bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P269: Glycemic Dysregulation Detected by Continuous Glucose Monitoring in Children With Metabolic Dysfunction-Associated Steatotic Liver Disease
Authors: Huneault Helaina , Ramirez Tovar Ana , Sanchez-Torres Cristian , Yaranga Claudia , DeSantos Karla , He Zhulin , Aguayo Liliana , Welsh Jean A , Vos Miriam B
Published: May 2024

MASLD, also known as NAFLD, is the leading cause of chronic liver disease in youth, especially among children who are obese and Hispanic/Latino. Insulin resistance and dysglycemia are strongly linked with MASLD. Current methods for evaluating dysglycemia, including fasting glucose, HbA1c, and oral glucose tolerance tests, have limitations. We utilized continuous glucose monitors (CGMs), wearable devices that detect 24 hour, real-time glucose alterations, to test our hypothesis that children with MASLD exhibit greater glycemic dysregulation compared to non-MASLD controls. This study included 19 Hispanic children (63% (12/19) male; mean age 7.8 years ± 0.9; mean BMI percentile 92% ± 17; 5% (10/19)) with MASLD who were otherwise healthy. Hepatic steatosis was measured by magnetic resonance spectroscopy (MRS). MASLD was defined as hepatic steatosis ≥5%, with at least one of five cardiometabolic risk factors. All participants underwent clinical evaluation and wore a blinded Dexcom G6 Pro CGM for 10 days or until the device became detached. Data was analyzed using RStudio v. 4.2.3. In children with MASLD, the mean time in range (TIR, 70-140 mg/dL) of 84% was lower than the mean TIR of 90% observed in non-MASLD controls (
p
=0.02). The mean high TIR (140-250 mg/dL) of 16 % in MASLD subjects was significantly higher than the 9% observed in non-MASLD controls
(p=
0.01). Mean average glucose and the coefficient of variation (CV) were also higher in children with MASLD, although differences were non-significant (
p
>0.05). Fasting insulin and ALT levels were significantly elevated in children with MASLD compared to controls
(p<
0.05).Findings demonstrate greater glycemic dysregulation in pre-pubertal children with MASLD compared to non-MASLD controls, as detected by CGM. Importantly, the 24 hour monitoring detected glycemic variability not apparent by fasting glucose or HbA1c. This study suggests early onset MASLD is associated with early glucose dysregulation, and treatments will need to address both conditions.
Abstract P289: In Africans With Abnormal Glucose Tolerance the Triglyceride-Glucose Index is a Feasible, Effective Way to Distinguish Between Beta-Cell Failure and Insulin Resistance
Authors: Worthy Charlita , Aravindakshan Pramodkumar , Sayed Mariam , Huefner Eliza , Hurston Jamaiica , DuBose Christopher W , Jagannathan Ram , Sumner Anne E
Published: May 2024

Background:
With the prevalence of abnormal glucose tolerance (Abnl-GT) soaring in sub-Saharan Africa, there is a growing appreciation that the major etiology of Abnl-GT in Africans may be beta-cell failure rather than insulin resistance (IR). As optimal therapy depends on etiology, distinguishing between beta-cell failure and IR is critical. However, identifying IR with formulas such as the Matsuda Sensitivity Index which requires insulin to be assayed in plasma, is expensive and rarely available in medical clinics in most African countries. Therefore, our goal was to use data from the Matsuda Index as the diagnostic standard, and determine how well the widely available, low-cost Triglyceride-Glucose Index (TyG) performs in distinguishing between beta-cell failure and IR in Africans with Abnl-GT.

Methods:
OGTTs and fasting triglyceride (TG) levels were obtained in 589 African immigrants living in the Washington DC area (Male: 64%, Age: 39±11, (mean±SD) range 20 -69y; BMI 27.9±4.5 kg/m
2
range 19.5-41.9). Glucose tolerance status was determined by ADA criteria for the OGTT. IR was defined as the lowest quartile of the population distribution of the Matsuda Index (≤2.89). As a primary etiology, beta-cell failure was defined as Abnl-GT in the absence of IR. Insulin secretion was calculated using the insulinogenic index. The formula for TyG was: ln(fasting glucose & fasting TG)/2. IR by TyG was defined by the highest quartile of its distribution across the cohort(≥3.38).

Results:
Abnl-GT occurred in 39% (228/589) of the enrollees. Among participants with Abnl-GT, the prevalence of beta-cell failure and IR were: 59% (134/228) vs. 41% (94/228),
P
<0.001, respectively. Compared to Africans with Abnl-GT and IR, Africans with Abnl-GT and beta-cell failure had less IR & lower insulin secretion (both P<0.001). Overall, with data from the Matsuda Index as the diagnostic standard, TyG correctly identified the etiology of Abnl-GT in 90% (205/228) of the participants with Abnl-GT, specifically 93% (125/134) with beta-cell failure and 85% (80/94) of participants with IR.

