bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P297: Long-Term Benefit Comparison of Absolute Risk Reduction versus Absolute Risk to Prioritize Statin Therapy
Authors: Kohli-Lynch Ciaran N , Moran Andrew E , Thanassoulis George , Sniderman Allan D , Zhang Yiyi , Pencina Michael , Pletcher Mark J , Vittinghoff Eric
Published: July 2021

Introduction:
Individuals with no established cardiovascular disease (CVD) are currently recommended preventive statin therapy based on 10-year absolute risk (AR) of CVD, and individuals with a 10-year AR ≥7.5% are recommended statins. However, individuals with elevated LDL cholesterol experience greater absolute CVD absolute risk reduction (ARR) from statin therapy compared with those with the same 10-year AR but with lower LDL. A previous study showed that ARR-based statin treatment would prevent more CVD events than AR-based treatment in the 10 years following treatment initiation.

Objective:
This study aimed to quantify the long-term benefits of treating patients based on ARR rather than AR.

Methods:
A microsimulation version of the CVD Policy Model, a decision-analytic state transition model, simulated intermediate-strength statin therapy in 40,000 CVD-free US adults (50% female) under a variety of treatment strategies. The model predicts health outcomes for individuals based on their age, sex, and risk factor profile, accounting for the competing risk of non-CVD mortality. Individuals entered the model aged 40 years, and a time horizon of 40 years was employed. Life year gains and CVD events prevented compared to no treatment were estimated for a range of 10-year ARR and AR treatment initiation thresholds.

Results:
At the same numbers of patient-years of treatment (PYoT), ARR consistently produced more life year gains than AR (Figure). A 10-year ARR threshold of ≥2.62% would lead to approximately the same PYoT as standard of care (10-year AR ≥7.5%) while preventing 60 additional CVD events and producing 421 additional life year gains in the cohort.

Conclusion:
Treating patients with statins based on ARR would yield significant health gains in the U.S. population compared to standard AR-based treatment strategies. The ARR strategy may also achieve greater adherence and uptake as it focuses on individuals with elevated levels of a modifiable risk factor.
Abstract P298: Light-to-Moderate Alcohol Consumption and Risk of Abdominal Aortic Aneurysm in the Physicians’ Health Study
Authors: Singh Rajat , Chen Jiaying , Wang Lu , Sesso Howard D , Gaziano John M , Djoussé Luc
Published: July 2021

Background:
Abdominal aortic aneurysm (AAA) is an increasingly recognized cause of morbidity and mortality in the aging US population. While moderate alcohol consumption has been shown to be associated with a lower risk of atherosclerotic macrovascular disease, its relationship with AAA remains inconsistent in previous studies. We therefore sought to elucidate the relationship between alcohol consumption and risk of AAA in a prospective cohort of middle-aged and older men.

Methods:
Our study included 21,842 male physicians (mean age: 53.7 years) in the Physicians’ Health Study I who reported no history of AAA at baseline. Self-reported information on alcohol consumption and known AAA risk factors including body mass index (BMI), smoking and exercise was obtained on baseline questionnaires. Incidence of clinically diagnosed AAA was assessed via self-reported information on annual questionnaires and validated successfully in a subsample. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of AAA in each category of alcohol intake. Cubic spline regression was used to assess non-linear trend.

Results:
During an average follow-up of 23.0 years, 655 cases of newly diagnosed AAA were reported. Compared with men reporting less than one alcoholic drink (combined beer, wine, and liquor) per month, the HR [95% CI] of incident AAA after adjustment for age, BMI, smoking, and exercise was 0.69 [0.50 - 0.95] with one to three drinks per month, 0.80 [0.60 - 1.08] with one drink per week, 0.75 [0.58 - 0.97] with two to four drinks per week, 0.67 [0.49 - 0.90] with five to six drinks per week, 0.77 [0.61 - 0.99] with one drink per day, and 0.73 [0.47 - 1.13] with two or more drinks per day (P, non-linear trend=0.17).

Conclusions:
In this large cohort of middle-aged and older male physicians, light-to-moderate alcohol consumption was associated with a lower risk of clinically diagnosed AAA.
Abstract P300: Presence of Mental Health Conditions Associated With Greater Adherence to Home-Based Cardiac Rehabilitation
Authors: Krishnamurthi Nirupama , Schopfer David , Whooley Mary A
Published: July 2021

Introduction:
Patients with mental health conditions have higher rates of ischemic heart disease but have been less likely than those without mental health conditions to participate in traditional (center-based) cardiac rehabilitation programs. We sought to examine the association of mental health conditions with rates of participation in (and completion of) home-based cardiac rehabilitation (HBCR).

Methods:
The Veterans Health Administration is developing new HBCR programs to improve access for patients with cardiovascular disease who are unable to attend traditional (center-based) programs. Among 323 hospitalized patients who were eligible and referred to cardiac rehabilitation at the San Francisco VA between 8/1/15 and 9/30/16, we evaluated the association of depression and/or PTSD (defined based on manual review of medical records) with participation in and completion of HBCR. Logistic regression models were used to adjust for patient demographics, primary indication for CR and comorbid conditions.

