bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P089: Does Social Support Attenuate the Impact of Poverty Status on Body Mass Index?
Authors: Kershaw Kiarri N , Hankinson Arlene L , Carnethon Mercedes R
Published: July 2021

Background:
Chronic stress associated with living in poverty may lead to higher levels of adiposity due to the adoption of obesity-promoting stress coping behaviors. Social support may provide an alternative means of coping with stress, but very few studies have investigated whether high levels of social support can mitigate the adverse impact of poverty on adiposity.

Hypothesis:
We hypothesized that social support modified the association between poverty and BMI whereby the association of poverty with BMI was weaker among adults who reported higher social support.

Methods:
National Health and Nutrition Examination Survey (2005–2008) participants ages 40+ (n=5,768) responded to questions about availability and adequacy of emotional social support (adequate, inadequate, and none) and about availability of financial support (yes/no). Poverty was defined as a poverty:income ratio ≤ 1.3. BMI (kg/m
2
) was calculated from measured height and weight. Sex-stratified multivariable linear regression with interaction terms for poverty and each measure of social support were used to test for effect measure modification in the relationships between poverty and BMI. Associations of each measure of social support with BMI were modeled separately.

Results:
Approximately 74.7% of women and 78.3% of men reported adequate emotional support. Available financial support was reported by 80.3% of women and 73.6% of men. Among women, higher poverty was related to higher mean BMI (beta=0.96; SE=0.32). Women who reported adequate emotional support had lower BMI than those who reported inadequate support (beta= −0.83; SE=0.35). Those who reported no available emotional support also had marginally lower mean BMI than women who reported inadequate support (beta= −1.27; SE=0.65;
P
=0.06). Women who reported having available financial support had lower BMI than those who reported no financial support (beta= −0.97; SE=0.40). There were no significant social support*poverty interactions. The relationship between poverty and BMI was similar in magnitude across levels of emotional support. Poverty was related to higher mean BMI for women who reported available financial support (beta=1.14; SE=0.45) but there was no difference in BMI among those who reported none (beta=0.02; SE=0.54). Neither measure of support was associated with BMI among men.

Conclusions:
Inadequate emotional support was associated with higher mean BMI in women than those who reported adequate support and those who reported no support. Lack of financial support was also associated with higher mean BMI in women. High social support did not offset the impact of poverty on BMI among women, suggesting social support may not be a sufficient strategy for coping with the stress of poverty.
Abstract P097: Low Medication Adherence is Related to Poor Hypertension Control among Patients with Chronic Kidney Disease
Authors: Vupputuri Suma , Muntner Paul , Winkelmayer Wolfgang C , Smith David H , Nichols Gregory A
Published: July 2021

Inadequately controlled blood pressure (BP) is an important risk factor for the progression of chronic kidney disease (CKD). Few data are available on the association between adherence to antihypertensive medications and BP control among patients with CKD. We investigated the association of adherence to angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) with BP levels and BP control among CKD patients (n=3077) at Kaiser Permanente Georgia (an insurer and health care provider). Patients were required to have 2 outpatient diagnoses of CKD in 2008-2009, at least 2 fills of ACEi/ARBs, be 18+ years of age, with at least 1 year of continuous membership and prescription benefits prior to 01/01/08 and have no history of end-stage renal disease. We defined uncontrolled BP as systolic/diastolic of ≥140/90 mmHg and also ≥130/80 mmHg. As a measure of adherence we calculated the medication possession ratio (MPR):
# of days medication supplied between the first and last prescription fills
Duration from first to last prescription date + days supply from last prescription
The mean age of our sample was 64.1 ±11.9 years; 53.1% were female, and 57.6% African-American. In this sample, 22.6% and 8.9% had low and very low medication adherence, respectively; while 25.6% and 58.6% had systolic/diastolic BP of ≥140/90 and ≥130/80 mmHg, respectively. The mean BPs and odds ratios (ORs) for uncontrolled BP associated with level of adherence to antihypertensive medications are given in the
table
. In conclusion, among patients with CKD, poor medication adherence to antihypertensive medications was consistently associated with uncontrolled hypertension. Targeting interventions to improve medication adherence among patients with CKD may be an important strategy to improve BP control and, in turn, slow the progression of CKD.