Conclusions:
As the TyG correctly identified the etiology of Abnl-GT in 90% of Africans, it may be a feasible, economically viable alternative to the Matsuda Index in determining whether Africans with Abnl-GT have beta-cell failure or IR. With correct information about Abnl-GT etiology, therapy for can be optimized.
Abstract P297: Associations Between Short-Term Outdoor Heat Measures and Markers of Immune Response and Inflammation
Authors: Riggs Daniel W , Cobbold Sonia , Sears Clara G , Malovichko Marina , Sithu Israel , Sansbury Brian E , Keith Rachel J , Srivastava Sanjay , Bhatnagar Aruni
Published: May 2024

Introduction:
Extreme-heat events increase mortality, and excessive deaths due to heat waves are overwhelmingly cardiovascular in origin. However, many previous studies only consider ambient temperature, which fails to capture the actual heat stress experienced by populations. Hot weather can interfere with a variety of biological processes including the promotion of systemic inflammatory responses, which play a critical role in the progression of cardiovascular disease (e.g., atherosclerosis). Our objective was to assess how short-term heat exposures are related to markers of inflammation and the immune response using physiologically-relevant heat metrics that capture additional meteorological conditions.

Methods:
Adult participants, aged 20-70 years, were recruited from a neighborhood in Louisville, KY during the summer months of 2018 and 2019. Circulating cytokines and immune cells were measured in 624 participants at baseline. Heat metrics, including temperature, net effective temperature, and Universal Thermal Climate Index (UTCI) were calculated as the 24hr mean on the day of participants’ clinical visit. Linear regression models were used to estimate associations between heat metrics and each biomarker, adjusting for socio-demographic and behavioral factors.

Results:
Participants were predominantly female (59%) and White (77%), with an average age of 49.5 years. The median daily temperature during study visits was 24.5 degrees C (IQR=3.8 degrees). The mean daily UTCI was positively associated with total circulating monocytes (4.2% per IQR; 95% CI: 0.3, 8.3), and classical monocytes (CD14
hi
CD16
lo
), while nonclassical monocytes (CD14
lo
CD16
hi
) displayed a negative association. We also observed positive associations with eosinophils 9.5% per IQR (95% CI: 0.6, 19.1) and Natural Killer T-Cells 9.9% per IQR (95% CI:2.8, 17.5), and a negative association with B-cells -6.8% per IQR (95% CI: -12.1, -1.1). In our cytokine analysis, UTCI was positively associated with TNF-alpha 7.0% per IQR (95% CI:2.8, 11.4) as well as IL-5 and MIP-1α. Similar, but attenuated associations were observed using daily temperature and other heat metrics.

Conclusion:
Short-term heat exposure may trigger an inflammatory response characterized by innate immune activation as evidenced by our results of higher total monocytes, classical monocytes, and TNF-alpha. Moreover, short-term heat exposure may impair adaptive immune response. These results suggest that exposure to high temperatures may increase susceptibility to infectious agents, environmental exposures, and accelerate the progression of cardiovascular disease.
Abstract P317: Patient Perceptions and Satisfactions of a Remote Blood Pressure Monitoring Program in an Integrated Healthcare System
Authors: Harrison Teresa N , Mora Marquez Janet , Juan Rachelle A , Ong-Su Angeline L , Brettler Jeffrey W , Mefford Matthew T , An Jaejin , Reynolds Kristi
Published: May 2024

Background:
Uncontrolled high blood pressure (BP) is a leading contributor to cardiovascular disease. Remote BP monitoring (RBPM) can empower patients to participate in their healthcare which may be important for improving BP control. The aim of this study was to understand patients’ attitudes toward and satisfaction with a RBPM program.

Methods:
We identified Kaiser Permanente (KP) Southern California members aged 18 years and older enrolled in a RBPM program. Eligibility criteria include having uncontrolled BP (≥140/90 mmHg), a smartphone, and an email address. Between July 27 and August 17, 2023, we emailed a letter of invitation and link to an online survey to 716 eligible members followed by 2 reminder emails. The survey consisted of 5 domains to assess patients’ experiences with a BP monitor and the KP Health Ally app: ease of use, trust, perceived benefits, privacy and overall satisfaction. Responses to each question were rated on a scale from 1 (disagree) to 7 (agree). The average score for each domain was calculated as the weighted sum of the questions. Antihypertensive medication adherence was reported on a scale ranging from “all of the time” to “less than half the time”.

Results:
A total of 71 patients (9.9%) responded to the survey with 60 (8.4%) completing all questions. Respondents had a mean age of 60.4 (SD 13.1) years, with 70.4% being female and 50.5% African American. Overall satisfaction and perceived benefits were the highest scoring domains followed by ease of use and trust in the monitor and app (Figure). Privacy concerns were minimal. The overwhelming majority of respondents (89.7%) reported taking their BP medications all or nearly all of the time.

Conclusion:
Most respondents rated the RBPM program with a high level of satisfaction, perceived benefits and had limited concern about privacy with the potential opportunity to improve patients’ trust in the BP monitor and app functionality. This high level of patient satisfaction and acceptability should lead to increased implementation and scaling of the RBPM program.
Abstract P318: Provider Barriers and Facilitators to Treatment Intensification for Patients With Uncontrolled Blood Pressure
Authors: Harrison Teresa N , Mora Marquez Janet , Ni Liang , Ong Angeline L , Brettler Jeffrey W , Wozniak Greg , Egan Brent , Rakotz Michael , Reynolds Kristi , An Jaejin
Published: May 2024

Background:
Hypertension is the leading cause of cardiovascular disease and premature death worldwide, however, therapeutic inertia, failure to intensify pharmacotherapy when blood pressure (BP) is not at goal, is a key obstacle to hypertension control. We aimed to identify barriers and facilitators to increasing the dose or adding a different antihypertensive medication class for patients with uncontrolled BP.

