bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P109: Association Of The 2017 ACC/AHA Blood Pressure Guideline With Blood Pressure Change In Community-dwelling Older Adults Between 2016-2019: A Difference-in-differences Analysis In The ARIC Study
Authors: Wang Michael C , Petito Lucia , Pool Lindsay , Foti Kathryn , Juraschek Stephen P , McEvoy John William , Nambi Vijay , Carnethon Mercedes R , Michos Erin D , Khan Sadiya
Published: April 2022

Introduction:
In 2017, the ACC/AHA revised the blood pressure (BP) guideline to lower the BP threshold for diagnosing and treating hypertension in older adults. Pharmacologic treatment is recommended for systolic BP (SBP) ≥130 mmHg in all older adults aged ≥65 years. Data on BP changes before and after publication of the guideline are needed to inform quality of care initiatives.

Methods:
We included participants from the Atherosclerosis Risk in Communities Study who attended a pre-guideline (2016-2017) and post-guideline (2018-2019) visit with a pre-guideline SBP between 120-159 mm Hg. We categorized participants based on their pre-guideline SBP according to the 2017 guideline: not reclassified to treatment (SBP 120-129), reclassified to stage 1 hypertension (SBP 130-139), or reclassified to stage 2 hypertension (SBP 140-159). To estimate the association of the 2017 guideline with SBP change, we performed a quasi-experimental analysis using difference-in-differences (DiD) regression. We compared changes in SBP between participants affected (SBP 130-139, 140-159) and those not affected (SBP 120-129) by the new SBP target, adjusted for traditional risk factors.

Results:
Of 2195 participants aged 71-94 years, mean (SD) SBP was 137.2 (10.8) mm Hg, and 77% were on antihypertensive therapy at the pre-guideline visit. Among participants with SBP ≥130 pre-guideline, 31% were at goal SBP <130 post-guideline. In adjusted DiD analyses, participants with SBP ≥130 pre-guideline had significantly lower mean SBP at the post-guideline visit (Stage 1 hypertension: -5.0 [95% CI: -6.7, -3.3]; Stage 2 hypertension: -9.7 [-11.3, -8.0]) compared with participants with SBP 120-129 pre-guideline (
Table
). Results were similar when stratified by sex and race.

Conclusions:
In a sample of community-based older adults, the post-guideline period was associated with significantly lower SBP in those reclassified to Stage 1 or Stage 2 hypertension. However, significant gaps exist in BP control and only a minority met the updated treatment goal.
Abstract P125: Change In Low-density Lipoprotein Cholesterol And Risk Of Subsequent Cardiovascular Events Among Patients With Myocardial Infarction
Authors: Manemann Sheila M , Cohen Sarah , Reading Stephanie R , Noshad Sina , Movva Naimisha , Weston Susan , Killian Jill , Chamberlain Alanna
Published: April 2022

Background:
Among patients who experience a myocardial infarction (MI), elevated low-density lipoprotein cholesterol (LDL-C) is a major risk factor for experiencing a subsequent cardiovascular (CV) event; however, real-world evidence is lacking in regard to how changes in LDL-C levels after a MI hospitalization are related to subsequent CV events.

Methods:
Adults with a hospitalized MI and an available baseline LDL-C (closest LDL-C within 2 years prior to hospital discharge) between 2012 and 2018 within a 27-county region across MN and WI were included for study. For each LDL-C measurement during follow-up (starting with the first LDL-C >30 days after baseline and ≤1-year post-discharge), percent change from baseline LDL-C was calculated. Patients were followed for subsequent CV events (composite endpoint 1: MI, ischemic stroke [IS], coronary artery bypass grafting [CABG], percutaneous coronary intervention [PCI]; composite endpoint 2: MI, IS, CABG, PCI, CV death). Cox models were used to evaluate the association between time-dependent LDL-C percent change and CV events, stratified by baseline LDL-C (<70, 70-99, ≥100 mg/dL).

Results:
Among 3,034 MI patients identified, 740 (24%), 940 (31%) and 1354 (45%) had a baseline LDL-C <70, 70-99 and ≥100 mg/dL, respectively. After a mean follow-up of 3.4 years, 471 and 667 patients experienced the composite endpoint 1 and 2, respectively. After covariate adjustment, a trend towards a lower risk of CV events with decreasing LDL-C from baseline, compared to those with no change or an increase in LDL-C, was observed among those with a LDL-C <70 and
>
100 mg/dl but not in those with a LDL-C 70-99 mg/dL (Table).

Conclusions:
In a population-based cohort of MI patients, there is evidence that patients with a decrease in LDL-C after MI may have a reduced risk of subsequent CV events. These results underscore the importance of lowering LDL-C after a MI and may help to identify subgroups at highest risk for additional CV events and those who may benefit from targeted LDL-C treatment recommendations.
Abstract P127: Differences By Gender In Autopsy-determined Myocardial Characteristics Following Myocardial Infarction
Authors: O'Neal Janelle , McCook Juan , Sunderraj Ashwin , Lomasney Jon W , Feinstein Matthew J
Published: April 2022

Introduction:
Women are at higher risk for heart failure and mortality after myocardial infarction (MI) than men. Differences in tissue-level response to ischemia and MI for women vs. men are incompletely understood and have the potential to contribute to differences in post-MI sequelae such as heart failure and sudden death.

