bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP74: Trends in Cardiovascular Health Counseling Among Postpartum Individuals in the United States From 2016-2020: The Pregnancy Risk Assessment Monitoring System
Authors: Cameron Natalie A , Yee Lynn M , Dolan Brigid M , O'Brien Matthew J , Greenland Philip , Khan Sadiya S
Published: March 2023

Introduction:
Poor pre-pregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are risk factors (RF) for lifetime risk of cardiovascular disease. Contemporary rates and trends of CVH counseling can inform strategies to optimize postpartum CVH.

Methods:
We used data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a national, population-based survey of postpartum individuals. The primary outcome was self-report of counseling received on “healthy eating, exercise, and losing weight gained during pregnancy,” at the 4-6 week postpartum visit. We calculated the age-standardized weighted percent of individuals reporting CVH counseling for each year, overall, and by RF strata: (1) any pre-pregnancy CVH factor (obesity, diabetes, or hypertension) and (2) any APO (gestational diabetes, hypertensive disorders of pregnancy, or preterm birth). We quantified annual average percent change (APC) from 2016-2020. Lastly, we pooled data from 2016-2020 and determined odds ratios (OR) of counseling comparing individuals with and without RFs, adjusted for age, education, postpartum insurance, and year of delivery.

Results:
Among 206,080 individuals (weighted N = 10,630,861), 89.8% (95% confidence interval 89.6-90.1%) attended a postpartum visit. In 2016, 57.6% (56.7%-58.5%) reported CVH counseling. From 2016-2020, counseling was similar or experienced small declines overall (APC -1.1%/year [-1.3, -0.8]), for any pre-pregnancy CVH factor (-0.2%/year [-1.1, 0.7]) and any APO (-1.5%/year [-2.2, -0.8]). Counseling was modestly higher among those with any pre-pregnancy CVH factor (OR 1.2 [1.2, 1.3]) or any APO (OR 1.1 [1.1, 1.2]) compared with individuals without RF (TABLE).

Conclusions:
Of the 9 of 10 individuals who attended a postpartum visit, only about half reported CVH counseling, even among those with poor pre-pregnancy CVH or APOs without improvement in the past 5 years. Multilevel efforts should prioritize the postpartum period as an opportunity for CVH promotion.
Abstract MP75: History of Infertility is Associated With Midlife Cardiovascular Health in Females
Authors: Nichols Amy R , Rifas-Shiman Sheryl L , Switkowski Karen M , Young Jessica , Hivert Marie-France , Chavarro Jorge , Oken Emily
Published: March 2023

Introduction:
Infertility, the inability to conceive for ≥12mo (≥6mo if age ≥35y), has been associated with increased risk for adverse cardiometabolic outcomes, but risk related to specific domains of cardiovascular health remain unclear. Utilizing the American Heart Association’s
Life’s Essential 8
(LE8) construct of cardiovascular health, we hypothesized that history of infertility would be associated with lower LE8 score (0-100) comprising four behavioral (diet, physical activity, sleep, smoking status) and four biological (BMI, blood pressure, blood lipids, glycemia) domains.

Methods:
Project Viva enrolled pregnant participants 1999-2002. We included participants who completed a midlife visit at approximately 18y postpartum (mean age 50.6y). Using multivariable linear regression, we examined relationships between any history of infertility (y/n) and mean LE8 overall, behavioral, biological, and individual component scores adjusted for race/ethnicity, education, household income, and age at midlife visit.

Results:
At midlife, 468 participants had complete data. The majority (67%, n=313) identified as non-Hispanic White and had a mean (± SD) LE8 overall score of 76.3 ± 12.2, behavioral score 76.5 ± 13.4, and biological score 76.0 ± 17.5. Overall, 35% (n=160) reported experiencing infertility in their lifetime. In adjusted models, estimated LE8 overall score was 3.3 points lower (β=-3.31, 95%CI -5.63, -0.98) compared to those with no history of infertility; a stronger association was detected for the biological (β=-4.64, 95%CI -8.13, -1.16) than the behavioral domain (β=-1.97, 95%CI -4.52 ,0.58). Of individual LE8 components, infertility was most strongly associated with a lower score for blood lipids (β=-8.77, 95%CI -15.1, -2.43) and glycemia (β=-4.84, 95%CI -8.71, -0.97) (Figure).

Conclusion:
A history of infertility was associated with lower overall and biological cardiovascular health scores and may indicate the need for enhanced cardio-preventive strategies during the reproductive years.
Abstract MP76: The Association Between Sleep Health and Gestational Weight Gain
Authors: Hawkins Marquis S , Pokutnaya Darya , Bodnar Lisa M , Levine Michele , Buysse Daniel , Davis Esa M , Wallace Meredith L , Rothenberger Scott , Zee Phyllis , Grobman William , Reid Kathryn J , Facco Francesca
Published: March 2023

Background:
Poor sleep health is associated with weight gain and obesity outside of pregnancy. Still, there is little research regarding the impact of sleep health on weight among pregnant populations, particularly using a multidimensional sleep-health framework. This study examined associations between mid-pregnancy sleep health indicators, multidimensional sleep health, and gestational weight gain (GWG).

Methods:
This was a secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n=745). Indicators of individual sleep health domains (i.e., regularity, nap duration, timing, efficiency, and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined “good” sleep health in each domain based on empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (<-1 SD), moderate (-1 or +1 SD), and high (>+1 SD).

Results:
We identified four distinct sleep profiles (Figure 1). While indicators of individual sleep domains were not associated with GWG, multidimensional sleep health was associated with higher risk of low GWG. Compared to people with a good sleep profile (Class 1), people with a low efficiency and long sleep duration profile (Class 4) had a 1.88 (95% CI 1.04 to 3.39) higher risk of low GWG (vs. moderate GWG) in models adjusting for education, depressive symptoms, race, smoking status.

