bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P093: Subclinical Thyroid Dysfunction And Fracture Risk In The Atherosclerosis Risk In Communities Study (ARIC)
Authors: Daya Malek Natalie , Fretz Anna E , Martin Seth S , Lutsey Pamela L , Kottgen Anna , Echouffo Tcheugui Justin , Selvin Elizabeth , Juraschek Stephen P
Published: April 2022

Introduction:
Overt thyroid dysfunction is a risk factor for bone-related outcomes. Clinical hyperthyroidism accelerates bone resorption without compensatory bone formation, reducing bone density. The link between subclinical hyperthyroidism and fracture risk is less clear.

Methods:
ARIC participants who were not on thyroid medication and had no history of fracture at visit 2 (1990-92) were included. Incident fracture was ascertained using ICD-9/10 codes from hospitalizations and linkage to inpatient and outpatient Medicare claims. We used Cox regression to examine the associations of subclinical hyperthyroidism (TSH<0.56 mIU/L, with normal FT4) and subclinical hypothyroidism (TSH>5.1mIU/L, with normal FT4, 0.85-1.4 ng/dL) with incident fracture. Euthyroidism (reference) was defined as TSH 0.56-5.1 mIU/L and normal FT4. We also modeled TSH using splines to characterize the continuous association of TSH with fracture risk.

Results:
There were 11,287 participants (mean age 57; 54% female; 25% black) of which 93% were euthyroid, 2.6% had subclinical hyperthyroidism, and 4.4% had subclinical hypothyroidism. Over a median follow-up of 21 years, there were 3,664 incident fractures (168.1 per 10,000 person-years). The adjusted hazard ratios of fracture were 1.33 (95% CI: 1.09, 1.63) for subclinical hyperthyroidism and 0.89 (0.76, 1.04) for subclinical hypothyroidism. When TSH was modeled as a spline, lower than normal range TSH was significantly associated with increased fracture risk
(Figure).
Fracture risk was highest for TSH levels <0.56 mIU/L, however, there was also an increased risk of fracture for TSH levels 0.56-0.75 mIU/L.

Conclusion:
Subclinical hyperthyroidism was an independent risk factor for fracture. The increased risk for fracture in individuals with a TSH<0.56 mIU/L highlights the need for more aggressive screening and potential treatment of patients with subclinical hyperthyroidism for bone mineral disease.
Abstract P095: Associations Of Age At Menarche With Blood Pressures In Childhood And Adulthood
Authors: Santos Maria P , Li Yaling , Bazzano Lydia A , He Jiang , Ley Sylvia H
Published: April 2022

Objectives:
The objective is to assess the associations of the timing of menarche with the blood pressures (BP) in childhood and adulthood.

Methods:
Participants of the Bogalusa Heart Study were included in this analysis (n=2,295). Our main outcome variables were systolic and diastolic BP in childhood and adulthood (≥20 years old). Incident hypertension was defined as systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher in adulthood (Stage 2). Age of menarche was defined as the reported onset of menstruation.

Findings:
Incidence of hypertension in adulthood was 3.1% (59/1929). Younger age at menarche was associated with high systolic and diastolic BP at both childhood and adulthood after multiple adjustments (all p for trend <0.002; Table). Compared to individuals who had the onset of menarche at 12-13 years, earlier age at menarche (OR 1.65 [95% CI 0.91-2.99]) and later age at menarche (1.17 [0.56-2.42]) had a non-significant trend of higher odds ratios for stage 2 hypertension in adulthood.

Conclusion:
Younger age at menarche is associated with higher systolic and diastolic BP in both childhood and adulthood.
Abstract P096: Developing A Lifestyle-Based Cardiovascular Health Tool For Teens
Authors: Zeichner Elizabeth , Bradley Kolbi , Patterson Sierra , Gooding Holly C
Published: April 2022

Purpose:
Previous studies have shown that young women have low awareness of heart disease, despite cardiovascular (CV) disease being the number one cause of death in women. While CV risk assessment tools exist for adults, there are no similar tools specifically for adolescents. This project focuses on developing a lifestyle-based CV health prediction tool and behavior intervention for young women.

Methods:
We report a qualitative case study of four hour-long semi-structured interviews with young women aged 13-21 years participating in a larger study to develop the new CV health tool. Patients were recruited from a primary care practice in Atlanta, GA. Participants completed the Healthy Heart Score survey, an existing web-based CV prediction tool developed for adults, while providing feedback on how to adapt the tool for young women. Topics included conditions to engage with the tool (e.g. at school or doctor’s office), app architecture (including layout, word choice, and use of visuals), and suggestions for improvement of the tool. We used qualitative coding and thematic analyses to synthesize data.

Results:
Prior to engaging with the Heart Healthy Score tool, participants initially demonstrated minimal knowledge of heart attacks/strokes (“I don’t know about preventing” [heart attacks and strokes]) and of their own risk (“I’ve never associated… young women with [heart disease]”). As participants used the tool, their knowledge of heart healthy choices and awareness of their own choices increased, cueing action (“I definitely need to get my health… together now before it’s too late”). Throughout the survey, teens had varied emotional reactions, from shame/embarrassment about health (“I… got upset because… I shouldn’t be eating this much”), to surprise/shock (“I thought I ate way more fruits and vegetables''), to enthusiasm to engage with app in the future (“I might like to use this tool because it’ll … help me [have] a better way of understanding … what to eat, what is healthy”). Participant recommendations to improve the tool for future use with teens focused on the importance of using examples and visual representations (“All the examples … really help me … figure out … how much I’m eating”, “I don’t really have a good idea of… what ounces really look like… a little visual would help [figure] that out”), and the importance of goal-setting and motivational language to incentivize teens to engage with the tool (“Instead of just telling you what you need to do to become better, they give you… an actual goal”).

