bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP75: Glycemia (Hemoglobin A1c) is Not Related to Incident Venous Thromboembolism in the Atherosclerosis Risk in Communities Study
Authors: Bell Elizabeth J , Lutsey Pamela L , Nambi Vijay , Cushman Mary , Selvin Elizabeth , Folsom Aaron R , Selvin Elizabeth
Published: July 2021

Introduction—
Diabetes has been inconsistently associated with increased risk of venous thromboembolism (VTE). Glycemia is positively associated with coagulation activation and hypofibrinolysis, resulting in a procoagulant state. However, there is little direct evidence on associations of glycemia with VTE.

Hypothesis—
Glycemia, as measured by hemoglobin A
1c
(A
1c
), is positively associated with incident VTE over a follow-up period of 15 years.

Methods—
The Atherosclerosis Risk in Communities (ARIC) study is a population-based cohort study of middle-aged adults followed for 15 years after visit 2, when A
1c
was measured. Because A
1c
is affected by treatment in diagnosed diabetics, separate analyses were conducted for individuals with diagnosed diabetes. Diagnosed diabetes was defined as taking diabetes medication or a history of diabetes (self-report). We assessed the relation between A
1c
and incident VTE during follow-up using Cox proportional hazards models, controlling for potential confounders: age, sex, race, smoking status and amount, hormone use, body mass index, and waist-to-hip ratio.

Results—
The cohort free of VTE and/or anticoagulant use in 1990-1992 included 11,976 participants without a diagnosis of diabetes (317 VTE events) and 1,040 participants with a diagnosis of diabetes (45 VTE events). As shown in the figure, the adjusted hazard ratio estimates, using participants with an A
1c
< 5.70 % and without diagnosed diabetes as the referent, were close to 1, regardless of A
1c
level and diabetes diagnosis status. Further, there was no relation in analyses conducted by VTE type (provoked and unprovoked) or in participants with diabetes (both diagnosed and undiagnosed) relative to those without diabetes.

Conclusions—
In conclusion, although a modest association cannot be ruled out, our findings do not support an association between A
1c
and VTE.
Abstract P028: The Influence of Exercise Dose, Exercise Intensity, and Weight Loss on C-reactive Protein in Sedentary Overweight Women
Authors: Tuite Patricia K , Burke Lora E , Coen Paul M , Henker Richard , Jakicic John M
Published: July 2021

Background:
Obesity is a modifiable risk factor associated with heart disease and an increased inflammatory state. Reducing weight and increasing physical activity have been shown to decrease heart disease risk. There is increasing evidence that weight loss leads to a reduced inflammatory state; however, there is less evidence on the combined role of weight loss and different doses of exercise.

Objective:
The purpose of the study was to examine the effect of exercise on change in high sensitivity C-reactive protein (hs-CRP) in overweight and obese women in a 6-month behavioral weight loss program.

Methods:
The parent study was a randomized trial testing different doses of exercise in a behavioral weight loss program. The sample (N = 182) consisted of sedentary overweight women with a mean (SD) age of 37.5 (±5.7) years and a baseline body mass index (BMI) of 32.7 (±4.2) kg/m
2
. Participants were randomly assigned to 1 of 4 exercise groups based on energy expenditure (1000 kcal/week or 2000 kcal/week) and intensity (vigorous vs. moderate). Groups included: vigorous intensity/high dose; vigorous intensity/moderate dose; moderate intensity/moderate dose; and moderate intensity/high dose. The dietary component included an energy restricted diet of 1200 kcal/day or 1500 kcal/day based on weight at baseline; daily fat intake recommendation was 20%-30% of total energy intake.

Results:
There were no statistically significant differences in hs-CRP levels between dose of exercise, moderate vs. high, (F=0.330, p=0.58) or level of intensity, moderate vs. vigorous (F=0.118, p=0.731). However, there was a significant decrease in hs-CRP from baseline to 6 months (F=25.553, p<0.0004). There was a significant 3 way interaction between energy expenditure, intensity, and time (baseline to 6-month) (F=4.035, p=0.035); post hoc analysis revealed a significant decrease in hs-CRP in the moderate/high (p<0.0004) and vigorous/moderate groups (p=0.004). The results were unchanged after controlling for the change in body weight, body fatness, or body distribution. The change in hs-CRP was not significantly correlated with the change in body weight, percent body fat, waist circumference, or self-reported physical activity. The hs-CRP at 6 months was correlated with 6-month measures of weight, BMI, percent body fat, and fat distribution (p<0.0004).

Conclusions:
The level of hs-CRP was reduced in overweight and obese women in response to a 6-month weight loss intervention that included a prescribed increase in energy expenditure and reduction in energy intake. We observed a significant reduction in the moderate intensity/high dose and vigorous intensity/moderate dose exercise groups, suggesting that at least a moderate level of exercise is needed to affect hs-CRP levels. Further research is needed to better determine the dose of exercise needed to reduce markers of inflammation.
Abstract P029: Associations between Weight Loss and Regain and Metabolic Measures in Obese Adults: Results from a 24-Month Behavioral Weight Loss Trial
Authors: Ambeba Erica J , Styn Mindi A , Brooks Maria M , Evans Rhobert W , Burke Lora E
Published: July 2021

Introduction:
Obesity is linked to the development of insulin resistance (IR) and type 2 diabetes. Weight loss achieved by lifestyle modification could improve insulin sensitivity (IS). However, weight loss is difficult to maintain, and individuals often weight cycle, potentially placing them at greater risk for adverse health outcomes.

