bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9637: Diverse Geometric Changes Related to Dynamic Left Ventricular Outflow Tract Obstruction Without Overt Hypertrophic Cardiomyopathy
Authors: Cha Jung Jun , Chung Hyemoon , Kim Ki Hyun , Yoon Young Won , Lee Byoung Kwon , Kim Jong Youn , Hong Bum-Kee , Rim Se-Joong , Kwon Hyuck Moon , Choi Eui-Young
Published: July 2021

Background:
Dynamic left ventricular (LV) outflow tract (LVOT) obstruction (DLVOTO) is not infrequently observed in older individuals without overt hypertrophic cardiomyopathy (HCM). We sought to investigate associated geometric changes and then evaluate their clinical characteristics.

Method:
A total of 168 patients with DLVOTO, which was defined as a trans-LVOT peak pressure gradient (PG) higher than 30 mmHg at rest or provoked by Valsalva maneuver (latent LVOTO) without fixed stenosis, were studied. Patients with classical HCM, acute myocardial infarction, stress induced cardiomyopathy or unstable hemodynamics which potentially induce transient-DLVOTO were excluded.

Results:
Their mean age was 71±11 years and 98 (58%) patients were women. Patients were classified as pure sigmoid septum (n=14) if they had basal septal bulging but diastolic thickness less than 15 mm, sigmoid septum with basal septal hypertrophy for a thickness ≥15 mm (n=85), prominent papillary muscle (PM) (n=20) defined by visually large PMs which occluded the LV cavity during systole, or as having a small LV cavity with concentric remodeling or hypertrophy (n=49). The prominent PM group was younger, had a higher S’and lower E/e’ than other groups. In all groups, a higher peak trans-LVOT PG was related to E/e’, right atrial pressure and pulmonary arterial systolic pressure. In multivariate analysis, resting trans-LVOT PG correlated to pulmonary arterial pressure (ß=0.200, p=0.016) after adjustment for E/e’, septal thickness and right atrial pressure.

Conclusion:
DLVOTO develops for various reasons, and patients with prominent PMs have distinct characteristics. DLVOTO-relieving medication may potentially reduce pulmonary pressure in this group of patients.
Abstract 9759: Race and Gender Differences in Survival Among Hospitalized Heart Failure With Preserved Ejection Fraction: The Atherosclerosis Risk in Communities (ARIC) Surveillance Study
Authors: Sharma Kavita , Agarwal Sunil K , Wrick Lisa M , Matsushita Kunihiro , Chang Patricia P , Shah Amil M , Kitzman Dalane W , Deswal Anita , Laura Loehr R , Coresh Josef , Rosamond Wayne D , Solomon Scott D , Russell Stuart D
Published: July 2021

Background:
Heart failure with preserved ejection fraction (HFpEF) accounts for about half of HF hospitalizations, and has been reported to be more common amongst Caucasians and women in outpatient population studies. There are limited data, however, on the influence of race and gender on survival in HFpEF. We evaluated whether clinical characteristics and outcomes differ amongst HFpEF patients by race and gender.

Methods:
HFpEF (EF≥ 50%) hospitalization cases from 2005-2009 adjudicated by a physician panel were analyzed from the community-based surveillance component of the ARIC study, comprising 4 US communities (Jackson, MS; Washington County, MD; Minneapolis, MN; and Forsyth County, NC; combined population in 2009 = 214,000). The association of race and gender with mortality at 28-days and 1-year was evaluated.

Results:
Of 3,786 (weighted n = 18,265) adjudicated acute decompensated HF cases, 1,726 (weighted n = 8114) were categorized as HFpEF. Patient characteristics included: female (44%), African American (AA, 32%), hypertension (83%), diabetes (46%), and mean BMI of 28. Compared to Caucasians, AA’s were younger (70 vs. 77 years, p<0.001), more frequently women (47% vs. 42%, p<0.001), with higher systolic blood pressure (SBP, 145 vs. 135 mmHg, p<0.001), and more prior HF hospitalizations (50% vs. 37%, p<0.001). Compared to men, women were older (76 vs. 73 years, p<0.001), with higher SBP (141 vs. 138 mmHg, p=0.03), and better renal function (eGFR 42 vs. 38 mL/min/1.73m
2
, p<0.001). Overall 28-day and 1-year mortality was 13.1% and 32.8%, respectively, with no differences in un-adjusted or adjusted estimates by race or gender (Table 1).

Conclusions:
In hospitalized HFpEF patients, overall 28-day and 1-year mortality were high without apparent race- or gender-based differences in mortality. These data may help inform the development of future interventions and resource allocation.
Abstract 9956: Effects of Robot-Assisted Therapy Combined With Electrical Stimulation on Motor Control, Motor Impairment, and Daily Function in Stroke Patients
Authors: Wu Ching-yi , Lin Keh-chung , Chen Hsiao-wen , Hsiao Man-chiao
Published: July 2021

Introduction:
Upper-limb robot-assisted therapy (RT) has been shown to improve motor recovery in chronic stroke patients. Some review studies demonstrated that compared with severely affected patients, moderately affected patients with stroke were more responsive to RT. Neuromuscular electrical stimulation (ES) can effectively induce muscle contraction for stroke patients with severe motor deficit. Thus, ES might serve as an adjuvant intervention for RT to optimize treatment effects. This study aimed to examine the effects of combined robot-assisted therapy with electrical stimulation (RT+ES) on motor control, motor impairment, and daily function.

