bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P104: Serum Homocysteine is Not Independently Associated with an Atherogenic Lipid Profile: The Very Large Database of Lipids (VLDL-21) Study
Authors: Lupton Joshua , Quispe Renato , Kulkarni Krishnaji , Martin Seth S , Jones Steven R
Published: March 2022

Background:
Hyperhomocysteinemia is an independent risk factor for cardiovascular disease, but the mechanism for this risk remains unclear. Complicating this association, reducing serum homocysteine (Hcy) has not been shown to decrease cardiovascular disease events in randomized controlled trials. This study aims to examine the relationship between Hcy and several lipid measures.

Methods:
Our analyses included a subset of 18,297 U.S. adults from the Very Large Database of Lipids, who had an extended lipid panel by density gradient ultracentrifugation, which included direct measurement of triglycerides (TG), and the cholesterol concentration of low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), non-HDL-C, very low-density lipoprotein (VLDL-C), and remnant-lipoprotein cholesterol (RLP-C: IDL-C + VLDL3-C). Additional measurements were levels of Hcy, hemoglobin A1c (HbA1c), insulin, creatinine, and blood urea nitrogen (BUN). Subjects were categorized into Hcy quartiles. Linear regression models were performed using lipid measures and Hcy as dependent and independent variables respectively, and further adjusted with potential confounders (age, sex, HbA1c, insulin, creatinine, and BUN levels) in multivariable regression.

Results:
In unadjusted analysis, levels of LDL-C (p<0.001), non-HDL-C (p<0.001) and HDL-C (p<0.001) were 7-10% lower whereas levels of TG (p<0.001), VLDL-C (p=0.016) and RLP-C (p<0.001) were 2-6% higher in the highest Hcy quartile. These associations between Hcy levels and lipids were eliminated (p-value range: 0.101-0.750) when controlling for age, sex, HbA1c, insulin, creatinine, and BUN.

Conclusions:
Although high levels of Hcy were associated with 2-6% higher TG-rich lipoproteins in unadjusted analysis, after adjustment for confounders our findings do not support the hypothesis that hyperhomocysteinemia is associated with an atherogenic lipid profile.
Abstract P120: Acute Dietary Nitrate Supplementation Does Not Attenuate Oxidative Stress or the Hemodynamic Response During Submaximal Exercise in Hypobaric Hypoxia
Authors: Carriker Colin R , Vaughan Roger A , Mermier Christine M , McLain Trisha A , Johnson Kelly E , Beltz Nicholas M , McCormick James J , Cole Nathan H , Witt Christopher C , Gibson Ann L
Published: March 2022

Introduction:
Oxidative stress is exacerbated during hypoxic conditions (i.e. high altitude exposure, congestive heart failure, or peripheral artery disease). Dietary nitrate supplementation increases plasma nitrite (denotes nitric oxide bioavailability), reduces resting/submaximal blood pressure (BP) and may enhance exercise performance in certain healthy and diseased populations.

Hypothesis:
We hypothesized dietary nitrate would improve arterial oxygen saturation (SaO
2
) and reduce: oxidative stress while reducing submaximal oxygen consumption, BP, and perceived exertion (RPE) during exercise in hypobaric hypoxia (3500m).

Methods:
Nine well-trained (60.0±7.0 ml/kg/min) males (29±7 yr) completed a maximal aerobic capacity test (VO
2max
) and five 5-min cycling bouts of increasing intensity at their normobaric elevation (1600m). Intensities at 25, 40, 50, 60, 70% VO
2max
were used during trial 2 (T2) and trial 3 (T3) cycling bouts. Participants minimized nitrate-rich food consumption during a 4-day dietary washout prior to T2 and T3. Participants consumed a nitrate-depleted placebo (PL) or nitrate-rich (12.8 mmol; NR) beverage 2.5 hours prior to T2 and T3 in a double-blind, placebo-controlled, crossover study. Exercise during hypobaric hypoxia (3500m; T2 and T3) consisted of a 5-min warm-up (25% of normobaric VO
2max
) and four (40, 50, 60, 70% of normobaric VO
2max
) additional 5-min cycling bouts each separated by a 4-min passive rest.

Results:
Pre-exercise plasma nitrite was elevated following NR consumption compared to PL (p<0.05). Beverage-specific oxygen consumption, SaO
2
, BP and RPE were similar at all submaximal intensities. In both conditions (PL and NR), following exercise at 3500m, markers of oxidative stress (catalase and 8-isoprostane) were elevated compared to baseline resting values (p<0.05). However, post-exercise oxidative stress markers were similar between groups (placebo vs nitrate rich) for both catalase and 8-isoprostane (p=.94 and p=.16; respectively).

Conclusions:
Our findings do not support the efficacy of dietary nitrate supplementation prior to exercise at altitude in a healthy population.
Abstract P138: The Association of a Greater Step Count with Body Composition in Young Adults
Authors: DeMello Madison M , Drenowatz Clemens , Hand Gregory A , Blair Steven N
Published: March 2022

Introduction:
Walking has been associated with a reduction of cardiovascular disease risk, but there remains limited information on the association between volume of steps and body composition. Therefore, the purpose of this study is to examine the association between the number of steps per day and percent body fat in young, generally healthy adults.

Hypothesis:
It is hypothesized that those with a greater number of steps per day will have a decreased percent body fat, compared to those who spend more time in sedentary behavior.