Objective:
The purpose of this secondary analysis was to examine how long-term changes in weight are associated with changes in factors related to the development of diabetes (IR and IS) among obese adults enrolled in a 24-month behavioral weight loss trial.

Methods:
The sample (N=66) included non-diabetic adults who lost and regained at least 10 lbs during the 24-month trial. All participants received standard behavioral weight loss treatment during the first 18 months. Assessments were conducted at baseline, 6, 12, 18, and 24 months. IR was assessed using the homeostatic model assessment (HOMA), and IS was assessed using the quantitative insulin sensitivity check for insulin sensitivity (QUICKI). Linear mixed modeling was used to examine the association between % changes in weight and % changes in fasting insulin, HOMA, and QUICKI. All models were adjusted for time, age, gender, race, % change in energy intake, and % change in physical activity.

Results:
The sample was 80% female and 86% White. At baseline, the mean (±SD) values were: age, 48.4±7.4 years; BMI, 34.5±4.4 kg/m
2
; energy intake, 2176.8±603.8 kcal/day; physical activity, 11.4±13.6 MET- hr/week; plasma insulin, 16.9±6.0 μU/mL; HOMA, 4.1±1.7; and QUICKI, 0.3±.02. On average, compared to baseline, participants experienced an 11% decrease in weight (p<.0001), a 9% decrease in insulin (p=.004), a 10% decrease in HOMA (p=.01), and a 2% increase in QUICKI (p=.0003) at 6 months. Following 6-month weight loss, an average of 8.4% weight was regained by 24 months (p<.0001), and the positive changes observed in the other measures were partially reversed, e.g., a 19% increase in insulin (p=.001), a 26% increase in HOMA (p=.001), and a 2% decrease in QUICKI (p=.0002). Overall, weight change was positively associated with changes in insulin [b(se)=0.5(0.1), p≤.0001] and HOMA [b(se)=0.8(0.2), p≤.0001], and negatively associated with a change in QUICKI [b(se)= -0.2(0.1), p≤.0001].

Conclusion:
In this unique sample of participants who weight cycled during a 24-month trial, weight loss improved metabolic outcomes; however, this was partially attenuated when weight was regained. These results reveal the effects of changes in weight on metabolic outcomes and highlight the importance of sustaining healthy lifestyle changes that support weight loss maintenance and improved metabolic outcomes.
Abstract P036: Parathyroid Hormone is Associated with All-Cause and Cardiovascular Mortality: The Hoorn Study
Authors: van Ballegooijen Adriana J , Reinders Ilse , Visser Marjolein , Dekker Jacqueline M , Nijpels Giel , Stehouwer Coen D , Pilz Stefan , Brouwer Ingeborg A
Published: July 2021

Introduction
Higher parathyroid hormone (PTH) concentrations have been associated with increased cardiovascular disease (CVD) mortality, although data in the general population are scarce.

Hypothesis
We hypothesize that higher serum PTH concentrations are associated with all-cause and CVD mortality in a prospective, population-based cohort of older men and women.

Methods
We included 633 participants of the Hoorn Study, a population-based cohort with oversampling of subjects with impaired glucose regulation; mean age 70.1±6.6 years, 50.7% female. Serum intact PTH concentrations were measured using a 2-site immunoassay. Outcomes were all-cause and CVD mortality based on clinical files and coded according to the ICD-9. We used Cox-regression to estimate survival curves and hazard ratios (HR 95% CI) for all-cause and CVD mortality adjusted for potential confounders using season-specific PTH quartiles.

Results
During a median follow-up of 7.8 years, 112 participants died, of which 26 deaths (23%) were due to CVD. Survival curves showed an impaired survival for all-cause (Log-rank p=0.054) and CVD mortality (Log-rank p=0.022) for people in the highest PTH quartile (Figure 1). In a multivariate model adjusted for age, sex, smoking, education level, BMI, glucose status, systolic blood pressure, anti-hypertensive drug use, the highest PTH quartile was associated with higher all-cause mortality; HR 1.98 (1.08, 3.64). Kidney function (estimated glomerular filtration rate and micro-albuminuria) attenuated the PTH risk association, but risk persisted; HR 1.93 (95% CI 1.04, 3.58). The results for CVD mortality showed a similar pattern, although the association was only significant in a threshold model (Quartile 4 vs. Quartile 1-3) HR 2.56 (1.11, 5.94).

Conclusion
In conclusion, among older men and women, higher PTH concentrations are associated with higher mortality risk. We suggest to evaluate whether individuals with high PTH concentrations benefit from therapeutic approaches targeted to decrease PTH concentrations.
Abstract P041: Glucose Rise on Statins in Older Age: Adaptive Protection Against Fatigue?
Authors: Golomb Beatrice A
Published: July 2021

Background:
We previously showed that statins increase a composite fatigue measure; and that statins increase glucose preferentially in those over age 55 - increasingly with each decade, particularly in presence of risk factors for impaired bioenergetics. We speculated that glucose elevations may be adaptive defenses of cell energy, and assessed whether greater glucose elevations on statins, in those over age 55, were linked to lesser risk of fatigue on statins.

Method:
1016 participants age >20 were randomized equally to simvastatin 20mg, pravastatin 40mg or placebo. Baseline and 6mo (on-treatment) glucose (mg/dL) were assessed and glucose change calculated. The fatigue change measure, summed self-rated changes in exertional fatigue and in energy (aligning signs). Regression assessed the relation of glucose-change to fatigue change (using the continuous glucose measure as the dependent variable), adjusted for baseline glucose, stratified by treatment.

