bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P123: Prospective Association Between Periodontal Disease And Brain Imaging Markers Of Cerebrovascular And Neurodegenerative Disease: The Atherosclerosis Risk In Communities Study
Authors: Adam Hamdi S , Lakshminarayan Kamakshi , Wang Wendy , Norby Faye L , Mosley Thomas , Walker Keenan , Gottesman Rebecca F , Meyer Katie , Hughes Timothy M , Pankow James S , Wong Dean , Jack Clifford , Sen Souvik , Lutsey Pamela L , Beck James D , Demmer Ryan
Published: May 2021

Background:
Periodontal disease (PD) is associated positively with neurocognitive outcomes. Few studies have investigated the relationship between PD and indicators of brain aging and vascular changes.

Hypothesis:
PD is associated with greater cerebral small vessel disease, lower total and regional brain volumes and elevated β-amyloid (Aβ) deposition.

Methods:
We included 6,793 participants who received full-mouth periodontal examinations and tooth counts at Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities Study. We used a modified 3-level version of the Periodontal Profile Class to categorize PD based on severity and extent of gingival inflammation and tissue loss. Among participants who attended Visit 5 (2011-2013), n=1,306 received a brain MRI and n=248 received a PET scan. Total brain volume, Alzheimer’s disease signature volume, and presence of microhemorrhages and cerebral infarctions were ascertained via 3T MRI; Aβ deposition was assessed from PET. We regressed brain volumes on baseline PD status using weighted multivariable linear regression. Presence of cerebrovascular microhemorrhages, infarctions, or elevated Aβ (standardized uptake value ratio>1.2) were regressed on PD category using logistic models. We examined the interaction between Apolipoprotein E ε4 (
APOE
) allele possession and PD categories on the Aβ outcome.

Results:
Prevalence of baseline periodontal disease was 73% (959/1306) and 87% (206/248) among the MRI and PET subgroups, respectively. PD was not associated with volumetric brain measures nor microhemorrhages. PD was inversely associated with the odds of subcortical and lacunar infarctions. PD and Aβ were not associated in main effect or interaction analyses, although there was a notably stronger association among carriers of
APOE
.

Conclusion:
PD was not associated with altered brain structure, cerebral microhemorrhages or elevated Aβ deposition. Counter to the hypothesis, PD and complete tooth loss were inversely associated with cerebral infarctions.
Abstract P130: Association Between Ready-to-eat Cereal Consumption And Nutrient Intakes Among Children 2 To 18 Years, Stratified By Household Income: Results From The National Health And Nutrition Examination Survey 2015-2018
Authors: Smith Jessica , Jain Neha , Normington James , Holschuh Norton , Zhu Yong
Published: May 2021

Ready-to-eat (RTE) cereal has been associated with higher diet quality and dairy intake (it is often consumed with milk) in children and is an affordable source of under-consumed nutrients and whole grains. Because of its affordability and accessibility, the contribution of RTE cereal to nutrient and whole grain intake could potentially differ by household income level. We hypothesized that children living in low income households, which may be more susceptible to poor dietary intakes due to food insecurity, may differentially benefit, in terms of nutrient intake, from RTE cereal consumption compared to children in higher income households. The objective of this study was to quantify the nutrient intakes of U.S. children who reported consuming RTE cereal eater versus those that did not according to household income. We used data from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey. Children 2 to 18 years (n=5,028) were stratified into six groups according to RTE cereal consumption (cereal eaters vs non-eaters) and poverty-to-income ratio (PIR; low-, mid-, and high-income). We calculated the difference in intakes of 28 nutrients between cereal eaters and non-eaters stratified by PIR. Overall, it appeared that there was a greater difference in intake of nutrients between RTE cereal eaters and non-eaters for the low-income compared to the high-income children. For example, in the low-income group, RTE cereal eaters had 23% higher calcium, 70% higher iron, and 90% higher vitamin D intake compared to non-RTE cereal eaters (p<0.0001 for all). In the high-income group, these differences were attenuated with cereal eaters having 12% higher calcium (p=0.03), 58% higher iron (p<0.0001), and 62% higher vitamin D intake (p<0.0001) compared to non-RTE cereal eaters. These data suggest that although cereal eaters had higher intake of under-consumed nutrients across all incomes, children in the low-income group particularly benefited.
Abstract P137: Association Of Equol Producing Capacity With Aortic Calcification In Middle-aged Japanese Men
Authors: Zhang Xiao , Fujiyoshi Akira , Kadota Aya , Ahuja Vasudha , Vishnu Abhishek , Kuller Lewis H , Ueshima Hirotsugu , Miura Katsuyuki , Sekikawa Akira M
Published: May 2021

Background:
Soy isoflavones (ISFs) are regularly consumed in Japan and other Asian countries where some studies showed a significant inverse association of ISFs intake with incident coronary heart disease (CHD). However, a US randomized clinical trial did not find ISFs as anti-atherogenic. This discrepancy may be due to the higher capacity of people in Japan than in the US to produce equol, a metabolite of ISF by the gut microbiome. Equol may have greater anti-atherogenic properties than ISFs. It is unknown whether equol producers (EP), people who produce equol after consuming ISF, have lower aortic calcification (AC), a biomarker of atherosclerosis, as compared to non-EP.

Aim:
To determine the association between equol producing status and AC in Japanese men.

