bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 05: Association Between Cumulative Social Risks and Life’s Essential 8 in US Adults: NHANES 2013-2020
Authors: Metlock Faith E , Ogungbe Oluwabunmi V , Teshome Biruk , HINNEH THOMAS , Sharma Garima , Dennison Himmelfarb Cheryl R , Commodore-Mensah Yvonne
Published: May 2024

Introduction:
Cardiovascular disease remains a leading cause of death in the U.S. Although social risks have been linked to cardiovascular health, our understanding of how co-occurring social risk factors collectively influence cardiovascular health remains limited. We sought to evaluate the contributions of cumulative social risks (SR) to cardiovascular health in US adults.

Methods:
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (2013-2020). Social risks (low family income, low education level, minority race/ethnic group, single-living status, uninsured, unemployed) were examined via self-report questionnaires. Cardiovascular health was modeled as quartiles of Life’s Essential 8 (LE8) scores. Cumulative SR was modeled as number of SR (0,1,2,3, and ≥ 4). Multinomial logistic regression models were used to assess the association between cumulative SR and LE8 scores, adjusting for age and gender.

Results:
Among 13,982 US adults (mean age 32 ± 25; 51% female), the prevalence of 0 SR, 1 SR, 2 SR, 3 SR, and ≥ 4 SR, were 16%, 36%, 29%, 13%, and 6%, respectively. Adults with one or more social risks had significantly higher odds of having worse LE8 scores across multiple quartiles. Compared to adults with the lowest SR (0), those with the highest SR (≥ 4) had significantly higher odds of worse LE8 scores (Quartile 1 adjusted odds ratio (aOR) 7.11; 95% CI 5.32-9.50; Quartile 2 aOR 5.22; 95% CI 3.88-7.04; Quartile 3 aOR 3.39; 95% CI 2.52-4.54).

Conclusion:
US adults with an increasing number of social risks were more likely to have worse cardiovascular health scores. Social and economic policies are necessary to address adverse social determinants to improve cardiovascular health.
Abstract 20: Dairy Consumption in Young Adulthood and Risk of Coronary Artery Calcification Later in Life
Authors: Cannon Ethan , Jacobs David R , Steffen Lyn , Pletcher Mark J , Shikany James M , Greenland Philip , Martignoni Felipe , Schreiner Pamela , Miedema Michael D
Published: May 2024

Introduction:
The relationship of dairy with cardiovascular disease (CVD) remains controversial. Meta-analyses have shown a modest, protective association of dairy, and other recent evidence has indicated that whole-fat dairy may not be inferior to low-fat dairy, despite concerns about its saturated fat content.

Hypothesis:
Intakes of total, whole-fat and low-fat dairy during young adulthood are inversely associated with risk of incident coronary artery calcification (CAC), a subclinical marker of atherosclerosis and predictor of future CVD events.

Methods:
In 3,110 young adult participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, dairy consumption was assessed via a validated diet history. Intake was averaged between baseline (1985-86) and year 7 exams. The first occurrence of CAC score >0 among years 15, 20 and 25 was identified in 904 participants; the remainder were censored at the last available of these exams. Cox proportional hazards regression was used to estimate associations of CAC incidence with each of total, low-fat, and whole-fat dairy.

Results:
Median daily consumption of total dairy was 1.2 servings in quartile 1 and 5.4 servings in quartile 4. After adjustment for energy intake and other variables, associations of total and low-fat dairy with CAC were null. However, a monotonic trend was observed across quartiles of whole-fat dairy intake, where individuals in the highest quartile had a lower risk of CAC (hazard ratio: 0.74 (0.60, 0.93)) compared to those in the lowest quartile.

Conclusions:
Whole-fat dairy showed an inverse association with CAC 15 to 25 years later. Possible explanations for this finding include potentially cardioprotective effects of the unique profile of fatty acids or other fat-soluble constituents found in dairy products, as well as the displacement of foods and beverages in the diet. These results challenge dietary guidelines that recommend replacing whole-fat dairy with low-fat alternatives.
Abstract 26: Types of Adverse Childhood Experiences and Association With Sleep Duration in Children: Analysis of 2020-2021 National Survey of Children’s Health
Authors: Song Minkyoung , McHill Andrew W , Dieckmann Nathan F , Musil Carol M , Hayman Laura L
Published: May 2024

Background:
The number of adverse childhood experiences (ACEs) is associated with suboptimal sleep duration in children; however, the differential association of types of ACEs with sleep duration in youth is unknown. Given the known associations of both ACEs and sleep duration with cardiovascular health, such an investigation will provide insights for targeted clinical intervention.

Objective:
We investigated the most frequently reported ACE types and the association between each type of ACE and sleep duration among U.S. children aged 6-17 years.

Methods:
We used data from the 2020-2021 National Survey of Children’s Health, the most recent publicly available dataset. Parents or guardians were asked whether their child had ever experienced ten different types of ACEs. Multinomial logistic regression was used to assess the association of sleep duration with each of ACEs. We used the American Heart Association (AHA) Life Essential 8 scoring algorithm to calculate scores for sleep duration (range 0 [lowest] to 100 [highest]). Participants were categorized into three subgroups: (1) meeting age-appropriate
optimal
sleep duration; (2) ≥1-<2 hour below or ≥ 1 hour above optimal sleep duration; and (3) ≥ 2 hours below optimal sleep duration. Analyses controlled for child’s sex, age, race/ethnicity, household poverty level, regular bedtime, physical activity, and caregiver’s level of education.

