bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP32: Associations of Metabolites With Glycemic Outcomes Among Bogalusa Heart Study and Atherosclerosis Risk in Communities Study Participants
Authors: Cueto Jenilee , Kelly Tanika N , He Jiang , Li Changwei , Nierenberg Jovia L , Gu Xiaoying , Boerwinkle Eric , Coresh Joe , Selvin Elizabeth , Yu Bing , Bazzano Lydia A , Rebholz Casey , Dorans Kirsten
Published: May 2024

Background:
Metabolomics may identify novel biomarkers for predicting, detecting, and managing diabetes. We evaluated the association of novel metabolites with diabetes, prediabetes, and continuous glycemic outcomes (fasting plasma glucose (FPG); hemoglobin A1c (HbA1c)) using data from the Bogalusa Heart Study (BHS) and Atherosclerosis Risk in Communities Study (ARIC).

Methods:
Untargeted ultrahigh-performance liquid chromatography-tandem mass spectroscopy was used to detect and quantify 1466 serum metabolites in 1194 BHS participants (2013-2016) with and without diabetes (defined as FPG ≥126 mg/dL or use of diabetes medication; prediabetes as FPG of 100 to <126 mg/dL). We assessed cross-sectional associations between all metabolites with FPG and HbA1c (linear regression) and with prediabetes and diabetes (multinomial logistic regression). Significant and novel metabolite associations in BHS were tested for replication (determined by statistical significance and consistent effect direction) among 1528 participants from ARIC (1990-1992). All analyses used Bonferroni-corrected alpha thresholds.

Results:
In BHS (mean age 48.1 y, 60% female), 16% of persons had diabetes and 32% had prediabetes. Mean FPG and HbA1c were 106.5 mg/dL and 5.9%, respectively. Among 163 novel glycemic-metabolite associations in BHS, 21 metabolites were tested for replication in ARIC (measured on a different platform): Six metabolites for diabetes, 9 for glucose, 12 for HbA1c, and 3 for prediabetes. Among metabolites tested, replication results for All (Black and White) and Black participants across ARIC subgroups identified glycylvaline as statistically significant for novel association replicated with HbA1c (Table).

Conclusions:
A significant novel metabolite association of glycylvaline, part of the dipeptide subpathway, with HbA1c was identified in BHS and replicated in ARIC. This dipeptide subpathway should be further explored as a potential subpathway to target for detection or management of hyperglycemia.
Abstract MP33: Investigating the Link Between Glucose Patterns Assessed by Continuous Glucose Monitoring With Cognitive Impairment in Older Adults With Diabetes
Authors: Ejimogu Emeka , Wang Dan , Hu Jiaqi , Gottesman Rebecca , Windham Beverly Gwen , Coresh Josef , Valint Arielle , Fang Michael , Selvin Elizabeth
Published: May 2024

Introduction:
There are no studies in older adults with type 2 diabetes that examine the link between day-to-day glucose patterns and cognitive dysfunction. Continuous glucose monitoring (CGM) is a minimally invasive technology that can assess glucose every 1-15 minutes and characterize nuanced patterns in glucose.

Hypothesis:
CGM can provide a comprehensive picture of glycemic variability in people with cognitive dysfunction.

Methods:
We conducted a cross-sectional study of participants with diabetes in the Atherosclerosis Risk in Communities (ARIC) Study (Visit 9, 2021-2022). ARIC participants wore a CGM (Abbott Libre Pro) and underwent cognitive testing in three cognitive domains (memory, executive functioning, and language). Scores were standardized and averaged to give a global cognitive z-score. We compared HbA1c and clinically used CGM parameters (mean glucose, coefficient of variation, percent time in glucose range of 70-180 mg/dL, and percent time above 180 mg/dL) across quartiles of cognitive z-scores, adjusting for age and sex. We calculated p-values for trends from linear or quantile regression treating the median of cognitive Z-score in each quartile as a continuous variable.

Results:
We included 383 participants with diabetes (mean age, 83 years). Across categories of cognitive functioning, participants in the lowest cognitive functioning categories had significantly higher HbA1c, glucose variability, and less percent time spent with glucose in range (70-180 mg/dl)
(Figure)
. There was no clear trend in CGM mean glucose (p=0.15)
(Figure, Panel B)
.

Conclusions:
Cognitive dysfunction was associated with an increased burden of glycemic dysregulation assessed through CGM and HbA1c. Our results suggest CGM may be a useful complement to HbA1c for monitoring glycemic control in this population. Figure: Hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) metrics across quartiles of cognitive Z-scores in older participants with diabetes in the ARIC Study (2021-2022)
Abstract MP43: Disparities in Cardiovascular Health in Childhood: The Young Hearts Study
Authors: Allen Norrina B , Marma Amanda M , De Ferranti Sarah D , Labarthe Darwin R , Davis Matthew , Petito Lucia , Daniels Stephen R , Chopra Aashima , Phillips Darci , Wang Yaojie , Rosenman Marc , Narayan Rashmi , Gooding Holly , Pletcher Mark J , Alenghat Francis , Gandhi Rupali , Lefaiver Cheryl , Luff Amanda , Khan Huma , Rios Ileah , Zmora Rachel , Yu Amy , Lloyd-Jones Donald M
Published: May 2024

Introduction:
Cardiovascular health (CVH) in childhood is associated with lifetime risk for CVD events. CVH declines with age, and only 50% of US adolescents have 5 of the 7 CVH metrics at ideal levels. Little is known about CVH in young children from diverse backgrounds. The aim of this study is to examine CVH scores by age, gender, race/ethnicity and social determinants of health in a large, diverse cohort of children aged 0-18 years.

