bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P018: Association Between Markers of Inflammation and Total Stroke by Hypertensive Status Among Women
Authors: Jimenez Monik C , Rexrode Kathryn M , Kotler Gregory , Everett Brendan M , Glynn Robert J , Lee I-Min , Buring Julie E , Ridker Paul M , Sesso Howard D
Published: July 2021

Background and Purpose:
High sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1) and fibrinogen are markers of systemic inflammation that have been associated with a greater risk and severity of total and ischemic stroke, as well as with elevated blood pressure, a primary risk factor for stroke. However, few studies have examined whether the role of these inflammatory risk factors on stroke pathophysiology is influenced by hypertension status.

Methods:
Blood samples were collected and assayed for hsCRP, sICAM-1, and fibrinogen among 27,330 initially healthy women from the Women’s Health Study who were followed from 1992-2014. Self-reported hypertension status, cardiovascular risk factors, lifestyle and alcohol consumption were obtained from the baseline questionnaire prior to randomization. New cases of stroke were ascertained by self-report on annual follow-up questionnaires and counted only if confirmed by medical records according to the National Survey of Stroke criteria. The primary outcome was total stroke with ischemic and hemorrhagic evaluated as secondary outcomes. Multivariable Cox models were utilized to estimate the overall association between each marker of inflammation and stroke, and also separately stratified by hypertension status.

Results:
We observed 629 incident total strokes over 477, 278 person-years. In overall multivariable analyses, the highest quartile of hsCRP and sICAM-1 were associated with a significantly greater risk of total stroke compared to the lowest quartile (hsCRP: HR=1.76, 95% CI: 1.38, 2.24, p-trend<0.001; sICAM-1: HR=1.29, 95% CI: 1.01, 1.65, p-trend =0.01). Fibrinogen was not significantly associated with risk of total stroke in multivariable models. All main effect estimates were attenuated when adjusted for baseline hypertension status. In analyses stratified by hypertension status at baseline, elevated hsCRP (extreme quartiles) was significantly associated with risk of total stroke only among prehypertensive (p-trend=0.03) and hypertensive women (p-trend=0.07), although the interaction was not statistically significant. In analyses by stroke type, the findings for ischemic stroke were similar to those of total stroke, while there was no significant association observed with hemorrhagic stroke for any of the measured markers of inflammation, among the limited number of events (n=111).

Conclusions:
In this cohort of women free of cardiovascular disease at baseline, elevated hsCRP and sICAM-1 were significantly associated with risk of stroke. Furthermore, the association between hsCRP and stroke may be restricted to prehypertensive and hypertensive women.
Abstract P109: Lipid Accumulation Product (LAP) is Associated with Hepatic Steatosis Among Individuals without Metabolic Syndrome
Authors: Oni Ebenezer T , Ogunmoroti Oluseye , Blaha Michael , Agatston Arthur S , Blumenthal Roger S , Carvalho Jose , Conceiçao Raquel , Santos Raul D , Nasir Khurram
Published: July 2021

Background:
The Lipid accumulation product (LAP) is a simple index formulated to identify cardiometabolic disorders. It has been shown to be predictive of the metabolic syndrome (MS) and its associated risk. Hepatic steatosis (HS) is associated with cardiometabolic disorders and considered an independent risk factor for increased cardiovascular disease (CVD). We evaluated the association of LAP with HS is the presence and absence of MS in an asymptomatic population.

Methods:
We evaluated 6,464 asymptomatic Brazilian subjects (43±10 years, 79% males) between November 2008 and July 2010. LAP (waist-58 х triglycerides [nmol/L]) was divided into quartiles and HS was defined by abdominal sonogram.

Results:
The overall prevalence of HS was 36% (n=2,310). There was a steady increase in HS prevalence with LAP quartiles: Q1- 3%, Q2- 14%, Q3- 31%, Q4- 52, p<0.001. Twenty percent had MS, 75% of whom were in the 4
th
quartile of LAP. In a logistic regression analysis higher quartiles of LAP were independently associated with higher prevalent odds of HS. When stratified by the presence of MS, the association only remained significant among persons without MS. See Table below.

Conclusions:
In an asymptomatic population there is an association between the higher LAP index and Hepatic Steatosis in persons without the metabolic syndrome. LAP index may be a relevant tool in predicting and screening for HS in individuals without MS.
Abstract P124: Leisure Time Physical Activity and Cardio-metabolic Health: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Lin Xiaochen , Alvim Sheila , Bensenor Isabela M , Simoes Eduardo J , Lotufo Paulo A , Liu Simin
Published: July 2021

Context:
Physical inactivity and cardio-metabolic diseases are increasingly prevalent in Brazil, and preventive guidelines are urgently needed for physical activity (PA) promotion in Brazilian populations.

Objective:
To investigate the association between leisure time PA and cardio-metabolic health in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods:
We conducted a cross-sectional analysis of the baseline data from 11,547 women and men aged 35-74 free of cardiovascular diseases (CVD) in the ELSA-Brasil. Data on PA was obtained using the International Physical Activity Questionnaire. Physical activity status was defined according to the American Heart Association’s recommendation (at least 150 minutes/ week moderate activities or 75 minutes/week vigorous activities). Multivariable linear/logistic regression models were used to examine the sex-specific associations of leisure time PA with intermediate cardio-metabolic markers (systolic/dialectic blood pressure (SBP/DBP), heart frequency, and Framingham Risk Scores) and cardio-metabolic diseases (hypertension, diabetes, and predicted 10-year risk of CVD). We also conducted two sets of sensitivity analyses using 1) an alternative definition of PA (PA-related energy expenditure ≥ 1000 kilocalories/week) and 2) additional adjustment for education and income.

