bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P301: Obesity and Mortality: the Jackson Heart Study
Authors: Min Yuan-I , Valle Karen A , Anugu Pramod , Gao Yan , Anugu Anshul , Norwood Arnita F , Correa Adolfo
Published: March 2019

Background:
Mortality has been reported to be lower among individuals classified as overweight/obese (based on body mass index (BMI, kg/m
2
)) when compared with their normal weight counterparts (“obesity paradox”). One possible reason for this apparent paradox is that BMI includes the weight of lean muscle and fat mass, both of which vary with age, sex, and race/ethnicity, and variations in these individual mass measures may not be reflected by the BMI. We compared associations between all-cause mortality and BMI and other obesity measures that may better reflect central adiposity, including waist circumference (WC, cm), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) in the Jackson Heart Study (JHS), a prospective cohort study of cardiovascular disease in African Americans.

Methods:
Data from 3,976 JHS participants (441 deaths) who attended Exam 2 (2005-2008) where various measures of obesity were collected, were analyzed. Cox regression models were used to evaluate the associations between obesity and all-cause mortality. “Time 0” for the survival analysis was the date of Exam 2 and the administrative censoring date was 12/31/2015. Obesity measures were analyzed as categories based on standard cut-points defining obesity and as quintiles. Covariates include age, sex and smoking. The predictive abilities of these obesity measures were assessed using c-index.

Results:
The age-sex-smoking adjusted mortality rates were the lowest among participants who were overweight (BMI 25-<30) or with class I obesity (BMI 30-<35). However, compared to normal weight participants (BMI 18.5-<25), only participants with class III obesity (BMI ≥40) had a significantly higher mortality (adjusted HR [aHR] 1.92 [95% CI 1.34-2.75]). In addition, higher mortality was associated with obesity defined by WC (>102 in men/>88 in women vs. ≤102 in men/≤88 in women; aHR 1.45 [1.16-1.82]) and by WHR (≥0.9 in men/≥0.85 in women vs. <0.9 in men/<0.85 in women; aHR 1.54 [1.21-1.95]); but not by BMI (≥30 vs. <25; aHR 1.04 [0.79-1.37]) or WHtR (≥0.5 vs. <0.5; aHR 1.03 [0.72-1.49]). Sex-stratified analyses suggest the stronger predictor for mortality was WC-defined obesity in men and WHR-defined obesity in women; however, test for interactions were not statistically significant. The associations were not found to vary by age (>65 vs. ≤65 years). Analyses using quintiles showed that the 5
th
quintiles were associated with a significant increase in mortality compared with the 1
st
quintiles for all obesity measures. The c-indexes were comparable for all obesity measures.

Conclusions:
The “obesity paradox” was suggested in the JHS based on BMI. However, only morbidly obese participants had a significantly higher mortality than normal weight participants. The recommended cut-points for defining obesity based on WC and WHR were significantly associated with increased mortality in this large cohort of African Americans.
Abstract P311: Testosterone Therapy and Risk of Venous Thromboembolism Among Men Without Hypogonadism
Authors: Walker Rob F , Zakai Neil A , MacLehose Richard F , Cowan Logan T , Alonso Alvaro , Lutsey Pamela L
Published: March 2019

Introduction:
Testosterone therapy (TT) prescriptions among men increased over 300% from 2001 to 2013 because of relaxed TT prescription guidelines for common symptoms (such as low libido and fat redistribution) associated with natural declines in testosterone as age increases. After concern about possible adverse cardiovascular effects from TT prompted a FDA warning in 2014, prescriptions of TT initially decreased and then plateaued. TT is often prescribed without clear clinical indication of a true hypogonadism diagnosis. TT may increase VTE risk through hematocrit levels which affect blood viscosity and platelet accumulation for up to 6 months. Previous studies regarding the association between TT and VTE are both limited and unclear.

Objective:
Using a case-crossover design, we assessed whether TT exposure increases the short-term risk of VTE. We also evaluated whether the association differed by age group.

Methods:
The case-crossover study included men diagnosed with VTE identified using validated algorithms from 2012 to 2016 in the U.S. MarketScan Commercial and Medicare Supplemental administrative database. After excluding participants with cancer and those with hypogonadism (for which TT is clinically indicated), we identified 36,251 male VTE patients with at least 1 year of follow-up prior to their diagnosis and evaluated whether they had a prescription for TT preceding their first VTE (0-6 months, ‘case period’ and 6-12 months ‘control period’). Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) of TT in the case period relative to the control period, after adjusting for number of hospitalizations per period. Associations were also evaluated separately in VTE patients <65 vs. 65+ years old.

Results:
Overall, 754 out of the 36,251 patients (2.1%) had at least 1 TT prescription during the 12 months prior to their VTE event. Of these, 588 were aged less than 65 years (78.0%) and 166 were aged 65+ years. Overall, use of TT did not vary substantially in the case period compared to the control period (OR: 1.19; 95% CI: 0.86, 1.64). However, the point estimate was slightly elevated for TT use (vs. no TT use) among men under 65 years old (OR: 1.31; 0.91, 1.89). For men aged 65+ the OR was 0.85 (95% CI: 0.42, 1.69).

Conclusions:
Overall TT was not associated with greater risk of VTE among this population of men without hypogonadism. However, when stratified by age sub-group there was some suggestion of a higher association of TT in younger men. This analysis suggests that TT overall is not a strong risk factor for VTE; however further studies are needed to determine if supraphysiologic TT doses especially those associated with polycythemia could increase VTE risk.
Abstract P320: Validation of Smartphone-Recorded Physical Activity for Predicting Cardiorespiratory Fitness
Authors: Eades Micah T , Juraschek Stephen P , Gervino Ernest V , Mukamal Kenneth J
Published: March 2019

Introduction:
While most smartphones can track physical activity, whether this readily available data is associated with clinically meaningful outcomes is unknown. We tested the hypothesis that smartphone-recorded physical activity is associated with cardiorespiratory fitness as measured by peak metabolic equivalents of task (METs) achieved on an exercise stress test.