Methods:
Twenty-nine patients (mean age: 65 years, mean onset time: 26 months) were randomized into one of the three groups: RT+ES, robot-assisted therapy with sham electrical stimulation (RT+sham ES), and control therapy (CT) groups. Each patient received 90-100 minutes of therapy, 5 days per week for a total of 4 weeks. Outcome measures, representing motor control, motor impairment, and daily function, were kinematic variables, the Fugl-Meyer Assessment (FMA), and the Motor Activity Log (MAL), respectively. Kinematic variables included total displacement (TD), peak velocity (PV), percentage of time where peak velocity occurs (PPV), and movement units (MU). All assessments were performed before and after treatment. Analysis of covariance was used to evaluate training effects.

Results:
Results showed significant group differences in two kinematic variables (PPV, F = 1.82, p < 0.01; normalized MU, F = 3.41, p = 0.05), proximal subscore of FMA (F = 3.58, p = 0.05) and MAL (amount of use, F = 4.38, p = 0.03; quality of movement, F = 3.71, p = 0.05) in favor of RT+ES. There were no significant group differences for TD, PV, the total FMA score, and the FMA distal subscore.

Conclusions:
These findings suggest that RT+ES may improve motor control by increasing movement smoothness, reduce motor impairment of proximal part of upper limb, and enhance the performance on daily activities. Further studies could may involve the outcome measures at the participation level such as performance on extended activities of daily living or community reintegration, and evaluate the follow-up effects for RT+ES training.
Abstract 03: Outpatient Care Preceding Incident Heart Failure (HF) and Implications for Long-Term Outcomes. The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Kucharska-Newton Anna , Chambless Lloyd , Camplain Ricky , Cuthbertson Carmen , Chang Patricia , Agarwal Sunil , Wruck Lisa , Allen Norrina , Shahar Eyal , Bertoni Alain , Heiss Gerardo
Published: July 2021

Hypothesis:
We hypothesized that outpatient management of patients at risk for a HF hospitalization is associated with lower mortality following an incident HF hospitalization.

Methods:
Patterns of outpatient visits prior to incident HF hospitalization were assessed among CMS Medicare beneficiaries with continuous fee-for-service eligibility residing during 2003-2006 in four geographic areas of CVD surveillance conducted by the ARIC Study. Incident HF hospitalization was defined as hospitalization with ICD9 code 428.x with no HF hospitalizations in preceding 2 years. Outpatient visits to primary care physicians, general internists, or cardiologists were identified from Carrier files. A comorbidity score was calculated from ICD9 codes at the time of incident HF hospitalization. Cox proportional hazard models adjusted for age, comorbidity score, gender, and race were used to estimate mortality.

Results:
Mean age among beneficiaries with observed incident HF hospitalization (n=2006; 90.4% white, 45.1% male) was 79.8 years (SD 7.4). Mean comorbidity score was 3.6 (SD 1.9). Mean number of outpatient physician visits occurring in two years preceding the incident HF hospitalization, was 9.6 (SD 9.0); 19.6% beneficiaries had no observed prior outpatient physician visits. Risk of death within one year of incident HF hospitalization was greater among those with no preceding outpatient physician visits as compared to those with at least one physician visit (adjusted HR=1.81 (95% CI 1.50, 2.18); Figure). Adjustment for the presence of an outpatient visit within 2 weeks following the HF hospitalization attenuated the risk of death (HR=1.56 (1.29, 1.89)).

Conclusion:
Lack of outpatient care in two years prior to a HF-related hospitalization is associated with increased mortality within one year following hospitalization. Further inquiry is warranted to assess whether the association reflects diversity in causes/manifestations of HF, ambulatory care received in ED settings, or benefits associated with outpatient care.
Abstract 26: DASH-Style Eating Pattern in Early Adolescence Reduces Cardiometabolic Risk Clustering
Authors: Moore Lynn L , Bradlee M. Loring , Singer Martha R , Daniels Stephen R
Published: July 2021

Cardiometabolic risk (CMR) factor clustering has its roots in childhood and the presence of multiple cardiovascular risk factors in younger populations has been linked with early vascular dysfunction. A

DASH-style eating pattern has been shown to reduce blood pressure and other selected cardiometabolic outcomes, primarily in adults, but its role in the development of CMR clustering during adolescence has not been studied. Data from the National Heart, Lung, and Blood Institute’s Growth and Health Study (NGHS) will be used to evaluate the relation between early-to-mid adolescent dietary intake and CMR clustering at the end of adolescence. The NGHS began in 1987-1988 with the enrollment of 2,379 adolescent girls (with approximately equal numbers of blacks and whites), ages 9-10 years. Diet was assessed using 3-day diet records during eight of 10 years of follow up. A total of 1,369 girls had complete data on diet, all potential confounding variables, and follow-up over 10 years for all CMR factors of interest. Risk factor clustering scores were created by summing individual CMR outcomes defined as follows: waist circumference ≥88 cm, systolic and/or diastolic blood pressure ≥90th percentile for age, sex and height, LDL ≥110 mg/dL, HDL <50 mg/dL, serum TG ≥110mg/dl, and HOMA-IR ≥4. Multiple logistic regression analyses were used to estimate the impact of a DASH-style pattern on the relative risk (odds ratio) of CMR clustering at the end of adolescence, defined as having ≥ 2 or ≥ 3 of the above risk factors at 18-20 years of age. The proportion of white and black girls with CMR clustering was very similar.