Results:
In total, 1,183 women and 1,387 men were classified as active. After taking into account multiple covariates, the favorable effects of leisure time PA on cardio-metabolic parameters were evident for both women and men
(Table)
. These associations did not change appreciably when the alternative definition of PA was used or additional socioeconomic variables were taken into account.

Conclusion:
We observed significant beneficial effects of leisure time PA on cardio-metabolic health in this large Brazilian population that are consistent with studies in high-income countries of North America and Europe.
Abstract P161: Effect of Yoga Program on Cardiovascular Function in Elderly with Stage-I Hypertension
Authors: Patil Satish G
Published: July 2021

Introduction:
Hypertension is a major cause of cardiovascular (CV) morbidity and mortality in elderly population. Hypertension along with aging leads to left ventricular hypertrophy, systolic and diastolic dysfunction and congestive heart failure. We aimed to determine the effect of yoga program on cardiovascular indices in elderly with stage-I hypertension.

Hypothesis:
We hypothesize that yoga lifestyle modality may induce significant beneficial changes in cardiovascular function in elderly individuals with hypertension. Yoga program may be more beneficial than walking for cardiovascular health in elderly.

Methods:
A parallel arm, open label, single blind, randomized controlled study was conducted on elderly people with stage-I hypertension aged above 60 years (n=44). Yoga group (n=24) was assigned for yoga practice (includes asanas, pranayama and meditation) and control group (n=20) for brisk-walk for one hour in the morning for 6 days in a week for three months. The outcome measures were cardiovascular indices derived from pulse wave analysis such as left ventricular ejection time (ET), diastolic time (DT) pulse duration (PD), percentage of mean arterial pressure (%MAP), upstroke time (UT), ejection slope (ES), ejection duration index (ED%), pre-ejection period (PEP), and heart rate.

Results:
The mean within-yoga group change in PD(ms) was -50.29 (CI=-98.5, -2.07; p=0.042), DT(ms): -49.04 (CI=-88.47, -9.61; p=0.017), ED%: 2.107 (CI=0.92, 3.28; p=0.001), HR(bpm): 4.41 (CI=0.43, 8.4; p=0.031), %MAP: 2.08 (CI=0.71, 3.44; p=0.04), ES (mmHg/ms): 14.62 (CI=-3.99, 33.24; p=0.118), ET (ms): -0.66 (CI=11.89, 10.55; p=0.903), UT(ms): -2.54 (CI=14.95, 9.87; p=0.676), PEP (ms): -1.25 (CI=-4.17, 1.67; p=0.11).

The mean within-control group change in PD(ms) was 11.15 (CI=-52.26, 74.56; p=0.717), DT(ms): 11.3 (CI=-50.56, 73.16; p=0.706), ED%: -0.101 (CI=-2.7, 2.5; p=0.936), HR (bpm): 0.35 (CI=-4.71, 5.41; p=0.887), %MAP: 0.65 (CI=-1.11, 2.41; p=0.451), ES(mmHg/ms): 0.75 (CI=-15.8, 17.38; p=0.926), ET(ms): 2.2 (CI=-10.5, 14.9; p=0.721), UT(ms): 4.7 (CI=-8.19, 17.59; p=455), PEP (ms): 2.1 (CI=-0.52, 4.72; p=0.11).

Analysis of Covariance showed a significant change between-groups in PD (p=0.021), DT (p=0.02), UT (p=0.048), ED% (p=0.049), HR (p=0.036) while no significant difference was observed in ES (p=0.248), ET (p=0.245), PEP (p=0.102) and %MAP (p=0.262).

Conclusions:
These findings indicate that the yoga practice can induce beneficial changes in cardiovascular function in elderly hypertensive subjects. Further, yoga may be better than walking in improving cardiac health in older individuals.
Abstract P165: Future Burden of Morbidity and Disability in England and Wales: A Modelling Study
Authors: Guzman Castillo Maria , Ahmadi-Abhari Sara , Bandosz Piotr , Shipley Martin , Capewell Simon , Singh-Manoux Archana , Kivimaki Mika , Brunner Eric , O’Flaherty Martin
Published: July 2021

Background:
Cardiovascular disease (CVD) and dementia have profound impacts on the morbidity and disability burden in older people. Uncertainty remains regarding the future incidence of these conditions. We forecast future levels of morbidity and disability in England and Wales up to 2040 under two scenarios regarding CVD and dementia future trends.

Methods:
We developed a probabilistic Markov model (IMPACT-BAM) which follows the transitions of the England and Wales population into health states characterised by the presence or absence of CVD, dementia and disability to 2040. Data sources include national health registers (ONS) and cohort studies (HSE, Whitehall II and ELSA). Modelled CVD and Non-CVD mortality and prevalence trends for disability and morbidity were used to estimate trends in life expectancy (LE), morbidity-free life expectancy (MFLE) and disability-free life expectancy (DFLE). We assumed that CVD incidence and mortality will continue their current trends and modelled two scenarios: Scenario A assumes constant dementia incidence, a common assumption when projecting future burden of dementia; Scenario B assumes 2% annual decline in dementia incidence, as suggested in UK population-based cohorts.

