bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P157: Does Physical Activity Modify the Association of 15 Well-established Obesity Loci with BMI: The ARIC Study
Authors: Young Kristin L , Monda Keri L , Demerath Ellen W , Kao W.H. Linda , Boerwinkle Eric , North Kari E
Published: July 2021

This study investigates gene-by-physical activity interaction with 15 well-replicated body mass index (BMI) loci in the Atherosclerosis Risk in Communities (ARIC) Study, a prospective, multi-center, bi-racial population-based cohort of adults (N=15,792 at baseline (1987-1989), aged 45-64). Our analyses were restricted to subjects of self-reported European descent with complete genotype and phenotype data (n=8059, 53% female, mean age 54.3 (SD 5.7)). BMI was computed from measured height and weight. Physical activity (PA) was measured using a modified validated Baecke questionnaire, resulting in an ordinal score ranging from 1.00-10.00 for sport and leisure-time activity. Physical activity was dichotomized at the sex-specific median for high/low PA, with high PA as the referent. BMI was regressed on single nucleotide polymorphism (SNP), PA level, SNP*PA level, and study-specific covariates assuming an additive genetic model. To account for multiple testing, interaction p-values less than 0.006 (0.10/15) were considered statistically significant. Mean BMI was 27.0 (SD 4.8) kg/m2, and sports and leisure time physical activity was 5.00 (SD 1.13, range 1.75-9.25) units. We replicated the main effects of SNP on BMI for FTO (rs9939609, p=8.52E-11) and SEC16B/RASAL2 (rs10913469, p=0.001), and NEGR1 was borderline significant (rs2815752, p=0.006). MAF was the only SNP that displayed a directionally inconsistent effect estimate with earlier findings (Beta: -0.02, SE -0.16, 0.13). Four of the interactions had a p-value <0.1, including SEC16B, PTER, NEGR1, and SH2B1. The largest magnitude effect estimates among the nominally significant interactions were observed for SNPs rs10913469 (locus SEC16B/RASAL2, frequency: 0.2024) and rs10508503 (locus PTER, frequency: 0.0871). For rs10913469, each additional copy of the risk allele resulted in an increased BMI of 0.58 kg/m2 for those in the low PA category, but an increase of only 0.07 kg/m2 for those in the high PA category (p-interaction=0.007). For rs10508503, each additional copy of the risk allele resulted in an increased BMI of 0.51 kg/m2 for those in the low PA category, and a decreased BMI of 0.14 kg/m2 for those in the high PA category (p-interaction=0.013). Mean BMIs for those in the low physical activity category increase with additional copies of the C (risk) allele (mean BMI for TT=25.6, TC=27.2, CC=27.6 kg/m2, p=0.04), while mean BMIs of those with high PA do not differ between genotypes (mean BMI for TT=26.7, TC=26.8, CC=26.6 kg/m2, p=0.51). While we found a significant main effect of the SEC16B/RASAL2 SNP on BMI (p=0.001), for the PTER SNP we did not (p=0.229). These novel findings demonstrate the importance of context specific genetic effects and contribute to the growing literature highlighting the possible importance of physical activity in the attenuation of underlying genetic risk.
Abstract P180: Time to Screen for Medication Non-Adherence in Patients with Uncontrolled Hypertension? Comparing the Test Properties of Two Commonly Used Self-Report Adherence Questionnaires
Authors: Kronish Ian M , Gallagher Benjamin , Ye Siqin , Edmondson Donald
Published: July 2021

Introduction:
One major cause of uncontrolled hypertension is poor medication adherence. Yet, clinicians are poor at judging adherence and the gold standard for measuring medication adherence - electronic monitoring - is rarely available in clinic settings. Self-report adherence questionnaires, by contrast, are free, simple to administer, and may be useful for screening.

Hypothesis:
To compare the test properties of the Morisky Medication Adherence Questionnaire (MMAQ) and the Visual Analog Scale (VAS) for diagnosing non-adherence in patients with uncontrolled hypertension, using electronic pillbox monitoring as the gold standard.

Methods:
Thus far, 48 patients with uncontrolled hypertension [BP ≥140/90 mmHg (or ≥130/80 mmHg if diabetic) on 2 serial clinic visits] have been enrolled during visits to a hospital-based primary care practice. Patients are asked to take up to 4 of their BP medications from a 4-bin electronic pillbox (MedSignals) that records the date and time each bin is opened. At the next visit, patients complete the MMAQ, comprised of 8 brief questions that assess pill-taking behavior. The MMAQ is scored from 0 to 8; 8 signifies perfect adherence. Patients also complete the VAS by marking an “X” on a line from 0% to 100% to indicate how often they took each of their BP medications. Sensitivity, specificity, and negative likelihood ratio (NLR) were assessed for each test. The gold standard for adherence was ≥ 80% adherence averaged across each of the electronically monitored medications.