Methods:
The Young Hearts (YH) Study is a pragmatic cohort in which parents and children complete annual surveys on demographics, family and social environment, contextual stress and resilience factors, and behaviors. This survey data will be combined with linked EMR data to provide clinical CVH metrics over time. Behavioral CVH (bCVH) was defined using the AHA’s Life’s Essential 8 (LE8) scoring where individual scores (range 0-100; 80+ is ideal) for each of the 4 health behaviors—diet, physical activity, nicotine exposure, sleep—were assessed using age-specific criteria and then averaged for a composite score. These results represent the first 3,534 participants recruited into the study. Linear regression models examined multivariate predictors of bCVH.

Results:
Among YH participants (mean age 9.5 years; 53% male, 20% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic Black, 7% other) the mean bCVH score was 72.5 (33% high CVH range, 60% moderate, 7% low). CVH scores were 96.2 for nicotine exposure, 44.3 for diet, 74.4 for sleep, and 74.8 for physical activity. Scores declined with age and were lowest for Non-Hispanic Black children (Figure). In adjusted models, significant predictors of lower bCVH scores included being Non-Hispanic Black, older age, lower family income, and lower parental education.

Conclusion:
Among this diverse cohort of children, more than half had non-ideal bCVH scores by a mean age of 9 years. Early primordial prevention efforts are critical to avert the reduction in CVH and eliminate disparities that emerge early in childhood and lead to excess burden of CVD across the lifespan.
Abstract MP45: Beyond Pregnancy: Meta-Analysis of Lifestyle Intervention for Prevention of Diabetes Mellitus in Women With Prior Gestational Diabetes Mellitus
Authors: Taj Shiza Saher , Ahmed Zahoor , Ong Kenneth
Published: May 2024

Introduction:
Among parous women,1 in 3 have a pregnancy complication, increasing chances of developing Diabetes Mellitus(DM), Hypertension, or heart disease. Lifestyle intervention is recommended to reduce cardiovascular morbidity risk after complicated pregnancies. The effect of lifestyle intervention on the risk of type 2 DM in women with prior Gestational DM (GDM) is not widely studied. Our study highlights the impact of lifestyle intervention on risk of type 2 DM in women with prior GDM.

Methods:
We ran a systemic literature search of PubMed, EMBASE, Clinical Trials.gov, and Google Scholar from January 2000 to August 2023 for relevant articles comparing lifestyle intervention (diet and physical activity) with standard care in women with prior GDM. The relative risk (RR) of DM with 95% confidence interval (CI) and p-values were extracted with fixed effect model using RevMan v.5.4.

Results:
Of 3100 articles that were screened, 28 underwent full-text review, and 11 studies met the inclusion criteria. Of 11 studies, 1661 were evaluated in intervention group (IG) and 1671 in control group (CG). The mean age of participants was 26.1-39 years, with a baseline body mass index (BMI) range (R) of 23.4-31.4 kg/m2 and a follow-up duration with R of 4-36 months. On analysis, the incidence of type 2 DM was 7.6% in IG compared to CG (10.35%). IG showed a 27% reduction in DM incidence as compared to CG, RR of 0.73(CI: 0.59-0.91) (p < 0.05) (Figure 1). On meta-regression analysis, duration of lifestyle intervention (R: 4-36 months) significantly impacted the observed reduction in incident type 2 DM (p < 0.05) (positive relation) as compared to baseline BMI (p = 0.21) (Figure 1).

Conclusion:
Our analysis highlights that lifestyle intervention in women with prior GDM positively reduces risk of type 2 DM, and intervention duration significantly impacts the long-term risk of DM and cardiovascular diseases. Further data is warranted from larger studies for stronger evidence regarding the benefits of lifestyle intervention in prior GDM patients
Abstract MP47: Fetal Life Exposure to GDM and Postnatal Breastfeeding and Beverage Intake in the First Year Are Associated With Severe Child Obesity at 6 to 11 Years: The SWIFT Study in Youth
Authors: Sun Baiyang , King Alexis S , Lo Joan C , Greenspan Louise C , Wakimoto Patricia , Alexeeff Stacey , Gunderson Erica P
Published: May 2024

Objective:
To evaluate associations between fetal exposure to GDM and postnatal breastfeeding (BF) and sugary beverages in the first year with risk of child overweight and obesity severity at 6-11 y.

Methods:
The sample included 850 children exposed to maternal GDM with BF and infant diet assessed by monthly surveys from birth to 1 y and weight and length/height measurements up to ages 6-11 y from electronic health records. Maternal GDM severity was classified by diagnosis time (Early <24 wks or Standard ≥24 wks) and treatment type (Diet or Medication). Child BMI percentiles at 6-11 y were categorized as normal <85
th
(referent), overweight 85
th
to <95
th
, moderate obesity 100 to <120% of 95
th
and severe obesity ≥120% of 95
th
. Multinomial logistic regression estimated adjusted odds ratios (aOR) and 95%CI of child BMI categories associated with fetal GDM exposure (diagnosis time & treatment) and postnatal diet; BF inadequate <6 months or adequate >6 months and sugary beverages (fruit juice or sugar added) adjusted for race/ethnicity, WIC recipient, pre-pregnancy BMI and gestational weight gain.

Results:
There were 480 (56.5%) children with normal weight, 150 (17.6%) with overweight, 155 (18.2%) with moderate obesity and 65 (7.6%) with severe obesity. Child average age (SD) at follow-up was 9.6 (1.4) y. Early GDM diagnosis was associated with aORs [95%CI] of severe obesity = 3.06 (1.33-7.04) with medication, and 2.61 (1.08-6.35) with diet and of moderate obesity = 1.93 (1.05-3.55) with diet vs. Standard diagnosis with diet. Inadequate BF with sugary beverage or fruit juice was associated with aOR [95%CI] of severe obesity = 3.06 (1.07-8.72) vs. adequate BF and no beverage.