Results:
Of the 323 eligible patients referred to HBCR, 127 (39%) suffered from depression and/or PTSD. Participation rates were 41% (52/127) in patients with vs. 32% (62/196) in patients without depression or PTSD (p=0.09). Among the 114 patients who agreed to participate in HBCR, 52 (46%) suffered from depression and/or PTSD. Rates of completing 9 or more sessions were 67% (35/52) in patients with vs. 44% (27/62) in patients without depression or PTSD (p=0.01). After multivariable adjustment, patients with depression and/or PTSD had a 3-fold greater odds of completing HBCR than those without depression or PTSD (OR 2.85, 95% CI 1.14- 7.17; p=0.02).

Conclusions:
Among patients referred to cardiac rehabilitation, those with a history of depression and/or PTSD were equally likely to participate and significantly more likely to complete HBCR than those without depression and/or PTSD. These findings suggest that patients with mental health conditions may be especially likely to benefit from HBCR.
Abstract P304: High Cardiovascular Health Metrics Score Predicts Slower Cognitive Performance Decline in Coronary Patients
Authors: Goldbourt Uri , Lutski Miri , Tanne David
Published: July 2021

Introduction:
In 2010, the American Heart Association introduced a metric defining the concept of ideal cardiovascular health (CVH) metrics as part of its 2020 Impact Goals definition designed for the health general population. Several studies have demonstrated that a higher number of ideal CVH metrics were associated with a lower rate of cardiovascular events, stroke and all-cause mortality.

Hypothesis:
We hypothesized that a modified cardiovascular health (CVH) metrics score among patients with CHD may be associated with the change in cognitive functions two decades later in patients.

Methods:
CVH metrics were assessed in a subgroup of men, who had previously participated in a secondary prevention trial and two successive examinations of cognitive function (N=200, mean age at baseline 57.3±6.3 yrs.). A CVH metrics score at baseline was calculated including 3 health parameters, glucose, LDL-cholesterol, blood-pressure; and 4 health behaviors, smoking, obesity, physical-activity and adherence to Mediterranean diet. We scored each of these CVH metrics into best (2 points), intermediate (1 point), and poor levels (0 points). Cognitive performance was evaluated 14.7±1.9 and 19.9±1.0 years after entry to the trial. Cognitive function was assessed using the NeuroTrax Computerized Cognitive Battery. Linear mixed model was used to assess change in cognitive functions between T1 and T2 cognitive evaluations.

Results:
Among the 200 patients, 68 (34.0%) had less than 7 (bottom group), 85 (42.5%) had 8-9 (middle group) and 47 (23.5%) had at least 10 CVH metrics points (top group). After adjustments, the top group of CVH score vs. others was associated with slower decline in overall cognitive performance composite z-score [0.23±0.09; p=0.009] and on tests of executive and visual spatial functions [0.23±0.11; p=0.047 and 0.49±0.17; p=0.004, respectively]. A 3 point-Increment in the health behaviors component was related to a slower decline in visuospatial functions [0.325±0.12; p=0.01].

Conclusion:
an inverse association was observed between the score of best CVH metrics and cognitive decline among men with pre-existing CHD.
Abstract P306: Negative Emotional States and Atherosclerosis in African American Adults: The Jackson Heart Study
Authors: Blaylock Waynesha E , White Wendy B , Morrison Alan , Sims Mario , Wu Wen-Chih
Published: July 2021

Background:
Atherosclerotic cardiovascular disease is prevalent among African Americans (AAs). Findings are mixed regarding the relationship between anger expression and peripheral atherosclerosis, as well as coronary atherosclerosis, as measured by coronary artery calcification (CAC). In addition, this relationship is unknown among AAs.

Hypothesis:
Higher anger levels are positively associated with CAC and abdominal-iliac artery calcification (AAC) among AAs.

Methods:
Using the Jackson Heart Study cohort (N=5301), we stratified 1809 participants who completed the Spielberger Anger Expression scale at baseline into four quartiles. The scale consists of 16 items, measuring anger-in and anger-out, with higher scores representing higher frequencies of anger expression. Total anger (anger-in and anger-out) quartiles were measured against CAC and AAC using ordinal logistic regression. CAC and AAC were categorized as: 0, 1-10, 11-100, 101-300, and greater than 300. Models were adjusted for potential confounding variables (age, sex, smoking, alcohol, diabetes mellitus, hypertension, and coronary heart disease).

Results:
The final study sample consisted of 34% (615 of 1809) male with a mean age of 54.0 (SD 10.79). Higher total anger was inversely associated with age and hypertension, but positively related to alcohol use and smoking status. Unadjusted analysis showed that total anger quartiles and anger-in quartiles were inversely related to CAC and AAC. The association of anger with CAC and AAC was non-significant after adjustment for confounders (Table).

Conclusion:
Before adjustment, higher anger levels showed a protective effect against coronary and aortic atherosclerosis. However, this relationship was no longer significant after adjustment for confounders suggesting that age and hypertension played a major role in the presence of atherosclerosis in this AA population. Future studies should investigate whether other negative emotional expressions are associated with atherosclerosis in AAs
Abstract P309: Social Network Analysis of Religious Organization Co-Affiliation, Exercise, and Weight in South Asians
Authors: Kandula Namratha R , Fujimoto Kayo , Zhao Yucheng , Kanaya Alka M , Schneider John A , Cooper Andrew , Puri Ankita , Dave Swapna , Siddique Juned
Published: July 2021

Objective:
Religious organizations may influence health behaviors by exerting social influence and reinforcing cultural beliefs. We tested the hypothesis that social influence, constituted by affiliating with or attending religious organizations, was associated with exercise and weight in South Asians.

