bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP26: Highly Sensitive Cardiac Troponin T is Associated with Cognitive Function and Incidence of Dementia
Authors: Schneider Andrea L , Rawlings Andreea M , Sharrett A. R , Alonso Alvaro , Mosley Thomas , Hoogeveen Ron , Ballantyne Christie M , Gottesman Rebecca F , Selvin Elizabeth
Published: July 2021

Introduction:
Clinical cardiovascular disease is a major risk factor for cognitive impairment and dementia, but less is known about the association of subclinical myocardial damage (measured by highly sensitive cardiac troponin T [hs-cTnT]) with cognition and dementia in the general population.

Hypothesis:
We hypothesized that higher levels of hs-cTnT would be associated with lower cognitive test scores and increased risk of dementia.

Methods:
We conducted cross-sectional (1996-1998) and prospective (follow-up through 2009) analyses of 8,601 participants in the ARIC Study without a history of cardiovascular disease or stroke. Cognition was measured by 3 tests: Delayed Word Recall (DWR), Digit Symbol Substitution (DSS), and Word Fluency (WF). Dementia was defined using ICD-9 codes. Linear regression and Cox proportional hazards models were adjusted for demographic, lifestyle, and cardiovascular factors.

Results:
66% of participants had detectable hs-cTnT (≥0.003 μg/L) (mean age 63; 59% female; 20% black). In cross-sectional analyses, higher hs-cTnT was associated with lower scores on DSS (p-trend <0.001) and WF (p-trend=0.002), but not DWR (p-trend=0.09) (Table). Similarly, hs-cTnT ≥0.014 μg/L (≥99th percentile) vs. <0.014 μg/L was associated with lower scores on DSS (-1.78 points [95% CI: -2.61, -0.95]) and WF (-1.04 words [95% CI: -2.00, -0.07]), but not on DWR. Over a median of 12 years, there were 338 incident dementia cases. In prospective analyses, higher baseline levels of hs-cTnT were associated with increased dementia risk (p-trend <0.001) (Table).

Conclusion:
Higher levels of hs-cTnT were associated with lower cognitive test scores at baseline and increased dementia risk during follow-up. Our results suggest that subclinical myocardial damage is associated with cognition and dementia. This association may be driven by shared risk factors for myocardial and cerebral injury or as a direct result of subclinical small vessel or cardiac disease; more work is needed to elucidate potential mechanisms.
Abstract MP27: Cardiovascular Biomarkers and MRI-defined Small Vessel Disease of the Brain in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Dadu Razvan T , Fornage Myriam , Virani Salim S , Nambi Vijay , Hoogeveen Ron C , Boerwinkle Eric , Alonso Alvaro , Gottesman Rebecca F , Mosley Thomas H , Ballantyne Christie M
Published: July 2021

Background:
Cerebrovascular and cardiovascular disease share common risk factors. Thus, biomarkers associated with subclinical cardiac injury may also be associated with silent cerebral injury. We hypothesized that levels of N-terminal brain natriuretic peptide (NT-proBNP) and cardiac troponin T measured with a highly sensitive assay (hs-cTnT) are associated with silent brain infarcts (BI) and white matter lesions (WML) on magnetic resonance imaging (MRI) in the Atherosclerosis Risk In Communities (ARIC) study.

Methods:
Brain MRI was performed at ARIC visit 3 (1993-1995) on 1920 participants. NT-proBNP and hs-cTnT were measured in all individuals at ARIC visit 4 (1996-1998). A subset (N=1112) of those individuals who had the initial MRI at Visit 3, had a follow up MRI in 2004-2006. We analyzed the association of NT-proBNP and hs-cTnT with the presence of MRI defined BI and WML on the initial MRI and on the follow-up MRI in participants without coronary heart disease and stroke. BI was defined as an area of abnormal signal intensity in a vascular distribution, ≥ 3 millimeters in size, and without mass effect. WML were estimated as the total volume of periventricular and subcortical white matter-signal abnormality.

Results:
In the adjusted model, individuals in the highest NT-proBNP quartile had significantly more BI and WML on the baseline MRI and more incident BI and WML progression on the follow up MRI when compared to the lowest quartile (Table). In the same model, individuals in the highest hs-cTnT category had significantly more BI and WML on the initial MRI and more WML progression on the follow up MRI when compared to the lowest category. Incident BIs were significantly more common in the 0.009 to ≤0.013 μg/L troponin category but not in the highest one, when compared to the lowest category (Table).

Conclusion:
NT-proBNP and hs-cTnT are independently associated with silent MRI-defined BI and WML suggesting that biomarkers for subclinical cardiac injury may also be useful to identify individuals with subclinical cerebral injury.
Abstract P025: Trying to Lose Weight: The Effect of Income and Age on Weight Loss Strategies in NHANES 1999-2010
Authors: Kakinami Lisa , Gauvin Lise , Barnett Tracie , Paradis Gilles
Published: July 2021

Background:
Two-thirds of the general US population is overweight or obese; those living in poverty are disproportionately affected. Although 30-50% of Americans report currently trying to lose weight, some strategies can be counterproductive. Even though increased physical activity and decreased fat consumption were recently reported to be among the most successful weight-loss strategies for obese persons, little is known about how income may be associated with the type of strategies used to lose weight.

Objective:
determine the association between income and types of weight-loss strategies.