Results:
In 2011, LE at age 65 was 18.4 years for men and 21.0 years for women. In Scenario A, LE at 65 in 2040 will increase to 26.7 and 24.8 years in men and women. DFLE at 65 will increase (by 5.5 years in men and 2.8 years in women, to 21.7 and 20.7 years respectively). MFLE at 65 will increase slightly (by 1.5 years in men and 1.4 in women, to 10.7 and 13.2 years respectively). Disability prevalence would increase by 3.1% to 14.4% ( 1,081,483 of 7,510,299) in men and decrease slightly (by 0.6% to 14% (1,214,754 of 8,676,813)) in women. In Scenario B, LE at 65 in 2040 will increase to a similar degree as in Scenario A, but DFLE and MFLE will increase faster (DFLE: by 7.5 years in men and 4.6 in women, to 23.7 and 22.5 years respectively; MFLE: by 4.5 years for both genders to 13.8 years in men and 16.3 in women). Disability prevalence will slightly increase (by 0.8% to 12.1% (908,746 of 7,510,299)) in men and decrease by 3.0% to 11.4% (989,157 of 8,676,813) in women.

Conclusions:
The future disability burden crucially depends on assumptions about future dementia incidence trends. If the dementia incidence continues unchanged, the duration of morbidity and disability will be prolonged. However, if dementia incidence decreases (as suggested in the UK and mirroring CVD declines) we could live more years in good health, with morbidity compressed into a shorter period before death.
Abstract P166: Folate Intake and Cognitive Status Among Adults 60 Years and Older: National Health and Nutrition Examination Survey (NHANES)
Authors: Shaheen Magda , Sherzai Ayesha , Sherzai Dean
Published: July 2021

Introduction:
Cognitive impairment in elderly is related to Alzheimer’s disease (AD). While an association is reported between cognitive function and lifestyle, conflicting results have been reported between folate and dementia and little is known of this relationship among elderly population in a national sample. Our purpose is to determine the relationship between folate intake and cognitive status among population ≥60 years in a representative sample of the National Health and Nutrition Examination Survey (NHANES).

Hypothesis:
folate intake are associated with cognitive status among population ≥60 years.

Methods:
We analyzed data from the NHANES 1999-2002. Cognitive status was measured by the digit symbol substitution exercise score. The main independent variables were folate intake. Folate intake was categorized into tertiles. We used multiple linear regression adjusting for age, gender, race, education, obesity, physical activity and co-morbidities. SAS V9.3 was used to analyze the data taking into consideration the design, strata and weight.

Results:
Of the 1,249 participants, 43% were male, 83% were white, 32% had less than high school education, 33% were obese, and 49.6% were not physically active. The mean age was 70± 0.45 years. Participants had a mean of 46±0.9 correct score in the cognitive test. Adjusting for the confounding variables, folate intake was associated with cognitive score (2nd tertile adjusted B=3.3 [95% confidence interval (CI)=1.4 and 5.2], p=0.002, and 3rd tertile adjusted B=2.5 [95% CI=0.60 and 4.3, p=0.013).

Conclusions:
Folate intake was independently associated with cognitive status score among participants ≥60 years old. More research is needed to determine the causal association.
Abstract P197: Structural and Functional Arterial Changes in Healthy Women Following Pregnancy
Authors: Desai Mansi , Niemczyk Nancy , Catov Janet , Bertolet Marnie , Barinas-Mitchell Emma , Columbus Mindy
Published: July 2021

Background:
Parity is associated with future maternal cardiovascular disease (CVD) risk in a J-shaped fashion. Markers of vascular aging and future CVD risk, such as common carotid artery intima-media thickness (CCA IMT) and inter-adventitial diameter (IAD), increase acutely during pregnancy. As reported previously, increased CCA IMT did not recede in the early postpartum period. This study aims to determine whether vascular changes during pregnancy persist beyond the initial postpartum period.

Methods:
This study is a follow-up to a prospective study that assessed vascular health in a cohort of 43 healthy women during a first pregnancy and at 6-8 weeks postpartum. Data on physical measures, biomarker assays, pregnancy outcomes, health history and CCA IMT and IAD via B-mode ultrasound were collected at a second post-partum visit 1-5 years following the index birth. Paired t-tests and multivariable linear regression were used to assess changes in vascular measures.

Results:
Sixteen participants with mean±SD age 32.4±4.4 years, BMI 25.6±3.1 kg/m
2
, cumulative breastfeeding time of 19.7±11.2 months and time from index delivery of 2.7±0.8 years completed the second postpartum visit. Eight of these women had ≥ 1 subsequent births. Compared to the third trimester, the decrease in IAD and increase in IMT observed early postpartum, persisted further out postpartum (figure). At the second postpartum visit, larger IAD was associated with higher blood pressure whereas thicker IMT was associated with less time since index birth, greater weight gain, shorter duration of breastfeeding, and lower insulin resistance (all p<0.05).

Conclusions:
Markers of vascular aging did not consistently improve 1 to 5 years after delivery. Persistence of pregnancy related vascular effects suggest a possible mechanism linking increased CVD risk with parity. Prolonged breastfeeding and weight management following pregnancy may be modifiable lifestyle factors affecting future maternal CVD risk.
Abstract P208: Anger During Young Adulthood Increases the Risk of Developing Coronary Heart Disease
Authors: Pollock Benjamin D , Chen Wei , Harville Emily , Zhao Qi , Bazzano Lydia
Published: July 2021

Background:
Some cohort studies have found that anger in adults aged 45+ is associated with incident coronary heart disease (CHD). However, this relationship has not been tested rigorously in young adults. We took advantage of longitudinal measures collected by the Bogalusa Heart Study to examine this association prospectively in young adults.

