Mental Health in Patients with Heart Failure
Authors: Chamberlain Alanna M , Finney Rutten Lila J , Manemann Sheila M , Boyd Cynthia M , Weston Susan A , Jiang Ruoxiang , Roger Veronique L
Published: March 2022

Background:
Social isolation has been shown to have a negative impact on psychosocial and physical health, particularly among older adults. However, these relationships have not been fully examined among patients with heart failure (HF).

Methods:
Residents from 11 southeast MN counties with a first-ever ICD-9 code 428 for HF between 1/1/2013 and 3/31/2014 (N=1649) were mailed a survey to measure social isolation (PROMIS Social Isolation Short Form) and functional status and mental health (PROMIS 29 Health Profile). A total of 778 patients returned the survey (response rate 47%), and among these, 645 completed all questions and were retained for analysis. Patients who returned a completed survey were similar on age (p=0.15), sex (p=0.80), and Charlson comorbidity index (p=0.28) to those who did not return or returned an incomplete survey. The relationship between social isolation and functional status and mental health was analyzed using linear regression, adjusted for age, sex, and Charlson comorbidity index.

Results:
Among 645 patients with HF, 53% were men, the mean age was 73 years, and the mean Charlson index was 2.2. The mean scores for each functional and mental health subscale and the total score increased with increasing severity of social isolation (Table). For example, the mean physical function scores were 8.6, 11.3, and 12.8 and the mean depression scores were 5.0, 7.3, and 9.8 for those with low, moderate, and high social isolation, respectively. In addition, the total score increased from 51.1 among those with low social isolation to 80.2 for those with high social isolation. Observed differences persisted after adjustment for age, sex, and comorbidity.

Conclusion:
In patients with HF, greater social isolation is associated with worse functional and mental health, independent of comorbidity. As functional status and mental health impact disease management, addressing social isolation may help with managing HF.
Abstract P121: Consumer-based Physical Activity Monitors and Research-grade Accelerometers Underestimate Physical Activity in a Semi-structured Setting
Authors: Montoye Alexander H , Tuttle Mary S , Nelson M. B , Steeves Jeremy A , Kaminsky Leonard A
Published: March 2022

Introduction:
Consumer-based physical activity (PA) monitors have become popular tools to track PA (steps and energy expenditure [EE]), but little is known about their accuracy and comparability to research-grade PA monitors.

Hypothesis:
We hypothesized that consumer-based PA monitors would have lower PA measurement accuracy than a research-grade PA monitor.

Methods:
Healthy adults (n=30 [n=15 male], aged 18-79 years) were fitted with three Fitbit PA monitors (One and Zip, left hip; Flex, non-dominant wrist), one Jawbone PA monitor (UP24, non-dominant wrist), and one research-grade, accelerometer-based PA monitor (ActiGraph Link; right hip). Subjects performed ≥12 activities from a list of 21 sedentary, household, and ambulatory activities during an 80-minute, semi-structured protocol while wearing all five monitors and a portable metabolic analyzer. Steps and EE were recorded from PA monitors at the beginning and end of the protocol. A previously validated EE prediction equation (Freedson) was used to estimate EE from PA (PAEE) using ActiGraph data. A previous lab visit by subjects was used to estimate resting EE; resting EE was added to PAEE to estimate total EE from the ActiGraph. Criterion measures included a trained research assistant counting total steps (with a hand tally counter) and the metabolic analyzer for measurement of total EE and PAEE (total EE - resting EE). Repeated measures analysis of variance was used to assess step, total EE, and PAEE measures among the consumer-based PA monitors, ActiGraph, and criterion methods.

Results:
Participants averaged 3,231±104 steps, 294±10 kcals for total EE, and 235±9 kcals for PAEE according to criterion measures. Consumer-based PA monitors and the ActiGraph significantly underestimated steps (mean difference [MD]: 714-1,047 steps [22.1-32.4%], p<0.01), total EE (MD: 37-109 kcals [12.6-37.1%], p<0.05), and PAEE (MD: 35-107 kcals [14.9-45.5%], p<0.05) compared to criterion measures. The Fitbit One, Zip, and Flex monitors estimated significantly higher steps than the ActiGraph (MD: 199-302 steps [9.1-13.8%], p<0.05), but there was no significant difference in steps estimated by the UP24 compared to the ActiGraph (MD: 144 steps [6.6%], p=0.21). All consumer-based monitors estimated significantly higher total EE and PAEE than the ActiGraph (MD: 23-60 kcals [12.6-32.7%] and 22-53 kcals [17.3.0-41.2%], respectively; p<0.05).

Conclusions:
All PA monitors underestimated steps, total EE, and PAEE compared to the criterion measures. Large variability existed in the step and EE estimates from the PA monitors tested. Contrary to our hypothesis, the research-grade ActiGraph monitor (using Freedson EE prediction equation) had more severe PA underestimates than the consumer-based PA monitors. In conclusion, estimates of PA between studies using consumer-based vs. research-grade PA monitors should be interpreted with caution.
Abstract P140: Association Between Physical Activity and Oxidative Stress Biomarkers in Generally Healthy Women: The Nurses’ Health Study
Authors: Wu Tianying , Yang Shuman , Jensen Majken , Rimm Eric , Willett Walter
Published: March 2022

Background:
The associations between physical activity and oxidative stress biomarkers are still controversial, and few large human studies have comprehensively investigated the relationship between physical activity and oxidative stress biomarkers. The purpose of this study was to examine the association between physical activity and oxidative stress biomarkers in a large sample of women by measuring biomarkers of both oxidation and antioxidant defense.