Methods:
A sample of 418 young adults (49% male), between the ages of 21 and 35 and a body mass index (BMI) between 20 and 35 kg/m2 provided valid objective activity data. Participants were given a SenseWear mini armband to wear for ten days with compliance set at 7 days of wear time, including 2 weekend days, with at least 21 hours of verifiable time per day. Step count was averaged per day based off the total days of armband wear. In addition, participants completed a dual x-ray absorptiometry scan to measure fat mass and fat free mass, percent body fat (BF) was then calculated.

Results:
The average BMI of the sample was 25.3 kg/m2 with a percent body fat of 22.5% and 34.1% for males and females, respectively. Males had higher step counts than females (p=.005). Quintiles were created based off average steps per day (±SD) (mean values for least steps to most steps: 4051 ± 336; 4503 ± 800; 7286 ± 360; 8544 ± 436; 12,011 ± 2,140). There was a linear trend across quintiles (p for trend < .01) of decreasing percent body fat with increased steps, after adjusting for age and sex. No significant difference between step quintiles was observed for BMI (p for trend = .06) after adjusting for the same covariates. Results were similar when analyzing males and females separately.

Conclusion:
In conclusion, these results indicate that a higher step count is associated with lower BF. Given that percent body fat is associated with various health outcomes and the fact that walking is an inexpensive and feasible activity for most populations, further efforts are needed to increase steps/day in US adults.
Abstract P150: Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women’s Health Initiative Observational Study
Authors: Haring Bernhard
Published: March 2022

Objective:
To determine whether adherence to dietary patterns assessed by the alternative Mediterranean diet score (aMED), the Healthy Eating Index (HEI) 2010, the Alternate Healthy Eating Index (AHEI) 2010 or the Dietary Approach to Stop Hypertension (DASH) diet score is associated with hip or total fractures in postmenopausal women.

Methods:
The Women’s Health Initiative Observational Study (WHI-OS) prospectively followed 90,014 postmenopausal women. Food frequency questionnaires were used to assess adherence to established healthy eating patterns at baseline. Incident total and hip fractures were queried annually. We excluded toe, finger, sternum and clavicle fractures as total fracture events since these fractures are less likely related to osteoporosis. Associations of first incident fractures with dietary patterns were estimated using covariate-adjusted Cox proportional hazards models.

Results:
During a median follow-up of 15.9 years, we documented 2,121 hip fractures and 28,718 self-reported total fractures. In multivariable analyses, adhering to aMED was associated with a lower risk for hip fractures (HR
Q5
= 0.80, 95% CI, 0.66, 0.97; p
trend
= 0.02) but not for total fractures (HR
Q5
= 1.01, 95% CI, 0.95, 1.07; p
trend
= 0.77). Greater adherence to HEI-2010 or DASH was inversely related to hip fracture risk (p
trend
= 0.02 and 0.03, respectively) but not to total fracture risk (p
trend
= 0.15 and 0.47, respectively). The AHEI-2010 was not associated with total or hip fractures.

Conclusions:
Higher aMED, HEI-2010 or DASH dietary scoring was associated with lower risk for hip fractures. These results support that following a healthy dietary pattern is one cornerstone to maintain bone health in postmenopausal women.

Table. Hazard Ratios (95% CI) for hip fractures and total fractures by quintiles of dietary pattern in the Women’s Health Initiative Observational Study
1

*Model 1 adjusted for age, race/ethnicity and body mass index.

** Model 2 model adjusted for age, race/ethnicity, body mass index, smoking status, physical activity, self-reported health, diabetes status, history of fracture at age ≥ 55, physical function score, number of chronic medical conditions, number of psychoactive medications and use of HT, bisphosphonates, calcitonin and SERM.

1
AHEI-2010, Alternative Healthy Eating Index[[Unable to Display Character: –]]2010; aMED, alternate Mediterranean Diet; DASH, Dietary Approaches to Stop Hypertension; HEI-2010, Healthy Eating Index[[Unable to Display Character: –]]2010; MCI, Mild Cognitive Impairment; PD, Probable Dementia. Quintile 1 (Q1) represents the least healthy quintile, whereas quintile 5 (Q5) represents the healthiest quintile.
Abstract P162: Maintenance of Gait Speed in Elderly Men and Women Reduces Risk of Hospitalization Irrespective of the Extent of Coronary Artery Calcium
Authors: Siggeirsdottir Kristin , Olafsson Orn , Launer Lenore J , Harris Tamara B , Aspelund Thor , Gudnason Vilmundur
Published: March 2022

Introduction:
Coronary artery disease (CAD) is a major contributor to medical costs in old age, including risk of hospitalization and risk of disability. Coronary artery calcium (CAC) is an accepted biomarker for CAD. Individuals lose their functionality with increasing age at different pace due to various reasons including chronic disease, such as CAD. Functional impairment, measured by gait speed, may be an important indicator of risk for hospitalization. We assessed the hypothesis that elderly people who maintain their gait speed are less likely to be hospitalized independent of CAD defined by CAC.

Methods:
Data from the population based AGES Reykjavik Study included 1208 men and 1660 women walking without aid, mean age 76.4 years (SD 4.9), were examined between 2002-2006 and 2007-2011. CAC was measured at visit one and gait speed at both visits. Hospital records were obtained for all participants. Hospital admission rates were estimated using age adjusted survival models according to baseline gait speed at [0.1-0.8), [0.8-1.0), [1.0-2.0) m/sec; change in gait speed (reduced, maintained or increased) and by CAC categories (0-300, and more than 300 Agatston units). Analysis was performed for men and women separately and the effect of adjusting for knee strength evaluated.

Results:
Both lower baseline and decreasing gait speed were associated with increased rate of hospitalization over five years follow-up. The rate ratio was slightly attenuated after adjustment for knee extension. When change in gait speed over five years period was examined, those who maintained or increased their gait speed had significantly lower age adjusted hospitalization rate for both men and women (Figure). This effect of gait speed was statistically significant for both CAC categories in all categories of gait speed (p< 0.05).