However, the types of risk factors differed by race with blacks being nearly twice as likely to have an increased waist size, elevated BP, or insulin resistance and white girls being much more likely to have abnormal lipid levels, particularly elevated triglyceride levels. By the end of adolescence, only 30.1% of girls had no abnormal CMR factors and 34.9% had a single risk factor; 16.6% of girls had two risk factors and 18.4% had between 3-6 prevalent risk factors. Higher intakes of fruit and non-starchy vegetables, dairy, and grains were independently associated with less CMR clustering. After adjusting for age, race, socio-economic status, height, physical activity, and television watching, girls with a DASH-style eating pattern during early-to-mid adolescence were nearly 50% less likely to have three or more CMR factors (O.R.=0.52; 95% CI: 0.30, 0.89) by late adolescence (at 18-20 years of age). These results suggest a DASH-style eating pattern during adolescence, characterized by higher intakes of fruit, non-starchy vegetables, and dairy, may lower risk for the development of subsequent cardiometabolic disorders.
Abstract 32: Global Burden and Control of Hypertension in 2010: Analysis of Population-Based Studies from 89 Countries
Authors: Mills Katherine T , Bundy Joshua D , Kelly Tanika N , Reed Jennifer E , Kearney Patricia M , Reynolds Kristi , Chen Jing , He Jiang
Published: July 2021

Background:
Hypertension is an important global health challenge due to its high prevalence and resulting cardiovascular disease and chronic kidney disease. Hypertension is the leading preventable risk factor for premature death and disability worldwide.

Objective:
We estimated the prevalence, awareness, treatment and control of hypertension worldwide in 2010 and compared the global burden of hypertension in 2000 and 2010.

Methods:
We searched MEDLINE for published reports from January 1, 2001 to June 30, 2014 and supplemented with manual searches of references from retrieved articles. We included population-based studies and applied sex-age-specific prevalence of hypertension from each country to population data to assess the number of hypertensive adults in each region and globally. Proportions of awareness, treatment and control from each country were applied to hypertensive populations to obtain regional and global estimates.

Results:
An estimated 29.8% (95% confidence interval 29.6-30.0%) of the world’s adult population in 2010 had hypertension (30.7% [30.4-31.0%] in men and 28.8% [28.6-29.0%] in women). The estimated total number of hypertensive adults in 2010 was 1.33 billion (1.32-1.34 billion); 346 million (336-356 million) in high-income and 985 million (977-994 million) in low- and middle-income countries. From 2000 to 2010, the age-standardized prevalence of hypertension increased by 2.5% worldwide. The hypertension prevalence decreased 3.5% in high-income countries, whereas the prevalence increased 4.5% in low- and middle-income countries. In addition, from 2000 to 2010 the number of hypertensive adults increased by 354 million (334 million in low- and middle-income countries compared to 19 million in high-income countries). Proportions of hypertension awareness, treatment and control worldwide in 2010 were 43.5% (43.1-44.0%), 33.8% (33.3-34.2%), and 12.3% (12.1-12.6%), respectively. The proportion of hypertension control was 27.7% (27.0-28.3%) in high-income and 6.9% (6.7-7.1) in low- and middle-income countries.

Conclusions:
Prevention and treatment of hypertension should be a global health priority due to its high prevalence and low control rate globally, especially in low- and middle-income countries.
Abstract 43: Association of Plasminogen Activator Inhibitor-1 with Prevalent and Incident Obesity is Independent of Inflammatory Markers: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Khan Sadiya S , Lloyd-Jones Donald M , Chan Cheelin , Liu Kiang , Cushman Mary , Kestenbaum Bryan , Ix Joachim , De Boer Ian
Published: July 2021

Background:
In experimental animal models, deficiency of plasminogen activator inhibitor-1 (PAI-1) protects against development of obesity. In addition, elevated circulating levels of PAI-1 are associated in cross-sectional studies with prevalent obesity in humans. However, no studies have investigated the prospective association between PAI-1 and incident obesity.

Methods:
Plasma PAI-1 levels were measured in a random sample of men and women at baseline (2000-2002) in the Multi-Ethnic Study of Atherosclerosis. Obesity was defined as body mass index (BMI) > 30kg/m2. Incident obesity was identified at four follow-up exams (2002-2011) among those who were not obese at baseline. Logistic regression was used to examine the odds ratios (OR) and 95% confidence intervals (CI) of prevalent obesity at baseline. Cox proportional hazards regression was used to estimate hazard ratios (HR) for time to incident obesity. The covariates used for adjustment included baseline demographics (age, race, sex, center), lifestyle risk factors (physical activity, dietary energy intake, smoking status, alcohol consumption, education), and inflammatory markers (CRP and IL-6).

Results:
In 839 participants mean age was 59 years old; 59% and 47% of the cohort were female and white, respectively. At baseline, each standard deviation (SD) increase in log(PAI-1) level was associated with an odds ratio (OR) for adjusted prevalent obesity of 2.70 (95% CI: 2.21 - 3.30, p<0.001. This association remained significant after further adjustment for IL-6 and CRP with OR 2.39 (95% CI: 1.94-2.94, p<0.001). Over a median follow-up of 8.5 years, 16% of participants developed obesity. The multivariable adjusted hazard ratio for incident obesity was 1.36 (95% CI 1.09-1.69, p<0.001) per 1 SD increase in log(PAI-1). (Table).

