bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P249: Determinants of Descending Aortic Dimensions in a Multi-Ethnic Population: The Dallas Heart Study
Authors: Guel David A , Peltz Matthias , Khera Amit , McIntire Donald D , Peshock Ronald M , Jessen Michael E
Published: July 2021

Introduction:
Accurate description of normal aortic size is fundamental to our ability to define aortic aneurysms. However, current definitions of normal aortic dimensions are based on small population samples with limited data on other variables. This study used data from a large unselected community population to define normal aortic dimensions and to examine relationships between aortic size and demographic and anthropometric variables.

Methods:
Data came from a validated multiethnic urban population sample. Adults (age 18 – 65) underwent collection of demographic and medical history data. A subset of participants (n=2643) underwent gated aortic MRI to measure descending aortic diameter at the level of the pulmonary artery bifurcation. Age, gender, ethnicity (white, black, Hispanic or other) and multiple indices of body size and composition were collected or calculated from available data (body mass index [BMI], body surface area [BSA]). Dual-energy x-ray absorptiometry was used to calculate total body fat mass and lean body mass. A univariate analysis was performed relating descending aortic diameter to each variable. A stepwise variable selection using a p-value criteria of 0.15 for entry and removal was used to identify variables independently associated with aortic size.

Results:
By univariate analysis, increased aortic size was associated with increased age, male gender, black ethnicity, and greater height, weight, waist and hip circumference, BMI, BSA , total body fat mass and total body lean mass. By multivariable analysis, age, lean body mass, ethnicity, gender, waist circumference, and hip circumference emerged as significant determinants of descending aortic diameter (see Table).

Conclusions:
The diameter of the descending aorta appears to increase with age and is larger in certain ethnic groups and in subjects with greater indices of body size. Definitions of normal values for descending aortic dimensions may need to consider these factors.
Abstract P251: The Impact of Clinical Risk Factors on Risk of Peripheral Arterial Disease in Men
Authors: Joosten Michel M , Pai Jennifer K , Rimm Eric B , Spiegelman Donna , Mittleman Murray A , Mukamal Kenneth J.
Published: July 2021

Background:
Previous studies have examined individual risk factors in relation to peripheral arterial disease (PAD) but the combined effects of these factors are largely unknown. We investigated the degree to which clinical risk factors may explain the risk of PAD among men.

Methods:
We prospectively followed 45,596 men from the Health Professional Follow-up Study without a history of cardiovascular disease at baseline during a 22-year period (1986–2008). We defined four clinical risk factors - smoking, history of type 2 diabetes, hypertension, and hypercholesterolemia - that were updated biennially during follow-up. Cox proportional hazard models were used to compare PAD risk across individual and joint risk factors.

Results:
During 874,769 person-years of follow-up, 497 confirmed PAD cases occurred. All four clinical risk factors were significantly and independently associated with a higher risk of PAD after multivariate adjustment (Figure). Risk of PAD more than doubled (hazard ratio: 2.14; 95% confidence interval [95% CI]: 1.95–2.35) for each additional risk factor compared with the group free of risk factors. Men without any of the four risk factors had a relative risk of PAD of 0.19 compared with all other men (95% CI: 0.11–0.31). In 96.8% (95% CI: 95.2–98.3%) of the PAD cases, at least one of the four risk factors was present. Overall, 8 out of 10 cases of PAD appeared to be attributable to these four conventional risk factors.

Conclusion:
The great majority of PAD can be explained by four conventional risk factors.

Figure legend:
Hazard ratios for incident peripheral arterial disease (PAD) according to individual and joint risk factors. Hazard ratios are adjusted for age, height, aspirin use, family history of myocardial infarction before age 60 y, geographical region, body mass index, physical activity, alcohol consumption (and each of the other three binary clinical risk factors in the individual risk factor analyses).
Abstract P254: Risk Factors For Venous Thromboembolism in a Cohort of French Women
Authors: Lajous Martin , Tondeur Laura , Fournier Agnes , Clavel-Chapelon Francoise
Published: July 2021

Background:
There is controversy over whether cardiovascular disease and venous thromboembolism (VTE) share risk factors. Prospective information on risk factors for VTE in otherwise healthy individuals is limited.

Methods and Results
We evaluated the relation between known risk factors for cardiovascular disease and incidence of VTE among 65,272 French women in the E3N prospective cohort study with no prior history of VTE and who were free of cardiovascular disease or cancer in 1993. All information was self-reported via mailed questionnaires and diet and physical activity were assessed using previously validated instruments. Between 1993 and 2007, 766 cases of deep vein thrombosis or pulmonary embolism were first identified through self-reports and validated using medical records and information from treating physicians. Cases were considered valid if the diagnosis was based on an imaging procedure. We evaluated the following risk factors: education, menopause, postmenopausal hormone use, treated hypercholesterolemia and hypertension, diabetes, body mass index (BMI), physical activity, smoking status and intake of alcohol, red meat, fish, fruits and vegetables, fiber and coffee. In a multivariable model with age as the time scale, we found that, compared to women with a BMI <22 kg/m2, the HR (95%CI) was 1.35 (1.14, 1.60) for 22–24.9 kg/m2, 2.11 (1.73, 2.57) for 25–29.9 kg/m2 and 2.88 (2.08, 3.98) for ≥30 kg/m2 and the p-trend was <0.0001. Menopause was found to be inversely associated with VTE risk [HR=0.60 (95%CI 0.45–0.80); postmenopausal vs. premenopausal women]. In analyses restricted to postmenopausal women, relative to never users current use of postmenopausal hormones was significantly associated to VTE risk [HR=1.44 (95%CI 1.18–1.74)]. No significant association was found with dietary and other cardiovascular risk factors.