Methods:
We recruited 51 Apple iPhone users from the Beth Israel Deaconess Cardiovascular Stress Testing Laboratory between September 2017 - June 2018. We securely downloaded iPhone activity episodes, or epochs, and calculated cumulative steps, distance, and duration; peak speed and duration; and average daily peaks for specific intervals preceding stress tests. Age, gender, height, weight, and METs were obtained from the medical record. In a 70% training set, we used linear regression to determine relationships between individual components of physical activity and METs and to derive a multivariable prediction algorithm for METs. We then tested the best performing algorithm (based on Akaike Information Criterion) in a 30% test set.

Results:
We collected over 1.1 million activity epochs with a median of 17,103 epochs per participant. Twenty participants were female, median age [interquartile range] was 67 [53, 71] years, and median time preceding stress test [range] was 535 [13, 1,147] days. Average daily peak speed at 180 days most strongly correlated with METs (R
2
=0.44, p<0.001), and correlation was similar at 3 days (R
2
=0.41, p<0.001). The best-fitting multivariable model included age, gender, height, weight, and average peak speed at 180 days.

Conclusion:
Smartphone-recorded physical activity is readily available and strongly associated with cardiorespiratory fitness, even in an external validation set.
Abstract P368: Impact of Subclinical Hypoglycemia on Mortality: Findings From the Third National Health and Nutrition Examination Survey
Authors: Chevli Parag A , Ahmad Muhammad I , Anees Muhammad A , Soliman Elsayed Z
Published: March 2019

Introduction:
Hypoglycemia has shown to be associated with increased risk of cardiovascular disease (CVD) events in diabetics. Although, very few studies have investigated incident CVD and all-cause mortality with regard to low fasting plasma glucose (FPG) in the population without diabetes.

Methods:
This analysis included 8497 participants (mean age=44 years, 53% women, 40% whites), free of CVD and diabetes at baseline, from the Third National Health and Nutrition Examination Survey (NHANES-III). Cox proportional hazards analysis, was used to report hazard ratio (HR) and 95% confidence interval (CI) for association of FPG categories (80-99 mg/dl (reference) <80 mg/dl, 100-125 mg/dl and ≥126 mg/dl) at baseline with CVD and all-cause mortality over the median follow-up of 14 years.

Results:
There were 570(6.7%) CVD and 2101(24.7%) all-cause deaths over the period of 14 years. Compared to referent category, in a model adjusted for age, sex, race, smoking, physical activity, systolic blood pressure, antihypertensive medications, body mass index and total cholesterol, low FPG was associated with significantly increased risk of CVD and all-cause mortality [HR(95% CI): 1.79(1.04-3.08) and 1.35(1.02-1.78) respectively]. This association was stronger among men than women for CVD mortality [HR(95%CI): 4.29(2.35-7.84) vs. 0.40(0.10-1.65) respectively; interaction p-value=0.0002] and all-cause mortality [HR(95%CI): 1.84(1.23-2.75) vs. 1.08(0.74-1.59), respectively; interaction p-value=0.02]. There was no significant association of impaired and diabetic range FPG with CVD mortality, but diabetic range FPG was significantly associated with increased risk of all-cause mortality [HR(95%CI): 1.25(1.04-1.51)].

Conclusion:
This analysis from a large, population-based survey revealed that subclinical hypoglycemia in non-diabetic individuals is a strong risk factor for CVD and all-cause mortality. Although, it is unknown whether avoiding hypoglycemia will reduce this risk.
Abstract P369: Coronary Heart Disease and Mortality Following a Breast Cancer Diagnosis
Authors: Guo Aixia , Zhang Kathleen , Foraker Randi
Published: March 2019

Background:
Coronary heart disease (CHD) is a leading cause of death for breast cancer survivors. While cardiotoxic breast cancer treatments are linked with cardiovascular injury and an increased risk of CHD, current risk prediction models for CHD do not consider the effect of cancer treatments and likely underestimate CHD and mortality risk in this population.

Methods:
We conducted support vector machine, decision tree, and logistic regression models on electronic health record data to evaluate the independent and joint effects of cardiovascular health (CVH) and cancer treatments on post-treatment CHD and all-cause mortality occurring within 10 years among 1934 women diagnosed with breast cancer in 2006 and 2007 at our medical center. CVH was classified as poor, intermediate, or ideal according to 5 factors: smoking, body mass index, blood pressure, glucose/hemoglobin A1c, and cholesterol. We considered anthracyclines and hormone therapies as cardiotoxic cancer treatments in these analyses.

Results:
Women with ideal CVH scores had a lower risk of CHD (23.7%) and death (14.3%) compared to those with poor CVH scores (61.9% for CHD, 32.5% for death). Women exposed to cancer treatments had a higher risk of CHD (58.9%) and death (37.5%) compared to women who were not exposed (29.1% for CHD, 15.4% for death). Meanwhile, the joint effects of poor CVH and receipt of cardiotoxic cancer treatments conferred a much higher risk of CHD (75.9%) and death (39.5%) compared to women with ideal CVH who did not receive treatments (20.8% for CHD, 11.2% for death). All approaches (
Figure 1
) demonstrated the highest area under the curve (AUC) for models considering the joint effects of CVH and cancer treatments (range: 0.70-0.75), followed by the independent effects of CVH (range: 0.65-0.66) and the independent effects of cancer treatments (range: 0.59-0.63).

