bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP01: Ideal Cardiovascular Health is Low Among U.S. Workers 45 Years and Older: Results of a National Population-based Cohort Study
Authors: MacDonald Leslie A , Bertke Stephen , Hein Misty J , Judd Suzanne , Baron Sherry , Merritt Robert , Howard Virginia J
Published: July 2021

Purpose:
We examined the prevalence of ideal cardiovascular health of workers within a national U.S. population-based cohort.

Methods:
Participants included 5,566 black and white men and women age 45 and older who were employed and free of CHD/stroke when enrolled into the REasons for Geographic and Racial Differences in Stroke Study. Clinical and behavioral cardiovascular risk factor data were obtained at enrollment. Ideal CVH (iCVH) was assessed from seven modifiable CVD risk factors based on the AHA’s Life’s Simple 7. Three clinical (blood pressure (BP), total cholesterol, fasting glucose) and 4 behavioral (physical activity, smoking, diet quality, BMI) factors were each scored according to AHA criteria. Jobs held at enrollment were grouped into aggregate standard occupational groups. National prevalence estimates were computed using SAS Survey Logistic with weights based on actual sampling probabilities of the sub-sample. In significance testing, each occupation group was compared with all other groups combined, adjusting for age, race, sex, and region (stroke-belt, other).

Results:
The prevalence of iCVH among older workers free of CHD/stroke is low. Although 88% were non-smokers and 78% had ideal glucose, 41% or less achieved ideal levels of all other risk factors. Management/professionals had higher ideal BP and BMI, and were more likely to be non-smokers and physically active; however those employed in business and finance were more likely to have a poor diet (72%). Ideal BP was highest for healthcare practitioners (43%) and those employed in the arts, entertainment, sports and media (47%). Service workers were more likely to have uncontrolled BP, glucose and cholesterol, have lower ideal BMI, and smoke. Uncontrolled BP was high among sales workers (23%) and highest (35%) among those in protective services (e.g., police, firefighters). Dyslipidemia was highest (22%) among personal care and service workers. Obesity was highest among those employed in healthcare support (54%) and food preparation and serving (55%). Those in sales and low status office work were more likely to smoke (17%) and be inactive (38%). Skilled laborers in installation, maintenance and repair had low dyslipidemia (5%), but had the lowest ideal BMI (10%). Transportation and material moving workers had high uncontrolled BP (24%) and the highest smoking prevalence (22%).

Conclusions:
The prevalence of iCVH among older workers free of CHD/stroke is low, but substantial differences in CVH exist by occupation. Targeted screening and health promotion is warranted to accommodate the information, resource, and schedule needs of older workers employed in diverse occupational settings with different clinical and behavioral risk factor profiles.
Abstract MP102: Family Caregiving is Associated with Increased Stroke Risk Among Strained Spouse Caregivers
Authors: Lakkur Sindhu , Howard Virginia , Judd Suzanne , Haley William , Roth David
Published: July 2021

Background:
As the American population ages, the number of family caregivers is expected to increase. Consequently, understanding the effects family caregiving has on the cardiovascular health of caregivers presents an important public health concern. Previous studies have observed associations between family caregiving and adverse cardiovascular health outcomes such as hypertension, coronary heart disease, and an increased Framingham Stroke Risk Score. However, the association between family caregiving and stroke risk is poorly understood.

Hypothesis:
We examined the association between family caregiving and risk of incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study to test the hypotheses that 1) family caregivers have higher risk of stroke compared to noncaregivers and 2) strained caregivers have higher risk of stroke compared to noncaregivers.

Methods:
The REGARDS study enrolled black and white participants, aged 45 and older, from 2003-2007. Participants were categorized as caregivers if they answered affirmatively to the baseline interview question, “Are you currently providing care on an on-going basis to a family member with a chronic illness or disability?” Caregivers were asked their relationship to the care recipient and the amount of perceived physical and mental strain they associated with care (none, some, a lot). Using a propensity score matching procedure based on 16 demographic, lifestyle, and stroke risk factors, caregivers (n=3,055) were individually matched with noncaregivers (n=3,055). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident stroke risk were calculated using Cox proportional hazards models.

Results:
During an average 8.5-year follow up period, 114 (3.73%) caregivers and 112 (3.67%) matched noncaregivers had an incident stroke. Caregivers did not have a higher risk of stroke compared to non-caregivers (HR=1.006, 95% CI=0.775, 1.306). The HRs (95% CIs) for incident stroke risk were 1.427 (0.938, 2.171) for caregivers reporting no caregiving strain, 0.918 (0.628, 1.341) for moderate strain, and 1.963 (0.977, 3.946) for high strain. Strained spouse caregivers who reported high or moderate strain had a 95% higher risk of stroke than matched noncaregivers (HR=1.958, 95% CI=1.002, 3.828).

Conclusion:
We observed that perceived caregiving strain, particularly among spouse caregiviers, is associated with increased risk of stroke. This group of caregivers may need targeted support. Further studies examining the nuanced effects of caregiver burden on cardiovascular health are required.
Abstract MP14: Preventable Stroke and Ischaemic Heart Disease Deaths in Argentina Comparative Risk Assessment of Different Levels of Physical Activity
Authors: Poggio Rosana , Rubinstein Adolfo , Irazola Vilma , Bardach Ariel , Danaei Goodarz
Published: July 2021

Introduction:
In Argentina physical inactivity was the fifth leading risk factor for all-cause mortality in 2010. The aim of this project was to estimate the numbers of ischaemic heart disease (IHD) and stroke deaths in Argentina attributable to different levels of physical activity (PA).