Conclusion:
These results show that maintenance of gait speed even in those who walk at a slow gait speed benefit by less hospitalization even if they have considerable CAD and thus potentially reduce health care cost.
Abstract P164: Ideal Cardiovascular Health and Vascular Aging
Authors: Gaye Bamba , Perrier Marie C , Thomas Frédérique , Guibout Catherine , Pannier Bruno , Boutouyrie Pierre , Jouven Xavier , Empana Jean P
Published: March 2022

Background:
Arterial stiffness is a robust subclinical marker of cardiovascular disease (CVD). Furthermore, under the vascular aging concept, arterial stiffness also reflects the cumulative exposure to environment over life. Studying whether and how cardiovascular health (CVH) at a given point in time correlates with arterial stiffness may help identifying asymptomatic subjects who are at high risk for future CVD and who could benefit the most from interventions. Here, we hypothesized that ideal CVH would be inversely associated with arterial stiffness.

Methods and results:
Common Carotid Artery IMT (CCA-IMT), carotid stiffness (Elastic Young’s modulus) and carotid distensibility were measured by three trained technicians certified in vascular echography using high-precision echotracking device in 6457 participants attending a health check up in a large health center in France between 2008 and 2012. Participants were categorized as having poor, intermediate and ideal cardiovascular health if they had 0-2, 3-4 and 5-7 ideal health metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure). Carotid parameters were dichotomized according to their median value and multivariable logistic regression analysis was performed to examine the relationship between ICVH (exposure variable) with each carotid parameter (outcome). Mean age was 59.4 (SD 6.2) years and 38.2 % were females. Poor, intermediate and ideal cardiovascular health was present in 39.93%, 49.75% and 10.32% of study participants. Mean CCA-IMT was 654.47 (SD 117.77) and 612.45 (SD 113.86) micrometers in subjects with a poor and an ideal CVH respectively, corresponding to an absolute difference of 42 micrometers. After multivariable adjustment and compared to poor ICVH, ideal CVH was associated significantly with lower CCA-IMT (odds ratio = 1.76; 95% CI: 1.46;2.11) and carotid stiffness (odds ratio = 2.19; 95% CI: 1.83;2.63), and higher carotid distension (odds ratio = 2.81; 95% CI: 2.34;3.39). Theses associations were stronger in magnitude with the biological as compared to the behavioral component.

Conclusion:
In asymptomatic subjects aged 50-75, an ideal cardiovascular health was associated with significantly less arterial stiffening. The absolute difference in CCA-IMT beteween ideal and poor CVH corresponds to a 4.2 years difference in vascular aging. This dramatic difference supports the promotion of ideal cardiovascular health.

Key words: Cardiovascular disease prevention, epidemiology, Carotid intima-media thickness, Vascular aging.
Abstract P178: Vitamin D Biomarkers with Risk of Hypertension and Renin-Angiotensin System
Authors: Wang Lu , Cook Nancy , Manson JoAnn E , Gaziano J. Michael , Buring Julie E , Sesso Howard D
Published: March 2022

Background:
Experimental studies suggest that vitamin D may potentially prevent the development of hypertension through down-regulation of the renin-angiotensin system. However, evidence from epidemiologic studies remains limited.

Objective:
In parallel nested case-control studies of women from the Women’s Health Study (WHS) and men from the Physicians’ Health Study (PHS) with >10 years follow-up, we examined the prospective associations between the circulating biomarkers of vitamin D status with risk of hypertension, as well as the inter-relation between vitamin D biomarkers and renin production.

Methods:
In each cohort, 500 incident hypertension cases and 500 controls were randomly selected from participants who were free of cardiovascular disease, cancer, and hypertension and provided bloods at baseline. Hypertension cases were identified based on self-reported blood pressure, physician’s diagnosis, or medication use. Controls were matched to cases on gender, age, race, follow-up time, and month of blood draw. Baseline plasma 25(OH)-vitamin D, parathyroid hormone (PTH), and total renin (pro-renin plus active renin) concentrations were measured. Analyses were first performed in each cohort separately and, given the similar results, finally combined for both cohorts.

Results:
Baseline concentrations of 25(OH)-vitamin D (mean of 26.6 vs. 27.0 ng/mL) and PTH (32.6 vs. 32.2 pg/mL) were similar in hypertension cases and controls. In the crude matched model, the risk of hypertension did not change with 25(OH)-vitamin D or PTH concentrations. Additional adjustment for other known hypertension-related risk factors minimally affected the associations. After adjusting for baseline smoking, alcohol use, exercise, menopausal status and hormone therapy use among women, body mass index, and history of diabetes and hypercholesterolemia, the relative risks of incident hypertension across increasing quintiles of 25(OH)-vitamin D were 1.00, 1.42 (95% CI: 0.94-2.16), 0.94 (95% CI: 0.60-1.48), 0.99 (95% CI: 0.61-1.61), and 1.03 (95% CI: 0.63-1.69) (p, trend, 0.48), and across increasing quintiles of PTH were 1.00, 1.26 (95% CI: 0.83-1.92), 0.91 (95% CI: 0.60-1.40), 1.10 (95% CI: 0.70-1.71), 0.92 (95% CI: 0.59-1.44) (p, trend, 0.50). These associations were similar in men and women. Among controls, plasma 25(OH)-vitamin D was inversely correlated with PTH (Pearson r: -0.24, p<0.0001), while neither 25(OH)-vitamin D (r: -0.02, p=0.53) nor PTH (r: -0.01, p=0.69) was correlated with total renin concentrations.