Discussion:
Multidimensional sleep health was more strongly associated with GWG than were individual sleep domains. Future research should determine whether sleep health is a useful intervention target for optimizing GWG.

Figure 1- Probabilities of each sleep characteristic by sleep profile, derived from latent class analysis
Abstract MP78: Race/Ethnic Disparities in Children’s Cardiovascular Health: The Role of Social Disadvantage in Early Life
Authors: Aguayo Liliana , Fields Nicole D
Published: March 2023

Introduction:
The loss of cardiovascular health (CVH) begins early in life and disproportionately affects racial/ethnic minorities, particularly children in single parent households, and households with lower education, family income and food insecurity. However, the contribution of these social determinants to CVH disparities in childhood are poorly understood.

Hypothesis:
We hypothesized that racial/ethnic differences in CVH among US children are explained by social disadvantages.

Methods:
Data from the 2013-2018 National Health and Nutrition Examination Survey for children aged 2-18 (N=4,792) were used. CVH was measured using the AHA Life’s Essential 8 scores that combine nicotine exposure, diet, physical activity, sleep, body mass index, and blood pressure, lipids, and glucose. Oaxaca-Blinder decomposition methods were used to quantify the contributions of parental education, marital status and household income to poverty ratio, and food security to differences in CVH by race and sex.

Results:
Mean CVH score was highest among non-Hispanic White (mean [SE] = 73.7 [0.5]) than non-Hispanic Black (71.3 [0.6]) and Hispanic children (71.0 [0.4]). There was no significant difference among Black-White boys (mean differences [MD] = -1.52; 95% CI: -3.25, 0.21). Black girls had significantly lower CVH than White girls (MD= -2.66; 95% CI: -4.40, -0.91). Differences in parental college education accounted for 46% of the differences in CVH scores (MD = -1.21; 95% CI: -1.89, -0.54). Among Hispanic children, both boys (MD = -2.47; 95% CI: -4.22, -0.73) and girls (MD = -3.09; 95% CI: -4.60, -1.58) had significantly lower CVH scores than White boys and girls, respectively. Differences in parental education explained 66% of the difference in CVH among White-Hispanic boys and girls (MD= -0.66; 95%CI-1.11, -0.20; and MD= -0.66; 95%CI-1.20, -0.13).

Discussion:
Differences in parental college education largely explained lower levels of CVH among US Black and Hispanic children, a predictor of future cardiovascular disease.
Abstract P102: Sex Differences in Laboratory Values Prior to In-Hospital Cardiac Arrest
Authors: Attin Mina
Published: March 2023

Introduction:
In-hospital cardiac arrest (IHCA) is a major public health problem. Before the pandemic, around 292,000 cases were treated yearly in the United States. It is associated with a significant morbidity and mortality, <25% survival rate to hospital discharge. The effectiveness of prediction methods and established therapies in preventing IHCA remains debatable. Limited sex difference studies for evaluating therapies have led to healthcare inequities, with women faring worse. Laboratory (lab) values that guide and evaluate the efficiency of therapies in hospitalized patients are not fully explored with respect to sex differences.

Hypothesis:
There is a statistically significant difference in the serum electrolytes, estimated glomerular filtration rate; uncorrected ionized calcium and lactate from arterial blood gas between females and males within 72 hours of IHCA.

Methods:
A retrospective study was conducted in a single academic medical center using electronic health records of adult patients (≥18 years old) with a history of cardiopulmonary diseases who experienced IHCA (n=98) in acute care or an intensive care unit (2014-2016). Only the first episode of IHCA was recorded during the period of hospitalization. Patients were excluded if the IHCA was due to trauma, terminal cancer, and human immunodeficiency virus infection or if patients were comatose. Lab values were analyzed with respect to hours and days prior to IHCA. Linear mixed effect models (p<0.05) were used to examine the sex differences in lab values within 72 hours/3 days of IHCA and were adjusted by age and ejection fraction using the Tukey-Kramer procedure. Day 0= 0-23 hours, Day 1= 24-47 hours, and Day 2=48-72 hours.

Results:
The sample’s characteristics included: age (69±15), sex (female 33%,), location (intensive care units 54%), the initial rhythm of cardiac arrest (ventricular tachycardia, ventricular fibrillation 28%), ejection fraction (44±20), history of coronary artery diseases (78%,), pulmonary diseases (29%), unsuccessful return of spontaneous circulation (38%), and survival to hospital discharge (22%). Unadjusted statistical significance within 72 hours of IHCA was found in sodium and chloride (p<0.0047, p<0.001). Statistical significance was found when adjusted by age and ejection fraction in sodium, potassium, and chloride (p<0.04, p<0.001, p<0.00). Significant statistical sex differences were found after adjusting for age and ejection fraction in potassium and lactate when comparing day 0 with day 1 and day 2 (p<0.03, p<0.001).

Conclusions:
Quantifying lab values concerning sex differences will tailor therapeutic therapies to biological differences and will guide the areas of improvements in patient outcomes.
Abstract P105: Peripheral Artery Disease and Subsequent Risk of Cancer: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Nohara Shoichiro , Mok Yejin , Van't Hof Jeremy , Salameh Maya , Joshu Corinne , Platz Elizabeth , Florido Roberta , Matsushita Kunihiro
Published: March 2023

Introduction:
Cardiovascular disease (CVD) and cancer share risk factors, including smoking and obesity. Indeed, an increased cancer risk was reported among patients with CVD, such as myocardial infarction. Lower extremity peripheral artery disease (PAD) has also been explored in this context, but most previous studies included only Whites, had follow-up <10 years, or did not account for key confounders like smoking.