Results:
As age advanced, glucose change over 6 months showed increasing inverse associations with fatigue change, on statins and particularly simvastatin (
Table
). Qualitatively similar tendencies on placebo did not reach significance.

Discussion:
Greater glucose rise in older age, particularly on statins, was linked to lesser fatigue and exertional-fatigue symptoms, with potential implications for function. We speculate that glucose rise e.g. in older age/ on statins may represent a physiological adaptation to protect against bioenergetic insufficiency.
Abstract P062: Ten Weeks of Daily Consumption of Common Fructose Containing Sugars Does Not Increase Liver Fat Content
Authors: Bravo Stephen , Lowndes Joshua , Yu Zhiping , Rippe James
Published: July 2021

Purpose:
Evaluate the effect of addition of commonly consumed fructose containing sugars to the usual diet on liver fat content.

Background:
Fructose induced triglyceride synthesis has been argued to be augmented when accompanied by glucose. As the most common sources of fructose, high fructose corn syrup HFCS) and sucrose, also contain glucose such a response would be particularly detrimental to metabolic health due to the known role of excess fat in the liver in the induction of abnormalities in glucose homeostasis, insulin resistance and the subsequent development of type II diabetes.

Methods:
For ten weeks, sixty-eight individuals (42.16 ± 11.66 years) consumed low-fat milk sweetened with either HFCS or sucrose such that the added sugar matched the 25th, 50th and 90th percentile population consumption levels of fructose. Fat content of the liver was obtained before and after the ten week intervention. Imaging was performed on a Philips 64-slice CT scanner. Region of interest measurements in the four sectors of the liver delineated by the hepatic veins were obtained in all patients, and converted to hepatocellular fat content percentages. Fat content of the liver remained unchanged (13.32 ±10.49 vs 13.32 ± 10.75%, p > 0.05). Group assignment did not affect the result interaction p > 0.05).

Conclusions:
These data suggest that ectopic fat storage in the liver is not promoted when fructose is consumed as part of a normal diet, even in amounts as high as the 90th percentile consumption level.
Abstract P080: Associations of Poor Sleep Quality and Quantity and Subclinical Atherosclerosis in Older Age - The Chicago Healthy Aging Study (CHAS)
Authors: Vu Thanh Huyen T , Allen Norrina B , Reid Kathryn J , Liu Kiang , Garside Daniel B , Daviglus Martha L , Zee Phyllis C
Published: July 2021

Background:
Previous studies have demonstrated a link between both sleep quantity and quality and an increased risk of CVD, stroke, and diabetes. However only a few population-based studies have information on the association of sleep quantity and quality and subclinical atherosclerosis as measured by coronary artery calcium (CAC) and ankle brachial index (ABI) -- a marker for peripheral arterial disease.

Methods:
CHAS data were used to investigate cross-sectional associations of short sleep duration and poor sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) (see Table Footnote for definition of poor sleep quality and quantity) and prevalence of
having CAC
(score > 0) or
low ABI
(<0.99). CAC, assessed by multi-detector computed tomography, was quantified by the Agatston’s method. ABI was calculated as the ratio of Doppler recorded systolic pressures in the lower and upper extremities (ABI >1.4 was excluded).

Results:
The study sample consists of 1,005 men and 390 women ages 65-84 (mean age 71) in 2007-10; 9% were African American. There are no differences in CAC prevalence among participants with or without short sleep duration (11.2% vs. 11.0%). For low ABI, these figures are 20% and10.8%, respectively. With multiple adjustments (see Table Footnote), there are no significant associations of short sleep duration or poor sleep total score with prevalent CAC. However, participants with short sleep duration are more likely to have low ABI, i.e., the odds (95% confidence interval) of having ABI <0.99 with sleep duration of <6hrs was almost two fold (1.02-3.13) compared to others (see Table).

Conclusion:
In older age, shorter sleep duration is associated with peripheral vascular disease. Sleep may represent a modifiable risk factor for CVD.
Abstract P081: Markers of Endothelial Function and Peripheral Arterial Disease among Women
Authors: Rivas-Tumanyan Sona , Mukamal Kenneth J , Pai Jennifer K , Joshipura Kaumudi J
Published: July 2021

Introduction:
Markers of endothelial function may be associated with increased risk for cardiovascular disease; however, prospective data for peripheral arterial disease (PAD) are limited. We evaluated the hypothesis that serum markers of endothelial dysfunction are associated with an increased risk of PAD among women.

Methods:
We conducted a nested case-control study within an ongoing prospective cohort of U.S. female nurses (Nurses’ Health Study). Among 32,826 NHS participants who provided blood samples in 1989-1990, after excluding those who had myocardial infarction, coronary heart disease, stroke, or carotid artery surgery prior to the PAD diagnosis, we included all incident PAD cases that occurred between 1990 and 2008 and were confirmed by medical records. Each case was individually matched with three eligible controls using risk-set sampling, by age, smoking, date of blood draw, and fasting status. We evaluated the association between serum levels of soluble intercellular adhesion molecule (ICAM-1), E-selectin, and the risk of PAD, using conditional logistic regression analysis.