Materials and Methods:
We conducted a population-level comparative risk assessment for different levels of PA. We obtained data on prevalence of different levels of PA from the Argentinian national survey of risk factors 2013 and used relative risk for stroke and IHD mortality from prior meta-analyses for each category of PA. The number of disease-specific deaths, by age and sex, were obtained from the vital registration system for the year 2010. We considered 4 categories of PA based on the metabolic equivalent tasks per minute per week (MET/minute/week): inactive, <600, ≥ 600 to <1,600 and ≥1,600. We calculated the population attributable fraction for different levels of PA by sex and age group.

Results:
In Argentina, 76.5% (CI 95%; 75.8-77.7) of the total population engaged <1,600 MET/min/week (72.8% in men and 81.1% in women). This level of insufficient activity was responsible for 26% of all IHD and stroke deaths in 2010 (11,234 of 43,796 deaths; 6,013 in men and 5,221 in women). It was also responsible for 29% (7,292) of the total IHD deaths and 21% (3,942) of the total stroke deaths. Almost half of the population or 52.5% (CI 95%; 51.3-53.7) engaged <600 MET/minutes/week (48.8% in men and 55.7% in women) and this level of inactivity was responsible for 17% (7,278 of 43,796 deaths) of all IHD and stroke deaths in 2010 (3,941 in men and 3,337 in women). It was also responsible for 20% (4,907) of the IHD deaths and 13% (2,371) of the stroke deaths The impact of physical inactivity and insufficient PA was higher in women due to lower level of PA compared to men and in the individuals younger than 70 years old due to a stronger association with the outcomes (higher relative risks), especially for IHD.

Conclusions:
Physical inactivity and insufficient physical activity contribute substantially to the burden of cardiovascular diseases in Argentina. Interventions to promote PA should be a priority to prevent cardiovascular disease.
Abstract MP20: Cardiovascular Protection by the Mediterranean Diet Differs Across Socioeconomic Groups: Prospective Findings From The MOLI-SANI Study
Authors: Bonaccio Marialaura , Di Castelnuovo Augusto , Pounis George , Costanzo Simona , Persichillo Mariarosaria , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia ,   MOLI-SANI Study Investigators
Published: July 2021

Introduction:
Low socioeconomic status is associated with poor health outcomes and unhealthy behaviors. The traditional Mediterranean diet (MD) has been related to reduced risk of major chronic diseases and mortality and exhibits a socioeconomic gradient.

Hypothesis:
The association of the MD with cardiovascular risk (CVD) may differ across different socioeconomic status groups.

Methods:
Population-based cohort study on 18,710 individuals apparently free at enrollment from CVD and diabetes, randomly recruited from the general population of the MOLI-SANI study (Italy). The cohort was followed up for a median of 4.3 years (81,367 person-years). Food intake was recorded by the EPIC food frequency questionnaire. Adherence to the MD was appraised by the Greek Mediterranean diet score. Household income (Euros/year) and educational levels were used as socioeconomic status indicators. Incident CVD events were identified from the hospital discharge records based on ICD-9 codes.

Results:
We identified 252 CVD events (CHD n=207, stroke n=45). A 2-point increase in the MD score was associated with 16% reduced risk (2% to 28%). The protective effect of the MD differed across educational levels and household income categories (p for interaction=0.042 and 0.0081 respectively) with subjects in the highest category of either education or income reporting a significant reduction of CVD risk in respect to the lowest (HR=0.40;0.23-0.69 and HR=0.38; 0.22-0.64 respectively). In multivariable analysis further controlled for adherence to the MD, nutrient intake varied across socioeconomic strata with those with higher status reporting higher intake of antioxidants and polyphenols (see Table).

Conclusions:
The protective effect of the MD on CVD risk was only evident within high socioeconomic status groups. At comparable levels of adherence to the MD, differences in dietary antioxidant and polyphenol intakes were apparent across population strata. These nutritional gaps may partly explain the observed socioeconomic pattern of protection.
Abstract MP31: Left Ventricular Hypertrophy by Electrocardiogram versus Cardiac Magnetic Resonance Imaging as a Predictor for Heart Failure: The MESA Study
Authors: Oseni Abdullahi O , Qureshi Waqas T , Almahmoud Mohammed F , Bertoni Alain , Bluemke David A , Hundley William G , Lima Joao A , Herrington David M , Soliman Elsayed Z
Published: July 2021

Background:
Left ventricular hypertrophy (LVH) is an established risk factor for heart failure (HF). However, it is unknown whether LVH detected by electrocardiogram (ECG-LVH) is equivalent to LVH ascertained by cardiac magnetic resonance imaging (MRI-LVH) in terms of prediction of incident HF using risk prediction models like the Framingham Heart Failure Risk Score (FHFRS).

Methods:
This analysis included 4745 (mean age 61+10 years, 53.5% women, 61.7% non-whites) from the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease at the time of enrollment. ECG-LVH was defined using Cornell’s criteria while MRI-LVH was derived from left ventricular (LV) mass measured by cardiac MRI. Cox proportional hazard regression was used to examine the association between ECG-LVH and MRI-LVH with incident HF. Harrell’s concordance C-index was used to estimate the predictive ability of the FHFRS when either ECG-LVH or MRI-LVH were included as one of its components. The added predictive ability of ECG-LVH and MRI-LVH were investigated using integrated discrimination improvement (IDI) index and relative IDI.