Medication Adherence
p-trend

High (MPR: ≥0.8) N=2109
Low (MPR: 0.5 to <0.8) N=694
Very low (MPR: <0.5) N=274

Mean systolic BP, mmHg
131.3 (13.0)
134.0 (14.7)
137.5 (15.4)
<0.0001

Mean diastolic BP, mmHg
72.5 (8.12)
75.7 (9.21)
78.7 (10.1)
<0.0001

OR for SBP/DBP ≥140/90 mmHg

Age, race, sex adjusted
1.0 (ref)
1.40 (1.14, 1.73)
2.30 (1.73, 3.06)
<0.0001

Multivariate adjusted
*

1.0 (ref)
1.24 (0.97, 1.57)
1.96 (1.40, 2.75)
<0.0001

OR for SBP/DBP ≥130/80 mmHg

Age, race, sex adjusted
1.0 (ref)
1.21 (1.00, 1.46)
1.81 (1.33, 2.45)
<0.0001

Multivariate adjusted
*

1.0 (ref)
1.11 (0.89, 1.38)
1.43 (1.01, 2.01)
0.04

*

Adjusted for age, race, sex, socioeconomic status, co-morbidities, clinical measures, and number of medication classes.
Abstract P101: Predictors of Coronary Artery Disease in Type 1 Diabetic Subjects With and Without Microalbuminuria: A 20 Year Follow Up Study
Authors: Orchard Trevor J , Pambianco Georgia
Published: July 2021

The incidence of nephropathy, a major predictor of coronary artery disease (CAD) in type 1 diabetes (T1D), has been strongly declining over the past several years. However, CAD rates do not appear to be declining commensurately. To identify similarities and differences in the CAD risk factor profile in subjects with and without microalbuminuria or worse (MA+), 20 year follow up data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset T1D (mean baseline age 28 and duration 19 yrs) were examined. MA+ was determined by kidney disease-related death, dialysis, transplant, or AER>20 μg/mL in 2 of 3 timed urine collections. CAD was defined as angina, ischemic ECG changes, revascularization, confirmed MI, or CAD death. Cox proportional hazard models, adjusted for all the significant univariate risk factors, were determined separately for subjects who developed MA+ before their incident CAD event and for those who had CAD without preceding MA (MA-). As we have previously shown that CAD risk factors to vary by sex, we performed sex specific analyses within each MA group to determine if the predictors of CAD differ by sex and MA status. The results of the sex-specific analysis are listed in the
table
below.

MA-
MA+

Men (n=15 cases/84
β (CI)
Men (n=65 cases/165)
β (CI)

nonHDL (mg/dl)
1.02 (1.0-1.04)
Diabetes Duration (years)
1.12 (1.1-1.2)

WHR
3.05 (.98-9.5)
AER (log)
1.34 (1.2-1.5)

Women (n=20 cases/92)

Women (n=56 cases/172)

Diabetes Duration (years)
1.11 (1.0-1.2)
Diabetes Duration (years)
1.11 (1.07-1.15)

Pulse Rate (bpm)
1.06 (1.0-1.1)
Hypertension
1.85 (1.0-3.2)

nonHDL (mg/dl)
1.01 (1.0-1.01)

In the MA+ group, diabetes duration predicted CAD in both sexes, with AER (men) and hypertension and nonHDL (women) also contributing. However, in the MA- group, duration was only predictive in women, where pulse rate (p=0.016) was also predictive, while in men nonHDL, and to a small extent WHR (p=.054) predicted CAD. In conclusion, these data suggest that further factors beyond standard risk factors and renal disease are operative in T1D, particularly pulse rate in women.
Abstract P103: Impairment of Lower Extremity Physical Performance in Non-Dialysis CKD.
Authors: Roshanravan Baback , Kestenbaum Bryan , Giffuni Jaimie , Robinson-Cohen Cassiane , Katzel Leslie I , Seliger Stephen L
Published: July 2021

Background:
Kidney dysfunction leads to the retention of metabolic waste products which may subsequently impair muscle function and physical performance.

