bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P055: Evaluating the Impact of the New Pediatric Clinical Practice Guideline on the Prevalence of Pediatric Hypertension and Associations With Adult Hypertension: The International Childhood Cardiovascular Cohort (i3C) Consortium
Authors: Khoury Michael , Khoury Phil , Hu Tian , Widome Rachel , Bazzano Lydia Bazzano , Burns Trudy L , Daniels Stephen R , Dwyer Terry , Ikonen Johanna , Juonala Markus , Kähönen Mika , Prineas Ronald J , Raitakari Olli , Sinaiko Alan , Steinberger Julia , Venn Alison , Viikari Jorma , Woo Jessica G , Jacobs David R , Urbina Elaine M ,   The International Childhood Cardiovascular Cohort(i3C) Consortium
Published: March 2019

Background:
New pediatric hypertension (HTN) definitions were recently introduced in a clinical practice guideline (CPG). We evaluated the impact of the CPG (compared to the previous guideline, the “Fourth Report”) on the prevalence of pediatric HTN and associations with HTN in adulthood.

Methods:
Data from the International Childhood Cardiovascular Cohort (i3C), a consortium comprising seven large, long-standing study cohorts from the United States, Finland, and Australia, were used. The mean of 2-6 BP measurements using an auscultatory technique were obtained. BP was categorized as normal, elevated, and hypertensive (stage 1 and 2) using the Fourth Report and CPG. For those with multiple BP assessments within an age category, a random assessment was selected for analysis. Childhood participants were contacted in adulthood and data on self-reported HTN was recorded.

Results:
There were 34,014 youth (mean age 10.4 ± 3.1 years, 49.4% male) with 92,751 BP assessments available for analysis. Use of the CPG increased hypertension prevalence from 7.6% to 13.5% (stage 1) and 1.3% to 2.5% (stage 2, p <0.0001). Among those 6 to <9 years, 805/880 (91.5%) re-classified from elevated BP to stage 1 HTN (Table). The greatest reclassification from stage 1 to 2 HTN occurred among those aged 15 to <18 years (294/597, 31.3%). The greatest reclassification to a lower BP category occurred among youth measured at age 13 to <15 years. Of 9,591 adults (mean age 48.8 +/- 7.9 years, range 21.0 - 64.6 years), 2,913 (30.4%) had self-reported HTN. The sensitivity for predicting adult HTN among those with HTN at any point in childhood was 13.4% and 22.4% (specificity 92.3% and 85.9%), as defined by the Fourth Report and CPG, respectively.

Conclusion:
The CPG resulted in a significantly increased prevalence of HTN in children and adolescents due to significant re-classification to higher BP categories. While the observed increases were not consistent across age groups, the results suggest increased sensitivity regarding the development of HTN in adulthood.
Abstract P062: The Benefits of Preemptive Transplant Vary by Cause of End-stage Renal Disease
Authors: Thomas Alvin , Holscher Courtenay , Haugen Christine , Jackson Kyle , Massie Allan , Segev Dorry , Henderson Macey , Al Ammary Fawaz , Brennan Daniel , Garonzik Wang Jacqueline
Published: March 2019

Introduction:
Cardiovascular events, i.e. cardiac arrest and arrhythmia, are the leading cause of death among patients with end-stage renal disease (ESRD). Kidney transplantation (KT) reduces mortality and is the preferred treatment for ESRD. Generally, preemptive KT, especially with a living donor, reduces mortality over KT after dialysis initiation. Mortality reduction by preemptive KT may vary by cause of ESRD.

Hypothesis:
Decreased all-cause mortality after preemptive KT varies by cause of ESRD.

Methods:
We studied 56,927 adult living donor KT recipients from 2000 to 2017 using the Scientific Registry of Transplant Recipients. We compared all-cause mortality in preemptive living donor KT recipients to those who underwent living donor KT within a year of starting dialysis, stratifying by cause of ESRD. We estimated the adjusted hazard ratio (aHR) of mortality comparing KT with <1 year on dialysis to preemptive KT recipients accounting for recipient and transplant factors using inverse probability weights.

Results:
Compared to recipients on <1 year of dialysis, preemptive KT recipients were more often female, older, college educated, employed, and had higher BMI (all p<0.001). The association between preemptive KT and post-KT mortality did vary by cause of ESRD (Figure 1). For example, among recipients with ESRD caused by type I diabetes, <1 year on dialysis was associated with a higher hazard of mortality (aHR: 1.32 (1.17-1.50), p<0.001). However, among recipients with ESRD caused by hypertension (p=0.1) or type II diabetes (p=0.3), there was not a statistically significantly difference in mortality comparing KT with <1 year on dialysis vs. preemptive KT.

Conclusions:
Our findings suggest that for particular ESRD patients, like those with type I diabetes, early counseling regarding preemptive KT and finding a living donor are imperative. Future studies should assess whether expedited review of potential living donors for these patients reduces mortality in this population at high risk of cardiovascular events.
Abstract P063: Serum Calcification Propensity and Cardiovascular Disease Events Among Patients With Chronic Kidney Disease: the CRIC Study
Authors: Bundy Joshua D , Cai Xuan , Mehta Rupal , Scialla Julia J , Block Geoffrey A , Feldman Harold I , de Boer Ian H , Lash James P , Chen Jing , Hsu Chi-yuan , Dobre Mirela A , Leonard Mary B , Rao Panduranga S , Go Alan S , Townsend Raymond R , Smith Edward R , Pasch Andreas , Isakova Tamara
Published: March 2019

Introduction:
Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease (CVD) events and vascular calcification is one pathway by which risk is increased.