Conclusions:
Earlier fetal exposure to maternal GDM and shorter BF combined with sugary beverages in the first postnatal year shows persistent higher risk of severe child obesity about 10 y later. These findings highlight pre-pregnancy screening to avert GDM and the importance of adequate BF and avoidance of sugary beverages and fruit juice among offspring exposed to GDM.
Abstract MP64: Cardiovascular Responses to Occupational Physical Activity Are Exaggerated by Work-Related Stress and Low Fitness
Authors: Quinn Tyler D , Bruehwiler Timothy , Chantler Paul D , Barone Gibbs Bethany
Published: May 2024

Introduction:
Proposed mechanisms explaining the link between high occupational physical activity (OPA) and cardiovascular disease hypothesize that high work-related stress and low worker fitness may exacerbate cardiovascular responses to OPA.

Hypothesis:
Direct associations between OPA and acute cardiovascular responses will be stronger under high work-related stress and in workers with lower fitness.

Methods:
19 male workers (age=46.6±7.9, 68.4% White) with high OPA jobs were observed for seven days. Steps, light (LPA), and moderate-to-vigorous physical activity (MVPA) during work were measured using a thigh-worn activPAL3 micro, hip-worn Actigraph GT3X-BT, and time-use diary. Heart rate (HR) was measured continuously with a Polar chest strap. 24-hour blood pressure (BP) was measured using an ambulatory BP monitor on one workday. Rate-pressure product (RPP), an indirect measure of cardiac workload, was calculated as systolic BP x HR. Daily work-related stress was measured with the Stress in General Scale (scores=-3-21 where higher scores indicate more stress). Worker fitness was estimated as VO
2
max (ml·kg
-1
·min
-1
) using a submaximal treadmill test. Effect modification by stress and fitness on the associations between OPA and RPP was examined using mixed effects models with interaction terms.

Results:
Work-related stress was directly associated with 24-hour RPP (β=94.10 mmHg*bpm/stress point, p=0.024) while worker fitness was not (β=-33.0 mmHg*bpm/VO
2
max, p=0.561). Direct association between RPP and occupational MVPA were stronger with higher work-related stress and lower fitness (Table 1, p-for-interaction<0.05 for all). Lower intensity OPA (steps and LPA) were also associated with exacerbated RPP responses outside of work with higher work-related stress (Table 1, p-for-interaction<0.001 for all).

Conclusions:
OPA performed under high stress or by workers with low fitness may exaggerate cardiovascular responses and contribute to OPA's paradoxical cardiovascular health associations.
Abstract MP69: The “Pressure” of Being an Adolescent in Palestine: Prehypertension and Hypertension Prevalence
Authors: Hamideh Dina M , Strong David , Bandoli Gretchen , Salman Zeena , Crespo Noe C , Al Zabadi Hamzeh , Haraka Amal , Alcaraz John , Mahmoud Lamees , Real Marcos , Ahmadi Nargis , Mansour Mariam , Hamideh Baseel , AlRousan Tala
Published: May 2024

Introduction:
Prolonged exposure to geo-political violence and forced displacement has adverse health impacts, such as hypertension in Palestinian populations residing in Palestine. Over 27% of adults in Palestine are reported as hypertensive, yet there is limited knowledge of hypertension rates among Palestinian adolescents. This study assessed the relationship between refugee status and (pre)hypertension among Palestinian adolescents residing in Palestine.

Hypothesis:
We hypothesized refugees would demonstrate higher prehypertension (PHTN;121/<80 to 129/<80 mmHg) and hypertension (HTN; ≥130/
≥
80 mmHg) prevalence compared to non-refugees, after controlling for age and sex.

Methods:
This cross-sectional study was conducted among Palestinian adolescents residing in refugee camps, villages, and cities in Palestine. A random sample of adolescents was recruited through schools from November 2022 to January 2023. Anthropometric measurements including blood pressure (mmHg), heart rate (BPM), body fat (%), height (cm), body weight (kg) and survey questionnaires were collected. Ordinal regression models were used to assess the relationship between refugee status and (pre)hypertension while controlling for age and sex. Interaction effects were conducted to assess the relationship of refugee status by sex on (pre)hypertension.

Results:
A total of 706 Palestinian adolescents (refugees= 377, [39.4 % females, 60.6 % males] and non-refugees= 329 [39.9% females, 60.1% males]) aged 13-17 (median= 14 years) participated. The overall prevalence of PHTN and HTN was 52.5% and 28.7%, respectively. Refugees had a lower prevalence of PHTN [25.5% vs. 27.0%] and HTN [12.7% vs. 16.0%] compared to non-refugees, although confidence intervals overlapped. Overall, there was no association between refugee status and (pre)hypertension in unadjusted models, or models adjusting for age and sex [AOR 0.88; 95% CI= 0.65-1.20]. The distribution of percent body fat was higher for non-refugees [37%; 95% CI=21%-39%] compared to refugee groups [24%; 95% CI=18-31]. Interaction effect regression models showed an association between refugee status and (pre)hypertension among females. Among females, refugees had 1.75 [95%CI=1.04-2.95] times higher odds of (pre)hypertension than non-refugees after adjusting for age.

Conclusions:
The overall PHTN and HTN prevalence for this participant sample is four and seven times the global average, denoting an alarming public health burden. Future studies should consider the assessment of psychosocial factors that may drive cardiovascular health disparities in adolescent Palestinians.
Abstract MP73: The Association of Urinary Metals With Cardiovascular Disease Incidence and All-Cause Mortality in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Martinez-Morata Irene , Schilling Kathrin , Glabonjat Ronald , McGraw Katlyn , Sanchez Tiffany , Kaufman Joel D , Vaidya Dhananjay , Post Wendy S , Jones Miranda R , Bancks Michael , Shimbo Daichi , Barr R. Graham , Shea Steven , Navas-Acien Ana
Published: May 2024

Background:
Environmental exposure to metals is widespread yet preventable and has been associated with cardiovascular disease (CVD) endpoints, although evidence from prospective studies with racial and ethnic diversity is limited.