Conclusions:
In prospective cohorts of men and women, we found no association between either baseline plasma 25(OH)-vitamin D or PTH with the risk of hypertension, or between either 25(OH)-vitamin D or PTH with total renin concentration. More research is needed to further elucidate the specific effect of vitamin D in the development of hypertension.
Abstract P181: Blood Pressure and All-cause Mortality Among Patients with Type 2 Diabetes
Authors: Li Weiqi , Katzmarzyk Peter T , Horswell Ronald , Wang Yujie , Hu Gang
Published: March 2022

Background:
The recommended goal for blood pressure (BP) control has recently been adjusted for people with diabetes, but the optimal BP control range for the diabetic population is still uncertain. Aims: To investigate the association between blood pressure and the risk of mortality among patients with type 2 diabetes.

Methods:
We performed a prospective cohort study of 35,261 patients with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of BP with all-cause mortality.

Results:
During a mean follow-up period of 8.7 years, 4,199 deaths were identified. The multivariable-adjusted hazard ratios of all-cause mortality associated with different levels of systolic/diastolic BP (<110/65, 110-119/65-69, 120-129/70-80, 130-139/80-90 [reference group], 140-159/90-100, and ≥160/100 mmHg) were 1.70 (95% confidence interval [CI] 1.42-2.04), 1.26 (95% CI 1.07-1.50), 0.99 (95% CI 0.86-1.12), 1.00, 0.92 (95% CI 0.82-1.03), and 1.10 (95% CI 0.98-1.23) using baseline BP measurements, and 2.62 (95% CI 2.00-3.44), 1.77 (95% CI 1.51-2.09), 1.22 (95% CI 1.09-1.36), 1.00, 0.90 (95% CI 0.82-1.00), and 0.98 (95% CI 0.86-1.12) using an updated mean value of BP during follow-up, respectively. The U-shaped associations were confirmed in both African American and white patients, in both men and women, in those who were or were not taking antihypertensive drugs; and in patients aged 30-49 years and 50-59 years.

Conclusion:
The current study found a U-shaped association between BP at baseline and during follow-up and the risk of all-cause mortality among patients with type 2 diabetes.
Abstract P183: Visit to Visit Variability in Diastolic Blood Pressure Predicts Incident Cardiovascular Disease Events in Middle-aged Adults
Authors: Hwang Shih-Jen , Larson Martin G , Liu Chunyu , Vasan Ramachandran S , Levy Daniel
Published: March 2022

Introduction:
visit-to-visit variability (VVV) in blood pressure (BP) relates to risk for cardiovascular disease (CVD) in clinical studies. It is unknown if VVV in systolic or in diastolic BP predicts incidents CVD in community-based middle-aged adults.

Methods:
The study sample comprised 1817 Framingham Heart Study (FHS) offspring cohort participants free of clinical CVD at the sixth examination (1995-1998) cycle who had attended examination cycles three, four and five at four year intervals. Exclusion criteria include medication treatment for elevated BP at any of the four examinations. We defined VVV in systolic and diastolic BP as the standard deviation of BP values across the four examinations. Incident CVD events were identified through physician panel review of medical records with follow-up through December 31, 2013. We used proportional hazards regression models to test associations of between VVV in systolic and diastolic BP and CVD risk adjusting for age, sex, body-mass-index, mean systolic and diastolic BP, total cholesterol, HDL cholesterol, medication treatment for hyperlipidemia, fasting blood sugar, diabetes, and cigarette smoking.

Results:
During follow up (average 16.2 years), 276 (15.2%) participants developed CVD. Mean and standard deviation values of VVV in systolic and diastolic BP were 8.09±4.48 and 5.38±2.5, respectively. Each standard deviation increase in diastolic BP VVV was associated with a hazards ratio (HR) of 1.08 (95% confidence interval [CI] 1.03-1.14) for incident CVD. The HR of systolic BP VVV was 1.03 (95% CI 1.00-1.06). Including both variables gave an HR of 1.01 (95% CI 0.98-1.04) for VVV in systolic BP and 1.08 (95% CI 1.03-1.13) for VVV in diastolic BP. There were significant linear trends in CVD risk according to quartiles of VVV in systolic and diastolic BP. Participants in the highest quartile of VVV in systolic BP had a HR of 1.68 (95% CI 1.13-2.50) for incident CVD; those with highest quartile of VVV in diastolic BP had a HR of 1.66 (95% CI 1.17--2.35).

Conclusion:
Visit-to-visit variability in BP predicts CVD risk in middle-aged adults.
Abstract P188: Repeated Blood Pressure Measurements in Relation to Cardiovascular and All[[Unable to Display Character: ‑]]cause Mortality in Individuals with and without Antihypertensive Medication: The Rancho Bernardo Study
Authors: Geleijnse Johanna M , Tielemans Susanne M , Laughlin Gail A , Boshuizen Hendriek C , Barrett-Connor Elizabeth , Kromhout Daan
Published: March 2022

Introduction:
The predictive value of systolic blood pressure (SBP) for cardiovascular disease (CVD) in individuals using antihypertensive medication has not yet been established in epidemiological studies. We investigated the association of average SBP and SBP trajectories with CVD and all-cause mortality, accounting for antihypertensive medication.

Methods:
Data from 762 participants from the Rancho Bernardo Study were used. Five examinations took place from 1984 - 2002; mortality data were obtained from 2002 - 2013. Average SBP was defined as the mean of all available SBP levels between 1984 - 2002 and SBP trajectories over this period were derived using groupbased trajectory modeling. Cox proportional hazards analysis was used to investigate associations of average SBP and SBP trajectories with CVD and all-cause mortality, adjusted for age, sex, plasma cholesterol, smoking, diabetes, and antihypertensive medication. We examined whether use of antihypertensive medication modified these associations by means of interaction terms in the multivariable models.