Methods:
Multilevel, cross-sectional data were collected from participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=700) were surveyed about their affiliation/membership in religious organizations (e.g., churches, temples, mosques) where South Asians participate using a comprehensive roster. MASALA participants who reported affiliating with or attending the same religious organization were classified as co-attendees. Body mass index (BMI) was calculated from measured height and weight, and physical activity (PA) was assessed using a validated questionnaire. The dependent variables were BMI categories (normal and overweight/obese), and meeting the minimum recommended amount of exercise (≥500 metabolic-minutes/week of moderate-vigorous PA). The main independent variable was affiliation exposure, a measure of the level of exposure to overweight/obesity and PA level among co-attendees at religious organizations, which is an indicator of social influence. Exponential random graph models were conducted to examine associations between exposure to co-attendees’ overweight/obesity and PA and individuals’ overweight/obesity and PA. Models controlled for individual-level sociodemographic, cultural, and network characteristics.

Results:
Participants (average age 59 years, SD=9 and 43% female) affiliated with 163 unique religious organizations, and the median number of affiliations was 3 (IQR 2-7). Participants were significantly more likely to be overweight/obese (aOR=2.3, 95% CI=1.1, 4.8) as they were increasingly exposed to other overweight/obese participants through co-affiliation in religious organizations. Individual-level network characteristics (e.g., number of overweight/obese friends/family) were not associated with overweight/obesity. Co-affiliation in religious organizations was not associated with PA; however participants with less traditional South Asian cultural beliefs were more likely to exercise at least 500 met-min/week (aOR=2.5, 95% CI= 1.4, 4.7) than those who held more traditional cultural beliefs.

Conclusion:
South Asians who were exposed to other overweight/obese South Asians through co-affiliation in religious organizations were more likely to be overweight/obese. These results provide evidence of multilevel social and cultural influences on health. Lifestyle interventions that address social and cultural drivers of behaviors and are implemented in partnership with religious organizations could be effective at reducing CVD risk in South Asians.
Abstract P314: Healthy Food Choices Are Correlated in a Large Employee Social Network
Authors: Levy Douglas , Pachucki Mark , O'Malley James , Porneala Bianca , Yaqubi Awesta , Thorndike Anne
Published: July 2021

Introduction:
Research suggests obesity may be transmitted through social networks. A possible pathway is social influence on food choice. We investigated peer influence on the healthfulness of worksite food choices using social network analysis in a large hospital employee population, hypothesizing that socially-connected employees’ food choices would be correlated.

Methods:
Data on all food purchases in 2016 were obtained from the hospital’s cash register database. The cafeteria system uses traffic light labels to mark foods as healthy (green), less healthy (yellow), or unhealthy (red). Employees’ food purchases were identified through the use of cafeteria debit cards; social ties among employees were inferred based on a validated algorithm using demographics and time/location of purchases. We used spatial autoregression (SAR) and generalized estimating equation (GEE) models to calculate associations between the proportions of employees’ and coworkers’ purchases that were labeled green (or red). SAR models assessed concurrent purchases of an employee and coworker, weighting the association between their purchases by the frequency and inferred strength of the social tie. GEE models assessed longitudinal relationships between purchases coworkers’ made in the presence of an employee in one 8-week period and the employee’s purchases in the next 8-week period. Food and beverages were analyzed separately. Models adjusted for employee and coworker confounders (age, sex, race/ethnicity, job type, education).

Results:
In all, 5,118 employees used cafeteria debit cards to make purchases. Up to 536,240 employee/coworker interactions were observed, depending on the model (SAR, GEE) and outcomes (green/red, food/beverages). SAR models showed that a 1 percentage point increase in the network-weighted average of coworkers’ green-labeled (healthy) food purchases was associated with a 0.39 percentage point increase in an employee’s concurrent green-labeled food purchases (p<.001). Positive associations were also observed for red foods (0.20), and green (0.14) and red (0.31) beverages (all p<.001). Longitudinal GEE models showed that employees, as a population, increased purchases of green-labeled items by 0.013 percentage points on average when coworkers with whom they visited cafeterias in the prior 8 weeks increased their purchases of green items by 1 percentage point (p<.001). Similar associations were observed for red foods (0.013), and for green (0.006) and red beverages (0.020) (all p<.003).

Conclusions:
Employees’ healthy and unhealthy food choices are correlated. Although one explanation is that people eat with others who have similar preferences, the longitudinal findings suggest that people create social norms for eating that influence peers. Worksite and other social networks may be novel targets for population-level interventions to promote healthy diet.
Abstract P316: Multiple Vulnerabilities to Health Disparities and Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Safford Monika M , Pinheiro Laura , Sterling Madeline , Richman Joshua , Muntner Paul , Durant Raegan , Booth John , Reshetnyak Evgeniya
Published: July 2021