Methods:
We prospectively measured physical performance in 183 stroke-free older adults with stage 3-4 CKD to determine the pattern of functional impairment and the relationship of performance with severity of CKD. Functional tests included the short physical performance battery (SPPB), 4 meter walk (gait speed), 6 minute walk distance (6MWD), timed get up and go test (TGUAG), grip strength, and peak expiratory flow. Physical performance in the CKD cohort was compared to normative data obtained from 78 non-CKD controls for the TGUAG and to expected performance from published normative data for other performance measures. Among CKD subjects, associations of performance with eGFR and proteinuria were estimated using linear regression adjusting for age, sex, race, height, and weight.

Results:
Mean eGFR was 34.8 ±12.5 mL/min/1.73m
2
, mean BMI 30.6 ±6 kg/m
2
, and median proteinuria 240 mg/g. Mean age was 66 ±7.7years, 91% were male, 33% African American, and 40% diabetic. CKD patients had significantly worse performance compared to predicted values on the TGUAG test (36 ±41% slower), gait speed (-31.7 ±15%), 6MWD (-31 ±15%), and peak expiratory flow (-25 ±34%). Among CKD subjects, lower eGFR and greater proteinuria were associated with worse performance on the
6MWD
(
Table
). In contrast, no significant associations were observed between eGFR or proteinuria with performance on the other physical performance tests.

Renal Function Measure
6 Meter Walk Distance (meters)

Units

β
*
(95%CI)

P value

GFR
MDRD
(mL/min/1.73m
2)

10mL/min/1.73m
2
decrement

−11.0 (-23.0, 1.1)
0.07

45-59
Ref

30-44
−7.0 (-38, 24)
.044

<30
−35 (-68, -1.3)

Proteinuria (mg/g Cr)

1 ln-increment
−11.0 (-21.1, -0.9)
0.033

0-299
Ref

≥300
−25.8 (-53, 1.38)
0.063

*

Adjusted for age, sex, race, height, and weight

Conclusions:
Older adults with CKD exhibit markedly reduced physical performance, especially for tests of lower extremity function. Lower renal function and greater proteinuria are associated with worse performance on the 6-minute walk test, a measure of submaximal gait.
Abstract P104: Serum Long-Chain Omega-3 Fatty Acids, Hair Mercury and Corrected QT Interval in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study
Authors: Virtanen Jyrki K , Mursu Jaakko , Voutilainen Sari , Tuomainen Tomi-Pekka
Published: July 2021

Background:
Fish consumption has been associated with reduced risk of sudden cardiac death. It has been suggested that the long-chain omega-3 fatty acids from fish are responsible for the beneficial effects of fish consumption. The QT interval on the ECG measures the duration of ventricular repolarization, and a long QT interval is one of the major risk factors for sudden cardiac death. Our goal was to study the association between the serum long-chain omega-3 fatty acids eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) and QT interval duration in middle aged men. As fish is also the major source of methylmercury, an environmental contaminant proposed to have adverse cardiovascular effects, we also evaluated the impact of methylmercury exposure on the QT duration.

Methods:
A total of 1411 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42–60 years and free of cardiovascular disease, were included. A standardized resting 12-lead ECG was used for recording. Men with QRS ≥120 ms were excluded. The heart rate-corrected QT interval (QTc) was calculated using the Bazett’s formula. Prolonged QTc was defined as QTc >440 ms. Quartiles of the percentage of EPA, DPA and DHA of all serum fatty acids were used as the exposure. Hair mercury in quartiles was used as a marker for methylmercury exposure.