Conclusions:
Elevated PAI-1 levels are associated with prevalent and incident obesity. These findings are consistent with results from murine studies and provide evidence suggesting a potential role of PAI-1 in the pathogenesis of obesity.
Abstract 46: A Randomized Trial of Moderate and Intensive Exercise on Fatty Liver and Cardiometabolic Risk Factors in Obese Adults
Authors: Zhang Huijie , Li Xuejun , Ma ZhiMin , Pan LingLing , Chen Zheng , Huang zhufeng , Han ChengKun , Chen Shi , Zhuang XiongJie , Lin Mingzhu , Li ZhiBin , He Jiang , Yang ShuYu , Li Xiaoying
Published: July 2021

Corresponding authors: Shu-yu Yang, Xiamen Diabetes Institute, Department of Endocrinology and Metabolism, The First Hospital of Xiamen, Xiamen University, 55 Zhenhai Road, Xiamen 361003, China ( xmyangshuyu@126.com). Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste 2000, New Orleans, LA 70112 (
jhe@tulane.edu
). Xiao-Ying Li, MD, PhD, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai 200025 (lixy@sibs.ac.cn).

Introduction:
Nonalcoholic fatty liver disease (NAFLD) and its cardiovascular complications are common public health problems.

Hypothesis:
Although the benefit of exercise on NAFLD and cardiometabolic risk factors is documented, the effects of intensive and moderate exercise on these outcomes have not been thoroughly investigated..

Methods:
We conducted a randomized controlled trial among 220 individuals aged 40-65 years with a waist circumference of ≥90 cm in men and ≥85 cm in women. NAFLD was defined by proton magnetic resonance spectroscopy (1H-MRS). Participants were randomly assigned to the intensive exercise group (vigorous exercise at 65-80% maximum oxygen consumption by running on a treadmill 30 min/day and 5 days/week for 6 months, followed by moderate exercise by brisk walking 150 min/week for another 6 months), the moderate exercise group (brisk walking 150 min/week for the entire 12 months), or the usual care control (lifestyle counseling for 12 months). The primary outcome was the change of intra-hepatic triglyceride content as determined by
1
H-MRS. Secondary outcomes were metabolic risk factors.

Results:
At 12 months, the mean change of intra-hepatic triglyceride content from baseline was -6.10% in the intensive exercise, -5.91% in the moderate exercise, and -2.73% in the control groups (P<0.0001). Compared to the control group,the intensive and moderate exercise groups had significant net reductions of intra-hepatic triglyceride content at 6 months (-4.56%, 95% CL-6.71 to -2.42, p<0.001 for intensive and -3.86%, 95% CL-6.01 to -1.71, p<0.001 for moderate) and 12 months (-3.37%, 95% CL-5.52 to -1.22, p<0.001 for intensive, and -3.19%, 95% CL-5.34 to -1.04, p<0.001 for moderate). The net changes of intra-hepatic triglyceride content were not significantly different between the two exercise groups. Both intensive and moderate exercise reduced waist circumference, body weight, and blood pressure; additionally, intensive exercise reduced body fat mass, visceral fat, and body fat percent.

Conclusions:
Moderate intensity and vigorous intensity exercise were equally effective in improving NAFLD and blood pressure while vigorous exercise produced greater reductions of body fat.
Abstract MP07: Rising Incidence and Prevalence of Atrial Fibrillation from 2004 to 2013: A Community-Based Study Using Electronic Medical Records
Authors: Williams Brent , Berger Peter
Published: July 2021

Introduction:
Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in clinical practice and is associated with an elevated risk of stroke and mortality. Evaluating community-level temporal trends in AF incidence and prevalence serve to describe the evolving public health and clinical burden of AF, however recent studies describing AF trends in community-based settings have been inconsistent, with no recent data evaluating trends among individuals under 65 years of age. Accordingly, this study sought to describe community-level trends in AF incidence and prevalence from 2004 to 2013 using the electronic medical records (EMR) of a single, large health care system.

Methods:
This study includes 329,634 patients receiving primary care and other health care services through the Geisinger Health System (Geisinger) over at least a two-year period. Geisinger consists of over 40 outpatient and seven inpatient facilities spread throughout central and northeastern Pennsylvania. Geisinger’s extensive EMR data repository contains information on demographics, vital signs, social history, diagnoses, medical history, problem lists, medications, procedures, laboratory results, and billing information from all Geisinger encounters since 2001. Incident and prevalent AF were identified by ICD-9 codes observed within any EMR domain. For incident AF, cases had no AF ICD-9 code in the EMR for at least two years prior to the diagnosis. Incidence and prevalence rates were age- and sex-adjusted to the 2010 US census and reported per 1000 person-years (persons). Stratified rates are reported across age groups (<45, 45-54, ¼, >85) and sex.

Results:
Age- and sex-adjusted AF incidence rates remained relatively stable from 2004 to 2008, but increased sharply thereafter. Incidence rates were 5.0, 5.2, and 8.4 cases per 1000 person-years in 2004, 2008, and 2013, respectively. The overall annual increase was 5.5% per year (95% CI: 4.8, 6.3%). Incidence rates increased significantly in all age and gender groups, with the largest relative increase observed among patients <45 years of age (annual increase in males: 10.8%, females: 11.6%). Prevalence rates increased consistently throughout the entire 10-year period from 23.5 to 39.2 AF cases per 1000 persons from 2004 to 2013 (6.0% annual increase; 95% CI: 5.7, 6.4%).