Results:
Mean age is 62 years (range 34 [[Unable to Display Character: –]] 83), 70% women, 62% Hispanic, 52% Black, and 50% with diabetes. Mean BP at enrollment was 160/88 mmHg. Patients were prescribed a mean (SD) of 2.6 (0.9) BP medications. Adherence was monitored for 41 +/- 23 days. Mean adherence by electronic monitoring was 78% (range 13%-100%); 42% were adherent (≥ 80%) by the gold standard. Using a cutpoint of 7.5 (67% of the sample were below this cutpoint), the MMAQ has a sensitivity of 94% and specificity of 54%, corresponding to a NLR of 0.10 (95%CI 0.01 to 0.67). Using a cutpoint of 80% (only 11% of the sample below this cutpoint), the VAS has a sensitivity of 28%, specificity of 67%, and a NLR of 0.72.

Conclusions:
The MMAQ, but not the VAS, is a sensitive tool for screening for non-adherence in patients with uncontrolled hypertension and may be useful for excluding medication non-adherence as the cause of uncontrolled hypertension for a large proportion of patients.
Abstract P184: Smoking, Menthol Cigarettes and All Cause, Cancer and Cardiovascular Mortality: Evidence from the National Health and Nutrition Examination Survey (NHANES)
Authors: Jones Miranda R , Navas-Acien Ana
Published: July 2021

Introduction:
Cigarette flavorings, with the exception of menthol, have been banned under the Family Smoking Prevention and Tobacco Control Act. The U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including the use of menthol, if the scientific evidence indicates harm; however few studies have evaluated the health effects of menthol as compared to nonmenthol cigarette use.

Objective:
To investigate the prospective associations of cigarette smoking and menthol cigarette use with all cause, cancer and cardiovascular mortality in U.S. adults.

Methods:
We studied 10,158 adults 20 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999-2004 and were followed for an average of 4.7 years.

Results:
Fifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The multivariable adjusted hazard ratios (95% confidence intervals [CI]) for former, current nonmenthol cigarette smokers and current menthol cigarette smokers compared to never smokers were 1.21 (0.93, 1.56), 2.46 (1.57, 3.83) and 2.10 (1.21, 3.66), respectively, for all-cause mortality, 0.86 (0.58, 1.27), 2.10 (1.05, 4.21) and 3.53 (1.55, 8.02) for cardiovascular mortality, 1.32 (0.73, 2.38), 4.04 (1.96, 8.35) and 5.50 (1.90, 15.88) for heart disease mortality and 1.94 (1.23, 3.05), 3.88 (2.21, 6.80) and 2.08 (1.01, 4.28) for cancer mortality. Compared to current nonmenthol cigarette smokers, adjusted hazard ratios (95% CI) for current menthol cigarette smokers were 0.87 (0.54, 1.42) for all-cause mortality, 1.66 (0.75, 3.68) for cardiovascular mortality, 1.39 (0.52, 3.67) for heart disease mortality and 0.57 (0.28, 1.18) for cancer mortality.

Conclusions:
In a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes, except maybe an increased risk for cardiovascular disease.
Abstract P189: Associations between Lactation and Maternal Measures of Total and Regional Adiposity 15 Years Postpartum: Results from the Study of Women’s Health Across the Nation
Authors: McClure Candace K , Shay Christina M , Tepper Ping G , Conroy Molly B , Sternfeld Barbara , Janssen Imke , Sutton-Tyrrell Kim , Schwarz Eleanor B
Published: July 2021

Objective:
It has been reported that mothers who do not breastfeed are at an increased risk of T2DM, metabolic syndrome, and CVD. We hypothesize that lactation may influence cardio-metabolic risk by altering maternal body composition. We examined the extent to which lactation was associated with regional and total adiposity in a sample of US women 15 years after their last birth.

Study Design
: Cross-sectional analysis of data provided by 1,268 women aged 45-58 who enrolled in the Study of Women’s Health Across the Nation (1996 -1997). Adiposity was assessed using dual-energy X-ray absorptiometry. History of lactation was self-reported and categorized into three groups: mothers who breastfed for ≥3 months after every birth, those who discontinued lactation within 3 months of some births, and those who never breastfed.

Results:
Compared with mothers who breastfed after every birth for at least 3 months, mothers who never breastfed had 0.87 kg greater trunk fat mass (FM), 1.3% greater % trunk FM, 1.3% lower % leg FM, and 0.075 greater trunk to leg FM ratio after adjustment for age, parity, height, years since last birth, race/ethnicity, socioeconomic, lifestyle, psychological, and family history variables, maximum gestational weight gain, and menopausal status. After additional adjustment for current BMI, women who never breastfed had 0.40 kg greater trunk FM and 0.053 greater trunk to leg FM ratio than mothers who breastfed every child for ≥3 months. Similarly, mothers who discontinued lactation within 3 months of some births had 0.28 kg greater trunk FM and 0.87% lower % leg FM than mothers who consistently breastfed.

Conclusion
: Women who did not breastfeed for at least 3 months after every birth exhibit less favorable body fat distributions 15 years postpartum. These results provide a potential physiologic basis for prior findings that women who do not breastfeed their children face increased risk of diabetes, the metabolic syndrome, and cardiovascular disease. Given existing disparities in rates of lactation, obesity and CVD, these findings have great clinical relevance and suggest the need for targeted lactation support for women at risk of cardiovascular disease.
Abstract P204: Tissue Plasminogen Activator (tPA) Eligibility for Acute Stroke in Urban and Rural Hospitals in North Carolina: The North Carolina Stroke Care Collaborative
Authors: Jones Sara B , Kucharska-Newton Anna M , Rosamond Wayne D
Published: July 2021

Introduction:
Thrombolytic therapy was approved over a decade ago for the treatment of acute ischemic stroke, yet administration remains infrequent in clinical practice partly due to pre- and in-hospital delays and patient contraindications. Reports of urban-rural differences in eligibility for and treatment with tPA are few. Understanding differences by hospital location may help identify quality improvement strategies unique to particular hospital systems, particularly those in non-metropolitan areas of North Carolina in which nearly one-third of the population resides.