Methods:
We analyzed clinical data and paired autopsy reports from decedent patients who underwent autopsy at a large urban medical center from 4/6/2002 to 4/1/2021. Using clinical autopsy reports completed by a trained pathologist, we then determined the presence or absence of five specific autopsy-based myocardial characteristics: fibrosis, pathologic evidence of a remote vs. acute myocardial infarction, myocardial inflammation, and/or myocardial infiltrates. Linked clinical data were used to determine demographics, anthropometrics, and presence/absence of clinical diagnoses (the latter of which were based on administrative codes). Our primary analyses compared the presence of autopsy-based diagnoses for men vs. women, stratified by prior clinical diagnoses of MI; we used Chi-square analyses with a p-value of <0.05 to indicate statistical significance.

Results:
Ages at death of men (N=152) and women (N=103) who had clinical diagnoses of MI preceding death and autopsy were similar (Table), but men with MI diagnoses were more commonly White non-Hispanic (75/152, 49%) whereas women were more commonly Black non-Hispanic (51/103, 50%). Women with clinical diagnoses of MI were significantly less likely to have myocardial fibrosis at autopsy compared with men (68% vs 79%; p=0.048).

Conclusions:
Among individuals with clinical diagnoses of MI prior to death, we observed that men were more likely to have autopsy-determined myocardial fibrosis compared with women. These data do not suggest increased post-MI myocardial scar among women as a likely cause of higher rates of heart failure following MI; however, our data require validation in other cohorts with linked clinical and pathology data.
Abstract P133: Proteins Predicting The Risk Of Peripheral Artery Disease (PAD): The Atherosclerosis Risk In Community (ARIC) Study
Authors: Hu Xiao , Hicks Caitlin W , Chen Jingsha , Mok Yejin , Hoogeveen Ron C , Tang Weihong , Selvin Elizabeth , Ballantyne Christie M , Tanaka Hirofumi , Heiss Gerardo M , Coresh Josef , Matsushita Kuni
Published: April 2022

Background:
PAD is associated with substantial morbidity and mortality, yet it is underdiagnosed mainly because many patients are asymptomatic and its screening is not widely conducted. Proteomic analysis may help identify predictors of PAD.

Aims:
To identify protein predictors of PAD and examine their predictive performance of incident and prevalent PAD beyond traditional risk factors in the ARIC study.

Methods:
Of 4,877 plasma proteins measured by SOMAscan, we first selected panels of proteins at ARIC visit 3 (N=10,302 participants free of PAD; 1993-95) associated with incident PAD in two steps: 1) we identified significant proteins using multivariable Cox models accounting for multiple comparisons; and 2) we selected proteins using LASSO Cox regression. We constructed 4 protein panels according to λ in LASSO and parsimony. We then evaluated c-statistics after adding each protein panel to a base model with established CVD risk factors. We finally used cross-sectional data at visit 5 (N=4,525; 2011-13) and logistic models to assess if these panels better identify older adults with prevalent PAD beyond traditional predictors. Incident PAD since visit 3 was based on hospitalization with PAD diagnosis; prevalent PAD at visit 5 was defined by ankle-brachial index ≤0.9.

Results:
There were 450 incident PAD cases after visit 3 (median follow-up: 23 years) and 344 prevalent PAD cases at visit 5. Of 103 proteins significantly associated with incident PAD, 4 protein panels were selected, including 5, 10, 34, and 56 proteins (e.g., angiopoietin-2 and renin), respectively. All 4 protein panels significantly improved c-statistics for incident PAD (e.g., 0.854 for base plus panel 4 vs. 0.807 for base model) (Figure 1A). The same protein panels improved the c-statistic for prevalent PAD at visit 5 compared to the base model (Figure 1B).

Conclusions:
Protein panels improved risk discrimination for both incident and prevalent PAD beyond established risk factors, with implications for targeted preventive therapies and screening of PAD.
Abstract P137: Maternal Or Parental Outcomes During Delivery Related Hospitalizations Among Pregnant Individuals With Obesity In The United States
Authors: Rubens Muni , Ramamoorthy Venkataraghavan , Saxena Anshul , Zhang Zhenwei , Ahmed Md Ashfaq , Veledar Emir , Garelnabi Mahdi O , Hernandez Agueda
Published: April 2022

Background:
The prevalence of obesity among people of reproductive age has steadily increased. The rates of both maternal/parental and fetal adverse outcomes increased significantly with higher BMI. In this study, we examined the national estimates of adverse maternal/parental and fetal outcomes among pregnant individuals with pre-pregnancy obesity using a nationally representative database.

Methods:
This was a retrospective observational analysis of data retrieved from the Nationwide Inpatient Sample database (2010-2014). The primary outcomes of this study were various adverse maternal/parental and fetal outcomes. Delivery related hospitalizations and all outcomes were identified using the ICD-9 codes. Additionally, propensity-score matching analysis was conducted.

Results:
There were a total of 18,687,217 delivery-related hospitalizations, of which 1,048,323 were among people with obesity. The mean age of pregnant persons with obesity was 28.5 years while among those without obesity was 28.0 years. Between both groups, most pregnant persons were White, followed by Hispanic and Black. Pregnant persons with obesity were more likely to have labor inductions (AOR: 1.51; 95% CI: 1.42, 1.60), cesarean deliveries (1.70; 1.62, 1.79), and greater length of stay after both cesarean deliveries (1.14; 1.08, 1.36) and vaginal deliveries (1.48; 1.23, 1.77). They were also more likely to have risk factors for adverse obstetrical outcomes such as gestational hypertension (2.17; 2.06, 2.29), preeclampsia (2.06; 1.42, 2.99), gestational diabetes (2.75; 2.60, 2.90), premature rupture of membranes (1.17; 1.08, 1.27), chorioamnionitis (1.39; 1.25, 1.55), and venous thromboembolism (1.63; 1.34, 1.99). Additionally, pregnant persons with obesity were more likely to have adverse fetal outcomes such as excessive fetal growth (3.18; 2.96, 3.43) and fetal distress (1.28; 1.21, 1.35).

