bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P190: Associations of 24-h Urinary Sodium/potassium (Na/K) Ratio with Recommended Intakes of Na and K: The INTERMAP Study
Authors: Iwahori Toshiyuki , Miura Katsuyuki , Ueshima Hirotsugu , Chan Queenie , Okuda Nagako , Yoshita Katsushi , Dyer Alan R , Elliott Paul , Stamler Jeremiah
Published: July 2021

Background:
High dietary sodium (Na), low dietary potassium (K) and high dietary sodium/potassium (Na/K) ratio are associated with adverse blood pressure levels and excess risks of cardiovascular diseases. 24-h urine collection is the gold standard for measuring dietary Na, K and Na/K ratio. Recommended levels of Na and K intakes are suggested in WHO guidelines; less than 85 mmol/day for Na; at least 90 mmol/day for K; there is no definitive guideline for Na/K ratio.

Objective:
Our primary aim was to compare the level of urinary Na/K ratio with the current recommended levels of Na and K intakes suggested in WHO guidelines.

Methods:
INTERMAP is an international study on associations of multiple dietary variables with blood pressure (BP), based on two timed 24-hr urine collections and dietary data from 4 in-depth 24-h dietary recalls in 4,680 men and women ages 40-59 years in China, Japan, United Kingdom and United States (US). Na/K ratio of 24-hr urine stratified in 1 unit intervals was compared with the current recommended levels of Na and K intakes suggested in WHO guidelines. Na intake was evaluated by urinary Na excretion; K intake by dietary K intake.

Results:
Thirty-one of the 4,680 INTERMAP participants (0.7%) had urinary Na/K ratio less than 1. The proportions of participants with Na excretion less than 2 g/day (85 mmol/day) among all 4,680 individuals were 77% (n=24), 19% (n=117), and 0.2% (n=11) in those with urinary Na/K ratio less than 1, 1 to 2, and more than 4, respectively. In US samples (n=2,195) the proportions were 88% (n=15), 19% (n=70), and 0.3% (n=6), respectively. The proportions of participants with dietary K intake more than 3.51 g/day (90 mmol/day) among all 4,680 individuals were 71% (n=22), 38% (n=233), and 2.4% (n=111) in those with urinary Na/K ratio less than 1, 1 to 2, and more than 4, respectively. In US samples the proportions were 59% (n=10), 38% (n=138), and 2.1% (n=47), respectively.

Conclusions:
WHO recommends Na intake less than 85 mmol/day, and K intake more than 90 mmol/day. Urinary Na/K ratio less than 1 is needed to ensure reasonable compliance with these recommendations. Currently, very few people satisfy urinary Na/K ratio less than 1, so population-wide efforts are needed to reduce salt (sodium chloride) and increase K intake.
Abstract P214: Anxiety and Depressive Symptoms are Associated with Coronary Artery Calcium. A Cross-sectional Analysis of Elsa-Brasil Baseline Data
Authors: Santos Itamar S , Bittencourt Marcio S , Rocco Priscila T , Pereira Alexandre C , Barreto Sandhi M , Brunoni André R , Goulart Alessandra C , Blaha Michael J , Lotufo Paulo A , Bensenor Isabela M
Published: July 2021

Background:
Prior mostly smaller studies of the association between symptoms of anxiety or depression and CAC have produced mixed results. Our aim was to investigate whether psychopathological symptoms and diagnoses of anxiety and depression were associated with coronary artery calcium (CAC) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Design:
Cross-sectional analysis

Methods:
We analyzed data from 4,279 ELSA-Brasil subjects (aged 35 to 74 years) from the São Paulo site who underwent CAC score assessment and who were without previous cardiovascular disease at baseline. Prevalent CAC was defined as a CAC score above zero. Anxiety and depressive symptoms were assessed using the Clinical Interview Schedule - Revised (CIS-R). We built binary logistic regression models to determine whether CIS-R scores, anxiety or depression were associated with prevalent CAC.

Results:
Prevalent CAC was found in 1,211 (28.3%) individuals. After adjustment for age and sex, a direct association between CIS-R scores and prevalent CAC was revealed (odds ratio [OR]:1.12; 95% confidence interval [95%CI]:1.04-1.22). This association persisted after multivariate adjustment for other cardiovascular risk factors (OR:1.11; 95%CI: 1.02-1.20). No independent associations were found for specific diagnoses of anxiety or depression and prevalent CAC. In post-hoc models, we found a significant interaction between age, CIS-R scores, and CAC (p=0.019), suggesting a stronger association in older individuals.

Conclusions:
Psychopathological symptoms were directly associated with coronary atherosclerosis in the ELSA-Brasil baseline. This association was evident after adjustment for age and sex, persisted in multivariate adjusted models, and seems to be stronger in older individuals.
Abstract P233: Presence and Gradation of Breast Arterial Calcification: Age and Ethnic Differences in a Cohort of Postmenopausal Women
Authors: Iribarren Carlos , Husson Gail , Sanchez Gabriela , Sadeghi Bahman , Javan Hanna , Cho Hyo-Min , Ding Huanjun , Molloi Sabee
Published: July 2021