Methods:
We included all acute ischemic strokes in the NC Stroke Care Collaborative, a voluntary state-wide quality improvement program, from Jan 2008 - Aug 2012 with valid, non-missing times from symptom onset to hospital arrival. Location of the 60 participating hospitals was classified as metropolitan, micropolitan, or smalltown using Rural-Urban Commuting Area codes. Rates of intravenous tPA eligibility and receipt were calculated by hospital location. Pre-hospital (onset to arrival) and CT (arrival to CT interpretation) delay times were compared using Wilcoxon tests. Reasons for non-eligibility by hospital location were compared using chi-squared statistics.

Results:
We identified 16,050 ischemic stroke patients (13,913 metropolitan, 1897 micropolitan, and 240 smalltown). Pre-hospital delay was longer among patients treated at smalltown compared with metropolitan hospitals (median hours [IQR] 3.8 [1.0-9.9] vs. 3.3 [1.3-8.2], p=0.04) but the proportion arriving within 2 hours of symptom onset was similar (38%). CT delay was slightly longer for patients at metropolitan compared with smalltown hospitals (1.1 [0.6-1.7] vs. 0.8 [0.5-1.2]; p<0.0001). Thirty-eight percent (2004 of 5276) of patients arriving within 2 hours were eligible for tPA at metropolitan hospitals compared with 41% (304 of 741) at micropolitan and 46% (42 of 92) at smalltown hospitals (p=0.1). Patients in smalltown compared with metropolitan hospitals had higher rates of ineligibility due to advanced age (5% vs. 3%) and family/patient refusal (9% vs. 3%), whereas patients in metropolitan hospitals had higher rates of contraindications (35% vs. 12%) and rapid improvement/symptom resolution (20% vs. 12%). Rece ipt of tPA among eligible patients was highest in metropolitan (70%, 1399 of 2004) compared with micropolitan (37%, 113 of 304) and smalltown hospitals (33%, 14 of 42; p<0.001).

Conclusion:
Receipt of tPA within 3 hours of symptom onset remains below guideline recommendations. Pre-hospital and CT delay times and eligibility for tPA were largely similar across hospital locations. Despite this, tPA administration was considerably lower at smalltown hospitals compared with hospitals in urban settings, suggesting the need for quality improvements targeted at smalltown hospitals that may have less stroke care capability.
Abstract P208: Racial Differences in Stroke Severity and Outcomes in Female Acute Ischemic Stroke Patients
Authors: Boehme Amelia K , Siegler James E , Albright Karen C , Monlezun Dominique J , Jones Erica M , Beasley T. Mark , Grotta James C , Savitz Sean I , Gonzales Nicole R , Martin-Schild Sheryl
Published: July 2021

Background:
Previous research has indicated that women and Blacks have worse outcomes following acute ischemic stroke (AIS). Little research has been done to investigate the influence of race in the presentation and outcome specifically among women with AIS.

Methods:
AIS patients presenting to two centers in the Stroke Belt (2004-2011) were identified by prospective registries. Men, women who did not identify as Black or White, and in-hospital strokes were excluded. Patient demographics, clinical characteristics, admission National Institutes of Health Stroke Scale (NIHSS) scores, favorable discharge disposition (home or inpatient rehab), time from last seen normal to ED arrival, and functional discharge outcome as measured by the modified Rankin Scale (mRS) were investigated. Patients were divided into 3 groups: (1) not treated with IV t-PA, (2) treated with IV t-PA within 3 hours of symptom onset, and (3) treated with IV t-PA beyond 3 hours.

Results:
Of the 8763 patients screened, 2217 women met the study criteria (59% White). White women were older (72 vs. 64; p<0.0001), had higher percentage of atrial fibrillation (24% vs. 11%; p<0.0001), lower percentage of diabetes (30% vs. 40%, p<0.0001), lower percentage of hypertension (73% vs. 84%; p<0.0001) and had a higher baseline NIHSS (9 vs. 7; p=0.0045) Administration of tPA was significantly less among Black women (36% Whites vs. 27% Blacks, p<0.0001). White women are at increased odds of receiving tPA treatment (OR=1.43, 95%CI 1.17-1.75, p=0.0005), and remain at increased odds after adjusting for age, baseline NIHSS, time from last seen normal and glucose (OR 1.42, 95% CI 1.11-1.81, p=00044). Despite the significant difference in treatment with IV tPA, White women had increased odds of having a poor functional outcome (OR=1.2, 95% CI 1.02-1.439,p=0.0250) and unfavorable discharge disposition (OR 1.4, 95% CI 1.18-1.67, p=0.0001), but stratifying by tPA treatment groups, race was not found to be predictive of outcome after adjusting for known confounders (i.e., age, glucose, baseline NIHSS, time from last seen normal).