Methods:
We conducted a qualitative study of healthcare providers from Kaiser Permanente Southern California (KPSC). Using a stratified purposeful sampling approach, we identified 300 providers across 15 medical centers and specialties and with a mix of treatment intensification rates. In 2 separate waves, we emailed a letter of invitation to 150 eligible providers followed by 2 reminder emails each two weeks apart. We sought to conduct 30 semi-structured interviews about management of patients newly diagnosed with hypertension including use of single-pill combination therapy (SPC) (the recommended first-line therapy within KPSC), barriers to therapeutic intensification and use of home BP monitoring for treatment intensification decision making. We used rapid analysis methods to code responses and develop themes.

Results:
A total of 11 interviews were completed with providers from family medicine (n=7), internal medicine (n=3) and cardiology (n=1) who had an average of 6 years of practice within KPSC. The majority of providers reported using monotherapy as first-line treatment while SPC therapy was reserved for younger patients and those with baseline systolic BP >160 mm Hg. Monotherapy was often preferred to help providers determine if the first-line medication is causing side effects. Nearly all providers reported maximizing the dose of one medication before adding another medication class. Providers ranked the barriers to intensifying patients’ treatment in order of importance as 1) side effects such as frequent urination, hyperkalemia, and hypotension, 2) nonadherence to the current antihypertensive medication regimen and patient preference/hesitancy, 3) comorbidities (e.g., kidney function), and 4) age-related factors such as memory loss and ability to complete follow-up labs. All providers reported using patients’ home BP readings for treatment decision-making with most recognizing that patients’ out-of-clinic BP may be lower than clinic BP.

Conclusion:
Providers embraced stepped-care treatment for newly diagnosed patients with hypertension with most preferring monotherapy as first-line treatment. Concerns with side effects, nonadherence to the medication regimen and shared decision-making are key factors in providers’ decisions to intensify therapy for patients with uncontrolled BP. Targeted interventions to address provider barriers to treatment intensification may be needed.
Abstract P320: Soluble Receptor for Advanced Glycation End Products and Incident Hypertension: REasons for Geographic And Racial Differences in Stroke (REGARDS)
Authors: Krumholz Sarah , Ramos Barrera Krystal , Olson Nels , Long Leann , Judd Suzanne E , Howard Virginia J , Cushman Mary , Plante Tim B
Published: May 2024

Background:
Black US adults experience greater hypertension burden than other groups and have lower levels of serum soluble receptor for advanced glycation end products (sRAGE). Higher sRAGE may dampen inflammation pathway activity. Inflammation is a hypertension risk factor. It is unclear if lower sRAGE is associated with greater risk of incident hypertension overall and among Black adults.

Objective:
To estimate the risk of incident hypertension by sRAGE level.

Methods:
REGARDS enrolled 30,239 Black and White adults in the 48 contiguous United States in 2003-07; a second visit occurred 2013-16. ELISAs measured sRAGE in 4,400 REGARDS participants who attended both visits. This analysis included participants with sRAGE levels and no prevalent hypertension. Hypertension was defined as BP ≥140/90 mm Hg or use of antihypertensive medications. Poisson regression estimated relative risk (RR) of incident hypertension by serum sRAGE quartiles in models adjusting for known confounders.

Results:
Among the 1803 participants (mean (SD] age 62 [8] years, 55% Women, 25% Black race) incident hypertension occurred in 35% (46% Black and 32% White participants). Median (IQR) sRAGE was 1114 pg/ml (206 to 4256) in Black and 1600 pg/ml (380 to 5500) in White adults. Models were stratified by race because of an sRAGE*race interaction on incident hypertension. Higher sRAGE was associated with lower hypertension risk in White participants in all models (
Table
). There was no association between sRAGE and hypertension in Black adults.

Conclusions:
Higher serum sRAGE was associated with lower hypertension risk in White, but not Black, adults when adjusted for known risk factors. Whether modifying sRAGE affects hypertension risk is unclear.
Abstract P322: Mapping Geographic Variation in Hypertension Prevalence in United States Congressional Districts Using Spatial Modeling
Authors: Ogungbe Oluwabunmi V , Teshome Biruk , Parikh Karan , Ibukun Folahan A , Wheeler-Martin Katherine , Dennison Himmelfarb Cheryl R , Cooper Lisa A , Commodore-Mensah Yvonne
Published: May 2024

Introduction:
Using spatial methods to explore drivers of hypertension (HTN) risks, commonalities, and differences across geographical areas can be assessed to inform future public health research and advocacy efforts.

Objectives:
To examine ecological associations between social determinants of health (SDoH), space, and HTN across congressional districts (CDs) in effect for the 118th US Congress.