Conclusions:
Through this case study, young women demonstrate a knowledge gap about heart disease risk and healthy choices. Adapting a CV health assessment tool for teens, with added examples, visuals, and motivational language, will allow teens to reflect on their own lifestyle choices, increase awareness of their risk for future heart disease, and ultimately serve as an impetus for behavior change.
Abstract P100: Changes In Adiponectin But Not Tnfα Predict Changes In Insulin Sensitivity Following Health Behavior Intervention Among Latino Youth
Authors: Pena Armando , Colburn Abigail , Nwabichie Eucharia C , Sears Dorothy D , Vega Lopez Sonia , Olson Micah , Ayers Stephanie , Knowler William , Shaibi Gabriel
Published: April 2022

Background:
Pediatric obesity is characterized by an imbalance in pro- and anti-inflammatory markers that are associated with cardiometabolic diseases. Adiponectin (Adpn), an anti-inflammatory marker, is associated with insulin sensitivity, while tumor necrosis factor-alpha (TNFα) has been associated with insulin resistance among youth with obesity. However, it is unknown whether longitudinal changes in Adpn or TNFα predict changes in insulin sensitivity among high-risk youth.

Methods:
A total of 73 Latino youth with obesity (age 13.3±1.4 y, Female 40.3%, BMIz 2.2±0.3) were enrolled in either a lifestyle intervention or usual care. Given that there were no between-group differences in changes in insulin sensitivity at 6-months, groups were combined for the present analysis. Fasting serum samples were used to measure high-molecular weight Adpn and TNFα before and after intervention. Insulin sensitivity was estimated by the whole-body insulin sensitivity index (WBISI) using insulin and glucose concentrations from a 75-g, 2-h oral glucose tolerance test. Baseline associations were analyzed using Pearson correlations. Linear regression was used to analyze whether changes in Adpn or TNFα predict changes in WBISI, adjusting for age, sex, and intervention assignment. Data from linear regressions are presented as betas (β) and standard errors (SE).

Results:
At baseline, WBISI was positively and significantly associated with Adpn (r=0.296, p=0.015) but not with TNFα (r=-0.171, p=0.168), adjusting for age and sex. Increases in Adpn were associated with increases in WBISI, whereby for every 1 μg/dL increase in Adpn, there was a 0.7 unit increase in WBISI (SE=0.3, p=0.027). Changes in TNFα did not significantly predict changes in WBISI (β=0.1, SE=0.5, p=0.915).

Conclusion:
Changes in Adpn but not TNFα were associated with changes in insulin sensitivity following intervention among Latino youth with obesity. Whether Adpn is the mechanism by which health behavior changes increase insulin sensitivity warrants further investigation among high-risk youth populations.
Abstract P105: Bypasses To Below-Knee Arteries May Expedite Amputation In Patients With Claudication
Authors: Kalbaugh Corey A , Witrick Brian , Howard Kerry A , McGinigle Katharine L , Lesko Catherine R
Published: April 2022

Objective:
Claudication is an early-stage subtype of peripheral artery disease that may result in surgical intervention. The purpose of this study was to compare the types of elective bypass in a population of Black and White patients with claudication and to identify actionable areas that may explain the higher limb amputation rates observed in Black patients.

Methods:
We identified Black and White patients undergoing elective infrainguinal bypass for claudication using data from the Vascular Quality Initiative registry (2011-2018). Distal bypass target was classified as 1) at or above the popliteal artery (above-knee) or 2) below the popliteal, including all tibial, peroneal, dorsalis pedis and tarsal/plantar arteries (below-knee). Graft conduit was categorized as vein or prosthetic. We calculated one-year risk of major lower limb amputation with 95% confidence intervals (CI) for all combinations of target and conduit, stratified by race. We then forced an intervention on the data to estimate the post-intervention incidence of amputation and the proportion of racial disparity eliminated and 95% CI if everyone received the gold standard treatment (above-knee, vein).

Results:
We identified 8,401 infrainguinal bypass revascularizations for claudication (12% Black/88% White); 82% were performed above-knee and 44% of those used a vein conduit. The remaining 18% of bypasses were to below-knee arteries, of which 78% used a vein conduit. The remaining 1,534 (18.3%) bypasses were to below-knee arteries, including 1,197 (78.4%) using vein and 330 (21.6%) using prosthetic material. One-year incidence of major limb amputation was 1.6% (1.3%,1.9%) among all grafts, 1.2% (1.0%,1.5%) in above-knee grafts, and 3.3% (2.4%,4.2%) in below-knee grafts. Black patients had higher incidence of amputation across bypass target/conduit groups compared to White patients; the difference was greatest for below-knee revascularizations (8.9%, 95% CI: 4.8%,12.3% v 2.1%, 95% CI: 0.9%,2.9%). Pre-intervention amputation incidence was 1.3% (1.0%,1.5%) in White patients and 3.6% (1.9%,5.2%) in Black patients. Overall amputation incidence decreased significantly after our gold standard intervention was applied for both White (1.0%; 0.7%,1.2%) and Black (2.0%; 0.7%,3.2%) patients. The risk difference (i.e. the disparity gap) between Black and White patients was lessened post-intervention by 56.8% (31.9%,116.3%).