Results:
ECG-LVH was present in 291(6.1%) while MRI-LVH was present in 499 (10.5%) of the participants. Over a median follow up of 10.4 years, 140 participants developed HF. Both ECG-LVH [HR (95% CI): 2.25(1.38-3.69)] and MRI-LVH [HR (95% CI): 3.80(1.56-5.63)] were associated with an increased risk of HF in multivariable adjusted models (Table 1). The ability of FHFRS to predict HF was improved with MRI-LVH (C-index 0.871, 95% CI: 0.842-0.899) when compared with ECG-LVH (C-index 0.860, 95% CI: 0.833-0.888) (p < 0.0001). To assess the potential clinical utility of using LVH-MRI instead of ECG-LVH, we calculated several measures of reclassification (Table 1), which were consistent with the statistically significantly improved C-statistic with MRI-LVH.

Conclusion:
Both ECG-LVH and MRI-LVH are predictive of HF when used in the FHFRS. Substituting MRI-LVH for ECG-LVH improves the predictive ability of the FHFRS.
Abstract MP64: Trends in Racial Differences in Control of Hypertension, 2008-2014
Authors: Reynolds Kristi , Bider Zoë , Koebnick Corinna , Kanter Michael , Handler Joel
Published: July 2021

Background:
Racial disparities in blood pressure control in the U.S. have been well documented. In 2010, Kaiser Permanente Southern California (KPSC), a large and diverse integrated health care delivery system that provides care to over 4 million members, implemented a series of changes in health care delivery to address the disparity in hypertension control. Key elements included changes to the care team, patient activation, meaningful use of health information technology, and leadership vision.

Methods:
We examined trends in hypertension control between 2008 and 2014 by race/ethnicity in KPSC members aged 18 years and older. Patients with hypertension were identified from the KPSC POINT® (Permanente Online Interactive Network Tool) population care management hypertension registry. Blood pressure control was defined according to JNC-7 criteria in the fourth quarter of each calendar year from 2008 through 2014.

Results:
Between 2008 and 2014, the hypertension population increased from 624,493 to 745,382, while the prevalence was stable (25.9% in 2008 and 25.6% in 2014). During this period, the proportion of Whites and Blacks decreased slightly from 45.4% to 43.0% and 14.3% to 13.5%, respectively, while the proportion of Hispanics and Asian/Pacific Islanders increased from 25.2% to 29.0% and 9.8% to 11.3%, respectively. Hypertension control increased from 74.0% in 2008 to 83.8% in 2014 and increased across age, sex, and racial/ethnic groups (Figure). Blacks had the largest improvement in hypertension control (68.8% to 80.8%), which was primarily driven by those aged 65+ years. The disparity in hypertension control between Whites and Blacks decreased from 6.9% to 5% between 2008 and 2014.

Conclusions:
While ecologic in nature, the secular increases in hypertension control suggest that implementation of a series of system-wide changes can affect all subpopulations.
Abstract MP69: Hypertension, Overweight and Obesity Among US Immigrants: An Analysis of the 2010-2014 National Health Interview Survey
Authors: Commodore-Mensah Yvonne Y , Turkson-Ocran Ruth-Alma , Aboagye Jonathan , Samuel Laura , Reilly Carolyn
Published: July 2021

Introduction:
Ethnic minority populations in the United States (US) are disproportionately affected by cardiometabolic risk factors including hypertension, overweight/obesity and diabetes. Currently, 13% of the US population are immigrants (41 million), and this number is growing and changing demographically.

Hypothesis:
We hypothesized that considerable variability will exist in the prevalence of overweight/obesity, diabetes and hypertension among immigrants.

Methods:
We used the National Health Interview Survey (NHIS) to compare hypertension, overweight and diabetes prevalence in adult US immigrants and pooled years 2010-2014.We calculated age and gender-adjusted prevalence of overweight/obesity, diabetes and hypertension by region of birth using multivariable logistic regression.

Results:
We included 54,984 participants from Europe(7%),South America(6%), Mexico/Central America/Caribbean(55%), Russia(1%), Africa(4%), Middle East(2%),Indian subcontinent(6%), Central Asia (7%) and Southeast Asia(11%). In age and gender-adjusted estimates, overweight/obesity and diabetes were least prevalent in Central Asian immigrants (32% and 6%, respectively) and most prevalent in Mexico/Central America/Caribbean immigrants (71% and 10%, respectively). The age-and gender adjusted prevalence of hypertension ranged from 17% (South America) to 25% (Russia). Table 1 provides the adjusted multivariable adjusted odds Ratios (OR) of overweight/obesity, diabetes and hypertension.

Conclusions:
We observed substantial heterogeneity in the prevalence of cardiometabolic risk factors among a nationally representative sample of US immigrants. Immigrants from Mexico/Central America/Caribbean, Africa and Asia had the highest odds for diabetes although Asian immigrants had the lowest odds of overweight/obesity. Our findings support the disaggregation of data on US immigrants to inform culturally-tailored public health strategies to prevent cardiometabolic disease.
Abstract MP84: Trans-ethnic Meta-analysis of Exome Chip Data Reveals Novel Low-frequency Variants Contributing to Central Adiposity
Authors: Young Kristin L , Justice Anne , Karaderi Tugce , Highland Heather , Graff Mariaelisa , Turcot Valerie , Auer Paul , Heard-Costa Nancy , Schurmann Claudia , Lu Yingchang , Pasko Dorota , Cupples L Adrienne , Fox Caroline , Winkler Thomas , Scott Robert , McCarthy Mark , Mohlke Karen , Loos Ruth JF , North Kari , Borecki Ingrid , Lindgren Cecilia ,   BBMRI,   GOT2D,   CHARGE,   GIANT
Published: July 2021