Methods:
We obtained aggregate district-level data from Congressional District Health Dashboard on health behaviors, exposures, and outcomes for US CDs in 2019. Primary outcome was HTN prevalence, defined as proportion of adults who self-reported diagnosed HTN. Exposure variables were SDoH: health outcomes (diabetes, obesity, frequent physical and mental distress), health behaviors (physical activity, binge drinking, smoking), clinical care (routine checkups), and physical environment (air pollution). We fitted a hierarchical Bayesian Besag-York-Mollié model using the integrated nested Laplace approximation (INLA) method, which allowed the estimation of spatial autocorrelation of HTN prevalence at CDs level, accounting for SDoH.

Results:
Across 421 CDs, we found a variation in the modeled linear proportion of 83% across the CDs in the United States after adjusting for known HTN risk factors at the CDs level. A notable degree of variation in HTN prevalence exists within specific CDs, independent of recognized risk factors (
Figure
). These unmeasured variables act as confounding elements, and districts with darker shading indicate increased HTN attributed to the district, while lighter, red-shaded districts exhibit a reduced district-specific proportion of HTN.

Conclusions:
Our findings show significant geographic variation of HTN beyond known risk factors which underscores the significance of adopting a spatial perspective to understand HTN prevalence. It emphasizes the necessity for tailored public health interventions that consider the unique geographic context of each CDs.
Abstract P334: The Impact of Cardiovascular Risk Factors on Cognition in Adults With Down Syndrome
Authors: Ptomey Lauren , Helsel Brian , Bodde Amy , Danon Jessica , Sherman Joseph , Forsha Daniel E , Donnelly Joseph
Published: May 2024

Introduction:
Most adults with Down Syndrome (DS) will develop Alzheimer's disease. Evidence in the general population suggests that factors associated with cardiovascular health including, moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure, are associated with better cognitive outcomes and decreased risk of Alzheimer's disease. Studies supporting these associations in adults with DS are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS.

Methods:
This is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO
2 Peak
) and cognitive function (CANTAB
®
DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes.

Results:
Complete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO
2 Peak
(21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ±14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO
2 Peak
was correlated with simple movement time (rho = -0.28, p=0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: β = -0.11, p=0.002; total errors: β = 0.58, p = 0.001) and reaction time (five-choice movement time: β = 4.11, p = 0.03; simple movement time: β = 6.14, p = 0.005) using age-and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time.

Conclusion:
Cardiovascular risk factors, including cardiorespiratory fitness and systolic blood pressure, were associated with cognition in adults with DS. Given the high prevalence of Alzheimer's disease in adults with DS, future research examining cardiovascular health and Alzheimer's disease risk is warranted.
Abstract P353: Effect of Exergaming-Based Dance Training Paradigm in Improving Cardiovascular Function and Functional Mobility Among People With Chronic Stroke
Authors: Subramaniam Savitha , Ma Jun
Published: May 2024

Background:
Dance-based exergaming (DBExG)
, could potentially facilitate cardiovascular conditioning and functional mobility while enhancing physical activity behavior among people with chronic stroke (PwCS). Albeit, PwCS exhibits limitations (e.g., health care, and travel) in laboratory/outpatient rehabilitation programs, making them inaccessible. The DBExG from the laboratory
(phase 1)
to a safe and feasible
home-based exercise program (phase 2)
could effectively improve cardiovascular and functional mobility and address the accessibility limitations.

Aim:
To evaluate the feasibility, effect, and adherence of DBExG in promoting heart rate variability (HRV) and functional mobility in a laboratory and home-based rehabilitation approach.

Design:
Pre-post interventional study.

Setting:
Laboratory (phase 1) and home-based (phase 2) settings.

Methods:
Community-dwelling PwCS (n=10) participated in the study and received DBExG training using the commercially available Kinect dance gaming “Just Dance 3”. The first 6 weeks of training were provided in the laboratory setting and were delivered in a high-intensity tapering method with the first two weeks consisting of 5 sessions/week, the next two weeks of 3 sessions/week, and the last two weeks of 2 sessions/week, with a total of 20 sessions. Followed by 4 more weeks of DBExG training in the participant’s house (3 days/week), with a total of 12 sessions. Feasibility was addressed by acceptability and retention. Data obtained for HRV analysis pre- and post-intervention consists of HRV for ten minutes in (1) supine resting position; and (2) quiet standing. High-frequency (HF) power measures as indicators of cardiac parasympathetic activity, low-frequency (LF) power of parasympathetic-sympathetic balance, and LF/HF of sympatho-vagal balance were calculated. Six-minute walk test (6-MWT) was used to assess functional mobility. Changes in physical activity during pre- and post-intervention for one week and also during dance training were assessed using Fibit.

Results:
All participants completed the laboratory and home-based DBExG. All participants reported enjoying the sessions and most felt they were beneficial. Study retention and session adherence was 90% and 96%, in phase 1, and 2 respectively. There were no falls, or adverse safety events reported in either phase of the study. The results showed improvements in HRV HF, LF, and LF/HF. The result findings indicated significant improvement in the 6-MWT. The number of steps during dance intervention increased significantly from 1
st
to the 32
nd
session.

