bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P246: Geographical Mapping and Cluster Analysis of Ischemic Stroke in Kentucky
Authors: Ngam Solina , Mansoor Hend , Manion Daniel , Jayawardhana Jayani , Delcher Chris
Published: May 2024

Background:
Stroke death is the third leading cause of death in the United States, the sixth leading cause of death in Kentucky (KY), and ischemic stroke (IS) is the most prevalent type in adults (~85%). Small area estimates of stroke incidence can help identify local interventions to lower the burden of vascular risk factors and risk of recurrent IS in these areas. Therefore, the goals of this study are to calculate small area IS incidence rates, examine clusters, and understand the distribution of IS in KY.

Methods:
Data was obtained from the Kentucky Hospital Inpatient Discharge and Outpatient Services Databases (HIDOSD) from 2012 to 2021; and the Kentucky Cabinet for Health and Family Services. HIDOSD represents KY emergency department discharges, inpatient data, and ambulatory facility services. We linked 5-digit Zip codes to (n=759) zip code tabulation areas (ZCTA) available from the US Census Bureau. The annualized IS rate per 100,000 was calculated by dividing the mean number of IS hospitalizations from 2012 to 2021 by the ZCTA 2020 population. We categorized IS rates by quartiles and calculated box plots in descriptive analyses. We tested for significant spatial clusters using the Local Moran’s I with Empirical Bayes rate smoothing in GeoDa.

Results:
From 2012-2021, 90,840 IS hospitalizations were reported in KY. The median IS rate was 226.5 per 100,000. The median rate in the highest quartile was 290.8 (IQR 171.7 - 290.8) vs 171.7 (IQR 171.7 - 290.8) in the lowest quartile. An area of high IS rate clusters (n=20) was identified in southeastern KY with lower clusters dispersed throughout the state. Figure.

Conclusions:
This 10-year analysis of IS hospitalizations across KY identified areas of potential intervention. Future efforts are needed to identify the social and medical contributors driving burden of IS in these areas and to design interventions targeted to improve health outcomes.
Abstract P247: Rural-Urban Disparities in In-Hospital Stroke Mortality in North Carolina
Authors: Pinapaka Mahesh V , Patel Mehul D , Chari Srihari V , Rosamond Wayne D
Published: May 2024

Introduction/Hypothesis:
Stroke remains a significant public health concern. North Carolina (NC) has the 11
th
highest stroke mortality in the United States and an increasingly diverse population with respect to rurality and race-ethnicity. We assessed the hypothesis that rural stroke patients have higher in-hospital mortality than urban stroke patients in NC. We also explored the interaction between rurality and race-ethnicity on stroke mortality.

Methods:
We conducted a retrospective study of stroke hospitalizations at 115 NC hospitals from January 2019-September 2020. Data were obtained from an inpatient database of patient demographics, county of residence, insurance, admission date, and discharge disposition and diagnoses. Eligible patients included adults with principal discharge diagnosis codes for stroke (ICD-10-CM I60.xx-I63.xx) and were classified by rurality defined by the NC Office of Rural Health. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) comparing in-hospital mortality in rural versus urban patients, overall and stratified by race-ethnicity subgroups.

Results:
Among 32,808 patients, 37% resided in rural counties. Patients were mean 69 years old, 50% female, 30% Black, and 3% Hispanic. Unadjusted in-hospital mortality was lower in rural versus urban patients (4.2% and 5.0%, respectively). Adjusted model found a weak, non-significant association between rurality and stroke mortality (OR 1.06, 95% CI 0.95-1.19; Table 1). In race-ethnicity subgroups, rural-urban ORs were not statistically significant although the point estimates suggest modestly greater differences among racial/ethnic minorities compared to White patients.

Conclusions:
We found minimal, adjusted rural-urban differences in in-hospital stroke mortality in NC statewide and within race-ethnicity subgroups. Further research is needed to investigate potential disparities in long-term stroke mortality and morbidity and their underlying determinants.
Abstract P257: Olfactory Impairment and Frailty in Older Adults the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Pleasants Hannah , Kucharska-Newton Anna , Chen Honglei , Yuan Yaqun , Chamberlin Keran , Couper David , Shrestha Srishti , Kamath Vidya , Deal Jennifer A , Palta Priya , Pinto Jay
Published: May 2024

Introduction:
Olfactory impairment, which has been associated with poor physical and cognitive performance has been understudied as a potential marker of frailty among older adults.

Hypothesis:
Poor compared to good olfaction is associated with the risk of frailty cross-sectionally and in longitudinal assessments.

Methods:
Olfactory function was evaluated among participants of ARIC Study Visit 5 (2011-2013) using a 12-item Sniffin’ Sticks test. The continuous olfaction score (range 0-12) was categorized as poor (0-8), moderate (9-10), or good (11-12). Frailty was based on the Fried frailty phenotype, encompassing the following criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Logistic regression models were used to examine the association of olfaction with frailty at Visit 5 and at Visit 6 (2016-2017), for participants robust at baseline. All models were adjusted for age, sex, race, field center, and cardiovascular risk factors. Interaction by median age, sex, and race was examined. Sensitivity analyses used inverse probability of attrition weighting.

Results:
Among 5094 study participants (mean age 75.3 (SD 5.0) years, 58% female, 21% Black), 32.5% had poor olfaction at Visit 5. A gradient in the association of olfaction categories with frailty status was observed in both the cross-sectional and longitudinal analyses. The adjusted odds ratio for the cross-sectional association of poor vs. good olfaction with frailty was 2.08 (95% CI 1.51, 2.86) and it was 1.82 (95% CI 0.86, 3.87) in longitudinal analysis (median follow-up time: 4 years). The findings remained consistent when adjusting for cardiovascular health and attrition. No observed associations differed by race or sex.