Methods:
We conducted a cross-sectional study among 1,144 generally healthy women ages 43-70 years, who were included in a prospective nested case-control study of coronary heart disease in the Nurses’ Health Study. Fluorescent oxidation products (FlOPs) are oxidation markers reflecting global oxidation burden. Antioxidant defense was quantified by the activities of three major antioxidant enzymes in erythrocyte (superoxide dismutase [SOD], glutathione peroxidase [GPx] and catalase [CAT]). Self-reported physical activity was estimated in metabolic equivalents per week. The associations of physical activity with the levels of FlOPs and the activities of SOD, GPx, CAT were analyzed with linear regression models.

Results:
Physical activity was not associated with FlOP levels, or GPx and CAT activities after adjusting for covariates (all Ptrend > 0.15). Higher levels of physical activity were associated with decreased SOD activity (Ptrend < 0.01). We then conducted subgroup analysis of participants with and without any vigorous physical activity. Greater levels of physical activity were associated with lower SOD activity among participants with any vigorous physical activity (Ptrend = 0.02).

Conclusions:
Greater physical activity was associated with lower SOD activity, but not with higher plasma FlOPs in generally healthy women.
Abstract P174: The Role of Kidney Function in the Effectiveness of Lifestyle Modifications for Hypertension: Results From the ENCORE Trial
Authors: Tyson Crystal C ,   ENCORE Investigators
Published: March 2022

Background:
Kidney function plays a major role in determining BP and may influence the effectiveness of lifestyle modifications on hypertension. We examined the role of kidney function on BP response to weight loss and dietary changes in the ENCORE trial.

Methods:
The ENCORE trial was a randomized controlled trial that compared the DASH diet alone or in combination with a weight management program in sedentary overweight or obese adults with above normal BP and preserved kidney function. Clinic and 24-hour ambulatory BP, body weight, diet intake, and 24-hour urine sodium were assessed at baseline and 4 months. Kidney function was assessed at baseline. The relationships between changes in BP and lifestyle behavior change (weight, DASH diet adherence, and urine sodium) were assessed using adjusted multivariable linear regression. Interactions between behavior changes and eGFR (“HI group”: ≥90 or “LO group”: <90 ml/min/1.73m2) were assessed.

Results:
Of 144 participants included in our analysis: women = 67%, mean age =52 years, mean clinic BP =138/86 mmHg, mean ambulatory BP =137/82 mmHg, median eGFR =90 (range 53-146 ml/min/1.73m2). Seventy-four participants were in the HI group and 70 were in the LO group. Improvements in clinic and ambulatory BP were significantly correlated with improvements in weight and DASH adherence (Ps<.05), but not with urine sodium excretion. Participants in the LO group experienced greater BP reductions from weight loss than those in HI group (Ps<.05) (Figure 1), while only participants in the HI group experienced a BP benefit from reduction in urine sodium (P=0.01). BP changes related to DASH adherence did not vary by eGFR.

Conclusions:
Among overweight and obese adults with above normal BP and preserved kidney function, baseline eGFR was observed to influence the magnitude of BP reduction from weight loss and sodium reduction. These findings suggest that certain lifestyle modifications may more favorably lower BP across different levels of kidney function.
Abstract P191: Measurements of Large and Small Artery Elasticity Indexes in a Swedish Population: Are Repeated Measurements Needed?
Authors: Daka Bledar , Allison Matthew , Hellgren Margareta I , Råstam Lennart , Lindblad Ulf
Published: March 2022

Aim:
The aim of this study was to investigate whether the repeated measurement of the pulse wave from the radial artery improve the precision of the estimated elasticity.

Method:
Between 2002 and 2005 a total of 2816 individuals (Men 1400) 35-74 years old, in the Skaraborg County in southern Sweden, were randomly selected for a health survey within the Skaraborg Project (the Vara-Skövde Cohort). All participants were examined with an oral glucose tolerance test (OGTT), blood pressure and anthropometric data. Pulse wave measurements were performed by two trained study nurses using the HDI/Pulse wave CR-2000 (Eagan, MN). Three repetitive measurements were performed within 5 minutes. Large and small artery elasticity indexes (LAEI and SAEI) from each measurement, as well as the mean value of the first two measurements and all three measurements were evaluated with intraclass correlation (ICC) and Pearsons correlation to investigate the precision of the test. Coefficient of variation (CV) was calculated for each measurement and for the variable of the mean of two first measurements and the mean of three measurements.