Central adiposity is a leading risk factor for cardiovascular disease, and genetic factors contribute both to fat distribution, measured as waist-to-hip ratio adjusted for BMI (WHRa), and to differences in central adiposity prevalence. To date, 49 loci have been associated with WHRa, based on studies of common [minor allele frequency (MAF) ≥5%] single nucleotide variants (SNVs), primarily in European descent populations. Our aim was to identify low frequency (LFV: MAF <5%) and rare (RV: MAF <1%) coding variants associated with WHRa using Exome-Chip data from 344,369 individuals of European (84%), South Asian (8%), African (5%), East Asian(2%), and Hispanic/Latino (1%) ancestry. We performed fixed effects meta-analyses of study-specific WHRa associations stratified by sex and ancestry and then combined across strata for both SNV and gene-based results. We used a strict definition of variants annotated as damaging by 5 algorithms to perform gene-based analyses using the sequence kernel association test (SKAT). Analyses included up to 284,499 SNVs (218,195 with MAF<5%), and 15,063 genes with at least one SNV that met our inclusion criteria. Five LFVs reached chip-wide significance (CWS: P<2.5E-7) in our all ancestry sex-combined analyses, including one novel non-synonymous LFV in
RAPGEF3
[MAF=0.01, β (SE) = -0.09 (0.012), P=1.28E-13]. In addition, one novel RV reached CWS in men for
UGGT2
[MAF<0.01, β (SE) = -0.142 (0.025), P=9.71E-9], and one RV reached CWS in women for
ACVR1C
[MAF<0.01, β (SE) = -0.09 (0.018), P=1.09E-7]. Gene-based analyses identified
RAPGEF3
(P=1.18E-11) as significantly associated with WHRa in the all ancestry sex combined analyses after correction for multiple tests (P<2.5E-6), though conditional analysis revealed that this result is driven by the top SV identified in this region.
RAPGEF3
also shows a significant association (p=4.68E-12) in all ancestry, sex combined gene-based analysis of BMI.
RAPGEF3
is expressed in subcutaneous and visceral adipose tissue, and has been implicated in insulin regulation. RAPGEF3 plays a role in the GLP1 pathway, which controls insulin secretion in response to blood glucose concentration. Our results highlight the importance of large-scale genomic studies for identifying LFV and RV influencing central fat distribution. Understanding these genetic effects may provide insights into the progression of central adiposity and highlight potential population-specific variants that increase susceptibility.
Abstract P010: Serum Vitamin D and Risk of Heart Failure: Prospective Results From the Moli-sani Study
Authors: Costanzo Simona , De Curtis Amalia , Di Castelnuovo Augusto , Persichillo Mariarosaria , Donati Maria B , de Gaetano Giovanni , Iacoviello Licia ,   MOLI-SANI Study Investigators
Published: July 2021

Introduction:
Vitamin D deficiency has been associated with the progression of heart failure (HF) and Vitamin D supplementation may have protective effects in patients with HF. However, little is known on the predictive value of circulating Vitamin D levels on HF risk.

Hypothesis:
Low serum Vitamin D levels are associated with incident HF in a large prospective cohort of Italian adults.

Methods:
We analyzed 18,689 (48.4% men, age ≥35 years) HF-free individuals randomly recruited from the general population of the Moli-sani study, for whom complete data on HF and serum Vitamin D were available. Vitamin D was measured on serum by an immunoassay in the central laboratory of European BiomarCaRE project (Abbott Architect 25-OH Vitamin D, Wiesbaden, Germany). The cohort was followed up for a median of 4.2 years (80,849 person-years). Baseline serum Vitamin D was categorized in deficient/insufficient, hypovitaminosis, and normal (Table). Incident cases of HF were identified by linkage with the regional archive of hospital discharges. Hazard ratios (HRs) were calculated using Cox-proportional hazard models.

Results:
Subjects with normal, hypo or insufficient levels of Vitamin D were 12.2%, 79.6% and 8.2%, respectively. We identified 412 incident cases of HF. The incidence of HF was 1.1%, 2.2% and 3.9%, respectively in subjects with normal, hypo and insufficient levels of Vitamin D. After a multivariable analysis, considering a large panel of potential covariates, individuals with deficient/insufficient levels of serum Vitamin D showed a higher risk of developing HF (HR: 1.78, 95% CI: 1.07-2.97) than those with normal levels. Further adjustment for C-Reactive Protein did not modify the association (Table).

Conclusions:
Deficiency of Vitamin D is associated with a significantly higher risk of HF in a general adult population. This association was not explained by an inflammatory marker such as C-Reactive Protein.
Abstract P063: Cigarette Smoking and Neuroimaging Indices of Cerebrovascular Health in a Population-based Cohort of Middle-aged Adults
Authors: Elbejjani Martine , Jacobs David R , Auer Reto , Bryan Nick R , Launer Lenore J
Published: July 2021

Introduction:
Several studies report an association between cigarette smoking and dementia. One proposed hypothesis is that smoking leads to adverse cognitive and brain changes through vascular pathways. To date, few data exist on the link between smoking and vascular brain measures. We examined, in a population-based middle-aged cohort, the association of history of cigarette smoking with three indicators of cerebrovascular health: (i) white matter (WM) integrity measured using WM-fractional anisotropy, (ii) abnormal WM volume, and (iii) cerebral blood flow (CBF) in the gray matter. We focused on lobar measures of these indicators to detect whether specific regional cerebrovascular indicators are differently related to smoking.

Hypothesis:
We assessed the hypothesis that smoking history is associated with more adverse cerebrovascular measures (lower fractional anisotropy, larger abnormal WM volumes, and lower CBF).