Breast arterial calcification (BAC) is an emerging marker of atherosclerotic cardiovascular disease (CVD) risk. However, most prior studies relied on traditional film mammography and on the dichotomy of presence/absence of BAC. Furthermore, race/ethnic differences in BAC are not well documented. The
M
ult
i
eth
n
ic Study of Br
e
ast A
r
terial Calcification and Cardio
va
scular Risk (
MINERVA
) study recruited 5,040 postmenopausal women after they underwent routine digital screening mammography at one of nine Northern California Kaiser Permanente Centers between 3/21/2013 and 9/1/2015. Study participants were free of CVD at baseline, and underwent an extensive clinic visit for ascertainment of CVD risk factors. Presence and gradation of BAC (calcium mass in mg) on raw images by dedicated software were ascertained by a novel densitometry method at the BAC Reading Center at UC Irvine. Data on BAC and demographics are presented here on the first 2,597 mammograms read. The mean age of the cohort was 66.5 ± 4.6 [range, 60-79 years old] and the ethnic breakdown was 67% white, 9% African-American, 10% Asian/Pacific Islander, 8% Latina and 6% mixed/other race. The overall prevalence of any BAC (calcium mass>0) was 30% (773/2,597) and increased with age: 26% in 60-69, 38% in 70-74 and 54% in 75-79 year old women. By race, BAC presence was higher in Latina (37%, 75/203), followed by African-American (30%, 66/222), white (29%, 514/1750), mixed/other (28%, 48/159), and Asian women (28%, 73/263). The age- and ethnic-specific gradation BAC data are summarized in the Table. Variation of BAC gradation was significant across age (Chi-square=142; p=0.0001) and nearly significant across race/ethnic groups (Chi-square=26; p=0.06). Overall, only 3% of women had a calcium mass between 11 and 25, with 3% over 25 mg. These percentages were higher among women over age 75 and in Latinas and African-Americans. These results document, for the first time, significant differences in BAC presence and gradation as a function of age and race/ethnicity.
Abstract P235: Superior Mesenteric Artery Calcification is Associated with Cardiovascular Risk Factors, Systemic Calcified Atherosclerosis and Mortality in Asymptomatic Adults
Authors: Lin Timothy C , Wright C. Michael , Criqui Michael H , Allison Matthew A
Published: July 2021

Arterial calcification is a hallmark of atherosclerosis and can be detected by computed tomography (CT). There are few epidemiological data regarding the superior mesenteric artery, the atherosclerotic occlusion of which contributes to mesenteric ischemia that may, in turn, lead to increased morbidity or mortality. This study tested the hypothesis that superior mesenteric artery calcification (SMAC) is associated with cardiovascular disease (CVD) risk factors, systemic calcified atherosclerosis, and both cardiovascular and all-cause mortality.

The presence and amount of arterial calcification was evaluated by CT in 4302 adults with no known CVD who were physician- or self-referred to obtain preventative health testing at a university-affiliated outpatient center. Laboratory data and medical histories were obtained concomitantly. A multiple logistic regression model was used to determine risk factor associations for SMAC presence, adjusted for calcification in five other arterial beds. In a separate logistic regression model adjusted for CVD risk factors, SMAC presence was used as a predictor for systemic calcified atherosclerosis, represented as having calcification in all five other arterial beds. Cox models, adjusted for CVD risk factors and calcification in other arterial beds, were used to examine the association of SMAC presence and amount (expressed as log[Agatston score+1]) with cardiovascular and all-cause mortality.

In the study sample, the average age was 56 years, 43.7% (1879 of 4302) were women, and 6.7% (290 of 4302) had SMAC. Age (OR=1.08, 95%CI [1.06 to 1.10]), male sex (OR=1.97, 95%CI [1.43 to 2.71]), dyslipidemia (OR=1.38, 95% CI [1.01 to 1.88]) and any smoking (OR=1.60, 95% CI [1.20 to 2.14]) were associated with SMAC presence. Moreover, SMAC presence was associated with higher odds for calcification in all five other arterial beds (OR=5.96, 95%CI [3.72-9.54]). Over a median follow-up time of 9.4 years, there were 234 (5.4%) deaths, 76 of which were CVD-related. SMAC presence (HR=1.57, 95%CI [0.93-2.68]) and amount (HR=1.30 per unit increase in log[Agatston score+1], 95%CI [1.00-1.68]) were each associated with a greater risk for CVD mortality. Similarly, SMAC presence (HR=1.52, 95%CI [1.10-2.12]) and amount (HR=1.25, 95%CI [1.06-1.48]) were each associated with a greater risk for all-cause mortality.

In conclusion, age, male sex, dyslipidemia, and any smoking were significant risk factors for the presence of SMAC. The association of SMAC presence with greatly increased odds for calcification in all other vascular beds suggests that calcification of the superior mesenteric artery occurs with subclinical, yet widely-manifest, systemic atherosclerosis. Finally, SMAC amount was significantly associated with incident cardiovascular mortality, while both SMAC presence and amount were significantly associated with all-cause mortality.
Abstract P262: Resequencing Study Identifies Epithelial Sodium Channel Genes and Novel Low Frequency Variants Associated with Blood Pressure Salt-sensitivity: The GenSalt Study
Authors: Anderson Christopher E , Li Changwei , He Jiang , Gu Dongfeng , Rao Dabeeru C , Hixson James E , Shimmin Lawrence C , Huang Jianfeng , Gu Charles C , Chen Jichun , Li Jianxin , Kelly Tanika N
Published: July 2021

Christopher E. Anderson, Changwei Li, Jiang He, Dongfeng Gu, Dabeeru C. Rao, James E. Hixson, Lawrence C. Shimmin, Jianfeng Huang, Charles C. Gu, Jichun Chen, Jianxin Li, Tanika N. Kelly