Conclusions:
AF incidence and prevalence have been increasing in the community over the last 10 years. Increases were observed in all age and gender groups, with notable increases in the very young. Prevailing trends may be attributable to increased application of AF diagnostics in an aging population and/or an increased clinical recognition of AF due to the recent availability of novel oral anticoagulants for stroke prevention. A mature EMR system functioning within a large health care system can be a powerful tool for performing epidemiologic studies and disease surveillance.
Abstract MP16: Adherence to Healthy Lifestyle Factors is Associated With a Lower Risk of Death Among US Male Physicians With Type 2 Diabetes
Authors: Petrone Andrew B , Gaziano J. Michael , Djousse Luc
Published: July 2021

Background:
Previous studies have suggested that adherence to a healthy lifestyle is associated with reduced risk of type 2 diabetes, cardiovascular disease, and mortality. However, it is unknown whether a combination of healthy lifestyle after the diagnosis of diabetes is associated with reduced risk of all-cause mortality.

Objective:
To test the hypothesis that healthy modifiable lifestyle factors are associated with a lower risk of all-cause mortality in people diagnosed with type 2 diabetes.

Methods:
A prospective cohort study of 1,160 male physicians from the Physicians’ Health Study with prevalent type 2 diabetes. Smoking habits, body mass index, exercise frequency, and alcohol consumption were assessed via questionnaire, and diet was assessed via a food frequency questionnaire between 1999 and 2002. Death was ascertained by an endpoint committee. Healthy lifestyle factors were defined as: 1) never or past smoking, 2) body mass index <25 kg/m
2
, 3) vigorous physical activity 1+ days/week, alcohol consumption of 1-2 drinks/day, and 5) being in the top two quintiles of the Alternative Healthy Eating Index score. We used Cox regression to estimate multivariable adjusted hazard ratios of death according to each lifestyle factor, and total number of healthy lifestyle factors met.

Results:
During a median follow-up of 9.2 years, there were 248 deaths. The mean age at baseline was 68.9 ± 8.2 years. Healthy diet score was associated with a 40% (95% CI: 20-55%) lower risk of mortality. Multivariable adjusted hazard ratios (95% CI) for mortality were: 1.0 (ref), 0.58 (0.42-0.80), 0.58 (0.41-0.81), and 0.55 (0.35-0.87) for meeting 0 or 1, 2, 3, and 4+ healthy lifestyle factors, respectively.

Conclusions:
Our data are consistent with an inverse association between the number of healthy lifestyle factors and risk of mortality in US male physicians with type 2 diabetes.
Abstract MP27: Cellphone Intervention for You (CITY): A Randomized, Controlled Trial of Behavioral Weight Loss Intervention by Cellphone or Personal Coaching for Young Adults
Authors: Svetkey Laura P , Intille Stephen S , Batch Bryan C , Corsino Leonor , Tyson Crystal C , Bennett Gary G , Bosworth Hayden B , Voils Corrine , Grambow Steven , Loria Catherine , Arteaga S S , Lin Pao-Hwa
Published: July 2021

Background:
Obesity affects young adults, leading to future morbidity and mortality. Early behavioral intervention may promote long-term weight control. Mobile technology-based (mHealth) interventions may be particularly effective in young adults. We compared both an mHealth behavioral weight loss intervention and a personal coaching weight loss intervention to no intervention (and to each other) in overweight/obese young adults.

Methods:
We randomized 365 generally healthy adults age 18-35 years with BMI > 25 kg/m2 (overweight or obese) to 24-months of intervention delivered primarily via investigator-designed cell phone (CP) or intervention delivered primarily via in-person (6 weekly) and by phone (23 monthly) coaching (PC), compared to usual care control group (Control). Primary outcome was weight change from baseline to 24 months. This study was conducted as part of the Early Adult Reduction of weight through LifestYle (EARLY) cooperative trials.

Results:
Randomized participants (N=365) had mean BMI 35 kg/m2, mean age 29yrs, were 70% women, 36% African American, 6% Latino. Final weight was obtained in 86%; missing weight was multiply imputed. At 24 months, weight loss was not different in either PC or CP vs Control (see Figure). Weight loss in PC was significantly greater than Control at 6 months. From baseline to 24 months, clinically significant weight loss (> 3% per national guidelines) occurred in 40% of PC, 34% of CP, and 30% of Control.

Conclusions:
mHealth alone may not be sufficient for weight loss in young adults but mHealth-enhanced contact with an interventionist has a modest short-term effect. Future interventions should maximize the complementarity of mHealth and personal contact to achieve larger and more sustained effect.
Abstract MP46: Growth Factors Are Associated With Imaging Markers of Brain Aging in Young Adults
Authors: Satizabal Claudia L , Beiser Alexa , Himali Jayandra J , Au Rhoda , Wolf Philip A , DeCarli Charles , Vasan Ramachandran , Seshadri Sudha
Published: July 2021

Metabolic and vascular dysregulation are related to stroke, cognitive decline and dementia. Growth factor biomarkers of these processes, such as Insulin-like Growth Factor 1 (IGF1) and Vascular Endothelial Growth Factor (VEGF) have been associated with risk of neurodegeneration and stroke in middle-aged and older Framingham participants. Additionally, hepatocyte growth factor (HGF) and angiopoietin 2 are novel biomarkers of interest as they have been related to cardiovascular events.

As abnormal brain changes probably start years before clinical symptoms, we hypothesize that circulating growth factors are related to MRI endophenotypes of brain aging.