Methods:
From 1985-1986, 768 young adults from the Bogalusa Heart Study completed the State Trait Anger Expression Inventory (STAXI) and were followed for cardiovascular risk factors. STAXI score is summed from a ten-point test with four response options (1=”never angry”; 2=”sometimes angry”; 3=”often angry”; 4=”almost always angry”). Multivariable linear regression, adjusted for race, BMI, pulse, blood glucose, and alcohol use, was used to test the association between anger and Framingham risk score as a global indicator of CHD risk. Participants were followed through 2010 and a general estimating equations model was used to assess the association between young adult anger (modeled using a restricted cubic spline function) and longitudinal development of CHD risk.

Results:
Our study population was (63.3%) female and (23.2%) black. At baseline, age ranged from 17-27 with a mean (SD) of 22.7 (2.4), and mean STAXI score was 18.6 (5.2). In cross-sectional analyses, STAXI score was not associated with CHD risk at baseline (p=0.20). However, after a median follow-up of 18 years, young adult anger was strongly associated (p=.006) with risk of CHD, with “always angry” subjects having a greater Framingham risk score at follow-up compared to “never angry” subjects (RR=1.71; 95%CI, 1.08 to 2.71), corresponding to a four-fold increase in 10-year risk of incident CHD (4% vs 1%, respectively).

Conclusions:
While it is currently established that anger in middle or late adulthood increases CHD risk, our analysis shows that, in fact, this relationship may be etiologically present much earlier in adulthood and among populations with a low overall CHD risk.
Abstract P213: Psychological Distress and Low Health Locus of Control are Associated with Insulin Resistance
Authors: Eriksson Maria C , Hellgren Margareta I , Daka Bledar , Johansson Boo , Råstam Lennart , Lindblad Ulf , Larsson Charlotte A
Published: July 2021

Introduction:
Comorbidity of depression and type 2 diabetes is common. Less is known about metabolic impairment in association with milder forms of mental health issues, such as psychological distress (PD) and health locus of control (HLoC).

Hypothesis:
To cross-sectionally assess the hypothesis that PD and low HLoC are associated with insulin resistance in a Swedish population.

Methods:
In 2002-2005, a random sample of 2816 men and women aged 30-74 years participated (76%) in a survey in two municipalities in southwestern Sweden. Participants answered questionnaires, performed an OGTT and had anthropometric measurements taken. PD was measured by the validated 12-item General Health Questionnaire. HLoC was measured with the question ‘‘Do you believe that you can do anything yourself in order to preserve good health?”. PD and HLoC were both dichotomized and then combined into a risk score to indicate if the participants were positive for
none
of the factors, for either
HLoC
or
PD
, or for
both
. Insulin resistance was estimated by HOMA-ir. For the present study, 2714 subjects without previously known diabetes were included.

Results:
In general linear models, using
none
as reference (Table I), associations with HOMA-ir were seen for participants with either
PD
or
HLoC,
as well as for those with
both
. The strongest association was seen for
both
and this association remained, as did that for
HLoC,
when adjusting for multiple confounders. However, when adding physical activity to the model (Table I) the association was lost also for those positive solely for
HLoC
compared to those positive for
none
of the factors. In fact, a multiplicative effect on HOMA-ir was indicated with regard to having
both
factors (Table I).

Conclusions:
In the present study, a combination of psychological distress and low health locus of control was significantly associated with insulin resistance, highlighting the importance of further implementation of health psychology in primary care in order to prevent type 2 diabetes and ultimately cardiovascular disease.
Abstract P218: Carotid Intima-media Thickness and Incident End-stage Renal Disease: The Atherosclerosis Risk in Communities Study
Authors: Pang Yuanjie , Sang Yingying , Ballew Shoshana , Grams Morgan , Heiss Gerardo , Coresh Josef , Matsushita Kunihiro
Published: July 2021

Introduction:
Carotid intima-media thickness (IMT) has been reported to predict kidney function decline. However, whether carotid IMT is associated with a hard kidney endpoint, end-stage renal disease (ESRD), has not been investigated.

Hypothesis:
We assessed the hypothesis that increased carotid IMT is associated with ESRD risk.

Methods:
We studied 13,197 ARIC participants at visit 1 (1987-1989) without history of cardiovascular disease including coronary heart disease, stroke and heart failure and assessed whether carotid IMT measured by B-mode ultrasound is associated with ESRD risk using Cox proportional-hazards models. Regarding carotid IMT parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation and internal carotid arteries) measurements.

Results:
Mean age was 54.0 (SD 5.7) years, and there were 3,373 (25.6%) blacks and 7,370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1,000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid IMT was significantly associated with ESRD risk (hazard ratios between quartiles 4 and 1, 1.43 [95%CI: 1.01-2.04] for overall mean IMT and 1.73 [95%CI: 1.22-2.44] for overall maximum IMT). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific IMTs, the associations with ESRD were most robust for bifurcation carotid. The adjusted hazard ratios between quartiles 4 and 1 were 1.48 (95%CI: 1.04-2.11) for mean bifurcation IMT and 1.42 (95%CI: 0.99-2.03) for maximum bifurcation IMT.

Conclusions:
Carotid IMT was independently associated with incident ESRD in the general population. Our findings suggest the shared etiology between atherosclerosis and ESRD and highlight the importance of monitoring kidney function over time in individuals with subclinical atherosclerosis.
Abstract P230: Markers of Hyperglycemia and Intracranial Atherosclerotic Stenosis by Magnetic Resonance Angiography
Authors: Fujiyoshi Akira , Suri M.Fareed K , Alonso Alvaro , Selvin Elizabeth , Chu Haitao , Guallar Eliseo , Qiao Ye , Zhang Yiyi , Wasserman Bruce A , Folsom Aaron R
Published: July 2021

Introduction:
Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke. Determinants of ICAS include conventional cardiovascular (CV) risk factors such as hypertension and dyslipidemia. The association of diabetes mellitus (DM) and/or hyperglycemia with ICAS, however, is less well documented.