Hypothesis:
PAD is independently associated with long-term cancer risk in a bi-racial cohort.

Methods:
We studied 13,102 ARIC participants without prevalent cancer at visit 1 (1987-89) (mean age 54 [SD 6] years, 54% women, and 26% Black) (funding: NHLBI, NCI, and NPCR). Incident cancer was ascertained by linkage to cancer registries and medical record review. We categorized PAD status at visit 1 into symptomatic PAD (intermittent claudication or a history of lower extremity revascularization), asymptomatic PAD (ankle brachial index [ABI] ≤0.9), and other ABI categories of >0.9-1.0, >1.0-1.1, >1.1-1.2, >1.2-1.3 and >1.3. We ran multivariable Cox models.

Results:
During the median follow-up of 25 years (IQI 15-27 years), there were 4,142 incident cancer cases. 25-year cumulative cancer incidence was 48% in symptomatic PAD, 39% in asymptomatic PAD, and 31-34% in the other categories. When we adjusted for demographic factors, both symptomatic and asymptomatic PAD showed significant hazard ratios for incident cancer (1.79 [95%CI 1.33-2.43] and 1.39 [1.18-1.63], respectively, vs. ABI 1.1-1.2, Model 1 in
Table
). After adjusting for additional potential confounders, including smoking and diabetes, these associations were somewhat attenuated but remained consistent (Models 2-4 in
Table
).

Conclusion:
Both symptomatic and asymptomatic PAD were associated with an increased risk of cancer independently of smoking and diabetes. Although potential mechanisms should be explored, clinicians should be aware of this excess cancer risk among patients with PAD when considering cancer prevention and screening.
Abstract P107: Utilization of Statins in Patients With versus Without Cancer and Atherosclerotic Cardiovascular Disease
Authors: Shahid Izza , Carrasco Avila Jorge , Gullapelli Rakesh , Avenatti Eleonora , Mandania Roshni , Farooq Nihan , Shah Aayush , Nagueh Sherif F , Malahfji Maan , Chang Jenny , Nasir Khurram
Published: March 2023

Background:
Patients with cancer and concomitant atherosclerotic cardiovascular disease (ASCVD) have an increased risk of cardiovascular mortality compared with general population. Accordingly, optimal utilization of statins remains crucial to curtail adverse cardiovascular events in this high-risk cohort. We sought to compare the demographic burden and utilization of statins in ASCVD patients with cancer versus without cancer.

Methods:
Houston Methodist Learning Health System Outpatient Registry is an EMR-linked registry which was queried for adult patients with established ASCVD (2016-2022). International Classification of Diseases 10
th
Revision Clinical Modification codes (ICD 10-CM) were utilized to ascertain ASCVD and cancer diagnosis. ATC codes were used to identify statin use and dose in the database, and this information was recorded based on medication reconciliation reviews with patients during every clinical encounter.

Results:
A total of 97,819 patients with ASCVD were included in this analysis of which 16,926 patients (17.3%) had a concurrent cancer diagnosis. Patients with ASCVD and cancer reported lower utilization of any statin (69.6% vs 71.2%) and high-intensity statin (33.2% vs 37.6%) compared with patients without cancer. Consistent results were observed across gender, age and racial strata with the exception of Hispanics and NHB, where ASCVD patients with cancer reported increased utilization of any statin compared with patients without cancer. Interestingly, patients with ASCVD and cancer were more likely to have LDL<70mg/dL compared with ASCVD patients without cancer (41.1% vs 36.2%) across gender, age and racial strata.

Conclusion:
Albeit higher risk of adverse cardiovascular events, utilization of statins, particularly high-intensity statins remains suboptimal in cancer patients with established ASCVD. Considering the underlying cardiovascular risk patients with cancer and concomitant ASCVD may derive the greatest benefit from intensive LDL-C lowering therapies.
Abstract P109: Access to Mental Health Care Services as a Risk Factor for Cardiovascular and Cerebrovascular Disease Mortality
Authors: Nmezi Nwakaego A , Turkson-Ocran Ruth-Alma , Commodore-Mensah Yvonne
Published: March 2023

Introduction:
Poor access to mental health care is a national epidemic. Individuals with unmet mental health care needs are at increased risk for poor CVH outcomes. Research examining the relationship between mental health care access and CVD/CVA mortality is scarce.

Hypothesis and Research Question:
We hypothesized that lack of mental health care access would be associated with increased CVD and CVA mortality. Additionally, we examined whether the relationship between mental health care access and CVD/CVA mortality differed by race and ethnicity.

Methods:
We analyzed data from the National Health Interview Surveys (NHIS) from the years 1999-2018. NHIS data were linked to mortality data from the National Death Index records up to 2018. The main predictor variable was access to mental healthcare services. The primary outcome was mortality due to CVD/CVA. Cox proportional hazards models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between mental healthcare access and mortality. The model was adjusted for known confounders. Models were stratified by race and ethnicity.

Results:
A total of 1,824,334 individuals were included in the study. Participants mean age was (±SD) 43.2 (±.17). Nearly 23% of individuals reported an inability to afford needed mental healthcare services. Mortality due to CVD/CVA was higher among individuals who were unable to afford needed mental healthcare services, however this association was only significant for NH Black (aHR: 1.39 [95% CI 1.05-1.84]) and White adults (aHR: 1.53 [95% CI 1.30-1.81]). Mortality from CVD/CVA due to lack of access to mental health services differed by race and ethnicity. After adjustment, mortality due to CVD or CVA was highest among NH White persons and lowest among NH Black persons.