Results:
The measurements were successful in 2733 subjects (97%). The mean LAEI in 1st, 2nd and 3rd measurements were respectively 16.2±5.6ml/mmHg, 16.3±5.4 ml/mmHg and 16.5± 5.4 ml/mmHg and for SAEI the corresponding results were 7.4±3.6 ml/mmHg, 7.5±3.6 ml/mmHg and 7.4±3.5 ml/mmHg. A significant successive increase was observed in both the LAEI and the SAEI; comparing the third to the first examination LAEI-diff by 0.28 ml/mmHg CI 0.14-0.43 0 p<0.001, and SAEI by 0.17 ml/mmHg CI 0.1-0.24 p<0.001). The between measurement correlations for the LAEI were 0.73 and 0.76, and for the SAEI 0.85 and 0.88, respectively. The intraclass correlations were high both for LAEI (0.90 and 0.89) and for SAEI (0.95 and 0.96). The CV decreased from 33-35 in the single measurement to 30 using three measurements for LAEI and from 47-49 to 47 for SAEI.

Conclusion:
Considering the high CV in both LAEI and SAEI repeated measurements are recommended. However, the high correlation between the mean of two and three measurements suggests only slight improvement in the precision is achieved with three examinations. As commonly recommended for blood pressure control we suggest using the mean of two measurements also for these indices of arterial elasticity.
Abstract P193: Prospective Association of Allostatic Load with Incident CVD in American Indians: The Strong Heart Study
Authors: Peng Hao , Yeh Fawn , Cole Shelley A. , Best Lyle G. , Roman Mary J. , Lee Elisa T. , Howard Barbara V. , Zhao Jinying
Published: March 2022

Background:
Chronic stress increases the risk of CVD. Allostatic load (AL) is a measure of multisystem physiological dysregulation resulting from long-term response to stress. American Indians (AIs) suffer higher rates of chronic stress and CVD, but no study has examined the association of AL with CVD in this high risk population.

Objective:
To examine whether baseline AL predicts incident CVD in AIs in the Strong Heart Study.

Methods:
Among 1400 apparently healthy AIs (free of CVD and diabetes at baseline) followed for an average of 7.8 years, we calculated AL score using 10 markers at baseline, including leukocyte telomere length, fasting glucose, total cholesterol, triglycerides, low- and high- density lipoprotein, estimated glomerular filtration rate, body mass index, and systolic and diastolic blood pressure. Each of the 10 markers was categorized as high or low risk according to criteria listed in Table 1. A composite AL score was calculated by summing the number of high-risk markers. CVD events were defined as fatal and nonfatal MI, congestive heart failure, and stroke. The association of baseline AL with incident CVD was examined by Cox proportional hazard model, adjusting for age, sex, study site, socioeconomic status, smoking and drinking at baseline.

Results:
The mean age at baseline was 55±8 years. Participants with AL scores of 0, 1, 2, 3 and 4+ comprised of 20%, 30%, 28%, 13%, and 9%, respectively, of the study population. A total of 224 participants developed CVD during the follow-up period. Compared to participants with an AL score of 0, those with a score of 1, (HR=1.62 [1.00 - 2.62]), 2 (HR=2.28 [1.42 - 3.66]), 3 (HR=2.25 [1.33 - 3.80]), or 4+ (HR=3.06 [1.77 - 5.30]) had significantly higher risk for developing CVD. Moreover, there was a dose-response relationship between AL and CVD (trend
P
<0.001).

Conclusion:
A higher AL score at baseline significantly predicts incident CVD among AIs, independent of sociodemographic and behavioral risk factors. The mechanisms underlying this association warrant further investigation.
Abstract P195: Reproductive History and Subsequent Stroke in Middle-aged African American Women: The Pitt County Study
Authors: Barrington Debbie , James Sherman
Published: March 2022

Introduction:
Women with a history of pregnancy loss or delivery of low birth weight (< 2500 grams) and/or preterm (< 37 weeks gestation) (LBW/PTB) infants have an increased subsequent risk for cardiovascular morbidity and mortality. The association between nulliparity and cardiovascular disease has been mixed; some studies reported excess risk among nulliparous women compared to women who had one or two births, while others found decreased risk. Research among African American women is limited regarding whether reproductive history influences risk for cardiovascular disease (e.g., stroke).

Hypothesis:
We investigated whether a history of pregnancy loss, LBW/PTB delivery and nulliparity increased risk for stroke among middle-aged African American women.

Methods:
Multiple logistic regression was used to determine the association between LBW/PTB delivery and hypertension among 750 African American female participants (mean baseline age = 35.4 years) in the Pitt County Study, a 13 year (1988-2001) probability-based cohort study in eastern North Carolina. Reproductive history and physician-diagnosed stroke were assessed by self-report in 2001. Statistical analyses adjusted for known and suspected confounders, including adult socioeconomic position, medical conditions, health behaviors, and psychosocial risk factors.

Results:
By 2001, 3% of the women, ages 37 to 63 years, reported having had a stroke. 33% reported at least one pregnancy loss and 21% had a reproductive history of LBW/PTB delivery. After adjusting for confounders, women with a history of pregnancy loss had 2.9 times the odds of stroke compared to those not experiencing a pregnancy loss; covariate-adjusted AOR = 2.94; 95%CI: (1.97, 4.37). Women with a history of LBW/PTB had a 61% greater odds of stroke compared to those who had only normal weight and at-term births, AOR = 1.61; 95%CI: (1.07, 2.44). Women who never had a pregnancy or a live birth also had increased risk for stroke, AOR = 5.09; 95%CI: (3.03, 8.54) and AOR = 2.85; 95%CI: (1.75, 4.64), respectively.