Methods:
Analyses included the 1999-2010 National Health and Nutrition Examination Survey participants that reported trying to lose weight in the last year and were stratified by age (youth: aged 8-19, n=3184; adults: 20+, n=5643) due to availability of covariates and different weight-loss questions. Annual household income was categorized as: <$20K, $20K-45K, $45-75K, and compared to the referent ($75K+). Multivariable models included sampling weights, and adjusted for sex, age, ethnicity, and whether the person was overweight or obese (body mass index > 25 for adults, or > 85th percentile for youth according to the CDC growth curves). Analyses among adults also adjusted for marital status and education. Multivariable logistic regression assessed the likelihood of using healthy weight-loss strategies (e. g., exercising) and unhealthy weight-loss strategies (e. g., skipping meals).

Results:
Compared to the referent, adults with lower household incomes were less likely to use healthy weight-loss strategies (Fig. 1) but unhealthy strategies were not associated; youth from lower income households were more likely to utilize unhealthy weight-loss strategies, and less likely to use healthy strategies.

Conclusions:
Weight-loss strategies differ based on income and age. Education efforts and environmental strategies should be done in tandem to increase use of healthy weight-loss strategies to curb the obesity epidemic.
Abstract P070: Dyslipidemic Adolescent and Adult African Americans Have Similar Cardio-Metabolic Risk
Authors: Tung Puneet K , Gidding Samuel , Keith Scott W , DeLoach Stephanie , Falkner Bonita
Published: July 2021

Background:
African Americans (AA) are at increased risk for developing diabetes mellitus. However, they are known to have lower triglycerides (TG) and higher high density lipoprotein-cholesterol (HDL-C) than other ethnic groups. Among AA, it is thought that adolescents are at lower cardiovascular risk and have lower levels of metabolic co-variants than adults, but there are no studies directly comparing adolescents and adults.

Objective:
To compare AA adolescents to adults with regard to the relationships of adiposity-related lipid risk markers (TG/HDL ratio and non HDL-C) with body mass index (BMI), waist circumference (WC), homeostasis model of insulin resistance (HOMA), and serum high sensitivity C-Reactive Protein (hsCRP).

Methods:
Healthy AAs (283 adolescents, 484 adults) were recruited from the same urban community. To create TG/HDL strata, adult tertiles were established. Non HDL-C strata were based on ATP III/NHLBI expert guidelines. Adolescents and adults in the low, middle and high strata were compared with regard to BMI, WC, HOMA, and hsCRP.

Results:
As both TG/HDL ratio and non HDL-C strata increased, BMI, WC, HOMA, and hsCRP increased in both adolescents and adults (Tables). Among 16% (44/283) of adolescents and 33% (161/484) of adults having a TG/HDL ratio above 2.028 (High group), BMI, WC, and hsCRP were similar in both age groups (Table 1). In 8% (22/283) of adolescents and 12% (60/484) of adults having an elevated non HDL-C (HIgh group), BMI, WC, and hsCRP were also similar (Table 2). HOMA was higher in adolescents, but after accounting for this age difference, was significantly associated with the high TG/HDL ratio and non HDL-C strata. Slopes of these relationships were steeper in adolescents than adults, therefore adolescents in the lower lipid strata had lower BMI, WC, HOMA, and hsCRP.

Conclusions:
Elevated TG/HDL ratio and non HDL-C are associated with similar levels of metabolic risk in adolescent and adult AAs. The relationship between HOMA and dyslipidemia is stronger in adolescent versus adult AAs.
Abstract P086: Fried Food Consumption and Risk of Type 2 Diabetes and Coronary Heart Disease: Two Prospective Studies in US Men and Women
Authors: Pan An , Cahill Leah E , Chiuve Stephanie E , Sun Qi , Willett Walter C , Hu Frank B , Rimm Eric B
Published: July 2021

Introduction:
Through the processes of oxidation, polymerization, and hydrogenation, the cooking method of frying modifies both foods and their frying medium. However, it remains unknown whether frequent consumption of fried foods is related to long-term cardio-metabolic health. Therefore, we aimed to prospectively examine fried food consumption and risk of developing incident type 2 diabetes (T2D) or coronary heart disease (CHD).

Methods:
Fried food consumption was assessed by questionnaire among 71,281 women from the Nurses’ Health Study (1984-2008) and among 39,835 men from the Health Professionals Follow-up Study (1986-2008) who were free of diabetes, cardiovascular disease and cancer at baseline. Time-dependent Cox proportional hazards models were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for T2D and CHD in each cohort, adjusted for demographic, diet, lifestyle and other cardio-metabolic risk factors. Results were pooled by inverse-variance-weighted random-effects meta-analysis.

Results:
We documented a total of 9452 incident T2D cases (6890 women and 2562 men) and 5296 incident CHD cases (2562 women and 2734 men). Compared to participants who consumed fried foods < once/week, individuals who consumed fried foods 1-3, 4-6 and ≥7 times/week had a significantly higher risk of T2D, with RRs (95% CIs) of 1.13 (1.00-1.28), 1.38 (1.30-1.46), and 1.51 (1.36-1.67), respectively. The association was generally stronger for eating fried food away from home (RR 1.79 [95% CI 1.45-2.21] comparing ≥4 times/week vs. < once/week) than eating fried food at home (corresponding RR 1.23 [95% CI 1.13-1.35]). For CHD the RRs (95% CIs) for eating fried food 1-3, 4-6 and ≥7 times per week were 1.05 (0.95-1.16), 1.18 (1.05-1.33), and 1.18 (1.02-1.36), respectively, compared to less than once per week. Eating fried food ≥4 times per week at home were associated with a higher risk of CHD (RR 1.17; 95% CI 1.04-1.32), but the association was not significant for eating fried food away from home (RR 1.10; 95% CI 0.92-1.32). When we included biennial measures of body mass index in the models as a potential mediator, all RRs were largely attenuated, albeit still significant for diabetes.