Conclusions:
A combination of laboratory, transitioned to home-based maintenance therapy approach appears feasible, safe, and effective thus promising for post-stroke rehabilitation. A larger randomized controlled trial is recommended to further investigate efficacy.
Abstract P355: Identifying Barriers and Facilitators to Home Blood Pressure Monitoring Among Pregnant Women With Hypertension Disorders of Pregnancy-A Qualitative Approach
Authors: Denu Mawulorm , Revoori Ritika , Sadaniantz Katherine , Chiriboga Gérman , Iyengar Sanjna , Staples Brooke , Forrester Sarah , Lemon Stephenie C , Moore Simas Tiffany , PERSON Sharina , McManus David , Mazor Kathleen , Kovell Lara
Published: May 2024

Background:
Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the US, contributing to over 30% of maternal deaths. Improved diagnosis, treatment, and outcomes of HDP may be achieved through home blood pressure monitoring (HBPM). However, there are many challenges to effective HBPM during pregnancy. We conducted this qualitative study to explore barriers and facilitators to HBPM.

Methods:
Pregnant or postpartum (within 3 years) women, aged 18-50 years with either hypertension (HTN) or preeclampsia, were recruited from a large academic medical center to participate in virtual focus group meetings (N = 5 groups, 2-6 participants/group). The discussions centered on experiences with HDP, HTN management, and HBPM. Focus group meeting audio recordings were transcribed, and thematic analysis was performed (by MD and RR). Meetings (between MD, RR, and LK) resolved any discrepancies, focusing on responses discussing barriers and facilitators to HBPM.

Results:
Of the 20 participants, mean age was 33.8 (SD 5.9) years, 35% were Hispanic, and 35% were Black. Facilitators to HBPM shared by participants included external support (e.g., partner, healthcare), free access/decision support, comfort in knowing BP readings outside healthcare setting, and technology support. Barriers to HBPM shared by participants were lack of knowledge/uncertainty about the equipment and process (e.g., technique, monitors, and logging), cost/access, traditional pathways for monitoring, and declining motivation.

Conclusion:
In this study involving women with HDP from diverse backgrounds, we identified several facilitators and barriers to HBPM. Many of the barriers can be overcome through patient education, technology support, reinforcement, and better access to validated monitors. Given the importance of HBPM in improving outcomes for pregnant women with HDP, it is important for healthcare providers and policy makers to work to reduce barriers and amplify facilitators to HBPM for better adoption.
Abstract P358: Association Between Psychological Distress and Cardiovascular Health Among Pregnant Individuals in the United States: Findings From Nationally Representative Data
Authors: Satti Danish Iltaf , Chan Jeffrey S , Mszar Reed , Kwapong Yaa A , Chan Raymond Ngai Chiu , Katz Miriam E , Metlock Faith , Commodore-Mensah Yvonne , Spitz Jared , Bonomo Jason A , Sharma Garima
Published: May 2024

Background:
Psychological health has an impact on pregnancy outcomes. The impact of psychological health during pregnancy on maternal cardiovascular health (CVH) is not well understood.

Methods:
Data from the US National Health Interview Survey (2013-2018) were used. All participants aged ≥18 years were included, excluding those with missing data for any of the exposure, outcome, or covariates. Psychological health was measured by the six-item Kessler scale (K6), and severe psychological distress (SPD) was defined as K6 ≥13. CVH was quantified based on the American Heart Association’s
Life’s Essential 8
; as detailed dietary data were unavailable, a seven-item CVH score was used (higher score indicated worse CVH). Multivariable Poisson regression was used to test associations between SPD and CVH, adjusting for the presence of any known cardiac condition, family income, education level, race, sex, sexual orientation, insurance coverage, and age.

Results:
Altogether, 1,111 participants were analyzed representing a weighted population of 1,576,091 persons. Worse psychological distress was independently associated with suboptimal cardiovascular health in pregnant individuals (adjusted risk ratio (aRR) 1.03 [95% confidence interval: 1.02, 1.04], p<0.001), with similar findings for SPD (aRR 1.34 [1.14, 1.58], p=0.001). These associations remained consistent regardless of age and race.

Conclusions:
Although SPD was relatively uncommon among pregnant individuals, it was strongly associated with worse maternal CVH. This underscores the critical need for a multidisciplinary approach that incorporates thorough psychological assessments in the care of pregnant individuals.
Abstract P364: A County Community Health Fair Served as a Strategy to Encourage Participation in Research Study
Authors: Caples Felicia V , Ferrell Tina D , Harris Kisa K , Smith Dantwan S , Lucas Eric D , Poe Kenyatta A , Ramachandran Vasan S , Henderson Frances C , Fox Ervin R
Published: May 2024

Background:
The voice of the community is powerful in suggesting strategies for engaging in research. Members of Oktibbeha and Panola County, Mississippi Advisory Boards affiliated with the Risks Underlying Rural Areas Longitudinal (RURAL) Study suggested that a health fair would spread the word throughout their communities about participating in the Study. The objective is to tell the story of how a County-wide community health fair can encourage those who attend to consider participating or not participating in the RURAL Study. The RURAL Study is an observational, population-based study focusing on heart, lung, blood and sleep disorders in 10 rural counties in four southern states: Alabama, Kentucky, Louisiana and Mississippi.