Hypothesis:
We assessed the hypothesis that a novel measure of serum calcification propensity is associated with CVD events among patients with CKD stages 2-4.

Methods:
Among 3397 participants from the prospective longitudinal Chronic Renal Insufficiency Cohort (CRIC) Study, calcification propensity was quantified at baseline as the transformation time (T
50
) from primary to secondary calciprotein particles, with lower T
50
corresponding to higher calcification propensity. CVD events are reported every six months and confirmed by medical record adjudication. Multivariable-adjusted Cox proportional hazards regression models, stratified by study site, were used to assess the associations of T
50
with risks of atherosclerotic CVD events (myocardial infarction, stroke, and peripheral artery disease) and congestive heart failure (CHF) events.

Results:
Over an average 7.1-year follow-up, we observed 571 atherosclerotic CVD events (312 myocardial infarction, 120 stroke, and 139 peripheral artery disease events) and 633 CHF events. The mean (standard deviation) T
50
was 313.4 (79.1) minutes. After adjustment for traditional CVD risk factors, lower T
50
was significantly associated with higher risk of atherosclerotic CVD, but not with risk of CHF. The addition of T
50
modestly improved atherosclerotic CVD event discrimination beyond ACC/AHA atherosclerotic CVD risk score variables (c-statistic 0.713 vs. 0.710; p<0.001). Adjustment for kidney function attenuated the association between T
50
and CVD events (Table).

Conclusions:
Among patients with CKD stages 2-4, higher serum calcification propensity is significantly associated with atherosclerotic CVD events, but not with CHF events. Future studies should evaluate whether T
50
and its determinants represent novel therapeutic targets.
Abstract P064: Hepatitis C Infection Does Not Confer Elevated Risk of Chronic Kidney Disease Among Hispanics/Latinos: Findings From the Hispanic Community Health Study/Study of Latinos
Authors: Wong Eugenia , Ricardo Ana C , Franceschini Nora , Lash James P
Published: March 2019

Background:
Chronic kidney disease (CKD) is estimated to affect 14% of adults in the US, and there is a continued need to identify actionable risk factors for impaired kidney function. Viral infections, including hepatitis C, have been demonstrated to cause secondary glomerular nephropathies, such as cryoglobulinemia. However, there has been conflicting evidence of causal associations between hepatitis C infection (HCV) and incident CKD. Furthermore, this relationship has not been well-studied in individuals of Hispanic or Latino descent.

Hypothesis:
We hypothesized that hepatitis C infection would be positively associated with incident CKD among Hispanics/Latinos.

Methods:
The study population was comprised of 11,120 participants of the Hispanic Community Health/Study of Latinos (HCHS/SOL), a cohort of adults sampled from four regions across the US. The cohort was 63% female, and mean age at baseline (2008-2011) was 47 years. HCV seropositivity was defined by detectable HCV antibodies and confirmation with either recombinant immunoblot assay (RIBA) testing or detectable HCV RNA. Individuals were determined to have CKD if they had estimated glomerular filtration rate <60 mL/min/1.73 m
2
and albumin/creatinine ratio >30mg/g. Those with prevalent CKD at baseline were excluded from the analysis. Logistic regressions were performed to estimate the odds ratios (OR) and 95% confident intervals [95% CI] of CKD at Visit 2 (2015-2017). Estimates were adjusted for demographic factors including age, gender, and self-reported heritage/background. Adjustments were also made for baseline educational attainment, smoking behaviors, body mass index, prevalent diabetes, and prevalent hypertension.

Results:
Over a median follow-up of 5.9 years, 202 cases of CKD occurred. Incident CKD was proportionally, more common among HCV infected individuals: 8 of 116 (6.9%) HCV seropositives experienced CKD, in contrast to 194 cases (1.8%) among the 11,004 non-infected individuals. The crude odds ratio of CKD among HCV infected participants was more than 4 times that of uninfected participants (OR 4.51 [1.97-10.34]). After adjustment for demographic factors, such as age and self-reported heritage, HCV infection continued to be associated with increased risk (OR 2.45 [1.02-5.89]). However, after further controlling for comorbid conditions, the odds ratio of CKD among HCV seropositives was attenuated and no longer significant (OR 2.25 [0.87-5.84]). Diabetes (OR 4.91 [2.73-8.83]) and hypertension (OR 2.22 [1.32-3.74]) were significantly associated with incident CKD.

Conclusion:
Among individuals of Hispanic/Latino origin, hepatitis C infection does not appear to be associated with increased risks of CKD. These results imply that primary and secondary prevention of diabetes and hypertension may hold higher priority than treatment HCV infection in efforts to prevent CKD among Hispanics/Latinos.
Abstract P065: The Weight Loss by Using the Smartphone Application for People with Metabolic Abnormalities: A Randomized Controlled Trial
Authors: Lee Jung Hyun , Shim Jee-Seon , Yeom Hyungseon , Lee Su Jin , Kim Hyeon Chang
Published: March 2019

Introduction:
Obesity has been an important issue for global health. The use of the smartphone application might contribute to weight loss. However, there is still little evidence for the effectiveness among people without overt metabolic disorder.

Hypothesis:
We assessed the weight loss for people who used the smartphone application with and without personal coaching, with respect to people who did not use any.