Objective:
We assessed the prospective association of urinary metals with incident coronary heart disease (CHD) and CVD and all-cause mortality in a diverse population of adults from the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
We included 6,638 MESA participants (mean (SD) age 62.1(10.2) years, 53% female, 39% non-Hispanic white, 27% non-Hispanic Black, 22% Hispanic/Latino, 12% Chinese). Urinary non-essential metals (cadmium, tungsten, and uranium), and essential metals (cobalt, copper, and zinc) were assessed at baseline (2000-2001). We used Cox proportional hazards regression to estimate adjusted (table footnote) hazard ratios (HR) for the association between urine metals with incident CHD, CVD, and all-cause mortality through 2019.

Results:
Over 17.7 years median follow up (IQR: 12.4, 18.5), 749 (11%) participants developed CHD, 1,162 (17%) developed CVD, and 1,844 (28%) died. In the models adjusted by sociodemographic and behavioral factors (Table 1, [Model 1]), one IQR increase in urinary cadmium, tungsten, cobalt, copper, and zinc at baseline was significantly associated with higher risk of incident CHD, incident CVD and all-cause mortality. Uranium levels were significantly associated with all-cause mortality and incident CVD, but not CHD. The magnitude of the association was attenuated when adjusting the models for clinical risk factors (Table 1, [Model 2]). A linear trend was identified for cadmium and copper and all endpoints.

Conclusion:
Our findings among a large and ethnically diverse US population support that metal exposure is associated with incident CVD and premature mortality. These findings can inform the development of novel preventive strategies to improve cardiovascular health.
Abstract MP78: A Comprehensive Investigation of the Effect of Dietary Intervention on Perfluorooctanoic Acid and Perfluorooctane Sulfonate
Authors: Zhang Ruiyuan , Sun Yixi , Tian Ling , Pan Yang , Sun Xiao , Huang Zhijie , Fan Jia , Zhang Kai , Li Shengxu , Bazzano Lydia A , Chen Wei , Chen Jing , Kelly Tanika N , He Jiang , Bundy Joshua D , Li Changwei
Published: May 2024

Introduction:
The US Environment Protection Agency has proposed National Primary Drinking Water Regulation for six per- and polyfluoroalkyl substances including perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS). The health effects of the two chemicals need to be thoroughly evaluated. In addition, few studies have investigated interventions that can help clear the two chemicals from the human body.

Hypothesis:
We hypothesize that the plasma metabolome reflects reactions of the human body to PFOA/PFOS exposures and dietary supplements can reduce PFOA/PFOS.

Methods:
In the Protein and Blood Pressure (ProBP) trial, 80 participants were randomly assigned to take 40 grams/day of soy protein, milk protein, or carbohydrate supplementation each for 8 weeks in a cross-over design. Plasma PFOA and PFOS levels were tracked from baseline to each of the three intervention phases. We analyzed the associations of serum PFOS and PFOA with a total of 964 known metabolites at baseline and each dietary intervention, respectively. Age, sex, and race were adjusted in all analyses. ProBP findings were evaluated for replication among 1261 participants of the Bogalusa Heart Study (BHS).

Results:
PFOA and PFOS were significantly reduced after phase I and were decreased further with intervention phases. Soy protein showed the strongest reduction on both PFOA (net change: -0.13, p=1.13х10
-5
) and PFOS (net change: -0.18, p=4.32х10
-5
) compared with carbohydrate and milk protein. After Bonferroni correction for 77 independent metabolite clusters (p<6.49х10
-4
), PFOS was positively associated with 54 metabolites (47 at baseline, 9 at soy protein, 8 at milk protein, and 6 at carbohydrate, respectively). Of which, 20 associations were replicated in BHS (
Table
). PFOA was positively associated with 3-methyladipate at soy protein and bilirubin (E,E) at milk protein.

Conclusions:
Dietary intervention reduced serum PFOA and PFOS. Several metabolites may play important roles in PFOA/PFOS related health effects.
Abstract P123: Obesity-Related Inflammasome Activation in COVID-19 and Chronic Conditions: A Post-Mortem Lung Biopsies Study
Authors: DAmico Raissa , Baena Carstens Lucas , DAgostini Julio C , Hlatchuk Elisa , Silva Sofia B , Nagashima Seigo , Baena Cristina P
Published: May 2024

Background:
Obesity has been identified as an independent risk factor for severe COVID-19 outcomes. The association between viral infections and obesity, observed previously, suggests that obese individuals are more prone to severe complications. Several factors, such as increased ACE2 receptor expression, anatomical effects on lung function, and chronic inflammation contribute to this relationship yet the activation of the NLRP3 inflammasome pathway is a key element in understanding this mechanism.

Objective:
This study, conducted with
post-mortem
lung biopsies of obese individuals who died from COVID-19 (Group A) and from chronic conditions (Group B), focused on the involvement of the NLRP3 inflammasome pathway. Our primary goal was to determine whether chronic NLRP3 inflammasome activation in obese individuals is different in critical COVID-19 and in critical chronic conditions.

Methodology:
We conducted a retrospective analysis utilizing clinical data and
post-mortem
lung tissue samples from two distinct groups. Group A comprised 14 obese patients who succumbed to COVID-19, while Group B consisted of 9 obese individuals who passed away from causes unrelated to COVID-19, including thromboembolic events, metastatic neoplasms and acute myocardial infarction. The average age of the groups A and B is, respectively, 67 (ranging from 51 to 86) and 62.6 (ranging from 42 to 79) years. Immunohistochemical analysis was employed to assess the expression of twelve markers associated with inflammation (IL-6, IL-8, TNF-α, IL-18, IL-1β and HIF 1-α.) and the NLRP3 inflammasome pathway (NLRP3, ASC, CASP-1, CASP-9, gasdermin-D). Statistical analysis was performed using Mann-Whitney, Student’s t-test and Fischer’s exact test.