Conclusion:
Pregnant persons with obesity had significantly greater risk for adverse obstetrical outcomes. Risk stratification of pregnant individuals based on obesity can inform obstetrical providers’ clinical decision-making and potentially improve patient outcomes and decrease costs. There is an opportunity to address these risks with pre-conception interventions. Future studies could examine the effect of pre-conception interventions such as counseling on pre-pregnancy weight management, lifestyle modifications addressing nutrition and activity, and pre-pregnancy bariatric surgery.
Abstract P144: Nutritional Intervention May Change Physical Activity Levels In Latino Families: A Cluster Randomized Control Trial
Authors: Shrout Tara A , King Colin , Denenberg Julie , Eastman Amelia , Allison Matthew A
Published: April 2022

Introduction:
Nutrition and physical activity (PA) are key components for the primary prevention of cardiovascular disease. There remains a paucity of longitudinal data on the role of specific nutritional interventions and how they may impact PA levels, particularly in Latino populations.

Hypothesis:
We hypothesized that high allocation of avocados in Latino families would result in higher PA levels, measured as metabolic equivalent minutes per week (MET-min/wk) .

Methods:
A total of 72 Latino families (235 participants, 150 women) in San Diego, CA, were randomized to low- or high-avocado allocation (3/family/wk or 14/family/wk, respectively). A 14-day run-in period was utilized to demonstrate adherence. MET-min/wk PA measures (total, occupational, recreational, transportation) were assessed at baseline, 3-months, and 6-months via the validated global physical activity questionnaire (GPAQ) (moderate PA, 4 METs; vigorous PA, 8 METs). Using ANCOVA, we compared mean differences in longitudinal PA measures.

Results:
Randomization assigned 35 families to high-allocation (0% attrition throughout) and 37 to low-allocation (8% attrition at 3 months, 16% attrition at 6-months) with no significant difference in baseline PA. While mean
total
PA in the low-allocation group declined over the 6-month trial period, the inverse appeared true for the high-allocation group (Figure). Compared to low-allocation, the mean
total
PA between baseline to 6-months was 2,154.75 MET-min/wk higher in the high-allocation group (p=0.001), and specifically that of moderate and vigorous
occupational
PA being 979.25 and 898.17 MET-min/wk higher in the high-allocation group (p=0.003 and 0.037), respectively. No significant differences were found for
recreational
or
transportation
PA.

Meaning:
In this trial, and compared with a lower allocation, higher allocation of avocados was associated with significant increases in longitudinal PA measures. Further studies are warranted to assess the role of dietary interventions on changes in PA.
Abstract P145: Health Literacy And Self-care Practices Among Rural Appalachian Adults
Authors: Dunfee Madeline , Smalls Brittany , Westgate Philip , Westneat Susan , Mudd Martin Gia , Schoenberg Nancy E
Published: April 2022

Introduction:
The prevalence of cardiovascular disease (CVD) and type 2 diabetes (T2DM) in Appalachian communities is among the highest in the nation. Health literacy, one’s ability to understand and use information to make health-related decisions, influences self-care practices which, in turn, shape chronic disease prevalence and outcomes.

Hypothesis:
Higher levels of health literacy are associated with optimal self-care practices among rural Appalachian adults with T2DM.

Methods:
Adults (N=356) diagnosed with T2DM were recruited from community sites across six rural Appalachian counties in Kentucky. Health literacy was measured using the New Vital Sign (NVS), with scores ranging 0-6. T2DM self-care was assessed using the Summary of Diabetes Self-Care Activities (SDSCA), with scores ranging 0-35. Linear mixed-effects models with random effects to account for clustering at the community level and household within site were fit to examine the association between level of health literacy and self-care practices.

Results:
The majority of the sample identified as female (65%), with a mean age of 64.2 years (SD: 10.6). The mean and median health literacy scores were 4.0 (SD: 2.0) and 5, respectively, indicating moderate health literacy. T2DM self-care scores ranged from 4-33 (Median= 17, Mean=17.1, SD: 6.3), indicating room for improvement concerning frequency of self-care practices. Specifically, average rates of self-care practices per week included following a generally healthy diet 3 days (SD: 2), exercising for 30 minutes 2 days (SD: 2), measuring blood sugar level 4 days (SD: 3), and practicing foot care 5 days (SD: 1). Health literacy was not associated with self-care practices when controlling for age, sex and financial status.

Conclusions:
Contrary to our hypothesis, results do not suggest a direct association between health literacy and T2DM self-care practices among Appalachian adults. Future studies should explore other personal or socio-cultural factors that may influence T2DM self-care among vulnerable populations experiencing numerous risk factors of cardiometabolic disease.
Abstract P148: Modifiable Obesogenic Behaviors Among Latino Adolescents With Suspected Non-alcoholic Fatty Liver Disease (NAFLD)
Authors: Rodriguez Luis A , Gopalan Anjali , Chandra Malini , Darbinian Jeanne A , Greenspan Louise C , Lo Joan C
Published: April 2022