Discussion:
Unlike data from previous studies, Black women who presented to these two centers with AIS had less severe neurologic deficits on presentation compared to their White counterparts. Despite differences in the proportion of Blacks and Whites treated with IV tPA, race was not significantly associated with outcome. In our study, age and stroke severity_not race_were the primary predictors for poor outcome.
Abstract P229: Incidence of Acute Myocardial Infarction in First and Second Generation Migrants: Do Second Generation Migrants Converge Towards the Host Population?
Authors: van Oeffelen Aloysia A , Vaartjes Ilonca , Stronks Karien , Bots L , Agyemang Charles
Published: July 2021

Background
Differences in acute myocardial infarction (AMI) incidence between migrants and the host population have been reported. Incidence may converge towards the host population over generations. We assessed whether AMI incidence differences between migrants and ethnic Dutch exist, and whether they converge towards ethnic Dutch over generations.

Methods
A nationwide register-based cohort study was conducted (n=7,601,785) from 1997 to 2007. Using Cox Proportional Hazard Models, AMI incidence differences between migrant groups and ethnic Dutch were estimated. If possible, analyses were stratified by generation.

Results
AMI incidence differences between migrants and ethnic Dutch depended on the migrant’s country of origin, and often varied between migrant groups originating from the same geographical region. For example, among North African and Mediterranean migrants, incidence was higher in Turkish (Hazard Ratio (HR):1·34;1·28-1·41), but lower in Moroccan migrants (HR:0·46;0·40-0·52) compared with ethnic Dutch. Most migrant groups had a similar or lower incidence than ethnic Dutch, which converged towards or exceeded the incidence in ethnic Dutch over generations. This was most profound in Polish and Chinese migrants (first generation Chinese: HR:0·51;0·42-0·62, second generation Chinese: HR:1·36;0·90-2·04).

Conclusions
Health care professionals and policy makers should be aware of substantial AMI incidence differences between migrant groups and the host population, and the often unbeneficial change over generations, most striking in some of Europe’s most expanding migrant groups (Polish, Chinese). Future research should be cautious when clustering migrant groups based on geographical region of the country of origin.
Abstract P234: Racial Disparities in Coronary Revascularization Procedure Mortality: Does the Type of Procedure Matter?
Authors: Sergeev Alexander V
Published: July 2021

BACKGROUND:
Racial disparities in treatment procedure mortality contribute to long-term mortality disparities. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI; coronary angioplasty) are two common revascularization procedures for coronary heart disease (CHD) interventional therapy. In-hospital post-coronary revascularization procedure mortality contributes to long-term, overall CHD mortality. While racial disparities in long-term CHD mortality have been reported, existence of racial disparities in post-procedure mortality remains an open question of important implications.

HYPOTHESIS:
We hypothesized that racial disparities in post-CABG and post-PCI mortality would exist.

METHODS:
We conducted a study of in-hospital mortality in 427,864 patients [mean+SD age: 66.1+11.8 years; 68.5% (292,955 of 427,864) males] after CABG and PCI during the years 2007,2009. Patient race was classified as white, black, or other (Asian, Pacific Islander, Native American). Because post-procedure length of stay in the hospital is relatively short (days, not months), post-procedure in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression models were used to obtain adjusted odds ratios (OR) for in-hospital death after CABG and PCI in relation to race, adjusting for confounding factors - patient and hospital characteristics (age, gender, socio-economic status, Elixhauser comorbidity measures, emergency department admission, rural/urban area status).

RESULTS:
Significantly higher percentage of black patients were admitted via emergency department (44.8%) as compared to other (37.8%) and white (36.2%) patients (p<0.001). Compared to whites and other patients, blacks had higher prevalence of congestive heart failure, diabetes mellitus, hypertension, obesity, and renal failure (p<0.001 for each condition). Crude post-CABG in-hospital mortality was 2.7% (2,982 of 111,830 patients) and post-PCI - 1.2% (3,890 of 316,034 patients). Adjusted post-CABG in-hospital mortality in blacks was higher than in whites (adjusted OR = 1.172, 95% CI: 1.006-1.364, p=0.042), but in other patients was similar to whites (adjusted OR = 1.048, 95% CI: 0.874-1.257, p=0.610). Adjusted post-PCI in-hospital mortality in blacks was lower (adjusted OR = 0.813, 95% CI: 0.710-0.931, p=0.003) and in other patients was higher (adjusted OR = 1.300, 95% CI: 1.129-1.496, p<0.001) than in whites.

CONCLUSIONS:
Our findings are indicative of two distinctive patterns of racial disparities in post-coronary revascularization procedure mortality. Blacks have a higher post-CABG mortality and lower post-PCI mortality than whites. Other patients have a higher post-PCI mortality than whites, but similar post-CABG mortality. Further studies of the mechanisms responsible for these racial disparity patterns are needed.
Abstract P237: Perceived Discrimination and Subclinical Atherosclerosis in the Dallas Heart Study
Authors: Lopez Lenny , Porneala Bianca , deLemos James A , Ayers Colby R , Albert Michelle A
Published: July 2021

Background:
Discrimination is a form of chronic psychological stress that might have negative cardiovascular disease (CVD) effects. Specifically, data about discrimination and subclinical atherosclerosis remain sparse and limited by imaging modality.