Conclusion:
We observed higher CVD/CVA mortality rates among individuals who were unable to afford needed mental healthcare services and their counterparts who obtained needed services. These results differed by race and ethnicity.
Abstract P110: Hypothalamic Amenorrhea Phenotype and Cardiovascular Disease Risk
Authors: Stuart Jennifer J , Manson JoAnn E , Bairey Merz C. Noel , Mukamal Kenneth J , Rexrode Kathryn M , Rich-Edwards Janet W , Shufelt Chrisandra L
Published: March 2023

Introduction:
Hypothalamic amenorrhea (HA) is a neuroendocrine disorder characterized by ovulatory dysfunction, anovulation, and infertility, which can be prolonged for months to years. Menstrual cycle irregularity and amenorrhea identify individuals with higher CVD risk, but existing evidence has not examined HA separately from polycystic ovary syndrome (PCOS). It remains unknown whether HA is associated with CVD events across the lifecourse.

Hypothesis:
We hypothesized that the HA phenotype (oligo/amenorrhea without PCOS traits) would identify individuals at increased risk for CVD.

Methods:
Nurses’ Health Study II participants with available information on menstrual cycle characteristics who were premenopausal and free of CVD at baseline comprised the analytic sample (n=83,281). Menstrual cycle regularity was retrospectively reported for ages 18-22y on the baseline questionnaire in 1989 while the 1993 biennial questionnaire captured current menstrual cycle regularity (at ages 29-49y); PCOS traits (severe acne, hirsutism) were additionally ascertained in 1993. Participants were followed for confirmed incident CVD (MI, stroke, and fatal CHD) from 1993 through 2017. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the relationship between HA and CVD, adjusted for age, race/ethnicity, parental education, parental history of CVD <60y, and behavioral risk factors (smoking, physical activity, diet, alcohol intake, body mass index).

Results:
Thirteen percent of participants (n=11,071) ever had HA: 8.5% of participants (n=7,081) had HA at ages 18-22y while 6.5% (n=5,428) had HA at ages 29-46y. Persistent HA (HA at both 18-22y and 29-46 y) was identified in 1.7% of participants (n=1,438). CVD events occurred in 253 individuals who ever had HA (HA at either 18-22y or 29-46y) and 1,228 individuals without the HA phenotype. Individuals who ever had HA had a 20% higher rate of CVD (CI: 1.05-1.38). HA phenotype at ages 18-22y was not associated with CVD risk (HR=1.14; CI: 0.96-1.35) while HA phenotype at ages 29-46y was associated with a 30% higher rate of CVD (CI: 1.10-1.54) compared to individuals without HA phenotype. Individuals with persistent HA across both age ranges had a 69% higher rate of CVD (CI: 1.24-2.28). Underlying associations were strongest between ever HA and stroke (HR=1.25; CI: 1.03-1.51) and between persistent HA and CHD (HR=1.90; CI: 1.27-2.86), although case counts were small.

Conclusions:
HA phenotype in mid-adulthood identified individuals at increased risk of CVD compared to those without HA. As there are multiple HA subtypes, defined by varying combinations of psychosocial stress, anxiety, physical activity and weight loss, future studies should examine which HA subtypes are associated with CVD risk.
Abstract P113: Cardiovascular Outcomes in Patients With NAFLD: A Six Year Epidemiologic Study 2015-2020
Authors: Khalid Yaser , Dasu Kirti , Dasu Neethi , Khalid Fizan , Umrani Rohan , Roy Trinava , Chhoun Christopher
Published: March 2023

Background:
The most common cause of mortality in patients with non-alcoholic fatty liver disease (NAFLD) is cardiovascular disease. Common pathways are hypothesized to be involved in the pathogenesis of both NAFLD and cardiovascular diseases. Our study aims to evaluate the impact of cardiovascular diseases on NAFLD.

Methods:
The Nationwide Inpatient Sample (NIS) is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from US hospitals. The National Inpatient Database (NIS) was sampled using ICD-10 codes for patients (> age 18) with NAFLD and cardiovascular diseases, which included coronary artery disease (CAD), hypertension (HTN), cerebrovascular accident (CVA), acute myocardial infarction (AMI), peripheral vascular disease (PVD), diabetes, versus patients with only NAFLD. Data was extracted from 2015 to 2020 and various parameters were analyzed using propensity matching utilizing the Kernel Method. Multivariate logistic regression was used to adjust for confounders. Primary outcome was mortality. Secondary outcomes were hospital length of stay (LOS) and total hospital charges (TOTCHG).

Results:
This study included 2,670,600 patients that had NAFLD of which there were 471,200 with CAD, 428,900 with diabetes, 337,750 with CHF, 324,750 with cardiac arrhythmias, 17,375 with CVA, 40,725 with AMI, 34,225 with PVD, and 1,107,725 with HTN. Patients with NAFLD and CVA (OR 5.71, CI 4.35-7.49, p<0.0001), AMI (OR 2.32, CI 1.79-3.00, p<0.0001), and cardiac arrhythmias (OR 2.61, CI 2.44-2.80, p<0.0001) had increased mortality compared to those with only NAFLD. Those with NAFLD and CVA had higher hospital LOS ( +4.12 days, CI 3.22-5.01, p<0.0001). Finally, patients with NAFLD and CHF ($6,564, CI $4,138-$8,989, p<0.0001), cardiac arrhythmias ($20,970, CI $18,209-$23,730, p<0.0001), CVA ($93,052, CI $65,547-$120,556, p<0.0001), and AMI ($46,632, $39,992-$53,273, p<0.0001) increased TOTCHG.