Conclusion
In this large prospective study only some risk factors for cardiovascular disease were associated to VTE incidence. We observed a strong inverse association between menopause and VTE.
Abstract P257: The Association of Metabolic Risk and Physical Activity Trajectories: CARDIA
Authors: Camhi Sarah M , Katzmarzyk Peter T , Broyles Stephanie , Church Timothy S , Hankinson Arlene L , Carnethon Mercedes R , Sternfeld Barbara , Lewis Cora E
Published: July 2021

Purpose:
To determine whether baseline metabolic risk in young adults is associated with physical activity (PA) trajectories over 20 years.

Methods:
The sample included young adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study, baseline ages 18–30 years (n= 4161). PA was determined from self-reported questionnaire at baseline and at years 2,5,7,10,15 and 20 of follow-up. Baseline metabolic risk was calculated using age-adjusted principal components analysis (elevated=top 10% of first factor), within sex-by-race groups, from mean arterial pressure (1/3(SBP-DBP)+DBP), glucose, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Repeated measures general linear modeling was used to generate PA trajectories over 20 years, separately in black men, white men, black women and white women, adjusting for age and smoking status. Time by metabolic risk interaction terms did not contribute significantly to any model for any sex-by-race group and were therefore not included in final models.

Results:
In black men, white men, and white women, PA (in exercise units) at baseline was significantly lower among those with elevated metabolic risk (elevated risk vs. normal risk: black men 473.0 ± 27.0 vs. 572.0 ± 22.7; white men: 498.0 ±20.6 vs. 568.7 ± 17.3; white women: 402.4 ± 17.0 vs. 481.1 ± 14.3), and these differences persisted over 20 years (black men: −98.9 ± 16.4, white men: −70.8 ± 12.5 , white women: −78.7 ± 10.2; all p<0.0001). There were no significant differences in PA by metabolic risk in black women (307.2 ± 15.5 vs. 317.4 ± 13.1, difference: −10.1 ± 9.3, p =0.27).

Conclusion:
Elevated metabolic risk is associated with lower levels of PA in early adulthood, and these differences persist over 20 years. Despite these lower levels at baseline, the PA trajectory declines at similar rates for those with and without elevated metabolic risk. Young adults with elevated metabolic risk are important to identify early, in order to prevent PA level gap which remains over 20 years between those with and without elevated metabolic risk.
Abstract P258: Physical Activity Attenuates the Impact of Obesity on Cardiometabolic Risk: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: McAuley Paul A , Chen Haiying , Lee Duck-chul , Artero Enrique G , Bluemke David A , Burke Greg L
Published: July 2021

Background:
The impact of higher physical activity on the relationship between adiposity and cardiometabolic risk is not completely understood.

Methods:
The cross-sectional association between body mass index (BMI) and cardiometabolic risk stratified by intentional physical activity was examined in 6814 Multi-Ethnic Study of Atherosclerosis participants, during 2000-2002. Self-reported physical activity in the lowest quartile (0-105 MET-minutes/wk) was categorized as inactive with the upper three quartiles (123-37,260 MET-minutes/wk) categorized as active. The association of BMI categories of normal-weight, overweight and obese stratified by physical activity status (inactive or active) with cardiometabolic risk factors (low HDL-cholesterol [<50 mg/dL], high triglycerides [TG] [≥200 mg/dl], hypertension [HTN] [BP ≥140/90 or current treatment], insulin resistance [highest quartile of homeostasis model assessment of insulin resistance index (HOMA-IR)], and impaired fasting glucose [IFG] [≥100 mg/dl]/diabetes mellitus [DM]) were assessed using logistic regression analysis, after adjusting for age, gender, race/ethnicity, and current smoking.

Results:
As expected, overweight and obese participants had a more abnormal risk profile. Among obese participants, those with increased physical activity had reduced odds of insulin resistance (47% lower; p<0.001) and IFG/DM (23% lower; p=0.04). Increased physical activity had a beneficial, but more modest effect on other traditional CVD risk factors (
Table
).

Conclusion:
A beneficial impact of physical activity on cardiometabolic risk was observed that partially attenuated the abnormal impact of obesity.

Odds ratio (95% CI) for cardiometabolic abnormality by BMI-PA category

Low-HDL
High-TG
HTN
HOMA-IR
IFG/DM

Normal Active
1.0 (reference)
1.0 (reference)
1.0 (reference)
1.0 (reference)
1.0 (reference)

Normal Inactive
1.3 (1.0-1.7)
1.4 (0.9-2.1)
1.1 (0.8-1.4)
1.1 (0.7-1.7)
1.0 (0.7-1.4)

Overweight Active
1.9 (1.6-2.2)
2.1 (1.6-2.6)
1.5 (1.3-1.8)
3.2 (2.5-4.2)
2.1 (1.7-2.5)

Overweight Inactive
2.5 (2.0-3.1)
2.0 (1.5-2.8)
1.5 (1.2-1.9)
3.8 (2.8-5.2)
2.1 (1.6-2.7)

Obese Active
2.9 (2.4-3.7)
2.5 (1.9-3.4)
2.2 (1.8-2.7)
7.6 (5.6-10.2)
3.4 (2.7-4.4)