Conclusions:
We observed risk of amputation higher than would be expected based on other studies of the natural history of claudication without bypass surgery; future work should identify the mechanisms that alter the natural history of claudication via open bypass surgery. Interventions below-knee or using a prosthetic graft were particularly harmful and their harm was concentrated in Black patients.
Abstract P110: Examining Health Literacy And Medication Adherence Among African Americans With Hypertension
Authors: Oyekanmi Christiana O , McDuffie Mary Joan , Lynch Erin , McCullers Asli , Cuffee Yendelela
Published: April 2022

Introduction:
It is estimated that almost 40% of American adults have limited health literacy. Adults with limited health literacy report being less knowledgeable about disease management, healthy behaviors, and they are less likely to utilize preventive services. Racial and ethnic minorities are disproportionately affected by limited health literacy. The objective of this study was to assess health literacy level and medication adherence among African Americans with hypertension receiving health care through Medicaid.

Hypothesis:
We hypothesize that lower health literacy may be associated with lower hypertensive medication adherence among African Americans. Moreover, we predict that African American men may have lower levels of health literacy and medication adherence in comparison to African American women.

Methods:
We conducted a cross-sectional case-control study. The participants were African American adults, recipients of Medicaid with hypertension living in Delaware. Data were obtained from Medicaid and secondary data sources. Variables included demographic characteristics, medication adherence, health literacy, and cardiovascular disease health outcomes. Adherence was based on the days of prescription refill controlling for the number of days eligible. Health literacy was obtained from the Health Literacy Data Map from the University of North Carolina Chapel Hill.

Results:
Within our sample, the mean health literacy score for those without hypertension, normotensive was slightly higher than those with hypertension. (Normotensive: 234.9 vs Hypertension: 233.7, p= .0001). Women were more likely to adhere to their medication than men (OR: 0.83, 95% CI: 0.75-0.92, p<=.001) Study participants reporting having a basic level of health literacy reported lower medication adherence than those with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, p=<0.001).

Conclusion:
Within our sample of African Americans with hypertension receiving health care through Medicare, lower health literacy was associated with lower adherence to medication. Our study highlights the necessity of providing literacy assistance and health education to promote healthy behaviors and lifestyle change such as medication adherence.
Abstract P113: Increasing Fruit And Vegetable Intake Prevents Incident Cardiovascular Disease And Cardiovascular Deaths
Authors: Atum Azuka , Hennessy Susan , Penko Joanne , Coxson Pamela , Wei Pengxiao , Boylan Ross , Bellows Brandon K , Zhang Yiyi , Moran Andrew E , Kazi Dhruv S , Bibbins-Domingo Kirsten
Published: April 2022

Background:
Dietary intake of fruit and vegetables (FV) in the US falls well below recommended guidelines with only 12.2% of adults consuming at least 1.5-2 cup equivalents of fruit and 9.3% consuming at least 2-3 cup equivalents of vegetables each day. The Dietary Approaches to Stop Hypertension (DASH) trial demonstrated that consuming a “Mediterranean diet” with increased average daily FV intake resulted in reductions of systolic blood pressure of 0.8mmHg in those without hypertension and 7.2mmHg in those with hypertension. We used simulation modeling to estimate the impact of increasing FV intake in the population who currently are low FV consumers on subsequent incident cardiovascular disease (CVD) and death.

Methods:
We used the CVD Policy Model, a dynamic state-transition model of CVD risk factors, events, and outcomes to simulate the impact of increasing FV intake by one cup equivalent per day in US adults aged 35-94 years with no prior CVD who consume less than cup equivalent of FV per day; based on the National Health and Nutrition Examination Survey (NHANES) years 2015-2018. We used estimates of FV intake on blood pressure reductions based on DASH and ran 10 year simulations, focusing on the population with uncontrolled hypertension (baseline systolic BP ≥140mmHg).

Results:
Based on NHANES, 40.5M US adults age 35-94 years without a history of CVD consume less than 1 cup equivalent of FV per day. Increasing FV intake by cup equivalents per day in this population is estimated to prevent 98,000 incident CVD and 16,000 CVD deaths over 10 years, of which 82,000 (84%) and 13,000 (81%) respectively occur in 8.9M of this population with uncontrolled hypertension. Women would be expected to realize the greatest population improvements with increase in FV consumption.

Conclusion:
Increasing fruit and vegetable consumption among US adults could yield considerable population health benefits in prevention of cardiovascular disease and death, particularly for those with existing hypertension.
Abstract P117: Association Of Ambulatory Blood Pressure Monitoring Parameters With Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-based Studies
Authors: Sakhuja Swati , Jaeger Byron C , Yano Yuichiro , Shimbo Daichi , Lewis Cora E , Clark Donald , Shikany James M , Schwartz Joseph E , Correa Adolfo , Muntner Paul
Published: April 2022

Objectives:
Ambulatory blood pressure (BP) monitoring (ABPM) parameters beyond mean BP may be useful for identifying individuals at high risk for cardiovascular end-organ damage. We examined the association between ABPM parameters, including 24-hour BP load, peak BP, peak increase in BP, and mean BP with left ventricular hypertrophy (LVH).

Methods:
Data were pooled from five US-based studies in which participants underwent ABPM for 24 hours (n=2,892). We defined systolic BP (SBP) load as the weighted average of the percent awake SBP readings ≥ 130 mm Hg and asleep SBP readings ≥ 110 mm Hg; peak SBP as the weighted average of awake and asleep 90
th
percentile of SBP; peak increase as the difference between the peak SBP and mean SBP. These parameters were then categorized into quartiles. LVH was assessed by 2D-echocardiography. Analyses were stratified by mean 24-hour BP < 130/80 and ≥ 130/80 mm Hg.