Conclusions:
Cancer treatment data should be considered along with traditional cardiovascular risk factor data in the prediction of CHD and mortality among breast cancer survivors.
Abstract P371: Short-term Repeatability of the Peguero Electrocardiographic Index of Left Ventricular Hypertrophy
Authors: Drager Dominique N , Meyer Michelle L , Soliman Elsayed Z , Heiss Gerardo
Published: March 2019

Background:
Electrocardiographic left ventricular hypertrophy (ECG-LVH) represents preclinical cardiovascular disease and predicts cardiovascular disease and mortality. Current criteria include the Cornell voltage, Sokolow-Lyon, and the newly developed Peguero index (S
D
+ SV
4
). While the Peguero index has been shown to have better prognostic prediction compared with current criteria, its short term repeatability remains uncertain.

Objectives:
Characterize the repeatability and minimal detectable change of the Peguero ECG-LVH index.

Methods:
Participants (n=63; mean age 50 years; 31 females) underwent two standardized visits one week apart. At each visit, trained and certified technicians obtained two ECGs following a standardized protocol. The Epidemiological Cardiology Research Center automatically processed the ECGs using GE Marquette GE 12-SL software (GE, Milwaukee, WI) to obtain the Peguero (S
D
+ SV
4
) LHV index, defined as the deepest S wave in any single lead S
D
+ SV
4
. We created a dichotomous using the following cut points: >2.3 mV for women and >2.8 mV for men. Random effects, mixed models were used to parse the variance of the index into the between-participant, between-visit, and within-visit components. We then calculated the intra-class correlation coefficient (ICC), Kappa coefficients, and minimal detectable change (95% confidence) between repeat measures.

Results:
Between-participant variation accounted for 93.58% (262,958 out of 280,985 SD points) of the total variation of the Peguero LVH index, while between-visit variation and within-visit variation were 5.51% (15,480 out of 280,985 SD points) and 0.91% (2,547 out of 280,985 SD points), respectively. The index had an ICC (95% confidence interval) of 0.94 (0.91-0.97) and a minimum detectable change value of 372.16 mV. Within visit Kappas were 0.79 (0.40-1.00) for the first visit and 1.00 (1.00-1.00) for the second visit. Between visit Kappas were 0.77 (0.70-0.84) for the first measurements of each visit and 0.79 (0.72-0.86) for the second measurements of each visit.

Conclusion:
The Peguero LVH index shows excellent repeatability for both within and between visits. The ICC and resulting confidence interval of the continuous index suggests near perfect agreement between groups. The Kappa values also suggest concurrence between groups of the dichotomous index, although the measures are not as precise as the ICC measure. The repeatability of this measure can be used to inform clinical and epidemiological studies and expand research of this novel index of ECG-LVH.
Abstract P379: Atherosclerotic Abdominal Aortic Plaque and All-Cause Mortality: The Framingham Heart Study
Authors: Gona Philimon N , Jaffer Farouc A , Tsao Connie W , Qazi Saadia , O’Donnell Christopher J , Manning Warren J , Chuang Michael L
Published: March 2019

Introduction:
Atherosclerotic abdominal aortic plaque (AAP) is often seen incidentally on magnetic resonance (MR) scans. Prevalence and burden of AAP are associated with cardiovascular disease (CVD) risk factors, but the relationship between AAP and all-cause mortality (“Death”) is not well characterized. We sought to determine whether AAP predicts Death among community-dwelling adults initially without clinically overt CVD.

Methods:
318 Framingham Offspring cohort members (age 60±9 yrs, 51% women) underwent noncontrast abdominal MR at 1.5 Tesla in 1998-1999. Participants were recruited from equal strata of age, sex and quintile of Framingham Risk Score (FRS), with double sampling of the top quintile. MR used ECG-triggered black-blood T2W turbo spin-echo with 1.03 x 0.64 x 5-mm
3
voxels. AAP was hand-traced and comprised discrete protrusions of ≥1mm into the aortic lumen. Participants were stratified into three levels of AAP: zero (AAP0); then among those with nonzero-AAP, subdivided into below median (AAP1) and above median (AAP2). FRS was calculated for each participant (using age, sex, systolic blood pressure, total and HDL cholesterol, diabetes, smoking); A Cox proportional hazards model adjusted for standardized, log-transformed FRS (zFRS) was used to determine hazard ratio (HR) for Death with AAP0 as the referent. The log-rank test was used to compare event-free survival.

Results:
AAP by MR was present in 40.4% of women and 42.1% of men. Over a median 14.8 years of follow up, there were 52 Deaths (5 CVD, 22 cancer, 25 other causes). AAP2 had HR=2.08 (95% CI 1.07 - 4.08, p=0.03); AAP1 was HR=1.37 (CI=0.65 - 2.92, p=0.4). The figure shows the Kaplan-Meier plot for survival; log-rank p=0.034.

Conclusions:
Among adults initially free of clinically overt CVD, above median burden of AAP was associated with 2-fold greater hazard of all-cause mortality. Although the majority of deaths were not principally due to CVD, excess AAP was a predictor of mortality over nearly 15 year follow up.
Abstract P381: Sedentary Behavior and All-Cause Mortality: A Review ofSystematic Reviews With Meta-Analyses
Authors: Mills Andrew L , Lee Jessica , Sever Trent , Shay Christina M
Published: March 2019

Introduction:
Growing evidence suggests that higher levels of sedentary behavior (SB) are associated with higher risk of death. Multiple systematic reviews with meta-analyses (SRMA) have been published on this topic and synthesis of these results would have great utility in facilitating knowledge uptake.

Purpose:
The purpose of this project is to synthesize existing SRMAs in order to examine associations between SB and all-cause mortality.