Results:
Group B showed significantly higher expression of IL-6 (p <0.0001), NLRP3 (p = 0.0004), IL-18 (p = 0.002), HIF 1-α (p = 0.0327), CASP-9 (p < 0.0001), and NF-Kb (p < 0.0001). No significant differences were found for IL-8 (p = 0.8291), TNF-α (p = 0.2349), IL-1β (p = 0.5856), gasdermin-D (p = 0.3301), and ASC (p = 0.0572). CASP-1 expression was higher in Group A (p = 0.0142) marking pyroptosis in the COVID-19 group.

Conclusion:
While our study did not confirm chronic NLRP3 inflammasome activation was different between the two obese groups, it did reveal a distinctive pattern of cell death through pyroptosis, prevalent in obese individuals with COVID-19. Our findings underscore the necessity for additional research to unveil obesity as the underlying mechanism governing disease severity in infectious diseases.
Abstract P131: Individualized Risk Prediction for Type 2 Diabetes: A Secondary Analysis of the Diabetes Prevention Program
Authors: Jaeger Byron C , Casanova Ramon , Wells Brian , Demesie Yitbarek , Stafford Jeanette , Bancks Michael
Published: May 2024

Introduction:
Type 2 diabetes (T2D) risk prediction models that predict risk with individualized preventive intervention effects can help targeted prevention.

Hypothesis:
An individualized T2D risk prediction model developed in the Diabetes Prevention Program (DPP) randomized trial that incorporates differential treatment effects based on an individual’s fasting glucose (FG) level and body mass index (BMI) will provide more accurate predictions than a model without individualized treatment effects.

Methods:
We included 2640 DPP participants randomized to the placebo, metformin, or lifestyle arms. Using 50% of the DPP sample, we developed a non-individualized Cox model predicting T2D risk over 3 years with adjustment for sex, hemoglobin A1c, triglycerides, FG, BMI, and treatment, and an individualized model with adjustment for these variables plus interactions between treatment and age, FG, and BMI. In the remaining 50%, we evaluated the prediction accuracy of both models using the concordance (C)-statistic. We repeated this process 100 times with different random splits. We externally validated models among Multi-Ethnic Study of Atherosclerosis (MESA) adults with prediabetes (n=1067) where model predictions were computed for each intervention scenario and averaged for all participants.

Results:
Mean (standard deviation) age of participants was 51 (11) years in the DPP and 64 (10) in MESA, with 67% and 54% women, respectively. Mean C-statistics for our individualized and non-individualized prediction models (100 splits) in DPP were 0.71 and 0.70, respectively (table). The individualized model predicted higher benefit of lifestyle intervention at lower BMI levels and higher benefit of both metformin and lifestyle at higher FG. The C-statistic of the individualized model was 0.78 in the MESA validation.

Conclusion:
Creating individualized estimates of intervention effects can improve accuracy of T2D risk prediction models, allowing patients to make more informed decisions about prevention strategies.
Abstract P138: Smoking Timing, Genetic Susceptibility, and Risk of Incident Type 2 Diabetes: A Cohort Study in UK Biobank
Authors: Hu Ying , Li Xiang , Wang Xuan , Ma Hao , Zhou Jian , Tang Rui , Kou Minghao , Heianza Yoriko , Liang Zhaoxia , Qi Lu
Published: May 2024

Objective:
Smoking is an establish risk factor for type 2 diabetes (T2D); however, little is known about how the timing patterns of smoking is related to T2D risk. We prospectively assessed the association of smoking timing with risk of T2D and examined whether smoking amount or genetic susceptibility might modify the relationship.

Methods:
This study analyzed 294815 participants from the UK Biobank who were free of diabetes at baseline and with complete data on the time from waking to the first cigarette. Cox proportional hazards models were used to evaluate the association between smoking timing and risk of incident T2D.

Results:
During a median follow-up time of 12 years, a total of 9937 incident cases of T2D were documented among the 294815 participants. Compared to non-smokers, shorter time from waking to the first cigarette was significantly associated with a higher risk of incident T2D (
P
for trend <0.0001). The adjusted hazard ratio (aHR) associated with smoking timing was 1.46 (95% confidence interval [CI] 1.17-1.81) for >2 hours, 1.51 (1.21-1.87) for 1-2 hours, 1.58 (1.34-1.85) for 30-60 minutes, 1.86 (1.57-2.21) for 5-15 minutes, and 2.01 (1.60-2.54) for <5 minutes, respectively. We found that even among light smokers, those with the shortest time from waking to the first cigarette had a 105% higher risk of T2D (HR 2.05, 95% CI 1.52-2.76), which was comparable to heavy smokers. The genetic risk score for T2D did not modify this association (
P
-interaction =0.51).

Conclusions:
Our findings indicate that shorter time from waking to the first cigarette is significantly associated with a higher risk of incident T2D, independent of the amount of cigarettes smoked.
Abstract P142: Trends and Racial/Ethnic Differences in Age at Diagnosis of Type 1 and Type 2 Diabetes Among Adults in the United States, 2016-2022
Authors: Li Kexin , Zhong Victor W
Published: May 2024

Introduction:
Age at diagnosis of diabetes and diabetes type are associated with medical costs, lost productivity, vascular complications, and premature mortality that affect people disproportionately by race/ethnicity. However, age at diagnosis of diabetes by diabetes type and race/ethnicity along with their temporal trends are unclear.

Hypothesis:
We assessed the hypothesis that different trends and racial/ethnic differences in age at diagnosis of diabetes by diabetes type existed between 2016 and 2022.