Results:
Complete biomarker data from 1990 was available for 144 cases and 431 controls. After accounting for matching factors, baseline ICAM-1 levels were associated with higher risk of PAD (RR for highest (T3) vs. lowest (T1) tertile=1.75, 95% CI: 1.05-2.90). The association was attenuated and no longer significant (RR T3 vs. T1=1.37, 95% CI: 0.75-2.49) after adjusting for serum levels of HDL and LDL-cholesterol, family history of myocardial infarction, relative weight, reported aspirin and cholesterol-lowering medication use, hypertension and diabetes diagnoses, physical activity, and pack-years of smoking. Additional adjustment for CRP levels further attenuated the relative risk (RR T3 vs. T1= 1.24, 95% CI: 0.67-2.29). We did not observe any significant association between baseline E-selectin levels and the risk of PAD (multivariate- and CRP-adjusted RR T3 vs. T1=0.93, 95% CI: 0.54-1.59).

Conclusions:
There was no association between ICAM-1 and E-selectin and subsequent PAD in this cohort of U.S women.
Abstract P102: Consumption of Fruits and Vegetables is Inversely Associated with Academic Performance Index Scores at a Large Urban School District
Authors: Alfonso Vivian H , Kuo Tony , McCarthy William J
Published: July 2021

More than 26% and 22% of 5
th
and 7
th
graders, respectively, in Los Angeles County are obese. Recent efforts to address this public health problem have focused on system-level changes in the food environment, especially in school settings. Los Angeles Unified School District (LAUSD), the second largest district in the nation, serves well over 650,000 meals a day, 80% of which go to students who qualify for free or reduced-price lunches (FRPL). Because the National School Lunch Program (NSLP) meals are often the primary source of nutrition for students from low-income families, this setting represents a natural opportunity to examine the effects of offering more healthful foods on student health and academic achievements. Effective in the 2011-12 school year, new standards for the NSLP included increased offerings of fruits and vegetables. Food production records from LAUSD were validated using data from plate waste studies at four randomly selected middle schools. Correlations between food production records and visually monitored plate waste varied by school size (r=0.194 and r=0.722 for large and small schools, respectively). Using school-level data (N=74), race/ethnicity was associated with Academic Performance Index (API) scores; the ethnic composition of each school was associated with the percent of students eligible for FRPL. Simple linear regression (SLR) analyses revealed an inverse association between consumption of fruits and vegetables and API scores (β
FV
=-1.44, p<0.001). The SLR also revealed an inverse association between percent of English learners and API score (β
E
=-5.81, p<0.001) as well as an inverse association between percent of students eligible for FRPL and API scores (β
L
=-3.13, p<0.001). The inverse relationship between healthful food consumption and standardized test scores may be a result of the high correlations between percent of English learners (E), percent of students eligible for FRPL (L) and weight of fruits and vegetables consumed per student (FV) (r
E-L
=0.80, p<0.001; r
E-FV
=0.52, p<0.001; r
L-FV
=0.68, p<0.001). These findings suggest that healthful eating may help optimize physical and cognitive development. Due to their significant contribution to the diets of school children, changes in school meal program offerings could broadly help improve nutrition for children in low-income areas.
Abstract P104: Impact of Avocado Enriched Diets on Serum Lipids: A Meta-Analysis
Authors: Shah Sachin A , Yan Fanny
Published: July 2021

Introduction:
Diet is integral to the management of dyslipidemia. Evidence suggests that diets rich in monounsaturated fatty acids (MUFA) benefit the serum lipid profile. Avocados offer a plant based source of MUFA, but the magnitude of benefit from avocado consumption remains unknown. We performed a meta-analysis to assess the impact of avocados on total cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), and triglycerides (TG).

Methods:
A literature search using the term “avocado” and “Persea Americana” was done using PubMed, CINAHL, Cochrane Database of Systemic Reviews and by hand searching of relevant primary and review articles. Studies were included for analysis if, controlled trials in human subjects evaluating avocado in the diet with adequate data reported for either, TC, LDL-C, HDL-C or TG. A weighted mean difference from baseline was calculated using the DerSimonian-Laird random-effects model. Subgroup analyses and the Q statistic were used to assess for heterogeneity. Publication bias was assessed through the Egger bias statistic and inspection of funnel plots.

Results:
From the 841 screened studies, 9 were included in the final analysis incorporating 186 unique subjects for all lipid endpoints. Dietary avocado intake resulted in a statistically significant decrease in TC and LDL-C of -15.30 mg/dl (CI -22.25 to -8.35) and -12.55 mg/dl (CI -19.89 to -5.21), respectively. TG reduced significantly by -24.17mg/dl (CI -41.94 to -6.41). HDL-C decreased non-significantly by -1.27mg/dl (CI -4.46 to 1.91). Subgroup analyses suggested that replacing regular dietary fats with avocado based fats results in a higher reduction in TC, LDL-C and TG compared to simply adding avocado to a free diet. The Q statistic was significant for all endpoints (p<0.001) while the Egger bias statistic showed a lack of publication bias for all endpoints except TG.

Conclusion:
Avocado enriched diets can lower TC, LDL-C and TG by 15, 13, and 24 mg/dl respectively. HDL-C is not significantly impacted. Of note, the reduction appears beneficial with a fat substitution strategy rather than the general addition of avocados to a free diet.
Abstract P108: Associations between Anthropometric Indices and the Prevalence of Heart Disease in Iran: The Golestan Cohort Study
Authors: Garg Vaani , Vedanthan Rajesh , Islami Farhad , Pourshams Akram , Poutschi Hossein , Khademi Hooman , Naemi Mohammad , Malekshah Akbar Fazel-Tabar , Jafari Elham , Salahi Rasool , Kamangar Farin , Pharoah Paul D , Abnet Christian C , Brennan Paul , Dawsey Sanford M , Fuster Valentin , Boffetta Paolo , Malekzadeh Reza
Published: July 2021

Background:
Both high and low body mass index (BMI) are associated with heart disease (HD). However, data are relatively lacking regarding the relationship between life-course trends in BMI and HD in low- and middle-income countries (LMICs).