Conclusions:
Frequent fried food consumption was significantly positively associated with incident T2D while moderately related to incident CHD, and these associations were largely mediated by body weight. Further studies are still needed to confirm these results and elucidate whether habitual fried food consumption is a marker of unhealthy lifestyle or has a causal role in the development of T2D and CHD. Nevertheless, the present study has identified a risk factor for T2D and CHD that may be readily modifiable by lifestyle or cooking changes that lead to the consumption of less fried foods.
Abstract P201: Inverse Association between Sleep Efficiency and Cholesterol Fractions in African Americans; the Cardiovascular Health Epidemiology Study
Authors: Pullen Paula R , Liu Jinnan , Collins Quarells Rakale , Bidulescu Aurelian
Published: July 2021

Background:
Previous studies have shown that African Americans (AA) have lower sleep efficiency than Caucasians. Less is known in AA regarding the effect of sleep efficiency on metabolic markers of cardiovascular disease such as serum levels of cholesterol fractions. Thus, we conducted a cross-sectional investigation among AA examining the relationship between sleep duration and efficiency with cholesterol levels. Our hypothesis was that there is an inverse association between the duration and efficiency of sleep and cholesterol fractions.

Methods:
Our study population (n = 35; 60% women) was recruited throughout metro Atlanta via convenience sampling with radio announcements, flyers and health fairs. Included were AA aged 30-65 with a blood pressure lower than 140/90 mm Hg. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-cholesterol) and their ratio was measured as continuous variables. Sleep efficiency was measured with an Actiwatch device as the proportion of actual sleep time to the total amount of bedtime sleep. Multivariable linear regression models were used to examine the effects of sleep efficiency and duration on TC, HDL-cholesterol and their ratio with adjustments for age and body mass index (BMI). Statistical significance was set at a p-value of <0.05 (two-tailed).

Results:
Among study participants, the mean (SD) was 52.3 (9.0) years for age, 31.6 (6.6) kg/m2 for BMI, 79.0 (7.5)% for sleep efficiency and 7.03 (1.3) hours for sleep duration. The mean (SD) was 195.5 (31.2) mg/dL for TC, 98.7 (31.2) mg/dL for triglycerides, 62.2 (17.9) mg/dL for HDL-cholesterol and 3.33 (0.83) for the ratio TC / HDL. Sleep efficiency correlated significantly with sleep duration (r = 0.36) and TC / HDL-cholesterol ratio (r = -0.32), but not with BMI or triglycerides. In the multivariable regression analysis, there was a statistically significant inverse association between sleep efficiency and the ratio of TC / HDL cholesterol (β = - 0.05, 95% confidence Interval = - 0.09, - 0.01; p = 0.008). No association was detected between sleep duration and cholesterol fractions (p = 0.90).

Conclusion:
Among African Americans, there is an inverse association between sleep efficiency and the ratio of TC to HDL-cholesterol. Reduced sleep efficiency might influence the cardiovascular risk through dyslipidemia.
Abstract P210: Risk Factors for Intraparenchymal Hemorrhage Subtypes: The Circulatory Risk in Communities Study (CIRCS)
Authors: Ohira Tetsuya , Eguchi Eri , Imano Hironori , Kitamura Akihiko , Kiyama Masahiko , Yamagishi Kazumasa , Sankai Tomoko , Umesawa Mitsumasa , Cui Renzhe , Okada Takeo , Tanigawa Takeshi , Ishikawa Yoshinori , Iso Hiroyasu
Published: July 2021

Background:
To evaluate risk factors for intraparenchymal hemorrhage (IPH) by its subtypes may contribute to more effective prevention of IPH, but few prospective studies have characterized risk factors for specific subtypes of IPH.

Hypothesis:
We assessed the hypothesis that the associations between traditional risk factors such as blood pressures and risk of IPH vary by IPH subtype.

Methods:
A prospective study of Japanese subjects aged 40-69 years was undertaken using the data collected from 9,086 participants (3,560 men and 5,526 women) in cardiovascular risk surveys of three communities between 1985 and 1994. The incidence of IPH between 1985 and 2008 was ascertained by systematic surveillance. The location of hemorrhage was assigned based on admission CT scan or MRI by trained physicians. IPH selectively involving the thalamus, basal ganglia or brainstem was defined as deep IPH, while IPH isolated to the cortex was defined as lobar. The hazard ratios (HRs) of incidence of IPH and its subtypes (deep IPH and lobar or cerebellar IPH) and 95% confidence intervals (CI) relative to the baseline variables were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model.