Results:
Mean (± SD) baseline age was 65.7 ± 8.4 years, and 67% were female. During a median follow-up of 11.7 years, 286 participants died, 34% due to CVD. For average SBP, each 20-mm Hg increment was associated with a 1.4-times greater CVD mortality risk and 1.2-times all-cause mortality risk (Table 1). For SBP trajectories
,
the highest trajectories were associated with a 2-to-3-times greater CVD mortality risk and 1.5-times greater all-cause mortality risk, compared with the lowest trajectory. These associations were not modified by antihypertensive medication (
P
for interaction >0.10).

Conclusions:
In the general middle-aged and older population of the Rancho Bernardo Study, long-term average SBP levels and trajectories were significant predictors of CVD and all-cause mortality, irrespective of prescribed antihypertensive medication in the 1980s and 1990s.
Abstract P199: Performance of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations by Socioeconomic Status. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Colantonio Lisandro D , Carson April P , Lloyd-Jones Donald M , Richman Joshua S , Howard George , Howard Virginia J , Safford Monika M , Muntner Paul , Goff David C
Published: March 2022

Background:
The Pooled Cohort risk equations over predict atherosclerosis cardiovascular disease (ASCVD) risk in some contemporary cohorts but not in others. ASCVD risk differs by socioeconomic status (SES) which may influence the performance of the risk equations. We analyzed the performance of the Pooled Cohort risk equations by SES and tested whether adding SES improves the discrimination of the Pooled Cohort risk equations.

Methods:
We used data from black and white participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study from 2003 to 2007 (all participants ≥45 years of age). The analysis was restricted to participants for whom ASCVD risk may lead to consideration of statin initiation (45-79 years of age without ASCVD or diabetes, LDL cholesterol 70-189 mg/dL, and not taking lipid-lowering medications, N=10,231). SES was assessed using data on living alone, education and household income. Incident ASCVD (fatal/non-fatal stroke, MI or CHD death) was adjudicated through December 2012.

Results:
The Pooled Cohort risk equations were well calibrated among participants with low SES but over predicted ASCVD risk among participants with higher SES (Table). Discrimination of the equations improved after adding household income (continuous net reclassification improvement: 0.12 [95% CI: 0.03, 0.21]) but not living alone (0.06 [-0.03, 0.14]), or education (-0.04 [-0.13, 0.06]). The continuous net reclassification improvement was 0.10 (95% CI: 0.02, 0.19) after adding the cumulative number of indicators for low SES to the variables in the Pooled Cohort risk equations.

Discussion:
SES may help explain why the calibration of the Pooled Cohort risk equations has varied across cohorts. Adding information on SES may improve the performance of ASCVD risk equations.
Abstract P200: Neighborhood Disadvantage and Poor Social Conditions Influence Cardiovascular Disease Incidence in African American Adults: A Prospective Analysis in the Jackson Heart Study
Authors: Barber Sharrelle , Hickson DeMarc A , Wang Xu , Sims Mario , Nelson Cheryl , Diez-Roux Ana
Published: March 2022

Introduction:
Racial residential segregation results in increased exposure to adverse neighborhood environments in African Americans; however the impact of economic and social neighborhood conditions on CVD incidence has not been examined in large, socioeconomically diverse African American samples.

Hypothesis:
Neighborhood disadvantage and poor social conditions (i.e. violence, physical disorder, and low social cohesion) will be associated with increased risk of developing CVD.

Methods:
The study included 4,096 African American women and men ages 21-93 from the Jackson Heart Study. Census tracts served as proxies for neighborhoods. Neighborhood disadvantage was assessed using 8 indicators from the 2000 US Census. Neighborhood-level social conditions including social cohesion, violence, and physical disorder were assed using self-reported, validated scales. Multivariable cox-proportional hazards models were used to calculate gender-stratified adjusted hazard ratios and 95% confidence intervals.

Results:
A total of 232 incident cases of CVD occurred during a median follow-up of 8.38 years. Age-adjusted incidence rates generally increased as neighborhood economic and social conditions worsened for both women and men. Among African American women, each standard deviation increase in neighborhood disadvantage was associated with a 25% increased risk of developing CVD after adjustment for socio-demographic characteristics (HR: 1.25, 95% CI: 1.05-1.49). Risk of developing CVD also increased as levels of neighborhood violence and physical disorder increased after socio-demographic adjustment (HR: 1.13, 95% CI: 1.00-1.28 and HR: 1.20, 95% CI: 1.02-1.40, respectively). No statistically significant associations were observed among African American men in multivariable-adjusted models.

Conclusion:
In conclusion, worse neighborhood economic and social conditions contributed to increased risk of developing CVD among African American women in our sample. Policies and interventions directly addressing these issues may alleviate the burden of CVD in this group.
Abstract P224: The Association of Surgical versus Natural Menopause with Future Left Ventricular Structure and Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Appiah Duke , Schreiner Pamela J , Nwabuo Chike C , Wellons Melissa F , Lewis Cora E , Lima Joao A
Published: March 2022

Introduction:
The association of surgical and natural menopause (SM and NM, respectively) with CVD outcomes is controversial. We assessed the hypothesis that CVD risk factor levels antecedent to menopause explain differences in future left ventricular (LV) structure and function parameters rather than type of menopause.