Objective:
To investigate the relationship between prevalent HD and anthropomorphic indices such as BMI, waist circumference (WC) and waist to hip ratio (WHR), as well as body size perception from adolescence to adulthood.

Methods:
Baseline data from the Golestan Cohort Study, a prospective population-based study in Iran, were used in this cross-sectional analysis. Current anthropometric indices were measured and body size perception using standard pictograms was assessed for age 15, age 30, and at the time of interview. We used logistic regression to evaluate associations of prevalent HD with anthropometric indices. Statistical analyses were performed using STATA version 11.

Results:
Complete data were available for 50,044 participants (age 40-75 years), of whom 6.1% reported a history of HD. For men and women, current BMI, WC, and WHR were associated with prevalent HD (p<0.001). Prevalence of HD increased with each quintile of WC and WHR (e.g. adjusted OR (95% CI) for highest WC quintile for men (≥105 cm) and women (≥108 cm) was 1.56 (1.28, 1.91) and 1.47 (1.24, 1.73), respectively). Among men, there was a U-shaped relationship between HD and body size perception at younger ages. Men also had a U-shaped relationship between HD and changes in body size perception over time, while women had a U-shaped relationship between HD and changes in body size perception from adolescence to early adulthood, but demonstrated a J-shaped pattern from early to late adulthood (Figure).

Conclusion:
Prevalent HD was associated with current anthropometric indices and temporal changes in body size perception for men and women. Public health interventions focused on the cumulative lifetime burden of risk factors such as obesity on cardiovascular morbidity and mortality are essential, particularly in LMICs.
Abstract P114: Association of Psychosocial Wtress with Incident Coronary Heart Disease and All-cause Mortality among Low and High Income Individuals in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Redmond Nicole , Richman Joshua , Gamboa Christopher , Albert Michelle A , Sims Mario , Durant Raegan , Glasser Stephen , Safford Monika M
Published: July 2021

Introduction:
Stress may increase risk for coronary heart disease (CHD) and death, especially for individuals living in poverty. Few prospective studies have examined the relationships between stress, CHD and mortality among minorities, who are more likely to be poor. We studied the association of perceived stress with incident CHD and mortality in a large biracial cohort.

Methods:
REGARDS includes 30,239 community-dwelling black and white participants age >45 years recruited from 2003-07. Recruitment oversampled the Stroke Belt and Buckle and included residents of 48 states. Participants were telephoned every 6 months for CVD endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin, and expert adjudication. CHD was defined as definite or probable myocardial infarction or CHD death. Stress was assessed using the 4-item Cohen’s Perceived Stress Scale (PSS). Among participants free of CHD at baseline, Cox models estimated hazard ratios for incident CHD and all-cause mortality through 12/31/2009, adjusting for socioedemographic, clinical, and behavioral CHD risk factors, and testing for interactions by race and income.

Results:
The analytic sample included 24,439 subjects with mean age 64.1 years (SD+9.3), with 58% women and 42% blacks. Over a mean follow-up of 4.2 (maximum 6.9) years, there were 659 incident acute CHD events and 1320 deaths. Analyses were stratified by income (Table) due to significant interactions with stress; no significant interactions were found by race. The highest quartile of stress was associated with higher risk for incident CHD among those with low income (HR 1.36, {95% CI 1.04, 1.78}) but not high income (HR 0.82, {95% CI 0.57, 1.16}). This relationship was slightly attenuated with full adjustment. Each increasing quartile of stress was associated with increasingly higher risk of death for those with low but not high income.

Conclusion:
Stress may confer greater risks of CHD and death for individuals with low but not high income.
Abstract P126: Relation of Depressive Symptoms to the Cross-Sectional and Longitudinal Association of Low Cardiovascular Risk with Subclinical Atherosclerosis - The Chicago Healthy Aging Study (CHAS)
Authors: Hernandez Rosalba , Allen Norrina B , Liu Kiang , Stamler Jeremiah , Reid Kathryn J , Zee Phyllis C , Wu Donghong , Kang Joseph , Garside Daniel B , Daviglus Martha
Published: July 2021

Background:
Previous findings on the association of depressive symptoms and subclinical cardiovascular disease (CVD) have been inconsistent. This study aimed to (1) examine the cross-sectional association between depressive symptoms (DS) and subclinical atherosclerosis in older age; and (2) determine whether presence of DS at older age relates to the long-term low-order association of favorable CVD risk factor profile (low-risk) at younger age with subclinical atherosclerosis in older age.

Methods:
CHAS participants (n=1,395) were examined in 1967-1973 (baseline) and 2007-2009 (follow-up). Baseline low-risk was defined as: (1) blood pressure ≤120/≤80 mmHg and no reported use of antihypertensive medication, (2) serum cholesterol <200 mg/dL and no reported use of lipid-lowering medication, (3) BMI < 25.0 kg/m
2
, (4) no diabetes, and (5) no smoking; not low-risk included all others. DS (≥16 on the Center for Epidemiologic Studies Depression Scale [CES-D]) and presence of coronary artery calcification (CAC) >0 (determined by computed tomography) were assessed at follow-up.