Methods:
A systematic literature review was conducted by querying multiple electronic databases and hand-searching references. Inclusion criteria were SMRAs that reported associations in adults (18+ years old); examined SB as an exposure; included all-cause mortality as an outcome; and where sufficient results were available. Eligibility assessment and data extraction were done in duplicate by two independent reviewers. Discrepancies were solved by consensus. Descriptive characteristics, point estimates, confidence intervals and
I
2
were extracted from eligible studies.

Results:
A total of 676 records were initially identified. After exclusions based on title, abstract, and full-text assessments, 5 eligible meta-analyses were identified, which included results based on 3,575,480 adults. Among the 5 meta-analyses, the studies per meta-analysis ranged from 3 to 12 and sitting time and television viewing time were the types of sedentary behaviors assessed. Effect sizes (OR, RR, HR) in the identified reports ranged from 0.96 to 1.59 (Figure 1).

Conclusions:
This systematic review of meta-analyses indicates a consistent dose-response of effect sizes between level of SB and all-cause mortality. This emphasizes the importance of targeting SB as a way of improving CV and overall health.
Abstract P385: Cigarette Smoking and Incident Stroke in African Americans of the Jackson Heart Study
Authors: Oshunbade Adebamike A , Yimer Wondwosen K , Valle Karen A , Clark Donald , White Wendy B , Defilippis Andrew P , Blaha Michael J , Benjamin Emelia J , O’Brien Emily , Butler Javed , Correa Adolfo , Hall Michael E
Published: March 2019

Background:
African-Americans (AAs) are disproportionately affected more by stroke compared to whites, however less is known about the relationship between stroke and cigarette smoking, a modifiable risk factor, in AAs. Therefore, we evaluated the relationship between cigarette smoking and incident stroke in the Jackson Heart Study (JHS).

Methods and Results:
JHS participants without a history of stroke (n= 4894) were classified by self-reported baseline smoking status into current, past (smoked at least 400 cigarettes/life) or never smokers at baseline (2000-2004). Current smokers were further classified by smoking intensity [number of cigarettes smoked per day (1-10,10-19 and ≥20)] and followed for incident stroke (through 2014). Stroke events were adjudicated in the JHS. Hazard ratios for incident stroke for each smoking group compared to never smokers were estimated using the Cox proportional hazard regression models after adjusting for covariates. At baseline there were 633 (13.1%) current, 892 (18.4%) past and 3327 (68.6%) never smokers. During follow-up (11.8 median follow-up years), 201 participants developed incident stroke. After adjusting for age, sex, body mass index, hypertension, diabetes mellitus status, total cholesterol, triglycerides, prevalent cardiovascular disease, physical activity, aspirin, statin, and alcohol consumption in the past 12 months and level of education, the risk for stroke in current smokers was significantly higher compared to never smokers (HR 2.33, 95% CI 1.16-4.68) but there was no significant difference between past smokers and never smokers (HR 0.96, 95% CI 0.53-1.75).There was a dose-dependent increased risk of stroke with smoking intensity which was not statistically significant.

Conclusions:
In a large prospective cohort of AAs, current cigarette smoking was associated with incident stroke in adjusted models. These findings suggest that smoking cessation may have potential benefits in reducing the incidence of stroke in this population.
Abstract P387: Comparing Cardiovascular Outcomes Among Smokers and E-Cigarette Users: A Review From National Health Interview Surveys
Authors: Vindhyal Mohinder Reddy , Ndunda Paul , Munguti Cyrus , Vindhyal Shravani , Okut Hayrettin
Published: March 2019

Background:
In 2016 according to the center for disease control (CDC), 11.3% of high school students and 3.2% of US adults reported using electronic cigarettes (E-cigs) in the previous 30 days. E-cigs have been advertised as a safer alternative to smoking. However, E-cig use, like smoking, delivers ultra-small aerosol particles which may be associated with cardiovascular disease. E-cig users have shown similar endothelial dysfunction, aortic stiffness, platelet activation, aggregation, and adhesion as seen with smoking in animal models.

Methods:
The National Health Interview Survey (NHIS) a survey of people aged 18 years and older, is conducted by the U.S. Census Bureau using in-person interviews in a random sampling of U.S households is conducted by the CDC. This study is a cross-sectional analysis of the NHIS data of 2014 (n= 36,697), 2016 (n=33,028) and 2017(n= 26,742). The following outcomes were analyzed for e-cig users vs. non-users and smoker’s vs. non-smokers: myocardial infarction, hypertension, diabetes, depression/anxiety/emotional problems, circulatory problems, and stroke. For the outcomes, multiple logistic regression model was conducted to determine the covariate-adjusted odds ratio as well as to achieve the most appropriate p-value for the effects in the model. Variables such as age, BMI and sex were considered as covariates in multiple logistic regression models using SAS 9.4 software.

Results:
Compared with non-E-Cig-users, E-cigarette users had a lower mean age (32.9 vs 40.4 years) and similar BMI (28.1 vs 28.07). In multiple logistic regression analysis, E-Cig users had higher odds of having myocardial infarction [OR - 1.558, 95% CI (1.447, 1.678), P <0.0001], stroke [OR - 1.297, 95% CI (1.201, 1.400), P <0.0001], depression/anxiety/emotional problems [OR- 2.200, 95% CI (2.063, 2.347), P<0.0001] and circulatory problems [ OR - 1.436, 95% CI (1.251, 1.648), P < 0.0001]. E-cig users had lower odds of having diabetes. There was no significant difference between the two groups on the odds of hypertension [OR - 0.971, 95% CI (0.942, 1.001), P = 0.059] and. Smokers had higher odds of myocardial infarction [OR- 2.652, 95% CI (2.516, 2.796), P <0.0001], stroke [OR - 1.781, 95% CI (1.691, 1.875), P <0.0001], depression/anxiety/emotional problems [OR-1.694, 95% CI (1.598, 1.795), P<0.0001], circulatory problems [OR - 1.491, 95% CI (1.338,1.661), P < 0.0001], Hypertension [OR - 1.483, 95% CI (1.452, 1.513), P < 0.0001] and Diabetes [OR - 1.170, 95% CI (1.130, 1.211), P < 0.0001] compared with non-smokers.