Methods:
A total of 129 participants (aged 30-59 years; 63 men; 66 women) were recruited from the community-based cohort study in Korea during 2017-18. The inclusion criteria were as follows. 1) no cardiovascular disease; 2) no medication for hypertension, diabetes and dyslipidemia; 3) no current use of the application for behavior modification; 4) at least two components of metabolic syndrome (waist circumference ≥ 90/80 cm (men/women), SBP/DBP ≥ 135/85 mmHg, triglyceride ≥ 150 mg/dL, HDL cholesterol < 40/50 mg/dL (men/women), and fasting glucose ≥ 100 mg/dL). Participants were educated for behavior modification and randomly assigned to three groups; CO (control, no use of the application), AO (the application only; without personal coaching) and APC (the application with personal coaching). The weight was measured during a screening examination and follow-up examinations at 1.5, 3 and 6 months from a start date. A linear mixed model including the data from participants who attended the follow-up examination at least once was used to assess the weight loss.

Results:
A total of 111 participants attended the follow-up examination at least once. The mean (±SD) weight of those at screening was 71.6±12.2 kg. The mean weight loss of participants after 6 months was 0.11±1.6 kg (p = 0.67) in CO, 0.34±2.8 kg (p = 0.45) in AO, and 0.96±2.2 kg (p =0.02) in APC. Compared with the weight loss in CO, there was no significant additional weight loss in AO (0.35 kg; p = 0.41, 0.60 kg after 3 months; p = 0.16 and 0.24 kg after 6 months; p = 0.58), however, there was significant additional weight loss in APC for 3 and 6 months later (0.51 kg after 1.5 months; p = 0.23, 0.93 kg after 3 months; p = 0.03 and 0.87 kg after 6 months; p = 0.04).

Conclusions:
The use of the application with personal coaching had the effect of losing weight. These results support that the use of the application can be useful for people with metabolic abnormalities that require weight loss.
Abstract P066: A Meta-Analysis of Protective Effect of Allopurinol in Preventing Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention
Authors: Mansoor Kanaan , Amro Ahmad , El-Hamdani Mehiar , Ogu Iheanyichukwu
Published: March 2019

Background:
Contrast- induced nephropathy (CIN) is an a major adverse outcome of both diagnostic and therapeutic cardiac catheterization procedures. It has been assoicated with prolonged hospitalization, morbidity and mortality. Aim of this study was to understand the protective effect on Allopurinol on CIN.

Methods:
Search for the literature was done of Science Direct, Pubmed/Medline, and Cochrane library. A total of 385 papers were reviewed according to the PRISMA protocol by two investigators, out of which 5 manuscripts were inculded in this study. Manuscripts which studied effect of allopurinol on CIN in patient undergoing PCI were included in the meta-analysis. In all studies CIN was diagnosed if there was >25% elevation in serum creatinine.

Results:
A total of 5 studies met the inclusion criteria. Risk difference was calculated for each study and was tabulated in a forest plot. Heterogeneity was 83.81% with P < 0.001 hence a random effect model was used. Overall Risk difference was -0.140 (CI 95% -0.257, -0.022).

Conclusion:
Our study demonstrates that Allopurinol potentially has a protective in preventing contrast induced nephropathy in patients undergoing percutaneous coronary intervention. Further large clinical trails are warranted to better understand this effect.
Abstract P073: A Novel Epigenetic Link Between Gestational Diabetes Mellitus and Macrosomia
Authors: Joyce Brian , Liu Huikun , Wang Leishen , Wang Jun , Zheng Yinan , Nannini Drew , Drong Alex , Shiau Stephanie , Li Weiqin , Leng Junhong , Shen Yun , Gao Ru , Hu Gang , Baccarelli Andrea , Hou Lifang
Published: March 2019

Background:
Gestational diabetes mellitus (GDM) is a known risk factor for macrosomia, with recent estimates suggesting that between 15-45% of newborns of mothers with GDM are macrosomic (vs. 12% in non-GDM mothers). This study’s objectives were to explore associations between both maternal GDM and children’s macrosomia and DNA methylation of eight genes selected based on a literature review of candidates potentially involved in GDM and obesogenic pathways (
IGF1
,
IGF2
,
H19
,
ARHGRF11
,
MEST
,
NR3C1
,
Adiponectin
, and
RETN
).

Methods:
Data were taken from the Tianjin GDM Observational study, in the 4th-largest city in China; subjects were ages 24-49 and diagnosed with GDM between 2005-2009. Baseline surveys were completed from 2009-2011 for 580 enrolled women-child pairs; an additional 580 women-child pairs without GDM and frequency matched on child sex and birth date were enrolled. We examined 572 GDM cases vs. 573 non-GDM controls; of these 177 children were born with macrosomia (114 to women with GDM, p<0.001). Anthropometric measurements of all enrolled women were completed as part of usual prenatal care; blood draws for DNA methylation analysis (using the Illumina 850K array) were collected from children (median age 5.9 years, range 3.1-10.0). We used logistic regression for all analyses and adjusted for maternal height, age, smoking status, pre-pregnancy overweight/obesity, weight gain during pregnancy, parity, and hypertensive disorders of pregnancy as well as child sex and gestational age at delivery. FDR adjustment was used to correct all candidate gene CpG analyses for multiple testing, with FDR-adjusted P<0.05 considered statistically significant.

Results:
After analysis of 345 CpGs in eight target genes, one CpG was associated with macrosomia (cg14428359) and one with GDM (cg19466922) at FDR < 0.05; both CpGs were located in the gene
MEST
(3’ and 5’ untranslated regions, respectively). One additional CpG site in the promoter region of
MEST
(cg05862114) was associated with both GDM and macrosomia before FDR adjustment. All three CpGs were hypomethylated in both children of GDM mothers and macrosomia cases.