Social determinants contribute to disparities in incident CHD but it is not known if they have an additive effect. We hypothesized that having more socially determined vulnerabilities to health disparities is associated with increased risk of incident CHD in the REGARDS study, a large biracial prospective cohort with physiological and survey measures. Experts adjudicated incident fatal and nonfatal CHD over 10 years of follow-up. Vulnerabilities included black race, low education, low income, and Southeastern US residence. The risks for CHD outcomes associated with 1, 2, and 3+ vs 0 vulnerabilities were calculated with Cox proportional hazards models adjusted for medical conditions, functional status, health behaviors, and physiologic variables. Of the 19,645 participants free of CHD at baseline (mean age 64 years, 57% women), 16% had 0 vulnerabilities, 36% had 1, 29% had 2, and 18% had 3+. Increasing numbers of vulnerabilities were associated with higher incidence (Figure) and risk of CHD that attenuated somewhat after multivariable adjustment (Table). These findings may provide a method of risk stratification useful for population health management.
Abstract P321: Family Member Incarceration and Subclinical Cardiovascular Disease in Mexican Women
Authors: Connors Kaela M , Flores-Torres Mario H , Stern Dalia , Valdemarsdottir Unnur , Lopez-Ridaura Ruy , Cantú-Brito Carlos , Catzin Andres , Rodriguez Beatriz , Pérez-Correa Catalina , Lajous Martín
Published: July 2021

Introduction:
Losing a family member to incarceration is a stressful life event associated with emotional and financial burdens potentially influencing cardiovascular health through altered behavioral changes and psychobiological processes. Because of men′s higher likelihood of incarceration, women may disproportionately shoulder this burden. As the prison population increases globally, there is a need to evaluate the impact of incarceration on cardiovascular health in women.

Hypothesis:
Women who have or have ever had a family member in prison are more likely to have subclinical CVD compared to women without ever having an incarcerated family member.

Methods:
We examined the association between family member incarceration, carotid artery intima-media thickness (IMT), and subclinical CVD (sCVD) in 1,848 women reporting no CVD from the Mexican Teachers’ Cohort. Between 2013 and 2016, women responded to family incarceration related questions from the Life Stressor Checklist (LSC). We categorized women according to their response on whether they have or have ever had a family member incarcerated. IMT was measured on both carotid arteries through ultrasound by standardized neurologists and log transformed. We defined sCVD as an intima media thickness of ≥0.8mm in either of the carotid arteries or the presence of plaque. We collected data on potential cofounders (age, site, health insurance provider, indigenous background, education, marital status, socio-economic status, and LSC-measured exposure to violence) and potential intermediates (anthropometry, smoking, physical activity, hypertension, diabetes, and self-reported treated depression). We used multivariable linear and logistic regression models to assess the association between family incarceration, IMT, and subclinical CVD.

Results:
Among 275 (14.9%) women having experienced family incarceration, obesity (40.4% vs. 37.8%), smoking (8.7% vs. 6.5%), hypercholesterolemia (20.4% vs. 17.5%), and depression (7.3% vs. 4.7%) were more common relative to women without family incarceration. We did not observe an association between family incarceration and IMT when comparing exposed to unexposed women (confounder-adjusted mean % difference=0.48; 95%CI -01.15, 2.11). The prevalence of sCVD was 28.4% in women who ever experienced family incarceration and 20.9% in women with no family incarceration. The confounder-adjusted odds ratio for sCVD among women that have ever had an incarcerated family member was 1.40 (95%CI 1.03, 1.91) relative to women with no family incarceration.

Conclusion:
Having or having had an incarcerated family member was associated with increased sCVD in middle-aged Mexican women. Incarceration of a family member may exert a psychological burden that could disproportionally affect women’s cardiovascular health.
Abstract P322: The Relationship Between Neighborhood Food Environment and Adiposity Measures: Data From the Dallas Heart Study
Authors: Andrews Marcus R , Ayers Colby , Ceasar Joniqua , Claudel Sophie , Das Sandeep , Neeland Ian , Tamura Kosuke , Powell-Wiley Tiffany
Published: July 2021

Background:
Existing research has established a link between dietary intake and adiposity measures, including body mass index (BMI) and waist circumference (WC). However, less is known about the relationship between objective food environment quality measures and adiposity [BMI and WC], particularly in diverse populations.

Methods:
Using cross-sectional data from the 2007-2009 Dallas Heart Study multi-ethnic cohort, we examined the relationship between local food environment quality and adiposity. We measured individuals’ census tract-level food environment quality using the CDC’s Modified Retail Food Environment Index (mRFEI), a ratio of healthy to unhealthy food stores within a ½ mile radius of each census tract (higher mRFEI=more healthy food access). We characterized BMI and WC as continuous measures. Using linear regression, we investigated the relationship between mRFEI and BMI/WC adjusting for confounders [age, gender, race/ethnicity, income, education, smoking status, and neighborhood deprivation index (NDI)]. Models were stratified by NDI to identify if these relationships were moderated by neighborhood deprivation.

Results:
The study population (n=1835) was 58% non-Hispanic blacks, 27% non-Hispanic whites, and 15% Hispanics. The mRFEI ranged from 0 to 50 across census tracts. In the fully adjusted model, higher mRFEI was associated with higher BMI (β=0.06 p=0.01), but not WC (β=0.09 p=0.13). When stratified by NDI, higher mRFEI was associated with greater BMI and WC in low deprivation areas, but not in medium or high deprivation areas (Figure).