Genetic association studies have identified significant associations between common variants from the epithelial sodium channel (ENaC) genes and blood pressure responses to dietary sodium interventions. The roles of low-frequency and rare ENaC variants in blood pressure salt-sensitivity remain largely unexplored. To test this hypothesis, we conducted an ENaC candidate gene resequencing study among participants in the Genetic Epidemiology Network of Salt-Sensitivity (GenSalt). The GenSalt study was conducted among 1,906 participants from 633 families who underwent a 7-day low-sodium (51.3 mmol sodium/day) followed by a 7-day high-sodium (307.8 mmol sodium/day) feeding-study. We chose the 300 GenSalt subjects with the highest and 300 GenSalt subjects with the lowest mean arterial pressure responses to the high sodium intervention to participate in the current resequencing study. Functional regions of three ENaC subunit genes (
SCNN1A
,
SCNN1B
and
SCNN1G
) were resequenced using the VariantSEQr
TM
system (Applied Biosystems; Foster City, CA). For gene-based analyses, variants with MAF less than 5% were first collapsed within each ENaC gene. The collapsed indicator variable was then tested for association with blood pressure salt-sensitivity using generalized estimating equations (GEE) to accommodate correlation of genotypes due to family structure and adjust for the fixed effects of age, gender and field center. Single variant analyses were performed for all low-frequency variants with a minor allele frequency (MAF) greater than 1% and less than 5%, again using GEE to accommodate family structure and adjust for covariables. We did not identify any associations between ENaC genes and blood pressure salt-sensitivity in the gene-based analyses. However, single variant analysis identified a novel association between a low-frequency variant in
SCNN1G
, rs148083677, and blood pressure salt-sensitivity (P=0.02). Each minor allele was associated with 71% lower odds of blood pressure salt-sensitivity. Although replication studies are needed, these findings provide promising evidence of a role for low-frequency ENaC variants in blood pressure salt-sensitivity.
Abstract P267: Geographic Patterns of Cardiovascular Disease Risk Factor Prevalence in the Continental US
Authors: Loop Matthew S , Howard George , de los Campos Gustavo , Al-Hamdan Mohammad Z , Safford Monika M , Levitan Emily B , McClure Leslie A
Published: July 2021

Objectives:
Our understanding of geographic variation in cardiovascular disease (CVD) risk factors is based upon self-reported variables or geographically limited coverage. Our objective was to explore geographic variation in measured hypertension, measured diabetes, measured dyslipidemia, and self-reported current smoking prevalence.

Methods:
We used baseline data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, whose community-dwelling participants were recruited nationally between 2003 and 2007. Participants underwent a telephone interview and in-home examination. Hypertension, diabetes, and dyslipidemia were based on physiologic measures or reported medication use. Current cigarette smoking was self-reported. Using participants’ residential latitude and longitude, we tested for clustering of each risk factor using the difference in Ripley’s K functions test and, when we found evidence of clustering, used thin plate regression splines (TPRS) in a logistic regression framework to create age- race-, and sex-adjusted maps of risk factor prevalence.

Results:
Risk factor status and location data were available for 27,787 of the 30,239 participants (92%). Mean (±SD) age of these participants was 65(±9) years, 41% were black, 55% were women, 59% had hypertension, 22% had diabetes, 54% had dyslipidemia, and 15% were current smokers. We found statistically significant geographic clustering of hypertension, diabetes, and smoking prevalence, but not dyslipidemia. The regions with the highest prevalence varied across risk factors (Figure 1).

Conclusions:
Louisiana and Mississippi might require the most intense management of CVD risk factors. These maps show variation across and within administrative units, providing an accurate representation of geographic variation in risk factor prevalence. High resolution maps could be put to use by healthcare organizations to justify requests for higher reimbursement rates based upon local population health.
Abstract P276: Self-perceived Diet Quality, Obesity Status, and Household Food Purchasing Behaviors Among US Adults
Authors: Singleton Chelsea R
Published: July 2021

Introduction:
Previous research suggests that consumer food purchasing behaviors (e.g. food venue choice, food purchasing expenses, convenience meal procurement) are associated with socioeconomic status, neighborhood environment and overall healthiness of diet. Little is known about how household food purchasing behaviors are related to individual diet perception and obesity status. This research aims to determine if self-perceived diet quality is associated with household food purchasing behaviors. Additionally, this research aims to examine how obesity status modifies associations between self-perceived diet quality and household food purchasing behaviors.

Hypothesis:
Self-perceived diet quality will be associated with household food purchasing behaviors. Associations will differ between obese and non-obese individuals.

Methods:
Data on a nationally representative sample of 12,095 US adults (i.e. ≥ 19 years old) who participated in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012 were obtained and analyzed. Self-perceived diet quality was reported by participants as being excellent, very good, good, fair or poor. Household food purchasing behaviors examined included # of convenience meals purchased per week and amount of money ($) spent per month doing the following: shopping at a supermarket, shopping at other food outlets, dining out, and purchasing carryout/delivered food items. Stratified linear regression models adjusted for age, sex, race/ethnicity, educational level, household size and Supplemental Nutrition Assistance Program participation were used for analyses.