Conclusion:
Poor olfaction is associated with prevalent and incident frailty. These findings suggest olfaction as a marker of frailty in older adults.
Abstract P273: Sex-Stratified Machine Learning Analysis of Proteomics, Phenotypic, and Genomic Influences on Visceral Adipose Tissue Volume in the UK Biobank
Authors: Azizi Zahra , Gupte Trisha , Kho Pik Fang , Nzenkue Kevin , Zhou Jiayan , Guarischi-Sousa Rodrigo , Panyard Daniel , Chen Ming-Li , Abbasi Fahim , CLARKE Shoa L , Tsao Philip S , Assimes Themistocles L
Published: May 2024

Introduction:
Adiposity distribution plays an important role in insulin resistance (IR); sex differences in body composition can influence the risk of cardiometabolic disease (CMD). We aimed to assess sex differences in the intersection of proteomic, genomic and phenotypic factors related to visceral adipose tissue (VAT) and IR.

Methods:
We examined UK biobank participants with proteomic data generated using the Olink proximity extension antibody assay (PEA). Association between proteomics, genomics and phenotypes with VAT volume was evaluated. To assess the complex relationships between features, a multistep approach was employed. Following evaluation of each feature types, the combined effects of proteomics, genomics and phenotypes were assessed. Then, top 30 features from the final model were examined (Figure). R2 was tested as an indicator of the variance of VAT explained by the features in each model and SHAP values were reported.

Results:
We analyzed a total of 5342 participants (52.2% female, mean age 54.8±7.9 years). Our analysis revealed significant variation in plasma proteins when added to phenotypes and genomic data in both sexes. Polygenic scores, phenotypic factors, proteomics, and the combined model explained 4%, 55%, 57%, and 60% of the variation in VAT in women, respectively. In men, these values were lower at 2%, 49%, 51%, and 56%, respectively. While there were common proteins between men and women, several sex-specific proteins were noted in women (e.g., FGF21, LDLR, INHBC, CES1, WFIKKN2, CLEC4A, CDHR2, PRSS8, TNXB, ERBB2, F9, THBS2, CCL16) and men (e.g., CA14, ADM, PON3, STC1, MEGF10, ASGR1, REN, FURIN, OXT, PSPN, HSP90B1, CTSD, SERPINB5, CNTN3, CTSB, WFDC12, and ADGRG1).

Conclusion:
Our study demonstrated the presence of significant sex differences in the plasma proteomics associated with VAT. These findings may provide insights into sex differences in protein expression related to CMD and enable an individualized measurement of adiposity as one means of better understanding the biology of IR.
Abstract P275: Long-Term Mortality Prediction Model for HIV Patients With Heart Failure: Analysis From a Multi-Center Cohort Database in New York City Health + Hospitals
Authors: Chen Yi-Yun , Borkowski Pawel , Nazarenko Natalia , Parker Matthew , Biavati Luca , Vargas-Pena Coral , Chowdhury Ishmum , Bock Joshua , Faillace Robert , Palaiodimos Leonidas
Published: May 2024

Introduction:
Given the intricate interplay of HIV infection and heart failure (HF), conventional mortality prediction models for general heart failure may prove insufficient for this specific population. Our objective is to assess the fitness of current HF death prediction models and develop a prediction model tailored to the unique challenges of long-term mortality risk in HIV patients with heart failure.

Method:
The statistical models were developed through New York City Health + Hospitals HIV Heart failure (NYC 4H) retrospective cohort. Demographic and medical factors were obtained through chart reviews, while social adversities were assessed via licensed social workers' psychosocial assessment notes. Patients with baseline cancer, no baseline ejection fraction (EF), or those below 18 years of age were excluded from the study. Multivariable logistic regression models were constructed to predict the risk of overall death. Model 1 was derived from the existing MAGGIC Risk prediction model for general heart failure patients. Model 2 employed backward step-wise selection from NYC 4H cohort for HIV HF biologic factors, functional status, medical and interventional treatment to predict mortality risk. Model 3 further adjusted for single significant social factors and insurance. Model comparison was performed using the area under the ROC curve.

Result:
The study comprised 597 HIV heart failure patients, averaging 61.1 years in age. Over the 4-year follow-up, 102 deaths (17.1%) were recorded. Model 1 (MAGGIC Risk prediction model) had an AUC of 0.72. Model 2, which included backward-selected variables such as age, race, HIV viral load at baseline and follow-up, CD4 count at baseline, EF at baseline, smoking status, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral arterial disease, chronic kidney disease, activities of daily living, obesity, implantable cardioverter-defibrillator implantation, and the total number of guideline-directed medical therapy, significantly improved the AUC to 0.85. Incorporating social factors such as exposure to any lifetime adversities, specific adversities (lack of family support, polysubstance abuse, and mental illness), and insurance status, model 3 raised the AUC to 0.88. In heart failure with reduced EF (HFrEF) subset (n=502), Model 2 and Model 3 achieved AUCs of 0.88 and 0.90, respectively.