Conclusions:
MEST
is a paternally imprinted gene that is highly expressed in fetal and placental tissue, and believed to play an important role in fetal development. It has also been found to have elevated expression in adipose tissue; epigenetic regulation of
MEST
may play an important role in the link between GDM and macrosomia.
Abstract P078: Racial Differences in the Association Between Diabetes and Length of Residence Among African Migrants to the US
Authors: Kamin Mukaz Debora
Published: March 2019

Background:
In the US, length of residence has been shown to increase diabetes risk in migrants. Unfortunately, there is a dearth of research on the topic for African migrants especially as it relates racial differences. However, the prevalence of diabetes is higher in North Africa compared to sub-Saharan Africa. Thus, the goal of our study was to assess the effects of race on the association between the length of residence and diabetes among African migrants.

Hypothesis:
There is a positive association between length of residence and diabetes among non-Black African migrants compared to Black African migrants.

Methods:
Data from the 2010-2017 NHIS (National Health Interview Survey) were analyzed. The initial sample selected 1911 individuals, 18 years or older, whose birthplace was Africa and who answered questions about diabetes diagnosis. After selecting on non-missing values, the final sample included 1899 African migrants. Chi-square tests and logistic models were used to assess the association between race, length of residence divided into less than 10 years vs 10 years or more and, diabetes. Results were weighted to account for the complex sampling design.

Results:
The prevalence of diabetes in the selected population was 5.9 % (95% CI: 4.8%-7.1%). The prevalence was significantly higher (p=0.027) for non-Black migrants (8.2%, 95% CI: 5.7-11.6%) compared to non-Black migrants (5.1%, 95% CI: 4.1- 6.3%). Additionally, a larger proportion of non-Black migrants (74.5%, 95% CI: 69.9-78.5%) had resided in the US for 10 years or more compared to Black migrants (58.6%, 95% CI: 55.6-61.6%; p<0.001). The age-and gender-adjusted regression analysis revealed there was no significant association between diabetes and length of residence (OR= 1.41, 95% CI: 0.78-2.55) in the general African migrant population. While the association remained non-significant among non-Black African migrants (OR=0.54, 95% CI: 0.15-1.92), the age-and gender-adjusted model revealed that Black Africans who had lived in the US for 10 years or more were twice more likely to be diabetic compared to those who had lived in the country for less than 10 years (OR=2.02, 95% CI: 1.09-3.77).

Conclusions:
In conclusion, in the US, the association between length of residence and diabetes was significant for Black Africans and non-significant for non-Black Africans. These results suggest the need for diabetes prevention programs that acknowledge the racial and cultural diversity of African migrants.
Abstract P080: Gut Microbiota, Gut-Derived Metabolites and Glucose Metabolism: Findings From a Monozygotic Twin Study
Authors: Zhu Yun , Strachan Eric , Fowler Emily , Bacus Tamara , Roy-Byrne Peter , Zhao Jinying
Published: March 2019

Background:
Gut microbiota dysbiosis disturbs metabolic homeostasis and contributes to a range of metabolic disorders including CVD and diabetes. Previous epidemiological studies using unrelated individuals may be confounded by age, sex, maternal diet, and early familial factors as well as many unknown or unmeasured factors. Using a well-matched co-twin control design, we examined the relationship between gut microbiome, gut-derived metabolites, and glucose metabolism in monozygotic twin pairs.

Objective:
To identify gut microbiome (both composition and abundance) and microbial metabolites associated with host plasma glucose and HbA1c, independent of potential confounding factors.

Methods:
This study included 37 monozygotic twin pairs (N=74, mean age 38.2 years old, 68.4% females). Gut microbiome profiles were assessed by 16S rRNA sequencing of the V4 hypervariable region. Concentrations of gut-derived metabolites in plasma were detected using untargeted LC-MS. After stringent QC, we obtained 89 operational taxonomic units (OTUs) at the genus level and 43 microbial metabolites in all twin pairs. The correlation between α-diversity (within-sample diversity, a higher α indicates higher richness of a bacterial species) and plasma glucose or HbA1c was estimated by Spearman correlation. The association of plasma glucose or HbA1c with each OTU or concentration of microbial metabolites was examined by matched twin pair analysis, adjusting for BMI, lipids, smoking, alcohol drinking and depression.

Multiple testing was controlled by Bonferroni correction (P<0.0005 for OTUs, P<0.001 for metabolites).

Results:
The α-diversity measured by Simpson Index was positively correlated with both HbA1c (r
2
=0.51, p=0.032) and fasting glucose (r
2
=0.48, p=0.043). Of the 89 OTUs at the genus level, abundances of
Ruminococcaceae, Lactobacillus, Lachnospiraceae
, and
Oscillibacter
were positively associated with both HbA1c (adjusted-P<0.0004) and fasting glucose (adjusted-P<0.0005), whereas abundances of
Holdemanella and Solobacterium
were positively associated with HbA1c (adjusted-P < 0.0005). Two microbial metabolites,
TMAO
and
threonine
, were significantly associated with HbA1c and glucose (all adjusted-P < 0.001).