Results:
The population was on average 46.6 (±0.9) years old, 51.1% female, 22.2% Non-Hispanic Black, 24.7% Hispanic and 36.6% obese (i.e. body mass index ≥ 30). Among all participants, analyses indicated that as self-perceived diet quality decreased, the # of convenience meals purchased per week and the amount of $ spent on carryout/delivery per month increased (p<0.001). Additionally, as self-perceived diet quality decreased, the amount of $ spent at the supermarket per month also decreased (p<0.001). Stratified regression models suggested that associations differed by obesity status. Regardless of how they perceived their diet quality, obese individuals spent similar amounts of $ at the supermarket and on carryout/delivered food items.

Conclusions:
Self-perceived diet quality is associated with household food purchasing behaviors. Additional research is needed to better understand how the dynamics of household food purchasing influences diet and obesity.
Abstract P315: Three-year Progression of Sleep-disordered Breathing is Associated with Cardiovascular Disease Risk Factors in Young Adults
Authors: Kline Christopher E , Rice Thomas B , Strollo Patrick J , Barinas-Mitchell Emma
Published: July 2021

Introduction:
Sleep-disordered breathing (SDB) is a common sleep disorder that is significantly associated with cardiovascular disease (CVD) risk. Less is known about the short-term cardiovascular implications of mild-severity SDB progression, as mild SDB is less commonly associated with CVD but often develops into more severe SDB over time if left untreated.

Hypothesis:
We hypothesized that worsening of SDB severity over 3 years would be associated with greater changes in common CVD risk factors (body weight, heart rate [HR], blood pressure [BP], insulin resistance, and C-reactive protein [CRP]).

Methods:
A sample of 32 adults (38.6±6.4 y; 31.9±4.0 kg/m2; 72% female) who previously had participated in a 1-year lifestyle intervention were followed from 1-year post-intervention (2Y) for an additional 3 years (5Y). At 2Y and 5Y, SDB was assessed with an ambulatory monitor (ResMed ApneaLink); the oxygen desaturation index (ODI; the number of times per hour of recording that the blood oxygen saturation [SaO2] level was reduced by ≥4%) and mean SaO2 served as the primary indices of SDB severity. At 2Y and 5Y, body weight and resting BP and HR were assessed using standard procedures and fasting blood samples were obtained and measured for glucose, insulin, and CRP. Insulin resistance was measured via the Homeostatic Model Assessment method. Multiple linear regression and analysis of covariance were used to examine the associations between changes in SDB severity and changes in CVD risk factors, adjusting for 2Y values of CVD risk factors.

Results:
ODI at 2Y was 5.3±6.6. At 5Y, ODI had changed (i.e., improved) by -0.2±4.9, with ODI worsening by ≥2 in 7 adults and improving by ≥2 in 11 adults. Mean SaO2 at 2Y was 95.5±1.6% and changed (i.e., improved) by +0.1±1.1% at 5Y; mean SaO2 worsened in 10 adults and improved in 12 adults. Three-year change in ODI, but not SaO2, was significantly associated with weight change (β=.42, P=.02). Compared to those whose ODI worsened or did not change, improved ODI was associated with more favorable changes in CRP (-1.8 vs. +0.8 mg/L; P=.04) and heart rate (-5.0 vs. +0.2 beats/min; P=.05); however, these associations were weakened after further adjustment for weight change (P=.16 and P=.07, respectively). Compared to those whose SaO2 remained unchanged or improved, worsened SaO2 was associated with increased insulin resistance (+1.1 vs. -0.4; P<.01); results were unchanged following adjustment for weight change (P=.01). Changes in ODI and SaO2 were not related to changes in BP.

Conclusions:
Even marginal worsening of SDB severity over 3 years is associated with elevation in some CVD risk markers. Treatment of mild SDB in young- to middle-aged adults may reduce risk for CVD.
Abstract P316: The Mediation of Racial Differences in Hypertension by Sleep Characteristics: Chicago Area Sleep Study
Authors: Rasmussen-Torvik Laura , de Chavez Peter , Kershaw Kiarri , Knutson Kristen , Kim Kwang-Youn , Zee Phyllis , Carnethon Mercedes
Published: July 2021

Introduction:
There are disparities in hypertension prevalence by race/ethnicity in the United States. Given differences in sleep by race and the association between sleep characteristics and hypertension, we examined whether racial differences in hypertension were partially mediated by differences in sleep.

Methods:
The Chicago Area Sleep Study (CASS) is a cross-sectional study of 155 black, 129 white, 103 Hispanic and 109 Asian men and women ages 35-64 who had an apnea/hypopnea index<15 determined during 1 night of screening (ApneaLinkTM). Participants wore wrist actigraphs for 7 days (ActiwatchTM) to determine sleep characteristics. The total sleep interval was determined using the Actiwatch event marker or sleep log and sleep % was calculated as duration (determined by actigraphy) /total sleep interval. Blood pressure was measured 3 times after 5 minutes rest; hypertension was determined according to JNC-VII 2010 criteria. To examine mediation, we used the approach and SAS macro developed by Valeri and VanderWeele and fitted two models; a Poisson regression model for hypertension and a linear regression model for sleep characteristic. From these combined models, we estimated the prevalence ratios for natural direct effects (PRNDE) of race on hypertension, natural indirect effects (PRNIE) (mediated by sleep characteristics), and total effect (PRTE). We also calculated the proportion of the total effects that were mediated by sleep characteristics.