Method:
This cross-sectional, population-based study included 302 Japanese men aged 40-49, free of CHD. EP was defined as participants with serum levels of equol ≥20 nM. AC was measured in the entire aorta and quantified by the Agatston method. The presence of AC was defined as AC score ≥10. We analyzed the association between equol producing status and AC using the Tobit and the logistic regressions.

Result:
We observed 125 participants as EP. In multivariable analyses, EP had non-significantly lower AC score by 147 (95% confidence interval (CI): -386, 92) units and an odds ratio of 0.71 (95% CI: 0.40, 1.26) for the AC presence as compared to non-EP. As significant interaction of equol producing status with age was present, we stratified the analyses by the median age. In men aged 45-49 years, EP had non-significantly lower AC score by 246 units and a non-significant 0.62 times the odds of AC presence as compared to non-EP; the corresponding values in men aged 40-44 were 12 units and 0.91 times (Table). Such an association was not observed with serum ISFs (data not shown).

Conclusion:
Japanese middle-aged men who were EP had non-significantly lower AC than non-EP and such association was stronger in men aged 45-49 than 40-44 years. Further study with much larger sample size is warranted.
Abstract P138: Diet Quality Improvements In Response To Evening Snacks That Differ By Carbohydrate And Fat Composition: A 6-week, Randomized, Crossover Trial In Participants With Impaired Fasting Glucose
Authors: Sapp Philip , Petersen Kristina , Kris-Etherton Penny M
Published: May 2021

Objectives:
To examine the effect of consuming one ounce of peanuts (PNUT) as an evening snack on diet quality compared to an isocaloric lower fat higher carbohydrate snack (LFHC), in individuals with impaired fasting glucose IFG.

Methods:
Fifty-one individuals (48% female; 42 ± 15 y; BMI 28.3 ± 5.6 kg/m
2
; glucose 100 ± 8 mg/dL; total cholesterol 189 ± 30 mg/dL; LDL-C 121 ± 26 mg/dL; HDL-C 53 ± 14 mg/dL; triglycerides 116 ± 73 mg/dL) were enrolled in this two-period, randomized, crossover trial. In random order, subjects consumed each snack in the evening (after dinner and before bedtime) for 6 weeks (PNUT: 164 kcal, 14 g fat, 2.2 g saturated fat, 6 g carbohydrate, 7 g protein, 2.4 g fiber; LFHC: 165 kcal, 6 g fat, 2 g saturated fat, 22 g carbohydrate, 7 g protein, 3.0 g fiber) with a 4 week compliance break. Subjects were instructed not to consume other caloric foods/beverages after dinner. Participants self-reported being adherent to the protocol on 88% of study days. Dietary intake was assessed using 24-hour recalls (ASA24® Dietary Assessment Tool) conducted at the beginning and end of each diet period. The Healthy Eating Index-2015 (HEI-2015) was calculated using the NCI SAS code.

Results:
There was no between-condition difference in the HEI-2015 score for PNUT compared to LFHC (mean difference 3.2; 95% CI -1.1, 7.4). Individual mean component scores were significantly different following PNUT compared to LFHC (whole grains: -2.0 [95% CI -3.1, -1.0]; seafood and plant protein: 1.5 [95% CI 0.8, 2.3]; fatty acids: 2.0 [95% CI 0.8, 3.2]; and saturated fat 1.2 [95% CI 0.1, 2.4]). Following PNUT, consumption of polyunsaturated fatty acids (3 g; 95% CI 0.2, 6.6), total protein foods (2.0 oz-eq; 95% CI 0.5, 3.4) and vegetable oils (6.5 g; 95% CI 1.6, 11.5) were higher whereas whole grain (-0.9 oz-eq; 95% CI -1.2, -0.5) consumption was lower compared to LFHC. No other differences in dietary intake were observed.

Conclusions:
In individuals with IFG, consuming 28g of peanuts as an evening snack increased consumption of total protein foods, oils, and polyunsaturated fatty acids and reduced whole grains compared to the LFHC snack. Overall diet quality was not increased, but fatty acid and total protein food scores improved.
Abstract P142: Metabolically Healthy Obesity In A Young Adult Population Provided By A Primary Healthcare Center In Brazil (LAPARC Study)
Authors: Marinho Beatriz D , de Souza Mello Tomás , Azevedo Rafael B , Barbalho Daniella , Muguet Clara , Ushijima Natalia , Libório Flávia , Borges Rodrigo , Aragão Ludmilla F , Fernandes Ana Cristina , Muxfeldt Elizabeth
Published: May 2021

Background:
Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective:
To evaluate the prevalence and CV risk factors associated with MHO in a young adult population provided by a Primary Healthcare Center in a large urban area of Brazil.

Methods:
A cross-sectional population study for CV risk assessment in adults aged 20-50 years old provided by a Primary Healthcare Center in Rio de Janeiro, Brazil. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycemic profile). Obesity was defined as a BMI ≥ 30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥ 200 mg/dL, HDL<40 mg/dL (men) and 50 mg/dL (women), triglycerides>150 mg/dL and increased waist circumference.