Conclusion:
HIV heart failure patients exhibit unique mortality prediction factors compared to general heart failure patients without HIV infection. Considering the high burden of social adversities, socioeconomic factors can enhance the predictive yield of models within this specific population.
Abstract P280: Understanding the Association Between Resilience Factors and Lifestyle-Based CVD Prevention Among Young Adults in Puerto Rico
Authors: Lopez-Cepero Andrea , Rosal Milagros C , Perez Cynthia
Published: May 2024

Background:
Recent research has identified associations between optimism and cardiovascular disease endpoints. However, other resilience factors like shift-and-persist (SP; adapting the self to stress while finding purpose in tough times), spirituality, social support, and life satisfaction have been understudied. We assessed associations among these factors and a lifestyle-based CVD metric (the Fuster BEWAT score (FBS)) and identified the strongest predictor among young adults in Puerto Rico (PR), a population with a high burden of CVD risk factors.

Methods:
This cross-sectional analysis used data from young adults (18-29y) who underwent survey and clinical assessments (September 2020-September 2023 ) as part of the PR-OUTLOOK study. Those with complete data were included (n=1,721; 61% female). SP was measured with the Chen scale, optimism with the Life Orientation Test-Revised-6 items scale, spirituality with the Daily Spiritual Experiences Scales, social support (from friends, family, and partner) with the Whalen scale, and life satisfaction with one item from the International Social Survey Program. Higher scores in all scales represent greater resilience and all were converted to z-scores. The FBS included blood pressure, exercise, weight, diet, and tobacco. All metrics were dichotomized as ideal (1) or non-ideal (0) and a total FBS was calculated and categorized according to the number of ideal metrics: poor (0-1), intermediate (2-3), and ideal (≥4). The intermediate and ideal groups were grouped for analysis due to small cell size. Logistic regression models assessed the association between each resilience factor and intermediate/ideal FBS (vs. poor) adjusting for socio-demographics, health insurance, and depression symptoms (Model 1), and for all other resilience factors (Model 2).

Results:
In the sample, 46% had a poor FBS score, 53% had an intermediate score, and 1% achieved an ideal score. In Model 1, a one standard deviation increase in SP was associated with a 21% higher odds of intermediate/ideal FBS (OR=1.21; 95% CI=1.08-1.36), while optimism, life satisfaction, and social support were associated with 17% (OR=1.17; 95% CI=1.05-1.32), 15% (OR=1.15; 95% CI=1.03-1.29), and 12% (OR=1.12; 95% CI=1.01-1.25) higher odds, respectively. Upon adjusting for all resilience factors (Model 2), only SP remained significantly associated with intermediate/ideal FBS (OR=1.17, 95% CI=1.01-1.35).

Conclusion:
While optimism, life satisfaction, and social support demonstrated initial associations with better FBS scores, SP emerged as the most significant resilience factor predicting FBS. If confirmed with longitudinal studies, SP could be an important target for future studies of CVD prevention interventions.
Abstract P281: Pre-Stroke Use of Dipeptidyl Peptidase-4 Inhibitors in Elderly Patients May Reduce Neurological Severity at the Onset of Stroke: A Retrospective Cohort Study
Authors: Mori Takahisa , Yano Tetsundo , Yoshioka Kazuhiro , Miyazaki Yuichi
Published: May 2024

Introduction:
Functional outcomes after acute stroke (AS) are related to the initial neurological severity. Therefore, neuroprotective agents to reduce initial brain damage at AS onset shows promise as a preventive approach. Dipeptidyl peptidase 4 inhibitors (DPP4i) have been reported to reduce stroke volume in mice. Therefore, DPP4i may exert neuroprotective effects on brain damage caused by AS. However, the association between pre-stroke use of DPP4i and neurological severity at the onset of AS has not been well studied.

Hypothesis:
Pre-stroke DPP4i use reduces neurological severity (NS) at the onset of AS.

Methods:
We conducted a retrospective cohort study involving patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined mild NS as a score of ≤5 points on the National Institutes of Health Stroke Scale. We used logistic regression analysis using variables for pre-stroke DPP4i initiation, calculated propensity scores for pre-stroke DPP4i use and implemented one-to-one propensity score matching (PSM). We compared the incidence of mild NS between the two groups.

Results:
Out of 4294 patients with AS, 3472 met the inclusion criteria. After PSM, we had 221 patients in each group. The median ages of DPP4i users and non-users were 79 and 78 years, respectively. Among the 221 DPP4i users and the 221 non-users, 140 (63.4%) and 121 (54.8%) patients had reduced NS, respectively (p=0.0659 by chi-square test, standardized difference=0.1756). The chi-square test did not show a significant difference in the matched cohort, but the standardized difference of 0.1 or more suggested that the two groups were not balanced on the incidence of mild NS.

Conclusions:
The pre-stroke use of DPP4i among elderly patients was associated with mild NS at AS onset, suggesting a potential neuroprotective effect of DPP4i on initial brain damage caused by AS. Further prospective studies with larger sample size are needed to verify the causal relationship between pre-stroke DPP4i use and NS at AS onset.
Abstract P284: Effects of a Laughter Program on Cardiovascular Risk Factors in Community-Dwelling Older Adults
Authors: Ohira Tetsuya , Funakubo Narumi , Eguchi ERI , Shirai Kokoro
Published: May 2024

Introduction:
While there have been several intervention studies on the psychological effects of laughter, few have examined both the psychological and physical effects in community-dwelling older people. This study aimed to examine the effects of a laughter program on body weight, waist circumference, heart rate, blood pressure, grip strength, and health-related quality of life (HRQOL) in community-dwelling older adults using an intervention trial in Japan.

Hypothesis:
Laughter-based interventions are effective in reducing cardiovascular risk factors and improving quality of life in the community-dwelling elderly population.