Obese Inactive
3.1 (2.4-4.1)
2.7 (1.9-3.8)
2.5 (2.0-3.3)
14.3 (10.3-19.7)
4.4 (3.4-5.9)
Abstract P261: Performing Recommended Physical Activity and Insulin Sensitivity by Body Mass Index, among US Adolescents: NHANES 1999–2006
Authors: Song MinKyoung , Carroll Dianna D , Imperatore Giuseppina , Caspersen Carl J , Fulton Janet E
Published: July 2021

Introduction:
Physical activity may enhance insulin sensitivity in youth, thereby reducing future risk of type 2 diabetes. However, no studies report the association between performing aerobic- or muscle-strengthening (MS) activities recommended in the 2008 Physical Activity Guidelines for Americans and insulin sensitivity, especially by body mass index (BMI) levels.

Objective:
To assess the association between meeting aerobic or muscle-strengthening guidelines and insulin sensitivity overall, and by BMI levels, in a nationally representative sample of US adolescents.

Methods:
We analyzed National Health and Nutrition Examination Survey (1999–2006) data for 2251 adolescents aged 12–17 years who answered 10 interviewer-administered physical activity questions. Adolescents met the aerobic guideline with ≥60 minutes/day of moderate- or vigorous- intensity level aerobic activities, and the MS guideline with ≥3 days/week of activities such as weight lifting or push-ups. We estimated insulin sensitivity via the Quantitative Insulin Sensitivity Check Index (QUICKI) calculated as 100/[log fasting insulin (μ U/mL) + log fasting plasma glucose (mg/dl)]. We used multivariable linear regression to assess the association between meeting the aerobic or MS guideline and insulin sensitivity overall, and by BMI levels (<85, 85–94, and ≥95 percentile), adjusting for demographics (age, sex, race/ethnicity, and family poverty income ratio). Significance was set at p < 0.05.

Results:
For these US adolescents, 40.6% [95% confidence interval (CI), 37.2, 44.1] met the aerobic guideline, 37.5% [34.2, 40.9] met the MS guideline, and their mean QUICKI value was 35.0 [34.7, 35.3]. With no adjustments, we found significantly higher insulin sensitivity values for meeting the aerobic guideline (ß=0.43 [0.04, 0.83]) and the MS guideline (ß=0.70 [0.24, 1.16]). After adjusting for demographics and meeting the aerobic guideline, adolescents meeting the MS guideline still had significantly higher levels of insulin sensitivity (ß=0.58 [0.08, 1.08]) which remained significant only for obese adolescents (BMI ≥95 percentile) (ß=0.87 [0.30, 1.45]) when stratified on weight status. With similar adjustments including meeting the MS guideline, those meeting the aerobic guideline did not have significantly higher QUICKI values.

Conclusions:
We found a significant positive association between meeting the MS guideline and insulin sensitivity among US adolescents who are obese. Increasing participation in MS activities might viably enhance insulin sensitivity among obese US adolescents to reduce future diabetes risk.
Abstract P262: Weight Gain with Aerobic Exercise Training Results from Increased Fat and Lean Mass
Authors: Holden Julie , Swift Damon , Johannsen Neil , Earnest Conrad , Church Timothy
Published: July 2021

Hypothesis:
Weight gained in response to aerobic exercise represents an increase in lean mass.

Methods:
Participants from the exercise group (n=68) of the Inflammation and Exercise (INFLAME) study had fat mass, lean mass, and weight measured at baseline and at follow-up. Fat mass and lean mass were measured using DXA. Changes in lean mass and fat mass were quantified across tertiles of weight change in the exercise training group and were analyzed using generalized linear models with adjustment for baseline value.

Results:
are presented as least squares means with 95% confidence intervals. Results: Overall, participants exhibited a mean (range) weight change of –0.73 kg (–9.00, 7.00; n=68) following exercise training. Tertiles of mean (range) weight change were: tertile 1 (most weight loss) –3.40 kg (–9.00,–1.50; n=23), tertile 2 (some weight loss) –0.70 kg (–1.30, –0.10; n=22), and tertile 3 (weight gain) 1.93 kg (0, 7.00; n=23). For those in tertile 3, we observed a significant increase (p<0.0001) in lean mass of 0.91 kg (95% CI, 0.48, 1.34) compared to those who lost weight −0.85 kg (−1.28,−0.42) in tertile 1 and −0.52 kg (−0.97,−0.08) in tertile 2. However, no significant difference in lean mass change was seen between the two weight loss tertiles. We also observed a significant increase in fat mass in participants who gained weight (tertile 3) 1.07 kg (0.41, 1.73) while those who lost the most weight (tertile 1) −2.55 kg (−3.21,−1.89) had a significant decrease in fat mass. Participants who experienced some weight loss (tertile 2) showed no significant change in fat mass, −0.24 kg (−0.91, 0.44).

Conclusion:
Weight gained with aerobic exercise training cannot be attributed to increased lean mass only. Our findings suggest that adults who gained weight with exercise showed significant increases in both fat and lean mass.
Abstract P264: Meeting
2008 Physical Activity Guidelines for Americans
Reduces Risk of Recurrent CVD Events in MI Survivors: The Western New York Acute MI Study (1996–2006)
Authors: Dorn Joan M , Hovey Kathleen , Trevisan Maurizio
Published: July 2021

Introduction:
The
2008 Physical Activity Guidelines for Americans
(PAG) recommend adults perform at least 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity activity or an equivalent combination of both in order to obtain important health benefits, including lower CHD risk. Despite advances in clinical medicine, survivors of MI remain at substantial risk of recurrent cardiovascular events and death. The aim of our prospective study was to examine whether meeting the PAG reduced risk of recurrent CVD events in MI patients.