We included 1,877 individuals aged 46±8 years from the Framingham Study. Blood samples were collected during 2008-2011, and used to measure IGF1, VEGF, HGF, angiopoietin 2 and its receptor tyrosine kinase (TIE2). Participants underwent brain MRI examination (2009-2013) from which brain volumes and white matter hyperintensities were estimated. We related growth factor levels to brain MRI markers adjusting for age, sex, time between blood draw and MRI, and cardiovascular risk factors.

Lower IGF1, as well as higher HGF and angiopoietin 2 levels were associated with higher ventricular volumes indicative of brain shrinkage. Higher TIE2 levels were associated with lower total brain and gray matter volumes, while higher angiopoietin 2 levels were associated with lower white matter volumes. Lower IGF1 levels were also associated with reduced hippocampal volumes. Finally, higher TIE2 levels were associated with larger white matter hyperintensities.

Our results suggest that growth factors are associated with neurodegenerative and cerebrovascular markers of brain aging in healthy young adults. Whereas IGF1 seems protective, higher levels of HGF, angiopoietin 2 and TIE2 were associated with greater subclinical brain injury. These associations expand our understanding of the earliest stages of brain aging. We will extend our findings by analyzing cognitive outcomes.
Abstract MP47: The Association of Socioeconomic Status with Subclinical Myocardial Damage
Authors: Fretz Anna E , Schneider Andrea L , McEvoy John , Hoogeveen Ron , Ballantyne Christie M , Coresh Joseph , Selvin Elizabeth
Published: July 2021

Background:
The association between socioeconomic status (SES) and clinical cardiovascular events is well established. However, little is known about the relationship between SES and subclinical myocardial damage, as assessed by a novel highly sensitive assay for cardiac troponin T (hs-cTnT).

Methods:
We conducted a cross-sectional analysis of 11,411 participants from the ARIC Study with no history of cardiovascular disease who had hs-cTnT measured at visit 2 (1990-1992). SES was defined using either annual household income, categorized as: low (<$16,000), mid-level ($16,000 - $34,999), high (≥ $35,000), or lifetime educational attainment, categorized as: low (<12th grade), mid-level (12th grade/some college) and high (college degree or higher). hs-cTnT was categorized as non-elevated (<14 ng/L) and elevated (≥ 14ng/L). Poisson regression was used to generate prevalence ratios for elevated hs-cTnT, separately by level of income and education after adjusting for demographic, clinical, and behavioral factors.

Results:
Persons with low income or low education were more likely to have subclinical myocardial damage as assessed by elevated hs-cTnT (≥14ng/L). Adjusted prevalence ratios for elevated troponin comparing low to high levels of income and education were 1.74 (95% CI: 1.32, 2.29) and 1.54 (95% CI: 1.21, 1.97), respectively (Table, Model 1). These results were slightly attenuated, but remained statistically significant after adjusting for cardiovascular risk factors and health behaviors (Models 2 and 3). Race-stratified results demonstrate a somewhat stronger and only significant association of low education with subclinical myocardial damage in blacks compared to whites (PR 1.83 vs 1.05, p-interaction =0.08). There was no race interaction with income (p-interaction =0.33).

Conclusions:
Low SES was associated with elevated hs-cTnT, independent of cardiovascular risk factors, especially in blacks. Further research is needed to explore how low SES contributes to subclinical myocardial damage.
Abstract MP56: Misclassification of Incident Heart Failure Hospitalizations in Administrative Claims Data: The Atherosclerosis Risk in Communities (ARIC) Study.
Authors: Camplain Ricky , Kucharska-Newton Anna , Chambless Lloyd E , Wright Jacqueline D , Butler Kenneth R , Cuthbertson Carmen , Heiss Gerardo
Published: July 2021

Background:
Estimation of disease incidence from administrative data requires an adequate look-back (prevalence) period to exclude pre-existing conditions from the incidence risk set. We characterized optimal lengths of the prevalence period to minimize misclassification of incident heart failure (HF) hospitalization, a proxy for incident HF.

Methods:
Data for participants of the ARIC Study (a prospective longitudinal cohort of 15,792 individuals sampled from 4 US communities) were linked with CMS Medicare claims from the years 2000-2012. We included only participants with >36 months of continuous CMS Medicare fee for service (FFS) enrollment. Each participant’s time-in-observation was divided into two phases. The first 36 months were the prevalence period. Observation time after an index date 36 months following the date of enrollment was the incidence period. HF hospitalizations were identified from CMS MedPAR records using ICD-9 code 428.xx in any position. Patients were classified as having a HF hospitalization in (a) both the prevalence and incidence periods, (b) in the prevalence period only, (c) in the incidence period only, or (d) neither. Incident HF was defined as the first HF hospitalization in the incidence period not preceded by a HF hospitalization in the prevalence period. The proportion of events misclassified as incident HF hospitalization was estimated from incremental reductions of the prevalence period to start 36, 30, 24, 18, 12, or 6 months before the index date. The impact of misclassification was estimated as differences in incidence per 1,000 patients at risk.

Results:
Of 11,054 ARIC participants enrolled in Medicare FFS, 9,568 met the study inclusion criteria. A total of 1,129 incident HF hospitalizations were identified based on the 36 month prevalence period, considered as the referent (incidence rate 118 HF hospitalizations per 1,000 patients at risk). Shortening the prevalence period to 24 months increased the HF incidence rate to 123 per 1,000, overestimating the number of incident HF hospitalizations by 4.2% while retaining over 90% of the sample. A 12 month prevalence period yielded an overestimation of the number of incident HF hospitalizations by 11% (incidence rate 129 per 1,000 patients at risk) while retaining 95% of the sample.