Results:
Among participants with mean 24-hour BP < 130/80 mm Hg, the prevalence of LVH increased from the lowest to the highest quartile for SBP load, peak SBP, peak increase in SBP, and mean SBP (
Table
). The adjusted prevalence ratio (PR) for the association of the highest versus the lowest quartile with LVH was 1.82 (95%CI: 1.08-3.05) for SBP load, 2.00 (95%CI: 1.18-3.38) for peak SBP, 1.38 (95%CI: 0.85-2.23) for peak increase in SBP, and 1.51 (95%CI: 0.98-2.32) for mean SBP. Among participants with mean 24-hour BP ≥ 130/80 mm Hg, the prevalence of LVH increased for all ABPM parameters from the lowest to the highest quartile. The multivariable-adjusted PR for the association of the highest versus the lowest quartile with LVH was 1.39 (95%CI: 0.98-1.97) for SBP load, 1.66 (95%CI: 1.09-2.53) for peak SBP, 1.08 (95%CI: 0.76-1.53) for peak increase in SBP, and 1.88 (95%CI: 1.24-2.83) for mean SBP.

Conclusion:
The 24-hour SBP load and peak SBP were associated with a higher prevalence of LVH when mean 24-hour BP was < 130/80 mm Hg. The 24-hour peak SBP and mean SBP were associated with a higher prevalence of LVH when mean 24-hour BP was ≥ 130/80 mm Hg.
Abstract P118: Longitudinal Work Hour Patterns Associated With Hypertension Risk
Authors: Lal Tia S , Conway Sadie H , Li Ruosha , Perkison William B , Zhang Feng , Aguilar David
Published: April 2022

Introduction:
Evidence shows a positive correlation between work hour (WH) duration and incident hypertension (HTN). However, little is known about the association between longitudinal WH patterns and the risk of incident HTN.

Hypothesis:
We hypothesized that the greatest risk of HTN would be observed in consistently long WH patterns and that age, sex, and ethnicity would modify the relationship between WH patterns and incident HTN.

Methods:
We utilized a representative sample of 10,338 U.S. adults from the Panel Study of Income Dynamics who reported weekly WH for a minimum of five years between 1985-2017 and did not have a history of HTN prior to reporting five years of WH data. Latent class linear mixed modeling was used to identify distinct longitudinal WH trajectory patterns. Weighted Cox proportional hazards model was used to examine the association between WH patterns and incident HTN, adjusting for age, sex, ethnicity, education, number of children, BMI, and smoking status after backwards step-down selection. We also tested for statistical interactions between WH patterns and baseline age, sex, and ethnicity.

Results:
Over a mean follow-up of 18.6 years, four WH trends were identified: steady (66.1%), increasing (12.1%), quickly decreasing (8.7%), and gradually decreasing (13.0%).

Only age (p<0.001) modified the association between WH patterns and incident HTN. In age-stratified analyses, adults aged 18-29 showed no significant association between WH patterns and HTN. In adults aged 30-39, a gradually decreasing WH trend showed lower HTN risk compared to those working steady hours (HR=0.51; 95% CI: 0.39-0.66). Among those ≥40 years, increasing (HR=0.59; 95% CI: 0.39-0.89), quickly decreasing (HR=0.49; 95% CI: 0.41-0.59) and gradually decreasing (HR=0.30; 95% CI: 0.23-0.40) WH patterns were associated with lower risk of HTN compared to those working steady hours.

Conclusion:
Compared to individuals working steady WH over many years, non-constant WH patterns were associated with a lower risk of incident HTN.
Abstract P120: Latent Group Trajectory Methods To Study Type 2 Diabetes Epidemiology: A Review Of The Literature
Authors: OConnor Sarah , Mésidor Miceline , Talbot Denis , Poirier Paul , Blais Claudia , Leclerc Jacinthe
Published: April 2022

Introduction:
The progression of type 2 diabetes (T2D) is unique to each patient and can be depicted through individual temporal trajectories. Latent group trajectory methods (latent growth mixture models [LGMM] or latent class growth analysis [LCGA]) can be used to classify similar individual trajectories in
a priori
non-observed groups (latent groups), sharing common characteristics. Although increasingly used in the field of T2D epidemiology, many questions remain regarding the utilization of these methods.

Objective:
To review the literature of longitudinal studies using latent group trajectory methods among individuals with T2D.

Methods:
MEDLINE (Ovid), EMBASE, CINAHL and Web of Science were searched through August 25
th
, 2021. Data were collected on the type of method used (LGMM or LGCA), characteristics of studies and quality of reporting using the GRoLTS-Checklist.

Results:
From the 4,694 citations screened, a total of 38 studies were included. The studies were published between 2010 and 2021. Total follow-ups ranged from 8 weeks to 11 years, with 95% (36 out of 38) studies with a follow-up of 1 year of more. The characteristics of studies are presented in Table 1. Regarding the quality of reporting, trajectory groups were adequately presented, however many studies failed to report important decisions made for the trajectory group identification. Many studies considered trajectory groups as exposures to a subsequent outcome. Yet, issues in relation with selection bias, immortal bias and residual confounding were suspected and poorly addressed.