Non-alcoholic fatty liver disease (NAFLD) disproportionally affects US children of Latino descent, who also have a higher burden of obesity and type 2 diabetes. We previously found significant associations between diet and sedentary behaviors and weight status, but it is unclear if these measured behaviors are associated with suspected NAFLD among Latino adolescents with obesity, which was the objective of this study. We used cross-sectional data from 10,087 Latino adolescents ages 13-17 years in northern California with a well-child visit in 2016-2019, health behavior assessment, and BMI ≥95th percentile. Adolescents self-reported on 4 daily obesogenic behaviors at the visit: 1) consuming <5 servings of fruits/vegetables; 2) drinking ≥1 juice/soda (12oz); 3) exercising/playing sports for <60 minutes; and 4) >2 hours of screen time. Suspected NAFLD was classified by serum alanine transaminase level ≥44 U/L (girls) and ≥52 U/L (boys). We used logistic regression to examine the associations of obesogenic behaviors with NAFLD, adjusting for age, gender, household language preference (English/Spanish), neighborhood deprivation index (quartiles), and Class 1, 2, and 3 obesity. Among 10,087 Latino adolescents with obesity, 88% (8,877) had ≥1 obesogenic behaviors and 10% (1012) had suspected NAFLD. None of the obesogenic behaviors were associated with NAFLD in unadjusted or adjusted models. Boys (vs girls) had higher odds of NAFLD (OR 2.2; 95% CI: 1.9-2.5), as did older adolescents (ages 16-17 vs 13-15, OR 1.7; 1.5-1.9) and those with more severe obesity (OR 2.2; 1.9-2.5, and OR 3.0; 2.5-3.6 for Class 2 and 3 (vs Class 1) obesity, respectively). In summary, older age, male gender and severe obesity were risk factors for suspected NAFLD while binary assessment of diet and sedentary behaviors were not, suggesting that more precise diet and exercise assessment tools are needed. The high burden of obesogenic behaviors and strong association of severe obesity with NAFLD point to important actionable targets for pediatric primary care.
Abstract P157: Racial Differences In Atrial Natriuretic Peptide And Insulin
Authors: Couch Catharine , Parcha Vibhu , Arora Pankaj , Gower Barbara
Published: April 2022

Low circulating concentrations of the natriuretic peptides (NPs) have been associated with greater risk for Type 2 diabetes (T2D). As a group, African Americans (AA) have lower NP levels and are disproportionately burdened by T2D. Insulin, which is higher in AA, has been shown to regulate NP concentration by increasing the NP clearance receptor. This secondary analysis tests the hypothesis that higher insulin in AA will be associated with lower levels of plasma N-terminal pro-atrial natriuretic peptide (NT-proANP).

Participants were 120 AA and European American (EA) men and women ages 19-45 years. Measures of insulin, including fasting insulin and insulin total and incremental area under the curve (AUC and iAUC, respectively, at 30 and 120 m), were derived from an oral glucose tolerance test (OGTT). Insulin sensitivity (SI
Clamp
) was assessed using the euglycemic glucose clamp. NT-proANP was measured from fasting samples obtained during the OGTT. Differences in NT-proANP by race was evaluated with analysis of covariance while adjusting for age, sex, and BMI. Linear regression models were used to examine associations between NT-proANP and insulin measures while adjusting for age, sex, race, and BMI.

Relative to EA, AA had higher insulin concentrations, lower insulin sensitivity, and lower NT-proANP levels (p<0.05). Fasting insulin and 30 m insulin AUC were inversely associated with NT-proANP (p=0.02, p=0.02, and p=0.04, respectively).

These results suggest that the lower NT-proANP observed in AA is related to higher insulin. Future research is needed to investigate the relationship between insulin, ANP, and the NP clearance receptor, particularly in populations at risk for chronic disease.
Abstract P159: The Optimal Method To Predict Hemoglobin A1c From Flash Glucose Monitor Data
Authors: Takeishi Soichi
Published: April 2022

In situations where it is difficult for patients to visit hospitals, such as the coronavirus disease pandemic, it is important to more detailly predict hemoglobin A1C (HbA1c) from flash glucose monitor (FGM) data. CGM data over 14 days can be obtained from a FGM sensor; therefore, there are many options for extracting the duration from which glucose levels are derived. Thus, the extracted durations were closely studied to determine which mean glucose levels can predict HbA1c more accurately. Seventy-three outpatients with type 2 diabetes mellitus underwent HbA1c testing, wore a FGM (FreeStyle Libre Pro), and did not change diabetic treatments, on a hospital visit. FGM data over 24 h х 13 days (from 00:00 on day 2 to 24:00 on day 14 [FGM attachment: day 1]) were analyzed. The mean glucose levels were calculated corresponding to the following durations: 1 day: day 2 ~ day 14 (n=13), 2 days: days 2-3 ~ days 13-14 (n=12) … 12 days: days 2-13 ~ days 3-14 (n=2), 13 days: days 2-14 (n=1) [total 91 durations] (extracted mean glucose levels). Data were analyzed in all patients (n=73), in patients with hypoglycemia in the 13 days (Hypo) group (n=40), and in patients without hypoglycemia in the 13 days (Nonhypo) group (n=33). In all patients, HbA1c was correlated to all 91 extracted mean glucose levels (r=0.76-0.86, p<0.001). HbA1c was the most significantly correlated to the mean glucose levels over 13 days (days 2-14). “Correlation coefficients between HbA1c and extracted mean glucose levels” (“r, HbA1c, EMGL”) were also correlated to number of extracted days for the extracted mean glucose levels (r=0.80, p<0.001 [n=91]). In the Hypo group, HbA1c was correlated to all 91 extracted mean glucose levels (r=0.55-0.73, p<0.001). The mean glucose levels over 13 days (days 2-14) were the most significantly correlated to HbA1c. “r, HbA1c, EMGL” correlated to the number of extracted days for the extracted mean glucose levels (r=0.68, p<0.001; Fig. 2). In the Nonhypo group, HbA1c was correlated to all 91 extracted mean glucose levels (r=0.73-0.87, p<0.001). The mean glucose levels over 12 days (days 2-13) were the most significantly correlated to HbA1c. “r, HbA1c, EMGL” correlated to the number of extracted days for the extracted mean glucose levels (r=0.61, p<0.001). The results of the present study are consistent with that of a previous study reporting that the minimum duration needed to estimate time in range over 90 days is 14 days. In the prediction of HbA1c using data from one FGM sensor, prolonged measurement can make the glucose management indicator more accurate. Especially for patients with hypoglycemia, the importance of prolonged measurement may be applicable.
Abstract P165: Glycemic Response To Initial Treatment In Data-driven Diabetes Clusters In A Real-world Sample Of Adults With Newly Diagnosed Diabetes
Authors: Raghavan Sridharan , Liu Wenhui , Warsavage Theodore , Phillips Lawrence , Reusch Jane E , Caplan Liron
Published: April 2022