Results:
During an average follow up of 19.2-years, 139 incident IPHs (103 deep, 31 lobar or cerebellar, and 5 mixed or unclassified IPHs) occurred. Systolic blood pressure, major ST-T abnormality on electrocardiogram, and excess ethanol intake (≥46g/day) were associated with increased risk of deep IPH, while serum total cholesterol levels was inversely associated with incidence of lobar and cerebellar IPH, even after adjustment for potential confounding variables. Serum total cholesterol levels also tended to be inversely associated with incidence of deep IPH, although it did not reach statistically significance. The multivariate-adjusted HRs (95%CI) of deep IPH were 1.14 (1.05-1.23) for systolic blood pressure (10mmHg), 2.09 (1.19- 3.66) for major ST-T abnormality, and 1.86 (1.02- 3.38) for excess ethanol intake. The adjusted HR (95%CI) of lobar and cerebellar IPH was 0.22 (0.07- 0.76) for the participants with higher total cholesterol levels (≥220 mg/dL), compared with those with lower total cholesterol levels (<160mg/dL). There were no associations of diabetes mellitus and smoking with both deep and lobar/cerebellar IPH.

Conclusions:
Impact of risk factors on incidence of IPH varied according to its subtype.
Abstract P248: Assessing for Bi-Directional Relationships between Body Mass Index and Mental Health Symptoms in Girls
Authors: McTigue Kathleen M , Cohen Elan , Hipwell Alison , Moore Charity , Loeber Rolf , Kuller Lewis H
Published: July 2021

Introduction
Obesity and mental health problems are increasing in youth; both are often under-treated. The interplay between mental health and body weight development in adolescent girls is not well understood.

Hypothesis
Bi-directional associations will be established between mental health symptoms (depression and conduct symptoms) and BMI in urban pre-adolescent girls.

Methods
We examined data from participants in an accelerated longitudinal cohort study of largely disadvantaged urban girls from a single US city (n=2,451; 53% African American). Data were collected annually over 6 years, starting in 2003 when girls were age 8-11. Depression and conduct symptoms (oppositional defiant disorder and conduct disorder symptoms combined) were collected via the validated Child Symptom Inventory (CSI-4) and height and weight were measured. Transitional models assessed for bi-directional associations between mental health symptoms and BMI. Random-effects mixed models identified within-subject and between-subject effects in models examining whether mental health symptoms predicted BMI. All models were adjusted for race, age, and receipt of public assistance, and when applicable, included interaction terms.

Results
Transitional models showed that prior depression symptoms (β=0.27; p<0.001) predicted an increase in BMI while prior conduct symptoms (β=0.04; p=0.05) showed a small and borderline significant effect on BMI. An increase in prior BMI predicted an increase in depression symptoms (β=0.074, p<0.001) but not conduct symptoms (β=0.028, p=0.125). Mixed models revealed significant between-girl and within-girl effects (β = 0.38 and 0.038, respectively, both with p<0.001) for depression symptoms predicting BMI. Conduct symptoms showed a significant between-girl effect (β=0.51; p=0.045) but a non-significant within-girl effect (β=0.011; p=0.080) when used to predict BMI.

Conclusions
We identified a clear bi-directional relationship between depression symptoms and BMI in under-privileged girls, and mixed models confirmed that a change in depression score is associated with increased BMI. While an increase in conduct symptoms shows a weak positive association with BMI, the association was not bi-directional. The potential for BMI and depression to each reinforce the other may represent a mechanism for the development of high-risk weight patterns in girls. Early identification of those at risk may facilitate preventive measures for both weight and mental health outcomes.
Abstract P256: Why BMI is not Enough: Prevalence of Metabolically Obese Normal Weight in the CARDIAC Project
Authors: Hunter Amy , Ice Christa , Neal William
Published: July 2021

Recent evidence suggest the presence of normal weight adolescents (as defined by BMI percentiles <85th) in the general population who present a clustering of metabolic abnormalities (MetS), commonly observed in the overweight and obese, which predispose them to cardiovascular disease and diabetes. MetS is generally defined as including insulin resistance, high low-density lipoproteins (LDL), low high-density lipoproteins (HDL), high triglycerides (TRIG), high systolic (SBP) and/or diastolic blood pressure (DBP). The goal of this study was to establish the prevalence of metabolically obese normal weight (MONW) children in a rural Appalachian.

Methods:
Data included 43,432 5th grade students from the 2002-2011 Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project. MetS included risk levels for LDL, HDL, TRIG, SBP, and acanthosis nigricans (AN) as a measure of insulin resistance.

Results:
22,331 (51.42%) were normal weight. Among those, 23.61% had at least one metabolic abnormality, 5.50% had two, 0.75% had three and 0.03% had four. Figure 1 shows frequencies of MetS and normal weight and overweight/obese participants. The odds of MetS were greater in those who were overweight or obese; however, of the 2,407 participants who had MetS when defined as 3 or more risk factors, 7.19% were of normal weight. Of the 8,336 participants who had MetS when defined as 2 or more risk factors, 16.18% were of normal weight.

We also explored gender differences among all students (n = 43,432). After controlling for weight status, being female was a risk factor for MetSyn diagnosis when defined as 2 or more (OR = 1.53) or 3 or more (OR = 1.34) risk factors.