Methods:
In Yao City, Osaka Prefecture, two school districts were selected and participants were recruited for a laughter program for seniors aged 70 and older in each district. One of the two districts was assigned to receive the laughter program first (laughter intervention group), and the other was assigned to receive the laughter program later (control group). A total of 87 people applied to participate (40 in the intervention group, mean age 75 years; 37 in the control group, mean age 75 years), and the intervention group received 10 laughter programs over 12 weeks. The laughter program was composed of an approximately 30-min lecture about laughter and health, or an approximately 30-min appreciation of
rakugo
by a professional performer of
rakugo
, a traditional form of Japanese comic storytelling, and an approximately 60-min laughter yoga class by the laughter yoga teachers.
Rakugo
was regarded as part of the laughter lectures, and three lectures were given. In both groups, participants were measured for weight, waist circumference, blood pressure, grip strength, and HRQOL at baseline and after 12 weeks. The effects of the laughter program on these factors were analyzed using analysis of covariance for change in each measure, adjusted for age, sex, baseline values, and medication use.

Results:
None of the participants were injured or physically ill from the laughter program. The laughter program significantly improved the mean waist circumference (
p
<0.001), heart rate (
p
= 0.04), grip strength (
p
<0.001), and mental component summary scores of HRQOL (
p
= 0.04). A similar tendency occurred for the mean changes in diastolic blood pressure and physical component summary scores of HRQOL. No significant changes were observed for body weight and systolic blood pressure.

Conclusion:
The comprehensive 12-week laughter intervention program, consisting primarily of laughter yoga, significantly improved physical and psychological functions such as waist circumference, heart rate, grip strength, and HRQOL among community-dwelling older adults.
Abstract P291: Understanding Participant Perspectives Towards the Formation of a National Participant Advisory Board Within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study: A Qualitative Study
Authors: Hubbard Demetria M , Brooks Marquita S , Judd Suzanne E , Safford Monika M , Levitan Emily B , Howard Virginia J , Baquero Elizabeth , Akinyemiju Tomi , Hannon Lonnie , Sterling Madeline R
Published: May 2024

Introduction:
While participant advisory boards (PABs) are common among public health initiatives and clinical trials, they are less common among national, epidemiologic cohort studies. PABs could add value to researchers and participants alike, but their formation and functioning in this context is less understood. We aimed to elicit the perspectives of participants from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) Study towards the formation of a PAB, which can inform future efforts to form one for this cohort study and others like it.

Methods:
REGARDS is a national prospective cohort study that enrolled >30,000 Black and White community-dwelling adults aged ≥45 years from 48 states 2003-2007. Enrollment and follow-up is ongoing and done through mail and telephone. We used a convenience sampling approach to recruit from a subset of participants who responded to a newsletter about joining a PAB. Participants completed a one-on-one telephone or Zoom-based interview with study staff following a semi-structured interview guide. Interviews were recorded and professionally transcribed. Data were organized with NVivo software. Informed by the Cargo and Mercer’s Health Equity Research Practice Framework for Academic-Community Partnerships, we conducted a thematic analysis. Each transcript was independently coded by two team members, then reconciled by a third. Major themes and subthemes were identified.

Results:
The 18 participants had a median age of 69 years, 67% were women, 39% were Black, and 78% had a college degree or higher. Overall, participants were enthusiastic about the PAB and were inclined to meet as a group regularly via Zoom or telephone. Four key themes emerged: (1) The PAB should form and function with a core set of principles, including: trust, diversity, mutual respect, and accountability; of these, diversity was most important; (2) The PAB should not only inform studies (i.e. research questions, methodology), but also assist with the dissemination of science to diverse networks; (3) A formal process is required to form and maintain the PAB, as well as keeping members engaged; (4) Core values influenced participants’ willingness to serve on the PAB; they included internal motivation, the desire to translate knowledge into action, and social and environmental justice.

Conclusion:
This study highlights a willingness of participants in large epidemiologic cohort to participate in a PAB. Our results can inform the formation of a PAB in the REGARDS Study, and may be important for other observational cohorts interested in including participants in an advisory capacity.
Abstract P294: Age-Sex Differences in the Global Burden of Deaths and Disability Due to Cardiovascular Disease Attributable to Environmental Risk Factors and Its Trend From 1990-2019 in G20 Countries: A Benchmarking Analysis
Authors: Desai Hardik Dineshbhai D , Dadhania Khush , Thota Anjani Kumar , Gadamidi Vinay Kumar , VEMPARALA Priyatha , Parisapogu Anusha , Alziadin Nmair , PATEL Juhi , MADHU Krupa
Published: May 2024

Background:
Cardiovascular Disease (CVDs) is the leading cause of deaths amongst G20 countries accounting for 35.44% deaths in the G20 Countries. The G20 countries, being major economies, have a significant impact on global environmental conditions.

Method:
Using Global Burden of Disease tool, we estimated the deaths and Disability adjusted life years (DALYs) stratified by age, sex, year, and location due to CVD attributable to environmental risk factors across the G20 Countries from 1990-2019.

Results:
From 1990-2019, the annual percentage change showed a 37% rise in deaths, rising from 2,608,027-3,571,390. During the same period, DALYs surged by 25%, going from 63,297,319-78,964,495. However, when evaluating the age-standardized rates, both deaths and DALYs displayed a decrease from 1990 to 2019. In 2019, Saudi Arabia recorded the highest ASMR rate at 114 (with a range of 92-137) per 100,000. Bulgaria closely followed with a rate of 113 (87-141). In terms of age-standardized DALYs rates, Saudi Arabia again stood out, registering the highest in 1990 with a value of 2573 ( 2069-3145). Evaluating by age groups, 80-84 year old witnessed the most significant death count in 2019 (527,371). Meanwhile, the age group of 65-69 years saw the highest DALYs count in 2019, (10.4 million). Over the last three decades, males consistently experienced higher counts of both deaths and DALYs compared to females.