Conclusions:
Altered gut microbiota (both composition and abundance) and gut-derived microbial metabolites are associated with glucose metabolism, independent of potential confounding variables.
Abstract P081: Applying Precision Public Health Tools to Address Health Disparities Among African-Americans in Alachua County, Florida
Authors: Cistola Andrew S
Published: March 2019

Precision Public Health (PPH) is the application of public health tools to population subsets with tailored interventions resulting in quantitative improvements in overall population health. The goal of PPH is to move from general impact to specific impact with interventions while maintaining a population focus in our outcomes. Precision Public Health at the University of Florida (PPH@UF) is a multi-disciplinary workgroup established in 2017 for the purpose of pursuing PPH practices. The primary product of the workgroup is the PPH@UF Libguide: a PPH focused tool designed to be a single place for public health workers to find necessary resources they need to understand their community and create effective interventions. Using the resources in this tool can help existing or new public health workers and researchers move from general population analysis towards precision in their interpretation of the data. This poster has two goals: 1) To show how the resources from the PPH@UF Libguide can be used to address health disparities among African-Americans in Alachua County and 2) To provide an example of how a PPH tool can increase the precision in population analysis aimed toward recommending interventions. The study utilized the PPH@UF Libguide to investigate a commonly known disparity between African-American and Caucasian diabetes deaths in Alachua County. By translating demographic data and investigating diabetes hospitalization, prevalence of diabetes by age over time, and population characteristics of relevant census tracts in Alachua County, we identified two specific census tracts that have significantly higher density of these individuals at risk. Using data from the Centers for Disease Control and presented by the Robert Wood Johnson Foundation, we were also able to observe that these tracts had very high rates of annual doctor visits but very low insurance rates and few locally available core preventative services. This indicates that interventions focusing on preventative care outside of doctor’s offices and connecting individuals to currently available community resources may be most helpful. The PPH@UF Libguide includes many different community partners who would be able to supply these types of resources and can serve not only as a research tool but also as a way to sort community health providers. Any intervention would include training individuals to access information on the PPH@UF Libguide for the needs of community members. By identifying a major community issue and providing a more precise geographic scope, supportive and integrated data, and a practical focus, the PPH@UF Libguide shows its ability to make efforts to address disparities among African-Americans in our community more effective. In conclusion, community health workers and advocates can utilize PPH tools similar to the PPH@UF Libguide to increase the impact and value of their community interventions.
Abstract P084: Neighborhood Deprivation is Associated With Diabetes Complications: Results From the UCSF Population Health Data Initiative
Authors: Lacy Mary E , Lyles Courtney R , Mujahid Mahasin S , Bibbins-Domingo Kirsten , Pletcher Mark J
Published: March 2019

Introduction:
Although neighborhood-level factors influence diabetes and diabetes complications, these determinants are often ignored in clinical practice. The widespread use of electronic medical records (EMR) represents a unique opportunity to incorporate these factors into clinical decision making through geocoding of a patient’s residential address. However, despite increasing interest, few examples exist of how to leverage geospatial data within a clinical care system to inform patient care. The objective of this study is to examine the association between neighborhood deprivation and diabetes complications using geocoded address and clinical data extracted from patients’ EMR.

Methods:
Using retrospective EMR data from UCSF Health (01/01/2015-06/30/2018), we identified a cohort of patients with diabetes using a combination of labs, diagnosis codes and medications (n=9,876). Patients’ residential addresses were extracted from EMR, geocoded, and assigned to census block/track. Area deprivation index (ADI) was calculated for each census block/track, categorized as high neighborhood-level deprivation (ADI ≥80
th
percentile) or not (ADI <80
th
percentile), and linked to patient-level data. ADI includes 17 measures of education, employment, housing-quality, and poverty and incorporates information from the Census and American Community Survey. We used logistic regression models to examine the association between ADI and the following diabetes-related outcomes: poor glycemic control (HbA1c ≥9%), severe hypoglycemia (ICD-9/10 codes for hypoglycemia-related ED visit or hospitalization), and retinopathy (ICD-9/10 codes). Models were adjusted for age, sex, race/ethnicity, and insurance coverage. Hypoglycemia and retinopathy models were additionally adjusted for last available HbA1c measure.

Results:
In fully-adjusted models, high neighborhood-level deprivation was associated with increased risk of poor glycemic control (OR: 1.18, 95% CI: 1.01, 1.40) and severe hypoglycemia (OR: 1.35, 95% CI: 1.04, 1.76). Conversely, high neighborhood-level deprivation was associated with decreased risk of retinopathy (OR: 0.78, 95% CI: 0.63, 0.96).

Conclusions:
Using EMR data, after controlling for several patient-level factors, neighborhood-level deprivation was associated with increased risk of poor glycemic control and severe hypoglycemia and decreased risk retinopathy. Understanding the patient’s broader social context could help inform risk stratification and tailoring of diabetes management. Future analyses will more fully characterize patients’ clinical and utilization-related characteristics and will include additional diabetes complications such as nephropathy, neuropathy and chronic kidney disease. This study represents an example of how neighborhood-level data obtained through patient’s EMR could be used to inform clinical practice.
Abstract P086: Significant Association of House Collapse With High Urine Na/K Ratios Among 24,580 Coastal Residents Who Survived the Great East Japan Earthquake
Authors: Mikami Takahiro , Tanno Kozo , Sasaki Ryohei , Takanashi Nobuyuki , Kotozaki Yuka , Hozawa Atsushi , Kogure Mana , Kuriyama Shinichi , Tsuji Ichiro , Sato Mamoru , Hitomi Jiro , Sakata Kiyomi , Sasaki Makoto
Published: March 2019

Introduction:
There is an association between dietary sodium/potassium intake and the pathogenesis of hypertension and cardiovascular disease. Some reports have indicated a correlation between psychological distress and high sodium intake. Victims who are affected by natural disasters tend to consume an unbalanced diet, with high sodium and low potassium levels, which may stem partly from high psychological distress due to natural disasters.

Hypothesis:
We tested the hypothesis that house collapse was associated with high urine Na/K (UNa/K) ratios in victims of the Great East Japan Earthquake. We also hypothesized that psychological distress could modify the relationship between house collapse and UNa/K ratio.