Conclusion:
E-cig users have higher odds of myocardial infarction, stroke, depression/anxiety/emotional problems, circulatory problems (including blood clots) and lower risk of hypertension and diabetes compared to non-E-cigarette users. However, there is a need for cohort studies to establish the causation linkage for the cardiovascular outcomes described above.
Abstract P389: Smoking, Biomarkers and Ischemic Stroke Risk: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort
Authors: Conde Juan , Pistilli Maxwell , Plante Timothy , Zakai Neil , McClure Leslie , Olson Nels , Howard George , Cushman Mary
Published: March 2019

Introduction:
Identifying biological pathways that mediate the increased stroke risk in smokers may allow study of novel strategies to reduce risk. In the REGARDS study, we evaluated the association of smoking status with incident stroke and assessed biomarkers as mediators of smoking related stroke.

Methods:
30,239 black and white adults aged 45 and older were enrolled in 2003-7, and followed for incident stroke. Biomarkers were measured in a case cohort substudy and compared across groups of smoking status (never, former or current). Hazard ratios (HRs) of stroke by smoking status and by pack years were calculated using Cox proportional hazards models.

Results:
Among 1,224 participants with biomarker data (mean age 62, 50% male, 50% black) there were 531 incident stroke cases over 12.9 yrs maximal follow up. Compared to never smokers, the multivariable (age, race, sex and Framingham risk factors) adjusted HR of stroke in current smokers was 1.30 (95% CI 1.11, 1.53) and in former smokers was 1.18 (95% CI 1.05, 1.32). The association of pack years with stroke was substantial in current smokers and weak in former smokers in the adjusted model (Table). Among 7 biomarkers, white blood count, interleukin-6 (IL-6) and fibrinogen were higher in former and current smokers, and with increasing pack years in both groups (data not shown). The association of pack years with stroke in current smokers was partly attenuated with adjustment for IL-6, but not white count or fibrinogen. Among former smokers, white count fully attenuated the weak association.

Conclusions:
Former and current smoking, and pack years (primarily among current smokers) were stroke risk factors in a contemporary biracial cohort. Among both current and former smokers, smoking-related stroke risk was attenuated after adjustment for IL-6 and white count respectively, suggesting biological pathways for intervention.
Abstract P400: Household Salt Intake Level is Associated With All-Cause, Cardiovascular and Stroke Mortality: A 24-Year Follow-Up of Nippon Data80
Authors: Shima Azusa , Miyamatsu Naomi , Miura Katsuyuki , Miyagawa Naoko , Okuda Nagako , Nishi Nobuo , Yoshita Katsushi , Kadota Aya , Suzuki Harumitsu , Kondo Keiko , Okamura Tomonori , Okayama Akira , Ueshima Hirotsugu ,   NIPPON DATA80 Rsch Group
Published: March 2019

Background:
Dietary salt intake is associated with the risk of raised blood pressure and cardiovascular diseases (CVD). In Asian countries, a major source of salt intake is seasoning or table salt from cooking at home. However, little is known about the relationship between salt intake level of the entire household and CVD mortality risk.

Objective:
We aimed to investigate the relationship between household salt level and mortality from all-causes, CVD, stroke and subtypes of stroke in a 24-year follow-up study of a Japanese representative population (NIPPON DATA80).

Methods:
NIPPON DATA80 is a cohort study based on the National Nutrition Survey and the National Survey on Circulatory Disorders conducted by Japanese government in 1980. A total of 8,702 individuals (56% women) who were living with someone such as family were included in this analysis. Participants were 30-79 years old and none had a history of myocardial infarction or stroke. Household salt level was evaluated as the amount of salt consumption (g) per 1000 kcal of total energy intake in each household. The amount of salt consumption and total energy intake were evaluated using 3-day weighed food records at baseline. We used Cox proportional hazards models to evaluate the effect of household salt level for each mortality. Multivariable-adjusted hazard ratios (HRs) and confidence intervals (CIs) for a salt increment of 2g/1000 kcal (1 standard deviation) were calculated after adjusting for sex, age, body mass index, smoking status, drinking status, daily physical activity level, household-based potassium, household-based saturated fatty acid and household-based long-chain n-3 polyunsaturated fatty acid.

Results:
In 186,186 person-years of follow-up, there were 27.1% (2360 of 8702) deaths, among which CVD were 787 (9.0%), and stroke were 361 (4.1%). Household salt level was 6.25 (±2.02) mg/1000 kcal. Multivariable-adjusted HRs for a 2g/1000 kcal increment in household salt level were 1.07 (1.02-1.11) for all-causes mortality, 1.11 (1.03-1.19) for CVD mortality and 1.12 (1.00-1.25) for stroke mortality. In the analysis for subtypes of stroke, the relative risk of mortality from cerebral hemorrhage was significantly increased (p for trend = 0.024); the HR (95%CI) for a 2g/1000 kcal increment of household salt level was 1.28 (1.03-1.59). However, the association for mortality from cerebral infarction was not significant (HR 1.05; 95% CI 0.91-1.22).