Methods:
Using data from the Dallas Heart Study, we assessed the association between perceived discrimination (discrimination) and traditional CVD risk factors, coronary calcium (CAC) score, aortic plaque area (APA) and aortic wall thickness (AWT) among 3,261 participants (1066 whites, 1645 blacks, 467 Hispanics) who responded to a previously validated discrimination questionnaire. Participants were asked about ever experiencing perceived discrimination in three domains: religion, race/ethnicity (R/E) and social class or income. If a participant checked yes for any of these domains, they were determined to have perceived discrimination. Responses were dichotomized (no vs. yes). Questions were analyzed individually and together as a composite score. Multivariable logistic regression models examined the association between discrimination and prevalent CAC, APA and AWT above the sex and age specific 75h percentile and 90th percentile cutpoints adjusting for traditional CVD risk factors, medication use, smoking status and level of physical activity. Subgroup analyses were also performed by race/ethnicity, gender, smoking status, presence of diabetes and/or hypertension.

Results:
Overall, 37% participants reported discrimination (23% white, 47% black, 31% Hispanic). Blacks who reported R/E discrimination were more likely to be men, have a higher LDL, and a higher education level. Hispanics who reported R/E discrimination were more likely to be women, have higher rates of smoking and a higher education level. No association was observed between perceived discrimination and CAC in either univariable or multivariable analyses. Similar findings were observed for APA and AWT. Findings were similar when discrimination according to race/ethnicity, religion, and social/class income were evaluated individually.

Conclusions:
In this analysis which utilized multiple sophisticated imaging modalities to assess subclinical atherosclerosis, perceived discrimination was not associated with the coronary calcium score in fully adjusted multivariable models. Although perceived r/e discrimination is associated with certain health characteristics that may result in negative health outcomes, our findings suggest that previously reported associations of perceived discrimination with adverse CVD outcomes are not mediated through accelerated atherosclerosis.
Abstract P243: Measurement Properties of the Short Acculturation Scale: Preliminary Findings from the Hispanic Community Health Study/Study of Latinos
Authors: Navas-Nacher Elena L , Gonzalez Patricia , Birnbaum-Weitzman Orit , Talavera Gregory A , Schneiderman Neil , Johnson Timothy , Gallo Linda , Penedo Frank , Kaplan Robert , Llabre Maria , Arguelles William , Daviglus Martha L
Published: July 2021

Background:
Extensive epidemiologic evidence suggests that greater acculturation levels are associated with higher risk of cardiovascular disease (CVD). However, there is little information on the reliability and validity of instruments to measure acculturation across Hispanic/Latino (H/L) groups who prefer to communicate in English or Spanish.

Objective:
To evaluate the psychometric properties of the Short Acculturation Scale (SASH) to determine whether it is a reliable measure in a large, diverse sample of H/Ls, and whether there is measurement invariance across language groups.

Methods:
Cross-sectional data were used from the multi-site HCHS/SOL (Bronx, Chicago, Miami and San Diego) and included Cuban, Dominican, Puerto Rican, Mexican, Central or South American background household resident adults (18 to 74 years old; n = 16,331). Households were selected using a stratified two-stage probability sampling design, and door-to-door recruitment with sampling weights calibrated to the 2010 US Population Census. A 10-item abbreviated version of the SASH was administered in English or Spanish per the participant’s preference. Standardized factor loadings were calculated for all item-level confirmatory factor analysis (CFA) and multi-group confirmatory factor analysis (MCFA) models.

Results:
The overall scale reliability was acceptable in the full sample (α =.90) and for both language versions (α =.78 for English, and α =.85 for Spanish). The Cronbach’s alphas were similar across H/L ethnic groups (ranging from α =.85 for South Americans to α =.89 for Mexicans). Data from the exploratory factor analysis suggested a 2 factor solution, with dimensions of language use and ethnic social relationships. In addition, CFA showed that the 2 factor solution was invariant across the Spanish and English groups.

Conclusion:
These preliminary findings suggest that the abbreviated SASH scale is reliable across language versions, and comparable (in terms of reliability and factors structure) across H/L ethnic groups.
Abstract P250: How to Successfully Manage Adolescents’ Metabolic Syndrome. Keep it Simple!
Authors: St-Pierre Julie , Thibault Charles B , Harvey Johanne , Fortin Helene , Lapointe JoAnnie , Desrosiers Dominique , Gaudet Daniel , Blackburn Patricia , Brisson Diane
Published: July 2021

Background:
The metabolic syndrome prevalence in adolescents is still rising (with up to 8% in some populations); this increase is mainly attributable to the obesity epidemic. Consequently, the long-term cardiovascular risk of these adolescents is very high. Unfortunately, despite this elevated risk, motivation and adherence to weight reduction programs still remain very low.

Hypothesis:
To verify if the combination of motivational interviewing, nutritional and physical education, and a close follow-up in a multidisciplinary, family-based weight-reduction pediatric clinic is effective to initiate and sustain beneficial lifestyle changes at 6 months.