Hypothesis:
In a community-based population, biomarkers of hyperglycemia will be cross-sectionally associated with prevalent ICAS independent of CV risk factors.

Methods:
Our analyses were conducted in a subsample of participants of the Atherosclerosis Risk in Communities (ARIC) Study who participated in the ARIC-Neurocognitive Study in 2011-13 with cerebrovascular magnetic resonance angiography and no history of stroke. For the present analyses, we grouped the participants into 3 categories based on the highest ICAS category among any of the intracranial arteries we assessed: “no stenosis”, “<50%”, or “≥50% (including occlusion)”. Diagnosed diabetes was defined as self-reported physician diagnosis or use of antidiabetic medication. Ordinal logistic regression provided odds ratios of prevalent ICAS according to quintile of glucose or glycated hemoglobin (HbA1c) adjusted for CV risk factors.

Results (Table):
There were 1,658 individuals included in our study (age 67-90 years, women 58%, Black 29%), 31% (514/1658) had diagnosed diabetes, 10% (165/1658) had ≥50 % stenosis at any of the intracerebral arteries. In crude analyses, those with higher glucose and HbA1c were more likely to have ICAS among the non-diabetes and the diabetes. In logistic regression, highest quintile of glucose, relative to the lowest, had odds ratio of 2.26 (95% confidence interval 1.48, 3.45) for being in each successive ICAS category after adjustment for CV risk factors.

Conclusion:
Higher glucose and HbA1c were associated with higher odds of ICAS independent of CV risk factors. The finding suggests that hyperglycemia plays a role in pathogenesis of ICAS.
Abstract P245: Is Self-efficacy Associated with Patterns of Self-weighing Behavior?
Authors: Zheng Yaguang , Sereika Susan M , Ewing Linda J , Danford Cynthia A , Terry Martha A , Imes Christopher , Goode Rachel W , Mendez Dara D , Mattos Meghan K , Hu Lu , Sun Ran , Burke Lora E
Published: July 2021

Introduction:
Our recent work demonstrated that obese/overweight individuals exhibit different patterns of self-weighing behavior over time. To identify possible contributors to varying patterns, we examined the differences in changes in self-efficacy (SE) by self-weighing pattern groups.

Hypothesis:
Higher self-weighing group would have greater increases in SE levels.

Methods:
This was an analysis of data from a 12-mo behavioral weight-loss intervention study. Each participant was given a Wi-Fi-enabled scale to transmit weight data to a server. Three self-weighing patterns were determined by group-based trajectory modeling:
high/consistent
(>6 days/week);
moderate/declined
(declined from 4-5 to 2 days/week);
minimal/declined
(5-6 to 0 days/week). SE was assessed semiannually by the Weight Efficacy Lifestyle (WEL) Scale, yielding ratings of one’s confidence to avoid eating under varied conditions (e.g., home, social settings) and moods (e.g., depressed, stressed). Higher scores indicate greater levels of SE. Linear mixed modeling was used for data analysis.

Results:
The sample (N=148) was 90.5% female, 81.1% White, with mean (SD) age of 51.3 (10.1) years and BMI of 34.1 (4.6) kg/m
2
. There were no significant differences in self-weighing groups for WEL total and subscale scores at baseline. There was significant group effect for changes in subscale score of Negative Emotions, group by time effect for Social Pressure and time effect for Positive Activities. The
high/consistent
self-weighing group showed significant increases in each subscale score and total score from 0 mos to 6 or 12 mos, with the subscale score of Social Pressure having a marginally significant increase at 12 mos, while the other two groups had no changes over time (see table).

Conclusions:
Participants in the
high/consistent
self-weighing group reported increased SE over time for eating in different contexts. Future work needs to explore strategies to improve eating self-efficacy and self-weighing for those unable to establish this habit.
Abstract P273: Dietary Saturated Fatty Acids and Coronary Heart Disease Risk in a Dutch Elderly Population: Food Source and Carbon Chain Length Matter
Authors: Praagman Jaike , de Jonge Ester A , Kiefte de Jong Jessica C , Beulens Joline W , Sluijs Ivonne , Schoufour Josje , Hofman Albert , van der Schouw Yvonne T , Franco Oscar H
Published: July 2021

Introduction:
The association between dietary saturated fatty acids (SFA) and the risk of coronary heart disease (CHD) is heavily debated and appears to be more complex than initially thought. The food source and carbon chain length of SFA, as well as the macronutrient replacing SFA in the diet may affect the association between dietary SFA and CHD.

Hypothesis:
We assessed the hypothesis that the association between dietary SFA and incident CHD is dependent on the food source of SFA, the carbon chain length of SFA, and the substituting macronutrient.

Methods:
From the Rotterdam Study, we included 4,722 healthy men and women, aged 55 years or older. Baseline (1998-1993) SFA intake was assessed using a validated food frequency questionnaire. Incident CHD comprised fatal and non-fatal myocardial infarctions and coronary mortality up to January 2011, and was assessed through digital linkage with municipality records and general practitioners. We used multivariable Cox’ proportional hazard models to calculate CHD risks for higher intakes of total SFA, SFA from specific food sources, SFA differing in carbon chain length, and for higher intakes of other macronutrients at the expense of total SFA.