Conclusions:
Selection of too short of a prevalence period to define incident hospitalized HF from CMS Medicare claims data can introduce substantial misclassification. Consideration of several prevalence periods indicates that a 24 month prevalence period reduces the potential for bias in the estimation of incident hospitalized HF while retaining most observations.
Abstract MP59: Mediating the Medical, Economic and Social Impact of HF: There is an APP for That
Authors: Houston-Feenstra Linda , Kagoda Mercy , Dysinger Wayne , Chatterjee Samir , Alnosayan Nagla , Alluhaidan Ala , Fabbri Sharon , Peterson Denise
Published: July 2021

The continued rise in cost of Heart failure (HF) management, begs the question, why can advances in science and medicine not stem this rising cost? Why do patients fail to adhere to prescribed medications and lifestyle recommendations? Lack of effective training for patient/families challenge successful transition to home due to conflicts generated by pressure within the patient’s home environment reinforced by societal attitudes about food. This pilot was designed as a multidisciplinary project, including information systems professionals, clinicians, and patients working together to develop/evaluate a customized mobile phone application (app). Using, home based monitoring of daily weights, blood pressure, heart rate, blood glucose, and a dash board of cumulative data accessed daily by clinicians. A built in algorithm identifies patients’ risk for re-admission based on changes in their vital signs or self-reported symptoms defined by clinical staff as representing best practices pathways decision points. 7 patients with a clinical diagnosis of HF who had documentation of at least one HF related admission in the past 14 months were recruited to trial the App. Patients have been followed for 120 days with an endpoint of 365 days. Data points for outcomes are: HF related hospitalizations; emergency department and urgent care visits, weight, blood pressure, and Minnesota living with heart failure quality of life. Preliminary data analysis shows mean compliance rate for daily measurements = 68.5%. Utilization has prevented one HF readmission, changed one admission from an acute ICU readmission into a short stay guided HF admission, accomplished by early identification of symptoms that unmanaged would have resulted in a more serious and lengthy admission. This integrated innovative system has demonstrated improved accountability and outcomes in the enrolled participants. Patient input at 120 days resulted in system revisions. Data collection will restart and continue to the 365 day end point.
Abstract MP69: Relationships Between Sleep Apnea, Cardiovascular Disease Risk Factors, and Aortic Pulse Wave Velocity over 9 Years: The Wisconsin Sleep Cohort
Authors: Stern Rebecca , Korcarz Claudia E , Peppard Paul E , Barnet Jodi H , Hagen Erika W , Young Terry , Stein James H
Published: July 2021

Background:
Cardiovascular disease (CVD) risk factors associated with obstructive sleep apnea (OSA) contribute to endothelial dysfunction and arterial stiffening. We hypothesized that OSA severity would predict aortic pulse wave velocity (PWV) after nearly a decade of aging in the Wisconsin Sleep Cohort (WSC).

Methods:
Subjects were 596 participants in the WSC that underwent overnight polysomnography between 2000 and 2008; subsequent tonometry data was acquired a mean of 8.8 (standard deviation, 2.1) years later. OSA severity was described by the apnea-hypopnea index (AHI), mean and minimum nocturnal blood oxygen saturation level (SaO
2
, %), and time with SaO
2
<90%. AHI+1 was log transformed. Participants using positive airway pressure therapy (PAP) at the tonometry visit were evaluated as a distinct categorical variable. Non-invasive applanation tonometry was used to derive aortic (carotid-to-femoral) PWV. Multivariable linear and logistic regression models that included CVD risk factors, antihypertensive, and lipid medications were fit to evaluate longitudinal associations between baseline OSA markers and future PWV.

Results:
At baseline, the 596 participants were mean 55.9 (7.3) years old (53% male, 97.5% Caucasian). Their mean body-mass index (was 31.4 (6.9) kg/m
2
, 89 (14.9%) had diabetes mellitus, and 252 (42.3%) were hypertensive. Excluding the 40 CPAP users, the mean AHI was 5.8 (7.6) events/hour (range 0.0-53.6); 54 (9.1%) had AHI ≥15 events/hr. Mean SaO
2
was 94.7% (2.1%) and minimum SaO
2
was 82.8% (9.5%). Time with SaO
2
<90% did not predict PWV. In models adjusted for age and sex, lower mean SaO
2
(β=-0.16, SE 0.06, p=0.004), lower minimum SaO
2
(β=-0.04, SE 0.01, p=0.005) and higher log
10
(AHI+1) (β=0.55, SE 0.20, p=0.005) predicted higher PWV a mean of approximately 9 years after OSA assessment. However, none of these associations were statistically significant after waist circumference (p≤0.005 for all 3 outcomes) and height were added to the models. For models with mean SaO
2
, waist circumference independently predicted PWV, but after addition of CVD risk factors, only age (β=0.14, SE 0.01, p<0.001), systolic blood pressure (β=0.02, SE 0.01, p<0.001), and diabetes status (β=0.96, SE 0.28, p=0.002) were independent predictors. Very similar results were observed for models with minimum Sa0
2
and PWV. None of the OSA parameters interacted with age or smoking status to predict PWV. Presence of Metabolic Syndrome did not predict PWV; it did not interact with OSA parameters to predict PWV.