Results:
A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 25% (161 of 632 individuals), of which 73% (117 of 161 individuals) were classified as MHO. Obese individuals are older, with a higher prevalence of physical inactivity (51% vs 41%, p=0.03), hypertension (44% vs 19%, p<0.001), dyslipidemia (50% vs 36%, p=0.002) and diabetes (7% vs 2%, p=0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p=0.02) and abdominal circumference (102 vs 110 cm, p=0.03), with lower diastolic BP.

Conclusions:
MHO was more prevalent in this young adult population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.
Abstract P175: Predicting Healthy Arterial Aging Versus Premature Atherosclerosis In Young Adults: The Bogalusa Heart Study
Authors: Razavi Alexander C , Bazzano Lydia A , He Jiang , Fernandez Camilo , Chen Jing , Krousel-Wood Marie , Whelton Seamus P , Kelly Tanika N
Published: May 2021

Introduction:
Early differentiation of healthy arterial aging versus premature atherosclerosis is important for optimal atherosclerotic cardiovascular disease (ASCVD) risk stratification and prevention. We sought to identify predictors for the long-term absence of carotid plaque in young adults.

Hypothesis:
Calcium and phosphate are found in excess in atherosclerotic lesions, therefore we hypothesized that mineral markers may help to explain residual heterogeneity in arterial aging phenotypes beyond traditional ASCVD risk factors.

Methods:
We included 508 participants from the Bogalusa Heart Study without clinical ASCVD who were free of carotid plaque at baseline (2001-02) and underwent ultrasound at follow-up (2013-16). Modified Poisson regression estimated the persistent absence of carotid plaque over 12.8 years.

Results:
Participants were on average 36.2 years old at baseline, 64% were women, and 29% were African American. Although a majority (97%) of participants had a 10-year ASCVD risk <7.5%, only 68% remained free of plaque (
Figure
). Beyond younger age (RR=1.20, 95% CI: 1.07-1.36, per 10 years) and a total cholesterol-HDL-cholesterol ratio <3.5 (RR=1.15, 95% CI: 1.01-1.30), normal values of traditional risk factors did not predict long-term absence of plaque. Independent from traditional markers, including glomerular filtration rate, serum calcium-phosphate product (RR=1.08, 95% CI: 1.01-1.14, per 1-SD lower), phosphate (RR=1.15, 95% CI: 1.03-1.29, per 1 mg/dL lower), and dietary sodium <2300 mg/day (RR=1.20, 95% CI: 1.03-1.41) significantly associated with non-development of plaque.

Conclusions:
Lower calcium-phosphate homeostasis and low sodium intake independently associated with long-term absence of carotid plaque. However, nearly one-third of young adults with a relatively low burden of traditional risk factors developed premature atherosclerosis. These results suggest that dietary and intrinsic minerals are early contributors to the development of arterial aging phenotypes.
Abstract P176: Proportionate Cardiovascular Mortality Patterns Among Patients With Inflammatory Disease In The United States, 1999-2018
Authors: Groenendyk Jacob , Sinha Arjun , Rivera Adovich , Feinstein Matthew J
Published: May 2021

Introduction:
Novel therapies have changed the clinical course of several chronic viral and inflammatory conditions over the past two decades. As the morbidity burden of these conditions has changed, competing risks for end-organ diseases including cardiovascular diseases (CVDs) may have likewise evolved. We therefore aimed to investigate changes in the relative burden of CVD mortality over the past two decades across several chronic infectious and inflammatory conditions.

Hypothesis:
Changes in proportionate CVD-related mortality over the past two decades differ across distinct infectious and inflammatory conditions.

Methods:
We analyzed 1999-2018 Multiple Causes of Death data from the Centers of Disease Control and Prevention. For several chronic infectious and inflammatory conditions, we analyzed patterns in age-adjusted cardiovascular proportionate mortality, defined as the fraction of deaths in a calendar year with CVD as the underlying cause. We compared age-adjusted proportionate CVD mortality, stratified by sex, for systemic lupus erythematosus (SLE), hepatitis C virus (HCV), human immunodeficiency virus (HIV), inflammatory bowel disease (IBD), psoriasis (PSO), rheumatoid arthritis (RA), and systemic sclerosis (SSc).

Results:
Proportionate CVD mortality in the general population decreased from 40.9% of 2319606 deaths (1999) to 30.6% of 2778169 deaths (2018), whereas it increased for chronic viral conditions (HCV: 7.0% to 10.2%; HIV: 1.9% to 6.7%) and changed little in SLE (15.3% to 14.4%). Patterns of decreasing proportionate CVD mortality over time were similar for IBD and RA as in the general population.

Conclusions:
Patterns in proportionate CVD mortality over the past 20 years vary considerably for different chronic infectious and inflammatory conditions. The underlying contributions of infectious and inflammatory burden, off-target effects of therapies, and dynamic changes in competing mortality risk merit further study.
Abstract P180: Hospital Readmission After Pediatric Congenital Heart Surgery: A Systematic Review And Meta-analysis Of Potential Risk Factors
Authors: Stabler Meagan E , Parker Devin M , Kothari Sarina , Dalmage Mahalia , Johnson Heather , Morgan Madeleine , Brown Jeremiah R
Published: May 2021

Objective:
Over 40,000 infants are born annually with a heart defect; 25% require surgery and of those 20% result in hospital readmissions. We sought to identify risk factors for short- and long-term readmission following pediatric congenital heart surgery (CHS) to reduce avoidable future admissions.