Hypothesis:
We hypothesized that MI survivors who met the current PAG had a more favorable prognosis than those who did not meet the guidelines.

Methods:
Incident MI cases (933 men, 354 women, 35–69 years old) recruited from 12 of 15 Western NY hospitals completed an interviewer-administered survey and clinic exam. Physical activity (PA) in the previous seven days was assessed using the Stanford 7-day PA recall. Minutes reported in moderate and vigorous intensity recreational, household and occupational activity (MVPA) were summed and participants were categorized as follows (min/week): inactive (0), insufficiently active (>0–<150), met (150–300), and exceeded the guideline goal (>300). Participant surveys, medical records and a search of the National Death Index Plus were used to determine fatal and non-fatal recurrent CVD (ICD9 390–450) events. Cox regression analysis adjusting for age (in years), gender, education (in years), race, BMI, smoking status, hypertension and use of diabetes and lipid medication was conducted to examine the association between PA and recurrent events.

Results:
During a mean follow up of 4.1 years, 301 recurrent CVD events occurred. At baseline, 174 (13.5%) participants reported no MVPA, 216 (16.8%) were insufficiently active, whereas 259 (20.1%) met and 638 (49.6%) exceeded the PAG, respectively. Multivariate adjusted hazard ratios (95% CI) for recurrent CVD events were Inactive [Ref (1.00)], insufficiently active [0.68 (0.46–1.01)], met [0.63 (0.43–0.92)], and exceeded the guideline goal [0.63 (0.45–0.87)], p-trend =0.019.

Conclusion:
In this prospective population-based study, there is evidence to support that meeting the
2008 Physical Activity Guidelines for Americans
has significant benefits on fatal and non-fatal recurrent CVD events in men and women following myocardial infarction.
Abstract P266: Physical Activity Intensity Is Associated With Visceral Fat Accumulation In A Multi-ethnic Cohort
Authors: Lesser Iris A , Yew Ann C , Lear Scott A
Published: July 2021

Introduction:
Excess accumulation of visceral adipose tissue (VAT) has been found to increase the risk of cardiometabolic disease. We have previously reported that Chinese and South Asians have higher amounts of VAT for a given body size compared to Europeans. Exercise has been shown to preferentially reduce VAT in a dose-response relationship with the intensity of physical activity (PA). The purpose of this study is to examine how the intensity of PA is associated with the amount of VAT in men and women of Chinese, European and South Asian origin.

Methods/Results:
The study population were 603 apparently healthy males and females between 30 and 65 years of age of Chinese (n = 207), European (n = 200), and South Asian (n = 196) origin who were part of the Multi-cultural Health Assessment Trial. PA was assessed using the Modifiable PA Questionnaire. Metabolic equivalents (METs) of reported activities were determined from the Ainsworth Compendium and were categorized into moderate (3–6 METs) and vigorous (>6 METs) intensities and reported as METs per week. Analysis of variance was used to determine differences in VAT and PA measures between ethnic groups. Linear regression analyses were used to explore the relationship between visceral fat and PA intensity. Moderate (p<0.001), vigorous (p<0.01) and total PA (p<0.01) differed significantly between all groups. Chinese and South Asians had greater amounts of VAT than Europeans adjusted for age, sex, BMI and income. Both moderate and vigorous PA were negatively associated with VAT after adjustment for confounders. When both moderate and vigorous PA were added to the model, the difference in VAT between Chinese and Europeans was no longer apparent (p=0.114). However, South Asians still had a significantly greater amount of VAT (p<0.001).

Conclusion:
Both PA and VAT differed among the ethnic groups. After consideration for differences in PA, there was no longer any difference in VAT between Chinese and Europeans suggesting that the higher amount of VAT observed in the Chinese population is a consequence of low PA levels. Consideration of PA did not affect differences in VAT in the South Asians and may indicate that other factors (whether dietary or genetic) play a role in the higher VAT amounts in South Asians.
Abstract P267: New Urbanism and Its Impact on Active Living among Inner City Children/Youth
Authors: Heath Gregory W , White-Woerner Sarah
Published: July 2021

Introduction:
Although it is known that urban design and land use at the community level contributes to active living, there remains a paucity of such information among low income and diverse populations affected by such infrastructure. Reconstruction of an inner city community in Chattanooga, Tennessee afforded the opportunity to assess the impact of new urbanist construction on active living among African-American children/youth living in the inner city.

Hypothesis:
Transportation and recreational physical activity levels among children/youth residing in a new urbanist community was hypothesized to be higher compared to demographically similar children/youth who reside in a more traditional inner city community.

Methods:
Using the System for Observing Physical Activity and Recreation in Communities (SOPARC) we examined an urban trail and recreational park areas of two distinct communities to assess physical activity, sports, and recreational of children/youth. SOPARC data were collected in each of 4 settings in each community (East, a traditional and South, a new urbanist) during four 1-h observation periods during 7 days of clement weather. Observations were made during each day of the week in each setting (i.e., Sunday through Saturday).