Conclusion:
This data adds to the emerging literature aimed towards unifying a definition of metabolic syndrome in children and suggest that definitions should include considerations for all weight categories. In addition, because BMI poorly distinguishes between lean and fatty mass, measures of obesity should include a measurement of adiposity, such as waist circumference.
Abstract P264: Circulating and Dietary Magnesium and Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis of Prospective Studies
Authors: Del Gobbo Liana C , Imamura Fumiaki , Wu Jason H , de Oliviera Otto Marcia C , Chiuve Stephanie E , Mozaffarian Dariush
Published: July 2021

Background:
Clinical hypomagnesemia and experimental dietary magnesium (Mg) restriction diets are associated with cardiac arrhythmias. Relationships between circulating or dietary Mg at usual concentrations or intakes and risk of cardiovascular disease (CVD), including fatal coronary heart disease (CHD), are not well established.

Objective:
We performed a systematic review and meta-analysis to summarize all available evidence from prospective studies on the associations between circulating and dietary Mg intake with incidence of total CVD, total CHD, and fatal CHD.

Methods:
Multiple literature databases and grey literature were systematically searched without language restriction from the earliest online index date to May 2012 for all prospective cohort or nested case-control studies examining the association of circulating or dietary Mg intake with incident total CVD, total CHD and fatal CHD. Two investigators evaluated full text articles for inclusion/exclusion and extracted data, independently and in duplicate. Linear dose-response relationships were assessed using generalized least-squares trend estimation, with pooled RR’s determined using fixed-effects or random-effects in the presence of heterogeneity (I2>30%). Potential non-linear associations were assessed using restricted cubic splines. Prespecified sources of heterogeneity were explored using meta-regression. Publication bias was assessed using formal statistical testing and visual inspection of funnel plots.

Results:
Of 2,303 abstracts reviewed, 16 studies met eligibility criteria, comprising 761,742 individuals and 11,995 total CVD, 7,534 total CHD, and 2,686 fatal CHD events. In pooled analyses, circulating Mg (per 0.2mmol/L increment) was associated with a 30% lower risk of total CVD (RR=0.70, 95% CI=0.56-0.88; I2=50%) and trends towards lower risk of total CHD (RR=0.83, 95% CI=0.75-1.05; I2=47%) and fatal CHD (RR=0.61, 95% CI=0.37-1.00; I2=80%). Dietary Mg (per 200mg/day increment) was not significantly associated with total CVD (RR=0.89, 95% CI=0.75-1.05; I2=67%), but was associated with a 22% lower risk of total CHD (RR=0.78, 95% CI=0.67-0.92; I2=44%). The association between dietary Mg and fatal CHD was non-linear (p<0.0001), with an inverse association observed up to a threshold of ~250 mg/day (compared to lower intakes, RR=0.73, 95% CI=0.62-0.86). Funnel plot asymmetry was evident for the association between circulating Mg and total CVD, explained by heterogeneity due to stronger associations (p=0.02) in studies including participants with prevalent CVD at baseline and evaluating fatal CHD.

Conclusions:
Circulating Mg and dietary Mg intake are associated with lower risk of CVD, in particular fatal CHD. These findings support the need for randomized clinical trials and experimental studies to evaluate the possible role of Mg in the prevention of CVD and CHD death.
Abstract P306: Italian National Health Examination Surveys 2008-2012: Differences in Measured and Self-reported Anthropometric Data
Authors: Palmieri Luigi , Donfrancesco Chiara , Lo Noce Cinzia , Dima Francesco , Gargiulo Lidia , Vanuzzo Diego , Giampaoli Simona
Published: July 2021

Background:
Health Interview Survey (HIS) collects only self-reported height and weight to estimate obesity prevalence. Because of self-reporting, estimated obesity prevalence could be too low. From 2008 to 2012 an Health Examination Survey/Osservatorio Epidemiologico Cardiovascolare (HES/OEC) has been implemented in Italy with the aim of assessing cardiovascular (CV) risk factors, prevalence of risk conditions and CV diseases for the Italian adult population. Differences in measured and self-reported main anthropometric measures are described.

Methods:
Random samples of general population stratified by age and sex were examined in all Italian regions (participation rate 56%). Self-reported height and weight were requested to participants just after the welcome at the screening center. Height and weight were then measured using standardized procedures and methods. BMI was categorized in 3 groups: normal (BMI<25 kg/m2), overweight (25<=BMI<30 kg/m2), obesity (BMI>=30 kg/m2). Comparisons between measured and reported height, weight, and calculated BMI in men and women were assessed using t-test for means and chi-squared test for prevalence for paired samples.

Results:
Data from 2,583 men and 2,575 women aged 35-79 years were analysed. In men, measured height was lower than self-reported (-2.1 cm.), measured weight resulted higher than self-reported (+0.3 kg.); as a consequence BMI calculated on measured data resulted higher than that based on self-reported data (+0.8 kg/m2). Prevalence of obesity was higher for measured data than for self-reported (+7.1%). In men, difference between measured and self-reported height resulted higher in obese category than in the overweight or normal groups (-2.6 cm.), as well as for weight (+1.6 kg.). Similar results were registered in women: measured height was lower than self-reported (-3.6 cm.), measured weight resulted higher than self-reported (+0.8 kg.); as a consequence BMI calculated on measured data resulted higher than that based on self-reported data (+1.6 kg/m2). Prevalence of obesity was higher for measured data than for self-reported (+9.2%). Difference between measured and self-reported height resulted higher in obese category than in the overweight or normal groups (-5.0 cm.), as well as for weight (1.8 kg.). Both in men and women differences increased by age-group.