Methods:
A systematic approach was used to search four electronic databases and retrieve articles published through 05/2020. We included observational and experimental studies that observed factors associated with 30-day or 1-year readmission after CHS. Studies with a composite outcome of readmission and death were excluded. For each independent risk factor, we assessed the pooled effect size and heterogeneity using a random-effects model. Risk of bias was assessed via the Newcastle-Ottawa scale.

Results:
After removing 970 duplicates, we screened 5,084 studies; 17 were included in the systematic review and 15 (N= 82,794; 9,856 readmitted) in the meta-analysis. Hospital readmission was significantly and positively associated with gestational age, non-white race, Hispanic ethnicity, government insurance, genetic abnormality, renal dysfunction, failure to thrive, mechanical ventilation, intraoperative ventricular dysfunction, RACHS score, STAT mortality score, cross clamp time, gastroesophageal reflux disease, postoperative arrhythmia, valve regurgitation, feeding difficulties, and ICU and hospital length of stay (LOS). Readmission definition (i.e., 1-yr vs 30-day) and LOS dichotomization (i.e., ≥ 10 or ≥ 14) resulted in significant subgroup differences for age at surgery and LOS. Five studies had higher potential for risk of bias.

Conclusions:
This is the first meta-analysis to identify patient and clinical factors associated with short and long-term readmission after pediatric CHS. Findings may support clinical decisions before undergoing surgery and identify patients that may benefit from receiving more aggressive care transitions prior to discharge to reduce avoidable hospital readmissions.
Abstract P181: Prediction Of Left Ventricular Diastolic Dysfunction Using Electrocardiographic Machine Learning In Asian Young Male Adults
Authors: Lin Gen-Min
Published: May 2021

Left ventricular diastolic dysfunction (LVDD) occurs at initial stage of heart failure. Electrocardiographic (ECG) criteria and machine learning for ECG features with or wihtout biological features have been applied successfully to predict LVDD in middle- and old-aged individuals. The purpose of this study is to clarify the performance of machine learning in young adults. In a large sample of 2,206 military males in Hualien, Taiwan, aged 17-43 years, the prevalence of LVDD is 4.26%. Five machine learning classifiers including random forest (RF), support vector machine (SVM), gradient boosting decision tree (GBDT), multi-layer perceptron (MLP) and logistic regression (LR) for the input of 26 ECG features with or without other 6 biological features (age, anthropometrics, and blood pressures) to link the output of LVDD are compared with the corrected QT interval (QTc) calculated by the Bazett’s formula, a traditional ECG criterion for LVDD. The definition of LVDD is based on either one of the echocardiographic criteria: (1) the E/A ratio of the mitral inflow <0.8; (2) the lateral mitral annulus velocity, e’ <10 cm/s; and (3) the E/e’ ratio >14. The area under the receiver operating characteristic (ROC) curve in machine learning of the RF, SVM, GBDT, MLP and LR for ECG only are 84.1%, 78.7%, 77.9%, 77.6% and 75.4%, which are all superior to 64.6% in the QTc interval. If the specificity is fixed around 70-80%, the sensitivity of these mahine learning classifiers for ECG only are 81.0%, 76.2%, 71.4%, 71.4% and 71.4%, which are all higher than 47.6% in the QTc interval. This study suggests that using machine learning for ECG features only to predict LVDD in Asian young adults is reliable and thereby it is possible for people to take an early preventive action on heart failure.
Abstract P184: Cardioprotective Effects Of Ivabradine After Coronary Revascularization: A Systematic Review
Authors: Moon Jooyoung , Moon Hanna
Published: May 2021

Background:
The perioperative management of cardiac risk for patients undergoing coronary revascularization has mostly centered around beta-blockers (BB). Ivabradine is a much newer drug that has been approved for stable angina and heart failure not fully controlled by BB. Emerging evidence suggests that it may have cardioprotective effects in high-risk cardiac patients. The objective of this study was to summarize the evidence on the use and effects of ivabradine in coronary revascularization patients.

Methods:
We performed a systematic review using the PubMed, EMBASE, and Google Scholar databases for studies published between 2010 and 2020. Two independent investigators reviewed studies reporting information on ivabradine use following coronary revascularization. We excluded articles written in languages other than English.

Results:
Eleven studies met our inclusion criteria, including a total of 3,847 patients (1994 with percutaneous coronary intervention [51.8%], 1680 with coronary artery bypass graft [43.7%], and 173 with other type of intervention [4.5%]). The studies were from seven different countries: Egypt, France, Germany, Greece, Italy, Romania, and Spain. The mean age ranged from 56.5 to 74.3. Males accounted for 70.9% of the patients, resulting in an M:F ratio of 1.4:1. For studies that compared the use of ivabradine to placebo/control, the latter being defined as standard medical therapy that either did or did not include BB, the results showed that the use of ivabradine resulted in significant reduction of heart rate, decreased number of angina attacks, lower nitrate consumption, improvement in quality of life, and increased cardiac index. Studies that compared the effects of ivabradine monotherapy to BB monotherapy showed that the former was associated with a higher rate of atrial fibrillation, but an overall better quality of life as measured by the EuroQol questionnaire. When combined therapy with ivabradine and BB was compared to BB monotherapy, the former was associated with a significant increase in diastolic function, improvement in left ventricular ejection fraction, and a decrease in incidence of arrhythmias. Eight of the eleven studies reported adverse events related to ivabradine use, the most frequent being bradycardia (range: 0 to 7.1%), phosphenes (range: 0 to 0.3%), and blurred vision (range: 0 to 0.2%).