Results:
The SOPARC assessments of the urban trail and pedestrian/bicycle routes in the South and East yielded a total of 672 and 436 children/youth observations, respectively. South children/youth were over three times more likely to engage in vigorous physical activity compared to their East counterparts (Mantel-Haenszel Chi Square = 19.67; P< 0.00001).

Conclusions:
The present findings support the hypothesis that enhanced environmental supports, such as those found within the South community, increase the likelihood of greater levels of activity among children/youth compared to children/youth that were not exposed to these environmental enhancements. This comparative difference was most remarkable when examining the SOPARC assessment differences along the transport path/sidewalk routes, with South children/youth being significantly more likely than the East children/youth to engage in more vigorous forms of physical activity along this transport/recreational corridor, providing evidence that access to these types of ‘urban’ trails appears to translate into increased opportunities for physical activity among children/youth.
Abstract P278: Life's Simple 7 and Risk of Incident Stroke in Black and White Americans: REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Kulshreshtha Ambar , Judd Suzanne , Vaccarino Viola , Howard Virginia , McClellan William , Muntner Paul , Hong Yuling , Safford Monika , Cushman Mary
Published: July 2021

Background:
The American Heart Association has developed Life’s Simple 7 (LS-7) as a measure of cardiovascular health. In a recent study, LS-7 showed a graded relationship with cardiovascular disease incidence. The association of LS-7 with incident stroke has not been reported previously.

Methods:
We analyzed data from REGARDS, a national population-based cohort of 30,239 blacks and whites, aged ≥ 45 years of age, sampled from US population between 2003 and 2007. Data for LS-7 was collected by telephone, mail questionnaires, and an in-home exam. Participants were contacted every 6 months for possible stroke, which was validated by physicians using medical record review. LS-7 components (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, diet) were each coded as: poor (1 point), intermediate (2 points) and ideal (3 points). An overall LS-7 score, created by summing the 7 component scores (possible range: 7 to 21), was categorized as: highest (17–21), medium (12–16) and lowest (7–11) cardiovascular health. Cox regression was used to model LS-7 score categories with stroke events.

Results:
There were 22,914 participants with data on LS-7 and no previous CVD. Mean age was 65 years, 40% were black, and 55% female. Over 4.9 years of follow-up, there were 432 incident strokes. Mean (SD) LS-7 score was 13.5 (2.5). After adjustment for age and sex, mean LS-7 scores were lower for blacks (12.9 ± 0.02) than whites (14.3 ± 0.02). LS-7 categories were associated with incident stroke in a graded fashion (figure). After adjusting for age, race, sex, income, and education, each better health category was associated with a 25% lower risk of incident stroke (HR=0.75, 95% CI = 0.63, 0.90). In stratified analyses, HR was similar for blacks and whites (p-value = 0.55).

Conclusion:
Blacks had lower levels of cardiovascular health factors than whites. Better cardiovascular health based on LS-7 score was associated with a lower risk of stroke. Results suggest that efforts to improve the LS-7 score may be useful for stroke prevention.
Abstract P281: Medication Adherence and Stroke/TIA Risk in Treated Hypertensives: Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Cummings Doyle M , Letter Abraham J , Howard George , Howard Virginia J , Safford Monika , Prince Valerie , Muntner Paul
Published: July 2021

Background:
Low medication adherence in treated hypertensives is an important modifiable barrier to achieving blood pressure (BP) control. The contribution of poor medication adherence to adverse cardiovascular outcomes such as stroke and transient ischemic attack (TIA) relative to other cerebrovascular risk factors is less well understood. We therefore examined the relationship between medication adherence and both adequate BP control (< 140/90 mmHg) and stroke/TIA incidence in treated hypertensive subjects (n = 15,071 subjects free of stroke/TIA at baseline; 51% black; 57% living in the Stroke Belt) in REGARDS, a population-based cohort study.

Methods:
BP was measured in the subject’s home by a trained health professional following a standardized protocol. Medication adherence was measured at baseline (4-item validated Morisky scale: 0 = perfect adherence, 4 = lowest adherence). Participants were contacted bi-annually by telephone for a median follow-up time of 5 years and self-reported stroke or TIA events were adjudicated by medical record review. We used logistic regression models to examine the association between medication adherence and BP control and Cox modeling to evaluate the effect of adherence on stroke/TIA risk, examining the mediating effects of systolic BP.

Results:
Perfect medication adherence (score = 0) was reported by 69% of subjects, 23% a score of 1, 5% a score of 2, and 3% a score of 3 or 4. Mean systolic BP varied from 130.8 ± 16.2 in those reporting perfect adherence (Morisky score of 0) to 137.8 ± 19.5 in those reporting low medication adherence (score of 3 or 4) (p for trend< 0.0001). Compared to a Morisky score of 0, each level of worsening medication adherence was associated with significant and increasing odds of inadequately controlled BP (≥ 140/90 mmHg) in fully adjusted models: score = 1, odds ratio (95% CI) = 1.19 (1.09 – 1.30); score = 2, 1.27 (1.08–1.49); score = 3 or 4, 2.21 (1.75 – 2.78). Compared to perfect adherence, low medication adherence was not independently associated with stroke [hazard ratio = 1.04 (95% CI: 0.51 – 2.12)] or stroke and/or TIA [hazard ratio = 0.81 (95% CI: 0.38 – 1.73)] after multivariable adjustment. However, in analyses with systolic BP as the mediating variable, low medication adherence was associated with an increased risk for stroke (hazard ratio = 1.08 (95% CI: 1.04 – 1.14) and for stroke and/or TIA [hazard ratio = 1.08 (95% CI: 1.03 – 1.12)] in fully adjusted models.