Methods:
We studied 825 premenopausal women (49% black) from the CARDIA study in 1990-1991 (baseline, mean age: 32 years) who later reached menopause by 2010-2011 and had echocardiographs at these two time points.

Results:
During 20 years of follow up, 508 women reached NM while 317 underwent SM (34% with bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have higher mean values of systolic blood pressure, body mass index as well as lower mean HDL cholesterol, physical activity, parity and years of education. With the exception of race, no statistically significant differences were found by ovarian status among women with SM. In 1990-1991, no differences in LV structure and function were found between women who later reach NM or SM. In 2010-2011, women with SM had significantly higher LV mass, LV mass/volume ratio, E/e’ ratio, and impaired longitudinal and circumferential strain than women with NM (Table 1). No significant differences in these measures were found among SM by ovarian status. Controlling for baseline echocardiographic parameters, demographics, BMI, physical activity, parity, smoking, systolic blood pressure and age at menarche in linear regression models attenuated these differences between groups (Table 1). Further adjustment for age at menopause and hormone therapy use did not change these results.

Conclusion:
In this study, presurgical CVD risk factors among women with SM attenuated the adverse postsurgical measures of LV structure and function found among such women. These data suggest that premenopausal CVD risk factors rather than gynecologic surgery predispose women with SM to elevated future CVD risk.
Abstract P229: Small Visceral Adipose Volumes and Quality Associated with Aortic and Coronary Artery Calcification in Women with SLE
Authors: Shields Kelly J
Published: March 2022

Introduction:
Women with systemic lupus erythematosus (SLE) have an increased risk of cardiovascular disease (CVD) not explained by CVD or SLE risk factors. Small visceral fat volumes of the heart and aorta quantified by computed tomography (CT) have been associated with subclinical CVD. Additionally, fat quality, assessed by CT attenuation (Hounsfield Units, HU), may confer CVD risk.

Hypothesis:
Low density (more negative HU) fat is associated with aorta and coronary artery calcification (AC/CAC) in women with SLE independent of fat volume and BMI or waist-to-hip ratio (whratio).

Methods:
CT scans from clinically CVD-free SLE women (n=143) were used to quantify AC/CAC (Agatston score) and aortic perivascular and total heart fat tissue (aPVAT, TAT) volumes. Fat quality was assessed using average HU (aorta:avgHUa; heart:avgHUh). Logistic regression models (any AC/CAC) were used and final models were adjusted for BMI or whratio.

Results:
In this study, AC/CAC was detected in 118/143 women (AC score (median (IQR)): 70(10-381) CAC score 1.4(0-30)). SLE women with any AC/CAC were more likely to be hypertensive and postmenopausal with a greater BMI (all p<0.05). Those with any AC had elevated circulating levels of CRP, fibrinogen and total cholesterol, while those with any CAC also had higher triglyceride, homocysteine, C3 and C4 (all p<0.05). SLE with any AC/CAC had greater volumes (cm
3
) of TAT (111 (84-137)) and aPVAT (34 (27-45)) when compared to those with no AC/CAC (TAT 71 (52-102); aPVAT 27 (23-30), both<0.01). SLE women with any AC/CAC had a more positive avgHUa (mean(std): -83.4(1.9)) when compared to those with no AC/CAC (-84.5(1.6)), p<0.03). In logistic regression analysis, TAT (OR[95%]: 2.8[1.4-5.6]), aPVAT (4.9[1.7-14]) and avgHUa (1.9[1.1-3.1]) were associated with any AC/CAC (all p<0.03). After adjusting for BMI or whratio, TAT remained associated with any AC (2.1[1.0-4.2] and 2.8[1.4-5.5], p<0.05) and any CAC (1.7[1.0-2.7] and 2.4[1.5-3.7], all p<0.05). Both aPVAT and avgHUa were attenuated when adjusting for BMI with any AC; however, avgHUa remained significant with any CAC (1.9[1.2-3.0), p<0.01). The association with any AC and CAC remained significant when adjusting for whratio for both aPVAT (5.4[1.8-16], 1.9[1.2-3.1], both p<0.01) and avgHUa (1.7[1.0-2.9], 1.9[1.2-3.1]) both p<0.04).When evaluating fat volume and quality with any CAC, avgHUa (2.1[1.3-3.5],p<0.01) attenuated aPVAT(1.3[0.86-1.8],p=0.2).

Conclusions:
Fat volumes surrounding the heart and aorta are greater and, contrary to our hypothesis, the avgHU was more positive in clinically CVD-free SLE women with calcification. This higher density may reflect unhealthy fibrotic fat. AC generally precedes CAC development and the independent association of both aPVAT and avgHUa suggest that the relationship between fat volume and quality may be an indicator of more advanced vascular calcification and CVD risk.
Abstract P250: Changes in Glycemia and Blood Lipids Following a 4 Month Mhealth Walking Intervention
Authors: Hook Benjamin E , Jarrett Catherine L , Herbold Jennifer L , Tucker Wesley J , Hurley Jane C , Todd Michael , Bhuiyan Nishat , Fernandez Jacqueline A , Adams Marc A , Angadi Siddhartha S
Published: March 2022

Introduction:
Walking interventions focused on increasing step counts are typically associated with salutary effects on glycemia, fasting insulin, insulin resistance and blood lipids which may be in turn associated with improvements in cardiorespiratory fitness (peak oxygen uptake [[Unable to Display Character: –]] VO
2peak
) and vascular stiffness. We
hypothesized
that a novel 4-month, behavioral economics-based walking intervention would have favorable effects on glucose homeostasis and blood lipids and that these in turn would be related to VO
2peak
and vascular stiffness (carotid femoral pulse wave velocity [[Unable to Display Character: –]] cfPWV).