Diabetes patient heterogeneity is well recognized. Statistical clustering methods are gaining popularity as a precision medicine tool for identifying diabetes subgroups. We evaluated data-driven clusters among individuals with newly diagnosed diabetes and examined associations with glycemic response to initial treatment in real-world care. We studied individuals in the US Veterans Affairs Health Care System with newly diagnosed diabetes based on diagnosis codes and medications who were initially treated with a single diabetes medication from 2005-2013. We performed
k
-means clustering as previously described based on age, body mass index (BMI), and hemoglobin A1c (HbA1c) at the time of diabetes diagnosis. We compared 5-year glycemic response by initial medication class (metformin, sulfonylurea, or insulin) in each cluster using linear mixed effects models, adjusted for age, race, sex, BMI, glomerular filtration rate, and HbA1c, and including a medication*time term to assess medication-specific HbA1c trends. Four clusters best fit the data for the 325,250 individuals studied (mean age 63.5 years, BMI 32.7 kg/m
2
, HbA1c 7.5%). Clusters corresponded to those identified previously in other studies with three characterized by extreme values of clustering variables: Cluster 1 with mean HbA1c 11.3% (N=35,071), Cluster 2 with mean BMI 41.1 kg/m
2
(N=70,909), Cluster 3 with mean age 76.8 years (N=92,363), and Cluster 4 with intermediate values for all the three variables (N=126,907). HbA1c trends differed by medication class in all four clusters (p<0.0001 for all). However, differences in HbA1c trends by medication class were clinically small in all 4 clusters (Figure). Mean HbA1c trend was lowest among metformin users, intermediate among sulfonylurea users, and highest among insulin users in all clusters.

Conclusion:
Data-driven clustering of individuals with newly diagnosed diabetes using routinely collected clinical variables may not help guide initial diabetes treatment choice with regard to glycemic control.
Abstract P179: The Association Of A Genetic Risk Score With Prevalent Coronary Heart Disease In The Hispanic Community Health Study/Study Of Latinos (HCHS/SOL)
Authors: Hutten Christina G , Durazo-Arvizu Ramon , Scannell Bryan Molly , Preudhomme Liana , Perreira Krista , Talavera Gregory , Smoller Sylvia W , Sun Jiehuan , Persky Victoria W , Sofer Tamar , Daviglus Martha L , Argos Maria
Published: April 2022

Background:
Coronary heart disease (CHD) is one of the leading causes of death for the Hispanic/Latino population living in the United States (US). One way to reduce the burden of CHD is to target therapy and primary prevention in high-risk groups. Towards this end, a genetic risk score (GRS) constructed from 71 single-nucleotide polymorphisms (SNPs) has been used in populations of European ancestry to identify those at higher risk for CHD events and who would benefit most from statin therapy.

Objectives:
The purpose of this study is to evaluate a 71-SNP GRS with prevalent CHD in the HCHS/SOL cohort.

Methods:
The HCHS/SOL is a prospective, multi-center, population-based study that enrolled 16,415 Hispanic/Latino adults aged 18-74 years from four US communities in 2008-2011. Prevalent CHD was defined as self-reported physician-diagnosed angina, myocardial infarction, bypass, angioplasty, stent placement or evidence of electrocardiographic abnormalities indicative of CHD. We leveraged genome-wide genotype data to assess the association between a 71-SNP GRS and prevalent CHD among 9030 HCHS/SOL participants with accessible genetic data. Multivariable logistic regression was used to derive odds ratios and 95% confidence intervals for the association between GRS and prevalent CHD, adjusted for sex, age, and the first 5 principal components and weighted to adjust for sampling probability and non-response. Stratified analysis was conducted to explore heterogeneity by Hispanic/Latino background group.

Results:
The 71-SNP GRS had a range of 43-87 risk alleles among participants. In multivariable logistic regression analyses, participants in the top quintile of the GRS had 1.42 (95% CI: 1.11, 1.82) higher odds of prevalent CHD than participants in the lower four quintiles combined. Stratified analyses showed stronger associations between the GRS and prevalent CHD by Hispanic/Latino background group, with the strongest associations observed among participants of Cuban (OR=1.86; 95%: 1.18-2.92) and Central American (OR=2.81; 95% CI: 1.28-6.17) backgrounds.