Conclusions:
This study demonstrates that ivabradine may be used alone or in addition to BB to reduce adverse cardiac events and improve the quality of life in patients undergoing coronary revascularization. However, there is no evidence that ivabradine is superior to BB when used alone. Further studies are needed to determine the optimal medical management for patients undergoing coronary revascularization.
Abstract P190: Social Isolation Associates With The Expression Of NKp46 On Natural Killer Cells Through A Relationship Partially Mediated By RANTES In African-American Women
Authors: Gray Veronica C , Turner Briana S , Gutierrez-Huerta Cristhian A , Neally Sam , Curlin Kaveri , Vijayakumar Nithya , Ortiz-Chaparro Erika , Tirado Brian A , Mitchell Valerie , Collins Billy S , Baumer Yvonne , Powell-Wiley Tiffany M
Published: May 2021

Chronic exposure to psychosocial and environmental stressors (PSES) has been shown to increase risk for diabetes, obesity, and cardiovascular disease and alter immune cell distribution and function. In Natural Killer (NK) cells, the impact of PSES has been demonstrated by a loss of NK cell numbers or function and a shift in NK cell subpopulations. NKp46 is an activating receptor on NK cells crucial for NK cell function. In this study, we aimed to determine if PSES is associated with NKp46 expression. We recruited 27 African-American women (age 59.85±1.91; BMI 34.06±1.67), characterized NKp46 expression from blood samples using flow cytometry, and determined serum cytokine levels using Luminex. Furthermore, study participants answered questionnaires to determine various psychosocial measures, socioeconomic status (SES), and home address for neighborhood deprivation (NDI). First, we determined that social isolation significantly associated with NKp46 expression (β=-0.51, p=0.02), while NDI and SES did not. Second, we identified biomarkers associated with social isolation. Social isolation significantly associated with the cytokine RANTES (β=0.64, p=0.01) after adjustment for cardiovascular risk and BMI. Third, we determined that RANTES also associated with NKp46 expression after adjustment (β=-0.54, p=0.01). We performed a mediation analysis using structural equation modeling to determine if RANTES could be a potential biological mediator between social isolation and NKp46 expression levels; this revealed that RANTES mediates 51.07% of the association (Figure). Thus, our study highlights the importance of further understanding the impact of PSES on immune cells and inflammation. Work to unravel the biology of adversity is crucial to address health disparities. In the future, larger studies should be conducted to identify underlying signaling molecules and pathways altering NK cells during chronic PSES that accelerate disease development and progression and ultimately, serve as targets for intervention.
Abstract P194: Psychosocial Stressors And Cardiovascular Disease Risk Factors In Young African American Women: A Systematic Review
Authors: Harris Latesha K , Berry Diane C , Cortes Yamnia I
Published: May 2021

Background:
Emerging evidence suggests that psychosocial factors are related to morbidity and mortality due to cardiovascular disease (CVD). African American women experience a unique multitude of psychosocial stressors, including racism, discrimination, poverty, neighborhood stress, anxiety, and depression. The impact of these stressors on CVD risk in African American women during early adulthood (age 19-24 years) is limited.

Objective:
In this systematic review, we synthesized and evaluated the existing evidence on the relationship between psychosocial stress and CVD risk in young adult African American women.

Methods:
We conducted a comprehensive search of the literature in PubMed, APA PsycINFO, and CINAHL for studies published between January 1975 and May 2020 that examined psychosocial stress and CVD risk factors in young adult African American women. Eligible studies measured at least one psychosocial stress exposure, a CVD risk factor, or subclinical CVD outcome (e.g., body mass index, blood pressure, carotid intima-media thickness), and included African American women age 19-24 years or reported sex-stratified analyses. We excluded reviews, editorials, case studies, and gray literature. Two reviewers independently screened studies for eligibility and appraised the quality of the included studies using the Newcastle-Ottawa Scale.

Results:
The literature search yielded 1,100 potentially relevant articles for review. Of these, we identified nine studies that met our inclusion criteria: six cross-sectional and three prospective cohort studies. The mean age of participants ranged from 19 to 22 years. Of the nine studies, eight found that stress (i.e., perceived stress, racial discrimination, internalized racism, depression) was related to higher body mass index and blood pressure. In one longitudinal study, a greater frequency of everyday discrimination was associated with a nearly 2-fold higher odds of excessive weight gain (>40 pounds) during pregnancy. Overall, the majority of studies (n=6) were rated
as
excellent
; the remainder were
good
and
fair.
The lowest risk of bias was the selection and outcome measurement.

Conclusion:
This systematic review found sufficient evidence to support a relationship between psychosocial stress and CVD risk factors in young adult African American women. However, future studies that follow women from childhood to early adulthood are needed to gain a better understanding of the impact of psychosocial stress on the progression of CVD risk. Further investigation on specific stressors relevant to early adulthood, including self-identity and social role stress, are needed to understand the full extent to which psychosocial stress impacts CVD risk in young African American women.
Abstract P196: Insomnia Symptoms And Ideal Cardiovascular Health In Older Women: Data From The Women’S Health Study
Authors: Hicks Cameron , Butler Jonathan , Slopen Natalie B , Williams David , Johnson Dayna A , Redline Susan , Buring Julie E , Albert Michelle A
Published: May 2021

Introduction:
While insomnia is associated with an increased risk of incident cardiovascular disease (CVD), its relationship with ideal cardiovascular health (ICH) is less certain. Given that sleep disturbances increase with age, we examined the relationship between insomnia symptoms and ICH in older women.