Results:
Among 1,130 CHAS participants with complete data (mean follow-up age=71.1), 6.9% met criteria for DS. Individuals with DS reported lower sleep quality (
p
<0.0001) and were more likely to be African American (p<0.0001). At older age, DS were not associated with CAC>0 after multivariate adjustment (
p
=0.38). Prevalence of DS did not vary significantly between baseline low-risk and not low-risk participants (5.8% and 7.2%,
p
=0.45). Regardless of late-life depressive symptom status, presence of CAC (indicated by CAC scores > 0) was less likely among low-risk persons (
p
=0.21) (Table 1). Results were consistent across different CAC score cut-points (data not shown).

Conclusion:
Depressive symptoms in older age were not associated with subclinical atherosclerosis or CVD risk status. Low CVD risk status in early-middle age was associated with lower CAC prevalence in older age among persons both with and without depressive symptoms.
Abstract P127: Posttraumatic Stress Disorder and Risk for Coronary Heart Disease: A Meta-analytic Review
Authors: Edmondson Donald , Kronish Ian M , Shaffer Jonathan A , Falzon Louise , Burg Matthew M
Published: July 2021

Context:
Recent evidence suggests that posttraumatic stress disorder (PTSD) may be associated with increased risk for coronary heart disease (CHD).

Objective:
To determine the association of PTSD to incident CHD using systematic review and meta-analysis.

Data Sources:
Articles were identified by searching Ovid MEDLINE, PsycINFO, Scopus, Cochrane Library, PILOTS database, and through manual search of reference lists.

Study Selection:
Prospective cohort studies that assessed PTSD in participants free of CHD and assessed subsequent CHD or cardiac-specific mortality.

Data Extraction:
We extracted estimates of the association of PTSD to incident CHD, as well as study characteristics. Odds ratios were converted to hazard ratios (HR), and a random-effects model was used to pool results.

Data Synthesis:
Five studies met our inclusion criteria (N= 401,712); 4 of these included depression as a covariate. The pooled HR for the magnitude of the relationship between PTSD and CHD was 1.53 (95% CI, 1.27-1.84) before adjustment for depression. The pooled HR estimate for the 4 depression-adjusted estimates (N= 362,388) was 1.22 (95% CI, 1.05-1.42).

Conclusion:
PTSD is independently associated with increased risk for incident CHD, even after adjusting for depression and other covariates.

Figure 1.
Forest plot of association of PTSD to incident MI or cardiac mortality

Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. The diamond represents the aggregate estimate, and its lateral points indicate confidence intervals for this estimate.
Abstract P128: Prevalence of Posttraumatic Stress Disorder Due to Stroke: A Meta-analysis
Authors: Edmondson Donald , Richardson Safiya , Fausett Jennifer K , Falzon Louise , Howard Virginia J , Kronish Ian M
Published: July 2021

Title:
Prevalence of posttraumatic stress disorder due to stroke: A meta-analysis

Objective:
To estimate the prevalence of stroke-induced posttraumatic stress disorder (PTSD) using systematic review and meta-analysis.

Methods:
Potentially relevant peer-reviewed journal articles were identified by searching the Ovid MEDLINE, PsycINFO, PILOTS Database, The Cochrane Library and Scopus from inception to April 2012; all searches were conducted on April 13, 2012. Observational cohort studies that assessed PTSD with specific reference to a stroke or TIA that occurred at least 1 month prior to the PTSD assessment were included. We abstracted PTSD rates and characteristics of the study and sample from all included studies. The coding of all articles included demographic information, sample size, study country, and method and timing of PTSD assessment.

Results:
Eight studies (N= 1,111) met our inclusion criteria. PTSD prevalence estimates varied significantly across studies by timing of PTSD assessment (ie., within 1 year of stroke vs greater than 1 year post-stroke; 70% of heterogeneity explained;
Q
1
=14.68;
P
<.001). The final aggregate prevalence estimate was 14% (95% CI, 11%-17%) from the random effects model comprised of an aggregate estimate of 25% (95% CI, 17%-35%) for PTSD within 1 year of stroke and 11% (95% CI, 8%-14%) after 1 year.

Conclusions:
Although posttraumatic stress disorder (PTSD) is commonly thought to be triggered by external events such as combat or sexual assault, these results suggest that as many as 1 in 4 stroke survivors develop significant PTSD symptoms due to the stroke. Further research is needed to determine whether stroke-induced PTSD increase recurrence risk in stroke patients.

Figure 1. Stroke-induced PTSD prevalence estimates

Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. Diamonds represent aggregate estimates, by PTSD assessment timing and overall.
Abstract P137: Walking Impairment and Vitamin D Deficiency in the Elderly, National Health and Nutrition Examination Survey 2001 to 2004
Authors: Moukarzel Lea , Mao Danlin , Eraso Luis H
Published: July 2021

Introduction:
Vitamin D deficiency has been reported in 36% of otherwise healthy adults and 57% of inpatients in the US. Vitamin D deficiency (< 15 ng/ml) is linked to increased muscle weakenss, cardiovascular disease and abnormal bone mineral metabolism. The elderly are more prone to vitamin D deficiency because of decrease dietary intake, diminished sunlight exposure and reduced skin thickness among other risk factors. We hypothesized that walking impairment in subjects older than 60 years old is associated to abnormal serum levels of 25-hydroxyvitaminD levels independent of traditional cardiovascular risk factors.