Methods:
We analyzed complete data collected from 24,580 coastal residents who did not take anti-hypertensive medications, were 20 to 74 years of age, and were enrolled in the Tohoku Medical Megabank Project Community-based Cohort (TMM CommCohort) Study. Participants were recruited between 2013 and 2015 at municipality-specific health checkup sites in the Iwate and Miyagi Prefectures. UNa/K ratios were assessed using spot urine samples. Participants were classified into four groups according to the extent of house collapse: total collapse (TC, n=4206); half collapse (HC, n=2825); partial collapse (PC, n=5964); and no damage (ND, n=11585). Using a covariance analysis, the multivariate-adjusted geometric means of the UNa/K ratios according to the group of house collapse were calculated, with adjustments for sex, age, systolic blood pressure, estimated glomerular filtration rate, HbA1c level, low-density lipoprotein cholesterol level, Kessler Psychological Distress Scale (K6) score, current alcohol consumption, current smoking habits, and daily exercise. In addition, after stratification according to K6 score (9/10), the multivariate-adjusted geometric means of the Una/K ratios were calculated according to house collapse group.

Results:
The multivariate-adjusted geometric means (95% confidence intervals) of UNa/K ratios of those whose houses underwent TC, HC, and PC were 3.33 (3.28-3.39), 3.37 (3.30-3.44), and 3.34 (3.30-3.40), respectively, all of which were significantly greater than the value of 3.23 (3.20-3.27) that was observed for the ND group. In analysis stratified by K6 score, the same tendencies were observed in both groups of K6<10 and K6≥10.

Conclusions:
House collapse was significantly associated with high UNa/K ratios, and psychological distress did not modify this association.
Abstract P089: Predictors of a Southern Diet Pattern in the REGARDS Study
Authors: Couch Catherine , Howard George , Howard Virginia J , Long Leann , Shikany James , Gutierrez Orlando , Zakai Neil , Cushman Mary , Levitan Emily , Manly Jennifer , Judd Suzanne E
Published: March 2019

Background:
The REasons for Geographic and Racial Differences in Stroke (REGARDS) study identified a dietary pattern from factor analysis associated with multiple diseases. This Southern dietary pattern, includes fried food, organ meats, processed meats, and sugar-sweetened beverages and is associated with increased risk of hypertension, cardiovascular disease stroke, sepsis, kidney disease, and cognitive impairment. Further, this dietary pattern mediates much of the black-white difference in incidence of both stroke and hypertension. Factors related to adherence to this dietary pattern have been less commonly studied. In this cross-sectional study, we examined predictors of the Southern diet in REGARDS, including 17212 black and white participants aged 45 and older. Studied predictors were race, sex, residence in the Southeast, education, income, neighborhood advantage, smoking status, living in an urban area, age, dietary factors, physical activity, medication adherence, general self-rated health, report of depressive symptoms, and living in a food desert. We used linear regression to obtain beta coefficients and modeled a one standard deviation difference in the Southern diet score. Of REGARDS participants with dietary data, 34% were black, 44% were male, 72% lived in an urban setting, and 37% had graduated from college. Among the possible predictors of adherence to a Southern diet pattern, black participants, males, residents of the Southeast, and current smokers were strongly adherent to the dietary pattern, even after adjustment for the other factors (table). Markers of socioeconomic status were strong predictors in unadjusted models but after adjustment for race, they were attenuated. Black race was the most potent predictor of a higher adherence to a Southern dietary pattern in REGARDS. As this diet is strongly associated with risk of several incident diseases, further work should focus on the contribution of this diet to broad racial disparities in chronic disease and life expectancy.
Abstract P091: Short-term Increased Dietary Potassium From Potato and Potassium Gluconate Has No Effect on Blood Pressure and Microcirculation in Pre-hypertensive-to-hypertensive Adults
Authors: Stone Michael S , Martin Berdine R , McCabe George P , McCabe Linda D , Weaver Connie M
Published: March 2019

Potassium is an essential nutrient of concern according to recent Dietary Guidelines for Americans Advisory Committees, with less than 3% of the population meeting the current adequate intake (AI) level of 4700mg/d. Increases in potassium intake have been linked to improvements in cardiovascular and other metabolic health outcomes. Blood pressure (BP) is currently the primary criterion for determining potassium requirements. In this clinical trial, we assessed the effects of increasing potassium intake on BP and microcirculation (endothelial function). Thirty pre-hypertensive-to-hypertensive (Systolic BP ≥ 120mmHg) men (N=15) and Women (N=15) with a mean ± SD age, BMI, and BP (systolic(SBP)/ diastolic(DBP)) of 48.2 ± 15 y, 31.4 ± 6.1, and 136.3 ± 11.9/ 86.1 ± 7.1 mmHg, respectively, were enrolled in a cross-over randomized control diet trial. Participants were assigned to a random order of four 16-day dietary potassium interventions including a basal diet (control) of 2300mg/d(~60mmol/d), and three periods of an additional 1000mg/d(3300mg/d(~85mmol/d) total) of potassium in the form of potatoes (baked, boiled, or pan-heated with no additional fat), French fries, or a potassium gluconate supplement. Each intervention period was separated by two or more weeks of wash out. Blood pressure was measured in triplicate using manual auscultation on days 1, 4, 6, 8, 11, 13, 15, 16, and 17 of each intervention. Microvascular and endothelial function were assessed via thermal hyperemia, utilizing laser Doppler flowmetry (LDF), at baseline and at the end of each intervention. Results for differences in both SBP and DBP ± SE were assessed at the end treatment (average of day 15, 16, and 17 measurements) using a mixed model with repeated measures and Dunnett adjustment (P < 0.05), with no significant differences among groups (control: 128.7 ± 2.1/ 83.6 ± 1.6, French fries: 127.7 ± 2.2/ 83.7 ± 1.6, potatoes: 127.6 ± 2.3/ 85.1 ± 1.6, supplement: 128.0 ± 2.2/ 83.7 ± 1.7). Utilizing the same statistical analysis, there were also no significant differences in endothelial function (measured as percent of cutaneous vascular conductance max (%CVCmax) ± SE) among groups (control: 87.4 ± 1.5%, French Fries: 87.7 ± 1.4%, potatoes: 88.3 ± 1.1%, supplement: 88.9 ± 1.0%). In this small, controlled feeding study of short duration, increased potassium from potatoes or supplement achieved 70% of recommended intakes, but had no significant benefit to blood pressure or microvascular function in men and women with higher cardiometabolic risk.
Abstract P100: Geographic Disparities in Hypertensive Disorders of Pregnancy: An Environment-Wide Association Study
Authors: Hu Hui , Pearson Thomas A , Zhao Jinying , Prosperi Mattia , Rasmussen Sonja A , Hong Xiao , Cottler Linda B
Published: March 2019