Methods:
Data come from the Coronary Artery Risk Development in Young Adults CARDIA-brain magnetic resonance imaging sub-study (n=538). Brain measures and self-reported smoking history were obtained at the 25th year follow-up (mean age=50). We used linear (for CBF and WM-fractional anisotropy) and multinomial logistic (for abnormal WM volume) regression models, adjusted for potential confounders (including vascular and lifestyle risk factors and medical conditions).

Results:
Compared to never-smokers, current smokers had lower WM-fractional anisotropy in all brain lobes (-0.005 lower fractional anisotropy in the occipital lobe and -0.006 in the other lobes; p<0.05). Smoking history was also associated with larger abnormal WM volumes: Compared to never-smokers, smokers and/or former-smokers had patterns of larger abnormal WM volumes in all lobes, with pronounced associations observed in the frontal lobe wherein smokers and former-smokers had up to twice the risk of having larger abnormal frontal WM volumes as never-smokers (p<0.05). Smoking history was associated with lower CBF in the occipital (-2.89 ml/100g/min (95%CI=-5.43, -0.36); p=0.03) and parietal lobes (-3.31 (95%CI=-5.91, -0.71); p=0.01).

Conclusions:
In this cohort of middle-aged adults, associations between smoking and adverse WM measures were observed in all brain lobes, whereas associations of smoking with CBF were localized in the occipital and parietal lobes. This localization may reflect a link between smoking and blood flow processes related to sensory-cognitive networks. In conclusion, results suggest that smoking is associated with three early-indicators of cerebrovascular burden (WM-fractional anisotropy, WM abnormal volume, and CBF) across the brain and that it may be differentially related to different regional cerebrovascular indicators.
Abstract P068: Use of Plastic Food Wrappers High in Phthalates is Associated with Metabolic Syndrome Among Mexican Women
Authors: Rodriguez Jordan , Gomez Humberto , Ortiz-Panozo Eduardo , Yunes Elsa , Lajous Martin , Lopez-Ridaura Ruy
Published: July 2021

Introduction:
Exposure to phthalates has been associated to metabolic abnormalities and cardiovascular risk. Commonly used plastic food wrappers may contain up to 40% of phthalates and could be an important source of exposure to these chemicals especially when heated.

Hypothesis:
Use of plastic food wrappers high in phthalates affects metabolic homeostasis.

Methods:
We assessed the cross-sectional relation of plastic food wrappers use and metabolic syndrome in 188 women from the Mexican Teachers’ Cohort. We evaluated self-reported frequency of use of food wrappers based on 3 questions and categorized participants in tertiles. Fasting blood samples and anthropometry were obtained in a clinical visit to determine metabolic syndrome status. Continuous variables were log-transformed. We used multivariable logistic and linear regression models to estimate odds ratios, mean % change and 95% confidence intervals (CI) for metabolic syndrome and its components using the lowest tertile of exposure as the reference.

Results:
Mean (±SD) frequency use of total plastic food wrapper was 1.52± 3 times/week and the prevalence of metabolic syndrome was 34%. Use of total plastic food wrappers was associated with metabolic syndrome even after adjusting for diet and other important confounders. The multivariable-adjusted odds ratio (OR) comparing extreme tertiles was 2.61 (95% CI: 1.03, 6.61; ptrend = 0.10). The association appeared to be driven by use of plastic food wrappers that were heated in a microwave oven. We did not observe an independent association with metabolic syndrome components.

Conclusions:
In this cross-sectional study use of plastic food wrappers, especially when heated in the microwave oven, was associated with the presence of metabolic syndrome. These associations did not appear to be driven by a particular metabolic syndrome component. Longitudinal studies are warranted to confirm this association, ideally with measures of urinary phthalate metabolites to confirm its mediation in the association.
Abstract P070: Long-term Cumulative Blood Pressure Improves CVD Risk Prediction Algorithms
Authors: Allen Norrina B , Ning Hongyan , Lloyd-Jones Donald
Published: July 2021

Background:
Published risk prediction algorithms only include current BP; however, long-term BP patterns are associated with atherosclerotic (AS)CVD incidence. We tested whether the long-term (5- and 10-year) cumulative blood pressure improves 10 year ASCVD prediction.

Methods:
This study used the Lifetime Risk Pooling Project (LRPP) including the Framingham, CARDIA and ARIC cohorts. Participants with 15- and 20-year follow-up (5- and 10- years prior to risk calculation and 10 year follow-up), no history of prior CVD, and between the ages of 45 and 65 at the time of risk estimation were included. We calculated 10 year ASCVD risk using the 2013 ACC/AHA 10-year ASCVD Pooled Cohort Equations. Study-specific coefficients were calculated. Differences in the C-statistic, the category-free net reclassification index (NRI) and improved discrimination index (IDI) were examined between the model with baseline as compared to the model with cumulative SBP. Analyses were stratified by gender.

Results:
Among 11,475 individuals (42.4% male and 12.7% African American), those in the highest tertile of cumulative SBP were older, more likely to be male, and had a higher burden of other CVD risk factors. Overall, 1,487 (13%) participants experienced a CVD event (mean follow-up time was 12 years). ASCVD incidence rates increased with higher tertiles of cumulative SBP from 4 events per 1,000 person-years in the lowest tertile to 8 and 18 in the second and third tertiles, respectively. No significant improvements were seen in the C-statistic when including 5- or 10-year cumulative SBP (see table). However, the replacement cumulative SBP resulted in significant improvements in model reclassification of NRI and IDI with greater improvements for the 10- than 5-year cumulative measure.