Conclusion:
Household salt level was associated with long-term risk of all-cause, CVD and stroke mortality in a representative population of Japanese men and women. The association was stronger for mortality risk from cerebral hemorrhage.
Abstract P405: Racial Disparities in Ischemic and Hemorrhagic Post-stroke Mortality in United States Veterans
Authors: Tarko Laura , Ho Yuk-Lam , Costa Lauren , Gagnon David R , Demissie Serkalem , Seshadri Sudha , Djousse Luc , Cho Kelly , Wilson Peter W , Aparicio Hugo J
Published: March 2019

Introduction:
Blacks and Hispanics have been shown to have higher stroke mortality than non-Hispanic whites. However, this may be due to higher incidence of strokes in blacks and Hispanics. Fewer studies have investigated health disparities in post-stroke mortality stratified by stroke type. We studied risk of mortality by race/ethnicity after either incident acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in a national sample of patients from the Veteran’s Health Administration (VHA).

Methods:
We included patients with a first occurrence of an inpatient AIS or ICH in a VHA hospital between 2002-2007. We categorized patients as non-Hispanic white, non-Hispanic black, or Hispanic. Veterans with any prior stroke-related code were excluded. For each of AIS and ICH, we constructed a piecewise multivariate survival model for post event all-cause mortality. We separated follow-up intervals into <30 day, 30-90 day, 90 day-1 year, and >1 year post admission.

Results:
We identified 36,569 patients with an incident stroke in 2002-2007 (91% AIS, 9% ICH). The proportion of white, black, and Hispanic patients with AIS was 68%, 26%, and 6% respectively; and in ICH was 63%, 27%, and 10%. Compared to whites, blacks had better survival for AIS in the first 30 days, while Hispanics tended to have better survival in the 30-90 day and >1 year intervals. With ICH, blacks had higher mortality in the first 30 days. (Table 1)

Conclusion:
Blacks experience better 30-day survival after AIS compared to whites, but worse 30-day survival after ICH. This may be driven by higher prevalence of hypertension in blacks leading to small vessel occlusion, which is associated with lower mortality, or poorer control of blood pressure in the setting of ICH, which is associated with higher mortality. Hispanic patients may have better long-term survival after stroke compared to whites, a ‘Hispanic paradox’ that has been shown in other studies. Stroke events should be stratified by ischemic and hemorrhagic type when evaluating for racial disparities in outcomes.
Abstract P413: Association Between High Sensitivity Troponin T and N-Terminal Pro B-Type Natriuretic Peptide and Fall Risk in Older Adult Participants of the Atherosclerosis Risk in Communities Study (ARIC)
Authors: Juraschek Stephen P , Daya Natalie , Appel Lawrence J , Miller Edgar R , Matsushita Kunihiro , Michos Erin D , Windham Beverly G , Ballantyne Christie M , Selvin Elizabeth
Published: March 2019

Background:
Many health practitioners worry that treating cardiovascular disease (CVD) risk factors (e.g. blood pressure) could contribute to falls in older adults. While prior CVD is a known risk factor for falls, it is unknown whether subclinical measures of myocardial injury and wall stress are related to falls among older adults without known CVD.

Hypothesis:
Markers of subclinical CVD, i.e. high sensitivity troponin T (hs-cTNT) and N-terminal pro b-type natriuretic peptide (NT-proBNP), are associated with new falls among older adults without known CVD.

Methods:
We examined the prospective association between hs-cTNT and NT-proBNP assessed at visit 5 (2011-2013) in ARIC participants who did not have a history of coronary heart disease, stroke, or heart failure. Falls were identified from hospital discharge ICD-9 codes or CMS claims. We determined fall incidence rates across the following categories approximating quartiles of hs-cTNT (<8, 8-10, 11-16, ≥17 ng/L) and NT-proBNP (<75, 75-124, 125-274, ≥275 pg/mL) via Poisson models adjusted for age, sex, and race. The relative risk between markers and fall risk was modelled via Cox models adjusted for demographic characteristics and fall risk factors.

Results:
In 4,303 participants (mean age 76 ± 5 yrs, 63% women, 24% black), there were 429 new falls during a median follow-up of 4.5 years. Incidence rates across categories of hs-cTNT were 10.9, 16.0, 18.9, and 26.5 per 1,000 person-years; and incidence rates across categories of NT-proBNP were 8.1, 15.6, 21.5, and 33.0 per 1,000 person-years. Hs-cTNT ≥17 vs <8 ng/L was significantly associated with a higher risk of falls (adjusted HR 2.22, 95%CI 1.56-3.18). Similarly, NT-proBNP ≥275 vs <75 pg/mL was significantly associated with a higher risk of falls (2.46; 1.72-3.51). Associations with fall risk were curvilinear for both markers (
Figure
).

Conclusions:
Subclinical CVD was associated with risk of falls in older adults. Further research is needed to delineate mechanisms by which subclinical CVD might contribute to falls.
Abstract P422: Accelerometer-Determined Sedentary Time and Physical Activity Across Employment Status Categories in CARDIA
Authors: Quinn Tyler D , Pettee Gabriel Kelley , Siddique Juned , Aaby David , Whitaker Kara , Lane-Cordova Abbi , Sidney Steve , Sternfield Barbara , Barone Gibbs Bethany
Published: March 2019

Prolonged sedentary behavior and insufficient physical activity is a common activity profile, especially in modern workplaces. Describing activity profiles by employment status groups could identify target populations for sedentary and activity intervention.

Methods:
This cross-sectional analysis of Year 20 CARDIA data (2005-6), included participants who had valid accelerometry data (≥4 days with ≥10 hours), reported occupational status, and were not currently a student (n=2,068). Uniaxial accelerometry data (ActiGraph 7164) were expressed in 60 second epochs and summarized as: average counts per minute (cpm) and time spent (min/day) in prolonged sedentary behavior (≥30 continuous minutes, SED
≥30
), less than 30-minute bouts of sedentary behavior of (SED
<30
), light physical activity (LPA), less than 10-minute bouts of moderate-to-vigorous physical activity of (MVPA
<10
), and bouted MVPA (≥10 minutes, MVPA
≥10
) using Freedson cutpoints. Employment status was self-reported as full-time, part-time, unemployed/looking for work, keeping house, or raising children. Omnibus group differences were analyzed using ANCOVA adjusted for sex, race, age, education, wear time, center, and BMI. Least square means of activity time across groups were calculated and standardized to population average wear time (14.8 hours).