Methods:
Adults aged 18 years or more were included from the National Health Interview Survey, 2016-2022. Type and age at diagnosis of diabetes were self-reported. Trends in age at diagnosis of type 1 diabetes (T1D) and type 2 diabetes (T2D) and in proportions of people with T1D or T2D diagnosed at different ages were assessed by linear and logistic regressions adjusted for sex and race/ethnicity, respectively. Racial/ethnic differences in age at diagnosis of T1D and T2D were estimated using Rao-Scott chi-square test.

Results:
Of 16,063 participants, 1,551 individuals had T1D with a mean [SE] age of 53.1 [0.6] years; 48.7% were women and 57.9% non-Hispanic White. T2D was found in 14,512 individuals with a mean [SE] age of 62.5 [0.2] years; 48.5% were women and 53.7% non-Hispanic White. The mean [SE] diagnosis age of T1D decreased from 37.5 [1.4] years in 2016 to 35.6 [1.4] years in 2022 (
P
for trend = 0.03). During the same period for T2D, the mean [SE] diagnosis age increased from 48.7 [0.4] years to 49.2 [0.3] years (
P
for trend <0.001). From 2016 to 2022, the proportion of people with T1D and T2D diagnosed at <45 years increased by 8% and decreased by 3% annually, respectively (
P
for trend ≤0.01); the proportion of people with T1D and T2D diagnosed at ≥60 years decreased by 9% and increased by 3% annually, respectively (
P
for trend ≤0.03). All results were adjusted for sex and race/ethnicity. Compared with non-Hispanic Whites, the mean diagnosis age of T1D was 7.8, 7.9, and 11.2 years higher whereas of T2D was 5.0, 6.4, and 2.5 years lower, respectively, in non-Hispanic Black, Hispanic, and non-Hispanic Asian people (all
P
for difference ≤0.002).

Conclusions:
In US adults, the mean age at diagnosis of T1D significantly decreased, whereas of T2D significantly increased from 2016 to 2022. Substantial differences in diagnosis age of T1D and T2D by race/ethnicity existed.
Abstract P151: Increased Gain of Skeletal Muscle Adiposity in Middle-Aged African Caribbean Men With Type 2 Diabetes
Authors: Cvejkus Ryan , Zmuda Joseph , Santanasto Adam , Wheeler Victor , Miljkovic Iva
Published: May 2024

While type 2 diabetes (T2D) is a known risk factor for the acceleration of muscle loss with aging, less is known about the impact of T2D on skeletal muscle fat infiltration (i.e., myosteatosis) and overall adiposity. Myosteatosis increases with aging, is greater in African as compared to European ancestry individuals, and plays an important role in the development of T2D. Thus, we investigated the association of T2D with changes in body adiposity distribution, with a particular interest in myosteatosis. T2D was identified by self-report, use of hypoglycemic agents, or fasting glucose levels of ≥ 126 mg/dL. Longitudinal changes in computed tomography-measured calf skeletal muscle density [as an inverse surrogate measure of intramuscular adiposity (mg/cm
3
)] and dual-energy X-ray absorptiometry-measured regional and whole body fat were examined by T2D status over an average of 6 years in 724 African-Caribbean men aged 40-54 years from the Tobago Health Study. Total body, arm, leg, and trunk adiposity increased to a significantly greater extent among men without compared to with T2D. In contrast, men with T2D had a 1.6 times greater decrease in calf skeletal muscle density compared with their non-diabetic counterparts (p=0.03). T2D is associated with lower gains in general adiposity, but an increased gain in skeletal muscle adiposity among middle aged African Caribbean men. Our novel findings suggest that middle-aged African Caribbean men with T2D might be at especially high risk for increased gain of myosteatosis. Interventions targeted for men in this age group could focus on controlling diabetes, slowing myosteatosis, and promoting healthy aging.
Abstract P157: Awareness of Heart Failure, Blood Pressure Management and Self-Efficacy: The Research Goes Red for Women Registry
Authors: Conners Katherine , Hashemian Maryam , Kinzy Claire , Hall Jennifer L , Herr Christine , Sharma Reeti , Mallya Pratheek , Zhao Juan , Ibrahim Nasrien , Shearer Joe , Hong Haoyung , Roger Veronique L
Published: May 2024

Background:
Heart failure (HF) is increasing in the U.S., and awareness is needed for prevention. Hypertension is the leading cause of HF, and adherence to antihypertensive medication is critical for reducing HF risk. Self-efficacy positively influences health-promoting behaviors.

Objectives:
Assess HF awareness, test associations with antihypertensive medication adherence and self-efficacy.

Methods:
We leveraged data from participants enrolled in the American Heart Association’s Research Goes Red registry, an online platform powered by Verily. Three surveys ascertained HF awareness, blood pressure management, and self-efficacy. HF awareness scores were calculated based on correct answers to five HF questions. Chi-squared and Kruskal-Wallis tests determined associations between survey domains and participant characteristics.

Results:
2,320 women took the HF awareness survey, 678 the blood pressure management survey, and 755 the self-efficacy survey. Participants were predominantly non-Hispanic White (78%) with a median age 51 (IQR: 39, 62). The median HF awareness score was 4 out of 5 (IQR: 4, 5). Participants with high HF awareness vs low were more likely to be older (p<0.001), non-Hispanic White (p<0.001), and less likely to smoke (p<0.001) or have depression (p=0.03). 89% of hypertensive participants reported medication adherence, which was not associated with HF awareness or self-efficacy. Participants with greater self-efficacy vs less were more likely to have higher HF awareness score (p=0.04), be older (p=0.01) and less likely to have depression (p=0.01).