Conclusions:
Measures of cumulative BP can improve the ability of CVD risk prediction models to correctly classify individuals. Additional studies on the inclusion of these measures in future risk prediction algorithms are warranted.
Abstract P075: Oncologists’ Perceptions of the Usability of SPHERE: an Electronic Health Record Application Based on Life’s Simple 7™
Authors: Foraker Randi E , Kelley Marjorie M , Tangasi Wilkister , Lin En-Ju , Weaver Kathryn E
Published: July 2021

Background:
We developed SPHERE, an electronic health record (EHR) data visualization application, to automatically populate with EHR data on the American Heart Association’s cardiovascular health (CVH) behaviors and factors. SPHERE was designed to increase patient-provider communication around Life’s Simple 7™, and utilized a stoplight color scheme as part of the visualization to indicate “ideal” (green), “intermediate” (yellow), and “poor” (red) CVH. Results from the SPHERE Study showed improvements in body mass index and diabetes status among eligible patients seen in the intervention clinic as compared to the control clinic. It remains unknown whether the use of SPHERE would be acceptable to oncologists in the survivorship care setting, even though cancer survivors are at high risk for developing cardiovascular disease.

Methods:
We conducted one-on-one interviews, using a think-aloud protocol, with 14 oncologists (10 community practice, 4 academic) who were practicing in the NCI Community Oncology Research Program (NCORP). During the 30-minute interview period, we asked each oncologist to use SPHERE and we obtained user feedback on the SPHERE application.

Results:
Half of the oncologists were male, and most (78%) were medical oncologists; 2 were gynecologic oncologists, and 1 was a radiation oncologist. When asked about discussing CVH with post-treatment, good-prognosis patients, no oncologists indicated that they “never” talked to patients about CVH or initiated those discussions. Eleven oncologists responded that discussing CVH was either “somewhat important” or “very important”, and 9 oncologists indicated they were “somewhat comfortable” or “very comfortable” discussing CVH with patients. Themes identified from transcripts of the 7 hours of interviews suggest 1) strong interest in the tool, 2) high perceived importance of discussing CVH with patients who had a good prognosis, 3) high usability, and 4) a belief that the tool would be helpful and not overly burdensome in practice. Duplication of preventative health efforts with the primary care provider as well as workflow and time constraints were identified as barriers by several oncology providers.

Conclusions:
Overall, these preliminary data demonstrate acceptability and feasibility of implementing the SPHERE application tool within NCORP community oncology practices. These qualitative data suggest great potential for automated EHR-based applications such as SPHERE to impact the CVH of cancer patients in survivorship care.
Abstract P086: Circulating MicroRNAs are Associated with Abdominal Adiposity and Fatty Liver in Asian Indians
Authors: Miles Kevin , Kanaya Alka M , Flowers Elena
Published: July 2021

Background:
Fatty liver is associated with abdominal adiposity, insulin resistance, and risk for diabetes and liver disease. Asians Indians have a high prevalence of fatty liver and abdominal visceral adiposity compared to other racial groups, and the causes are not well understood. Circulating microRNAs (miRs) identify latent risk factors for diabetes and biologic mechanisms underlying disease. Previous studies identified associations between circulating microRNAs and obesity in Caucasians. No prior studies evaluated association between circulating microRNAs and fatty liver and abdominal adiposity in Asian Indians.

Hypothesis:
Circulating microRNAs are associated with the presence of fatty liver and elevated waist circumference in Asian Indians.

Methods:
We studied 136 participants (49% women, age 56 ± 8 years) from the Metabolic syndrome and Atherosclerosis in South Asians Living in America (MASALA) pilot study. Elevated waist circumference at baseline was defined as >90cm for men and >80cm for women. Fatty liver was measured using computed tomography images of the liver and spleen (in Hounsfield units) and was defined as liver to spleen ratio <1. Circulating microRNAs (n=30) were measured from plasma collected during the baseline visit using the Firefly Circulating microRNA assay. Unadjusted and multivariate-adjusted logistic regression models were created.

Results:
Elevated waist circumference was present in 115 (85%) and fatty liver was present in 24 (18%). In age and sex adjusted models, miR-423 was inversely associated with elevated waist circumference (p<0.05). This miR was also inversely associated with metabolic syndrome (p<0.1) in the subset of individuals not taking hypertension or diabetes medications (n=88). MiR-146a, miR-146b, miR-197, miR-20b, miR-21, miR-222, and miR-24 were inversely associated with fatty liver (p<0.05 for all). These microRNAs show moderate to high inter-correlations (r=0.4-0.9). None of these miRs were significantly associated with metabolic syndrome or diabetes. MiR-486, which is associated with glycemic impairment and progression in Asian Indians and insulin resistance and response to thiazolidenidones, was positively associated with fatty liver (p<0.1).

Conclusions:
We found significant relationships between fatty liver and waist circumference and numerous circulating microRNAs. MicroRNAs inversely associated with fatty liver are correlated and may be co-expressed in order to regulate biologic pathways related to fatty liver. There is no overlap between miRs associated with fatty liver and miRs associated with diabetes and metabolic syndrome. Additional studies are needed to determine whether circulating microRNAs might be useful biomarkers for the detection of fatty liver, which biologic pathways are implicated, and whether there are differences between race/ethnic groups.
Abstract P087: Ethnic and Educational Disparities in Morbid Obesity Among Employees of a Large Healthcare Organization: The Baptist Health South Florida Employee Study
Authors: Osondu Chukwuemeka U , Aneni Ehimen C , Younus Adnan , Rouseff Maribeth , Das Sankalp , Parris Don , Guzman Henry , Tran Thinh , Malik Rehan , Aziz Muhammad A , Ogunmoroti Oluseye , Feldman Theodore , Agatston Arthur S , Veledar Emir , Virani Salim , Nasir Khurram
Published: July 2021

Background:
Ethnic differences in obesity are well documented; however, the epidemiological evidence of the impact of socioeconomic and educational status on its relationship is sparse. We sought to assess the impact of educational attainment, as a proxy of socioeconomic status, on the association between ethnicity and morbid obesity (MO) among employees of Baptist Health South Florida (BHSF), a large nonprofit healthcare organization.