Methods:
We carried out secondary analyses on a subsample of sedentary, overweight/obese adults who participated in a 4-month, 2x2, randomized-controlled walking intervention examining the effects of goal setting (static v. adaptive goals) and rewards (immediate v. delayed) on steps/day (N=96). Fasting blood samples (n=58) were collected from participants before and after the intervention. Premenopausal females were in the follicular phase of their menstrual cycles. Lipid and glucose levels were measured using an automated chemistry analyzer, while insulin was measured using radio-immunoassay. Homeostatic model of insulin resistance (HOMA-IR) was calculated using the following formula (HOMA-IR=glucose x insulin / 405). We examined associations [partial correlations (adjusted for age)] between changes in blood biomarkers and VO
2peak
and cfPWV, irrespective of group, and we used linear mixed models to examine between-group differences in levels of and change in biomarker outcomes.

Results:
Groups did not differ in overall levels of, or degree of change in, biomarker outcomes (all p>0.05). Mean changes, irrespective of group, in biomarkers were as follows: glucose Δ= 0.74± 4.5mg/dl; insulin Δ= 0.09 ± 4.1 μU/ml; total cholesterol Δ= 0.24 ± 20.6 mg/dl; HDL-C Δ= 0.27 ± 5.1 mg/dl; LDL-C Δ= 1.3 ± 19.9 mg/dl; triglycerides Δ= 1.7 ± 27.2 mg/dl; HOMA-IR Δ = -.0548 ± 1.05). We found no significant associations between change in biomarker levels and change in VO
2peak
or change in cfPWV (all correlation coefficients < 0.15; p > 0.05).

Conclusion:
A 4-month, behavioral economics-based mHealth intervention focused on increasing steps/day did not bring about favorable changes on markers of glycemia, insulin resistance and blood lipids.
Abstract P274: Trans-generational Impact of Diet in Pregnancy: Maternal Dietary Intake of Grains During Pregnancy and Offspring Growth and Obesity From Birth Through Age of 7 Years
Authors: Zhu Yeyi , Olsen Sjurdur F , Mendola Pauline , Hu Frank B , Zhang Cuilin
Published: March 2022

Introduction:
Emerging data from animal studies suggest that diet during pregnancy may affect fetal growth and metabolic programming of the offspring with long-term consequences. Epidemiologic data on transgenerational effects of maternal diet are sparse.

Objective:
We prospectively investigated the association of maternal diet, in particular, intake of grains during pregnancy with offspring growth and risk of obesity from birth through age 7 years among high risk populations, women complicated by gestational diabetes (GDM) and their children born from the index pregnancy.

Methods:
In the Danish National Birth Cohort (1996-2002), 918 women complicated by GDM and their singleton children were included in the study. Diet during pregnancy was measured by a validated food frequency questionnaire. Offspring body mass index z-scores (BMIZ) by WHO references were calculated using clinically measured weight and length/height at birth, 5 months, 12 months, and 7 years. Overweight/obese was defined by WHO cutoffs. Linear and Poisson regression with robust standard errors were applied, adjusting for maternal pre-pregnancy BMI and other demographic, lifestyle, and dietary factors.

Results:
Refined grain intake during pregnancy was significantly and positively associated with offspring growth at 7 years: adjusted β coefficient (95% CI) for a 1-serving per-day increment of refined grains associated with BMIZ at 7 years was 0.09 (0.02, 0.16). At 7 years, offspring born from women who consumed refined grains in the highest quartile (≥4.7 servings/day) experienced more than 1.7-fold increased risk of overweight/obesity as compared to those in the lowest quartile (<2.2 servings/day) [adjusted relative risk (RR) (95% CI) = 1.74 (1.03, 2.93)]. Corresponding RR (95% CI) comparing the extremely high amount of refined grains (the highest 10th percentile, ≥5.9 servings/day) to the lowest quartile was 2.59 (1.28, 5.23). The associations appeared being modified by offspring diet and lifestyle factors during childhood: being more pronounced among children with less favorable lifestyle (i.e., who were breastfed <6 months, physically inactive, or consumed more sugar sweetened beverages). Moreover, substitution of 1 serving/day of refined grains with an equal serving of whole grains among women was associated with an 11% (95% CI: 0.82, 0.98) reduced risk of overweight/obesity at 7 years among the offspring.

Conclusions:
Our findings suggest that higher intake of refined grains during pregnancy was significantly associated with greater offspring BMIZ and increased risk of overweight/obesity at 7 years. Such associations could be potentially modified by offspring diet and lifestyle factors during childhood.
Abstract P282: Dairy Fat and Risk of Cardiovascular Disease in 3 Cohorts of US Adults
Authors: Chen Mu , Sun Qi , Pan An , Li Yanping , Manson JoAnn E , Rexrode Kathryn M , Willett Walter C , Rimm Eric B , Hu Frank B
Published: March 2022

Background:
Few prospective studies have examined dairy fat in relation to cardiovascular disease (CVD).

Objective:
We aimed to evaluate the association between dairy fat and incident CVD in US adults.

Design:
We followed 41,852men in the Health Professionals Follow-Up Study (1986-2010), 70,636women in the Nurses’ Health Study (1980-2010), and 90,056 women in the Nurses’ Health Study II (1991-2011). Dairy fat and other fat intakes were assessed every 4 years by validated food-frequency questionnaires.