Conclusion:
These findings add further evidence that low medication adherence is strongly associated with poor BP control; and through BP, low adherence is also associated with an increased risk of stroke or TIA.
Abstract P282: First-ever Ischemic Stroke in the Very Elderly: Trends, Characteristics and Outcome in a National Registry
Authors: Gur Alex Y , Tanne David , Bornstein Natan M , Milo Ron , Auriel Eitan , Shopin Ludmila , Koton Silvia
Published: July 2021

Background:
The incidence of ischemic stroke significantly increases with age. With increasing life expectancy, very old subjects will constitute the majority of stroke patients. However, epidemiological and clinical features of very elderly patients with stroke are still uncertain. Our aim was to study the patients' characteristics, outcome and trends in the very elderly (aged ≥ 85 years) in comparison with patients aged 65–84 years with a first-ever ischemic stroke in the National Acute Stroke Israeli Survey (NASIS) registry.

Methods:
The NASIS registry is a nationwide prospective hospital-based study performed triennially (2004, 2007, 2010). Patients with ischemic stroke aged ≥85 years were compared with those 65–84 years old regarding their baseline characteristics, stroke severity, etiology of stroke and stroke outcomes. Stroke severity was determined according to the National Institute of Health stroke scale (NIHSS) score and functional disability using the modified Rankin scale (mRS). Logistic regression analyses were used in the comparison of outcomes adjusting for potential confounders. Trends in patients' characteristics and stroke outcome were studied.

Results:
A first-ever ischemic stroke was diagnosed in 3125 patients. The proportion of very elderly (≥85 years) patients among the NASIS population increased from 18.3% in 2004 to 19.9% in 2007 and 24.5% in 2010 (p=0.005). The percentage of women was higher in patients aged ≥85 years (p<0.0001). Atrial fibrillation, congestive heart disease and prior disability were significantly more prevalent in the very elderly. The very elderly presented with more severe strokes: 36.3% of the ≥85 years-old patients had NIHSS≥11 compared with 22.0% in the younger age group. Adjusted rates of in-hospital complications [OR (95% CI=1.7 (1.3–2.2)] and severe disability or death (mRS>3) [1.4 (1.0–1.9)] were increased for very elderly patients. In the analysis of trends by registry period, rates of dyslipidemia increased from 25.4% in 2004 to 63.7% in 2010 (p for trend<0.0001) and hypertension increased from 74.8% in 2004 to 90.5% in 2010 (p for trend=0.0004). A significant decrease in the rate of in-hospital mortality among the very old patients is evident: rates decreased from 18.7% in 2004 to 5.7% in 2010 (p for trend=0.0005).

Conclusions:
There is an increasing proportion of very elderly subjects, mostly women, among first-ever ischemic stroke patients. Current information on age specific aspects of stroke in the very elderly is crucial to set up successful prevention pathways and implementing well-organized stroke care for this population.
Abstract P288: Statin Prescription Patterns at Discharge among Ischemic Stroke Patients. The North Carolina Stroke Care Collaborative
Authors: Kucharska-Newton Anna , O'Brien Emily , Bennett Paige , Rosamond Wayne
Published: July 2021

Background:
Current American Heart Association/American Stroke Association guidelines recommend in-hospital initiation of statin therapy for stroke patients at the time of hospitalization and at discharge. Nationwide data suggest that despite a favorable trend of increased prescribing of statins at discharge, the overall proportion of stroke patients discharged with statin therapy is significantly below the guideline recommendations. Study aim: To evaluate statin prescribing patterns at discharge for patients hospitalized for ischemic stroke in 56 North Carolina (NC) hospitals participating in the NC Stroke Care Collaborative (NCSCC).

Methods:
We used data on ischemic stroke admissions in 2008 through 2011 to hospitals affiliated with the NCSCC. Of the total n=39,345 stroke admissions, 23,643 (60%) were admissions for ischemic stroke, as ascertained from ICD-9 discharge codes. Excluded from analysis were stroke admissions that resulted in transfer to another hospital (n=346), patients on observation (n=105) and comfort care only (n=589), patients who died prior to discharge (n=926), those whose hospital visit did not result in admission (n=9), those missing information on statin prescription at discharge (n=3,402), and those with a documented reason for not prescribing statin therapy at discharge (n=675). The final sample size was 19,064 ischemic stroke events. Linear and logistic regression models were used to evaluate factors associated with statin prescribing patterns.

Results:
Documented statin prescription at discharge varied by age, with the highest proportion of prescriptions registered for stroke patients aged 56-65 years (86%). Statin prescribing at discharge was significantly (p<0.01) lower among patients< 56 years (81%) and those >65 years of age (77%). After adjusting for age, factors associated with low statin prescribing in this population were female gender, small hospital bedsize, academic affiliation of the hospital, and rural location of the hospital. Medical history of dyslipidemia and evidence of lipid lowering medication at admission were positive predictors of statin prescribing at discharge.