Methods:
Among women participating in the ongoing Women’s Health Study stress cohort with no apparent history of CVD [N= 2588; Mean age= 72.5 ± 6.3], insomnia symptoms were characterized as self-reported difficulty falling asleep or waking up multiple times a night, three or more times per week. Ideal cardiovascular health, as defined by the American Heart Association’s 2020 Impact goals, included standard optimal targets for blood pressure, total cholesterol, glucose, body mass index, physical activity, diet, and smoking. We examined the relationship between insomnia symptoms and ICH using logistic regression, adjusting for clinical and demographic variables.

Results:
Of the 26588 participants, 52% reported insomnia symptoms, and 38% had ICH. Women with insomnia symptoms had significantly lower odds of ICH after full adjustment for age, race/ethnicity, education, income, depression/anxiety, marital status, and sleep duration (OR [95% CI]: 0.73 [0.64-0.83]). Moreover, compared to women without insomnia symptoms, those with insomnia symptoms were significantly more likely to have hypertension, diabetes, hypercholesterolemia, depression, anxiety, currently smoke, drink one or more alcoholic beverages per day, have a BMI >30, or exercise less frequently.

Conclusion:
In older women, insomnia symptoms were significantly associated with lower odds of ideal cardiovascular health even after adjusting for socioeconomic status, psychosocial factors, and sleep duration. These results suggest insomnia screening may be an important component of cardiovascular health promotion in this patient population. Further research is needed to evaluate the effects of sleep behavioral interventions on improving ICH.
Abstract P199: Sleep Health Varies By Immigration Status And Acculturation Level In Women: Results From The American Heart Association Go Red For Women Strategically Focused Research Network
Authors: Samayoa Ivan A , Makarem Nour , Cao Vivian , Maguire Moorea , Xi Huaqing , Liang Citina , Giardina Elsa-grace V , Aggarwal Brooke A
Published: May 2021

Introduction:
The Healthy Immigrant Effect refers to the phenomenon that recent immigrants are on average healthier than their native-born counterparts. Greater immigrant acculturation to the US has been linked to increased risk of cardiovascular disease (CVD), frequently attributed to factors including the adoption of Western diets and decreased physical activity. While immigrants may have healthier habits than US adults, which may confer protection from CVD, there is little research on sleep health, particularly in immigrant women.

Hypothesis:
We hypothesized that immigrants, particularly those with greater acculturation, would have more sleep problems.

Methods:
Baseline data from a 1-y, community-based cohort of 506 women (61% racial/ethnic minority, mean age=37±16y) was used to evaluate cross-sectional associations between acculturation and sleep. Women self-reported their immigration status and national origin. Acculturation was measured from responses to questions regarding language preference, nativity (sorted by regions: Asia, Caribbean, Latin America, other), length of residency in the US, and age at immigration. Sleep duration, sleep quality, risk of obstructive sleep apnea (OSA) and insomnia were assessed using validated questionnaires. Logistic regression models adjusted for age, health insurance, education and BMI were used to evaluate associations between acculturation measures and sleep characteristics.

Results:
Women who were immigrants (n=176) reported lower mean sleep duration (6.60 ± 1.25 vs. 6.85 ± 1.22 h, p=0.02) compared to non-immigrants (n=323); non-immigrants were more likely than immigrants to sleep ≥7h/night (OR: 1.50, CI: 1.01-2.22, p=0.04). Women who immigrated to the US before vs. after age 25 y had lower odds of having sleep onset latency ≥26 min (OR:0.97, CI:0.95-1.00, p=0.03). Immigrant women living in the US >10y vs. <10y had more than 2-fold higher odds of having longer sleep onset latency (≥26 min) (OR:2.43, CI:1.09-5.41, p=0.03). Immigrants from the Caribbean were more likely than immigrants from other regions to be at a high risk for OSA (OR:2.65, CI:1.07-6.55, p=0.04).

Conclusions:
Compared to non-immigrants, immigrant women exhibit shorter habitual sleep duration. Sleep problems may vary by age of immigration, years lived in the US, and region of origin, as those who immigrated when they were older and those who had lived in the US>10 y required more time to fall asleep and Caribbean immigrants had higher OSA risk.
Abstract P221: Metabolic Syndrome And Its Factors Associate With Non-calcified Coronary Plaque Burden In Chronic Inflammation: Results From A Prospective Observational Study
Authors: Teklu Meron , Zhou Wunan , Patel Nidhi , Manyak Grigory , Dey Amit K , Lateef Sundus , Uceda Domingo , Abdelrahman Khaled , Rodante Justin , Keel Andrew , Machado Tania , Scott Colin , Kapoor Promita , Sorokin Alexander V , Teague Heather , Playford Martin , Chen Marcus Y , Mehta Nehal N
Published: May 2021

Introduction:
Psoriasis is a common, inflammatory skin disease associated with systemic inflammation and heightened risk of cardiovascular diseases (CVD). Population studies have shown that psoriasis is associated with metabolic syndrome (MetSyn) and its individual components. However, the impact of MetSyn on early atherosclerosis in chronic inflammatory diseases assessed as non-calcified coronary plaque burden (NCB) by coronary computed CT angiography (CCTA) is not known.