Results:
Figure 1 shows activity profiles of employment groups rank ordered by cpm. Cpm and most types of activity differed modestly but significantly across employment groups, except for MVPA
≥10
. Unemployed participants had the highest cpm, the most MVPA
≥10
and SED
≥30
, but the least SED
<30
. Participants working part-time had the most MVPA
<10
. Full-time workers had the least LPA. Those raising children had the least SED
≥30
and MVPA
≥10
, but the most LPA. Participants keeping house had the least cpm and MVPA
<10
.

Conclusions:
Public health intervention programing could consider differences in activity profiles across employment status groups.
Abstract P424: Worksite Food Purchases Are Associated With Employees’ Overall Dietary Intake and Health
Authors: McCurley Jessica L , Levy Douglas E , Rimm Eric B , Anderson Emma M , Sanford Jenny M , Gelsomin Emily D , Thorndike Anne N
Published: March 2019

Introduction:
Most Americans spend half their waking hours at work. We hypothesized that the healthfulness of worksite food purchases was associated with employees’ overall dietary intake and cardiometabolic health.

Methods:
Participants were 602 hospital employees who regularly used worksite cafeterias and enrolled in a worksite nutrition study in 2016-18. All hospital cafeterias used traffic-light labels (green = healthy, yellow = less healthy, red = unhealthy). We calculated the proportion of participants’ green- and red-labeled items purchased during a 3 month baseline period. Participants completed 2 online Automated Self-Administered 24-hour dietary recalls used to calculate a baseline Healthy Eating Index (HEI) score (range 0-100, higher = healthier diet). Additional baseline measures included BMI, blood pressure (BP), and HbA1c. Hypertension (HTN) and prediabetes/diabetes (pre-DM/DM) diagnoses were determined by self-report and/or medication use and/or baseline measures (HTN: systolic BP ≥ 150 mmHg or diastolic BP ≥ 90 mmHg; pre-DM/DM: Hb A1c ≥ 5.7). Linear and logistic regression analyses examined differences in HEI scores and cardiometabolic variables by tertiles of green- or red-labeled purchases, adjusting for age, sex, race, ethnicity, education, and number of purchases.

Results:
Mean age of participants was 43.6 yrs; 79% (N=478) were female and 81% (N=488) white. Mean BMI was 28.3 kg/m
2
(SD: 6.5), 63% (N=377) were overweight/obese, 21% (N=124) had HTN, and 27% (N=160) had pre-DM/DM. Mean number of items purchased during the observation period was 112 (SD: 21); mean baseline HEI score was 60.4 (SD: 12.5). The table shows that proportions of green and red items purchased were associated with diet quality (HEI score) and cardiometabolic risk (BMI, HTN, DM).

Conclusions:
Food purchases at work were associated with employees’ overall diet quality and cardiometabolic risk factors. Results suggest that interventions to promote healthier worksite food choices have potential to impact overall health.
β
2
-Adrenergic Stimulation Compartmentalizes β
1
Signaling Into Nanoscale Local Domains by Targeting the C-Terminus of β
1
-Adrenoceptors
Authors: Yang Hua-Qian , Wang Li-Peng , Gong Yun-Yun , Fan Xue-Xin , Zhu Si-Yu , Wang Xiao-Ting , Wang Yu-Pu , Li Lin-Lin , Xing Xin , Liu Xiao-Xiao , Ji Guang-Shen , Hou TingTing , Zhang Yan , Xiao Rui-Ping , Wang Shi-Qiang
Published: March 2019

Rationale:

βARs (β-adrenergic receptors) are prototypical GPCRs (G protein–coupled receptors) that play a pivotal role in sympathetic regulation. In heart cells, β
1
AR signaling mediates a global response, including both
l
-type Ca
2+
channels in the sarcolemma/T tubules and RyRs (ryanodine receptors) in the SR (sarcoplasmic reticulum). In contrast, β
2
AR mediates local signaling with little effect on the function of SR proteins.

Objective:

To investigate the signaling relationship between β
1
ARs and β
2
ARs.

Method and Results:

Using whole-cell patch-clamp analyses combined with confocal Ca
2+
imaging, we found that the activation of compartmentalized β
2
AR signaling was able to convert the β
1
AR signaling from global to local mode, preventing β
1
ARs from phosphorylating RyRs that were only nanometers away from sarcolemma/T tubules. This offside compartmentalization was eliminated by selective inhibition of β
2
AR, GRK2 (GPCR kinase-2), βarr1 (β-arrestin-1), and phosphodiesterase-4. A knockin rat model harboring mutations of the last 3 serine residues of the β
1
AR C terminus, a component of the putative βarr1 binding site and GRK2 phosphorylation site, eliminated the offside compartmentalization conferred by β
2
AR activation.