Conclusion:
Based on our study results, cardiovascular diseases such as AMI, CVA, and arrhythmias significantly increased mortality, hospital LOS, and TOTCHG. There needs to be increased monitoring and individualized treatment for each patient group that worsens hospital outcomes for patients with NAFLD. Further studies are required to understand the potential mechanisms that lead to these outcomes.
Abstract P114: Revisiting the Impact of Obstructive Sleep Apnea (OSA) on Cardiovascular Disease and Outcomes
Authors: Khalid Yaser , Dasu Kirti , Dasu Neethi , Khalid Fizan , Kadiyala Bhavana , Umrani Rohan
Published: March 2023

Background:
Previous studies have shown a direct correlation between having obstructive sleep apnea (OSA) and developing cardiovascular disease. Patients with OSA and cardiovascular disease also have higher morbidity and mortality. However, randomized trials have not shown an improvement in cardiovascular outcomes if OSA is better controlled and treated. For this study, the aim was to revisit the impact of OSA on cardiovascular outcomes using a large database.

Methods:
The Nationwide Inpatient Sample (NIS) is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from US hospitals. The National Inpatient Database (NIS) was sampled using ICD-10 codes for patients (> age 18) with OSA and cardiovascular diseases, which included coronary artery disease (CAD), hypertension (HTN), cerebrovascular accident (CVA), acute myocardial infarction (AMI), peripheral vascular disease (PVD), diabetes, versus patients with only OSA. Data was extracted from 2015 to 2020 and various parameters were analyzed using propensity matching utilizing the Kernel Method. Multivariate logistic regression was used to adjust for confounders. The primary outcome was mortality. Secondary outcomes were hospital length of stay (LOS) and total hospital charges (TOTCHG).

Results:
This study included 11,701,550 patients had OSA of which there were 4,061,025 with CAD, 1,842,025 with diabetes, 3,677,950 with CHF, 3,257,950 with cardiac arrhythmias, 152,100 with CVA, 339,000 with AMI, 328,300 with PVD, and 4,276,200 with HTN. Patients with OSA and CVA (OR 4.80, CI 4.30-5.37, p<0.0001), AMI (OR 2.67, CI 2.44-2.91, p<0.0001), and cardiac arrhythmias (OR 2.33, CI 2.27-2.40, p<0.0001) had increased mortality compared to those with only OSA. Those with OSA and CVA had higher hospital LOS ( +2.24 days, CI 1.99-2.51, p<0.0001). Finally, patients with OSA and CHF ($1,701, CI $687-$2,715, p<0.0001), cardiac arrhythmias ($15,393, CI $14,152-$16,634, p<0.0001), CVA ($39,339, CI $34,640-$44,037, p<0.0001), and AMI ($36,984, $34,099-$39,870, p<0.0001) increased TOTCHG.

Conclusion:
Based on our study results, cardiovascular diseases (CVD) such as AMI, CVA, and arrhythmias had significantly increased mortality, hospital LOS, and TOTCHG in patients with OSA. There is still a direct correlation between certain cardiovascular diseases and OSA. Our study shows increased morbidity and mortality as well in this patient population. Thus, OSA remains an important risk factor in CVD and new randomized trials are required to further study the relationship between OSA and cardiovascular disease in order to mitigate and prevent adverse hospital outcomes.
Abstract P117: Weight Loss is Associated With Increases in Mitochondrial DNA Copy Number
Authors: Okonkwo Chiamaka , Ozkan Bige , Echouffo Tcheugui Justin B , Gerstenblith Gary , Coresh Josef , Arking Dan E , Ndumele Chiadi E
Published: March 2023

Background:
Mitochondrial DNA copy number (mtDNA-CN) is a surrogate measure of mitochondrial function that is independently associated with increased cardiovascular disease risk. Individuals with obesity and cardiometabolic risk factors have lower mtDNA-CN levels. However, the modifiability of mtDNA-CN following a weight loss intervention has remained largely unexplored.

Hypothesis:
Bariatric surgery-induced weight loss is associated with longitudinal increases in circulating mtDNA-CN levels.

Methods:
In the BARI-Heart prospective cohort of bariatric surgery patients, we quantified mtDNA-CN from whole blood samples collected at three visits: 3 to 6 months prior to surgery, 2-4 weeks prior to surgery, and 6 months post-surgery. We used linear mixed models with random effects to assess changes in mtDNA-CN after bariatric surgery, with the pre-surgery visits while awaiting bariatric surgery serving as the control period. We used multivariable linear regression to evaluate the dose-response association between weight loss and change in mtDNA-CN.

Results:
We included 71 participants (mean age 45 years, 74% female, 88% White). While mtDNA-CN levels did not change significantly during the pre-surgery period (V1 to V2), mtDNA-CN significantly increased after bariatric surgery (V2 to V3) (Figure). In linear mixed models adjusting for age, sex, and smoking, mtDNA-CN was higher after bariatric surgery than immediately prior to bariatric surgery (Table: ß=0.141, p < 0.001). This increase in mtDNA-CN remained significant following further adjustment for changes in cardiometabolic risk factors (ß=0.116, p < 0.01). In linear regression, each 10% greater weight loss was associated with a 1.6% increase in mtDNA-CN.

Conclusions:
Weight loss via bariatric surgery is associated with significant increases in mtDNA-CN, independent of cardiometabolic risk factors. Improvements in mitochondrial function may mediate some of the cardiovascular benefits of significant weight loss.
Abstract P119: Circulating microRNA-122 and Improvement in Cardiovascular Health in Response to Weight-Loss Diets: The Preventing Overweight Using Novel Dietary Strategies (Pounds Lost) Trial
Authors: Xue Qiaochu , Heianza Yoriko , Li Xiang , Kou Minghao , Ma Hao , Wang Xuan , Rood Jennifer , Bray George , Sacks Frank M , Qi Lu
Published: March 2023

Introduction:
The microRNA-122 (miR-122) is widely involved in the post-transcriptional regulation of glucose and lipid metabolism, and cardiovascular system.