Conclusions:
Our results confirm how important is to produce standardised measures, also to adjust and correct self-reported height and weight, in order to have a reliable picture of obesity in the population. At present obesity is still a priority in public health and is one of the main indicator to plan community actions for cardiovascular disease prevention in the population.
Abstract P386: Adult Height and Coronary Artery Calcium in the NHLBI Family Heart Study
Authors: Miedema Michael D , Petrone Andrew , Pankow James , Hunt Steven C , Kraja Aldi T , Arnett Donna K , Gaziano J. Michael , Djousse Luc
Published: July 2021

Introduction:
Adult height is inversely associated with the risk of developing hypertension, hyperlipidemia, and diabetes. Height has also shown an inverse association with coronary heart disease and cardiovascular mortality, but the relationship between height and subclinical atherosclerosis is unclear. Coronary artery calcium (CAC) is a marker of atherosclerosis and a strong predictor of cardiovascular events. The relationship between height and CAC has not been well studied.

Objective:
To test the hypothesis that adult height is inversely associated with CAC.

Methods:
We studied 3,360 individuals from the National Heart, Lung, and Blood Institute Family Heart Study. Adult height was self-reported and CAC was measured by EBCT. We used generalized estimating equations to estimate adjusted prevalence odds ratios across quintiles of height.

Results:
Mean age of the sample was 54.9 years (SD +/- 12.9) and 57% were women. Baseline characteristics of the participants in sex-specific quintiles are shown in Table 1. After adjusting for age, the prevalence odds ratios for CAC decreased from the lowest quintile to the highest quintile (p-value for trend 0.02). After further adjustment for race, waist circumference, smoking, and field center, height remained inversely associated with CAC (adjusted odds ratios 1.0 [reference], 1.52 [1.13-2.05], 0.98 [0.75-1.28], 0.90 [0.68-1.20], 0.78 [0.58-1.03], p-value for trend <0.01). Additional adjustment for alcohol consumption, exercise, and total cholesterol did not materially change the strength of the association between height and CAC. No interaction was seen for gender or race.

Conclusion:
Adult height is inversely associated with the presence of CAC in middle-aged men and women.
Abstract P397: Circulating Species of Matrix Gla Protein and the Risk of Vascular Calcification in Healthy Women
Authors: Dalmeijer Gerdien , van der Schouw Yvonne , Magdeleyns Elke , Vermeer Cees , Velthuis Birgitta , de Jong Pim , Beulens Joline
Published: July 2021

Background:
Matrix Gla protein (MGP) is an inhibitor of vascular calcification that requires vitamin K for its carboxylation. Circulating MGP occurs as various species with different conformations depending on carboxylation and phosphorylation. Total uncarboxylated MGP (t-ucMGP) is the sum of non-phosphorylated and phosphorylated uncarboxylated MGP (dp-ucMGP and p[[Unable to Display Character: ‑]]ucMGP) and mainly consists of p-ucMGP. Due to its phosphorylated group p-ucMGP has a strong calcium-binding capacity irrespective of the Gla content. In high risk populations, high levels of t[[Unable to Display Character: ‑]]ucMGP were associated with decreased calcification, while high levels dp-ucMGP were associated with low vitamin K status and increased vascular calcification. These relations have never been investigated in a healthy population.

Objective:
This prospective study investigates the association between circulating matrix Gla protein species and vascular calcifications among postmenopausal women.

Design:
In a prospective cohort of 571 healthy women, MGP levels were measured by ELISA techniques at baseline. Vitamin K intake was estimated from a validated food frequency questionnaire. Calcification was measured in the coronary arteries, aortic valve, mitral valve, and aortic arch by multi-detector computed tomography after 8.5 years follow-up. Coronary artery calcification (CAC) was defined present if Agatston score was ≥10 and the calcification score was calculated as the sum of the calcified areas. Multivariate adjusted relative risks (RR) and odds ratios (OR) were estimated using modified Poisson regression and multinomial logistic regression per standard deviation of MGP species and the no calcification group was used as reference.

Results:
Of the women, 24% had no calcification while 5% had calcification in all areas. High dp-ucMGP levels, reflecting poor vitamin K status, were (p=0.08) associated with more CAC (RR
SD
1.07;95%CI 0.99-1.15) and calcification areas (OR
(4 areas vs no calcification)
1.49; 95%CI 0.95-2.35, p=0.09). High t-ucMGP levels were associated with less calcification (OR
(4 areas vs no calcification)
0.63; 95%CI 0.36-1.10, p=0.10). Desphospho-carboxylated MGP was not associated with calcification. High phylloquinone intake was not associated with the number of calcified areas OR
(4 areas vs no calcification)
1.14 (95%CI: 0.72-1.81, p=0.57). In contrast, higher menaquinones intake was associated with less calcification areas (OR
(4 areas vs no calcification)
0.39; 95%CI: 0.21-0.74, p=0.004).