Results:
Parental divorce was the most frequently reported ACE (28.1%) followed by financial hardship (12.9%) and drug abuse (10.1%) among U.S. children aged 6 to 17 years. Adjusting for covariates, 5 of 10 ACEs (parental divorce, parental imprisonment, domestic violence, living with someone who had a problem with alcohol or drugs, unfair treatment because of their sexual orientation or gender identity) were significantly associated with suboptimal sleep category 2. All 10 ACEs were significantly associated with suboptimal sleep category 3.

Conclusions:
These findings support that ACE type is differentially associated with suboptimal childhood sleep duration and suggests that certain traumatic events experienced during childhood could amplify the adverse effects of poor sleep on cardiovascular health. Healthcare providers should consider screening for ACE type concurrent with sleep duration to better understand aspects contributing to cardiovascular health in childhood.
Abstract 40: Causal Aspects of Preeclampsia and Gestational Hypertension for Risk of Future Cardiovascular Diseases
Authors: Taageby Nielsen Sofie , Luo Jiao , Qvist Thomassen Jesper , Frikke-Schmidt Ruth
Published: May 2024

Introduction:
Preeclampsia is a multifactorial disease and a cause of maternal and neonatal morbidity and mortality. Observational studies show that women with preeclampsia have increased risk of cardiovascular diseases later in life. Whether this association is causal is however uncertain.

Hypothesis:
We assessed the hypothesis that preeclampsia and gestational hypertension are causal risk factors for future cardiovascular diseases, including ischemic heart disease, myocardial infarction, stroke, ischemic stroke, atrial fibrillation, and heart failure.

Methods:
For this purpose, we performed one-sample Mendelian randomization (MR) analyses using individual level data from 202,876 white British women from the UK Biobank. Subsequently, two-sample MR analyses were performed using summary level data from FinnGen and from the to date largest consortia for each endpoint individually and then pooled in fixed-effects meta-analyses. Genetic instruments for preeclampsia and gestational hypertension were from the most updated genome-wide association study (n=20,064 preeclampsia cases; n=703,117 controls; n=11,027 gestational hypertension cases; n=412,788 controls).

Results:
In one-sample MR analyses, the odds ratios (95% CI) for preeclampsia were 1.26 (1.11-1.43) for ischemic heart disease, 1.26 (0.99-1.60) for myocardial infarction, 1.28 (1.04-1.57) for stroke, and 1.37 (1.08-1.74) for ischemic stroke; for gestational hypertension the odds ratios (95% CI) were 1.17 (1.07-1.28) for ischemic heart disease, 1.16 (0.98-1.36) for myocardial infarction, 1.35 (1.17-1.56) for stroke, 1.36 (1.15-1.60) for ischemic stroke, 1.16 (1.04-1.29) for atrial fibrillation, and 1.22 (1.04-1.43) for heart failure. The two-sample MR analyses confirmed all associations from one-sample MR analyses with similar results from multiple sensitivity analyses. The MR-Egger results did not suggest pleiotropy.

Conclusion:
Genetic predisposition to preeclampsia or gestational hypertension was associated with increased risk of cardiovascular diseases later in life, suggesting preeclampsia as a likely causal factor.
Abstract MP11: Sodium Reduction in Combination With the Dietary Approaches to Stop Hypertension Diet Lowers 10-year Atherosclerotic Cardiovascular Disease Risk: Results From the Dietary Approaches to Stop Hypertension-Sodium Trial
Authors: Knauss Hanna M , Kovell Lara C , Miller Edgar R , Appel Lawrence J , Mukamal Kenneth J , Plante Timothy B , Juraschek Stephen P
Published: May 2024

Introduction:
The Dietary Approaches to Stop Hypertension (DASH) diet lowers estimated 10-year ASCVD (atherosclerotic cardiovascular disease) risk. The impact of sodium reduction, alone or in combination with the DASH diet, is not known.

Objective:
To determine the effects of the sodium reduction alone and when combined with the DASH diet on 10-year ASCVD risk.

Methods:
The DASH-Sodium trial randomized 412 adults with systolic blood pressure (BP) 120-159 mmHg and diastolic BP 80-95 mmHg to the DASH diet or a typical American diet (control). Within each arm, individuals consumed 3 different levels of sodium in random order: low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Each period lasted 4 weeks. Pooled cohort equation-estimated 10-year ASCVD risk scores were calculated at baseline and at 4, 8, and 12 weeks of feeding.

Results:
Among the 412 participants (mean [SD] age 48 [10] years; 57% female, 57% Black), sodium reduction decreased ASCVD risk scores in both DASH and control diets (
Figure 1
). Compared to high sodium intake, low sodium intake changed ASCVD risk by -9.4% (95% CI -11.7, -7.0). Compared to a typical American diet, the DASH diet changed 10-year ASCVD by -5.3% (95% CI -9.3, -1.2). Compared to a high sodium-control diet, the combination of both low sodium intake with DASH changed ASCVD risk by -14.1% (95% CI -18.6, -9.3).