Conclusions:
History of pregnancy loss, LBW/PTB delivery and nulliparity were independently associated with increased risk for stroke among middle-aged African American women. These findings highlight the potential of reproductive history to be a clinically useful predictive marker of later-life stroke for African American women.
Abstract P206: Dog Ownership and the Risk of Cardiovascular Disease: A Nation-wide Cohort Study
Authors: Mubanga Mwenya , Byberg Liisa , Ingelsson Erik , Fall Tove
Published: March 2022

Introduction:
Conflicting results surround the relationship between dog ownership and the risk of developing cardiovascular disease. Registration of dog ownership has been mandatory in Sweden since 2001 and it is estimated that 83% of dogs are registered. The aim of this study was to use the Swedish national dog registers to assess the association of dog ownership and incident cardiovascular disease.

Methods:
The study cohort was defined from the Register of the Total Population including all Swedish residents aged 40-75 years in 2001. The personal identity number was used to link records to the Longitudinal Integration Database for Health Insurance and Labor Market Studies, the National Patient Register and the Cause of Death Register for socioeconomic variables and health outcomes. Dog exposure was defined as being registered or having a partner registered as a dog owner in either the Swedish Board of Agriculture and/or the Swedish Kennel Club dog registers. Study participants with cardiovascular events before baseline or immigrating to Sweden after 1987 were excluded. Outcomes were examined independently and included coronary heart disease, heart failure, ischemic stroke and hemorrhagic stroke. Cox proportional hazards regression using age as time-scale was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Study subjects were censored at death, emigration or 31st December 2012. Models were adjusted for sex, marital status, presence of children <18 years in the household, country of birth, province of residence, education level and income.

Results:
The study population included 3 113 864 individuals, of whom 169 395 (5.4%) were dog owners. At baseline, the median age was 55 years in non-owners (interquartile range, IQR, 48 -62) and 52 years in dog owners (IQR 46-58). Dog ownership was inversely associated with hemorrhagic stroke (30 513 events, HR 0.93 [95% CI 0.88-0.98]), ischemic stroke (91 160 events, HR 0.94 [0.91-0.98]) and heart failure (67 740 events, HR 0.95 [0.91-0.99]). There was no association with coronary heart disease (165 275 events, HR 0.99 [0.97-1.01]).

Conclusion:
Our study provides evidence that dog owners are at a lower risk for ischemic stroke, hemorrhagic stroke and heart failure. This relationship could be explained by a positive effect of dog ownership on daily exercise and psychosocial health or be due to unmeasured confounding. Although the cohort was free from cardiovascular disease at baseline, we cannot exclude the possibility that those individuals that buy a dog have better overall health than those that do not.
Abstract P226: Higher Calcium Density in Abdominal Aortic Calcium (AAC) and Coronary Artery Calcium (CAC) Does Not Increase Risk for Cardiovascular Disease (CVD) Events: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Forbang Nketi I , Ix Joachim , Remigo-Baker Rosemay , Allison Matthew , McClelland Robyn , Sandfort Veit , Michos Erin
Published: March 2022

Background:
AAC and CAC independently and similarly predict CVD events, but only AAC independently predicts all-cause mortality (ACM). The standard calcified plaque score, the Agatston method, up-weights for greater calcium density, thus modeling higher calcium density associated with increased CVD risk. We evaluated this model by comparing associations of density and volume separately of AAC and CAC for incident coronary heart disease (CHD, defined as myocardial infarction, and resuscitated cardiac arrest), CVD (defined as CHD plus stroke and stroke death), and ACM.

Methods:
Cox-proportional hazard model was used to compare independent associations of AAC and CAC density and volume to CHD, CVD, and ACM, with adjustments for the General Framingham Risk Score (composite of CVD risk factors, predicts 10 year CVD risk), ethnicity and statin therapy. Density was calculated as:

Density = Agatston / (volume, mm
3
/ CT scan slice thickness, mm). Agatston = area, mm
2
X density.

Results:
In 997 participants with prevalent AAC and CAC, mean age was 66 ± 9 years, mean AAC density 3.10 ± 0.58, and mean CAC density was 2.75 ± 0.72, 58% were men, 46% were European-, 24% were Hispanic-, 16% were African-, and 13% were Chinese-Americans. Over a mean follow-up of 9 years, there were 77 CHD, 118 CVD, and 169 ACM. Compared to the 0-50
th
, the >75
th
percentile of AAC density was non-significantly associated with lower ACM but not CHD or CVD (Table). Also, the >75
th
percentile of CAC density was non-significantly associated with lower CHD and CVD, but not ACM. In contrast, compared to the 0-50
th
, the >75
th
percentile of AAC volume was significantly associated with higher CHD, CVD, ACM, and the >75
th
percentile of CAC volume was significantly associated with higher CHD, CVD, but not ACM.