Conclusions:
Although LCGA were preferred, the context of utilization, data sources and research questions were diverse and unrelated to the type of method used. We recommend authors to clearly report the decisions made in trajectory groups identification.
Abstract P121: Measuring The Impact Of Inaction On Health Disparities In Limb Amputation
Authors: Kalbaugh Corey A , Witrick Brian , Howard Kerry A , McGinigle Katharine L , Lesko Catherine R
Published: April 2022

Objective:
Peripheral artery disease (PAD) is a common atherosclerotic disorder that reduces blood flow to the lower extremities. There are significant racial disparities in the outcomes of patients with PAD. Ideally, understanding the result of inadequate implementation of proven interventions on health disparities might provoke a policy and culture shift in the provision of care for minoritized persons. We demonstrate a method that leverages knowledge of interventions that we know
should
be implemented to optimize care for people with PAD, to identify the extent to which disparities might be mitigated by more universal uptake of those interventions.

Methods:
We compare racial disparities as they exist currently with disparities that would exist under complete uptake of interventions to improve PAD and vascular care. This counterfactual world is modeled by upweighting people who received the proposed interventions to represent the study population at the start of follow-up. It relies on the assumption that we have measured (and adjusted for) all confounders of the intervention (a hypothesized mediator of the observed health disparities) and the outcome. A unique feature of the application of this method to this problem is our ability to demonstrate how, even when guideline-based care appears evenly distributed by race/ethnicity, increasing access to such care may still decrease health disparities. This method was previously proposed for estimating potential reductions in racial disparities for people with HIV.

Results:
Across 100,579 infrainguinal revascularizations among Black (n=15,442), Hispanic (n=5,506) and White (n=67,651) patients treated for symptomatic PAD, Black (56.5%) and Hispanic patients (57.6%) were slightly less likely than White patients (59.8%) to receive Class I recommended aspirin and statin therapy prior to their procedures. One-year risk of amputation was 2.7% (95% CI: 2.6%,2.8%) in White patients, 5.8% (5.4%,6.2%) in Black patients and 5.6% (5.0%,6.2%) in Hispanic patients. Had all patients received the appropriate anti-ischemic medications, amputation risk would have been lower across all three race-ethnicity groups. However, specifically, the risk difference (RD) for Black vs White patients would have reduced by 8% (-3%,20%) and the RD for Hispanic vs White patients would have reduced by 18% (-1%,36%).

Conclusions:
Not only is provision of aspirin and statin for infrainguinal revascularization good for all PAD patients, it is also a social justice imperative.
Abstract P122: Addressed-based Sampling Of People Living In Rural Southeast Usa
Authors: van den Heuvel Edwin R , Agans Robert P , Kalsbeek William D , Judd Suzanne E , Ramachandran Vasan S
Published: April 2022

Introduction:
The RURAL cohort study addresses critical knowledge gaps regarding heart and lung disorders in rural Southeastern USA. Using CDC mortality data, RURAL selected ten counties from four states (Alabama, Mississippi, Louisiana, and Kentucky) that are ecologically paired for their five-year low and high CVD mortality rates. RURAL will recruit a representative sample of 4600 participants using addressed-based sampling and an intensive community engagement, yet representative sampling from rural areas is challenging.

Hypothesis:
Address-based sampling using dedicated mailings and telephone calls will yield representative samples from the ten target counties.

Methods:
A dynamic sampling strategy was implemented to obtain balanced response rates for sex, age groups and race. An initial wave of random addresses was used to estimate response rates. A second wave with Bernoulli probabilities was used to reduce overrepresented subgroups. Finally, a third wave with requests for referrals (network sampling) will be used to increase underrepresented subgroups. Eligible participants collected from households and referrals are rostered, complete a baseline exam, undergo an mHealth assessment and are scheduled for a medical examination in a mobile examination unit (MEU).

Results:
Sampling of 693 participants from 19,460 inhabitants in age range 25 to 64 years started in Dallas County, Alabama. Address sizes, rostered participants and sample size imbalances are listed in the Table.

Bernoulli probabilities [55-64 men: 80%; 55-65 women: 55%; 45-55 women:76%] corrected the imbalance in response rates for sex and age groups 45-54 and 55-64 (see Table). Referrals in wave 2 will further balance the sample.

Conclusion:
Our initial sampling experiences in rural Alabama showed lower than expected response rates and imbalances across subgroups. These results emphasize the importance of network sampling with well-adjusted Bernoulli probabilities for representative sampling in rural areas.
Abstract P126: The 2020 Us Presidential Election, Sociopolitical Stress And Acute Cardiovascular Disease Hospitalizations
Authors: Mefford Matthew T , Rana Jamal S , Reynolds Kristi , Ranasinghe Omesh N , Mittleman Murray A , Liu Jennifer , Qian Lei , Zhou Hui , Harrison Teresa N , Geller Alan C , Sloan Richard P , Mostofsky Elizabeth , Williams David R , Sidney Stephen
Published: April 2022

Background:
Prior studies demonstrated a higher risk of acute cardiovascular disease (CVD) around population-wide psychosocial or environmental stressors. Less is known about the impact of sociopolitical events. The objective of the current study was to examine acute CVD hospitalizations following the 2020 presidential election.

Methods:
We examined hospitalizations for acute CVD around the 2020 presidential election, among adults enrolled in Kaiser Permanente Southern and Northern California, two integrated health care delivery systems that provide care for >9 million persons. CVD was defined as hospitalizations for acute myocardial infarction (AMI), heart failure (HF) or stroke. Rate ratios (RR) and 95% confidence intervals (CIs) were calculated comparing rates in the five days following the 2020 election to the same five days two weeks prior.