Conclusion:
Environmental risk factors contributed to 26.78% of CVD-related deaths and 29% of DALYs, underscoring the critical role of environment in cardiovascular health outcomes in G20 Countries. it's essential to integrate environmental risk assessments into routine check-ups and tailor treatment plans that address specific environmental exposures linked to CVD. There's an urgent need for policy reforms promoting environmental health, coupled with widespread community education about the environmental determinants of cardiovascular diseases.
Abstract P305: Room for Improved Secondary Prevention of Major Cardiovascular Events Among the Population With New Onset Diabetes: A Longitudinal Latent Class Trajectory Analysis
Authors: Oconnor Sarah , Blais Claudia , Sylvain-Morneau Jérémie , Diop Awa , Mésidor Miceline , Leclerc Jacinthe , Poirier Paul
Published: May 2024

Background:
After a diagnosis of diabetes, specialist physicians may play a key role in the secondary prevention of major cardiovascular events (MACE). Yet, trajectories of visits to specialists are heterogenous and their efficacy in the prevention of MACE remains unexplored.

Goal:
To assess whether trajectories of visits to specialists are associated with MACE among new cases of diabetes.

Methods:
Using the Quebec Integrated Chronic Disease Surveillance System, we identified new cases of diabetes ≥20 years old during fiscal year 2013, who had no prior history of MACE (ischemic cardiopathy, stroke, myocardial infarction or cardiovascular death). Firstly, individual trajectories according to the presence/absence of ≥1 ambulatory visit to a specialist (cardiologist, internist, endocrinologist) were compiled over consecutive 3-month periods up to 2 years following diagnosis. Patients with no visit were compiled in a “primary care only” group, while others were classified in groups using latent class growth analysis. Patients who had a MACE during this period were excluded. Secondly, the risk of MACE occuring after the 2 years following diagnosis up to December 31
st
2019 was compared between groups using a marginal Cox proportional hazards regression model, adjusted with inverse probability weighting and providing adjusted hazard ratio (aHR) with 95% confidence intervals (CI).

Results:
Among the 24,782 patients included, 5 groups were identified (
Figure 1
). A total of 2,837 MACE occurred. Compared with the “primary care only group”, those who consulted a specialist were at higher risk of MACE (Regular/frequent visits: aHR: 1.50 [95% CI: 1.26 to 1.66]; Late visits: aHR: 1.41 [1.13 to 1.73]; Regular/sparce visits: 1.38 [1.27 to 1.51]; Early visits: 1.36 [1.19 to 1.54]), while no difference was observed between these groups.

Conclusions:
Although confounding by indication cannot be totally ruled out, these results may suggest room for improvement in the secondary prevention of MACE after a diabetes diagnosis.
Abstract P313: Cumulative Birth History and Incident Hypertension 2-7 Years After a First Birth
Authors: Catov Janet M , McNeil Rebecca , Wiener Laure E. , Sorbye Linn Marie , Bairey Merz Noel , Chung Judith , Greenland Phillip , Haas David , Hoffman Matthew , Levine Lisa , Mercer Brian , Pemberton Victoria L , Reddy Uma , Saade George , Silver Robert , Varagic Jasmina , Yee Lynn , Grobman William
Published: May 2024

Background:
Women with adverse pregnancy outcomes (APOs) have excess cardiovascular (CV) risk, often presenting as chronic hypertension (HTN) after delivery. The accrual of CV risk according to complete birth history is understudied.

Methods:
The nuMoM2b Heart Health Study is a prospective cohort of nulliparous individuals at 8 US sites followed from the 1
st
trimester (baseline) of their 1
st
pregnancy to a CV visit 2-7 years later. This analysis (n=3483) includes those with up to 2 births delivered before the CV visit; those with HTN before the 1
st
pregnancy were excluded. APOs (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, birthweight <5
th
%ile, stillbirth) were adjudicated via medical record (70%) or self-report (30%). Individuals were analyzed by APO history; those with no APOs were the referent (Table). HTN status 2-7 years after baseline was evaluated (BP ≥130/80 mmHg or medication). Multivariable logistic regression estimated the association between APO history and incident HTN (aOR; iHTN) accounting for baseline demographics, CV risk factors, and race/ethnicity, understood as a social construct, given known disparities in APOs and CVD.

Results:
Individuals with no APO in either birth had the lowest iHTN (n=1224; 13.2%; Table). Those with recurrent APO (n=227; iHTN 33.0%) and APO in the 1
st
birth and no later births (n=534; iHTN 36.7%) had the highest iHTN. Accounting for covariates, those with a 1
st
birth APO and no later births had 2.54-fold (95% CI 1.93, 3.34) higher iHTN. Those with APOs in both births and APO in only the 2
nd
birth had 2.12-2.13-fold increased odds of iHTN. Those with an APO in the 1
st
birth and an uncomplicated 2
nd
birth had modestly elevated iHTN (aOR 1.35, 95% CI 0.99, 1.85).