Results:
Participants’ mean age was 47.8 years. Sleep duration was longest in whites 445 min (SD=53min), followed by Asians 413 min (SD=51 min), Hispanics 417 min (SD=79 min) and Blacks 409 min (SD=67 min). Average sleep percentage was 92% (SD=4%) in whites, 88% (SD=5%) in Blacks, 91% (SD=5%) in Asians, and 90% (SD=4%) in Hispanics. In models adjusted for age, race, sex, education, smoking status, alcohol intake, physical activity, depressive symptoms and work schedule the direct effect (prevalence ratio) of race on hypertension was 4.6 for Blacks vs. whites, 1.5 for Asians vs. whites and 2.2 for Hispanics vs. whites. The indirect effects (mediated by sleep percentage) for the three groups were 1.19, 1.06, and 1.05 respectively, suggesting that sleep percentage mediated 10 % of the difference in prevalence for hypertension between Blacks and whites, 10% of the difference between Asians and whites and 7 % of the difference between Hispanics and whites. In contrast, there was no evidence that sleep duration mediated the race differences in hypertension.

Conclusions:
While sleep duration did not contribute to race differences in hypertension prevalence, sleep percentage, which may reflect quality of sleep, may contribute to racial differences in rates of hypertension.
Abstract P325: Emergency Department Visit Rates for Influenza-like Illness Can be Used to Predict Seasonal Cardiovascular Disease Mortality Rates Among Older Adults
Authors: Nguyen Jennifer , Yang Wan , Ito Kazuhiko , Matte Thomas , Shaman Jeffrey L , Kinney Patrick L
Published: July 2021

Introduction:
In temperate regions, cardiovascular deaths and influenza epidemics peak with regularity during the winter months.

Hypothesis:
We assessed the hypothesis that population increases in seasonal influenza infections are associated with a rise in mortality due to cardiovascular causes, and that influenza incidence can be used to predict cardiovascular mortality rates during the influenza season.

Methods:
We used time series regression models, adjusted for season and time trend, to quantify the temporal association between influenza incidence and cardiovascular mortality during the influenza season in New York City. Mortality data on date of death, age, and underlying cause of death were obtained from the New York City Office of Vital Statistics. Daily mortality counts from 2006 to 2012 were aggregated for all cardiovascular causes (International Classification of Diseases, Revision 10 (ICD-10) codes I00-I99), ischemic heart disease (ICD-10 codes I20-I25), and myocardial infarction (ICD-10 code I21). Influenza incidence was represented using four different measures: emergency department visits for influenza-like illness, grouped by age ≥ 0 and age ≥ 65 years, and these same measures scaled by laboratory surveillance data for viral types/sub-types. The 2009 H1N1 pandemic period was excluded from temporal analyses and reserved for out-of-sample prediction.

Results:
There were 73,384 cardiovascular deaths among adults age ≥ 65 years during the influenza seasons between 2006 and 2012, excluding the 2009 H1N1 pandemic period. Interquartile range increases of the four indicators of influenza incidence in the previous 21 days were associated with increases in cardiovascular mortality of between 2.3% (95% confidence interval (CI): 0.7%, 3.9%) and 6.3% (95% CI: 3.6%, 8.9%), and increases in ischemic heart disease mortality of between 2.4% (95% CI: 1.1%, 3.7%) and 7.0% (95% CI: 4.1%, 10.0%). Associations were most acute and strongest for myocardial infarction mortality, with interquartile range increases for the four influenza indicators during the previous 14 days associated with mortality increases between 5.9% (95% CI: 2.7%, 9.2%) and 12.8% (95% CI: 5.1%, 20.6%). Out-of-sample prediction of cardiovascular mortality among adults age ≥ 65 years during the 2009-2010 influenza season yielded average estimates with 94.4% accuracy.

Conclusions:
Emergency department visits for influenza-like illness are associated with and predictive of cardiovascular disease mortality in New York City. Retrospective estimation of influenza-attributable cardiovascular mortality burden, combined with accurate and reliable influenza forecasts, could predict the timing and burden of seasonal increases in cardiovascular mortality.
Abstract 21: Years of Life Lost from Cardiovascular Disease Mortality Among Hispanics
Authors: Rodriguez Fatima , Hastings Katherine , Hu Jiaqi , Palaniappan Latha
Published: July 2021

Background:
Hispanics face a disproportionate burden of cardiovascular disease (CVD) risk factors yet paradoxically experience lower death rates as compared to their non-Hispanic white (NHW) counterparts. Years of life lost (YLL) is a more precise measure of premature mortality.

Hypothesis:
We hypothesize there will be heterogeneity in the YLL due to CVD between Hispanic subgroups.

Methods:
We used data from the National Center for Health Statistics Mortality file to compare deaths for Hispanic (n=832,550) subgroups and NHWs (n=7,770,145) <75 years of age from 2003 to 2012. We identified all CVD deaths and by subtype (i.e. ischemic, cerebrovascular, hypertensive and heart failure) using the underlying cause of death (ICD-10: I00-I78, I20-I25, I60-I69, I11, I13 and I50, respectively). YLL was calculated by age categories standardizing with 2000 U.S. Census population. Population estimates were calculated using linear interpolation from 2000 and 2010 U.S. Census.

Results:
After standardization, 11.4 year-losses per 1000 people due to CVD for NHWs and 8.2 per 1000 for Hispanics. Overall, Hispanics had lower YLL compared to NHWs and Puerto Ricans had higher losses among Hispanic subgroups. Most Hispanics had higher YLL for cerebrovascular disease than NHWs (Hispanics 1.1 times higher, Puerto Rican 1.2 times higher and Mexican 1.3 times higher) (Figure).