Conclusions:
Sodium reduction and the DASH diet both independently reduced 10-year ASCVD risk. Moreover, the combined impact was additive. These findings support dietary sodium reduction in addition to the DASH diet for ASCVD prevention.
Abstract MP46: Recurrent Hypertensive Disorders of Pregnancy and Subsequent Maternal Coronary Heart Disease and Stroke
Authors: Malek Angela M , Wilson Dulaney A , Mateus Julio , Pittman Jessica , Turan Tanya N , Hunt Kelly J
Published: May 2024

Introduction:
Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies and lead to maternal morbidity and mortality. Prior HDP increases HDP risk in subsequent pregnancies with little known about coronary heart disease (CHD) and stroke in recurrent HDP. We aimed to assess the relationship between recurrent HDP and subsequent CHD and stroke.

Methods:
This retrospective cohort study included women aged 12-49 with one or more singleton, live birth in South Carolina from 2004-2016. Deliveries were evaluated for HDP (preeclampsia, eclampsia, gestational hypertension) defined by birth certificate and/or hospitalization/emergency department (ED) visit data. Women were classified as having no, one, or two or more pregnancies with HDP. Hospitalization/ED visit and death certificate data defined incident CHD and stroke. Extended Cox models with time varying covariates were used to evaluate the association of recurrent HDP with CHD and stroke controlling for sociodemographic, behavioral, and clinical characteristics.

Results:
The 163,598 women (non-Hispanic White (NHW; 57.8%), non-Hispanic Black (NHB; 33.9%), and Hispanic (8.3%) had two or more (3.3%), one (12.0%), or no (84.7%) HDP pregnancies. Women with recurrent HDP were more likely to develop subsequent CHD or stroke after covariable adjustment (Table 1). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of CHD (HR=2.25; 95% CI: 1.97-2.56 and HR=2.98; 95% CI: 2.43-3.67, respectively). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of stroke (HR=2.05; 95% CI: 1.61-2.61 and HR=2.97; 95% CI: 2.04-4.32, respectively).

Discussion:
Women with recurrent HDP are at higher risk of subsequent CHD and stroke. Higher incident CHD and stroke risk appears to persist into the next pregnancy with accumulated HDP conferring higher risk.
Abstract MP71: Novel Association Between Parity and Skeletal Muscle Adiposity in Middle-Aged and Older African Caribbean Women
Authors: Zhang Zhongjie , El Khoudary Samar R , Cvejkus Ryan , Rosano Caterina , Wheeler Victor , Kuipers Allison L , Miljkovic Iva
Published: May 2024

Objective:
Pregnancy and parity (number of children born to a women) are associated with alterations in metabolism and lifestyle, which may affect women’s short- and long-term cardiometabolic health. Greater skeletal muscle adiposity (myosteatosis) is recognized as a major risk factor for cardiometabolic diseases, especially in African ancestry individuals. While lifetime parity has been previously associated with greater central obesity years after childbearing ceased, it remains unclear whether parity is associated with myosteatosis.

Methods:
We examined the association of parity (0, 1, 2, 3, 4+) with myosteatosis and general and central obesity among 1,119 African Caribbean women, aged 40-84 years, recruited from 2019 to 2023 without regard to health status. Calf myosteatosis area was measured by CT-derived intermuscular adipose tissue (IMAT, mm
2
) and skeletal muscle density (mg/cm
3
, with a lower density indicating more adiposity). Multivariable linear regression models were used to estimate the adjusted means of IMAT, muscle density, BMI, and waist circumference for each parity group.

Results:
The mean age of women who reported ever being pregnant (N=969) was 55.8 (SD=9.0) years. They were obese on average (BMI=32.1 (SD=6.8) kg/m
2
), and had given birth to an average of 3 (SD=2.3) children. In multivariable models, higher parity was significantly associated with higher IMAT and lower muscle density, after accounting for age, BMI, physical activity, and comorbidities (see Table). Parity showed no associations with BMI or waist circumference.

Conclusions:
Parity may be associated with greater accumulation of adiposity in skeletal muscle, despite no link with general or central adiposity among African Caribbean women. Our novel findings, if confirmed in prospective studies, might highlight the need for tailored strategies for maintaining healthy muscles in multiparous women of African ancestry.

Table. Adjusted population marginal means (95% CI) for myosteatosis by parity groups in African Caribbean women
a
Abstract MP72: For African-Born Blacks Living in the United States the Body Mass Index of Preference is in the Normal Weight Category
Authors: Hurston Jamaiica S , Worthy Charlita C , Huefner Eliza , Sayed Mariam , DuBose Christopher W , Mabundo Lilian S , Tulloch-Reid Marshall K , Horlyck-Romanovsky Margrethe , Younger-Coleman Novie , Sumner Anne E
Published: May 2024

Background:
Both health and health behavior are highly influenced by cultural attitudes towards body size. However, the body size of preference and the degree to which body size dissatisfaction occurs in African-born Blacks living in the United States is unknown.

Methods:
To address this data gap, height and weight were measured, and BMI calculated in 412 African-born Blacks living in the Washington, DC area (female: 42% (174/412), age 39±11y (mean±SD), range 20-69y, range, BMI 27.9±4.6kg/m
2
, range 19.5-47.3kg/m
2
). The Stunkard Figure Rating Scale was used to assess both body size preference and body size dissatisfaction. The Stunkard scale has 9 silhouettes which correspond to four BMI categories: Underweight: 1-2; Normal-Weight: 3-4; Overweight: 5-7; Obesity: 8-9. Participants chose the silhouettes which corresponded to their perceived BMI and to their ideal BMI. Body size dissatisfaction was calculated as the difference between perceived and ideal BMI.