Conclusion:
Women’s awareness of HF and adherence to antihypertensive medication in this cohort was high. Depression and younger age may be important factors affecting both women’s awareness of HF and confidence in managing their chronic disease medication plans. Hispanic, non-Hispanic Black, and young women may benefit from increased education on and awareness of HF
Abstract P174: Food as Medicine: Evaluating the Effect of a Food Insecurity Intervention on Lipid-Lowering Prescription Medications
Authors: Abid Aneeqa , Tester June , Goldman Rosas Lisa , Xiao Lan
Published: May 2024

Introduction:
Food insecurity and chronic diseases are interrelated challenges, as access to healthful food can hinder effective prevention and management of chronic diseases such as hyperlipidemia. ‘Food as Medicine’ programs that integrate food deliveries and behavioral interventions into healthcare have been recommended for addressing this challenge. While there is some evidence to support the benefits of these initiatives, there has been limited research to evaluate their effectiveness, especially on outcomes related to hyperlipidemia or lipid medication utilization.

Methods:
This study utilized a quasi-experimental design, using propensity-score matching to compare participants enrolled in the Recipe4Health intervention (R4H) to a control group of participants in clinics where this intervention was not implemented. R4H included 12 weekly deliveries of produce, with or without group medical visits (GMV) with 12 weekly sessions. We examined whether R4H was associated with a change in the intensity of participants’ prescribed regimens. Patient prescriptions for statins as well as any other prescription medications and relevant supplements were assessed. Regimens were standardized to assess whether if a patient’s daily prescribed regimen intensified (e.g. increased dose or added medications), de-intensified (e.g. decreased dose and/or removed medications), or demonstrated no change. Two outcome measures were defined, Overall Regimen Change and Statin-specific Change. Adult participants were included, excluding pregnant women. Generalized linear mixed models were used assuming a multinomial distribution for the outcomes separately for the categories.

Results:
Patients who took part in the R4H with GMV were more likely to have a medication regimen intensification compared to controls (28.2% vs. 21%, p=0.05). Although not significant, there was a trend of greater reduction in overall medication regimen among patients who participated in R4H with GMV compared to controls ( 6.1/5.2% vs. 1.4%). There was a non-significant trend of reduction in medication among patients in Food Farmacy with GMV/without GMV alone compared to controls for the statin potency change outcome (1.2/3.2% vs 0%), whereas the trend of medication intensification was comparable for all three groups.

Conclusion:
These results indicate that the group medical visit component of the R4H intervention may have increased patient engagement with medical services, thus resulting intensified medication regimen.
Abstract P175: Total Fasting and Post-Load and Individual Fasting Non-Esterified Fatty Acids and Total and Cause-Specific Mortality: The Cardiovascular Health Study
Authors: Bene-Alhasan Yakubu , Shitole Sanyog G , Matthan Nirupa R , Lichtenstein Alice H , Ix Joachim H , Buzkova Petra , Hirsch Calvin , Siscovick David S , KIZER JORGE R , Djousse Luc , Mukamal Ken J
Published: May 2024

Background:
Total fasting non-esterified fatty acid (NEFA) levels have been associated with total and cause-specific mortality in older adults, but the corresponding associations with NEFA levels following the metabolic challenge of an oral glucose tolerance test (OGTT) and with individual fasting NEFA species have not been quantified

Methods:
We studied 1996 participants from the Cardiovascular Health Study with a mean age of 78 years who had total serum NEFA measured enzymatically before and two hours after an OGTT and fasting individual NEFA measured using gas chromatography in samples collected in 1996-1997. 1678 participants died over a median follow-up of 11 years. Multivariable Cox proportional hazard models were used to evaluate adjusted hazard ratios (aHR) for mortality associated with standard deviation increments of fasting and post-load total NEFA and fasting individual and subclasses (saturated, monounsaturated, n-3 and n-6 polyunsaturated, and trans)

Results:
Fasting NEFA were associated with an increased risk of all-cause mortality (aHR 1.17, 95% CI 1.10 - 1.23). In contrast, levels of post-load NEFA were not associated with mortality (aHR 0.98, 95% CI 0.93 - 1.03). Among NEFA subclasses, only monounsaturated fatty acid (MUFA) were associated with total mortality (aHR 1.24, 95% CI 1.09 - 1.41). In cause-specific analyses, MUFA were associated with higher risk of death from dementia, cardiovascular, respiratory, infectious and kidney disease. For individual NEFAs, nervonic acid (aHR 1.06, 95% CI 1.01 - 1.12) and petroselaidic acid (aHR 1.21, 95% CI 1.03 - 1.42) were associated with higher risk of all-cause mortality whereas eicosapentaenoic acid (aHR 0.90, 95% CI 0.82 - 0.99) was associated with lower risk

Conclusion:
Among community-dwelling older adults, total fasting but not post-load NEFA were associated with higher risk of death. Among subclasses and individual species, MUFA, nervonic, and petroselaidic acids were associated with higher risk, and eicosapentanoic acid with lower risk, of mortality.
Abstract P178: Prevalence of Elevated LDL-C and Non-HDL-C in Adults With Total Serum Cholesterol in the Normal Range
Authors: Essa Mohammed , Zhang Zhiyaun , Martin Seth S , Michos Erin D , Jones Steven R , Spatz Erica S , Blumenthal Roger S , Faridi Kamil
Published: May 2024

Background:
Normal serum total cholesterol (TC) based on standard lab definitions is typically considered <200 mg/dL. However, normal TC levels do not indicate optimal levels of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C), the two measures most associated with risk of atherosclerotic cardiovascular disease (ASCVD).

Methods:
This study included all adults ≥18 years of age in NHANES from 1999-2018 without ASCVD and with TC <200 mg/dL while not on lipid-lowering therapy (n = 11,843). We evaluated age-adjusted, survey-weighted prevalence of LDL-C ≥100 mg/dL or non-HDL-C ≥130 mg/dL in the total population and within subgroups.