Conclusions:
Premature mortality from CVD varies greatly by Hispanic subgroups. These findings suggest the importance of disaggregating CVD mortality by Hispanic subgroup and using more sensitive measures of premature death in public health analyses.
Abstract 34: Cardiorespiratory Fitness Response to Short Term Supervised Exercise Training Predicts Age Related Cardiorespiratory Fitness Decline Over Long Term Follow up
Authors: Pandey Ambarish , Slentz Cris A , Johnson Johanna L , Berry Jarett D , Kraus William E
Published: July 2021

Introduction:
Substantial heterogeneity exists in the cardiorespiratory fitness (CRF) change response to short-term supervised exercise training and its long-term prognostic implication is not well understood. Here, we evaluated the association between the short-term training related changes in CRF and CRF levels 10 years later.

Methods:
STRRIDE trial participants that were originally randomized to exercise training for 8 months and participated in the 10-year follow up visit were included. CRF levels were measured at baseline, post-training (8 months), and 10-year follow-up as peak oxygen uptake (VO
2
, ml/kg/min) using the maximal treadmill test. Participants were stratified into low, moderate, and high CRF response (CRF-R) groups according to the training-regimen specific tertiles of CRF change from baseline to post-training. Adjusted linear regression models were used to determine the association between short-term change in CRF with training and CRF levels at 10-year follow-up.

Results:
The study included 80 participants (age = 52 years, 35% women). There was no significant difference in the baseline characteristics of the CRF-R groups. At 10-year follow-up, high CRF-R group had the lowest decline in CRF compared with moderate or low CRF-R groups (-0.005 vs. -2.6. vs. -3.6 ml/kg/min, p = 0.009, Figure). This was largely related to the differential age-related changes in peak oxygen pulse across the three groups (0.58 vs. -0.23 vs. -0.86 ml/beat, p = 0.02) with no difference in the peak heart rate change. In adjusted analysis, high CRF-R was significantly associated with higher CRF levels at follow-up independent of the exercise intervention and other baseline characteristics [High vs. Low (ref) CRF-R: Std β = 0.25; p = 0.004]

Conclusion:
CRF change in response to short-term training is a significant predictor of age-related CRF decline over long-term follow-up. Thus, training responsiveness may identify individuals at risk for exaggerated CRF decline with aging and associated incidence of cardiovascular diseases.
Abstract 37: The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study
Authors: Ross Leanna M , Barber Jacob L , Sui Xuemei , Blair Steven N , Sarzynski Mark A
Published: July 2021

Purpose:
To examine the cross-sectional association between cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH) in middle-aged adults.

Methods:
The association between CRF and ideal CVH score was examined in 11,590 adults (8,865 men, 2,725 women) from the Aerobics Center Longitudinal Study. CRF was measured as duration in minutes from a maximal treadmill test. The AHA’s ideal CVH score was calculated on a 14 point scale using data on smoking status, BMI, physical activity (MET-min/wk), healthy diet, total cholesterol, blood pressure, and fasting plasma glucose recorded between 1987 and 1999. Participants were grouped into categories of inadequate (0-4), average (5-9), and optimum (10-14) based on their CVH score. Three CRF groups were created from age- and sex-specific quintiles based on the previously established cutpoints of treadmill time: low, moderate, and high CRF. We used general linear and logistic regression models adjusted for age, sex, and year of examination to evaluate the association of CRF with ideal CVH score.

Results:
The mean CVH score for men was 8.4 ± 2.2 and 9.7 ± 2.0 for women. Approximately 33% of men and 57% of women had optimum CVH, while only a small proportion of participants had inadequate CVH (5.1% M, 1.4% F). Treadmill time was moderately correlated (p<0.0001) with CVH score in both men (r=0.56) and women (r=0.50). CRF explained 16% and sex 18% of the variance in CVH score (both p<0.0001). Our adjusted model found that participants in the optimum CVH category had 20% and 43% higher CRF levels than those in the average and inadequate CVH groups (p<0.0001), respectively (
Figure 1
). The adjusted odds (95% CI) of having optimum CVH were 14.0 (11.0-17.8) and 3.1 (2.4-4.0) times greater for high CRF and moderate CRF, respectively, compared to low CRF (p<0.0001).

Discussion:
Higher levels of cardiorespiratory fitness are associated with better cardiovascular health profiles in both men and women. Thus, improving fitness represents a strategy to improve cardiovascular and public health.
Abstract MP002: Active Exercise Buddies Help Women With Young Children Improve Physical Activity
Authors: Choi JiWon
Published: July 2021

Introduction:
Women with young children are vulnerable to physical inactivity due to physical, emotional, or social changes resulting from pregnancy and child rearing. Family/friend social support is considered as an enabler to physical activity (PA) among physically inactive women with young children. However, little is known about how to utilize family/friend social support in this population.

Purpose:
The purpose of this pilot randomized controlled trial was to examine the potential efficacy of a 12-week buddy PA intervention in increasing PA among women with young children.