Results:
Women had a higher BMI than men (29.1±5.0 vs. 27.0±4.2,
P
<0.001). As their ideal body size, 75% (131/174) of women and 60% (143/238) of men chose the two silhouettes in the normal weight BMI category, specifically 3 or 4. However, silhouette 4 was chosen more often than silhouette 3 (61% vs. 39%,
P
<0.001). In addition, and very importantly, as their body size of preference, no participant chose silhouettes in the obese BMI category. Overall, body size dissatisfaction occurred in 75% (309/412) of participants with women being more dissatisfied than men (84% (146/174) vs. 69% (164/238),
P
<0.001). Dissatisfaction due to feeling too large occurred in 63% (260/412); whereas dissatisfaction due to feeling too small occurred in 12% (49/412). Mean BMI in participants who were dissatisfied because they were too large was: 29.8±4.3 kg/m
2
. Whereas mean BMI in participants who were dissatisfied because they felt too small was: 23.1±2.8 kg/m
2
. Silhouettes of preference in 74% (36/49) of the participants who thought they were too small were 4 and 5.

Conclusion:
Neither high nor low BMI categories were valued by the participants. Overall, the majority of African-born Blacks living in the United States preferred a body size in the normal-weight BMI range.
Abstract P102: Costs, Accessibility, and Utilization: Disparities in Anti-Arrhythmic Drug Use in Atrial Fibrillation Patients
Authors: Workman Connor , Won Daniel , Walker James , Malaisrie S. Christopher , Kohli-Lynch Ciaran
Published: May 2024

Background:
Patients with atrial fibrillation (AF) have an increased risk of stroke, heart failure, and other cardiac-related complications. AF is recognized as a significant contributor to rising healthcare costs due to increased hospitalizations, medical visits, and medications. However, utilization and costs of anti-arrhythmic drugs (AADs) for AF treatment remain unknown.

Methods:
This cross-sectional study uses data from the Medical Expenditure Panel Survey for 2016-21 and includes AF patients prescribed Class I-V AADs. Our survey-weighted model calculates national estimates and adjusted odds ratios (OR) for associations between demographic factors, days of medication supplied, and out-of-pocket (OOP) cost.

Results:
Patients with AF were significantly more likely to receive the lowest decile of days’ supply of AADs (<85 days) if they were below age 60 (OR 4.93, p = 0.005) compared to patients older than age 80 or insured through only Medicare (OR 2.93, p = 0.023) or other federal or state insurances (OR 3.70, p = 0.007) compared to private insurance. Compared to patients with a family income of less than $15k per year, AF patients were significantly more likely to pay in the top decile for cost per day supply of AADs (91 cents/day) if they had a family income between $15-30K. AF patients with Medicaid were significantly less likely to pay in the top decile for cost per day supply of AADs (OR 0.19, p = 0.001) compared to patients with private insurance. Patients with AF underutilized AADs significantly more in 2021 compared to 2016 (OR 3.28, p = 0.029).

Conclusions:
Younger age and public insurance were associated with a lower days’ supply of AADs for AF patients. Patients with a family income around the typical state’s Medicaid income limit ($15-30K) pay significantly higher OOP costs for AADs. To increase AAD adherence, policies should aim to decrease AAD cost for patients marginally above public insurance income limits and to educate patients below age 60 on the importance of AADs in treating AF.
Abstract P107: The DASH Diet Reduces Markers of Subclinical Cardiac Injury Over an 8-week Period: Results From an Individual Level Meta-Analysis
Authors: Grobman Ben , Liu Michael , Mita Carol , Appel Lawrence J , Kovell Lara , Miller Edgar R , Zhang Mingyu , Mukamal Ken J , Juraschek Stephen P
Published: May 2024

Introduction:
The Dietary Approaches to Stop Hypertension (DASH) diet has previously been shown to reduce blood pressure and low-density lipoprotein (LDL) cholesterol as compared to the typical American diet. However, direct evidence linking the DASH diet with clinical markers of cardiovascular disease (CVD) is limited.

Objectives:
To perform a systematic review of trials examining the DASH diet and sensitive markers implicated in CVD: high-sensitivity cardiac troponin (hs-cTnl), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity c-reactive protein (hs-CRP) to determine the effects of the DASH diet on subclinical cardiac injury.

Methods:
We systematically reviewed 1122 abstracts from PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (date range 1997 to 2022). We retrieved data from two trials (DASH and DASH-Sodium, using 8-week biomarker measurements), and combined data from the trials to determine subgroup effects. We used mixed effects tobit models to determine the effects of the DASH diet (versus an isocaloric typical American diet) on hs-cTnl, NT-proBNP, and hs-CRP. Effects were determined overall and in subgroups of age, sex, race, hypertension status, obesity, and smoking status.

Results:
Of the 632 participants included, mean age (SD) was 47 (10.5); 54% were female and 55% were Black. Compared to an isocaloric control diet, the DASH diet reduced hs-cTnl (β = -17.7%, 95% CI: -26.3, -8.1), NT-proBNP (β = -8.6%, 95% CI: -16.8, 0.4), and hs-CRP (β = -11.1%, 95% CI: -20.7, 0.2). Effects were consistent across demographic groups, although the DASH diet had a larger effect on hs-CRP among men (
P
-interaction = 0.016) (
Figure
).