Conclusion:
Our findings show that a previously developed 71-SNP GRS is associated with prevalent CHD among Hispanic/Latino participants. These findings may have important implications for lessening future CHD health disparities among Hispanics/Latinos living in the US.
Abstract P187: Meeting Research Study Recruitment Targets Is Meaningful For Residents In Rural Mississippi Counties
Authors: Agor Akachi , Ferrell Tina , Harris Kisa K , Ramachandran Vasan S , Fox Ervin R , Henderson Frances C
Published: April 2022

Background:
Rural communities have historically been difficult to study compared to their urban counterparts and are underrepresented in research. There are several potential barriers to reaching rural populations; however, there remains a knowledge gap regarding participation in health research by rural people. To drive meaningful, lasting change in rural communities through research, investigators sought to understand the facilitators and barriers to conducting research among rural populations. We conducted focus group interviews to elucidate the viewpoints of the Community Advisory Board (CAB) members in Oktibbeha and Panola Counties.

Objective:
The purpose of this study was to identify barriers and facilitators to participation in research in Oktibbeha and Panola Counties in the Risk Underlying Rural Area Longitudinal (RURAL) Study.

Method:
Data were collected via focus group interviews of eight men and women with diverse economic and educational backgrounds to represent the demographics of each county best. Each interview was recorded using digital recorders and then transcribed . A thematic analysis of the data was developed from each of the transcripts, then analyzed and interpreted by three qualitative researchers.

Results:
Focus Group Participants (FGPs) identified the strengths of their counties that make it easy to participate in research as; progressive thinking and diversity, close-knit communities where people know each other so that the word gets out, and “where
trust
is key.” Barriers to participation in research were identified as limited prior exposure to research, distrust of the process, fear that data may paint their community in a negative light, and fear that the government will take something away from them as a consequence of participation in research. Reaching the target number of participants for each county is achievable according to FGPs and would mean the groundwork they have laid has been effective. Approaches for getting the word out to people in Panola and Oktibbeha Counties about the RURAL Study included use of radio and TV, social media, word-of-mouth, door-to-door, community events, churches, paper media, going into the community, community outreach, and communicating the benefits of the research.

Conclusion:
Investigators concluded that reaching the target number of participants for each county is meaningful to the CABs, and it is highly likely that the recruitment target will be achieved.
Abstract P189: Leveraging Existing Cohort Study Infrastructure And Community Trust To Promote Covid Vaccination In Rural Mississippi: Experience From NHLBI’s RURAL Cohort Study
Authors: Cobb Keith O , Henderson Frances C , Alvarez Kristie A , Taylor-Bufford Tammy T , Simmons Sue H , Landrum Emily L , Ramachandran Vasan S , Fox Ervin R
Published: April 2022

Background:
The current surge in COVID-19 infections in the rural south is primarily due to the large number of unvaccinated individuals. Increasing the number of individuals getting vaccinated in rural areas remains a challenge due to multiple factors including education, vaccine literacy and hesitancy, and access to vaccination sites.

Objective:
Investigators in the Risk Underlying Rural Areas Longitudinal (RURAL) Study used existing community partnerships with local advisory boards and with state organizations to promote vaccinations in a pair of low-risk and high-risk rural counties in Mississippi.

Methods:
The Mississippi Core of the RURAL Study is responsible for community engagement, forming community advisory boards and promoting the RURAL Study among residents of Oktibbeha and Panola Counties. We partnered with community advisory board (CAB) members to identify geographic sites that have a need for increasing vaccinations and assessed the willingness of the facilities to serve as a site for ‘popup’ vaccination clinics. We partnered with the Mississippi State Medical Association and the Mississippi Department of Health to identify COVID 19 vaccination providers in these rural areas. Working with physicians on the CAB and local county hospitals, we secured staffing, vaccines and equipment and scheduled dates and times for popup vaccination clinics at 4 sites in Panola County and 5 sites in Oktibbeha County. Popup clinics were promoted locally by physicians and churches, and through RURAL investigators using both social media and news media. Investigators evaluated: 1) the success of popup clinics; 2) number of persons vaccinated at each clinic; and 3) sex, age range and race of those receiving vaccinations collected.

Findings:
All nine of the COVID19 popup vaccinations clinics were successfully set up and run. A total of 77 individuals received vaccinations (32 in Panola County and 45 in Oktibbeha County). In Panola County more men than women received vaccinations and all age ranges (12-19, 20-29, 30-39,40-49, 50-59, 60-69, ≥ 70 years) were represented. The majority of those receiving vaccinations in Panola County were Non-Hispanic Black Americans. In Oktibbeha County more men than women received vaccinations and older age ranges (> 50 years) predominated. In Oktibbeha County there was a more even balance of Non-Hispanic Black and White Americans among those receiving vaccinations. Panola County vaccinations were mostly first-time vaccinations and Oktibbeha County vaccinations were mostly booster doses.

Conclusion:
Existing cohort study infrastructure and human resources offer a unique opportunity to leverage existing community collaborations to promote vaccinations in a national pandemic.
Abstract P192: Disparities In Stroke And Mortality In Children With Congenital Heart Defects
Authors: Ibeh Chinwe , Bilski Amanda , Argenio Melissa , Mammadli Gular , Lewis Matthew , Rosenbaum Marlon S , Miller Eliza C
Published: April 2022

Background:
Critical congenital heart defects (CCHD) are a subset of cyanotic lesions that require intervention within the first days to weeks of life for survival. For children born with CCHD, the neonatal period is considered the time of highest risk for stroke and overall poor outcomes. Prior studies have identified racial differences in neonatal outcomes among children with CCHD. Whether these differences persist throughout childhood is unclear.

Methods:
Using the National Inpatient Sample database, we analyzed all children with CCHD ≤ 18 years hospitalized from 2005-2018. Primary outcome was a composite of incident stroke (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) and all-cause mortality within strata of ages and years and over the 14-year period of observation. Chi-square tests and multivariable regression were used to assess differences in outcomes. Trends were analyzed adjusting for sex, insurance, and hospital features.