Conclusion:
The risk of iHTN after a 1
st
birth differs depending upon the cumulative birth history, with recurrent APO or APO in a 1
st
birth with no later births portending the highest risk for iHTN. Longer term follow-up is needed to assess the contribution of additional reproductive factors to loss of CV health.
Abstract P314: Blood Pressure Control Across the State of Alabama
Authors: Clarkson Stephen , Cherrington Andrea , Jackson Elizabeth A , Hearld Larry , Horton Trudi , Hubbard Demetria M , Smith Kimberly , Richman Joshua
Published: May 2024

Introduction:
Alabama has the highest rate of death from cardiovascular disease among all 50 states. Along with common risk factors, hypertension remains one of the leading risk factors for development of CVD. The Alabama Cardiovascular Cooperative (ALCC) is a 3-year funded initiative to promote the coordination of Alabama-wide efforts to improve cardiovascular risk and reduce disparities through initiatives like the Heart Health Improvement Project (HHIP).

Methods:
The purpose of this analysis was to understand and establish baseline rates of HTN among adults living in Alabama who receive care in a clinic enrolled in the HHIP. Fifty primary care sites, a mix of federally qualified health centers (FQHC) and non-FQHCs were enrolled. At goal blood pressure was defined as mean SBP<140mmHg and DPB<90mmHg. Rates were estimated and differences tested using logistic regression with sites as random effects.

Results:
Among HHIP practices, 42 practices provided BP data from 39,368 patients (Table 1). Black patients with HTN were younger and had higher systolic and diastolic blood pressures. Overall, 57.7% of patients had blood pressure at goal, 64.6% among Whites vs. 51.2% among Blacks (p<0.01).

Conclusions:
More than half of patients with a diagnosis of hypertension seen in clinics enrolled in the HHIP had blood pressure that was adequately controlled, but Black adults with hypertension had significantly lower total rates of controlled blood pressure when compared to White adults. Initiatives like the HHIP are needed to address the disparate outcomes faced by adults with hypertension living in Alabama.
Abstract P332: Metabolically Healthy Obesity is Associated With Higher Levels of Executive Function in Middle-Aged Adults: The Bogalusa Heart Study
Authors: O'Connell Samantha , Kang Soo , Fernandez Alonso Camilo , De Anda-Duran Ileana , Moukaled Shirine , Chen Wei , Harville Emily , Bazzano Lydia A , Mills Katherine T
Published: May 2024

Introduction:
Obesity in midlife is associated with an increased risk of cognitive decline. It remains unclear if there is a difference in cognitive function between individuals with obesity and metabolic dysfunction (metabolically abnormal obesity - MAO) versus those with metabolically healthy obesity (MHO). We assessed the relationship between MHO (vs MAO) and cognitive function in mid-life among Black and White individuals in the Bogalusa Heart Study.

Methods:
The Bogalusa Heart Study is a longitudinal cohort exploring the natural history of cardiovascular disease among Black and White individuals in Bogalusa, Louisiana. This cross-sectional analysis included 659 participants with obesity, defined as BMI ≥ 30 kg/m
2
. Metabolic abnormality was defined as the presence of one or more of the following: systolic blood pressure ≥ 130 mm Hg, diastolic blood pressure ≥ 85 mm Hg, taking blood pressure lowering medication, triglycerides ≥ 150 mg/dL, HDL-C < 40 mg/dL (men) or < 50 mg/dL (women), taking lipid-lowering medication, fasting plasma glucose ≥ 100 mg/dL, or taking diabetes medication. Healthy metabolic status was defined as the absence of blood pressure, lipid, and glycemic abnormalities. Cognitive function was measured using a total of 9 neuropsychological tests assessing attention/information processing speed, executive function, and episodic memory. Linear regression models were used to determine the association between MHO and a demographically standardized global cognitive score and individual domain-based z-scores adjusting for smoking status and education.

Results:
Participants had a mean age of 47.8 ± 5.3 years, 42.7% self-identified as Black, and 64.1% were female. The prevalence of MHO was 9.9%. MHO was associated with higher levels of executive function compared with MAO (β=0.46; SE=0.19; p=0.0145). No significant differences were observed between MHO and MAO participants on global cognitive score, processing speed, or episodic memory.

Conclusions:
Our study found that MHO is associated with better levels of executive function in midlife. While additional studies are needed, these findings suggest that interventions that reduce metabolic abnormalities related to blood pressure, lipids, and glucose may reduce obesity-related decreases in executive function among middle-aged individuals with obesity.
Abstract P333: Plasma Proteins, Structural Brain Reserve, and Onset of Alzheimer’s Disease: Proteome-Wide Mendelian Randomization
Authors: Pan Yang , Sun Xiao , Huang Zhijie , Zhang Ruiyuan , Kirkpatrick Brenna , Aronov Avi , Li Changwei , Kelly Tanika N
Published: May 2024

Introduction:
While the emergence of amyloid-clearing treatments for Alzheimer’s disease is promising, the identification of additional therapeutic options for Alzheimer’s disease and related dementia syndromes (AD/ADRD) remains urgent. Plasma proteins represent a class of actionable drug targets AD/ADRD treatment. Yet, the role of the blood proteome in influencing structural brain reserve, and consequently, cognitive performance and the development of AD, remains elusive.

Hypothesis:
Plasma proteins may causally associate with changes in structural brain reserve and cognition phenotypes.

Methods:
We conducted proteome-wide Mendelian randomization (MR) to identify potentially causal associations of plasma proteins with changes in brain reserve, proxied by brain imaging-derived phenotypes (IDPs), cognitive performance, and AD onset. Genetic instruments for plasma proteins were previously developed by integrating summary data from five genome-wide association studies (GWASs) of plasma proteome. Summary statistics from large GWASs of 12 AD-associated IDPs (N=33,224), cognitive performance (N=257,841), and two AD cohorts (IGAP consortium, N=63,926, and FinnGen study, N=309,154) are obtained to perform two-sample MR. Causal estimates from two AD outcomes are meta-analyzed to improve statistical power. Correction for multiple testing and sensitivity analyses are performed.