Conclusions:
We observed an age-dependent pattern of statin prescribing at discharge for patients in hospitals affiliated with the NCSCC. The lower proportion of hospitalized ischemic patients over 65 years of age that are discharged on statin therapy compared to those younger is consistent with reports from other studies. The relatively low proportion of patients younger than 56 years with statin prescription at discharge requires further investigation.
Abstract P291: Anger Expression and Risk of Stroke Subtypes: The Circulatory Risk in Communities Study (CIRCS)
Authors: Ohira Tetsuya , Tanigawa Takeshi , Imano Hironori , Kitamura Akihiko , Kiyama Masahiko , Yamagishi Kazumasa , Sankai Tomoko , Cui Renzhe , Okada Takeo , Ishikawa Yoshinori , Iso Hiroyasu
Published: July 2021

Background:
Previous studies have reported that anger expression style is associated with cardiovascular disease and its risk factors. Epidemiologic data regarding the association between anger expression and risk of stroke have been inconsistent, and few studies have reported the association of anger expression with stroke subtypes.

Hypothesis:
We assessed the hypothesis that suppressed anger is associated with increased risk of stroke, and the associations vary by stroke subtype.

Methods:
A prospective study of Japanese subjects aged 30–74 years was undertaken using data collected from 6,276 participants (2,285 men and 3,991 women) in cardiovascular risk surveys conducted in four communities between 1995 and 1998. We used the Spielberger Anger Expression Scale to measure self-reported levels of anger expression style; anger expressed outwardly is regarded as “anger-out” and anger held in or suppressed is classified as “anger-in.” The incidence of stroke was ascertained by systematic surveillance. The hazard ratios (HRs) of incidence of stroke and its subtypes and 95% confidence intervals (CI) relative to the lowest tertile of anger expression were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazards model.

Results:
During an average follow up of 9.1-years, 129 incident strokes (50 hemorrhagic, 77 ischemic, and 2 unclassified strokes) occurred. Men with “anger-in” scores in the highest tertile had a 1.7-fold multivariable-adjusted relative risk of stroke as compared with those in the lowest tertile, but it did not reach statistical significance (HR; 1.73, 95% CI; 0.94–3.19, p=0.08). When stratifying for stroke subtypes, the associations between “anger-in” and stroke tended to be stronger for hemorrhagic stroke than ischemic stroke; HRs (95% CI) were 3.82 (1.03–14.1) for hemorrhagic stroke and 1.32 (0.64–2.71) for ischemic stroke. Anger-in score was not associated with incidence of either hemorrhagic or ischemic stroke in women. In men and women, there were no significant associations between “anger-out” and incidence of stroke. As compared with the lowest tertile of “anger-out” scores, the multivariable-adjusted HRs of stroke for the highest tertile of “anger-out” scores were 1.39 (0.74–2.59) for men and 1.48 (0.78–2.78) for women, respectively.

Conclusions:
Suppressed anger may be associated with increased risk of hemorrhagic stroke among middle-aged Japanese men, but not women.
Abstract P297: A Pathway Analysis of 32 Genetic Variants in Leukotriene Genes and Subclinical Atherosclerosis in American Indians: The Strong Heart Family Study
Authors: Yang Jingyun , Cole Shelley , Haack Karin , Zhang Ying , Howard Barbara V , Best Lyle G , Roman Mary J , Devereux Richard B , Lee Elisa T , Zhao Jinying
Published: July 2021

Background:
Atherosclerosis is an inflammatory disease involving the joint contribution of multiple genetic polymorphisms. Leukotrienes are inflammatory mediators and genetic polymorphisms in key leukotriene genes have been associated with atherosclerotic cardiovascular disease (CVD). While each genetic variant may have only a minor effect on disease risk, their joint contribution to the occurrence of disease may be larger.

Objective:
To examine the joint impact of 32 SNPs in key leukotriene genes on subclinical CVD assessed by carotid plaque score using a pathway-based approach.

Methods:
We genotyped 32 tagSNPs in three genes (ALOX5, ALOX5AP and LTA4H) encoding key enzymes for leukotriene production in 3,665 American Indians recruited by the Strong Heart Family Study from Oklahoma (OK), South/North Dakota (DK) and Arizona (AZ). Subclinical atherosclerosis was assessed by carotid plaque score using ultrasound. We conducted a pathway-based analysis to evaluate the joint impact of these 32 SNPs on atherosclerotic plaque score, adjusting for classical cardiovascular risk factors, including age, sex, body mass index (BMI), cigarette smoking status (current, former vs. never), alcohol intake (current, former vs. never), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood pressure, diabetes, levels of physical activity, fibrinogen, and renal function (assessed by estimated glomerular filtration rate, eGFR). To avoid population substructure, all statistical analyses were stratified by study center (OK, AZ, and DK). Multiple testing was adjusted using the Bonferroni correction.

Results:
Multiple SNPs showed individual marginal association with carotid plaque score, but only one (rs2660880 in LTA4H gene in OK, P=0.001) passed adjustment for multiple testing. However, a genetic pathway analysis demonstrated that the leukotriene pathway as a whole in consideration of the joint contribution of all 32 SNPs was significantly associated with carotid plaque score in participants from OK (P=0.002) and DK (P=0.012), but not those from AZ.

Conclusion:
Genetic variants in the leukotriene pathway jointly contribute to subclinical atherosclerosis in American Indians. Our results could potentially lead to novel molecular strategies for the prevention and treatment of cardiovascular disease.
Abstract P300: Major Risk Factors For Coronary And Aorto-iliac Calcium In Middle-aged Black And White Adults: Results From CARDIA
Authors: Goff David C , Jacobs David , Terry J G , Sidney Stephen , Carr J J
Published: July 2021

Background:
Abdominal aorto-iliac atherosclerosis occurs earlier in the course of disease than coronary artery atherosclerosis and is often present in persons free of coronary atherosclerosis. Accounting for this early stage of disease might improve the ability to evaluate risk factors for atherosclerosis.