Conclusion:
The DASH diet reduced subclinical cardiac damage and inflammation over an 8-week period. These data provide evidence of the direct benefits of the DASH diet on cardiac health.
Abstract P109: HDL Cholesterol Confers Exceptionally Strong Cardioprotective and Metabolic Effects in Native Hawaiian and Pacific Islander Populations
Authors: Szatrowski Austin , Sun Patrick , Lee Yoonseo , Lord George , Hallee Logan , Hedges Jerris , Khomtchouk Bohdan B
Published: May 2024

Relative to the general population, Native Hawaiian and Pacific Islander (NHPI) communities are significantly more prone to obesity, diabetes, and heart disease. Our population-based longitudinal study focuses on HDL cholesterol levels and cardiovascular risk among NHPI and other (comparison) populations. Given the importance of health disparities in cardiovascular disease among the people of Hawai'i, this study holds considerable importance for establishing more diverse, equitable, and inclusive healthcare and precision medicine approaches. Specifically, we communicate a novel data-driven finding, revealed from a statistical and machine learning analysis of epidemiological data from the NIH
All of Us
Research Program, showing that the cardioprotective effect of high-density lipoprotein (HDL) cholesterol is significantly stronger in NHPI populations relative to other racial/ethnic demographics (including White, Black, and Hispanic/Latinx communities). Our results indicate that: 1) the cardioprotective effect of HDL against coronary artery disease (CAD), acute myocardial infarction (MI), and major adverse cardiovascular events (MACE), is much more powerful in NHPI populations compared to any other racial/ethnic groups currently represented in
All of Us
. 2) HDL has an exceptionally strong negative relationship with Type II diabetes (T2D) incidence in NHPI populations, which is also significantly stronger than in other ethnicities. In NHPI populations, these results suggest that an additional emphasis ought to be placed on the cardiac and metabolic-protective effect of HDL level as a key biomarker/risk factor in physicians’ assessment of cardiometabolic disease risk. These cardiovascular health equity findings highlight the importance of more and improved diversity, equity, and inclusion efforts to adequately serve growing subpopulations of historically underrepresented groups such as NHPIs within the US healthcare system.
Abstract P115: Urban Greenspace and All-Cause, Cardiovascular Disease-Specific, and Breast Cancer-Specific Mortality Among Older Women With Breast Cancer in the United States: Regional Variations Within the Surveillance, Epidemiology, and End Results and Medicare Linked Database
Authors: Bikomeye Jean C , Tarima Sergey , Zhou Yuhong , Kwarteng Jamila L , Beyer Andreas M , Yen Tina W , Winn Aaron N , Beyer Kirsten M
Published: May 2024

Background:
Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality in the US. Cancer survivors are at increased risk for adverse CVD outcomes due to multiple factors, including cardiotoxicity. Research suggests that greenspace contributes to better health outcomes, including CVD and breast cancer (BC).

Objective:
To explore relationships between urban greenspace and all-cause (ACM), CVD-specific (CVDSM), and BC-specific (BCSM) mortality and explore regional differences among older women diagnosed with BC in the US SEER-Medicare database.

Methods:
The 2011 national landcover database was linked to the 2010 census tracts and the 2010-2017 SEER-Medicare BC cohort. Women were included if they were 66+ years at diagnosis, had invasive BC, enrolled in Medicare Part A and Part B for 12 months before diagnosis, and had a census tract match for greenspace. Independent variable ‘greenspace’ was census tract percent tree canopy quartiles. Outcomes were all-cause, CVD, and BC-specific survival. Censoring was determined by the end of the study date, 12/31/2018. Covariates included age and comorbidity at BC diagnosis, race/ethnicity, dual enrollment in both Medicare and Medicaid eligibility, neighborhood social vulnerability, and tumor stage.

Results:
Regional variations in association between greenspace and BC survival were observed (Table 1). Greenspace is protective for ACM and BCSM in California, Washington, New Jersey, and Michigan, while no significant associations were observed in Georgia or Louisiana. For CVDSM, greenspace is protective in CA, while no significant differences were observed in Washington, Louisiana, and Michigan. An inverse relationship is observed for CVDSM in Georgia and New Jersey.

Discussion:
Our findings warrant more studies to investigate why greenspace is protective in some areas (i.e., CA, NJ, MI) or hazardous in other areas (i.e., GA). There is a need to identify critical factors and pathways contributing to these greenspace-survival differences.
Abstract P126: Presentation Differences in ST-Segment Elevation Myocardial Infarction Between 2019-2021 Related to COVID-19
Authors: Lantz Rebekah , Walk Casey , Hefner Dylan
Published: May 2024