Results:
During a median follow up of 16.3 years 569 CHD events occurred. Median total SFA intake was 15.7 en% per day, and the top three food sources were cheese (20.0%), meat (17.8%), and milk and milk products (13.1%). Total SFA intake was not significantly associated with CHD risk (Hazard Ratio (HR) per 5 en%: 1.13, 95%CI: 0.94, 1.22). Neither was SFA from specific food sources, although the data suggested an increased CHD risk for a higher intake of SFA from meat (HR per 1 en%: 1.06, 95%CI: 0.99, 1.14). Regarding SFA differing in carbon chain lengths, a higher CHD risk was observed for C16:0 intake (HR
1en%
: 1.18, 95%CI: 1.03, 1.35), but not for the remaining SFA. No significant associations with CHD risk were observed for each 5% lower intake of energy from SFA and a concomitant higher intake of 5% of energy from carbohydrates (HR
5en%
: 0.90: 0.80, 1.02), polyunsaturated fatty acids (HR
5en%
: 0.90, 95%CI: 0.71, 1.15),
cis
-monounsaturated fatty acids (HR
5en%
:1.09, 95%CI: 0.98, 1.22), or vegetable protein (HR
5en%
: 0.88, 95%CI: 0.50, 1.53).The exception was substitution of SFA with animal protein, which was associated with higher CHD risk (HR
5en%
: 1.24, 95%CI: 1.01, 1.51).

Conclusions:
In this Dutch elderly population, with a high median intake of total SFA, the association between SFA intake and CHD risk depends on the SFA food source and carbon chain length. Future intervention studies are needed to determine the importance of the SFA food sources, and to confirm that C16:0 is more strongly related with CHD risk than other SFA.
Abstract P278: Metabolomic Profiles Associated with Dietary Patterns in Women
Authors: Chandler Paulette D , Balasubramanian Raji , Paynter Nina , Giulianini Franco , Snetselaar Linda G , Liu Simin , Eaton Charles , Tobias Deirdre , Manson JoAnn E , Giovannucci Edward , Clish Clary , Rexrode Kathryn E
Published: July 2021

Background:
Dietary patterns have a complex impact on metabolism with certain foods increasing specific metabolite levels. Metabolomic profiling, an emerging technology, may offer insights into the biological mechanisms linking the Western dietary pattern (WD) with cardiovascular disease and cancer.

Methods:
Metabolomic profiling of 371 metabolites by tandem quadrapole liquid chromatography/ mass spectroscopy was available on 1153 healthy, control subjects in the Women’s Health Initiative. Metabolites were log-transformed and standardized and each considered individually in statistical models. Using factor analyses, we analyzed dietary data and identified two major dietary patterns: WD (high in meat, poultry, fish, solid fat, oils, cheese, processed meats, refined grains, and added sugars) and Prudent dietary pattern (PD) (high in fruits and vegetables). Linear regression models were created with the dietary pattern scores (WD or PD) as a continuous variable for the primary exposure and each metabolite as the outcome. Models were adjusted for matching factors in the primary study (race, time period, hysterectomy status), as well as for body mass index and medications (antihypertensives, anti-diabetic drugs, aspirin and statins). Significant results were defined as FDR adjusted p<0.05.

Results:
Median age was 68 years (interquartile range 62-72). After multivariable adjustment, WD was inversely associated with 2 metabolites: eicosapentaenoic acid (EPA) and docosahexaenoic acid DHA (FDR p=0.01); these were positively associated with the PD, (FDR p<0.0001). PD was significantly associated with 85 metabolites (mostly lipids) including 4 phosphatidylcholines (FDR p<0.0001); among significant inversely associated metabolites were 11 acylcarnitines (e.g.C4-OH-carnitine, FDR p <0.0002), 2 polyunsaturated fatty acids (docosatrienoic acid, FDR p=0.0004 and myristoleic acid, FDR p=0.049), and 12 plasmalogens (e.g. C36.2, C36.3, C36.4 phosphatidylethanolamines,FDR p<0.0001).

Conclusions:
PD is associated with multiple metabolites involved in mitochondrial fatty acid oxidation, as well as several associated with insulin resistance. EPA and DHA levels were lower in those with WD and higher among those with PD. These metabolites may be involved in how dietary patterns impact chronic disease.
Abstract P280: Changes in Food Prices Improve Cardiovascular Disease (CVD) Outcomes
Authors: Sy Stephen , Peñalvo Jose , Abrahams-Gessel Shafika , Alam Sartaj , Pandya Ankur , Mozaffarian Dariush , Gaziano Thomas A
Published: July 2021

Introduction:
Changes in food prices can lead to healthier dietary patterns. Recent meta-analyses suggest the responses differ by food category with respect to impact on disease outcome.

Hypothesis:
We tested the hypothesis that a 10% subsidy on price of fruits, vegetables and whole grains, and a 10% tax on sugar-sweetened beverages, would have differential effects on CVD mortality, non-fatal MI and stroke, and diabetes over a 5-year period through a 20-year period in the U.S.

Methods:
We used an individual-based microsimulation CVD risk prediction model of a million adults created from NHANES sample (aged 35+). Model inputs included patient risk factor information, CVD risk equations, and intervention effectiveness data. The baseline cohort was expanded by adding additional groups of 35-year olds annually to produce cross-sectional outcomes from 2015-2035.

Results:
Using a conservative estimate of population growth, we project that the subsidy-increased consumption of fruits and vegetables would lead to 5- and 20-year reductions of CVD deaths by 8% and 10%, reductions in non-fatal MI by 16% and 18%, and reductions in non-fatal stroke by 25% and 24%, respectively. Subsidy-increased whole grain consumption would have corresponding reductions of 2.5% and 3% for CVD deaths and 9.1% and 9.7% for MI (Table). Tax-induced decreased consumption of sugar sweetened beverages would reduce 5- and 20-year CVD deaths by 0.8% and 1.3%, MI by 2.5% and 2.5%, stroke by 1.8% and 2.3%, and diabetes by 2.6% and 9.8%. Combined these numbers translate to prevention of over 3.5 million CVD deaths and over 4 million combined CVD events by 2035, assuming independent benefits for each food group.