Hypothesis:
We assessed the hypothesis that decrease in circulating miR-122-5p would be associated with the improvement in cardiovascular health (CVH) score and each component health metric in response to dietary weight-loss interventions.

Methods:
Circulating miR-122-5p levels were measured at baseline and 6 months among 509 participants with overweight or obesity from the POUNDS LOST trial. We evaluated the CVH score using the newly updated algorithm -life’s essential 8 and calculated the composite score from the available biological health factors (body mass index [BMI], blood lipids, blood glucose, and blood pressure) across the 2-year intervention period.

Results:
At baseline, lower levels of miR-122-5p were associated with higher CVH scores (P<0.001). Greater decreases in log-transformed miR-122-5p induced by calorie-restricted diets were significantly associated with greater improvement in overall CVH score (β[SE]= -2.98[0.7], P<0.001), non-HDL metric (β[SE]= -3.72[1.33], P=0.005) and BMI metric (β[SE]= -4.78[1.12], P<0.001) over 6 months. The trajectory of the composite CVH score over the 2-year intervention period differed significantly between the patterns of change in miR-122-5p (
P
time*miR-122-5p
=0.001). We also found a significant interaction between change in miR-122-5p and dietary fat intake on the 6-months change in CVH (
P
= 0.025); a greater decrease in miR-122-5p showed a greater improvement in CVH at 6 months among participants assigned to a low-fat diet.

Conclusions:
In conclusion, participants with decreased circulating miR-122-5p levels in response to dietary weight-loss interventions had significant improvement in CVH and achieved CVH benefits most strongly when consuming a low-fat diet.
Abstract P121: Varying Determinants of Endothelial Dysfunction by Age Group Among Mexican Americans
Authors: Lee Miryoung , Garcia-Sayan Enrique D , Stone James R , Stone Danielle M , McPherson David D , Fisher-Hoch Susan P , McCormick Joseph B , Laing Susan T
Published: March 2023

Endothelial dysfunction assessed by impaired brachial flow-mediated dilation (FMD) is a predictive factor of incident CVD. Most studies included small proportions of Hispanics or Latinos. We aimed to assess determinants of impaired FMD in a large population-based sample of asymptomatic Mexican-Americans.

Methods:
Cardiometabolic biomarkers, visceral adipose tissue (VAT), and FMD were obtained from 960 participants (57.9% females, mean age 52.1±0.9 years, age 18-85 years) from the Cameron County Hispanic Cohort. Sex-specific median values of %FMD were used to divide participants into two groups: those with FMD below (low %FMD) and above the median (high %FMD). The sample was further stratified into younger (age<55 years) and older (age ≥ 55 years) age groups. Survey-weighted logistic regression analyses were conducted to evaluate the effects of factors on the %FMD groups.

Results:
There was a high prevalence of obesity (49.1%), hypertension (47.8%), diabetes (26.1%), hypercholesterolemia (46.7%), and metabolic syndrome (38.2%). The median FMD response was 4.2%±0.3% [3.8% (SE 0.4) in males and 4.5% (SE 0.4) in females]. Low %FMD group was significantly older, had higher VAT, SBP, or plasma glucose levels, and had metabolic syndrome compared to those in the high %FMD group. Multivariable-adjusted age-stratified logistic regression analyses showed that among older participants, male gender [OR =2.4 (1.4-4.2)] and having hypertension [OR=2.3 (1.3-4.3)] or pre-diabetes [OR=3.4 (1.5-7.5)] remained significantly associated with odds of low %FMD. Among younger participants, only high LDL [OR=2.8 (1.6-4.9)] or having metabolic syndrome [OR=1.9 (1.1-3.6)] were significantly associated with odds of low %FMD.

Conclusion:
We found age-dependent associations between cardiometabolic biomarkers and an FMD response below the gender-specific median in a population composed of Mexican-Americans without prior CVD. Targeting specific risk factors by age may mitigate progression to incident CVD in this high-risk group.
Abstract P126: Sociodemographic Predictors of Diet Quality During Adolescence
Authors: Decker Jessica , Zemel Babette , Mitchell Jonathan
Published: March 2023

Introduction:
Optimal nutrition is critical for near-term health, during periods of growth in childhood, and long-term health in adulthood (e.g., heart disease). The Healthy Eating Index (HEI) is an indicator of diet quality that is aligned with the Dietary Guidelines for Americans, which declines in U.S. children aged 2-18 years. Effective nutrition interventions are needed to address this decline in diet quality. Understanding sociodemographic determinants of diet quality in adolescents will help to inform such interventions. We aimed to describe changes in diet quality and to determine if sociodemographic factors associated with diet quality in adolescence.

Methods:
Participants of the Sleep and Growth Study (S-Grow) completed three 24-hour diet recalls in 8
th
and 9
th
grade. The diet data were processed using Nutrient Data System for Research software to calculate HEI-2015 score (range: 0-100, with a higher score indicating greater diet quality) using 13 food group components. Linear mixed effect models were used to assess: 1) changes in HEI-2015 score (and individual components) from 8
th
to 9
th
grade, 2) sociodemographic associations with HEI-2015 score (sex, race, body mass index [BMI], and household income), and 3) sociodemographic factor-by-grade interactions to determine if any associations differed in 8
th
and 9
th
grades.