Conclusion:
In mutually adjusted models, although volume of AAC and CAC increased CVD risk, density of AAC and CAC did not. Thus, the Agatston method of up-weighting calcium scores for greater density, in CVD risk prediction, may be inappropriate for the aorta and coronary arteries.
Abstract P231: Electrocardiographic Versus Echocardiographic Left Ventricular Hypertrophy as a Predictor of Cardiovascular Disease Events in the General Population
Authors: Leigh John A , O’Neal Wesley T , Soliman Elsayed Z
Published: March 2022

Introduction:
It is uncertain whether left ventricular hypertrophy (LVH) detected by the electrocardiogram (ECG) is able to be used as an alternative to LVH detected by imaging in population studies.

Aim:
We compared the risk of cardiovascular disease (CVD) associated with LVH as measured by Minnesota ECG classification (ECG-LVH), the most common ECG classification in population studies, with LVH detected by echocardiography, the most common tool to estimate left ventricular mass in clinical practice.

Methods:
This analysis included 4,076 participants (41% male, 86% white), aged 65 years or older from the Cardiovascular Health Study who were free of CVD at the time of enrollment. ECG-LVH was defined by the Minnesota ECG Classification criteria from baseline ECG data that were read centrally. Echocardiographic LVH (echo-LVH) was defined as left ventricular mass >95th percentile using sex-specific cut-points.

Results:
ECG-LVH was detected in 144 (3.5%) participants and echo-LVH in 199 (4.9%) participants. Over a mean follow-up of 10.6 years, a total of 2,274 CVD events occurred. In a multivariate Cox regression analysis adjusted for age, sex, race, education, income, body mass index, HDL-cholesterol, total-cholesterol, smoking status, systolic blood pressure, diabetes, aspirin and blood pressure lowering drugs, the risk of CVD events associated with ECG-LVH (HR=1.84, 95% CI=1.51, 2.24) was higher than that associated with echo-LVH (HR=1.35, 95% CI 1.12, 1.62). The association between ECG-LVH and CVD events was not substantively altered with further adjustment for echo-LVH (HR=1.81, 95% CI=1.49, 2.21).

Conclusion:
The association of ECG-LVH with CVD events is not dependent on echo-LVH and provides additional support to the concept that ECG-LVH is an electrophysiologic marker with predictive properties independent of left ventricular anatomy.
Abstract P285: Adherence to the Mediterranean Diet is Associated with Longer Telomere Length in Patients with Coronary Artery Disease
Authors: Pimple Pratik M , Wilmot Kobina , Al Mheid Ibhar , Zhao Jinying , Lin Jue , Blackburn Elizabeth , Rooks Cherie , Goetz Margarethe , Sun Yan , Bremner J. Douglas , Quyyumi Arshed A , Vaccarino Viola
Published: March 2022

Introduction:
The Mediterranean diet pattern has been consistently shown to be beneficial for cardiovascular health in both observation studies and intervention trials. Fruits, vegetables, olive oil and nuts, key components of the Mediterranean diet, have antioxidant and anti-inflammatory properties known to affect biological aging. Leukocyte telomere length (LTL) is a marker of biological aging, and shorter LTL has been associated with CVD and its risk factors. Adherence to the Mediterranean diet has been linked to longer LTL in a community sample, but whether this is also true among patients with established coronary artery disease (CAD) is not known.

Methods:
Diet was assessed using the Block 2005 food-frequency questionnaire in 270 subjects with pre-existing CAD. A Mediterranean diet score (MDS) ranging from 0 to 8 was calculated using established methodology; a higher score indicates greater adherence to Mediterranean diet. The score was divided into 3 categories: low MDS (score ≤ 2), moderate MDS (score 3-5) and high MDS (score ≥ 6). LTL was measured by quantitative PCR. The association between MDS and LTL was assessed using linear regression models.

Results:
Mean age was 64 years (SD: 9), 55 (20%) were females and 181 (67%) were whites. After adjusting for age, sex, race, CAD risk factors, and total calorie intake, there was a graded association between MDS categories and LTL. Compared with patients in the low MDS category, those in the moderate MDS category had 0.05 units longer LTL (0.84 vs. 0.79, 95% CI: 0.01, 0.09), and those in the high MDS category had 0.06 units longer LTL (0.85 vs. 0.79, 95% CI: 0.02, 0.10), p for trend = 0.01 (Figure 1).

Conclusion:
Among subjects with pre-existing CAD, adherence to the Mediterranean diet pattern is associated with longer telomere length. In our sample, patients with at least moderate adherence to the Mediterranean diet were biologically about 10 year younger than their chronological age compared with those in the low MDS category.
Abstract P295: Association of Intermuscular Fat Density with Hyperinsulinemia and Insulin Resistance
Authors: Miljkovic Iva , Kuipers Allison , Carr J Jeffrey , Terry James G , Nair Sangeeta , Ge Yaorong , Cvejkus Ryan , Tilves Curtis , Bunker Clareann , Patrick Alan , Zmuda Joseph
Published: March 2022

Background:
Emerging evidence indicates that ectopic fat, such as that in the visceral depot or muscle fat infiltration, may be associated with diabetes, independent of general obesity.Very little is known about the health effects of fat density, an emerging novel indicator of fat quality. Existing studies have focused on visceral or pericardial fat density. There is currently no information on muscle fat density and its associations with diabetes or other cardio-metabolic disorders.