Results:
Among 6,396,830 members ≥18 years, rates of hospitalization for CVD following the election (666 hospitalizations; rate = 760.5 per 100,00 person-years [PY]) were 1.17 times higher (95% CI 1.05, 1.31) compared to the same five days two weeks prior (569 hospitalizations; rate = 648.0 per 100,000 PY). (Table) RR for AMI, stroke, and HF were 1.42 (95% CI 1.13, 1.79), 1.02 (95% CI 0.86, 1.21) and 1.18 (95% CI 0.98, 1.42), respectively.

Conclusions:
Higher rates of acute CVD were observed following the 2020 presidential election. Awareness of the heightened risk of CVD and strategies to mitigate risk during significant sociopolitical events are needed.
Abstract P128: Prevalence Of Pre-frailty And Frailty In The Physical Activity Daily (PAD) Trial
Authors: Jones Raymond , Enogela Ene M , Zumbro Emily L , Soukhamneut Phonchit , Buford Tom W , Richardson Caroline , Jackson Elizabeth A
Published: April 2022

Introduction:
Frailty is a multidimensional, geriatric syndrome characterized by decreased physiologic reserve and resistance to stressors. Frailty is associated with increased mortality among cardiac patients; however, data on patients with peripheral arterial disease (PAD) are limited.

Purpose:
The purpose of this observational study was to identify the prevalence of unique physical frailty clusters in a sedentary, PAD cohort in the Physical Activity Daily (PAD) Trial.

Methods:
This study utilized baseline information from the Physical Activity Daily (PAD) Trial (2014 – 2021). Sedentary adults with documented PAD, defined as ankle-brachial index [ABI] < 0.9, within the University of Michigan and University of Alabama at Birmingham health systems were enrolled. We clustered three PAD-relevant frailty phenotypes using the Fried’s frailty index —1) self-reported exhaustion (SRE), 2) weakness (WN), and 3) slow walking speed (SWS)—and observed the prevalence of pre-frailty (1-2 characteristics) and frailty (3 characteristics) in the PAD cohort.

Results:
A total of 106 participants (age, 66.9 [8.4] years; female 37 [34.9%]; White 89 [84.8%]) were assessed for unique frailty clusters. Of the 106, 34.9% were characterized as robust/non-frail, 61.3% were pre-frail and 3.7% were frail. Overall, the most common phenotype component among this PAD cohort was WN (44.3%). Among pre-frail and frail participants, WN (30.4%) was the single-most occurring phenotype followed by SRE (23.2%) and SWS (5.8%). Additionally, WN + SWS (18.9%) was the most prevalent pre-frailty cluster followed by SRE + WN (13.0%) and SRE + SWS (2.9%).

Conclusions:
In this cohort of participants with PAD, pre-frailty was the most common accounting for 61.3%. Given the high number of adults who transition from pre-frailty to frailty, efforts to identify the clustering of phenotypes in PAD patients who are pre-frail is warranted. The implementation of rehabilitative strategies within this population is of importance to prevent the development of pre-frailty into frailty.
Abstract P129: Qanadli Index And SPESI Score Correlation With Echocardiographic Indexes In Patients With Submassive Pulmonary Embolism
Authors: Jafarian Kerman Scott R , Hajsadeghi Shokoufeh , Shamsadini Ali
Published: April 2022

Introduction:
While management and risk stratification of pulmonary embolism (PE) are still unclear, early understanding of the severity of the diseases can help both physician and the patient to set up better milestones. Clinical and obstruction scoring indexes have been utilized as a semi-quantitative measure in numerous settings; however, there has not been a direct comparison reporting mortality and morbidity rates in patients with submissive PE. Here, we mainly focus on the relationship between Qanadli and sPESI indexes with echocardiographic findings in patients with pulmonary emboli.

Methods:
A total of 200 adult patients who were admitted with diagnosis of PE between January 2014 and March 2019, were retrospectively included in this cross-sectional study. Patients were assessed for Qanadli index, ECG and echocardiographic findings, mortality, and morbidity, and sPESI score. Descriptive, regression and receiver operation characteristic (ROC) analyses were performed.

Results:
The relationship between total Qanadli score and right ventricle enlargement (p=0.004), McConnel sign (p=0.037), pulmonary artery hypertension (p=0.008), Tricuspid regurgitation severity (p=0.009), pulmonary artery pressure (p=0.006), 4-month follow up Ejection fraction (p=0.006) and systolic blood pressure (p=0.019) were significant. Qanadli score’s performance as a predictor of death with ROC curve (AUC) was found to be %70.11. There was no correlation between Qanadli and sPESI scores.

Conclusion:
While there were significant relationships between Qanadli score and few of the indicators, the relationship between total Qanadli score and sPESI score and mortality was not significant. Therefore, it might not be a good predictor for mortality and morbidity.
Abstract P132: Self-reported Recreational Physical Activity And Incident Venous Thromboembolism Risk In The Women’s Health Initiative
Authors: Harrington Laura B , Johnson Eric , LaMonte Michael J , Allison Matthew A , Eaton Charles B , Wactawski-Wende Jean , Manson JoAnn E , Lee I-Min , Jensen Majken K , Wellenius Gregory , Kabrhel Christopher , LaCroix Andrea Z , Mukamal Kenneth J
Published: April 2022

Introduction:
The association between physical activity (PA) and incident venous thromboembolism (VTE) is inconsistent and incompletely characterized.

Hypothesis:
Higher amounts of self-reported total PA will be associated with a lower risk of incident VTE.