Results:
Among 956 proteins with genetic instruments that satisfied MR assumptions, genetically determined levels of 14 plasma proteins were associated with at least one of the 10 AD-related IDPs at a false discovery rate of 5%. Six of these proteins were associated with white matter hyperintensities, an IDP known to be involved in cognitive decline. In addition, 26 plasma proteins were associated with cognitive performance, and four were causally linked to AD. Notably, four identified proteins were associated with structural brain reserve and either cognition or AD. Specifically, ADAM12, CREB3L4, and UROS were associated with distinct IDPs and cognitive performance, while TMEM106B, a protein that forms age-dependent amyloid filaments, was associated with increased hippocampal tail volume and AD.

Conclusions:
This study identified potential causal plasma proteins underlying structural brain reserve, cognitive performance, and AD, offering insights into the molecular etiology of these conditions and potential targets for drug development.
Abstract P339: Waist Circumference During Young Adulthood and Risk For Diabetes in Middle Adulthood Differ by Baseline Weight Status: The CARDIA Study
Authors: Booker Robert , Wong Mandy , Bancks Michael P , Bhatt Ankeet S , Carnethon Mercedes R , Chow Lisa S , Lewis Cora E , Schreiner Pamela J , Zink Jennifer , Alexandria Shaina J
Published: May 2024

Introduction:
Body mass index (BMI) and waist circumference (WC) capture related but distinct measures of adiposity (overall vs central adiposity). It is unclear if changes in WC are associated with incident diabetes mellitus (DM) and whether the relation is similar between BMI groups.

Methods:
We included 3,234 CARDIA participants (61% Black, 63% females, mean age 24.7 [3.7] years at baseline) without prevalent DM from baseline (1985-1986) through exam Year 20 (Y20; 2005-2006). Incident DM after Y20 was defined as fasting blood glucose ≥126 mg·dl
-1
, post-load blood glucose ≥200 mg·dl
-1
, HbA1c ≥6.5%, or use of antidiabetic medication through exam Year 35 (2022-2023). WC (cm) and BMI (kg·m
-2
) were measured at baseline and Y20. WC change was calculated as the difference between Y20 and baseline examinations. We categorized participants into three WC 20-year change groups: no change (±≤6 cm), decrease (>6cm loss), and increase (>6cm gain). We used Cox proportional hazards regression to estimate HR (95% CIs) for incident DM over 15 years. The model was adjusted for baseline age, sex, race, field center, education, smoking status, alcohol intake, diet score, physical activity, HDL, LDL, and BMI status (
Table
footnote). We assessed interactions of WC change with BMI status and sex, respectively.

Results:
The 15-year incidence of DM was 30% (973 cases, 40,037 person-years). Compared with no change in WC, WC decrease was not associated with incident DM (0.84 [0.66, 1.06]) (see
Table)
, but WC increase was associated with a greater 15-year risk of DM (1.21 [1.02, 1.44]). Interactions of WC change with sex (
p
=0.35) and BMI status (
p
=0.68) were null. Associations between 20-year WC change and subsequent DM risk were consistent between 20-year BMI status change groups.

Conclusion:
An increase in central adiposity during young and middle adulthood portends subsequent DM risk. Investigation of more accurate physiological measures of total adiposity and its distribution may help inform adipose tissue-specific pathways underlying DM risk.
Abstract P341: Physical Activity and Dual Energy X-ray Absorptiometry Measured Body Composition in Global Multi-Ethnic Cohorts
Authors: Carter Jennifer L
Published: May 2024

Background:
Obesity is an important risk factor for the development of heart disease, and unfortunately rates of obesity have been growing worldwide. Obesity is often defined by body mass index (BMI) ≥30kg/m
2
, however, BMI cannot distinguish between fat or lean mass nor differences in fat distribution. Dual energy x-ray absorptiometry (DXA) provides more detailed measurements of body composition, but research assessing the association between physical activity and detailed body composition measures in diverse populations is lacking. This study therefore examined associations between physical activity and DXA-derived measures of adiposity in Chinese, Malay, Indian and White European adults from two large-scale prospective cohort studies.

Methods:
From 2006-2010, adults from the general population were recruited to both The Malaysian Cohort (TMC) study (N=119 555) and the UK Biobank (N=502 487). Physical activity was self-reported by questionnaire at baseline assessment and approximately 5-yearly resurveys in both cohorts. Between 2020-2023, 5489 participants underwent a DXA scan in TMC; while between 2014-2023, 60 280 participants had DXA scans in UK Biobank. Analyses excluded participants with missing data and prior diseases that may impact body composition. Multivariable linear regression (adjusted for demographic and lifestyle confounders) was used to examine associations between physical activity and body composition measures across ethnic groups, and estimates were corrected for regression dilution bias by using estimates of ‘usual physical activity’ derived from repeat measurements.

Results:
After exclusions, 1723 Chinese, 1245 Malay and 609 Indian participants were included in the TMC analyses and 56 758 White Europeans in the UK Biobank (mean age 57.1 years, 41.2% male in TMC and 54.7 years, 47.7% male in UK). In TMC, physical activity was not associated with BMI, however it was inversely associated with DXA adiposity measures and positively associated with lean mass. Comparing the highest quintile of physical activity to the lowest, total fat mass was 0.7 kg lower (95%CI: -1.1- -0.3) and total lean mass was 0.6 kg higher (0.3-0.9). There was no evidence of effect modification by ethnicity in TMC, but results in White Europeans were stronger: total fat mass was 3.9 kg lower (-4.1- -3.6) and lean mass was 1.2 kg higher (1.1-1.4) comparing the highest to lowest quintiles of physical activity.