Conclusion:
High dp-ucMGP levels, reflecting a poor vitamin K status, may be associated with more calcification, also in a healthy population. High menaquinones intake was associated with less calcification. Consistent with high-risk populations, high t-ucMGP levels seem to associated with fewer calcification areas.
Abstract P400: Dietary Pattern is Associated with Better Cognitive Function: The CARDIA Study
Authors: Zhu Na , Jacobs David R , Meyer Katie A , He Ka , Launer Lenore J , Reis Jared P , Yaffe Kristine , Sidney Stephen , Whitmer Rachel , Steffen Lyn M
Published: July 2021

Primary prevention of cognitive function decline is important for a middle-aged population, but further evidence about the influence of dietary pattern is needed. An A Priori Diet Quality Score (diet score) and cognitive function were studied in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study of black and white men and women aged 18-30 in 1985-86 (year 0, Y0). We hypothesized that a higher diet score, measured at Y0 and Y20, predicts better cognitive function measured at Y25. The diet scores incorporated 46 foods groups (each in servings/day categorized into quintiles), with higher scores indicating higher quality diets. The score was the sum of quintile ranks of foods rated healthy, 0 for foods rated neutral, and reversed quintile ranks of foods rated less healthy. Cognitive tests at Y25 measured verbal memory (Rey Auditory-Verbal Learning Test (RAVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (Stroop Test). Higher cognitive function is reflected by higher RAVLT and DSST scores and lower Stroop Test scores. For each additional 10 units of diet score at Y20, the RAVLT was 0.23 words recalled higher, the DSST was 0.87 digits higher, and the Stroop Test score was 0.69 lower. Diet score measured at Y0 was less strongly but still significantly associated with cognitive scores. In exploratory analysis, we found that education modified the relation between diet pattern and cognitive function measures, e.g. diet and DSST at Y20 were associated in less educated subjects, but not in higher educated subjects (P for interaction =0.02). In conclusion, higher diet score was associated with better cognitive function 5 years later in apparently healthy middle-aged adults. However, diet pattern was not related to some measures of cognitive function in better educated subjects, conceivably because of compensatory behaviors in better educated people that would maintain higher cognitive function scores, despite lower quality diet.
Abstract P436: Trait Anxiety and Anger Do Not Predict Incident Type 2 Diabetes Independent of Depression: The Multi-Ethnic Study of Atherosclerosis
Authors: Abraham Sherley , Diez Roux Ana , Hill-Briggs Felicia , Seeman Teresa , Szklo Moyses , Schreiner Pamela J , Golden Sherita H
Published: July 2021

Introduction:
Prior studies have shown a bidirectional association between depression and type 2 diabetes mellitus (T2DM); however, the prospective association of anxiety and anger with T2DM is not established. We hypothesized that trait anxiety and anger would predict incident T2DM, independent of depressive symptoms, in a multi-ethnic cohort.

Methods:
In the Multi-ethnic Study of Atherosclerosis (MESA), we prospectively examined the association of trait anxiety and trait anger (assessed via the Spielberger Trait Anxiety and Trait Anger Scales, respectively) with incident T2DM over 7 years in 5,941 White, Black, Hispanic, and Chinese participants (53.6% women, mean age 61.8 years) at baseline without prevalent T2DM or cardiovascular disease. We used multivariable logistical regression models to calculate the odds ratios (OR) of incident T2DM by anxiety quartile and anger category (low, medium, high).

Results:
In the minimally adjusted model, compared to quartile 1, the OR for incident T2DM were 1.25 and 1.38 for trait anxiety quartiles 3 and 4, respectively and the OR for incident T2DM was 1.50 for those with high trait anger compared to low trait anger (Table). In both models, these associations were attenuated and became non-significant following additional adjustment for depressive symptoms (modeled as continuous Center for Epidemiological Studies-Depression score) and antidepressants. Additional adjustment for socioeconomic, behavioral, metabolic, and inflammatory factors did not change either association (Table).

Conclusion:
Higher trait anxiety and anger were associated with incident T2DM; however, these associations appeared to be explained by the presence of depressive symptoms and socioeconomic status. These data suggest that the emotional traits of anxiety and anger may impact T2DM risk due to their symptoms overlap with depression.
Abstract 02: Population Strategies to Decrease Sodium Intake: A Global Cost-Effectiveness Analysis
Authors: Webb Michael , Fahimi Saman , Singh Gitanjali M , Khatibzadeh Shahab , Micha Renata , Powles John , Mozaffarian Dariush
Published: July 2021

Background:
Excess sodium intake is a major risk factor for CVD globally. Yet, the cost-effectiveness of policy interventions to reduce sodium consumption in every country has not been quantified.

Methods:
We characterized global sodium intakes, blood pressure (BP) levels, effects of sodium on BP, and CVD rates, each by age and sex in 187 countries based on the 2010 Global Burden of Diseases study. Nation-specific costs of a policy that combined education with targeted industry agreements to reduce sodium were estimated using the WHO NCD Costing Tool. Nation-specific impacts on mortality and disability-adjusted life years (DALYs) were modeled using comparative risk assessment, based on various scenarios including 10%, 30%, 1 g/d, and 3 g/d achieved sodium reductions over 10 yrs. Cost-effectiveness (CE) was evaluated as PPP-adjusted international $ per DALY saved over 10 yrs.

Results:
Worldwide, a 10% sodium reduction within each country was projected to avert an average of 5,655,000 CVD-related DALYs/year, at an average cost of 1.11 international dollars per capita over the 10 yr intervention. The average CE ratio was I$207/DALY. Across 21 world regions, sodium reduction would be most CE in South Asia and East/Southeast Asia (each I$120/DALY); across 187 countries, the most CE were Moldova (I$9.89/DALY), Azerbaijan (I$12.82/DALY), and Uzbekistan (I$12.85/DALY). The least CE region was Australia/New Zealand (I$922/DALY), although this CE was still substantially below the usual threshold to define an intervention as CE (3.0 GDP per capita). 99% of the world's population live in countries in which the intervention had a CE ratio < 1.0 GDP per capita, and 95% in countries with a CE ratio < 0.1 GDP per capita - far below standard acceptable CE ratios of 3.0 GDP per capita.