Conclusions:
Better neighborhood food environment quality was paradoxically associated with higher adiposity in low NDI areas among a diverse population in Dallas County, Texas. Our findings contribute to growing literature around aggregate measures of food environment quality, highlighting potential limitations of the mRFEI in characterizing the impact of the spatial distribution of healthy food outlets on adiposity in lower resource environments.
Abstract P332: Socio-environmental Influences on Youth Total Sedentary Time: Results From the Hispanic Community Health Study / Study of Latino Youth
Authors: Garcia Melawhy L , Castaneda Sheila F , Gallo Linda C , Lopez-Gurrola Maria , Perreira Krista M , Sotres-Alvarez Daniela , Isasi Carmen R , Chambers Earle C , Daviglus Martha L , Van Horn Linda , Everson Kelly R , Carlson Jordan A , Talavera Gregory A
Published: July 2021

Introduction:
Sedentary behavior (SED) is associated with higher obesity and cardiometabolic risk in youth, independent of physical activity. Studies showing the association between screen time and SED among Hispanics/Latinos, have primarily focused on Mexican-origin Hispanics. Additional research is needed to examine other socio-environmental factors that can influence SED among diverse Hispanics/Latinos. This cross-sectional study examined the home-, neighborhood-, and school- environment to identify factors associated with total sedentary time among youth.

Methods:
Data from 1,104 youth ages 8-16 years and 728 caregivers (mean age 43.1 ± 8.2 years) from four U.S. cities, who participated in the Study of Latino Youth (2012-2014), were examined. Associations between socio-environmental factors (measured by self-report) and total sedentary time (measured by one-week Actical accelerometry) were examined in linear regression models that included MVPA minutes/day, demographic covariates, and accounted for the complex survey design and sampling weights.

Results:
Mean sedentary time was 10.1 ± 1.8 hours/day. Home environment factors, such as electronics in the bedroom and parent limit setting, were not associated with total sedentary time. Presence of barriers to physical activity in the neighborhood (e.g., muggings, gangs) was associated with 13.4 more minutes of sedentary time per day. Attending a school that never/rarely compared to sometimes offered after school physical activity opportunities was associated with more sedentary time (B=38.0 minutes/day; 95% Confidence Interval: 13.5-62.4).

Conclusions:
The study findings highlight the need for future research to investigate other sources of sedentary behavior in the home for interventionist to focus on specific SED-based strategies to decrease sedentary time among youth. Minimizing barriers by identifying safe places to be active in participant’s neighborhoods may also support youth to spend less time indoors where sedentary time is prevalent.
Abstract P333: Characteristics Associated With Lower Blood Pressure When Using a Sit-Stand Desk
Authors: Taormina John M , Kowalsky Robert J , Perdomo Sophy J , Jones Melissa A , Barone Gibbs Bethany
Published: July 2021

Introduction:
In a recent randomized crossover trial, using a sit-stand desk to alternate postures resulted in small but statistically significant decreases in average blood pressure (BP) across a simulated workday.

Hypothesis:
We tested the hypothesis that certain baseline characteristics are associated with a greater acute BP-lowering response to use of a sit-stand desk.

Methods:
This secondary analysis used data from all subjects (n=25; 36% female; mean (SD) age 42 (12) years, screening baseline SBP 132 (9) mmHg and DBP 83 (8) mmHg, BMI 32 (5) kg/m
2
) completing a randomized crossover study with two simulated workday conditions: 1) continuous sitting (SIT) and 2) alternating sitting and standing every 30 minutes (SS). Oscillometric BP was measured hourly. Average time spent sitting and in moderate-to-vigorous intensity physical activity (MVPA) were reported using the Global Physical Activity Questionnaire. Linear regression models identified whether participant characteristics (morning BP per 10 mmHg; age > 50 years; sex (female); MVPA ≥ 150 mins/week; sedentary time ≥ 10 hours/day; BMI ≥ 30 kg/m
2
) were associated with a greater BP-lowering effect of using a sit-stand desk with a backward selection stepwise approach removing independent variables with P ≥ 0.2.

Results:
Lower morning baseline SBP (β = 2.8 mmHg per 10 mmHg, P = 0.012) and higher MVPA (β = -4.4 mmHg, P = 0.025) were associated with a greater SBP-lowering effect; higher age (β = -3.8 mmHg, P = 0.170) and higher BMI (β = 4.2 mmHg, P = 0.067) were retained in the model but were not statistically significant. Higher MVPA (β = -3.0 mmHg, P = 0.040) and lower BMI (β = 4.1 mmHg, P = 0.002) were associated with a greater DBP-lowering effect; female sex (β = -1.7 mmHg, P = 0.172) was retained in the model but was not statistically significant (
Figure 1
).

Conclusions:
In conclusion, physically active, non-obese adults with lower SBP experienced the most beneficial BP response to intermittent standing. Future studies should investigate the mechanisms explaining this acute BP response.
Abstract P335: Associations of Sleep Duration and Sleep Quality With Physical Performance in Older Adults --The Chicago Healthy Aging Study (CHAS)
Authors: Vu ThanhHuyen T , Reid Kathryn J , Daviglus Martha L , Garside Daniel B , Liu Kiang , Carnethon Mercedes R , Lloyd-Jones Donald M , Zee Phyllis C
Published: July 2021

Background:
Sleep duration (too short or too long) is associated with lower physical performance. However, the association of sleep duration and physical performance, taking into account the quality of sleep (e.g., sleep disturbance) in older populations, has not been thoroughly investigated.