Interpretation:
This is the first large-scale study to examine associations between physical activity and DXA-derived measures of body composition in multi-ethnic cohorts from Malaysia and the UK. The findings support physical activity interventions to reduce obesity-related disease across diverse populations and highlight the value of using detailed body composition measures.
Abstract P343: Diet Behaviors, Income, and Body Composition Among Diverse Adult Populations in the United States
Authors: Choupani Fatemeh
Published: May 2024

Background:
Dietary behavior and food components contribute to an increased risk of obesity development and other metabolic disorders across racial groups. Those with favorable healthy diet behaviors and higher incomes experience a lower risk of obesity. Little is known about the effects of diet behaviors and income on body composition among Hispanic and non-Hispanic Black men and women. As a step toward developing successful obesity interventions among minority populations, this study aimed to investigate associations and interactions among eating outside of the home, fast foods, and income with multiple measures of obesity.

Method:
Publicly available data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) for 3942 Hispanic, non-Hispanic White, and Black women and men were analyzed using two-way MANOVA and sample independent t-tests. Diet behaviors included eating foods outside of the home (FOH) and fast food (FF), while obesity measures included body mass index (BMI), percent of body fat (POF), and waist circumference (WC).

Results:
Adults were 20-80 years old, with a mean BMI of 25.1, SD=6.4 (men, 24.9; women, 25.2), showing healthy weight overall. On average, men were eating more FOH (
M
=0.84, 95% CI: 0.59 to 1.08,
p
<0.001, Cohen’s
d
=0.1) and FF (
M
=0.57, 95% CI: 0.22 to 0.92,
P
<0.001, Cohen’s d=0.2) than women; Black men were eating more FOH (
M
=1.09, 95% CI: 0.61 to 1.58,
p
<0.001, Cohen’s
d
=0.3) than Black women; and there were no significant mean differences on eating FF among Black men and Black women. Women with income <$25000/year were eating more FF and had higher BMI (π
2
=0.013) and POF (π
2
=0.013,
p
<0.05) than men. On average, Hispanic, White, and Black men were more likely to eat more FOH (
p
<0.001) than Hispanic, White, and Black women, and Hispanic and Black women with income <$25000/year were eating more FF and FOH and had higher BMI and WC than Hispanic, White, and Black men (
P
<0.05).

Conclusion:
Understanding associations between diet behaviors, income, and obesity across sex differences and ethnic groups is important to address multilevel public health interventions for those in need of obesity treatment. Additionally, it is important for providers and health professionals to understand obesity risks that are unique by racial group when developing tailored intervention and prevention programs.

Key Words:
Diet, behavior, income, body mass index, Percent of body fat, waist circumference
Abstract P349: Physical Activity Perceptions and Engagement of Patients Prescribed an Anti-Obesity Medication in a Medical Weight Loss Clinic
Authors: Rogers Renee J , Herrmann Stephen D , Hastert Mary , Stolte Sarah , Beaver Cathleen , Donnelly Joseph E , Jakicic John M
Published: May 2024

Introduction:
Physical activity (PA) may elicit important health benefits when coupled with contemporary anti-obesity medications (AOM). However, currently there is little known about perceptions of PA and associated PA engagement of patients receiving these AOM therapies.

Hypothesis:
We assessed the hypothesis that PA would differ by perceptions of confidence to engage in PA, current and future importance of PA, and PA amount in patients receiving AOM treatment within the context of a medical weight loss clinic.

Methods:
An electronic survey was distributed to patients in a clinical research registry who were receiving treatment with an AOM at a university medical center-based weight loss clinic. The survey included questions about their perceived confidence to do structured PA or exercise regularly (PA-CONFIDENCE) and perceived importance of structured PA or exercise for management of their body weight currently (PA-IMPORTANCE) or in the future (PA-FUTURE). Participants also reported their current level of PA.

Results:
Survey responses were received from 96 patients. For these analyses, data were examined for patients currently prescribed a GLP-1 AOM (83 patients). High PA-CONFIDENCE was reported by 44.6% of participants, with 34.9% and 20.5% reporting moderate and low PA-CONFIDENCE, respectively. PA was 154±117 min/wk, 107±105 min/wk, and 76±77 min/wk for high, moderate, and low PA-CONFIDENCE (p=0.033). Participating in ≥150 min/wk of PA was reported by 54.1% with high, 20.7% with moderate, and 11.8% with low PA-CONFIDENCE (p=0.002). Ratings of PA-IMPORTANCE were 63.9% for high, 28.9% for moderate, and 7.2% for low. Participating in ≥150 min/wk of PA was reported by 48.2% with high, 12.5% with moderate, and 0% with low PA-IMPORTANCE (p=0.002). Ratings of PA-FUTURE were 79.5% for high, 18.1% for moderate, and 2.4% for low. Current participation in ≥150 min/wk of PA was reported by 33.7% with high, 12.5% with moderate, and 0% with low PA-FUTURE (p=0.002).

Conclusions:
Less than one-half of patients prescribed an AOM report confidence to engage in regular structured PA, and of those with high confidence only approximately one-half achieve current public health recommendations for PA. While more than one-half of patients report that PA is important, less than one-half engage in the recommended amount of PA. Strategies are needed to increase perceived confidence to perform and importance of PA in AOM treated patients, and to increase PA participation.