Results:
The mean±SD concentrations were 4.70±1.61% for EPA+DPA+DHA, 1.69±0.92% for EPA, 0.55±0.10% for DPA and 2.46±0.74% for DHA, of all serum fatty acids. The mean QTc interval in the quartiles of serum EPA+DPA+DHA was 417, 417, 415 and 414 ms (P for trend 0.02), after adjustment for age, examination year, smoking, alcohol intake, physical activity, body mass index, education, income, diabetes, treated hypertension and arrhythmia medication. Prolonged QTc was found in 169 of the 1411 men (12%). The multivariate-adjusted odds ratio (OR) for prolonged QTc in the quartiles of EPA+DPA+DHA was 1, 0.90, 0.83 and 0.63 [95% confidence interval (CI) 0.39–1.02, P for trend 0.05]. The OR in the highest vs. the lowest quartile was 0.58 (95% CI 0.36–0.93, P for trend 0.03) for EPA, 0.68 (95% CI 0.43–1.09, P for trend 0.06) for DPA and 0.59 (95% CI 0.35–0.98, P for trend 0.04) for DHA. The mean±SD hair mercury concentration was 1.9±2.0 μg/g. Hair mercury was not associated with QTc, unadjusted or adjusted. The multivariate-adjusted OR for prolonged QTc in the quartiles of hair mercury was 1, 0.97, 0.99 and 1.04 (95% CI 0.64–1.69), P for trend 0.80.

Conclusions:
Increased concentration of long-chain omega-3 fatty acids in serum, a marker of fish or fish oil consumption, appears to protect against prolonged QTc in eastern Finnish middle-aged men. Methylmercury exposure is not associated with QTc in this study population.
Abstract P106: Dietary Patterns and Incidence of Atrial Fibrillation: the Health Professionals Follow-up Study (HPFS)
Authors: Kalantarian Shadi , Imamura Fumiaki , Lajous Martin , Rimm Eric , Hu Frank , Willett Walter , Mozaffarian Dariush
Published: July 2021

Introduction:
Atrial fibrillation (AF) is a growing public health problem. Overall diet quality has proven informative for studying chronic diseases, but potential relations with AF risk are unknown.

Methods:
We followed 39,840 US male health professionals free from AF at baseline (age 70.5±9.8 y) for incidence of AF from 2002 to 2010. Diet was assessed every 4 ys by validated questionnaires, with cumulative updating of past diet. We also performed analyses evaluating only more recent diet. A diet pattern was characterized based on biologic considerations using 8 dietary factors that might influence risk factors for AF: higher fruits, vegetables, whole grain, seafood, nuts, and polyunsaturated to saturated fat ratio, and lower glycemic load and trans-fat. Each factor was scored in quintiles (1- 5), in ascending order for more healthful factors and descending order for less healthful factors. These scores were summed to quantify the diet pattern score (range 8-40). Incident AF was identified from initial self-report that was also subsequently confirmed by detailed supplementary questionnaire; these methods were validated against medical records in a subset (positive predictive value=95%). We estimated risk using Cox models adjusting for age, prevalent diseases, lifestyle habits, and health-seeking behaviors (greater multivitamin use; more routine physical, sigmoidoscopy, and rectal exams).

Results:
During 308,144 person-years follow-up, 879 incident AF cases occurred. Men with higher diet scores were older, less likely to smoke, more likely to be physically active and be on aspirin, and more likely to have health seeking behaviors. The multivariable-adjusted HR (95%CI) for quintiles 2 to5 vs. quintile 1 were 1.06 (0.84, 1.33), 1.04 (0.82, 1.32), 1.15 (0.92, 1.45), and 1.26 (0.98, 1.60), respectively (p trend=0.04). Exploring each of the 8 dietary factors individually, none were significantly associated with incident AF, except seafood which was inversely associated (HR for quintile 5 vs. 1=0.79; 95%CI=0.63, 1.00). Health-seeking behaviors were associated with trend toward AF risk (extreme quartile HR 1.21, 95% CI 0.92-1.59). Stratified by health seeking behavior, the diet score showed positive association with AF only in men with greatest health seeking behaviors (p trend 0.01), but not in the other groups (p>0.8). Sensitivity analyses using only more recent diet, stratifying by aspirin use, or limiting to symptomatic AF cases did not appreciably alter results.