Conclusions:
Pricing interventions resulting in differential changes in dietary habits can significantly reduce CVD outcomes in the U.S by different amounts. Further research should be done in assessing the cost-effectiveness of applying these price changes, as well as the compliance of the population to maintain healthy dietary habits over the 20-year horizon.
Abstract P290: Short-term Weight Change and Long-term Mortality in the Trials of Hypertension Prevention
Authors: Cook Nancy R , Appel Lawrence J , Whelton Paul K
Published: July 2021

Introduction:
Although weight loss has favorable effects on intermediate outcomes, such as blood pressure and insulin resistance, few studies have examined its effects on long-term outcomes including total mortality.

Methods:
In the Trials of Hypertension Prevention (TOHP) individuals aged 30-54 years with high normal BP were randomized to a weight loss intervention, to one of several other lifestyle or dietary supplement interventions, or to usual care. All participants from Phase 1 (1987-90) and Phase 2 (1990-5) were followed for mortality through 2013. The association of weight change during any of the interventions with long-term mortality up to 18-24 years after the trial periods was examined among 3828 participants who fell into a high baseline weight stratum, defined as body mass index at least 26 kg/m2 in men and 24 kg/m2 in women.

Results and Conclusions:
There were 1477 high-weight participants in Phase 1 and 2351 in Phase 2, of whom 21% and 50%, respectively, were assigned to a weight loss intervention. Overall, mean weight change during the trial period was -1.8 lbs (-0.8% of baseline body weight) over 1.5 years in Phase 1 and 1.6 lbs (0.8%) over 3-4 years in Phase 2. A total of 556 (15%) lost > 5%, 1,101 (29%) lost <=5%, 1,567 (41%) gained less than 5%, and 604 (16%) gained > 5% in body weight. Corresponding hazard ratios (HRs) for total mortality were 0.82 (95% confidence interval (CI)=0.57-1.18), 0.94 (95% CI=0.72-1.23), 1.00 (reference), and 1.29 (95% CI=0.92-1.80) (p-trend = 0.046). There was a direct linear relationship with percent change in weight during the trial period and later mortality (HR=1.14 per 5% change, 95% CI=1.02-1.28, p=0.019). This association persisted throughout the course of mortality follow-up (Figure). In these healthy individuals taking part in lifestyle and nutrition supplement trials , short-term weight change was directly associated with mortality about two decades later. These results are consistent with a long-term beneficial effect of presumed intentional weight loss on total mortality.
Abstract P302: Lack of Obesity Paradox in 30 Day and Annual Cumulative Acute Decompensated Heart Failure Readmissions
Authors: Valadri Ravinder , Singhania Namrata , Deborah Deborah , English Richard , Naing LeYu , Desai Khushbu , Litchman Maureen , Linda Thomas , Pancholy Samir , Veledar Emir
Published: July 2021

Background:
Recent study demonstrated paradoxical relationship between body mass Index (BMI) and all cause mortality in patients with acute decompensated heart Failure (ADHF), where higher BMI was associated with decreased mortality. We sought to test whether this relationship exists between BMI and ADHF readmissions

Methods:
Consecutive patients presented to the emergency department from March 2014 to July 2015 with the diagnosis of ADHF were analyzed in a retrospective cohort study. Cohort was grouped in to prespecified BMI categories; normal weight (BMI <26 Kg/m2 ), Over weight (BMI 25-30 Kg/m2 ) and Obese (BMI >30 Kg/m2 and above). Primary endpoints were incidence of 30 day ADHF readmission and time to first ADHF readmission from the index hospitalization. Patients with end stage COPD on home O2, cirrhosis and end stage renal failure on dialysis were excluded. Unplanned hospitalizations due to other cause than ADHF were excluded. ADHF hospitalizations were adjudicated by an independent blinded clinician

Results:
Cohort (N=188) consisted 51(27.1%) normal weight, 61 (32.4%) over weight and 76 (40.4%) obese patients. Females were 63% (N=119), patients with heart failure with preserved ejection fraction were 47% (N=90), Obese [BMI 31(28-38) Kg/m2; Median (IQR)] patients were younger (median age; 77 years vs 83 years; P=0.002), whereas other covariates were similar between groups. In median follow up of 1.2 years, total 30 day ADHF readmissions were 32 and total ADHF admissions were 214. Incidence of both 30 day and total ADHF readmissions were similar in all 3 BMI categories; ANOVA P=0.18 (30 day ADHF readmissions) and P= 0.62 (total ADHF readmissions). Obesity was neither associated with risk for 30 day readmission; OR=0.64 (CI: 0.20 - 2.0; P= 0.45) nor with the time to first ADHF readmission from the index hospitalization; log rank P=0.5 (Figure 1)

Conclusions:
Higher BMI is not protective against ADHF readmissions in patients with ADHF. Further studies are needed in larger data sets to validate our findings.
Abstract P310: Predictors of Phase III Enrollment in Participants Completing Phase II Cardiac Rehabilitation in a Large Urban Cardiac Rehabilitation Center
Authors: Ganga Harsha V , Jantz Jennifer , Choudhary Gaurav , Wu Wen-Chih
Published: July 2021

Background:
Short duration of outpatient Phase II cardiac rehabilitation (CR) program is not sufficient to sustain benefits of CR. Participation in long-term Phase III CR improves exercise capacity and lipoprotein profile.