Results:
During 4,324,477 person-years of follow-up, we documented 10,834 incident CVD cases including 5,107coronary heart disease (nonfatal myocardial infarction or fatal coronary disease) and 5,843 stroke cases. In multivariate analyses, dairy fat intake was not significantly related to the risk of total cardiovascular disease (for a 5% increase in energy from dairy fat, the relative risk (RR) was 1.00, 95% CI: 0.95-1.04), or coronary heart disease [RR: 1.02; 95%CI: 0.95-1.09] or stroke [RR: 0.98; 95%CI: 0.92-1.05]. In models estimating the effects of exchanging different fat sources, compared with equivalent energy from dairy fat, a 5% replacement in energy intake of dairy fat with vegetable fat was associated with a 10% (95%CI: 8%-12%) reduction in the risk of CVD. Substitution of other animal fat with dairy fat was not significantly associated with CVD risk.

Conclusion:
These results suggest that replacing dairy fat with carbohydrates or other animal fat was not associated with CVD risk. However, replacing dairy fat with vegetable sources of fat was associated with a lower risk of CVD.

Figure 1. RR and 95% CI for cardiovascular disease associated with isocaloric substitutions (5% of energy) of vegetable fat (A) polyunsaturated fat (B) and other animal fat (C) for dairy fat.
Abstract P287: The Association Between Usual Fast Food Intake Over 25 Years and Non-alcoholic Fatty Liver Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Odegaard Andrew O , Jacobs David R , Steffen Lyn M , Pereira Mark A
Published: March 2022

Introduction:
Nonalcoholic Fatty Liver Disease (NAFLD) is a common obesity related complication that is strongly associated with cardiometabolic morbidity. Despite being a major cardiometabolic risk factor, there is minimal understanding of the relationship between modifiable factors such as diet with NAFLD. Therefore, we examined the association between usual fast food intake habits over 25 years beginning in young adulthood and the odds of having NAFLD during middle age.

Hypothesis:
A higher average frequency of visits to fast food restaurants over 25 years is positively associated with NAFLD.

Methods:
We analyzed data from the CARDIA study and included participants with at least 2 assessments of fast food restaurant visit frequency (assessed exam year 0, 7, 10, 15, 20, 25) over 25 years and Computed Tomography (CT) quantification of liver fat at the year 25 exam (age 43-55 years). NAFLD was defined as liver attenuation ≤ 40 Hounsfield units after the exclusion of other causes of liver fat (e.g. heavy alcohol use). Logistic regression models were used to test the association between the average fast food restaurant visit frequency and NAFLD. This analysis includes 2,682 participants.

Results:
The prevalence of NAFLD at year 25 was 9.8% (264/2682). There was a strong positive association between higher fast food restaurant visit frequency over 25 years and the odds of NAFLD independent of sugar and artificially sweetened beverages, overall diet, and relative lifestyle factors (Table). This association was still positive after adjustment for BMI at year 25. Results were consistent by sex, race, and BMI.

Conclusions:
These results underscore how a higher usual frequency of fast food intake from early adulthood through middle age is positively associated with NAFLD during middle age, and driven by but not dependent on higher levels of relative weight.
Abstract P296: Longitudinal Association of Changes in Abdominal Fat Quantity and Quality with Changes in Cardiovascular Disease Risk Factors
Authors: Lee Jane J , Pedley Alison , Hoffmann Udo , Massaro Joseph M , Fox Caroline S
Published: March 2022

Introduction:
Subcutaneous (SAT) and visceral adipose tissue (VAT) are associated with adverse cardiometabolic risk profiles. We explored the degree to which changes in abdominal fat quantity and quality are associated with changes in cardiovascular disease (CVD) risk factors over time.

Methods:
Framingham Heart Study Third Generation cohort participants (n=1,106; 44.1% women; mean age 45.1 years) who underwent multi-detector computed tomography assessment for two consecutive examinations from 2002 to 2005 and from 2008 to 2011 were included in this analysis (mean interval 6.1 years). Abdominal adipose tissue volume in cm
3
and attenuation (indirect measure of fat quality) in Hounsfield units (HU) were determined by multi-detector computed tomography-acquired abdominal scans. Multivariable-adjusted linear and logistic regression models were constructed to examine the longitudinal associations between changes in abdominal fat volume and attenuation with changes in CVD risk factors. Multivariable-adjustment included baseline abdominal adipose tissue, baseline CVD risk factors, baseline age, smoking status, alcohol intake, physical activity, postmenopausal status, and hormone replacement therapy.

Results:
The mean fat volume change was 602 cm
3
for SAT and 703 cm
3
for VAT; and the mean fat attenuation change was -5.5 HU for SAT and 0.07 HU for VAT. An increase in fat volume and decrease in fat attenuation were associated with adverse changes in CVD risk factors. An additional 500 cm
3
increase in fat volume was associated with incident hypertension, hypertriglyceridemia, and metabolic syndrome (all
p
<0.05). Similarly, each additional 5 HU decrease in fat attenuation was associated with adverse changes in CVD risk factor profiles. For example, a 5 HU decrease in SAT attenuation was associated with an increase of 2.89 mmHg of systolic blood pressure, 2.24 mmHg of diastolic blood pressure, 1.29 mg/dL of fasting plasma glucose, 5.01 mg/dL of total cholesterol, and 0.11 mg/dL of log triglycerides; and a decrease of 3.25 mg/dL of high density lipoprotein cholesterol (all
p
<0.05). The majority of these associations remained significant even after further accounting for body mass index change, waist circumference change or respective abdominal adipose tissue volumes.

Conclusions:
Increasing accumulation of fat quantity and decreasing fat attenuation are associated with worsening of CVD risk factors beyond the associations with generalized adiposity, central adiposity, or respective adipose tissue volume. Our findings highlight the importance of quantitative and qualitative aspects of adipose tissue for a better understanding of CVD risk.