Hypothesis:
We hypothesized that those with MetSyn in psoriasis would have increased NCB compared to non-MetSyn and that MetSyn and its components would associate with NCB in fully adjusted models.

Methods:
The cohort consisted of 336 psoriasis patients free of cardiovascular disease, of which 326 had adequate data to classify MetSyn based on the International Diabetes Federation criteria (waist circumference, triglycerides, HDL cholesterol, blood pressure and fasting glucose). Of these, 260 had quantitative CCTA data available for analyses (Stata 16).

Results:
Of the 260 patients, 80 had MetSyn (31%). The MetSyn group had increased cardiometabolic disease and more adverse coronary characteristics including higher non-calcified (
p
<.001) and high-risk plaque (
p
=.02)
(Table)
. In fully adjusted models for Framingham risk score, lipid lowering therapy and biologic use, MetSyn (β=0.31;
p<
.001) and its individual components of waist circumference (β=0.33;
p
<.001), triglycerides (β=0.17;
p
=.005), blood pressure (β=0.18;
p
=.005) and fasting glucose (β=0.17;
p
=.009) associated with NCB.

Conclusions:
MetSyn and its components were associated with NCB in psoriasis suggesting that early atherosclerosis is importantly impacted by poor cardiometabolic health. Components of MetSyn should be assessed in psoriasis patients and patients educated about this heightened risk of CVD associated with MetSyn.
Colchicine to Prevent Periprocedural Myocardial Injury in Percutaneous Coronary Intervention: The COPE-PCI Pilot Trial
Authors: Cole Justin , Htun Nay , Lew Robert , Freilich Mark , Quinn Stephen , Layland Jamie
Published: May 2021

Background:

Periprocedural myocardial infarction and injury (PM-injury) are the most common complications of percutaneous coronary intervention (PCI) and are associated with future adverse cardiac events. Inflammation plays a pivotal role in the development of PM-injury. In this randomized pilot trial, we assessed the effect of an anti-inflammatory medication colchicine on periprocedural myocardial injury.

Methods:

Patients undergoing PCI for stable angina or non–ST-segment–elevation myocardial infarction were randomized to oral colchicine (1 mg followed by 0.5 mg 1 hour later) or placebo, 6 to 24 hours preprocedure. Blood samples were taken immediately pre- and 24-hours post-PCI. The primary outcome, periprocedural myocardial infarction, was defined by an increase in post-PCI troponin >5×99th% upper reference limit when the pre-PCI troponin was normal, or >20% increase in post-PCI troponin when the pre-PCI troponin was raised, including supporting evidence of new myocardial ischemia. Major PM-injury was defined as per periprocedural myocardial infarction without supporting evidence of new myocardial ischemia. Minor PM-injury was defined by post-PCI troponin increase >99th% upper reference limit but ≤5×99th% upper reference limit.

Results:

A total of 196 patients met inclusion criteria and were randomized. One hundred twenty-one patients were excluded (no PCI, unstable troponin before PCI, or poor-quality measurements) leaving a study population of 75 patients. Thirty-six patients were randomized to colchicine and 39 to placebo preprocedure. Forty-four presented with non–ST-segment–elevation myocardial infarction and 31 with stable angina. High-sensitive (hs) troponin-I pre-PCI was similar between treatment groups (colchicine: 79 ng/L [4–1336] versus placebo: 35 [5–448],
P
=0.42). Absolute change in hs-troponin-I (calculated as 24-hour post-PCI minus pre-PCI measurements) was significantly lower in the colchicine group: 59 (1–221) versus placebo: 166 (53–530),
P
=0.02. No patients developed periprocedural myocardial infarction in either group. Significantly fewer patients developed major PM-injury: 11 (31%) versus 21 (54%),
P
=0.04 or minor PM-injury: 21 (58%) versus 33 (85%),
P
=0.01, if given colchicine pre-PCI.

Conclusions:

In this randomized pilot trial, colchicine given 6 to 24 hours pre-PCI reduces periprocedural myocardial injury.

Registration:

URL:
https://www.anzctr.org.au
; Unique identifier: ACTRN12615000485538.
Changes in Home Blood Pressure Monitored Among Elderly Patients With Hypertension During the COVID-19 Outbreak: A Longitudinal Study in China Leveraging a Smartphone-Based Application
Authors: Zhang Shuyuan , Zhou Xiaoyang , Chen Youren , Wang Lixin , Zhu Bingpo , Jiang Yinong , Bu Peili , Liu Wei , Li Dianfang , Li Yuming , Tao Yanhua , Ren Jie , Fu Li , Li Yufeng , Shen Xiaomei , Liu Hualing , Sun Gang , Xu Xinjuan , Bai Jingjing , Zhang Weili , Cai Jun ,   On behalf of the STEP Study Group
Published: May 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic has impacted clinical care worldwide. Evidence of how this health crisis affected common conditions like blood pressure (BP) control is uncertain.