Results:
Among adults with normal TC, half (95% CI 48.5-51.3%) had either LDL-C ≥100 mg/dL or non-HDL-C ≥130 mg/dL. Among all subgroups, the highest prevalence of elevated LDL-C or non-HDL-C was seen in adults with elevated triglycerides (85.5% [95% CI 80.0-91.0%] for those with triglycerides > 400 mg/dL and 67.0% [95% CI 64.0-69.9%] with 150-400 mg/dL) or metabolic syndrome (66.2%, 95% CI 63.2-69.1%). A higher prevalence of elevated LDL-C or non-HDL-C was also seen in adults who were male, 40-80 years of age, or of Hispanic ethnicity, as well as those with pre-diabetes, diabetes, or elevated body mass index (Table). Prevalence of elevated LDL-C or non-HDL-C was substantially lower with decreasing levels of TC, ranging from 37.4% (95% CI 36.0-38.8%) for adults with TC <190 mg/dL down to 0.2% (95% CI 0.0-0.5%) for adults with TC <150 mg/dL (Table).

Conclusions:
Among adults free of ASCVD with TC <200 mg/dL and not on lipid lowering therapy, half have elevated serum LDL-C or non-HDL-C. Current definitions of normal TC are therefore insufficient to identify ASCVD risk in the general population, particularly those with metabolic syndrome, elevated blood glucose or triglycerides, or increased body weight. Lower goals for normal TC and increased emphasis on non-HDL-C should be considered as part of public health measures for primary prevention.
Abstract P180: Navigating Lipid Discrepancies: Implications for Cardiovascular Risk With LDL, Non-HDL, LDL-P, and ApoB
Authors: Hassan Sharjeel , Triffon Douglas W
Published: May 2024

Background:
Lipid discordance, characterized by conflicting results among various lipid measures used in cardiovascular risk assessment, has been a subject of interest and concern. Previous comparisons of LDL-C and non-HDL-C with ApoB and LDL particle numbers as cardiovascular risk predictors have shown conflicting results, partly because they were treated as independent variables. This study aimed to examine the extent of lipid discordance and its implications for risk assessment.

Methods:
A cross-sectional study involving 106 individuals with lipid panels was conducted, and LDL cholesterol (LDL-C), non-HDL cholesterol (non-HDL-C), LDL particle number (LDL-P), and Apolipoprotein B (ApoB) were measured using standardized methods. Lipid discordance was defined as disagreement in risk categorization between different measures based on established cut-off values. Prior studies have described three different approaches to identify discordance such as quintiles, percentiles or the median, and all have demonstrated similar clinical results. Our analysis utilized the percentile method.

Results:
The results revealed a substantial level of lipid discordance, with 91.5% of individuals having at least one discordance among the four lipid measures. Most prevalent was the discordance between LDL-C and LDL-P, observed in 70.75% of individuals, with an average discordance of approximately 45.03% for LDL-P. Additionally, 20.75% of individuals displayed discordance between LDL-C and ApoB, averaging about 17.07%. The remaining 8.49% showed relative concordance.

Conclusion:
Our study highlights significant lipid discordance among various measures, impacting cardiovascular risk assessment. Increased ApoB or LDL particle numbers elevate risk, even with stable LDL-C and non-HDL-C. Conversely, low ApoB or LDL particles and elevated LDL-C or non-HDL-C indicate lower risk. We stress the limitations of population-based lipid management and advocate personalized strategies based on the most discordant lipid measure, improving accuracy and outcomes. Individualized risk assessment and tailored interventions are crucial.
Abstract P182: Ratio of Cholesterol to Triglycerides Within High-Density Lipoprotein (HDL) as a Novel Marker of Risk for Myocardial Infarction (MI)
Authors: Koyama Yuka , Avery Christy L , Young Kristin , Koenigsberg Sarah , Downie Carolina G , Meyer Michelle , Chasman Daniel I , Rexrode Kathryn M , North Kari E , Ding Ming
Published: May 2024

Background:
HDL cholesterol, together with LDL-c and triglycerides, are biomarkers widely used to assess risk of myocardial infarction (MI). Thereafter, apoA1 and HDL particle number (HDL-P) were identified as biomarkers inversely associated with risk of MI. State-of-the-art nuclear magnetic resonance spectroscopy allows for profiling of lipidomic markers within HDL, providing an unprecedented opportunity to identify novel biomarkers of MI.

Methods:
We examined associations between HDL lipid components and risk of MI in the UK Biobank. We leveraged the most up to date lipidomic data measured by NMR. A total of 8229 MI incidents were documented among 249,140 participants over a median 17.7 years of follow-up.

Results:
Independent of existing risk factors including LDL-c, triglycerides, apo-A1, HDL-P, the percentage of cholesterol over total lipids in HDL was inversely associated with the risk of MI with Hazard Ratio (HR) of 0.85 (0.76, 0.95), when comparing the highest quintile to the lowest. The percentage of triglycerides in HDL was positively associated with 1.13 (1.01, 1.26). We created the ratio of cholesterol to triglyceride within HDL and found it to be inversely associated with risk of MI (HR=0.89 [0.79, 0.99]). This finding is robust and consistently supported across subclasses of HDL.

Conclusions:
The ratio of cholesterol to triglycerides within HDL particles may be a new marker of risk for MI, independent of existing biomarkers.

Table 1
. Hazard Ratios for Myocardial Infarction (MI) across Percentages of Lipids in HDL.

Model 1: Cox model adjusted for conventional covariates: Age, Sex, Race, Body Mass Index, Hypertension status, Statin Use, Type 2 Diabetes status, Smoking, Education, Alcohol intake, and Townsend Deprivation Index, LDL-C, and TriglyceridesModel 2: Cox model adjusted for Model 1 covariates plus Apolipoprotein A1 and HDL particle number.