Methods:
To engage the communities with the RURAL Study, Health Fairs were implemented in Panola and Oktibbeha Counties in Mississippi. Following the Health Fairs, Investigators conducted focus group interviews with four groups of attendees in each County to explore the success of the Health Fair and the attendees’ willingness to participate or not participate in the RURAL Study. Focus group interviewees were RURAL Study Community Advisory Board (CAB) members, local community engagement consultants, men, and participants at-large. Investigators conducted focus group interviews following the June 11, 2022, Oktibbeha County Community Health Fair and following the Panola County Community Health Fair held on April 29, 2023. Interviews were digitally recorded and transcribed. The transcripts were analyzed using thematic analysis.

Results:
Thirty-two individuals were interviewed representing Oktibbeha (17) and Panola (15) counties. Two main themes arose from the focus group interviews: giving and gathering information/getting the word out and enlightened awareness of requirements for and benefits of participation. Giving and gathering information/getting the word out included dissemination of information through promotional material, word of mouth, social media, flyers to churches, and presentations by the RURAL Study Principal Investigator. Attendees could gather information and be assisted in signing up to be a participant. Enlightened awareness of the requirements for and the benefits of participation included the realization that participation in the RURAL Study provides free screening, allows participants to keep up with their health, helps the individual participant and his/her kids, and benefits the community. Health Fair attendees who didn’t know that they could participate learned that they could.

Conclusions:
Providing detailed information through many channels and engaging the community can help to promote interest in a research study. A County Community Health Fair served as a community engagement strategy to encourage attendees to consider participating in the RURAL Study.
Abstract P378: Life’s Essential 8 and Personal Income Level in Korean Adults
Authors: Lee Ju-Mi , Park In-Kyu , Nam Hae-Sung
Published: May 2024

Introduction:
The COVID-19 pandemic has raised global income inequality. This study analyzes the association between personal income level and cardiovascular health matrix (CHM) utilizing AHA life’s essential 8 in Koreans.

Methods:
This study used the 2019-2021 Korean National Health and Nutrition Examination Survey. Those who have missing data for assessing Life’s essential 8 were excluded. A final total of 12,923 participants were enrolled in this study. We used Life's essential 8 CHM Metrix as exposure, defined by the AHA. Diet redefined them appropriately for the Korean population. The unweighted average of each CHM score was calculated, and the cardiovascular health assessment groups were categorized as "high (80-100)," "medium (50-79)," and "low (0-49)" and then subjected to logistic regression analysis. The results were adjusted for sex, age, education, drinking status, perceived stress, and family history of physician chronic disease diagnosis.

Results:
Score of diet, physical activity, nicotine exposure, sleep health, body mass index, blood glucose, and blood pressure were positively associated with personal income level (Figure 1). Compared to the middle CVH group and lower income level group, higher income levels were associated with being in the high CVH group before (OR 1.6, 95%CI 1.4-1.8) and after adjusted (OR 1.5, 95%CI 1.2-1.7) confounders.

Conclusions:
This study showed that personal income was positively associated with the total life’s essential 8 CVH score and individual factors of life’s essential 8. Our results imply that socioeconomic factors, specifically personal income levels, exert influence even within what is considered an individual's realm (diet, physical activity, nicotine exposure, sleep health, body mass index, blood glucose, blood pressure) of control.
Abstract P380: Fatherhood and Cardiovascular Health: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Parker John James , Garfield Craig F , Simon Clarissa D , Colangelo Laura A , Bancks Michael P , Rana Jamal S , Gabriel Kelley P , Allen Norrina B
Published: May 2024

Introduction:
Emerging literature links fatherhood to men’s health but lacks comprehensive investigation of associations with cardiovascular health (CVH).

Hypothesis:
Fatherhood will be associated with total CVH and individual CVH metrics.

Methods:
We included men from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort study which enrolled Black and White individuals aged 18-30 years at baseline (1985-86). CVH was defined using the American Heart Association's Life’s Essential 8 (LE8) scores (0-100) and was calculated at the year 20 follow-up examination to most accurately classify men’s fatherhood status. Multivariable linear regression tested for difference in total CVH and CVH metrics by fatherhood status (father vs non-father vs stepfather & living with children vs not) and age at transition to fatherhood; models adjusted for age, race, marital status, education, having a primary care clinician, income, current alcohol consumption & CESD depression score.

Results:
In this sample of 1026 men, mean age at LE8 assessment was 45.4 (SD=3.5) years, 720 (70.2%) were fathers, 243 (23.6%) were non-fathers, 63 (6.1%) were stepfathers, and 384 (37.4%) self-identified as Black. The mean age men became fathers was 29.2 years. In adjusted models, there was evidence of interaction between the age at fatherhood and race on total CVH score (
p
=0.07). For white men, becoming a father at <20 years was associated with lower total CVH, compared with 30-34 (
p
<.01) and ≥35 years (
p
=0.02); this association was not found for Black fathers (Figure 1). In adjusted models, stepfathers had worse BMI scores than non-fathers (least squares mean 51.1 vs 64.3, p<0.01), but otherwise there was no difference in total CVH or CVH metrics between non-fathers, fathers, stepfathers, or men living with or without children.

Conclusion:
Fatherhood is a social determinant of health and understanding its influence may provide opportunities to improve men’s health, particularly among men who become fathers at young ages.
Abstract P388: Higher Social Vulnerability Was Associated With Less Community-Based Rehabilitation Utilization After Stroke
Authors: Zhang Shuqi , Freburger Janet , Johnson Anna M , Patterson Charity , Jones Sara
Published: May 2024

Background:
Timely rehabilitation care significantly improves function and mobility after stroke, but barriers exist in access and utilization. The impact of neighborhood social determinants of health is not fully understood. Our study aims to estimate the association between Social Vulnerability Index (SVI), a measure of a community's need for support, and post-stroke rehabilitation utilization.