Methods:
A multivariable adjustment was performed using the National Health and Nutrition Examination Survey database and a graded association was present between serum 25-hydroxyvitaminD levels and walking impairment. We analyzed data from 2,322 participants of the NHANES 2001-2004 survey ages 60 years or older who responded to the walking impairment (WI) questionnaire and had serum 25-hydroxyvitamin D levels measured. Walking impairment was defined as an affirmative answer to the question: “have you had pain in either leg while walking?” A 25 hydroxyvitamin D deficiency level was defined as a serum level of 15ng/dl or less. PAD was defined as an ABI of less than 0.9 in either leg.

Results:
The prevalence of individuals 60 year or older with walking impairment due to leg pain in the United States is 25 % (S.E, 1.3). Mexican Americans (31.43%) had a higher prevalence of WI than Whites (24.28%) or African Americans (28.67%). Walking impairment was also statistically significant among those with a history of diabetes mellitus, cardiovascular disease, and peripheral arterial disease. Results also showed that C-reactive protein and alkaline phosphates were higher among those with walking impairment. A multivariable adjustment was performed and a graded association was present between serum 25-hydroxyvitaminD levels and walking impairment. An odds ratio of 1.526186(p= 0.013) for walking impairment was present among vitamin D deficient subjects after adjusting for age, gender, and race-ethnicity. The association remained after further adjusting for C-reactive protein, chronic kidney disease, smoking, history of diabetes, PAD, and history of cardiovascular disease (O.R. =1.416255, p=0.045).

Conclusion:
Walking impairment is associated with 25-hydroxyvitaminD deficiency in the elderly independent of traditional cardiovascular risk factors. These results warrant further studies to determine if vitamin D supplementation improves functional capacity and reduces cardiovascular disease in the elderly.
Abstract P138: Association between Cardiovascular Fitness and Accelerometer-Derived Physical Activity and Sedentary Time in the General Population
Authors: Kulinski Jacquelyn , Khera Amit , Ayers Colby , Das Sandeep , de Lemos James , Berry Jarett
Published: July 2021

Objectives:
Prior literature suggests that sedentary behavior may represent a risk factor that is independent of physical activity. The mechanism for this association remains poorly understood. We hypothesized that sedentary behavior might be inversely associated with cardiorespiratory fitness, independent of moderate and vigorous activity.

Methods:
We included 2,223 participants (ages 12-49 years, 47% female) without known heart disease who had both cardiovascular fitness testing and at least one valid day of accelerometer data from NHANES 2003-2004. From accelerometer data, we quantified bouts of exercise (at least 8 of 10 minutes above previously defined thresholds corresponding to moderate- or vigorous-intensity activity) as mean minutes of activity bouts per day for each participant. Sedentary time was defined as <100 counts per minute of wear time in mean minutes per day. VO2 max estimates were derived from a sub-maximal exercise treadmill test using measured heart rate responses to known levels of exercise workloads. Multivariable-adjusted linear regression analyses were performed with fitness as the dependent variable. Models were stratified by gender and adjusted for age, BMI, mean wear time and included both sedentary and moderate-vigorous activity time.

Results:
We observed that moderate and vigorous exercises levels were positively correlated to VO2 max (R=0.237, p<0.0001). Sedentary time was found to be inversely associated with VO2 max (R=-0.07, p=0.002). With each additional minute of moderate-vigorous activity, VO2 max increased by 0.05 ml/kg/min (p=0.001, men) and 0.08 ml/kg/min (p=0.004, women). For each additional minute of sedentary time, VO2 decreased by 0.01 ml/kg/min in both men (p=0.026) and women (p=0.001).

Conclusions:
After adjustment for moderate and vigorous activity, sedentary behavior appears to have a minor, inverse association with fitness. These findings suggest that the risk related to sedentary behavior might be mediated, in part, through lower fitness levels.
Abstract P167: The Long-term Effect of a Low-Carbohydrate Diet on Appetite Hormones: A Randomized Controlled Trial
Authors: Hu Tian , Reynolds Kristi , Yao Lu , Bunol Calynn , Liu Yanxi , Chen Chung-Shiuan , He Jiang , Bazzano Lydia
Published: July 2021

The long-term effects of low-carbohydrate diets on hormones related to appetite are unclear.

We recruited a total of 148 study participants with a body mass index of 30 - 45 kg/m2 (Mean: 35.4 kg/m2) who were free of diabetes, cardiovascular diseases and kidney disease. The participants were randomly assigned to either a low-carbohydrate diet (<40 g/day; N=75) or a low fat (<30% energy from fat, <10% from saturated fat; N=73) diet. Two 24-hour dietary recalls were conducted at each clinic visit (0, 3, 6 and 12 months of the intervention). Participants met with a study dietitian weekly for the first month followed by group settings bi-weekly for 5 months then monthly for the subsequent 6 months. Each group was provided the same behavioral curriculum related to diet emphasizing portion control and eating habits. Total ghrelin and peptide YY were determined using radioimmunoassay methods.

Of the study participants, 60 in the low-fat group (81.1%) and 59 in the low-carbohydrate group (79.7%) completed the entire intervention. The mean age was 46.8 years, 88.5% were women and 55.1% were African-Americans. The low-carbohydrate group lost approximately 3.5 kg more body weight than did the low-fat group (P value: 0.002) over the course of the intervention. Both diets decreased total peptide YY and ghrelin. Compared to low-fat diets, the low-carbohydrate diet resulted in a significantly greater decrease in total peptide YY at 6 (Net change: -6.8 ph/mL; P value: 0.04) and 12 months (Net change: -10.6 ph/mL; P value: 0.02). The changes in total ghrelin were not significantly different throughout the study.