Methods:
Flyers posted in public places, advertisements via a local newspaper and campus shuttle buses as well as online postings through local parents’ groups were used for recruitment between January 2015 and March 2016. Out of 108 women who contacted the research team via telephone or email, 79 met the eligibility criteria. The inclusion criteria were 1) 18-44 years of age; 2) having at least one child aged less than 5 years; 3) having at least one family member or friend who can support PA and reside in the community with the participant; 4) 25 kg/m
2
≤ body mass index < 45 kg/m
2
; and 5) intent to increase PA. After run-in, 49 women were randomized into one of the two groups (the buddy group and the control group). Women assigned to the buddy group designated an exercise buddy and received a face-to-face session along with their buddies. Both participant as well as buddy received an accelerometer and installed its mobile app on their mobile phones. The primary outcome was the mean number of steps per day for the prior week measured by accelerometer. The effect of the intervention versus control condition on the primary outcome was examined in an intent-to-treat approach. We also did per-protocol-analyses to compare three groups, dividing the buddy groups into 2 groups depending changes in PA among buddies (active buddy and inactive buddy) along with the control group.

Results:
47 women completed the study. There were no significant differences between the intervention and control groups in steps at baseline (
p
= 0.46) as well as in changes in mean steps per day (
p
= 0.56). When the three groups (active buddy, inactive buddy, and control groups) were compared, there was no significant difference among groups in steps at baseline (
p
= 0.61), but overall changes in mean steps per day during 12 weeks were significantly different among groups (
p
= 0.018). The active buddy group (
p
=0.005) and the control group (
p
=0.023) showed significantly higher step changes than the inactive buddy group (1779 and 1272 vs. 76).

Conclusions:
The study findings indicate that having an inactive buddy for exercise would not help women to increase their PA and could be worse than having no buddy. Women may need to join a social network of physically active individuals and emulate other physically active people.
Abstract MP003: Development and Validation of a Prediction Model of Weight Loss Maintenance or Regain at 4 Years in the Look AHEAD Trial
Authors: Berger Samantha E , Huggins Gordon S , McCaffery Jeanne M , Lichtenstein Alice H
Published: July 2021

Introduction:
The development of type 2 diabetes is strongly associated with excess weight gain and can often be partially ameliorated or reversed by weight loss. While many lifestyle interventions have resulted in successful weight loss, strategies to maintain the weight loss have been considerably less successful. Prior studies have identified multiple predictors of weight regain, but none have synthesized them into one analytic stream.

Methods:
We developed a prediction model of 4-year weight regain after a one-year lifestyle-induced weight loss intervention followed by a 3 year maintenance intervention in 1791 overweight or obese adults with type 2 diabetes from the Action for Health in Diabetes (Look AHEAD) trial who lost ≥3% of initial weight by the end of year 1. Weight regain was defined as regaining <50% of the weight lost during the intervention by year 4. Using machine learning we integrated factors from several domains, including demographics, psychosocial metrics, health status and behaviors (e.g. physical activity, self-monitoring, medication use and intervention adherence). We used classification trees and stochastic gradient boosting with 10-fold cross validation to develop and internally validate the prediction model.

Results:
At the end of four years, 928 individuals maintained ≥50% of their initial weight lost (maintainers), whereas 863 did not met that criterion (regainers). We identified an interaction between age and several variables in the model, as well as percent initial weight loss. Several factors were significant predictors of weight regain based on variable importance plots, regardless of age or initial weight loss, such as insurance status, physical function score, baseline BMI, meal replacement use and minutes of exercise recorded during year 1. We also identified several factors that were significant predictors depending on age group (45-55y/ 56-65y/66-76y) and initial weight loss (lost 3-9% vs. ≥10% of initial weight). When the variables identified from machine learning were added to a logistic regression model stratified by age and initial weight loss groups, the models showed good prediction (3-9% initial weight loss, ages 45-55y (n=293): ROC AUC=0.78; ≥10% initial weight loss, ages 45-55y (n=242): ROC AUC=0.78; (3-9% initial weight loss, ages 56-65y (n=484): ROC AUC=0.70; ≥10% initial weight loss, ages 56-65y (n=455): ROC AUC = 0.74; 3-9% initial weight loss, ages 66-76y (n=150): ROC AUC=0.84; ≥10% initial weight loss, ages 66-76y (n=167): ROC AUC=0.86).

Conclusion:
The combination of machine learning methodology and logistic regression generates a prediction model that can consider numerous factors simultaneously, can be used to predict weight regain in other populations and can assist in the development of better strategies to prevent post-loss regain.
Abstract MP014: Very Long Chain Saturated Fatty Acids and Diabetes Risk: Meta-Analysis of Cohort Studies in the FORCE Consortium
Authors: Fretts Amanda , Imamura Fumiaki , Yu Chaoyu , Frazier-Wood Alexis C , Lankinen Maria , Rajaobelina Kalina , Tintle Nathan L , Virtanen Jyrki K , Wong Kerry , Yang Wei-Sin , Mozaffarian Dariush , Lemaitre Rozenn
Published: July 2021

Background:
Circulating saturated fatty acids are biomarkers of diet and metabolism that may influence the pathogenesis of diabetes. Unlike palmitic acid (16:0), which has been extensively studied, little is known of the relationship of very long-chain saturated fatty acids (VLSFAs), with 20 carbons or more, to diabetes risk.

Objective:
To investigate the associations of circulating levels of VLSFA with incident diabetes.

Methods:
A meta-analysis was conducted within a consortium of prospective (cohort or nested case-control) studies having circulating measures of one or more VLSFAs, including arachidic acid (20:0), behenic acid (22:0) and lignoceric acid (24:0). Standardized analysis was conducted in each study using pre-specified models, exposures, outcomes, and covariates. Study-specific estimates were pooled using fixed effects meta-analysis.