Subjects and Method:
Fifty (50) families with adolescents (10-17 years old) characterized by obesity and metabolic syndrome were recruited with their families. The cardiometabolic risk profile (including body mass index, waist circumference, blood pressure, glucose, insulin, lipids and apolipoprotein B levels) of every subject was evaluated and explained to the adolescent and his/her parents. With motivational interviewing techniques and educative approaches, adolescents were brought to set up, at the first visit, a one month, one health challenge change. In subsequent visits, anthropometric measurements were recorded and, based on their first month’s success, new healthy challenges were proposed by the adolescent.

Results:
Adolescents participating in this program were initially highly motivated to initiate a one month healthy challenge with an average score of 7/10. Eighty percent of them chose to stop drinking juice or soda beverages as their first challenge. At one month, over 80% of them observe a weight reduction or no weight gain. At this point, the adolescents’ perception of success is the main source of motivation to introduce new health challenges in their life. At 3 and 6 months, healthy habits are still present in over 70% of them. Interestingly, these changes are accompanied by modifications in anthropometric covariables. At 6 months, we observe a significant reduction of body mass index (p=0.027) and waist circumference (p=0.047) in addition to a trend towards a reduction of mean weight (p=0.054).

Conclusion:
With counselling based on education, motivational techniques and a family approach, a high proportion of adolescents have initiated and maintained healthy changes. At 6 months, waist circumference reduction was the strongest change. This combined familial approach appears promising to reduce metabolic syndrome prevalence in adolescents. The prospective data collection is still ongoing, with the first adolescents recruited now reaching the one-year follow-up.
Abstract P280: Serum L-Selectin and Subclinical Cardiovascular Outcomes: The Multi-Ethnic Study of Atherosclerosis (MESA) Study
Authors: Berardi Cecilia , Decker Paul A , Kirsch Phillip S , de Andrade Mariza , Tsai Michael , Pankow James S , Sale Michele M , Sicotte Hugues , Tang Weihong , Hanson Naomi , Polak Joseph F , Bielinski Suzette J
Published: July 2021

L-selectin is an adhesion molecule constitutively expressed on leukocytes and mediating their interaction with the endothelium. As a member of the selectin family, it plays a crucial role in leukocyte adhesion to and migration through the endothelial wall during inflammation. A protective role of L-selectin in early atherosclerosis was demonstrated in animal models. Previous studies assessing the relationship of this protein with cardiovascular disease were inconsistent. Lower serum L-selectin levels were found in patients with coronary artery disease (CHD) and peripheral artery disease (PAD) compared to controls. In contrast, plasma levels of L-selectin were increased in patients with CHD and PAD. These inconsistencies might be due to an interaction of soluble L-selectin with clotting factors or anticoagulants present in plasma but not in serum. Also, the small number and Caucasian predominance of patients included in previous studies represent limitations that need to be addressed using a rigorous, population-based approach. Herein, we seek to investigate the association of serum L-selectin with subclinical outcomes in a large, ethnically heterogeneous population. In a randomly selected subset of 720 subjects for each of the four ethnicities included in the Multi-Ethnic Study of Atherosclerosis (MESA), serum samples were available for 2403 individuals (579 African Americans, 620 Caucasians, 600 Chinese and 604 Hispanics). Serum L-selectin levels and intima-media thickness (IMT) were measured at exam 2 and CAC was measured at exam 2 or 3 during the cohort follow up. Regression analysis and the Tobit model were used to assess the association of L-selectin levels with IMT and CAC respectively. The mean age was 63±10 years and 47% were men. The mean±SD protein levels were significantly different across ethnicities (867±192 ng/mL in African Americans, 956±215 ng/mL in Caucasians, 834±174 ng/mL in Chinese and 904±195 ng/mL in Hispanics; p<0.0001). In the univariate analysis, age was inversely correlated to the protein levels; in addition, levels were lower in males, regardless of ethnicity and in smokers, except among Hispanics. L-selectin was associated with modestly lower CAC only among Chinese (p=0.030), the association persisted after adjustment for traditional risk factors (p=0.046). No significant association was demontrated between the protein levels and IMT. In conclusion, in this large diverse population, we found that serum L-selectin was modestly associated to measures of subclinical atherosclerosis in Chinese but not in African, European or Hispanic Americans.
Abstract P293: Resting Metabolic Rate, Cardiorespiratory Fitness, and Racial Differences in Adiposity among Adult Women
Authors: Shook Robin P , Hand Gregory A , Paluch Amanda E , Hebert James R , Wang Xuewen , Blair Steven N
Published: July 2021

Background:
African American (AA) adult females have a higher prevalence of overweight and obesity compared to their Caucasian (Cauc) peers. Lower resting metabolic rate (RMR) values, a hypothesized contributor to higher levels of adiposity, have been observed among AA women. However, it is unknown whether cardiorespiratory fitness (CRF) is associated with RMR in this population.

Methods:
Sixty-two overweight/obese (body mass index [BMI] ≥25.0) yet healthy women (42 Cauc, 20 AA) between the ages of 21-35 years were recruited for the present study. RMR was measured using a ventilated hood system. Participants arrived fasted for at least 12 hrs and having refrained from alcohol/exercise for at least 24 hrs. Participants rested in a supine position for 30-minutes, followed by a 30-minute RMR gas collection period. Body weight (BW) and height were measured and body fat (BF) was calculated as the percentage of total weight identified as fat tissue by dual x-ray absorptiometry. CRF was measured via a metabolic cart during a modified Bruce treadmill protocol. Total energy expenditure (TEE) was assessed using an arm-based physical activity monitor worn at all times for 10 consecutive days. Energy intake (EI) was assessed over a 14-day period via interviewer-administered dietary recall.