Results:
A total of 59,438 children with CCHD were hospitalized during the study period: 58% were White (W), 15% Black (B), and 27% Hispanic (H). Overall rate of stroke or death was 4.7% in White children, 6.6% in Black, and 5.6% in Hispanic. Disparities were most pronounced in infancy (Figure; relative differences (RD) compared to White children: 27% (B) and 20% (H), P=0.000) and in early childhood (Figure; RD: 42% (B) and 9% (H), P=0.002). Black and Hispanic children with CCHD had higher rates of stroke and death from 2005-2009 (Figure; RD compared to White children: 24% (B), 22% (H); P = 0.001) and in 2015-2018 (Figure; RD: 21% (B), 18% (H); P = 0.000). These disparities did not change significantly over time in crude or adjusted models (P=0.07, P=0.06).

Conclusion:
Racial and ethnic disparities in stroke and death among children with CCHD persist after the neonatal period with only modest change in these differences in recent years. Further work identifying the mediators of these disparities is necessary to improve outcomes in this vulnerable pediatric population.
Abstract P211: Effect Of An Mobile Health Weight Loss Intervention On Healthy Eating Index Diet Quality: The Smarter Randomized Controlled Trial
Authors: Cheng Jessica , Sereika Susan M , Costacou Tina , Conroy Margaret B , Parmanto Bambang , Rockette-Wagner Bonny , Kriska Andrea , Burke Lora E
Published: April 2022

Introduction:
Dietary modification is key to standard behavioral treatment for weight loss. However, few studies assess whether diet quality—the overall healthfulness of the diet—is improved over the course of the intervention. As diet quality is relevant to health separate from its effect on weight, it may be an important endpoint to assess. The purpose of this secondary analysis of a randomized mobile health weight loss trial was to assess whether self-monitoring with automated, personalized feedback (SM+FB) compared to self-monitoring alone (SM) resulted in improved diet quality.

Methods:
Adults (N=502) with overweight/obesity (n=251 in SM+FB; n=251 SM) were provided calorie, fat gram, and physical activity goals and instructed to weigh daily, wear a Fitbit activity tracker, and self-monitor diet. Feedback messages were sent up to three times daily to SM+FB participants and were based on participant reported intake of calories, fat, and sugar but did not specifically target diet quality. Diet data were collected from two dietary recalls at baseline, 6 months, and 12 months using the Automated Self-Administered system (ASA-24). The Simple Scoring method was used to calculate Healthy Eating Index 2015 (HEI-2015) total scores as it aligns with the Dietary Guidelines for Americans. Change in diet quality was assessed using two-way repeated measures analysis of variance. Missing dietary data was imputed using last observation carried forward. Analyses used intention to treat.

Results:
The overall sample was mostly female (79%), white (82.5%), and middle-aged (mean=45.0 years, SD=14.4 years). Baseline HEI-2015 total scores were similar between SM (mean=54.44, SE=0.78) and SM+FB (mean=55.49, SE=0.82) and did not improve for either group over 6 months (SM: mean=55.64, SE=0.77; SM+FB: mean=56.89, SE=0.88) or 12 months (SM: mean=56.21, SE=0.81; SM+FB: mean=56.10, SE=0.88). Group, time, and group by time interaction effects were all non-significant (p>0.003) after Bonferroni adjustment.

Discussion:
Given that the HEI-2015 total score ranges from 0 to 100 with 74 meeting Healthy People 2020 goals, the diet quality of participants was less than ideal (grade: F) at baseline. The small improvements over time were likely not clinically significant. Future mHealth interventions might consider ways to increase user engagement, customization of additional features beyond feedback, and the addition of more targeted nutritional education in order to improve diet quality.
Abstract P220: Low Levels Of Endogenous Estrogen Are Associated With Elevated Risk Of Cardiovascular Disease Mortality In Young And Middle-Aged Men In The United States
Authors: Appiah Duke , Luitel Sujata , Nwabuo Chike C , Ebong Imo A , Winters Stephen J
Published: April 2022

Background:
While endogenous estrogen deficiency in men due to inactivating mutations of the aromatase gene results in profound metabolic dysfunction, evidence for the association of estradiol with cardiovascular disease (CVD) in men overall is inconsistent, with most studies performed among older men or patients with CVD. We investigated the association of total estradiol (E2) or free estradiol (FE2) and CVD mortality in a nationally representative sample of US men.

Hypothesis:
Low levels of E2 or FE2 will be associated with elevated risk of CVD mortality.

Methods:
Data on 954 men without CVD, cancer, diabetes and not on androgen therapy or taking anabolic steroids who participated in Phase 1 (1988 to 1991) of the third National Health and Nutrition Examination Survey and for whom E2 was measured, and were followed for mortality through to December 31, 2015 were included. Fasting serum levels of E2 were measured using competitive electrochemiluminescence immunoassays. Free estradiol was estimated from estradiol, sex hormone binding globulin, and albumin. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results:
The average age of participants at baseline was 35.7 (Standard deviation (SD) ±11.6) years with 11% and 6% of them reporting Black and Hispanic race and ethnicity, respectively. During a median follow-up of 25.2 years, 40 CVD deaths were recorded, with the cumulative incidence greater among men with low E2 or FE2 (Figure). Controlling for baseline age, race/ethnicity, education, systolic blood pressure, body mass index, physical activity, smoking status, alcohol intake, HDL cholesterol, c-reactive protein and total testosterone levels, a 1 log SD decrease in E2 (HR: 2.38, 95%CI: 1.11-5.00) or FE2 (HR: 1.96, 95%CI: 1.03-3.70) was associated with elevated CVD mortality.