Methods:
Eligible women were Women’s Health Initiative (WHI) Hormone Therapy (HT) trial and Observational Study (OS) participants without prior VTE, able to walk at least one block, with baseline PA data (n=110,631). At multiple timepoints, women reported their current usual frequency and duration of walking and low, moderate, and strenuous intensity recreational PA, which were used to estimate energy expended. VTE, including deep vein thrombosis and pulmonary embolism, were validated in the WHI-HT and self-reported in the WHI-OS. Multivariable-adjusted (Table) Cox Proportional Hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of time-varying total PA and incident VTE risk, with women censored at death, loss to follow-up, and three years after their final PA measure.

Results:
At baseline, women were 64 years of age on average. Over an average of 9.9 years of follow-up, 1,403 women experienced incident VTE. In primary confounder-adjusted models, compared with women who reported no PA, higher tertiles of total PA were associated with a lower risk of incident VTE (high vs. no PA HR=0.60; 95% CI: 0.51, 0.71; p-trend<0.001) (Table). Further adjustment for potential mediators on the causal pathway (physical function, self-reported health, body mass index [BMI], cardiovascular-related factors) attenuated but did not eliminate this association (high vs. no PA HR=0.81; 95% CI: 0.68, 0.97; p-trend=0.017).

Conclusions:
Compared to no PA, higher tertiles of total PA were associated with a lower risk of incident VTE, even after adjusting for potential mediators reflecting physical function, health, BMI, and cardiovascular risk. Our results add to the apparent health benefits of even moderate amounts of recreational PA.
Abstract P141: Infant Mortality Risk In Hypertensive Disorders Of Pregnancy
Authors: Malek Angela M , Wilson Dulaney A , Mateus Julio , Turan Tanya N , Lackland Daniel T , Hunt Kelly J
Published: April 2022

Introduction:
Hypertensive disorders of pregnancy (HDP) increase the risk of infant and maternal morbidity and mortality, disproportionately affecting racial and ethnic minority groups. Less is known about disparities in infant mortality by mother’s HDP status. We assessed the relationships between HDP and pre-pregnancy hypertension and other pregnancy and delivery characteristics with infant mortality.

Methods:
This retrospective cohort study included 667,359 live, singleton deliveries (mother’s race/ethnicity: non-Hispanic White [NHW; 56.5%], non-Hispanic Black [NHB; 32.2%)], Hispanic [9.0%], other race/ethnicity [2.2%]) in South Carolina (2004-2016) to women aged 12-49 years. HDP (pre-eclampsia, eclampsia, gestational hypertension) and pre-pregnancy hypertension were defined by hospitalization/emergency department (ED) visit data or birth certificates. Infant mortality within one year (n=2,431) was defined by death certificates. Logistic regression models controlled for covariates.

Results:
Deliveries to women with pre-pregnancy hypertension with superimposed HDP (2.1%), HDP (16.9%), pre-pregnancy hypertension without superimposed HDP (0.3%), and neither condition (80.6%) were described. Infant mortality was increased for women with HDP with and without pre-pregnancy hypertension. Also associated with higher odds of infant mortality were NHB mothers, with high school education or less, Medicaid, higher pre-pregnancy BMI, no prenatal care, increasing number of prior pregnancies, prior Cesarean section, prior preterm birth, and women smoking during pregnancy; with the odds lower for increasing maternal age, Hispanic mothers, and female sex of baby.

Discussion:
The odds of infant mortality were increased 48% in women with HDP and 83% in women with both HDP and pre-pregnancy hypertension than women with neither condition after adjusting for pregnancy and delivery characteristics. Future studies are needed to identify social or other factors contributing to differences.
Abstract P150: Blood Pressure Trajectories For 16 Years And The Development Of Left Ventricular Hypertrophy And Increased Left Atrial Size: The Korean Genome And Epidemiology Study
Authors: Lee Ju-mi , Kim Seong Hwan , Lee Seung Ku , Shin Chol , Park Jae-Hyeong
Published: April 2022

Background:
Single blood pressure (BP) measurement is associated with the development of target organ damage including left ventricular hypertrophy (LVH) and left atrial (LA) enlargement (LAE). However, long-term patterns of BP and their effects on LVH and LAE are poorly understood. We evaluated the association between BP trajectories and the presence of LVH and LAE.

Methods:
This analysis enrolled participants who attended a health examination from 2001 to 2016 (visit 1 to 8) in Ansan cohort study. Among the initial total of 10030 participants, we excluded 1787 participants because their BP measurements were less than three times. An additional 5678 participants were excluded because they had no echocardiographic examinations to evaluate LVH at visit 8. Thus, we enrolled 2,565 participants (1267 males, 47.8 ± 6.7 years old) in this study. The previous studies selected mid-BP for identifying trajectories because Mid-BP showed the greatest predictive utility for cardiovascular diseases. Based on the previous study, we also used mid-BP to identify trajectories. The current sample has more than three times times of BP measurements over 16 years. Latent mixture modeling was used to identify trajectories in mid-BP over time. Linear logistic regression was used for assessing BP trajectories with the outcomes.

Results:
We identified 4 distinct mid-BP trajectories: group 1 (lowest, 20.9%, n = 536), group 2 (36.2%, n = 928), group 3 (32.3%, n = 828), and group 4 (highest, 10.6%, n = 273). Compared with the lowest group, trajectories with elevated mid BP had greater odds ratios having LVH and LAE by multivariable-adjusted regression models. Adjusted odd ratios for LVH were 1.432 (95% CI = 1.138 -1.802,
P
= 0.002) for group 2, 2.718 (95% CI = 2.103 - 3.513,
P
< 0.001) for group 3, and 2.480 (95% CI = 1.742 - 3.530,
P
< 0.001) for group 4. Adjusted odd ratios for LAE were 1.200 (95% CI = 0.814 - 1.769,
P
= 0.358) for group 2, 1.599 (95% CI = 1.084 - 2.360,
P
= 0.018) for group 3, and 1.944 (95% CI = 1.212 - 3.118,
P
= 0.006) for group 4.