Results:
Cauc and AA participants were similar in terms of age (27.6±4.2 years), weight (79.9±9.9 kg), BMI (29.4±2.9 kg/m2), body fat percentage (41.0±5.1 percent), and EI (1760±397 kcal/day). Compared to Cauc, AA women were slightly shorter (162.4±7.0 vs. 165.8±5.1 cm, p=0.0371), lower CRF (27.4±3.8 vs. 31.4±5.2 ml/kg/min, p=0.0032), lower TEE (2438±264 vs. 2598±303 kcal/day, p=0.0102) and lower RMR (1436±222 vs. 1569±181 kcal/day, p=0.0154). Energy expenditure resulting from moderate/vigorous activity was higher in Cauc females (552±386 vs. 355±197 kcal/day, p=0.0102). RMR was correlated with fat mass, CRF and race. After adjustment for age, race, body weight, fat-free mass, fat mass, and CRF, the least squares means for RMR remained lower in AA compared to Cauc (1444 vs. 1565 kcal/day, p=0.0034) and was only significantly related race (p=0.0034).

Conclusion:
The results of this study confirm previous research reporting lower RMR values among AA females compared to their Cauc counterparts, though these differences did not result in variations of adiposity. The current analyses suggest CRF plays an important role in the determination of RMR. The differences among racial groups in energy expenditure resulting from moderate/vigorous activity may play a key role in the determination of CRF and ultimately RMR.
Abstract P295: The Association of Chronic Stress with Obesity among Hispanic/Latino Adults. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Isasi Carmen R , Parrinelo Christina M , Gallo Linda C , Carnethon Mercedes R , Birnbaum-Weitzman Orit , Espinoza Rebeca A , Penedo Frank J , Perreira Krista M , Schneiderman Neil , Sotrez-Alvarez Daniela , Van Horn Linda
Published: July 2021

Objectives:
Prior studies suggest that high stress levels are associated with obesity. However, few studies distinguish between type, duration or timing of stressful exposures. In this study, we examined the association of chronic and recent stress with excess weight in a diverse sample of Latino adults.

Methods:
HCHS/SOL is a multicenter cohort study of Latino adults (ages 18-74 years) from 4 US cities (Bronx, Chicago, Miami and San Diego).The Sociocultural Ancillary Study (2009-2011) is a sample of 5,253 participants (61% female) from HCHS/SOL. Overweight was defined as BMI 25-29.9 and Obese as BMI ≥30. Three indicators of stress were studied: chronic stress lasting for at least 6 months (Chronic Burden Scale), lifetime exposure to stressors (Traumatic Stress Schedule), and perceived stress during the last month (past month, Cohen’s Perceived Stress Scale). Odds ratios (OR) were calculated using multinomial regression models to describe the odds of obesity or overweight relative to normal weight; models were adjusted for study sampling design and potential confounders.

Results:
37% of participants were overweight and 41% obese. Mean (standard error) scores of chronic stress, traumatic stress and perceived stress were 1.8 (0.04), 2.1 (.04), and 14.9 (0.16), respectively. After adjustment for confounders, the odds of obesity increased with number of chronic stress events. A higher number of traumatic events were associated with overweight but the association was not longer significant after adjustment for confounders (Table). No association between perceived stress with overweight or obesity was observed.

Conclusions:
Exposure to chronic stressors lasting ≥6 months is more relevant for obesity prevalence than recent exposure (past month) in Hispanics. As high stress and obesity are important problems among Hispanics, stress management techniques may need to be incorporated in obesity prevention and treatment programs for this population.
Abstract P298: An Obesogenic Neighborhood Environment Factor Score and Changes in BMI in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Meyer Katie A , Duffey Kiyah J , Rodriguez Daniel A , Lewis Cora E , Kiefe Catarina I , Gordon-Larsen Penny
Published: July 2021

We sought to identify obesogenic elements of the neighborhood environment using 15 years of individual-level and GIS-derived data in the CARDIA cohort (n=5,115; aged 18-30 at year 0, 1985/86), and to test associations with 15-year BMI change. We first used reduced rank regression (RRR) to derive a weighted combination (factor score) of environmental variables that explained variability in obesity-promoting diet and physical activity (PA) behaviors. RRR outcome variables were diet quality, fast food consumption, and PA; predictors of these behaviors were neighborhood-level indicators of walkability, PA facilities, restaurants and food stores, food prices, cost of living, population density, and neighborhood SES. In our model, a high score reflected: 1) a greater number of fee-based PA facilities, 2) higher food prices, and 3) higher neighborhood SES. We next quantified the association between the factor score and BMI change, hypothesizing an inverse association. In repeated-measures linear regression (4 waves; n=16,343), we observed significant inverse associations between the time-varying environmental factor score and BMI increases, with larger increases among those younger at baseline (figure), adjusting for time-varying covariates. Using a novel application of RRR, we identified an obesogenic score of environmental components that explained variability in diet and PA behaviors and was associated with BMI change in CARDIA.
Abstract P303: Association of Overweight/Obesity and Self Reported Health Status in Hispanics: A Comparison with Non Hispanic Whites
Authors: Ingram Connie , Canossa-Terris Maria , Comerford Mary , Kurlansky Paul
Published: July 2021

Introduction
The growing global prevalence of obesity is recognized as an important risk for cardiovascular disease. Understanding self perception of weight as it pertains to health is critical to the success of weight reduction programs. The impact of ethnicity on this association has not been examined.