Results:
The HEI-2015 score was stable from 8
th
(44.6) to 9
th
grade (45.3). Similarly, HEI component scores were stable from 8
th
to 9
th
grade, except for an increase in green vegetables (beta=0.37, P<0.05) and a decline in added sugars (beta=-0.50, P<0.05). Black (compared to White) adolescents and those living in households with <$40K (compared to >$99K) annual income were associated with lower overall diet quality (beta=-3.28, P<0.05; beta=-4.90, P<0.05; respectively). Male (compared to female) sex was associated with higher total dairy intake (beta=1.74, P<0.001); those with obesity (compared to normal weight) were more likely to have lower seafood intake (beta=-1.00, P<0.001) and higher refined grains intake (beta=1.26, P<0.05). The interaction analyses revealed that some household income and BMI associations with changes in HEI outcomes from 8
th
and 9
th
grades were distinct. For example, total fruit intake declined from 8
th
to 9
th
grade, but specifically among adolescents living in households with incomes of $40-69K (beta=-0.77, P=0.02) and for adolescents with obesity (beta=-1.03, P=0.003).

Conclusion:
Diet quality was consistently suboptimal in 8
th
and 9
th
grades (i.e., 45/100). Further, we detected sex, race, and household income disparities in diet quality. Overall, these data will help to inform future intervention efforts to improve and prevent reductions in diet quality in adolescents.
Abstract P135: Travel Time to Specialty Care and Risk of Death for Children With CHD
Authors: Parker Devin , Stabler Meagan , Young Callie , Zimmerman Meghan , Mackenzie Todd , Shi Xun , Brown Jeremiah R
Published: March 2023

Introduction:
Children with congenital heart disease (CHD) typically require care from a multi-disciplinary team of providers and treatment at specialized care centers. Although access to specialty care is known to influence patient outcomes, little is known regarding geographic access to care for children with congenital heart disease. This study calculated travel time to specialized care centers and the relationship with mortality for children residing in Colorado.

Methods:
We analyzed all payer claims data (APCD) from Colorado (CO) from 2012-2019. Travel times were calculated using a network analysis of the road distance weighted by travel speeds from the geographic centroid of every ZIP code in CO to that of the actual specialized care center. Specialty care centers were uniquely identified by their National Provider ID (NPI) and defined by categorizations from the American Medical Association (AMA). Mortality was defined by discharge status.

Results:
There were 27,344 children with CHD who received specialized care in the study period, accounting for 437,071 total encounters. Of the children with CHD, there were 355 deaths. Children that died had an average of 98 visits per year, while children that survived had an average of 70 visits (p=<0.001). Among the children who lived, 62.8% of their total specialty care visits were <30 minutes away, compared to 59.7% among those who died. CHD who died had a consistently higher proportion of visits that required greater travel to care.

Conclusion:
Specialized care centers are often located in urban areas and treat patients from diverse geographic areas. There is significant travel burden for children with CHD.
Abstract P136: Young Women Accept a Developmentally Appropriate Cardiovascular Risk Assessment Tool That Changes Their Perceived Risk of Heart Disease
Authors: Karim Brianna , Jergel Andrew , Bai Shasha , Bradley Kolbi , Arconada Alvarez Santiago J , Gilmore Amanda K , Greenleaf Morgan , Kottke Melissa J , Parsell Maren , Patterson Sierra , Sotos-Prieto Mercedes , Zeichner Elizabeth , Gooding Holly C
Published: March 2023

Introduction:
Cardiovascular disease (CVD) remains the leading cause of death for women in the US, yet many young women are unaware of their lifetime risk of CVD. We employed user-centered design principles to adapt a validated CVD risk prediction tool for young women.

Hypothesis:
We hypothesized that young women would rate the tool (HerHeart) as user-friendly, be likely to recommend it to their friends, experience a change in their perceived risk of CVD, and report intent to change their health habits after engaging with it.

Methods:
We recruited 13 young women ages 13-21 from two clinical practices in Atlanta, GA to engage with the HerHeart CVD risk prediction tool. Participants rated the tool’s usability via the Website Analysis and Measurement Inventory (WAMMI), which is scored from 0 to 100. Participants rated their perceived 10-year and lifetime risk of CVD on a visual analog scale from 0 (Never going to happen) to 10 (Definitely will happen) before and after completing the tool. Participants reported their likelihood of recommending the tool to their friends and changing their health habits from 0 (Not likely at all) to 10 (Extremely likely).

Results:
Participants rated the tool’s usability highly on the WAMMI (M = 78.62 +/- 9.70). Participants’ perceived 10-year risk of a heart attack increased from a mean of 0.85 +/- 0.99 to 1.83 +/- 1.90, and perceived lifetime risk increased from a mean of 2.38 +/- 2.72 to 2.75 +/- 2.63, on the 10-point scale after engaging with the tool. Participants were more than likely to recommend HerHeart to their friends (M = 8.00 +/- 2.22) and to report intent to change their health habits (M = 8.82 +/- 1.47) after completing the tool. Participant data captured in the HerHeart tool are shown in the Table.

Conclusions:
The HerHeart tool is acceptable to young women and demonstrates potential for changing their risk perception and improving their health habits to reduce their risk of CVD. Recruitment is ongoing and will include input from clinicians on the feasibility of incorporating the tool in clinical practice.
Abstract P137: Dietary Omega-3 Fatty Acid Consumption and the Incidence of Atrial Fibrillation in the Million Veteran Program
Authors: Guardino Eric T , Li Yanping , Nguyen Xuan-Mai T , Wilson Peter W , Gaziano J. M , Cho Kelly , Benjamin Emelia J , Djoussé on behalf of the VA Million Veteran Luc
Published: March 2023

Background:
Although recent large randomized clinical trials showed an increased risk of atrial fibrillation (AF) with marine omega-3 fatty acids supplements, it is unclear whether dietary marine omega-3 fatty acids assessed through food frequency questionnaires are associated with AF risk. Hence, we sought to test the hypothesis that dietary eicosapentaenoic acid/docosahexaenoic acid/docosapentaecnoic acid (EPA/DHA/DPA) is associated with a higher risk of AF in a large prospective cohort of US Veterans.