Our findings suggest that the low-carbohydrate diet did not result in a greater loss of appetite, compared to the low-fat diet.
Abstract P178: Pedometer Feedback Intervention Increases Time Spent in Moderate-to-Vigorous Physical Activity in Cardiac Rehabilitation Patients
Authors: Ozemek Cemal , Byun Wonwoo , Riggin Katrina , Strath Scott , Kaminsky Leonard
Published: July 2021

Introduction:
Pedometer feedback with step goals has previously been demonstrated to be effective in increasing daily steps in cardiac rehabilitation patients. These monitors allow the individual to track steps taken during a day, which may influence the frequency or duration of structured physical activity that is intended to achieve a step goal. However, it is not known whether an increase in step counts by pedometer feedback with step goals also increases time spent in recommended intensity levels for improved health, specifically moderate-to vigorous physical activity (MVPA), in cardiac rehabilitation patients.

Hypothesis:
Pedometer feedback with weekly step goals will increase time spent in MVPA, mediated by an increase in step counts in cardiac rehabilitation patients.

Methods:
A total of 31 (22 men and 9 women, age 62 ± 9 years) patients participated in a 12-week maintenance cardiac rehabilitation, pedometer based step goal intervention. Prior to the intervention, each subject’s one week baseline average daily step count was measured and 10% of this value was used to increase step goals during the intervention. Each week the step goal was met, the following week’s goal was appropriately increased. However, if the step goal for the week was not achieved, the step goal would not increase until the goal was fulfilled. Additionally, daily step counts and time spent in MVPA and light physical activity were assessed at baseline (without pedometer feedback) and for each intervention week (with pedometer feedback) using a Kenz Lifecorder PLUS monitor (Nagoya, Japan). Average time spent in light physical activity (activity level of 1-2) and MVPA (activity levels ≥3), were determined according to activity intensity level defined by the manufacturer’s analyses program.

Results:
The average step count for the baseline week was 5546 ± 2679 steps/day which significantly increased to 8348± 3613 steps/day by week 12 (p<0.01). The average time spent in MVPA also significantly increased (p<0.01) from 19 ± 16 min/day at baseline to 38 ± 23 min/day at week 12. In addition, there was a significant increase (p<0.05) in time spent in light physical activity from baseline (42 ± 18 min/day) to week 12 (51 ± 24 min/day).

Conclusion:
Findings of this study demonstrate that a 12-week pedometer feedback-based intervention was effective in increasing time spent in MVPA in maintenance cardiac rehabilitation patients. Cardiac rehabilitation facilities can utilize pedometer feedback and goal setting to promote increases in time spent in recommended activity levels previously associated with improved health outcomes.
Abstract P195: Lack of Association between Sleep Duration and ECG Arrhythmia Risk Measures: Chicago Area Sleep Study
Authors: Ng Jason , Zee Phyllis C , Goldberger Jeffrey J , Knutson Kristen L , Liu Kiang , Kim Kwang-Youn A , de Chavez Peter J , Carnethon Mercedes R
Published: July 2021

Introduction
Sleep duration is significantly associated with cardiovascular disease risk factors such as hypertension, diabetes, and obesity in adults at low risk for obstructive sleep apnea. Although it is known that apnea increases the risk for sudden cardiac death, it is not known whether adults with short sleep duration independent of apnea have a higher risk for cardiac arrhythmias

Hypothesis
We tested the hypothesis that sleep duration in adults at low risk for obstructive sleep apnea would be associated with ECG measures that are known risk factors for ventricular arrhythmias.

Methods
The Chicago Area Sleep Study recruited 610 participants via commercially available telephone listings. Participants were screened using in-home apnea detection equipment (ApneaLinkTM) for one night to exclude subjects with apnea/hypopnea index ≥ 15. Participants wore wrist actigraphs for 7 days to objectively determine sleep duration. A 10-minute 12-lead ECG was recorded for each subject. Standard measures of heart rate, PR interval, and QTc interval were obtained along with markers of ventricular repolarization, Tpeak to Tend interval (Tpe) and spatial QRS-T angle. Signal-averaged ECG analysis was performed to measure filtered QRS duration (fQRSd), RMS voltage of terminal 40 ms (RMS), and duration of terminal QRS signals <40μV (LAS). Participants with atrial fibrillation, >20% ectopic beats and those using antihypertensive and sleep medications were excluded from analysis. The effect of sleep duration on the ECG parameters was estimated using a multiple linear regression model adjusting for demographics (sex, age, and race) and cardiovascular risk factors (BMI, hypertension, coronary heart disease, and diabetes).

Results
ECGs from a total of 504 participants (200 male, 48±8 years old) were analyzed. Mean sleep duration was 7±1 hrs, heart rate was 64±9 bpm, PR interval was 165±18 ms, and QTc interval was 424±23 ms. Mean Tpe interval was 83±14 ms and spatial QRS-T angle was 29±26 deg. The signal-averaged ECG measures of fQRSd, RMS, and LAS had mean values of 78±12 ms, 58±34 μV, and 24±9 ms, respectively. In an unadjusted model, there was a borderline association between sleep duration and QTc (β=0.004 ms/hr, SE=0.0023, p=0.08). However, that association was no longer significant following adjustment with demographics and cardiovascular risk factors. No other ECG measures were associated with sleep duration.

Conclusions
In a population at low risk of obstructive sleep apnea, ECG-based measures of cardiovascular risks were not associated with sleep duration. Previously reported associations between short sleep and cardiovascular events may not be arrhythmic in origin.