Between March 2020 to October 2021, COVID-19 accounted for 12.2% of deaths, about 350,000 people in the United States. The pandemic virus accounted for the third leading cause of death behind heart disease and cancer. Importantly heart disease deaths increased 4.1% in the first year of exposures from 2019 to 2020 which may reflect delay to pursue medical care due to COVID. Because of lockdown mandates it was suspected that chronic and incident diseases had poorer disease control and delayed diagnosis of primary conditions due to decreased contact within the medical system with the purpose of decreasing viral spread. We wished to collect background presentation differences in a specific cohort at risk, STEMI-activated patients, for years 2019 to 2021. 1001 adults were STEMI-activated January 2019 to December 2021. Patient demographics, risk factors, details of presentation and rationale for cath-lab activation were obtained. Average age 63.5 years old, BMI 30.2 kg/m2, and 68.8% males, which was not statistically significant. Hypertension, hyperlipidemia, diabetes, peripheral vascular disease, chronic lung disease, prior CABG, tobacco use, dialysis renal disease, history and newly diagnosed congestive heart failure were not significant between years. However cerebrovascular disease(CVA) was three times more prominent for patients presenting in 2019 compared to 2020. There were no differences in details of presentation for location of cardiac arrest (out-of-hospital, transfer, in-hospital). Rationale for cardiac cath was significant for new onset angina significant in 2019 and 2021. Worsening angina was significant in 2019. COVID-19 continues to affect many aspects of society and healthcare but how it has affected background disease control remains unclear. Patients in our sample were similar age, BMI and gender. Background risk factors were significant for CVA which was 1.87 times higher in 2019. New onset angina led to more caths in 2019 and 2021, and worsening angina was a significant complaint in 2019 compared to other years. There were not the amount of differences we expected suggesting that chronic diseases and new diagnoses remained at near the same level through years of pandemic consideration.
Abstract P127: Health Literacy and COVID-19 Infection and Vaccination: The C4R-MESA Study
Authors: Merkin Sharon S , Jin Yiqun , Balte Pallavi , Hinckley Stukovsky Karen , Allen Norrina B , Bertoni Alain G , Lutsey Pamela L , Pankow Jim S , Post Wendy S , Seeman Teresa , Shea Steven , Watson Karol E , Oelsner Elizabeth
Published: May 2024

Rationale:
Health literacy (HL) is associated with health prevention behaviors and may influence COVID-19 outcomes.

Objective:
To test associations of HL, risk of COVID-19 infection, and receipt of COVID-19 vaccines in a multi-ethnic US community-based sample.

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) assessed participant levels of HL via follow-up phone calls in year 18 (2016-18), as well as the impact of the COVID-19 pandemic via questionnaires designed by the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study (2020-23). The 4 HL items asked about difficulty in the ability to read, comprehend, and complete medical materials and understand medical statistics (scales 1-5, low to high difficulty); scores were summed and dichotomized into adequate (≤10) or low (>10) HL. COVID-19 data included infection and vaccination status and time (days) until infection and vaccination (March 2020-February 2023). Unadjusted comparisons of COVID-19 data and HL were assessed by Chi-square and T-tests. Cox proportional hazards models were adjusted for age, sex, race/ethnicity, and then additionally for income and education.

Results:
Of 3412 participants (mean age 77 years; 54% female; 41% White, 13% Chinese, 26% Black 20% Hispanic), 409 (12%) had low HL and 360 (11%) had incident COVID-19 infections. In the subset with vaccination data (N=1781), 94% were vaccinated. While HL was not significantly associated with incident COVID-19 infection, low (vs adequate) HL was significantly associated with longer time-to-vaccination and lower adjusted hazards of vaccination (
Table
).

Conclusions:
Our findings suggest that low levels of HL are associated with delayed COVID-19 vaccination, even after accounting for demographic and socioeconomic indicators. Improving health literacy in the population may empower and encourage individuals to engage in disease prevention behaviors, including vaccination.

Table:
Associations of Health Literacy (HL) with COVID-19 Infection and Vaccination
Abstract P128: Self-Reported Resilience During the COVID-19 Pandemic: The C4R-MESA Study
Authors: Ogungbe Oluwabunmi V , Wang Tianyou , Balte Pallavi , Krishnaswamy Akshaya , Slone Sarah , Meyer Diane , Hirsch Jana , Allen Norrina B , Hinckley Stukovsky Karen , Barr R. Graham , Oelsner Elizabeth , Post Wendy S
Published: May 2024

Background:
Resilience, or the ability to bounce back from adversity, may be associated with health and wellbeing during disaster events such as the COVID-19 pandemic.

Objectives:
To examine correlates of resilience, as self-reported during the COVID-19 pandemic, in multi-ethnic, US community-dwelling adults.

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) assessed the impact of the pandemic on participants via questionnaires designed by the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study. Based on one item from the Brief Resilience Scale,
“I tend to bounce back quickly after hard times,”
participants who responded with “agree” were defined as resilient and compared to those who responded “neutral” or “disagree” (not resilient). Logistic regression was used to test associations of resilience with age, sex, race and ethnicity, education, BMI, smoking, hypertension, diabetes, COVID infection history, insurance status, and household income.

Results:
Of 1880 participants (mean age 75.0±7.6 years; 55% female; 75% White, 55% Chinese, 81% Black, 75% Hispanic; 9% uninsured), 73% were identified as resilient. Race and ethnicity were significantly associated with resilience: compared to White, Black participants were more likely to report resilience (aOR:1.51;95%CI:1.10-2.06), and Chinese participants were less likely (aOR:0.47;95%CI:0.34-0.66). There were no differences in self-reported resilience, comparing Hispanic to White participants (
Table
).

Conclusion:
During the COVID-19 pandemic, three-quarters of community-dwelling US results reported that they were resilient. Variation in self-reported resilience was observed according to race and ethnicity. Further research is needed on resiliency and how it may influence psychosocial well-being and cardiovascular health.
Abstract P163: Smoking Timing and Hazard of Incident Heart Failure: A Cohort Study in UK Biobank
Authors: Hu Ying , Li Xiang , Tang Rui , Zhou Jian , Kou Minghao , Wang Xuan , Ma Hao , Heianza Yoriko , Liang Zhaoxia , Qi Lu
Published: May 2024

Objective:
Smoking is an establish risk factor for heart failure (HF); however, little is known about how the timing patterns of smoking is related to HF risk. We prospectively evaluated the association of smoking timing with hazard of incident HF; and examined whether smoking intensity or smoking burden might modify the relationship.