Methods
The sample included 927 Hispanic (H) and 72 Non-Hispanics white (NHW) adults who received free cardiovascular screening from Florida Heart Research Institute. Overweight and obesity were measured by Body Mass Index. Self-perceived health status was characterized as excellent, very good, good, fair or poor health. Logistic regression was used to determine independent risk factors for perceived fair-poor health, as well as for excellent, very good health. Odds ratios and 95% Confidence Intervals were calculated.

Results
Both H and NHW overweight/obese subjects tended to view their health as good, very good or excellent: H (overweight 81.1%/obese 73%) and NHW (89.3%/66.7%). Logistic regression revealed the following independent correlates of self-perceived very good or excellent health: NHW (OR 3.618, CI 2.126, 6.157, p<0.001) and exercise (OR 1.640;CI 1.186, 2.268; p=0.003). Hypertension (OR 0.392; CI 0.246, 0.625; p<0.001), overweight (OR 0.551, CI0.386, 0.785, p=0.001) and obesity (OR 0.431, CI 0.288, 0.644; p<0.001) were all negatively associated with very good/excellent status.

Conclusions
Although it is not surprising that participation in regular exercise is associated with a better self-perception of health status, or that hypertension and obesity is correlated with a worse self-assessed health status, there are two striking findings that emerge from this data:

1. The vast majority of both H and NHW subjects do not perceive either overweight or obesity to be a major health problem.

2. Hispanics have a significantly worse self-perception of health status even after controlling for associated factors.This information provides a critical foundation for overcoming fundamental barriers to effective patient education_a critical first step in addressing the current epidemic of obesity in ethnically diverse populations.
Abstract P317: Prevalence, Awareness, Treatment, and Control of Hypertension in the Southern Cone of Latin America
Authors: Rubinstein Adolfo L , Irazola Vilma E , Poggio Rosana , Lanas Fernando , Calandrelli Matías , Ponzo Jacqueline , Olivera Hector , Seron Pamela , Bazzano Lydia , Gutierrez Laura , He Jiang
Published: July 2021

Objective:
Hypertension is the major preventable risk factor for cardiovascular disease (CVD) and premature deaths worldwide. We conducted a population-based cross-sectional study in a multistage-probabilistic sample of around 8,000 subjects aged 35-74 years old from 4 cities of the Southern Cone of Latin America (SCLA): Bariloche and Marcos Paz in Argentina, Temuco in Chile and Canelones in Uruguay, to estimate the prevalence and distribution of hypertension, and to determine hypertension awareness, treatment, and control in this population.

Methods:
Three blood pressure (BP) measurements were obtained by trained observers. Data on history of hypertension and use of BP medications was obtained from a standard questionnaire. Hypertension was defined as a mean systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or use of antihypertensive drugs. Prevalence of hypertension was calculated by weighting sampling factors derived from population census data from 2010 for each city.

Results:
Of the adult population aged 35-74 yrs, 43.3 % (44.7% in men and 41.5% in women) had hypertension. The age-specific prevalence was 24.9%, 39.8%, 59%, and 71.8% for ages 35-44, 45-54, 55-64 and 65-74 yrs, respectively. In addition, the prevalence of hypertension decreased with the levels of education (52.2%, 40.7% and 33.6% for primary, secondary and tertiary/university education, respectively). Overall, 62.2% of hypertensives were aware of their diagnosis, 47.7 % were under drug treatment, and 21.5 % achieved BP control (<140/90 mm Hg). The percentage of patients, who were aware, treated, and controlled was 53.3 %, 37.7 %, and 13.6 %, respectively in men, and 73.9 %, 60.9 %, and 31.7 % in women. The age-specific rate of awareness was 38.6%, 55.8%, 70.9%, and 78.4% for ages 35-44, 45-54, 55-64, 65-74 yrs. The hypertension control rates were 13.5%, 16.6%, 24.3% and 30.0% for patients aged 35-44, 45-54, 55-65, and 65-74 yrs. The control rates were 62.4%, 44.6%, 41.7%, and 41.9% among those who were under drug treatment for the above age-groups.

Conclusion:
In the SCLA, hypertension remains a significant public health problem. The prevalence of hypertension is high while the awareness, treatment and control are unacceptably low in the general population and vary by age, gender, and education levels. There is a clear gradient by age regarding hypertension control, which is better in the oldest stratum. This finding seems to be related to better awareness rates and hence more chances to be treated for aged subjects. However, when considering only those who are receiving drug treatment, the youngest are better controlled than the oldest, mainly due to higher levels of BP in the latter. These data provide a basis for targeting public health policies to reduce BP levels and the prevalence of hypertension in the region.
Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Glasser Stephen P , Halberg Daniel L , Sands Charles , Muntner Paul , Safford Monika
Published: July 2021

Background:
Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD).

Methods:
We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors.

Results:
This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001).

Conclusions:
High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.