Results:
Current findings were based on 9 participating studies, including 46,549 total participants and 13,750 incident diabetes. In multivariable-adjusted analyses, higher levels of all 3 VLSFAs were associated with lower risk of incident diabetes. Pooled RRs (95% CI) per interquintile range were 0.80 (0.71-0.90) for 20:0; 0.83 (0.76-0.91) for 22:0; and 0.70 (0.63-0.79) for 24:0, after adjustment for demographics, lifestyle factors and clinical conditions. Additional adjustments for circulating palmitic acid and triglyceride levels moved the RRs toward the null (illustrated for 24:0, in model 3 of the
Figure
).

Conclusions:
Based on meta-analysis of results from several studies around the world, biomarker levels of VLSFA are associated with lower risk of incident diabetes, potentially mediated by effects on circulating triglycerides and 16:0.
Abstract MP020: Sleep as a Mediator of Racial Disparities in Cardiometabolic Disease Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Curtis David S , Fuller-Rowell Thomas E , El-Sheikh Mona , Knutson Kristen L , Kershaw Kiarria N , Carson April P , Carnethon Mercedes R
Published: July 2021

Introduction:
Approximately half of the disparity in premature mortality between African American (AA) and European American (EA) adults is due to greater hypertension, diabetes, and stroke risk. The current study tests sleep as a mediator of racial disparities in cardiometabolic (CMB) disease risk in adulthood.

Methods:
A total of 618 CARDIA Study members took part in a sleep sub-study (2003-2005) and had measured CMB risk (2000-2011; mean age at baseline=40.1; 43.5% AA; 56.5% EA; 42.1% male). Sleep efficiency (% of time in bed asleep) and total sleep time were assessed via actigraphy for six total nights in years 17 and 18 of the CARDIA Study. CMB risk was assessed in years 15 and 25 from borderline high (coded as 1) and high (coded as 2) levels in seven markers using recommended cutpoints from NCEP ATP III and AHA: blood pressure, glucose, insulin resistance, waist circumference, triglycerides, HDL-C, and C-reactive protein. Scores were averaged across markers, ranging from 0 to 2 (a score of 1 indicates a borderline high average in the seven markers). Using linear path models, sleep variables were tested as mediators of racial disparities in ten-year changes in CMB risk.

Results:
AAs obtained less efficient sleep and less total sleep than EAs (76.5% vs 84.3%; 5.63 hrs vs. 6.43 hrs), and AAs had higher CMB risk at both periods (Mean at Y15: .75 vs. .55; Y25: .94 vs. .67) (
p
’s < .001). Mediation tests are shown in the Table. Race was indirectly associated with increasing CMB risk over the ten-year period via sleep efficiency, explaining 25% of the racial disparity. Racial disparities in CMB risk were attenuated by 24.5% when adjusting for sleep time, although the mediation test was not significant. After adjusting for education and household income, 18.1% of the race disparity in diverging CMB risk was explained by sleep efficiency and 20.8% by sleep time.

Conclusions:
Differences in sleep likely contribute to greater CMB risk among AAs as compared to EAs in adulthood. Sleep may be an important intervention point to reduce racial health disparities.
Abstract MP028: Bi-directional Relationship Between Sleep and Sedentary Behavior in Adults Who Are Overweight and Obese
Authors: Imes Christopher C , Kline Christopher E , Rockette-Wagner Bonny , Baniak Lynn M , Mendez Dara D , Chasens Eileen R , Sereika Susan M , Burke Lora E
Published: July 2021

Introduction:
It is assumed that inadequate sleep is associated with sedentary behavior and that being active during the day improves sleep. Given the emergence of sedentary behavior as an independent risk factor for cardiovascular disease (CVD), a better understanding of this bi-directional relationship in adults who are obese is needed for developing CVD-risk reducing interventions.

Hypotheses:
Total sleep time (TST) is negatively associated with next day sedentary time (SED) and SED is negatively associated with that night’s TST in adults who are obese.

Methods:
We used objective baseline data from the EMPOWER Study, a 12-mo study of lapses during weight loss. We instructed subjects to wear accelerometers on the waist (ActiGraph GT3X) for 7 days and wrist (Actiwatch 2) for 14 days to assess daily activity and sleep, respectively. Subjects with ≥2 weekdays and 2 weekend days of overlapping data were included. SED was defined as <150 counts/min. Linear mixed modeling was used to examine the associations between TST and SED; each directional relationship was examined separately. Covariates included sex, race, body mass index (BMI), age, and day of the week.

Results:
The majority of subjects (N=109) were white (82.6%), employed (92.6%), and female (89.0%) with mean (±SD) age of 50.6±10.6 years and BMI of 33.8±4.6 kg/m
2
. Mean daily TST and SED were 409.5±83.0 min and 638.8±132.2 min, respectively. Previous night’s TST independently predicted the next day’s SED (p<.001) with each 3 min increase in TST being associated with a 1 min decrease in SED. SED did not predict that night’s TST. Weekends were associated with less SED (p<.001) and greater TST (p<.001; see Table).

Conclusions:
Sedentary behavior and decreased TST were prevalent in this sample of mostly middle-aged working women. Less TST was associated with greater SED and weekdays were associated with greater SED and less TST, highlighting how weekdays influences these behaviors. These findings point to a need for interventions to increase TST in an effort to reduce SED and CVD risk.