Methods:
Using data from the Chicago Healthy Aging study conducted in 2007-10, we investigated a cross-sectional association of a combination of sleep duration and sleep disturbance with muscle strength (hand grip), and performance [4m gait speed and Short Physical Performance Battery (SPPB)]. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration [categorized as short (≤ 6 hours), normal (7-8 hours), and long (≥ 9 hours)] and sleep disturbance (defined as either cannot fall asleep within 30 minutes or waking up in the middle of the night or early morning three or more times per week). (See Table and Table Footnote for definitions of sleep duration and disturbance, and physical performance categories). Multivariable logistic regression analysis was used.

Results:
The study sample consists of 952 men and 350 women, ages 65-84 (mean age 71) in 2007-10; 9% were African American.12.6 % had SPPB score ≤ 8, 6.8 % had gait speed on 4 meter course < 0.8 m/s, and 23.4 % had low sex-BMI specific handgrip strength. As compared to the group with normal sleep duration (7-8 hours) without sleep disturbance, adjusted odds (95% confidence interval) of low gait speed <0.8 m/s in those with short sleep duration (≤ 6 hours) and sleep disturbance was much higher [2.00 (1.06-3.75)]. Similarly, the odds of low sex-BMI specific handgrip strength was about 2 times higher in those with long duration of sleep (≥ 9 hours), compared to those with normal sleep duration without sleep disturbance. No association was found for Short Physical Performance Battery (see Table).

Conclusion:
In older age, short sleep duration with poor quality as well as excessive sleep duration were associated with the greater likelihood of having low muscle strength and performance.
Abstract P337: Adolescent Sleep is Associated With Physical Activity and Sedentary Behavior Patterns
Authors: Parascando Jessica A , He Fan , Elavsky Steriani , Bixler Edward O , Fernandez-Mendoza Julio , Vgontzas Alexandros N , Liao Duanping
Published: July 2021

Introduction:
A decrease in sleep quantity and quality is a growing concern in the adolescent population. Concurrently, an increase in physical inactivity has been shown to be related to numerous health consequences. There is a lack of literature on the relationship between sleep, physical activity (PA) and sedentary behavior (SB) in the adolescent population, particularly looking at night-to-night sleep irregularity.

Hypothesis:
We hypothesized that increased PA and decreased SB in both objective and subject modalities would be associated with greater habitual sleep duration (HSD) and lesser habitual sleep variability (HSV) in this adolescent population.

Methods:
Objective and subjective sleep and activity measurements were collected from 295 adolescents in the Penn State Child Cohort follow-up examination. Objectively-measured variables were obtained through 7 consecutive days of actigraphy collection. HSD was calculated as the average sleep duration across 7 nights, and HSV was calculated as the standard deviation (SD) of intra-individual sleep duration. Subjects with <5 nights of sleep data were excluded from analysis. Self-administered questionnaires were used to collect subjectively-measured sleep, PA, and SB data. The relationships between sleep and behavior measures were assessed using linear regressions. All models were adjusted for age, sex, race and BMI percentile.

Results:
On average, our sample was 16.8 years, 52% male, and 79% white. We found that higher SB was associated with shorter HSD. With one SD change in objectively-measured SB (1014 minutes), HSD is reduced by 16 (3.6) minutes (p<0.05). Although not statistically significant, subjective SB showed a similar pattern. Unexpectedly, both objective and subjective measures of increased PA were associated with shorter HSD. In terms of HSV, we found that higher subjective SB was associated with greater HSV; specifically, with one SD change in subjectively-measured SB (8.64 points), HSV increased by 0.011 (0.004) minutes. None of the PA measures were significantly associated with HSV.

Conclusions:
In conclusion, objectively-measured sleep patterns are related to physical activity/inactivity. Our results emphasize the need of future studies to systematically assess the inter-relationship of sleep and physical activity in this population.
Abstract P339: Impaired Cardiac Autonomic Modulation in Adolescents: Role of Insomnia Symptoms, Objective Short Sleep Duration and Night-To-Night Sleep Variability
Authors: Fernandez-Mendoza Julio , He Fan , Liao Duanping , Vgontzas Alexandros N , Bixler Edward O
Published: July 2021

Introduction:
Impaired cardiac autonomic modulation (CAM), as measured by heart rate variability (HRV), has been associated with increased risk of cardiovascular morbidity. Inadequate sleep has been shown to contribute to impaired CAM, however, it is not clear what sleep problems are independently associated with impaired CAM in adolescents, a population in which insomnia symptoms, short sleep duration and night-to-night sleep variability are highly prevalent.

Hypothesis:
Insomnia symptoms, objective short sleep duration and high sleep variability are independently associated with worse HRV indices in adolescents.

Methods:
Data from the Penn State Child Cohort, a randomly-selected sample of 421 adolescents (12-23y) was used. Insomnia symptoms were defined by the presence of self-reported difficulties falling and/or staying asleep on the Pediatric Sleep Questionnaire. All subjects underwent 9-hour, in-lab polysomnography (PSG) and wore an actigraphy (ACT) monitor in the non-dominant wrist for 7 days. Mixed-effect regression models predicting HRV indices included insomnia symptoms, PSG sleep duration and ACT sleep duration and its variability (standard deviation) adjusted for each other as well as for sex, race, age, body mass index, and apnea/hypopnea index.