Methods:
This study included 308490 participants from the UK Biobank who were free of HF at baseline and completed the questionnaire on the time from waking to the first cigarette. We evaluated the association between smoking timing and hazard of incident HF using Cox proportional hazards models.

Results:
During a median follow-up time of 12 years, a total of 6917 incident cases of HF were documented. Compared to non-smokers, the multivariate hazard ratios [95% confidence interval (CI)] of incident HF were 1.47 (1.11-1.95) for >2 hours, 1.74 (1.34-2.25) for 1-2 hours, 2.21 (1.83-2.66) for 30-60 minutes, 2.24 (1.82-2.76) for 5-15 minutes, and 2.39 (1.79-2.19) for <5 minutes of the time from waking to the first cigarette, respectively, independent of smoking intensity or smoking burden (
P
for trend <0.001). The positive associations between shorter time from waking to the first cigarette and hazard of incident HF were more pronounced in female participants than in male participants (
P
-interaction=0.001). We found that even among participants with light smoking intensity, those with the shortest time from waking to the first cigarette had a 178% or a 261% higher risk of HF (HR 2.78, 95% CI 1.92-4.03), comparable to that among people with heavy smoking intensity or heavy smoking burden, respectively.

Conclusions:
Our findings indicate that shorter time from waking to the first cigarette is significantly associated with a higher hazard of incident HF, independent of smoking intensity or smoking burden.
Abstract P173: Examining Sexual Identity Differences in Ideal Cardiovascular Health
Authors: Sharma Yashika , Caceres Billy A
Published: May 2024

Introduction:
Recent evidence suggests that sexual minority (e.g., gay, lesbian, bisexual, queer) adults in the United States are at increased risk of cardiovascular disease compared to heterosexual adults. However, the majority of cardiovascular health (CVH) research among sexual minority adults has focused on investigating differences in individual CVH metrics rather than comprehensive measures of CVH.

Methods:
We analyzed nationally representative data from the National Longitudinal Study of Adolescent to Adult Health to examine sexual identity differences in ideal CVH (i.e., individual CVH metrics and cumulative ideal CVH score) among adults. Participants received a score of 0 (poor), 1 (intermediate), or 2 (ideal) for each CVH metric, and scores were summed to calculate cumulative ideal CVH scores (continuous; range 0-12). We ran sex-stratified multiple logistic and linear regression models to examine sexual identity differences in ideal CVH. Models were adjusted for demographics, health insurance coverage, and adverse childhood experiences.

Results:
The final sample included 3,492 participants with a mean age of 21.8 (+/- 1.76) years. Approximately 60% were female, over 76% were White and around 90% were non-Hispanic. Compared to exclusively heterosexual women, mostly heterosexual (AOR 0.89, 95% CI = 0.79-0.99) and lesbian (AOR 0.73, 95% CI = 0.55-0.91) women had lower odds of meeting ideal criteria for tobacco use. In contrast, lesbian women had higher odds of meeting ideal criteria for glycosylated hemoglobin (AOR 1.22, 95% CI = 1.09-1.35). Among men, compared to exclusively heterosexual men, mostly heterosexual (AOR 0.87, 95% CI = 0.76-0.97) and bisexual (AOR 0.86, 95% CI = 0.74-0.97) men had lower odds of meeting ideal criteria for tobacco use and blood pressure, respectively. Gay (AOR 0.79, 95% CI = 0.67-0.90) and bisexual (AOR 0.75, 95% CI = 0.54-0.96) men had lower odds of meeting ideal criteria for physical activity, but gay men had higher odds of meeting ideal criteria for body mass index (AOR 1.25, 95% CI = 1.00-1.55). No sexual identity differences were observed for cumulative ideal CVH scores among women and men.

Conclusions:
As one of the first studies to use nationally representative longitudinal data to examine sexual identity differences in ideal CVH, this study makes an important contribution to the literature on CVH among sexual minority adults. Findings highlight significant CVH disparities in sexual minority adults and suggest there is a need to develop interventions that focus on improving their CVH. Future research is needed to investigate factors that may contribute to the CVH disparities observed among sexual minority adults in this study.
Abstract P193: Sex Moderates Diet Quality Differences in Integrated Collaborative Care for Comorbid Obesity and Depression: Post-Hoc Analysis of the Research Aimed at Improving Both Mood and Weight Randomized Clinical Trial
Authors: Chin Sydney W , Lv Nan , Tang Zhengxin , Parikh Aankika , Ma Jun
Published: May 2024

Background:
High-quality diets, such as the Dietary Approaches to Stop Hypertension (DASH), are associated with lower risk for obesity and obesity-related chronic diseases. It is unclear whether diet quality improves aside from reduced calories in evidence-based behavioral weight loss interventions.

Objective:
Leveraging data from the Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial, the objective of this post hoc analysis is to investigate (1) whether the study intervention was associated with improved diet quality in adults with comorbid obesity and depression, compared to usual care; and (2) whether the associations were modified by sex.

Methods:
Participants completed 24-hour dietary recalls at baseline, 6, 12, 18, and 24 months. Dietary outcomes included the DASH score as the composite measure of diet quality and its components. Between-group differences in dietary outcomes were examined among 409 participants and by sex, using repeated-measures mixed-effects linear models.