Conclusions:
The longitudinal associations between OSA and PWV are confounded by body size and influenced by diabetes mellitus and blood pressure. These results suggest that weight management and blood pressure control may help prevent arterial stiffening associated with sleep apnea.
Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications
Authors: Xu Tan , Zhang Yonghong , Sun Yingxian , Chen Chung-Shiuan , Chen Jing , He Jiang ,   for the CATIS investigators
Published: July 2021

Introduction:
The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain.

Hypothesis:
We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications.

Methods:
The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events.

Results:
Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension.

Conclusion:
Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.
Abstract MP90: Carotid Arterial Stiffness is Associated with An Increased Risk of Incident Cerebral Microbleeds in Older People: the Age, Gene/Environment Susceptibility-Reykjavik Study
Authors: Ding Jie , Bots Michiel L , Sigurdsson Sigurdur , Garcia Melissa , Harris Tamara B , Eiriksdottir Gudny , van Buchem Mark A , Gudnason Vilmundur , Launer Lenore J
Published: July 2021

Introduction:
Cerebral microbleeds (CMBs) resulting from cerebral amyloid angiopathy are predominantly located in lobar regions, whereas those from hypertension are in deep and infratentorial regions. Although age and high blood pressure are major risk factors for CMBs, the underlying mechanisms remain unclear; arterial stiffness may be important.

Hypothesis:
We hypothesized that carotid arterial stiffness, would be associated with incident CMBs. Given the spatial distributions of the underlying arteriopathies in which hypertensive arteriopathy typically affects the small perforating end-arteries of the deep structures, we further hypothesized that the associations would be more robust for deep CMBs attributed to hypertensive arteriopathy.

Methods:
In the prospective, population-based Age, Gene/Environment Susceptibility-Reykjavik Study, 2,512 participants aged 66-97 years underwent a baseline brain MRI examination and carotid ultrasound in 2002-2006, and returned for a repeat brain MRI in 2007-2011. Common carotid arterial stiffness was assessed using a standardized protocol and expressed as carotid arterial strain (CAS), distensibility coefficient (DC) and Young’s elastic modulus (YEM). Log-binomial regression was applied to relate carotid arterial stiffness parameters to CMBs incidence.

Results:
During a mean follow-up of 5.2 years, 463 people (18.4%) developed new CMBs, of whom 292 had CMBs restricted to lobar regions and 171 had CMBs in a deep or infratentorial region. After adjusting for age, sex and brain MRI interval, all arterial stiffness parameters were each significantly associated with incident CMBs (Risk ratio [RR] per SD decrease in CAS, 1.11 [95%CI, 1.02-1.21]; RR per SD decrease in natural log-transformed DC, 1.14[1.05-1.23]; RR per SD decrease in natural log-transformed YEM, 1.13[1.04-1.22]) and deep CMBs (RR, 1.17[1.00-1.36]; 1.24[1.07-1.43]; 1.22[1.06-1.41] respectively) but not with lobar CMBs. When further adjusted for baseline vascular risk factors including blood pressure and use of blood pressure lowering drugs, the presence of carotid plaque, prevalent CMBs, subcortical infarcts and white matter hyperintensities, the associations persisted.

Conclusion:
Our findings support the hypothesis that localized increases in carotid arterial stiffness may contribute to the development of CMBs, especially those occuring in a deep location.
Abstract P003: Distribution of Ideal Cardiovascular Health Metrics in US and Non-US populations: A Meta-Analysis of Proportions
Authors: Younus Adnan , Aneni Ehimen , Ogunmoroti Oluseye , Jamal Omar , Ali Shozab , Shaharyar Sameer , Aziz Muhammad , Malik Rehan , Ahmad Rameez , Osondu Chukwuemeka , Roberson Lara , Post Janisse , Feldman Theodore , Maziak Wasim , Agatston Arthur S , Veledar Emir , Nasir Khurram
Published: July 2021

Introduction:
With the development of new health metrics to define ideal cardiovascular health (CVH), several studies have examined the distribution of the American Heart Association (AHA) 2020 ideal CVH metrics both within and outside the United States (US). In this meta-analysis of proportions, we synthesized available data on ideal CVH metrics distribution in US cohorts and compared them with non-US populations.

Methods:
A MEDLINE database search was conducted using relevant free text terms such as “life’s simple 7”, “AHA 2020”, “American Heart Association 2020” and “ideal cardiovascular health” between January 2000 and October 2014. Studies were included in the meta-analysis if the proportions achieving ideal for 0, 1, 2, 3, 4, 5 or ≥6 ideal CVH metrics were known or could be estimated. A meta-analysis of proportions was conducted for US and non-US studies using a random effect model (REM). REM models were chosen because of the significant heterogeneity among studies.

Results:
Overall the pooled data consisted of 10 US cohorts with a total population of 94,761 participants and 6 non-US cohorts with a total of 130,242 participants. The table shows the pooled prevalence of ideal CVH factors in this population. Overall the pooled estimates of US cohorts showed 15% had 0-1 ideal CVH metrics (inter-study range: 7-22%), while 3% (inter-study range: 1-10%) had 6-7 ideal CVH metrics. This is comparable to 12% (inter-study range 1-17%) and 2% (inter-study range: 1-12%) for 0-1 and 6-7 ideal CVH metrics in the non-US studies.

Conclusion:
The proportion of persons achieving 6 or more ideal CVH metrics in both US and non-US cohorts is very low and the distribution of CVH metrics is similar in both US and non-US populations. Considering the strong association with worse outcomes, a coordinated global effort at improving CVH should be considered a priority.