Results:
Shorter PSG sleep duration and higher ACT sleep variability were independently associated with decreased parasympathetic and increased sympathetic nervous activity [e.g., SDNN: 2.05±0.70, p<0.01 and -4.50±1.14, p<0.01 and Log-HF: 0.10±0.03, p<0.0 and -0.10±0.05, p=0.05, respectively], while ACT sleep duration or self-reported insomnia symptoms were not [e.g., SDNN: -0.57±0.84, p=0.49 and 0.90±1.26, p=0.47 and Log-HF: -0.06±0.04, p=0.12 and 0.05±0.06, p=0.37, respectively].

Conclusions:
Objective, but not subjective, measures of sleep are associated with impaired CAM in adolescents. Interestingly, short PSG sleep duration and high ACT sleep variability are independently associated with impaired CAM, which indicates that these two objective measures may help identify distinct sleep phenotypes associated with increased cardiovascular risk in adolescents. Future studies should examine whether a more severe type of insomnia symptoms, i.e., chronic insomnia, is associated with impaired CAM in adolescents.
Abstract P343: Sex Differences in Cardiovascular/Cerebrovascular Mortality Risk Associated With Chronic Insomnia
Authors: Fernandez-Mendoza Julio , He Fan , Vgontzas Alexandros N , Liao Duanping , Bixler Edward O
Published: July 2021

Introduction:
It remains unknown whether individuals with chronic insomnia are at increased risk of mortality, particularly cardiovascular or cerebrovascular (CVD/CBV) mortality. Given the higher prevalence of insomnia in women than in men, it is unknown whether its prognosis in terms of mortality is also different across sexes.

Hypothesis:
The risk of CVD/CBV mortality associated with chronic insomnia is significantly higher than in non-complaining individuals and this risk is modified by sex.

Methods:
We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1,741 men and women (48.7 ± 13.5 years) who were studied in the sleep laboratory and followed-up for their cause of death up to 15 years. Sleep difficulty was assessed based on three levels of severity: chronic insomnia (i.e., a complaint of chronic sleep difficulties lasting at least 1 year), poor sleep (i.e., moderate-to-severe sleep difficulties at any given time) and none (i.e., absence of either of the two categories). Cox regression models controlled for potential confounders, including age, race, body mass index, years of education, smoking, sleep disordered breathing, alcohol use, mental health problems, hypertension, diabetes, heart disease, stroke and other physical health problems.

Results:
Poor sleep and chronic insomnia were significantly more prevalent in females (26.7% and 10.7%, respectively) than males (17.6% and 4.1%, respectively). A significant interaction (p = 0.04) showed that the risk of CVD/CBV mortality associated with chronic insomnia was modified by male sex, while poor sleep was not significantly associated with increased risk of CVD/CBV mortality in either males or females. Chronic insomnia was associated with a 2.9-fold (95%CI=1.53-5.61) increased risk of CVD/CBV mortality in males even after adjusting for all confounders, while this risk was not significantly elevated in females (HR=1.13, 95%CI=0.56-2.31).

Conclusions:
Chronic insomnia is associated with increased risk of CVD/CBV mortality in males, while it has a better prognosis in females despite its higher prevalence. These data suggest potential sex-related vulnerabilities in the underlying mechanisms linking chronic insomnia with CVD/CBV morbidity and mortality.
Abstract P346: Joint Associations of Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Incident Cardiovascular Disease
Authors: Ogilvie Rachel P , Lakshminarayan Kamakshi , Patel Sanjay R , Lutsey Pamela L
Published: July 2021

Background:
Although excessive daytime sleepiness (EDS) is a common symptom of obstructive sleep apnea (OSA), and both EDS and OSA have separately been associated with increased risk of cardiovascular disease (CVD), their joint association with CVD risk is unknown. Examining the association of EDS and OSA with CVD risk may help refine the OSA phenotype.

Methods:
Among 3,874 Sleep Heart Health Study participants without prevalent CVD, moderate to severe OSA was defined by an apnea hypopnea index (AHI) ≥ 15 events per hour on in-home polysomnography. EDS was defined as an Epworth Sleepiness Scale score ≥ 11. Incident CVD events included adjudicated myocardial infarction, coronary revascularization and stroke. Cox proportional hazards models adjusted for age, sex, alcohol, smoking, and body mass index.

Results:
Mean age was 63.0 years with 55.4% female, mean AHI 9.3 events/hour, and 23.4% with EDS. Over a median of 10.4 years of follow-up, we identified 653 incident cases of CVD. In adjusted analyses, EDS (Hazard ratio: 1.22, 95% CI 1.01-1.47) but not moderate-severe OSA (HR: 0.98, 0.81-1.20) was associated with incident CVD. In stratified analyses, the CVD incidence rate varied from 15.6/1000 person-years in those with no OSA or EDS to 26.0/1000 person-years in those with OSA and EDS (figure). In multivariable analyses, the hazard ratio for moderate-severe OSA and EDS compared to no OSA and no EDS was 1.26 (0.91-1.73). Formal tests of statistical significance of the OSA and EDS interaction were not significant on either the additive or multiplicative scales.

Conclusions:
Having both EDS and moderate-severe OSA was not associated with an increased risk of CVD in our data.
Abstract P350: Suboptimal Sleep and Metabolic Syndrome Risk Among White, Black, and Hispanic Women in the United States
Authors: Gaston Symielle A , McWhorter Ketrell L , Park Yong-Moon , Sandler Dale P , Jackson Chandra L
Published: July 2021

Introduction:
Previous studies identify suboptimal sleep as a risk factor for metabolic syndrome (MetS), but many lack racial/ethnic minorities. Our study objective was to investigate the relationship between suboptimal sleep and risk of MetS by race/ethnicity.