Methods:

We used longitudinal BP data from an ongoing randomized clinical trial to examine variations in home BP monitored via a smartphone-based application (app) in a total of 7394 elderly patients with hypertension aged 60 to 80 years stratified by their location in Wuhan (n=283) compared with other provinces of China (n=7111). Change in morning systolic BP (SBP) was analyzed for 5 30-day phases during the pandemic, including preepidemic (October 21 to November 20, 2019), incubation (November 21 to December 20, 2019), developing (December 21, 2019 to January 20, 2020), outbreak (January 21 to February 20, 2020), and plateau (February 21 to March 21, 2020).

Results:

Compared with non-Wuhan areas of China, average morning SBP (adjusted for age, sex, body mass index) in Wuhan patients was significantly higher during the epidemic growth phases, which returned to normal at the plateau. Between-group differences in ΔSBP were +2.5, +3.0, and +2.1 mm Hg at the incubation, developing, and outbreak phases of COVID-19 (
P
<0.001), respectively. Sensitivity analysis showed a similar trend in trajectory pattern of SBP in both the intensive and standard BP control groups of the trial. Patients in Wuhan also had an increased regimen change in antihypertensive drugs during the outbreak compared with non-Wuhan patients. Expectedly, Wuhan patients were more likely to check their BP via the app, while doctors were less likely to monitor the app for BP control during the pandemic.

Conclusions:

Our data demonstrate that the COVID-19 pandemic was associated with a short-term increase in morning SBP among elderly patients with hypertension in Wuhan but not other parts of China. Further study will be needed to understand if these findings extended to other parts of the world substantially affected by the virus.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03015311.
Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States
Authors: Wadhera Rishi K. , Figueroa Jose F. , Rodriguez Fatima , Liu Michael , Tian Wei , Kazi Dhruv S. , Song Yang , Yeh Robert W. , Joynt Maddox Karen E.
Published: May 2021

Background:

Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether diverse racial/ethnic populations have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths.

Methods:

We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March to August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust SEs to compare change in deaths by race/ethnicity for each condition in 2020 versus 2019.

Results:

There were a total of 339 076 heart disease and 76 767 cerebrovascular disease deaths from March through August 2020, compared with 321 218 and 72 190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age–sex standardized deaths per million, 1234.2 versus 1208.7; risk ratio for death [RR], 1.02 [95% CI, 1.02–1.03]), non-Hispanic Black (1783.7 versus 1503.8; RR, 1.19 [95% CI, 1.17–1.20]), non-Hispanic Asian (685.7 versus 577.4; RR, 1.19 [95% CI, 1.15–1.22]), and Hispanic (968.5 versus 820.4; RR, 1.18 [95% CI, 1.16–1.20]) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 versus 258.2; RR, 1.04 [95% CI, 1.03–1.05]), non-Hispanic Black (430.7 versus 379.7; RR, 1.13 [95% CI, 1.10–1.17]), non-Hispanic Asian (236.5 versus 207.4; RR, 1.15 [95% CI, 1.09–1.21]), and Hispanic (264.4 versus 235.9; RR, 1.12 [95% CI, 1.08–1.16]) populations. For both heart disease and cerebrovascular disease deaths, Black, Asian, and Hispanic populations experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term,
P
<0.001).

Conclusions:

During the COVID-19 pandemic in the United States, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.
Non–High-Density Lipoprotein Cholesterol Predicts Adverse Outcomes in Acute Ischemic Stroke
Authors: Wang Guangyao , Jing Jing , Wang Anxin , Zhang Xiaoli , Zhao Xingquan , Li Zixiao , Wang Chunjuan , Li Hao , Liu Liping , Wang Yongjun , Wang Yilong ,   on behalf of the China National Stroke Registry II Investigators
Published: May 2021

Background and Purpose:

Non–high-density lipoprotein cholesterol (non–HDL-C) was significantly related to adverse outcomes in patients with cardiovascular disease. We aim to investigate the associations of non-HDL-C and adverse outcomes in acute ischemic stroke.

Methods:

Among 19 604 patients with acute ischemic stroke admitted to the China National Stroke Registry II, 16 113 with both total cholesterol and HDL-C were analyzed. Patients were classified into 5 groups by quintiles of non-HDL-C. The outcomes included recurrent ischemic stroke, intracranial hemorrhage, and all-cause death within 1 year. The relationship of non-HDL-C with the risk of outcomes was analyzed by Cox regression models.

Results:

Among the 16 113 patients, the median (interquartile range) of non-HDL-C was 3.41 (2.78–4.10) mmol/L. After adjustment for confounding variables, patients in the top quintile of non-HDL-C were associated with higher risk of recurrent ischemic stroke within 1 year (adjusted hazard ratio, 1.46 [95% CI, 1.20–1.77]), compared with those in the third quintile. Patients in the bottom and top quintile of non-HDL-C were associated with higher risk of all-cause death within 1 year (adjusted hazard ratio, 1.22 [95% CI, 1.01–1.47] and adjusted hazard ratio, 1.40 [95% CI, 1.15–1.70], respectively), compared with those in the third quintile. However, non-HDL-C levels were not significantly predictive in intracranial hemorrhage.

Conclusions:

Non-HDL-C may be a qualified predictor for recurrent ischemic stroke and all-cause death within 1 year in patients with acute ischemic stroke.