Results:
Changes in DASH scores did not differ between the intervention and usual care control groups through 24 months in both women and men. Compared with controls, men in the intervention group had significantly decreased nut, seed, and legume intake at 6 (mean difference, -1.1; 95% CI, -1.9, -0.3 servings/day; P=0.01) and 12 months (-1.0; -2.0, -0.0 servings/day; P=0.048). Compared with controls, women in the intervention group had significantly decreased fruit and vegetable intake at 18 (-1.8; -2.9, -0.6 servings/day; P=0.002) and 24 months (-1.1; -2.2, -0.1 servings/day; P=0.03), and whole grain intake at 24 months (-0.5; -0.9, -0.1 servings/day; P=0.03), but increased percent calories from fat at 24 months (3.6; 0.6, 6.5; P=0.02).

Conclusions:
Diet quality not only did not improve in an effective behavioral weight loss intervention but deteriorated in women, in particular. These post-hoc findings warrant confirmation and may suggest that behavior change techniques targeting diet quality that are tailored to women and men need to be an explicit focus of behavioral weight loss interventions aside from caloric reductions.
Abstract P209: Accelerometer-Measured Sedentary Behaviors and Venous Thromboembolism Risk Among Older Women
Authors: Harrington Laura B , Cushing-Haugen Kara L , Nguyen Steven , LaMonte Michael J , Stefanick Marcia L , Allison Matthew A , Wallace Robert B , Manson JoAnn E , Jensen Majken K , Kabrhel Christopher , Wellenius Gregory A , Lee I-Min , Bellettiere John , Mukamal Kenneth J , LaCroix Andrea Z
Published: May 2024

Introduction:
Venous insufficiency, which can occur with prolonged sedentary behavior, is associated with venous thromboembolism (VTE) risk. Whether accelerometer-measured sedentary behaviors are associated with VTE risk is unknown.

Hypothesis:
Longer total sitting times, mean sitting bout durations, and time spent in prolonged sitting bouts are associated with a greater risk of incident VTE.

Methods:
We studied participants of the Women’s Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health (OPACH) study without prior VTE, with adherent accelerometer wear, and with sedentary behavior data (n=5,591). Between May 2012-April 2014, participants wore the ActiGraph GT3X+ triaxial accelerometer at the hip for 7 days. Three sedentary behavior measures were classified using the Convolutional Neural Network Hip Accelerometer Posture algorithm: total sitting time, mean sitting bout duration, and time spent in prolonged (≥30 minutes) sitting bouts. VTE events were centrally adjudicated. Multivariable-adjusted (Table) Cox models estimated HRs and 95% CIs for each sedentary behavior in relation to VTE risk. Women were censored at death, loss to follow-up, or end of follow-up (February 2023). Mediation by BMI was evaluated for behaviors associated with VTE.

Results:
On average, participants were 79 years old. Over a mean follow-up of 8.2 years, 229 women experienced a VTE. In primary confounder-adjusted models, longer mean sitting bout durations were associated with greater incident VTE risk (HR per 5-minute increase=1.15; 95% CI: 1.04, 1.28) (Table). BMI mediated approximately 30% of this association (p<0.01). We found no significant evidence that total sitting time nor time spent in prolonged sitting bouts were associated with VTE.

Conclusions:
Longer mean sitting bout duration was associated with greater VTE risk, with substantial mediation by BMI. Our results suggest that reducing sedentary bout length in older women may reduce VTE risk.
Abstract P210: Incident Venous Thromboembolism and Subsequent Risk of Cardiovascular Outcomes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mok Yejin , Salameh Maya , Cushman Mary , Kamin Mukaz Debora , Lutsey Pamela L , Rosamond Wayne D , Folsom Aaron R , Tang Weihong , Matsushita Kunihiro
Published: May 2024

Background:
Venous thromboembolism (VTE) and atherothrombosis have different mechanisms of thrombosis formation. A few previous studies reported those having a VTE have greater risk of incident atherothrombotic disease. These studies have several limitations, such as inadequate adjustment for key confounders (e.g., obesity), selected study populations in clinical trials, and small sample size. Moreover, the links of VTE to heart failure (HF) and peripheral artery disease (PAD) are not well understood.

Hypothesis:
VTE is independently associated with a range of incident cardiovascular outcomes.

Methods:
In 12,988 ARIC participants without history of VTE or cardiovascular disease at baseline (1987-89), we quantified the association of VTE, as a time-varying exposure, with incident myocardial infarction (MI), stroke, HF, PAD (overall and its severe form, critical limb ischemia [CLI]) using multivariable Cox regression. We also considered unprovoked and provoked VTE separately.

Results:
Over a median follow-up of 25 years, 901 participants experienced incident VTE. In the same timeframe, there were 1,950 MI events, 1,247 stroke events, 2,981 HF events, and 516 PAD cases (including 207 CLI cases). Participants with VTE, compared to those without, had a higher risk of all cardiovascular outcomes (
Table
). The associations were particularly evident for incident PAD and CLI (adjusted HR 2.32 [95% CI 1.53, 3.52] and 3.44 [2.01, 5.88], respectively). Provoked VTE showed similar associations with all cardiovascular outcomes, whereas unprovoked VTE was significantly associated with MI, HF, and CLI only (
Table
).

Conclusions:
In this large community-based study, VTE was robustly associated with subsequent risk of different cardiovascular outcomes, independent of potential confounders. Patients with VTE should be considered at high risk of other cardiovascular outcomes and receive optimal preventive therapy for cardiovascular diseases, including atherosclerotic disease and HF.