Methods:
Data was collected from employees participating in an annual Health Risk Assessment in 2014. Educational attainment was self-reported while weight, height and other biometric measures were measured in person. MO was categorized using eligibility criteria for bariatric surgery as outlined by the 1991 NIH consensus guidelines for surgery for the obese.

Results:
Data was collected for 9361 participants (mean age 42.8 ± 12.1 years, 74% females, 63% Hispanic). Overall, 7% meet criteria for MO (Non-Hispanic White [NHW]: 5%; Hispanics: 6%; Non-Hispanic Black [NHB]: 12%). A lower education was associated with a greater prevalence of morbid obesity (Post graduate/ professional: 4.2%; completed college: 5.2%; some college or lower: 9.8%) The highest (18%) and lowest (4%) prevalence of MO were observed in NHB with some college education or lower (SCL), and in Hispanics with post-graduate or professional educational (PG) attainment respectively. Among PG, compared to NHW, the odd ratios (95% CI) for presence of MO among NHB was 1.3 (0.6 - 2.5). Conversely, the respective MO risk for NHB vs. NHW was 4 fold higher (2.5 - 6.4) among those with SCL. Interaction of ethnicity and educational attainment for predicting MO was significant (p <0.05) adjusting for age and sex.

Conclusion:
Underlying differences in educational status significantly impact ethnic disparities in morbid obesity. The co-existing influence of education and racial disparities should be jointly addressed to maximize yield of future wellness efforts aimed at optimizing CV health.
Abstract P093: Influence of Comorbidities on Outcomes in Atrial Fibrillation: A Population-based Case-control Study
Authors: Chamberlain Alanna , Alonso Alvaro , Gersh Bernard , Manemann Sheila , Killian Jill , Weston Susan , Roger Veronique
Published: July 2021

Background:
Differences in the impact of comorbid conditions on outcomes in atrial fibrillation (AF) patients compared to population controls have not been well documented.

Methods:
The prevalence of 19 chronic conditions and smoking status was obtained in 1430 patients with incident AF from 2000-2010 and 1430 controls matched 1:1 on sex and age (within 5 years) from Olmsted County, MN. Andersen-Gill models determined associations of each condition with all-cause hospitalizations in AF cases and controls after adjusting for all other conditions and accounting for the matching. Cox regression determined associations of each condition with death.

Results:
Among 1430 matched pairs (median age 76 years, 48.6% men), the prevalence of chronic conditions was higher in AF cases compared to controls for all conditions except asthma, dementia, depression, hepatitis, and osteoporosis. Over a mean follow-up of 6.3 years, 2678 hospitalizations and 812 deaths occurred. The rates of hospitalization were 59 and 26 per 100 person-years and the rates of death were 10 and 5 per 100 person-years in AF cases and controls, respectively. After adjusting for all other conditions, the risk of hospitalization was lower in AF patients compared to controls for those with coronary artery disease, arthritis, cancer, chronic obstructive pulmonary disease, and osteoporosis (figure). In contrast, the risk of hospitalization was higher in AF cases for those with diabetes and substance abuse. For deaths, the only comorbidity with different associations between AF cases and controls was depression. The hazard ratios (95% CI) for death were 2.02 (1.26-3.24) in AF cases and 0.90 (0.58-1.38) in controls (p-value for interaction=0.008).

Conclusions:
AF patients have a higher prevalence of chronic conditions compared to population controls. The associations of comorbidities with hospitalizations differed between AF cases and controls, suggesting that management of comorbidities in patients with AF may need to be tailored to this specific patient population.
Abstract P096: Trends in Heart Disease Mortality Among Mississippi Adults Over a Three Decade Period, 1980 Through 2013
Authors: Mendy Vincent L. , Vargas Rodolfo , El-sadek Lamees , Gamble Abigail
Published: July 2021

Background:
Heart disease (HD) mortality has declined in Mississippi over recent decades however it remains as the leading cause of death among Mississippians. Trends in Mississippi HD mortality have not been thoroughly explored. This study examined trends in HD mortality from 1980 through 2013 among Mississippi adults (≥ 25 years) and further assessed trends by race and sex.

Methods and Results:
Data from Mississippi Vital Statistics (1980 through 2013) were used to calculate age-specific HD mortality rates for Mississippi adults. Cases were identified using underlying cause of death codes from the International Classification of Diseases, Tenth Revision (ICD-10), including I00-I09, I11, I13, and I20-I51. Joinpoint software was used to calculate the average annual percent change in HD mortality rates for the overall population and by race, sex, and race and sex.

Overall, the age-adjusted HD mortality rates among Mississippi adults decreased by 36.5% between 1980 and 2013 with an average annual percent change of -1.60% (95% CI -2.0 to -1.3). During this period, HD mortality rates decreased annually on average by -1.30% (95% CI -1.98 to -0.69) for black adults; by -1.60% (95% CI -1.74 to -1.46) for white adults; by -1.30% (95% CI -1.5 to -1.1) for all females, and by -1.90% (95% -2.2 to -1.5) for all males.