Conclusions:

β
2
AR stimulation compartmentalizes β
1
AR signaling into nanoscale local domains in a phosphodiesterase-4–dependent manner by targeting the C terminus of β
1
ARs. This finding reveals a fundamental negative feed-forward mechanism that serves to avoid the cytotoxicity of circulating catecholamine and to sharpen the transient β
1
AR response of sympathetic excitation.
“Worth the Walk”: Culturally Tailored Stroke Risk Factor Reduction Intervention in Community Senior Centers
Authors: Menkin Josephine A. , McCreath Heather E. , Song Sarah Y. , Carrillo Carmen A. , Reyes Carmen E. , Trejo Laura , Choi Sarah E. , Willis Phyllis , Jimenez Elizabeth , Ma Sina , Chang Emiley , Liu Honghu , Kwon Ivy , Kotick John , Sarkisian Catherine A.
Published: March 2019

Background

Racial/ethnic minority older adults have worse stroke burden than non‐Hispanic white and younger counterparts. Our academic‐community partner team tested a culturally tailored 1‐month (8‐session) intervention to increase walking and stroke knowledge among Latino, Korean, Chinese, and black seniors.

Methods and Results

We conducted a randomized wait‐list controlled trial of 233 adults aged 60 years and older, with a history of hypertension, recruited from senior centers. Outcomes were measured at baseline (T0), immediately after the 1‐month intervention (T1), and 2 months later (T2). The primary outcome was pedometer‐measured change in steps. Secondary outcomes included stroke knowledge (eg, intention to call 911 for stroke symptoms) and other self‐reported and clinical measures of health. Mean age of participants was 74 years; 90% completed T2. Intervention participants had better daily walking change scores than control participants at T1 (489 versus −398 steps; mean difference in change=887; 97.5% CI, 137–1636), but not T2 after adjusting for multiple comparisons (233 versus −714; mean difference in change=947; 97.5% CI, −108 to 2002). The intervention increased the percent of stroke symptoms for which participants would call 911 (from 49% to 68%); the control group did not change (mean difference in change T0–T1=22%; 99.9% CI, 9–34%). This effect persisted at T2. The intervention did not affect measures of health (eg, blood pressure).

Conclusions

This community‐partnered intervention did not succeed in increasing and sustaining meaningful improvements in walking levels among minority seniors, but it caused large, sustained improvements in stroke preparedness.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
02181062.
Taxonomy, ecology and analysis of type material of some small Encyonopsis with description of new species in Ireland
Authors: KENNEDY BRYAN , BUCKLEY YVONNE , ALLOTT NORMAN
Published: March 2019

The Encyonopsis microcephala-complex occurs in oligo-mesotrophic freshwaters and is often abundant in the periphyton of low nutrient lakes of high conservation value. It is globally distributed and increasing in apparent diversity with the discovery of additional species. To better differentiate this taxonomic aggregate, we re-examined the original type material of E. alpina, E. angusta and E. tavirana with light (LM) and scanning electron (SEM) microscopy. We investigated the morphology, ultrastructure and ecology of Encyonopsis populations from Ireland, which included previously unreported taxa and morphodemes of E. krammeri, E. neerlandica and E. subminuta. The apparently cosmopolitan E. microcephala was not found in collections from Ireland but two new species were described and compared to others in the complex. Encyonopsis carraensis sp. nov. was associated with a marl-precipitating community in low nutrient lakes, while Encyonopsis hibernica sp. nov. occurred in more productive waterbodies. Several Encyonopsis species had environmental optima near the oligo-mesotrophic boundary characteristic of the microcephala-complex. However, the niches of others were distributed along a wider gradient of water quality. Therefore, when Encyonopsis populations are prevalent in epilithic communities, the use of a more refined taxonomy is recommended for lake ecological assessment.
Molecular phylogeny of some genera of Pamphagidae (Acridoidea, Orthoptera) from China based on mitochondrial 16S rDNA sequences
Authors: ZHANG DAO-CHUAN , LI XIN-JIANG , WANG WEN-QIANG , YIN HONG , YIN ZHAN , YIN XIANG-CHU
Published: March 2019

Based on the mitochondrial 16S ribosomal DNA partial sequences (473 bp) of 9 species of Pamphagidae (Acridoidea, Orthoptera) from China and of 4 species of Pamphagidae and 2 species of Pyrgomorphidae and Acrididae (as outgroups) retrieved from GenBank, we constructed the molecular phylogeny using the Neighbor Joining (NJ) and Minimum Evolution (ME) methods based on the nucleotide Kimura 2-parameter model. The results of our study shown that: 1) the ranges of the 16S rDNA nucleotide divergence between two species of a genus were 0.21%, among genera of a subfamily were 0.42–3.38%, and among subfamilies of Pamphagidae were 1.90–8.88%, respectively. The phylogenetic tree shows that: 1) all Pamphagidae taxa form a monophyletic clade, and are well separated from the outgroup; 2) the African taxa Porthetinae (Lobosceliana brevicornis) and Akicerinae (Batrachotetrix sp.) are distinctly separated from the Chinese taxa Prionotropisinae; 3) Haplotropis bruneriana and Glauia terrea of Pamphaginae are nested in the middle of the tree, but their phylogenetic status is uncertain in this study; 4) 8 genera of Asiotmethis, Beybienkia, Mongolotmethis, Sinotmethis, Rhinotmethis, Filchnerella, Eotmethis and Pseudotmethis from China are all grouped into the subfamily Prionotropisinae, but their phylogenetic relationships are not clearly resolved.
Taxonomy of Simulium guaporense Py-Daniel (Diptera: Simuliidae) from Brazil, with the first description of males and females
Authors: HAMADA NEUSA , HERNANDEZ LUIS M. , LUZ SERGIO LUIZ BESSA
Published: March 2019

We describe Simulium guaporense Py-Daniel adults and redescribe some morphological characters of its larvae and pupae based on specimens collected near the type locality in Rondônia State, Brazil. We report this species for the first time in Mato Grosso State. This species was placed originally in the S. siolii species group of the subgenus Psaroniocompsa; however, the thoracic pattern of the adults of S. guaporense is similar to that of species in the S. auristriatum species group. The immature stages were found on deciduous leaves and trailing vegetation in sandy-bottomed streams. Females were collected biting humans.