Methods:
This study is an observational, secondary analysis of the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 41 North Carolina hospitals from 2016-2019. This analysis included 4765 individuals (51.2% female; 74.8% Whites; mean age 69.9) discharged directly home after stroke and linked to administrative claims. Utilization of physical or occupational therapy was obtained from outpatient, carrier file and home health claims. Geocoded participant addresses were linked to 2018 summary SVI percentile ranking and its four sub-domains at the Census tract level. Generalized estimation equations with cluster of Census tract and hospital were used to estimate the association between quintiles of SVIs and incidence proportion of rehabilitation use within 30 days. Covariates included patients’ socio-demographics, clinical characteristics, and comorbidities.

Results:
The overall proportion of rehabilitation use by 30 days was 38.6%, ranging from 34.6-46.5% across SVI quintiles. In multivariable analysis, quintiles of higher summary SVI were associated with lower rehabilitation use compared with the least vulnerable quintile (RD and 95% CI, Q5 vs Q1: -0.098 [-0.147 to -0.049]; Table). There was a significant decreasing trend across quintiles (P-trend < 0.001). Similar results were observed for SVI sub-domains except for minority status and language.

Conclusion:
Higher social vulnerability was associated with less post-stroke rehabilitation use. The finding is useful to identify communities for targeted interventions to improve access and utilization to rehabilitation.
Abstract P415: Validation of an Algorithm to Identify End-Stage Kidney Disease Cases in Electronic Health Record Data
Authors: Gao Chenxi , Xu Yunwen , Sang Yingying , Chang Alexander R , Green Jamie , Grams Morgan , Shin Jung-Im
Published: May 2024

Introduction:
End-stage kidney disease (ESKD) is an important clinical outcome. However, there is limited work on validating algorithms to detect ESKD cases within electronic health record (EHR) data.

Hypothesis:
Algorithms using diagnostic and procedure codes in EHR data can accurately identify ESKD cases.

Methods:
Using data from Geisinger linked to the United States Renal Data System (USRDS), we developed algorithms to identify individuals with ESKD (either dialysis or kidney transplant, whichever occurred first) and validated them against ESKD cases ascertained from the USRDS data from January 1, 1996, through June 28, 2018 (gold standard). We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results:
To identify dialysis cases, we required 1) diagnosis codes of stage 5 chronic kidney disease or ESKD with dialysis codes within seven days or 2) three dialysis codes lasted longer than a month with any two consecutive codes occurring within 3 months. To identify kidney transplant cases, we required 1) one procedure code of kidney transplant or 2) one diagnosis code of kidney transplant in inpatients or problem list. Among 572,574 individuals (mean age, 41.6 years; female, 55.4%; White, 92.9%), the algorithms identified 4,187 ESKD cases (3,875 dialysis and 792 kidney transplant cases), while there were 4,529 ESKD cases (4,368 dialysis and 772 kidney transplant cases) by USRDS data. Our ESKD identifying algorithms’ sensitivity, specificity, PPV, and NPV were 71.1%, 99.8%, 76.9%, and 99.8%, respectively. Median (interquartile range) duration between incident dates by the algorithm and by the USRDS was -2 (-21, 86) days (
Table
).

Conclusions:
The algorithms developed by diagnostic and procedure codes accurately identified ESKD cases with high specificity in EHR data. Further validation is required in different health systems.

Table
The validity of the algorithms to identify ESKD cases

IQR: interquartile range
Abstract P438: Combined Association of Body Mass Index and Central Obesity on Mortality Risk in Diabetes Population: The China Health And Retirement Longitudinal Study (CHARLS)
Authors: Zhang Ruolin , Ding Xiong , Zhou Huiyuan , Zhang Xian , He Zhengting , Yan Lijing L
Published: May 2024

Introduction:
Abdominal fat is associated with an elevated mortality risk and higher healthcare costs. Body mass index (BMI), commonly used to measure body fatness, underestimates excess abdominal fat due to its limited accuracy in reflecting fat and muscle distribution. Waist circumference (WC) is a more precise indicator of central obesity, which is defined as excess abdominal fat accumulation. The joint associations of combined BMI and WC with mortality risk in the diabetes population are not fully understood.

Methods:
We included individuals with diabetes and at least one measure of BMI and WC, from 2011, 2013, and 2015 waves with follow-up to 2018 in CHARLS. All individuals were classified into four groups: normal weight without central obesity, normal weight with central obesity (WC, male ≥ 90 cm, female ≥ 85 cm), overweight (BMI ≥ 24 kg/m
2
) without central obesity, and overweight with central obesity. Multivariable logistic regression was used to model the associations between four groups and the mortality risk among people with diabetes adjusted for demographic characteristics, smoking, drinking, multimorbidities, and diabetes treatment.