Conclusions:
Between 1980 and 2013 a continual decrease in HD mortality among Mississippi adults was observed. Disparities in the magnitude of the decrease in HD mortality existed by race and sex.
Abstract P105: Early Adolescent Waist Size and Body Mass Index are Stronger Predictors of Lipid Levels After Ten Years Than Percent Body Fat in Black and White Girls
Authors: Ferreira Sanae E , Singer Martha R , Bradlee M L , Daniels Stephen R , Moore Lynn L
Published: July 2021

Cardiometabolic risk begins in childhood and poses additional hazards for later chronic disease. In this study, we assessed the hypothesis that pre-adolescent measures of body fat (ages 9-10 years) would predict later adolescent lipid levels (ages 17-20 years) and that racial differences may exist in the efficacy of particular measures of body fat for predicting future lipid levels. Data from the NHLBI’s Growth and Health Study were used to evaluate the independent effects of early adolescent body mass index (BMI), waist circumference (WC), and percent body fat (%BF) - all distinct measures of body composition - in this cohort of Caucasian (white) and African-American (black) girls, initially 9-10 years of age. Girls with complete data (n=634, white; n=738, black) for body fat, relevant confounders, and follow-up lipid levels (i.e., HDL, LDL, and triglycerides) at 17-20 years of age were included. In late adolescence, there were statistically significant trends of increasing LDL and triglycerides and decreasing HDL levels (p<0.05 for all) across quintiles of all body fat measures at 9-10 years of age. By 17-20 years, white girls (vs. black girls) in the highest BMI quintile had slightly higher mean LDL levels (112.7 vs. 105.1), lower HDL levels (48.0 vs. 51.4), and much higher triglyceride levels (109.8 vs. 76.8 mg/dL). After adjusting for age, SES, height, age at menarche, physical activity, television viewing, fruit and vegetable consumption, and dietary fiber, WC was the strongest predictor of late-adolescent triglycerides and HDL levels in both whites and blacks while BMI was an equally-good predictor of LDL. Percent body fat using bioelectrical impedance analysis was generally a weaker predictor of lipid outcomes. Girls in the highest quintile (Q5) of WC had mean triglyceride levels that were 31.1 and 14.9 mg/dL higher than those in the lowest quintile (Q1), for whites and blacks, respectively; mean differences (Q5-Q1) in TG associated with BMI were 27.7 and 12.0 mg/dL, and for %BF were 13.6 and 7.2 mg/dl, respectively. White and black girls, respectively, in Q5 of WC at 9-10 years of age had HDL levels that were 7.8 mg/dL lower in late adolescence than those of girls in Q1. These results suggest that WC and BMI as simple anthropometric measures of body fat in pre-adolescent girls may be useful in identifying girls who are at risk for dyslipidemia by the time of later adolescence.
Abstract P114: Metabolic Syndrome is Associated with Abnormal Ankle Brachial Index: Estimates From the National Health and Nutrition Examination Survey (1999-2004)
Authors: Singh Sarah , Pilkerton Courtney , Frisbee Stephanie
Published: July 2021

Introduction:
Metabolic syndrome (MetS) and low ankle-brachial index (ABI) share interrelated cardiovascular risk factors and are thus both strong indicators of an atherosclerotic process. However, few clinicians consider metabolic syndrome as a risk factor for abnormally low ABI and subsequent peripheral arterial disease. Therefore, it is necessary to highlight the relationship between abnormal ABI and MetS and the role of cardiovascular risk factors on this relationship.

Hypothesis:
We hypothesize that persons with MetS compared to those without, are more likely to experience abnormally low ABI even after accounting for additional cardiovascular risk factors not defined in the MetS.

Methods:
The eligible population consisted of 7,458 men and women aged 40 years and older, with and without cardiovascular disease (CVD) participating in The National Health and Nutrition Examination Survey from 1999-2004. Subjects were evaluated, according to the American Heart Association definitions, for abnormally low ABI < 1.0 (which included borderline low and low ABI) and metabolic syndrome with ≥ 3 of the following 5 components; central obesity, hypertriglyceridemia, low HDL cholesterol, hyperglycemia and hypertension. Ordinal logistic regression models were used to identify relationships between abnormal ABI and MetS, with adjustments for additional cardiovascular risk factors in multivariate models.

Results:
Participants with metabolic syndrome, as compared to those without, were 1.51 (95% CI, 1.01-2.26) times more likely to experience abnormally lower values of ABI after adjusting for gender, race, education, smoking and CRP. The relationship between abnormal ABI and MetS was modified by age (p value 0.01) but not by gender (p value 0.10) or race (p value 0.09). Additionally, odds of a lower ABI was highest for those with 4-5 components of MetS compared to those with 0-2 components (OR, 2.22; 95% CI, 1.44 to 3.43). Examining individual MetS components in fully adjusted models revealed that hypertriglyceridemia (OR, 1.69; 95% CI, 1.16 to 2.46) and low HDL cholesterol (OR, 1.81; 95% CI, 1.15 to 2.87) were associated with higher odds of abnormal ABI.

Conclusions:
In conclusion, the presence of MetS in adults with and without CVD was associated with abnormally low ABI, even after accounting for additional cardiovascular risk factors not defined by the MetS. This study suggests that timely clinician awareness of abnormally low ABI in persons with at least three MetS components, hypertriglyceridemia or low HDL cholesterol, may be useful in preventing the debilitating effects of peripheral artery disease.