Methods:
The aim of this preliminary study was to investigate whether visceral (VAT) or intermuscular (IMAT) adipose tissue density was associated with measures of glucose and insulin homeostasis independent of fat depot volume. We hypothesized that adipose tissue characterized by higher density would be associated with lower glucose and insulin fasting serum levels, and lower homeostasis model assessment of insulin resistance (HOMA-IR). Adipose tissue volume (cm3) and density (Hounsfield units) were measured in the abdomen and thigh from computed tomography scans in 193 non-diabetic black men aged 50 to 87 years (mean age 61 years, mean BMI 27 kg/m2). All measures were transformed to normal distribution and partial Pearson correlation coefficients were calculated.

Results:
In models adjusted for age and corresponding fat volume, thigh IMAT density and abdominal paraspinal IMAT density were inversely associated with fasting insulin (=-0.15 and r=-0.16, respectively; both p<0.05) and HOMA-IR (r=-0.18 and r=-0.19, respectively; both p<0.05). These associations were only slightly attenuated after additional adjustment for BMI (p for all <0.07). In contrast, VAT density was not associated with fasting insulin or HOMA-IR after adjustment for VAT volume or BMI. No fat density measure was associated with fasting serum glucose in any model.

Conclusion:
We found a novel correlation between lower intermuscular fat density and hyperinsulinemia and insulin resistance among non-diabetic black men. These results suggest that muscle fat quality may be a novel predictor of diabetic risk even independent of overall and ectopic fat volume.
Abstract 06: Body Mass Index Growth Trajectories During Childhood and Adult Obesity Risk
Authors: Zhang Tao , Xi Bo , Li Chunhong , Bazzano Lydia , He Jiang , Whelton Paul , Chen Wei , Li Shengxu
Published: March 2022

Background:
Obesity measures track from childhood to adulthood. However, information is limited regarding the relationship between body mass index (BMI) growth trajectories during childhood and adult obesity risk. We hypothesize that BMI growth rates at different childhood age windows have influences on adult obesity, independent of absolute BMI values.

Methods:
The longitudinal study cohort consisted of 2,732 adults (1,772 whites and 960 blacks; 1,226 males) who had BMI measured at least 4 times from childhood (4-19 years) to adulthood (20-51 years). A random-effects mixed model was used to construct growth curves of BMI from childhood to adulthood in race-sex groups. Model-estimated linear growth rates (kg/m
2
/year) in BMI at different childhood ages, calculated by using the first derivatives of the growth curves, were linked to adult obesity (BMI>=30) in multivariable regression models, adjusted for adult age, race, sex, adult smoking and alcohol drinking, and childhood BMI levels.

Results:
BMI from childhood to adulthood fit cubic growth curves; linear and nonlinear curve parameters differed significantly between race-sex groups. BMI levels showed race and sex differences from age 15 years onwards. Obese adults had significantly higher BMI levels than non-obese adults from childhood to adulthood. Differences in linear and nonlinear slope parameters of BMI between obese and non-obese groups were all significant (p<0.001). The association patterns of childhood BMI growth trajectories with adult obesity were similar in all race-sex groups. In the total sample, the association between childhood BMI growth rate and adult obesity was peaked at age 17 (odds ratio=5.7 and 95% confidence interval=4.7-6.8) as shown in the figure.

Conclusions:
These observations indicate that adult obesity originates in early life with different longitudinal BMI trajectory profiles. Puberty is a crucial period for the development of obesity in later life, which has implications for obesity prevention beginning in childhood.
Abstract 19: State-level Disparities in Health Loss Due to Cardiovascular Causes: Results of the Global Burden of Disease 2015 Study
Authors: Roth Gregory A , Johnson Catherine O , Kassebaum Nicholas J , Mokdad Ali H , Naghavi Mohsen , Vos Theo
Published: March 2022

Introduction:
Reducing cardiovascular (CVD) health disparities is a major policy goal in the United States but comprehensive and comparable estimates of CVD disease burden do not exist. The GBD2015 study developed a method to estimate disability-adjusted life-years (DALYs) lost to CVD for each state.

Hypothesis:
We assessed the hypothesis that health loss due to CVD is no longer declining in the United States.

Methods:
We used death certificates, health surveys, commercial databases, and published literature to estimate CVD death rate and prevalence. Our analyses corrected for use of non-specific causes of death, readmission rates, and variation in the use of ICD codes. Models were run separately by age, sex, state, cause, and year. Disability weights were derived from large-scale surveys of the public. Uncertainty intervals (UI) were estimated using 1000 draws from the posterior distribution of each model.

Results:
In the U.S. in 2015, 13.63 million DALYs were lost due to CVD (95% UI 13.1-14.2), which accounted for 15.4% (95% UI 14.1-16.9%) of total DALYs for the United States. From 1990-2015, the annualized rate of change for CVD DALYs (per 100,000 persons) was -1.2%, but for 2010-2015, this rate was 0.5%. The smallest annualized rate of change for CVD DALYs (per 100,000, age-standardized) from 1990-2015 was observed in Oklahoma (-1.1%) while the largest change was in New York (-2.6%). For only 2010-2015, this rate declined in most states but increased in Idaho, Indiana, Mississippi, and Maine by 0.02-0.47%. Ischemic heart disease was the predominant cause of health loss for all states.