Conclusions:
In this nationally representative sample of U.S young and middle-aged men, low levels of total estradiol or free estradiol were associated with elevated risk for CVD mortality.
Abstract P223: The Relationship Between Positive Psychological Well-being And Dietary Intakes During The Covid-19 Pandemic: A Cross-sectional Analysis
Authors: Benasi Giada , St-Onge Marie-Pierre
Published: April 2022

Introduction:
The Covid-19 pandemic had a negative impact on mental health and lifestyle behaviors, including dietary habits. Negative psychological factors are known to adversely impact lifestyle behaviors, but the influence of positive psychological well-being on dietary intakes is relatively unknown.

Hypothesis:
We assessed the hypothesis that psychological factors related to both negative emotional states and positive psychological well-being would have an impact on dietary intakes among adults reporting poor sleep quality and at least moderate perceived stress during the Covid-19 pandemic.

Methods:
Thirty-one individuals (age 40.2±13.0 y, 81% women, 55% White, BMI 23.2±2.6 kg/m
2
) were enrolled in a pilot study testing the efficacy of a well-being and sleep hygiene intervention to improve sleep, diet, and mental health. Questionnaires were administered at baseline to assess diet (single-day food recall), psychological well-being (Psychological Well-Being scales of autonomy, environmental mastery, personal growth, purpose in life, positive relations with others, and self-acceptance) and negative emotional states (Symptom Questionnaire scales of anxiety, depression, hostility, and somatization). Separate linear regression models were estimated for each psychological variable that was significantly correlated with diet at baseline, controlling for age, sex, and BMI.

Results:
Linear regression models showed that, at baseline, higher depression and hostility were associated with higher energy (
B
= 77.6±20.3 (
SE
),
p
< 0.001 and
B
= 65.2±25.7,
p
= 0.01, respectively) and fat (
B
= 4.6±1.5,
p
= 0.004 and
B
= 4.9±1.7,
p
= 0.008, respectively) intakes. Higher depression was also associated with higher intakes of protein (
B
= 3.0±1.0,
p
= 0.006), carbohydrate (
B
= 6.5±2.5,
p
= 0.01), sugar (
B
= 3.9±1.1,
p
= 0.001), and sodium (
B
= 130.7±36.6,
p
= 0.001). Higher positive relations was associated with lower carbohydrate (
B
= -5.1±2.4,
p
= 0.04) and sugar (
B
= -3.6±1.0,
p
= 0.001) intakes, and higher purpose in life was associated with lower sugar (
B
= -3.3±1.2,
p
= 0.008), cholesterol (
B
= -14.7±5.9,
p
= 0.01), and saturated fat (
B
= -1.2±0.4,
p
= 0.008) intakes. When controlling for baseline levels of depression, hostility and purpose in life were no longer associated with dietary intakes, while positive relations remained associated with sugar intakes (
B
= -2.3±1.2,
p
= 0.04).

Conclusions:
Under stressful circumstances, both negative emotional states and positive psychological well-being are associated with dietary intakes. Despite depression having the strongest overall impact on dietary intakes, positive relations with others independently affected sugar intakes. Personalized approaches focused on positive psychological well-being, along with distress reduction, should be considered in interventions aimed at promoting healthy dietary behaviors.
Abstract P234: Electronic Medical Record Use Among Adults With Self-reported Hypertension: Analysis Of The 2020 Health Information National Trends Survey
Authors: Spaulding Erin , Miller Hailey , Turkson-Ocran Ruth-Alma , Koirala Binu , Ogungbe Oluwabunmi , Byiringiro Samuel , Nwokeji Uchenna , Gleason Kelly T , Baptiste Diana , Martin Seth S , Commodore-Mensah Yvonne
Published: April 2022

Background:
Nearly half of adults in the United States have hypertension (HTN). Given the rapid uptake of electronic medical records (EMRs), providing patients with access to their EMR has emerged as a viable tool to improve adherence to guideline-directed medical therapy and blood pressure control. However, little is known about the prevalence of and sociodemographic differences in EMR use among adults with HTN.

Methods:
We used cross-sectional data from the 2020 Health Information National Trends Survey (HINTS) among English and Spanish speaking adults to examine (1) the prevalence of EMR use between individuals with and without self-reported HTN, and (2) social determinants of EMR use among individuals with self-reported HTN. EMR use was dichotomized into not having used and having used an EMR at least once in the past 12 months. Self-reported HTN was defined as having been told by a doctor or health professional that they had HTN. Weighted analyses were conducted by fitting generalized linear models using multivariable Poisson regression to determine independent sociodemographic determinants of EMR use among adults with HTN.

Results:
Among 3,805 respondents, 36% reported having HTN. About 44% of respondents with versus 38% without HTN reported accessing their EMR at least once in the past 12 months (
P
=0.04). Among adults with HTN, the mean age was 56 (SE: 0.67) years, 52% were men, and 67% were Non-Hispanic White. Among adults with HTN, those with lower education [≤ high school graduate: aPR: 0.70 (95% CI: 0.53 - 0.93)], lower income [≤$34,999: aPR: 0.70 (95% CI: 0.50 - 0.97)], and not using the internet [aPR: 0.21 (95% CI: 0.11 - 0.38)] were less likely to report EMR use (Table).

Conclusion:
EMR use was higher among individuals with HTN, indicating that EMRs may be a useful tool for HTN management. Social determinants such as lower education and income were associated with no EMR use. Policies aimed at improving internet access are needed to ensure equitable access to EMRs for individuals with HTN.