Conclusions:
National education and industry-agreement strategies to reduce dietary sodium would have substantial impacts on CVD and be extremely cost-effective in nearly every country worldwide.

CE of 10% reduction intervention: GDP/capita per DALY
Abstract 07: Trajectories of Weight Change and Their Association with Barriers to Healthy Eating during 18-month Weight Loss Treatment
Authors: Zheng Yaguang , Sereika Susan M , Imes Christopher C , Ye Lei , Mattos Meghan , Mancino Juliet M , Danford Cynthia , Burke Lora E
Published: July 2021

Introduction:
Obesity research has typically focused on the overall weight change pattern in randomized clinical trials (RCTs), ignoring the clustering of individuals with distinct weight change patterns (e.g., continuing to lose, maintain weight loss, or regain weight). The study aim was to identify trajectories of weight change and their associated predictors.

Methods:
This was a secondary analysis of longitudinal weight data pooled from two RCTs using standard behavioral treatment for weight loss. Weight was measured using a digital scale at baseline, 6, 12 and 18 mos. Group-based trajectory modeling was used to identify distinct classes of trajectories of percent weight change. Percent change in Barriers to Healthy Eating (BHE) subscale scores (emotions, daily mechanics and social support) were simultaneously added in the final trajectory model to examine their associations with weight change trajectories.

Results:
The pooled sample included 338 adults, which was mostly female (85.2%), White (73.7 %), 45.7±9.0 years old with 15.6±2.8 years of education, and a BMI of 33.9±4.3 kg/m2. As shown in the graph, three trajectory groups were identified: maintainers, regainers, and non-responders. Percent weight change was associated with BHE emotions (b=.053, p<.001) as well as social support (b=0.029, p=.003) for maintainers, emotions for regainers (b=0.071, p<.001), and daily mechanics for nonresponders (b=0.059, p <.001).

Conclusions:
This is the first study to identify distinct weight loss trajectories during active weight loss treatment for adults. What distinguished the maintainers from the regainers was the level of perceived barriers related to managing emotions and the availability of social support, while the group that was unsuccessful at achieving a clinically significant weight loss was challenged by the daily mechanics of adopting a healthy diet. The dimensions of barriers to healthy eating associated with weight change trajectories vary and should be considered in future weight loss programs.
Abstract 18: Whole Grain Intake and Risk of All-Cause and Cause-Specific Mortality in US Men and Women
Authors: Wu Hongyu , Flint Alan J , van Dam Rob , Rimm Eric B , Holmes Michelle , Willett Walter C , Hu Frank B , Sun Qi
Published: July 2021

Background:
Whole grains are rich in fiber, vitamins, minerals, and antioxidants that have favorable effects on health through multiple pathways. Although epidemiologic studies have suggested that whole grain intake may reduce risk of type 2 diabetes, hypertension and cardiovascular disease (CVD), limited evidence exists regarding whole grains’ associations with mortality in prospective studies.

Methods:
Whole grain consumption was measured using a validated food frequency questionnaire every 2-4 years among 74,341 women in the Nurses’ Health Study (1984-2010) and 43,990 men in the Health Professionals Follow-Up Study (1986-2010) who were free of CVD, diabetes, and cancers at baseline. Intake of whole grain foods including brown rice, dark breads, whole-grain ready-to-eat cereals, cooked cereal, popcorn, wheat germ, bran and other grains. We used the cumulative average of whole grain intake from all available dietary questionnaires from baseline through the end of follow-up were used to better represent long-term or habitual intake, and to minimize within-person variation. Cox regression models were used to evaluate the associations between whole grain intake and mortality.

Results:
We documented 26,918 deaths in these two cohorts during 2,731,264 person-years of follow-up through 2010. After multivariate adjustment for potential confounders, including age, smoking, BMI, physical activity, and alternate healthy eating index, the hazard ratios (HRs) of total mortality comparing the highest with the lowest quintile of whole grain intake was 0.89 (95% confidence interval [CI] 0.84, 0.94, P for trend < 0.0001) in NHS and 0.92 (95%CI 0.87, 0.98, P for trend = 0.01) in HPFS; and the pooled HR was 0.91 (95% CI 0.85, 0.95). An inverse association was observed for CVD mortality: the pooled HRs (95% CIs) comparing extreme quintiles were 0.85 (95%CI 0.78, 0.92, P for trend < 0.0001). Whole grain intake was not significantly associated with cancer mortality, the pooled HR was 0.98 (95% CI 0.91, 1.04, P for trend = 0.49). In addition, total bran intake was observed to be significantly inversely associated with CVD mortality, with pooled HR 0.80 (95% CI 0.73, 0.87, P for trend < 0.0001), while total germ intake was not associated with risk of mortality after adjustment for bran intake. These associations did not change materially among men and women who had a healthful lifestyle or diet. In sensitivity analysis, to minimize reverse causation, we used a 4-year lagged analysis or further stopped updating diet after participants reported occurrence of hypertension and high cholesterol, and all these sensitivity analysis indicated the robustness of our results.

Conclusions:
Our data support the hypothesis that higher whole grain consumption may have beneficial effects on lowering total and CVD mortality in US men and women.