Methods:
We analyzed data from Million Veteran Program participants who completed self-reported food frequency questionnaires. We used multivariable Cox regression to estimate hazard ratios of AF across quintiles of omega-3 fatty acids consumption and a cubic spline analysis to assess the dose-response relationship between omega-3 fatty acids and AF.

Results:
Of the 301,294 Veterans studied, the mean intake of omega-3 fatty acids (EPA/DHA/DPA) was 0.39 g/day (SD 0.38), the mean age was 64.9 (SD 12.0) years; 91.2% (274,881 of 301,294) male and 84.0% (253,144 of 301,294) White. Consumption of EPA/DHA/DPA exhibited a non-linear inverse relation with incident AF characterized by an initial decline to 11% at 0.75 g/day of marine omega-3 fatty acids intake followed by a plateau.

Conclusions:
Contrary to our hypothesis, dietary EPA/DHA/DPA was not associated with a higher risk of AF but was inversely related to AF risk in a non-linear manner.
Abstract P139: Behavioral Weight Loss Programs for Cancer Survivors: A Non-Randomized Clinical Trial
Authors: Yeh Hsin-Chieh , Jerome Gerald J , Wang Nae-Yuh , Dalcin Arlene , Bunyard Linda , Durkin Nowella , Charleston Jeanne , Kanarek Norma , Carducci Michael , Appel Lawrence J
Published: March 2023

Background:
Clinical trials for weight loss in cancer survivors have been shown to be safe and effective. Pragmatic approaches are needed to facilitate broader adoption. The ASPIRE study evaluates real-world, lifestyle weight loss programs in Maryland on reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes. Here we report 6-month data on weight change.

Methods:
Participants were adults with overweight or obesity, who had a history of solid malignant tumors and completed curative intent treatment. The exclusion criteria were minimized to increase generalizability. Participants self-selected 1 of 3 programs: the Self-Directed (SD) Program provided evidence-based, written materials; the App-Directed (AD) Program additionally provided a commercially available, free smartphone app and weekly diet and exercise tips; and the Coach-Directed (CD) Program additionally included 1-on-1 telephonic coaching. SD and AD had versions with and without weight tracking; CD required weight tracking. Weights were transmitted to the study team using cellular technology with the scales provided and collected at baseline, 3, 6, and 12 months.

Results:
5,644 cancer survivors were invited, mostly via electronic health records; 9% expressed interest. Of these, 67% enrolled (total n=340; n=240 in weight tracking programs; 54% black, 74% women.) Participants in CD were younger, more likely to be women, less likely to have bachelor’s degree, and weighed more than those in SD. At 6m, weights were obtained from 97.5% of participants. Within-program weight reduction was most significant in CD. In the adjusted mixed-effects models, compared with SD participants, CD participants achieved significant weight reduction (see Table)

Conclusion:
Remotely delivered weight loss programs are desirable and can be broad- reach. Intervention with remote coaching was effective. While selected by many participants, app-directed program with weight tracking but without coaching led to small weight reduction.
Abstract P141: Six-Month Follow-Up of
Menopausia, Salud, Corazón
(Menopause, Health, Heart): A Multi-Component Intervention to Reduce Cardiovascular Disease Risk in Midlife Latinas
Authors: Cortes Yamnia I , Duran Mayra , Cazales Andrea , Harris Latesha K. K , Marginean Valentina , Crandell Jamie , Stoner Lee , Giscombe Cheryl , Perreira Krista
Published: March 2023

Background:
Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Latina White women, potentially due to multiple sociocultural and environmental factors. The purpose of this study is to evaluate the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas. Here we report data at a 6-month follow-up.

Methods:
This is a randomized two-group, repeated measures experimental study. Forty-nine perimenopausal Latinas (age 40-60 years) were randomized to a 6-month multi-component intervention or wait-list control. The intervention consists of 12-weekly culturally tailored Spanish language-based sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. Between May 2021 and June 2022, thirty-five participants (18 intervention and 17 control) completed a 6-month follow-up. Primary outcomes at this study visit included weight, body mass index, waist circumference, and blood pressure. Secondary outcomes included health behaviors and psychological factors (nutrition, physical activity, sleep, self-efficacy, perceived stress). We assessed the initial efficacy of the intervention at 6 months using general linear models for continuous outcomes and logistic regression for categorical outcomes. Models adjusted for outcome measures at baseline and baseline group differences (health insurance, vasomotor symptoms). Models were two-sided at a level of significance of p≤0.1.

Results:
At baseline, the mean age was 47.8 ± 4.4 years, 37% had less than high school education, 97% were born outside of the United States, and 51% reported it was somewhat/very difficult to pay for basics. Women in the intervention group were more likely to have health insurance (61% vs 24%, p=0.06) and less likely to report any vasomotor symptoms (44% vs 77%, p=0.09). At 6 months (post-intervention), compared to the waitlist control group, the intervention group had lower perceived stress (ß[SE]= -2.15 [1.05], p=0.05) and systolic blood pressure (ß[SE]= -2.72 [1.61], p=0.1) even after adjusting for baseline measures and group differences. There were no other significant differences post-intervention.

Conclusions:
This pilot study found that a culturally tailored Spanish language intervention consisting of nutrition education, physical activity, and stress management may be effective in reducing stress and blood pressure in perimenopausal Latinas —key risk factors for CVD.