Hypertensive disorders of pregnancy (HDP) are significant contributor to maternal and infant morbidity and mortality, and large geographic disparities exist. Although the importance of an individual’s surrounding environment as a potentially modifiable risk factor for HDP has been recognized and multiple environmental factors have been associated with HDP, only a few components in the environment have been assessed, often separately, with no consideration of the totality of environment. To address this, we conducted an environment-wide association study (EWAS) using the Florida Vital Statistics Birth Records including 2,119,324 women with conception dates between January 1, 2005 and December 31, 2014. EWAS is an agnostic and hypothesis-free approach. A wide range of environmental data from 12 sources were collected, harmonized, integrated, and spatiotemporally linked to the women based on their geocoded residential address and pregnancy period. A total of 5,510 factors characterizing women’s surrounding natural, built, and social environment during pregnancy (i.e. climate, air pollution, noise, greenness, walkability, food access, socioeconomics, social capital, housing, and safety) were included in the analysis. A random 50:50 split divided the data into training and testing sets. Environmental factors were individually examined after adjusting for age, race/ethnicity, education, marital status, WIC (Women, Infants, and Children Nutrition Program) recipient, smoking during pregnancy, pre-pregnancy BMI, parity, season, and year of conception. Mixed-effects models were used to account for the multilevel structure. A factor is deemed as “significant” if it has a false discovery rate-adjusted p-value (or q-value)<0.01 in the training set and a p-value<0.01 in the testing set. We identified 1,208 factors significantly associated with HDP, with strong associations observed between HDP and three categories of environmental factors: 1) neighborhood social capital (i.e. ZIP Code-level density of fitness and recreational sports centers, OR per standard deviation increase [OR
sd
]: 0.34, 99% CI: 0.25, 0.46), 2) food access (i.e. low access tract at 10 miles, OR=1.27, 99% CI: 1.17, 1.47), and 3) bikeability (OR
sd
=0.86, 99% CI: 0.83, 0.89). EWAS is a promising approach to identify novel environmental factors associated with cardiovascular diseases. Environmental exposures appear to play a critical role, both in identifications of pregnant women at increased risk of HDP and in determinations of potential target for public health interventions.
Abstract P105: Less Walkable Neighborhoods Are Associated With Worse Cardiovascular Risk Profile
Authors: Howell Nicholas A , Tu Jack V , Moineddin Rahim , Chu Anna , Booth Gillian L
Published: March 2019

Introduction:
There is mounting evidence that neighborhoods that have low levels of walkability have higher burdens of cardiovascular disease (CVD) risk factors such as obesity and hypertension. However, few studies have examined the impact of walkability on overall cardiovascular risk.

Hypothesis:
We hypothesized that residents living in less walkable communities have a higher burden of cardiovascular risk factors and a greater predicted risk for future CVD events.

Methods:
We assembled a cross-sectional sample of community dwelling adults aged 40-74 on January 1, 2008 from the CANHEART cohort. We ascertained systolic blood pressure, HDL and total cholesterol, smoking status, and diabetes status using a combination of EMR, clinical laboratory databases, and health administrative databases. The primary outcome was an estimated total 10-year cardiovascular disease risk of ≥ 7.5% using the ACC/AHA Pooled Cohort risk score. Walkability was measured using a validated index and divided into quintiles from lowest (Q1) to highest (Q5). The associations were tested using linear and logistic regression with cluster-robust standard errors, adjusting for confounders.

Results:
In total, 44,448 individuals were included in the analysis. Individuals living in less walkable areas had a higher predicted 10-year CVD risk than those living in highly walkable areas. The association was non-linear, as individuals living in neighborhoods of mid-range walkability (Q3) were even more likely to have an estimated 10-year CVD risk exceeding 7.5% in comparison to those in Q5 (OR = 1.33, (1.23, 1.45)). Conversely, we observed monotonic associations between decreasing walkability and higher mean systolic blood pressure (Q1 vs. Q5: +2.73 mmHg, 95% CI: +2.11, + 3.35) and odds of diabetes (Q1 vs. Q5: OR = 1.29, 95% CI: 1.13, 1.47). Dose-response associations were also observed between decreasing walkability and lower HDL cholesterol (Q1 vs. Q5: -1.93 mg/dl, 95% CI: -2.32, -1.16) and likelihood of being a current smoker (Q1 vs. Q5: OR = 0.76, 95% CI: 0.67, 0.85).