Objective:
We examined the associations of major risk factors with the presence of coronary artery calcium (CAC) and abdominal aorto-iliac calcium (AoIC) in the absence of CAC in 1994 black and white men and women participating in the CARDIA study at the year 25 exam in 2010–11.

Methods:
Multinomial logistic regression was used to examine the associations of risk factors measured at year 15 with the presence of CAC and AoIC (Agatston scores ≥1) at year 25. Ordinary logistic regression was used to examine the associations of risk factors with presence of CAC (ignoring AoIC) at year 25.

Results:
457 (22.9%) had both CAC and AoIC, 139 (7.0%) had CAC only, 632 (31.7%) had AoIC only, and 766 (38.4%) had neither. The 596 with CAC (+/−AoIC) were analyzed as one group vs. AoIC only, both in comparison with no calcification. Most risk factors had similar association with CAC (+/−AoIC) and AoIC only, including total and HDL cholesterol, triglycerides, systolic and diastolic blood pressure, smoking status, waist circumference and education. When comparing odds ratios (OR) for CAC (+/−AoIC) and AoIC only, both vs. no calcification, substantial differences were seen for comparisons of blacks vs whites (0.52 for CAC, p<0.0001 and 0.88 for AoIC, p=0.34), women vs men (0.34 for CAC, p<0.0001 and 0.96 for AoIC, p=0.77), and use vs. nonuse of drugs for blood pressure lowering (2.24, p=0.0023 and 1.27, p=0.36) and lipid lowering drugs (2.39, p=0.07 and 0.98, p=0.97). Accounting for the presence of AoIC without CAC resulted in uniform strengthening of the associations of risk factors with CAC. The most impressive change was for current smoking. The OR for CAC was 2.01 (95% CI: 1.53, 2.65) when ignoring AoIC and 4.47 (3.15, 6.32) when accounting for AoIC. AoIC alone was also strongly associated with smoking with an OR of 3.84 (2.80, 5.28).

Conclusions:
AoIC, an early manifestation of subclinical atherosclerosis, is associated with the major risk factors for CAC. The race and sex differences shown here, including little race or sex difference in AoIC only, are consistent with previous autopsy studies and deserve further etiologic research. Accounting for the presence of AoIC without CAC results in stronger estimates of risk factor associations with CAC. Studies that have not accounted for the presence of atherosclerosis in other vascular beds may have under-estimated the associations of established and novel risk factors with CAC.
Abstract P309: Prevalence of Low Ankle-Brachial Index among Individuals with Non-High Risk for Coronary Heart Disease: Data from the National Health and Nutrition Examination Survey 1999–2004
Authors: Ning Hongyan , Lloyd-Jones Donald
Published: July 2021

Background:
Abnormal ankle-brachial index (ABI) is prospectively associated with coronary heart disease (CHD) independent of traditional Framingham risk scores (FRS) variables. Two-thirds of CHD events occur in individuals with lower FRS (<20%). Evaluating the role of supplemental risk assessment with ABI among those subjects may have significant public health impact. We explore prevalence of abnormal ABI among the low-intermediate risk US population according to sex, age and race.

Methods:
We included 5035 cardiovascular disease-free, nonpregnant, nondiabetic individuals aged from 40 to 79 years from the National Health and Nutrition Examination Survey 1999–2004, representing approximately 75 million US adults. FRS was used to estimate participants’ 10-year risk for CHD, and two risk categories were defined as low (> 6%) and intermediate (6% – < 20%). Individuals with risk estimates ≥ 20% were excluded from this analysis. Abnormal ABI was defined as ABI < 0.9. Participants were categorized into younger ages (40–64) and older ages (65–79). The number needed to screen (NNS), which is the number of people within each stratum that needed to be screened to detect one person with abnormal ABI was used to assess the yield of screening for ABI.

Results:
Mean age was 53.1 years, with 45% (2261/5035) male, 19% (978/5035) non-Hispanic Black. Weighted prevalence of an abnormal ABI was 1.63% (61/2261) in men and 3.78% (138/2774) in women, corresponding to 2.1 million US adults aged 40 and above. Abnormal ABI was observed in 0.4% (2/714) and 2.4% (59/1488) in men (NNS=357 and 26) of those with low and intermediate risk, and 2.8% (85/2248) and 9.4% (53/526) in women (NNS=26 and 10), respectively. Older participants have higher prevalence of abnormal ABI than younger both in men (4.4% (29/435) vs. 1.8% (32/1826), NNS=15 and 57) and women (7.5% (63/748) vs. 2.9% (75/2026), NNS=12 and 27). Non-Hispanic Blacks have higher prevalence of abnormal ABI than other races in men (Black: 3.1% (21/458) vs. White: 1.6% (29/1144) and others: 0.9% (11/659)) as well as in women (Black: 7.1% (40/520) vs. White: 3.7% (64/1379) and others: 2.3% (34/875)).

Conclusions:
Among individuals at low-intermediate predicted 10-year CHD risk in US population, we observed concordance between abnormal ABI prevalence and FRS risk strata. The yield of screening and possibility of identifying abnormal ABI cases is highest in those with intermediate risk, especially older ages, non-Hispanic blacks and females.