Hypothesis:
We examined the factors predicting Phase III CR enrollment in those who have successfully completed Phase II CR in a large urban CR center.

Methods:
4714 participants who completed structured 36-session Phase II CR program from the year 2000 to 2014 were included in this retrospective study. Multivariable logistic regression model was used to identify demographic, socio-economic factors predicting Phase III CR enrollment. The Cochran-Armitage test was used to assess temporal trends in Phase III CR enrollment.

Results:
A total of 901, out of 4714 participants completing Phase II CR, enrolled into Phase III CR. Mean age was 65 years and 31% were females. Univariate predictors include age, race, education, occupation, income, return to work obligation, insurance status, weight loss, depression and anxiety, exercise duration, and metabolic equivalents (METs). On multivariable logistic regression, those with at least college education (Odds Ratio [OR] 1.5,95% confidence interval [CI], 1.07-2), depression (OR,1.5, 95% CI, 1.07-1.96), weight loss (OR, 1.03, 95% CI, 1.01-1.05) and attending more Phase II sessions (OR,1.06, 95% CI, 1.02-1.10) were more likely to enroll whereas those living > 30 minutes from CR center (OR, 0.40, 95% CI, 0.20-0.75), with higher METs (OR,0.93, 95% CI, 0.87-0.99) and exercising longer (OR, 0.96, 95% CI, 0.93-0.99) were less likely to enroll. There is significantly increased temporal trend for Phase III CR enrollment (Z=11.34, P<0.0001).

Conclusion:
In participants completing Phase II CR, higher education, depression and weight loss predict increased Phase III CR enrollment whereas increased distance from CR center or better exercise capacity predict decreased Phase III CR enrollment.
Abstract P319: Prospective Association Between Beta-2 Microglobulin and the Risk of Ischemic Stroke in Women
Authors: Rist Pamela M , Jiménez Monik C , Rexrode Kathryn M
Published: July 2021

Introduction:
Elevated beta-2 microglobulin (B2M) is associated with total stroke. Previous studies have not examined the association between B2M and ischemic stroke risk or ischemic stroke subtypes. We hypothesized that women with higher B2M levels would be at increased risk of experiencing ischemic stroke events.

Methods:
We performed a nested case-control study among women enrolled in the Nurses’ Health Study who provided blood samples at baseline (1989-1990) and were free of cardiovascular disease and cancer. We measured B2M levels in 460 ischemic strokes cases which occurred between 1989-2008 confirmed by medical record review and classified as thrombotic or embolic, and in 460 controls matched 1:1 to the cases on age, race, date of blood collection, menopausal status, postmenopausal hormone use, and smoking status. We analyzed the association between B2M and ischemic stroke using multivariable conditional logistic regression conditional on the matching factors and adjusted for physical activity, body mass index, aspirin use, alcohol consumption, log transformed total cholesterol to HDL cholesterol ratio, and history of diabetes, high blood pressure, and coronary heart disease or revascularization.

Results:
The mean age at baseline was 60.5 years with a median of 9.0 years to stroke event. Median levels of B2M were higher among cases (1.86 mg/L) than controls (1.80 mg/L; p-value for Wilcoxon rank sum test=0.009). Those in the highest B2M quartile had a multivariable adjusted increased risk of ischemic stroke compared to those in the lowest quartile (OR=1.68; 95% CI: 1.08, 2.62) (Table). Other quartiles were not associated with an increased risk of ischemic stroke compared to those in the lowest quartile. The association between B2M and thrombotic ischemic stroke was similar to the overall ischemic stroke results. However, we observed no association between B2M and embolic ischemic stroke risk.

Conclusion:
High levels of B2M were associated with an increased risk of ischemic strokes of thrombotic origin among women.
Abstract P320: Dairy Consumption and Risk of Stroke: A Systematic Review and Dose-response Meta-analysis of Prospective Cohort Studies
Authors: de Goede Janette , Geleijnse Johanna M. , Pan An , Gijsbers Lieke , Soedamah-Muthu Sabita
Published: July 2021

Introduction:
A higher milk consumption may be associated with a lower stroke risk. We conducted a comprehensive systematic review and dose-response meta-analysis of milk and other dairy products with stroke risk.

Hypothesis:
We assessed the hypothesis that milk and possibly other types of dairy consumption were inversely associated with stroke risk.

Methods:
Through a systematic literature search prospective cohort studies of dairy foods and incident stroke in stroke-free adults were identified. Random-effects meta-analyses with summarized dose-response data were performed taking into account sources of heterogeneity and spline models were used to systematically investigate nonlinearity of the associations.

Results:
We included 17 studies with 10-26 years of follow-up that included 675,389 individuals and 28,912 stroke events. An increment of 200 gram of daily milk intake was associated with a 7% lower risk of stroke (RR 0.93; 95% CI 0.88-0.97; P=0.003; I2=85%). RRs were 0.82 (95% CI 0.75-0.90) in East Asian and 0.98 (95% CI 0.96-1.01) in Western countries (median intakes 38 and 266 g/d respectively) with moderate heterogeneity within the continents. Cheese intake was marginally inversely associated with stroke risk (RR 0.97; 95% CI 0.94-1.01 per 40 g/d). Risk reductions were maximal around 125 g/d for milk and from 25 g/d onwards for cheese. Based on a limited number of studies, low-fat milk was inversely and high-fat milk directly associated with stroke risk. No associations were found for yogurt, butter or total dairy.

Conclusions:
Milk and cheese consumption were inversely associated with stroke risk. Future epidemiological studies should provide more details about dairy types, including fat content. In addition, the role of dairy in Asian populations deserves further attention.