Results:
Among 940 participants (mean age 60.4 years, 58.3% women), there were 124 incident cases of death recorded. Compared to normal weight without central obesity group, the mortality risk was increased among normal weight with central obesity group (Adjusted odds ratio = 2.11, 95% CI: [1.07, 4.18]). Other groups exhibited no statistically significant association with mortality risk (Figure 1). In sensitivity analysis excluding individuals with BMI ≤ 18.5 kg/m
2
, results were largely consistent with the previous findings.

Conclusions:
A significant association between central obesity and increased mortality risk in diabetes population was revealed. While, overweight with central obesity showed no significant association to mortality risk. Our findings stress the importance of customized strategies for central obesity in the diabetes population to reduce medical expenses.
Abstract P447: Heart Disease Health Disparities Among Native Hawaiian and Pacific Islander Communities in the United States: A Systematic Review
Authors: Doan Lan N , Murata Michelle , Samoa Raynald A , Hade Erinn , Yi Stella S
Published: May 2024

Background:
Heart disease is a leading cause of death among Native Hawaiian and Pacific Islander (NH/PI) communities. However, the nature of disease development and risk factors is not well characterized due to poor availability of disaggregated data, hampering efforts towards the design and implementation of culturally-relevant interventions. The purpose of our review is examine known gaps in heart disease prevention measures and programs for NH/PI populations to identify opportunities to mitigate health disparities through structural- and provider-level factors.

Methods:
We conducted a systematic search of PubMed, Embase, and CINAHL databases to identify peer-reviewed articles focused on heart disease (coronary artery disease, heart attack, heart failure) in NH/PI populations. Eligible studies were assessed for their relevance to NH/PI populations living in the US, US territories and Freely Associated States and their coverage of topics such as prevalence, risk factors, cultural determinants, prevention, and management.

Results:
Of the 1,440 articles initially identified (3 duplicates removed), 1,437 article titles and abstracts were screened, 585 full-text articles were screened for eligibility and 68 articles were included for analysis. The main reasons for exclusion were the absence of NH/PI individuals, lack of focus on heart disease, grouping NH/PI people with Asian American and other racial groups, and studies conducted outside the US (e.g., Australia, New Zealand). Many of the included articles examined prevalence, risk factors, health behaviors, knowledge, and healthcare utilization, from sources such as the Multiethnic Cohort Study, Behavioral Risk Factor Surveillance Systems, National and Hawaii Vital Statistics and claims data. Culturally-grounded interventions, community-based programs, and initiatives (e.g., Native Hawaiian Health Research Project, Ohana Heart Project, Pacific Islander Health Care Project, Wahine Heart Wellness Program), which incorporate traditional practices, were identified as showing promise in reducing risk and improving heart health among NH/PI adults.

Conclusion:
The review unveiled a disproportionate burden of heart disease and high prevalence of obesity, diabetes, and hypertension among NH/PI communities, often attributable to lifestyle behaviors, socioeconomic factors, and limited access to healthcare. These disparities are compounded by the underrepresentation of NH/PI populations in national health surveys and the scarcity of comprehensive epidemiological studies featuring robust NH/PI samples. It is evident that further research and policy initiatives are crucial to increase research investments and promote data equity and disaggregation for this population.
Abstract P455: Effects of COVID-19 Pandemic on Racial Disparities in Coronary Artery Disease Mortality: Has the Existing Gap Worsened?
Authors: Sergeev Alexander V
Published: May 2024

Background:
Previous studies have indicated that the novel coronavirus SARS-CoV-2 (COVID-19) pandemic resulted in an increase of coronary artery disease (CAD) mortality across various population groups. However, it remains unknown whether the pandemic changed the dynamic of earlier documented existing racial disparities in CAD mortality.

Study Objective:
To investigate racial disparities in the magnitude of
changes
in CAD mortality rates from the pre-pandemic to COVID-19 pandemic era.

Methods:
Using the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying causes of death in the U.S., we analyzed CAD mortality rates in relation to race, adjusting for age and gender. CAD deaths were identified using the ICD-10 codes I20-I25 for the first three years of the pandemic (from March 2020 through February 2023; COVID-era CAD mortality) and for the three years immediately preceding the pandemic (2017-2019; pre-COVID CAD mortality). General linear modeling (GLM) analysis was conducted using SAS (version 9.4).

Results:
During the first three years of the pandemic, the overall crude CAD mortality rates increased from 160.619/100,000 in pre-COVID era to 164.773/100,000 (p<0.001). Age-adjusted analyses demonstrated that African Americans and Asians experienced a more pronounced increase in age-adjusted CAD mortality rates than whites, when comparing the change in CAD mortality rates from the pre-COVID to COVID era. While age-adjusted CAD mortality rates increased from the pre-COVID to COVID era both in African Americans, Asians and whites, the magnitude of the change (the mortality rate increase) in African Americans was 19.538/100,000 greater than the magnitude of the mortality rate change in whites (p=0.08). Asians experienced a similar gap: the magnitude of the pre-COVID/COVID-era increase in their age-adjusted CAD mortality rate was 19.560/100,000 greater than the magnitude of the pre-COVID/COVID-era increase experienced by whites (p=0.09).

Conclusions:
While the magnitude of the
change
in racial CAD mortality disparities in relation to COVID-19 pandemic has not reached the conventional statistical significance level, the worsening of gap is alarming and warrants further investigation.