Conclusions:
The decline in CVD burden has slowed in all states, with rates rising in several states. Further efforts are needed to understand state-level factors influence changing rates of CVD burden.
Abstract 24: Childhood Risk Factor Patterns Predict Adult Type 2 Diabetes Better Than Single Childhood Risk Factor Measures: The International Childhood Cardiovascular Cohort (i3C) Consortium
Authors: Hu Tian , Sinaiko Alan , Urbina Elaine , Raitakari Olli , Woo Jessica , Bazzano Lydia , Steinberger Julia , Burns Trudy , Juonala Markus , Venn Alison , Daniels Stephen , Prineas Ronald , Dwyer Terence , Magnussen Costan , Jacobs David
Published: March 2022

Background:
Childhood risk factors predict adult onset type 2 diabetes mellitus (T2DM). We developed a novel statistical approach using risk factor patterns to improve prediction.

Methods:
The cohort included 5269 individuals from the Bogalusa Heart Study, Cardiovascular Risk in Young Finns Study, Childhood Determinants of Adult Health Study, Childhood Cohort Studies in Minneapolis and Cincinnati, and the Muscatine Study. All had 2+ childhood measures of risk factors between ages 3 and 20 in 1970s-90s and reported whether they had T2DM between ages 21 and 63 in 2011-16. We established sex-specific polynomial age patterns to represent standard growth curves for each risk factor and computed the residual from this standard for each observation within ages 3-20. Residuals were regressed on age within each person to get a personal intercept and slope, and then 9 patterns were formed as intercept tertiles crossed with slope tertiles within each intercept tertile. T2DM associations with risk factors were assessed by using either the first childhood measurement or childhood patterns of body mass index (BMI), systolic blood pressure (SBP), and height (HT), with covariates age at first visit, sex, race, and study.

Results:
Mean age at first measure was 9.2 (SD 3.3) y, 41% male, 85% white, 12% black, with 2-19 repeats of childhood risk factor measures. Risk factor patterns tended to diverge from each other by mid-childhood and measured adult risk factor values were well predicted, diverging widely across the childhood patterns (not shown). After mean follow-up of 29.0 (SD 8.1) y, 282 (5.4%) participants self-reported T2DM. T2DM was predicted by the model including first measures of BMI (positive), SBP (positive), and HT (inverse), but the corresponding pattern model improved prediction probability by 55% (Table).

Conclusion:
These findings show the value of using multiple risk factor measurements during childhood and the potential for developing risk factor pattern charts to be used as clinical standards for predicting adult T2DM risk.
Abstract 32: Racial Differences in Cardiorespiratory Fitness Between African and Caucasian Americans: A Meta-analysis
Authors: Swift Damon L , Nevels Tyara R , Landrine Hope , Lavie Carl J , Newton Robert L , Das Bhibha M , Vos Paul , Houmard Joseph A
Published: March 2022

Introduction:
Cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular disease (CVD). Recent data suggests that African Americans (AA) have reduced levels of CRF compared to Caucasian Americans (CA). However, this viewpoint has not been widely accepted and it is unclear whether racial differences in CRF may be of a large enough magnitude to increase the risk of CVD.

Methods:
A literature review was conducted for studies comparing CRF levels between AA and CA adults. Studies were eligible for inclusion if CRF was assessed by an exercise test (submaximal or maximal), CRF was compared between AA and CA adults, examined an adult study population, and was published in a peer-reviewed journal. Potential studies were excluded if the sample included children or adolescents, the sample size was less than 15 participants in each racial group, or the study evaluated participants who had significant health conditions. Meta-analyses were performed comparing CRF between AAs and CAs in two analyses: 1) all studies compared using metabolic equivalents (METs) and 2) restricted only to studies that quantified CRF by directing measuring maximal oxygen consumption (considered the gold standard). Both fixed effects and random effects models were fit to these data. Because of the heterogeneity only results from the random effects models are reported. Analyses were performed using R (version 3.1, R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/) and the rmeta package (version 2.6).

Results:
There were 27 studies (n=131,084) that that met the criteria for the meta-analysis (23 studies excluded). In both the analyses for METs (27 studies, Summary effect: 0.91, CI: 0.8 to 1.0) and directly measured VO
2
max (16 studies, Summary effect: 3.2, CI: 2.1 to 4.3) as the criteria for CRF, AA had lower fitness compared to CA adults.

Conclusions:
The present study suggests that AAs have lower CRF compared to CAs based on epidemiological studies and clinical trials whether directly measured using indirect calorimetry or maximal METs estimated from exercise testing. A difference of 0.91 METs is associated with ~13.7% higher risk of CVD based on previous epidemiological data. Thus, lower CRF in AA adults may represent a health disparity risk factor and interventions to improve CRF in sedentary AAs may be warranted.
Abstract 45: Trends in Cardiovascular Disease (CVD) Risk Factor Screening and Counseling: Impact of the Affordable Care Act (ACA)
Authors: Pool Lindsay , Akhabue Ehimare , Carnethon Mercedes R
Published: March 2022

Introduction:
The Affordable Care Act (ACA), signed into law in 2010, was incrementally implemented by a series of reforms including an expansion of health insurance coverage and preventive services coverage without co-pay. It is not known whether CVD preventive services have increased as a result of enhanced healthcare access.