Hypothesis:
We hypothesized that the positive association between suboptimal sleep and MetS is stronger among Black and Hispanic compared to White women.

Methods:
We used longitudinal data (2003-2015) from 50,884 female participants (aged 35-74 years) of the Sister Study who were non-pregnant and without cardiovascular disease or cancer. We defined suboptimal sleep by: duration (short: <7 hours, recommended: 7-<9 hours, long: ≥9 hours) and dichotomized (yes/no) sleep parameters including sleep irregularity (
Abstract P354: Assessment of Phased Implementation of a Mobile Stroke Unit for Acute Ischemic Stroke Treatment
Authors: Sanchez Molero Soraya , Diaz Cynthia , Boozan James , Stiefel Michael F
Published: July 2021

Introduction:
The timing of administering tissue-type plasminogen activator (tPA) in patients with an ischemic stroke is directly related to clinical outcomes. The use of a mobile stroke unit (MSU) is a strategy to provide acute ischemic stroke assessment and treatment in a more rapid fashion compared to standard stroke transport and management. Our program initiated the use of a MSU in 2017 as a part of a phased implementation program. We sought to determine the impact of the MSU on the timing of stroke care in the region as it related to proximity to the hospital.

Methods:
We collected data during the first 9 months of 2017 on patients who were transported to the hospital as pre-hospital stroke alerts (PHSA) via conventional ambulance or via the MSU. Using a retrospective case-controlled design we compared process metrics associated with the phased implementation of the MSU with conventional pre-hospital stroke alerts as standard of care (SOC).

Results:
There was a total of 178 stroke alert patients; 72 in the MSU group and 106 in the PHSA group. 35 patients received tPA, 16 in the MSU, 19 in SOC. There was no significant difference in age, body weight, race, gender, and length of stay in the hospital in the two groups.

The time from 911 call to arrival on scene was 12.06 min versus 20.4 min in the PHSA and MSU groups, respectively. Despite a longer time for arrival TPA administration for patients within a 5 miles radius of the hospital was 89 ± 25 mins in the SOC group and 78±12 mins in the MSU group (p=0.11). For 911 calls originating 10-20 miles from the hospital, the time for 911 call to tPA was 106 ± 23 mins in the PHSA group (n = 4) and 86 ± 2 mins in the MSU group (n = 4).

Conclusion:
Our initial results are comparable with previously reported data . Our data suggests the MSU may have a greater impact on reducing time to tPA for those further from the hospital or where transport time is delayed. The role of the MSU for non tPA patients such as mechanical thrombectomy, intracerebral hemorrhage and subarachnoid hemorrhage warrants further investigation.
Abstract P360: Comparison of Screening Electrocardiogram and Transthoracic Echocardiogram Abnormalities With ASCVD Risk Score Among Community Dwelling Women
Authors: Agdamag Arianne Clare , Gomez Joanne , Rajan Kumar , Fleisher Emma , Kats Isabel , Aggarwal Neelum , Braun Lynne , Sanghani Rupa , Williams Kim A , Volgman Annabelle
Published: July 2021

Background:
Increased detection of heart disease in women has been advocated nationally in recent years. The atherosclerotic cardiovascular disease (ASCVD) risk score was validated as determinant of the 10-year risk for first occurrence of nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke in 2013. While measurement of blood pressure, glucose, and lipid levels are common in screening, the utility of non-traditional methods such as electrocardiogram (ECG) and transthoracic echocardiography (TTE) remains unknown. We examined the association of ECG and TTE abnormalities with ASCVD risk score among asymptomatic women from a community-based event.

Methods:
Data were gathered from 355 women (mean age 53±13 years, 24.2% African American, 59.7% Caucasian, 6.2% Hispanic, 9.9% Others) from a voluntary cardiovascular community screening event sponsored by the 2BigHearts Foundation and Rush University Medical Center in February 2007 and May 2008. Demographics, lipid panel, blood pressure, self- reported medication lists, co-morbidities, screening TTE, and ECG were obtained. The 10-year ASCVD risk score was ascertained for the cohort (283 persons, 79.7%). Chi-square testing was used to determine association of ECG and/or TTE abnormalities with ASCVD risk score.

Results:
The average ASCVD risk score for the entire cohort was 5.49%, with a range from 0.1-49.2. The mean ASCVD risk score was elevated in patients with either ECG or TTE abnormalities compared to those with normal findings (ECG: 7.59±9.46 vs. 4.62±5.39, p<0.0014; TTE: 8.19±10.12 vs. 4.81±5.73, p<0.037). The presence of both ECG and TTE abnormalities was associated with a higher mean ASCVD risk score compared to having either ECG or TTE abnormalities alone (ECG+TTE: 13.07±14.32 vs. ECG: 5.7±6.19 vs. TTE: 5.27±4.65, p<0.006).

Conclusion:
Detection of ECG and/or TTE abnormalities are associated with elevated ASCVD risk scores in this cohort of asymptomatic women and could potentially identify patients at higher risk for cardiovascular events, and facilitate aggressive risk factor modification. Further studies are needed to confirm ECG and TTE as viable additional screening tools to traditional risk screening.