Conclusions:
Our study suggests that long-term higher mid-BP were an independent risk factor for having LVH among middle-aged males and females. Also, higher mid-BP was an independent risk factor for having future LAE in middle-aged females. Higher long-term mid-BP was an independent risk factor of cardiac structural changes such as LVH and LAE among middle-aged population.
Abstract P153: Racial/ethnic- And Education-level Differences In Poor, Intermediate, And Ideal Cardiovascular Health Among Women Of Reproductive Age: Behavioral Risk Factor Surveillance System, 2019
Authors: Hayes Donald K , Coronado Fatima , Ford Nicole , Fang Jing , Robbins Cheryl L , Ko Jean , Loustalot Fleetwood V
Published: April 2022

Introduction:
The American Heart Association (AHA) promotes ideal cardiovascular health (CVH) to reduce the risk of heart disease and stroke by achieving seven metrics (normal weight, not smoking, ≥5 fruits and vegetables daily, physical activity ≥150 minutes per week, no diabetes, no high blood pressure, and no high cholesterol). Overall, about 5% of the adult population report ideal CVH. Characterizing CVH among women of reproductive age (WRA; 18-44 years of age) offers opportunities to promote overall cardiovascular and preventive health along the life course.

Methods:
Data from the 2019 Behavioral Risk Factor Surveillance System was used to estimate define CVH categories (poor, intermediate, ideal) among 38,012 WRA from 49 states (New Jersey didn’t meet standards for weighting), District of Columbia, Guam, and Puerto Rico. Per commonly used standards, having
>
6 metrics defined ideal CVH, 3-5 metrics defined intermediate, and 0-2 metrics defined poor CVH. A generalized logit model was used to estimate the associations between race/ethnicity and education with CVH (poor vs intermediate CVH, and ideal vs. intermediate CVH), accounting for age and insurance status.

Results:
Overall, 8.6% (95%CI:8.2-9.1%) of WRA reported poor CVH, 85.4% (95%CI: 84.8-86.1) reported intermediate CVH, and 6.0% (95%CI:5.5-6.5) reported ideal CVH. Non-Hispanic Black (NHB) WRA had higher odds of reporting poor vs. intermediate CVH (AOR=1.34; 95%CI:1.14-1.58) and lower odds of reporting ideal vs. intermediate CVH (AOR=0.47; 95%CI:0.33-0.68) compared to non-Hispanic White WRA. College graduates also had lower odd of reporting poor vs. intermediate CVH (AOR=0.21; 95%CI:0.17-0.27) and higher odds of reporting ideal vs. intermediate CVH (AOR=2.59; 95%CI:1.52-4.43) compared to those with less than a high school education.

Conclusion:
Most WRA have intermediate CVH, nearly 1 in 10 have poor CVH, and only about 1 in 16 have ideal CVH. The CVH metric used in this study provides evidence of the disproportionate burden of poor CVH among NHB WRA and women with less than a college degree. Understanding the barriers to ideal CVH for WRA, particularly social and structural determinants, may improve cardiovascular health and reduce disparities across the life course.
Abstract P156: Achieving Diabetes Remission Through Lifestyle Intervention: Preliminary Results From A Scoping Review Of The Literature And Implications For Africa
Authors: Duhuze Karera M Grace , Wentzel Annemarie , Waldman Zoe , Patterson Arielle , Schenk Blayne R , DuBose Christopher W , Horlyck-romanovsky Margrethe , Sumner Anne E
Published: April 2022

Background:
Africa is experiencing the most rapid rise of type 2 diabetes (T2D) in the world. In addition, Africa has the highest proportion of undiagnosed cases. If people with T2D are undiagnosed, then complications progress, outcomes are poor, and social and financial costs escalate. Our goal with this review is to determine whether Life-Style Intervention (LSI) as primary treatment can lead to remission of T2D. LSI generally includes some combination of dietary change, weight loss, exercise, and counseling. If LSI alone leads to high rates of T2D remission, this will provide both the impetus and justification for investing scarce health care resources in programs which would convert undiagnosed T2D into diagnosed T2D.

Methods:
PubMed, Embase, Cochrane and CINAHL were searched between September 1
st
and September 13
th
, 2021 for studies that assessed whether LSI, as the only treatment would lead to remission in either newly diagnosed or established T2D.

Results:
The search identified 1162 articles. After removal of duplicates (n=291), 871 are being screened for eligibility. To date, data have been extracted from 11 of the articles which met the inclusion criteria. None of the 11 studies were conducted in Africa. Three of the 11 studies reported on newly diagnosed T2D cases. All three were successful in achieving a high rate of T2D remission with LSI. Strategies which were successful in converting T2D to prediabetes included: (1) a caloric decrease of only 500 less than predicted maintenance; (2) a low carbohydrate diet; and (3) a 10% loss in baseline weight. Exercise and counseling regimens varied widely between the three trials. The eight articles which enrolled patients with known T2D focused largely on very low calorie diets and intensive psychologic support and counseling. Factors in these studies which were associated with success were: T2D duration less than 5 years, weight loss of >10% in the first year, and higher insulin concentrations at baseline.

Conclusion:
Literature review, even if scant, will provide currently known best practices. They will help us move forward in the design of culturally sensitive lifestyle interventions that would be acceptable to African participants and economically attractive to government and health care agencies.