Hypothesis:
We hypothesized that CVD risk factor screening and counseling would increase among US adults over the period of ACA implementation, 2011-2015.

Methods:
The National Health Interview Survey is a telephone survey of a random sample of the US civilian noninstitutionalized population. Respondents (n=101,243) from survey years 2011, 2013, and 2015 were asked whether, in the past year, they had a screening test for blood pressure, cholesterol, and diabetes, and counseling about diet and smoking cessation from a health professional. We calculated annual percent change (APC) for each preventive service, using weighted constant-time Cox regression models, and examined whether findings were similar across demographic groups.

Results:
Health insurance coverage increased from 2011-2015, primarily among lower socioeconomic status (SES) individuals and younger adults. There were significant annual increases in the prevalence of screening and counseling for each CVD risk factor (Table). Increases were larger among lower SES groups for blood pressure and cholesterol screenings. Increases were larger among younger age groups for blood pressure, cholesterol, and diabetes screenings, but were larger among older, Medicare-eligible adults for diet counseling. There were no significant differences in APC increases by gender or race.

Conclusions:
CVD risk factor screening and counseling increased during ACA implementation. Differential increases across SES and age groups indicate improved access to care in populations that have been previously underserved. Outreach is needed to ensure newly insured persons are aware of covered CVD preventive services.
Abstract MP007: Higher Plasma Galectin-3 is Associated With Increased Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Fashanu Oluwaseun E , Norby Faye , Aguilar David , Ballantyne Christie , Hoogeveen Ron , Chen Lin Y , Soliman Elsayed Z , Alonso Alvaro , Folsom Aaron R
Published: March 2022

Background:
Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia associated with increased risk of cardiovascular sequelae, including heart failure (HF), stroke, and premature mortality. Galectin-3, a beta-galactoside binding lectin involved in important regulatory roles in adhesion, inflammation, immunity, and fibrosis, may be relevant to AF etiology. We tested the hypothesis that plasma galectin-3 concentration would be associated positively with the incidence of AF independent of traditional AF risk factors and incident HF and coronary heart disease (CHD) in a large community-based cohort in the US.

Methods:
Our analysis included 8,777 participants free of AF at visit 4 (1996-98) and with measures of plasma galectin-3 from the biracial Atherosclerosis Risk in Communities (ARIC) study. Incident AF was ascertained through the end of 2013 from study visit ECGs, hospitalizations and death certificates. Multivariable Cox proportional hazards models, adjusted for AF risk factors (Model 1) plus incident HF and CHD (Model 2), were used to estimate hazards ratios for the association between galectin-3 and incident AF.

Results:
The mean age (SD) of participants was 62.5 (5.6) years; 58.7% were women and 21.5% blacks. During a median follow-up of 15.7 years, 1,233 incident cases of AF were observed. After adjusting for AF risk factors, participants with galectin-3 levels greater than 19.5 ng/ml had a significantly higher risk of incident AF when compared to the referent group (4.4 - 11.9ng/ml), with hazard ratios of 1.44 for the 90
th
- 94.9
th
percentile, and 1.61 for the 95
th
- 100
th
percentile (p-trend = 0.0003). The association between galectin-3 concentration and incident AF was attenuated somewhat after accounting for incident CHD and HF as time dependent variables (p-trend=0.03) (Table 1).

Conclusion:
Elevated plasma galectin-3 is associated independently with increased risk of incident AF.
Abstract MP034: Muscle strength and Short-term Risk of Cardiovascular Outcomes in Community-dwelling Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Matsushita Kunihiro , Ding Ning , Ballew Shoshana H , Palta Priya , Schrack Jennifer A , Windham Beverly G , Coresh Josef
Published: March 2022

Background:
Muscle weakness has been shown to predict mortality in older adults. However, its contribution to different cardiovascular disease (CVD) subtypes is not well known.

Methods:
Among 5,484 participants (age 67-91 years) in the ARIC Study at visit 5 (2011-13), we quantified the associations of grip strength (measured by Jamar Hydraulic Hand Dynamometer) with the risk of coronary heart disease (CHD including myocardial infarction or coronary death), stroke, and heart failure (HF) using Cox models.

Results:
Over a median follow-up of 1.7 years, there were 119 cases of CHD, 47 cases of stroke, and 168 cases of HF. In crude models, the lowest sex-specific quartile of grip strength demonstrated significantly higher risk of CHD and HF compared to the highest quartile (Table). After accounting for potential confounders such as diabetes, body mass index, and blood pressure, the significant association was only observed for HF (HR 2.09 [95% CI 1.25-3.50] between the lowest vs. highest quartile).

Conclusion:
Weaker muscle strength was significantly associated with CVD risk in community-dwelling older adults, but its independent association was most evident for HF. Our results suggest the pathophysiological link between skeletal muscle function and HF as well as potential usefulness of grip strength to classify HF risk in older adults.