Conclusions:
Residents living in less walkable neighborhoods had a higher burden of CVD risk factors and a higher estimated risk of future CVD. Conversely, the likelihood of smoking was higher in more walkable neighborhoods, suggesting this may be an area to focus smoking cessation efforts.
Abstract P111: A Mendelian Randomization Study of Alcohol Intake and Ischemic Stroke in a Han Chinese Population
Authors: Shi Mengyao , Zhang Yonghong , Li Changwei , Wang Aili , Xu Tan , Sun Xiao , Bu Xiaoqing , Chen Jing , Kelly Tanika N , He Jiang
Published: March 2019

Introduction:
Observational studies have reported inconsistent relationships between alcohol intake and ischemic stroke risk. The
ALDH2
gene encodes an enzyme critical for alcohol metabolism and can serve as an unconfounded proxy for alcohol intake. The current study examined the association between the
ALDH2
gene and ischemic stroke among 11,753 Chinese participants.

Hypothesis:
This study hypothesized that carriers of the
ALDH2
variant tend to drink less alcohol and thus have lower risk for ischemic stroke.

Methods:
The discovery stage included 999 ischemic stroke cases and 1,001 controls with no history of atherosclerotic disease. The
ALDH2
gene was sequenced using the SOLiD 4hq platform. Variants with minor allele count (MAC) >10 were each tested for association with stroke using logistic regression models. Interactions between alcohol intake and
ALDH2
variants were also tested. Aggregate analysis of rare variants (MAC <20) used the sequence kernel association test. Variants with P<1х10
-4
were replicated among 4,724 ischemic stroke cases and 5,029 controls from the China Stroke Project.

Results:
An interaction of alcohol drinking with the
ALDH2
rs671 variant, which encodes an inactive aldehyde dehydrogenase isozyme that limits tolerability to alcohol, on ischemic stroke risk was identified using the 2 degree of freedom test (P=2.77х10
-5
, 3.66х10
-11
, and 1.01х10
-15
in discovery, replication and joint analyses, respectively). Among drinkers, each copy of the variant allele conferred decreased odds of ischemic stroke, with odds ratios (95% CI) of 0.38 (0.25, 0.60), 0.79 (0.69, 0.91), and 0.74 (0.65, 0.85) in discovery, replication and joint analyses, respectively. While no association between the variant allele and stroke was observed among non-drinkers in the discovery stage [odds ratio (95% CI): 1.00 (0.82, 1.23)], the protective relation persisted among non-drinkers in the replication and joint analyses [odds ratios (95% confidence interval): 0.77 (0.71, 0.84) and 0.80 (0.74, 0.87), respectively]. This inconsistency may have resulted from disparate frequencies of former drinkers included in the non-drinking groups. No additional variants were identified.

Conclusions:
This large-scale genomic study implicates increased alcohol intake as an etiologically relevant risk factor for ischemic stroke.
Abstract P112: Prediction of the Development of Aortopathy in Patients With Bicuspid Aortic Valves
Authors: Gaye Bamba , Björck Hanna M , Ladouceur Magalie , Vignac Maxime , Olsson Christian , Cereceda Anders F , Eriksson Per
Published: March 2019

Background:
Little is known about the association between bicuspid aortic valves (BAV) and ascending aorta dilatation in the population. We aimed to firstly determine the predictors of aortopathy in BAV patients and secondly to develop a clinical classifier to predict aortopathy in a large group of individuals with bicuspid aortic valve.

Method:
This study includes 1041 patients (including 545 BAV patients and 506 tricuspid aortic valves (TAV) patients) aged 18 or above with aortic valve disease and/or ascending aorta dilatation but devoid of coronary artery disease and primarily not planned for another concomitant valve surgery. Aortic complications of patients were assessed at baseline. Using automated machine-learning, we applied 10-fold cross-validation logistic regression incorporating multidimensional information (i.e., valvular dysfunction, valves morphology, blood sampling, genetic data, clinical data, family history of cardiovascular diseases, prevalent diseases data, demographic characteristics, lifestyle habits data and medication).

Results:
Among the 545 BAV subjects (age 64.89 +/- 12 years, 68% men). The prevalence of BAV associated with aneurysm (dilatation) (BAV-D) and without aneurysm (BAV-ND) was 54.9% and 45.1% (p<0.001), respectively. Comparing BAV-D and BAV-ND, significant differences in valvular dysfunction pattern were noted, with aortic stenosis predominating in BAV patients without aneurysm (79.3% vs. 68.7% in BAV with aneurysm; p=0.007), and aortic regurgitation in BAV patients with aneurysm (33.7% vs. 25.1% in BAV patients without aneurysm; p =0.03). No differences in age, prevalence of male sex and BMI were observed between BAV-D and BAV-ND Our descriptive analysis showed several patterns of significantly differently associated traits, between undilated and dilated BAV patients (i.e, blood pressure, hypertension, body surface area, height, high-sensitivity CRP, sibling history of myocardial infarction and mother history of myocardial infarction before 65 years, low density lipoprotein (LDL), prevalent MI, prevalent diabetes and prevalent stroke, BAV phenotype). Our predictive classifier included these traits and showed sensitivity of 80% specificity of 84%, negative predictive value of 76%, and positive predictive value of 82% to predict BAV individuals who are of a high risk of developing aneurysm. All these analyses were also performed in TAV patients and showed different patterns of aneurysm manifestation compared to BAV patients

Conclusion:
Our findings raise the issue of how to implement prevention of aortopathy in BAV patients in a clinical setting and suggest/demonstrated that cardiovascular risk profiles appear to be more predictive than valve morphology, genetic data and circulating plasma proteins.