Conclusions:
Contrary to our hypothesis, a more healthful diet pattern was linked to higher AF risk. This association might partly relate to unmeasured or residual confounding due to greater health seeking behaviors that could increase AF diagnosis. Overall, our novel findings suggest no major benefits of a generally healthy diet on AF incidence, except perhaps for seafood consumption.
Abstract P111: Serum and Dietary Magnesium and the Incidence of Atrial Fibrillation in Whites and African Americans: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Misialek Jeffrey R , Lopez Faye L , Huxley Rachel R , Peacock James M , Chen Lin Y , Soliman Elsayed Z , Agarwal Sunil K , Alonso Alvaro
Published: July 2021

Background:
Low serum magnesium (Mg) has been associated with a higher cardiovascular risk and other cardiovascular diseases (CVD) including ventricular arrhythmias. However, the association between serum or dietary Mg and atrial fibrillation (AF) has not been investigated to date.

Methods:
We studied 14,290 men and women (75% white, 53% women, mean age 54) free of AF at baseline participating in the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort in the United States. Serum Mg was assessed at baseline (1987-89) and a second visit (1990-92) while dietary Mg was assessed at baseline and a third visit (1993-95). The mean value of two Mg measurements were used for individuals who attended both visits while the baseline Mg measurement was used for individuals who did not attend another visit or were censored. Incident AF cases through 2008 were ascertained from electrocardiograms, hospital discharge codes, and death certificates. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals for AF associated with serum and dietary Mg quintiles. Models were initially adjusted for age, sex, race, and ARIC field center, and additional models further adjusted for other cardiovascular risk factors and prevalent CVD. Dietary Mg analyses included correlated dietary covariates in all models. Interaction by race and sex was tested for serum and dietary Mg.

Results:
Over a median follow-up time of 19.7 years, 1,613 incident AF cases were identified. Higher serum Mg was associated with lower AF risk even after adjustment for cardiovascular risk factors and other CVD (table), with no evidence of significant interactions between serum Mg and sex or race. No significant association was identified between dietary Mg and AF.

Conclusion:
High serum Mg was associated with a lower AF risk, and this association was not different between whites and African Americans. Dietary Mg was not associated with AF risk. Funding(This research has received full or partial funding support from the American Heart Association, National Center)
Abstract P112: Racial Differences in the Incidence of and Risk Factors for Atrial Fibrillation in Older Adults: The Cardiovascular Health Study
Authors: Jensen Paul N , Thacker Evan L , Dublin Sascha , Psaty Bruce M , Heckbert Susan R
Published: July 2021

Objectives
. The goals of this analysis were to determine the age and sex-specific incidence of atrial fibrillation (AF) in white and black participants in the Cardiovascular Health Study with up to 19 years of follow-up, and to compare traditional risk factors (BMI, BP, diabetes, PR interval, and alcohol use) and emerging risk factors (N-terminal pro-B-type natriuretic peptide (NT-proBNP), FEV1, and cystatin C) for incident AF in blacks versus whites.

Methods
. From among 5,888 participants ≥65 years old, those with prevalent AF at baseline (n=167), or who did not self-report white or black race (n=36) were excluded. Incident AF was determined by hospital discharge diagnosis or annual study ECG. Age and sex specific incidence rates of AF in white and black participants were calculated as the number of cases divided by the number of person years in each age-sex-race category. Age and sex adjusted Cox proportional-hazards models were used to assess associations of the risk factors with incident AF, by race.

Results
. At baseline, the average age of included participants (n=5,685) was 73 years. Traditional cardiovascular disease risk factors were more prevalent among blacks than whites. During 63,741 person years of follow-up (mean 11.2 years per person), 1,531 incident AF cases were identified, 1,359 in whites and 172 in blacks. The incidence of AF was lower for blacks than whites (
Table 1
). Adjusted for age and sex, blacks had a 29% lower risk of AF than whites (HR: 0.71, 95%CI: 0.61, 0.84). For both blacks and whites, higher BMI, systolic BP, NT-proBNP, and cystatin C, and lower FEV1 were associated with incident AF. Only higher BMI was more strongly associated with incident AF in blacks versus whites (per 5 kg/m
2
, HR for blacks: 1.29, 95%CI: 1.12, 1.47; HR for whites: 1.10, 95%CI: 1.04, 1.17; HR for interaction: 1.17, 95%CI: 1.01, 1.35; p = 0.03).

Conclusions
. The incidence of AF was lower for blacks than whites, despite the fact that blacks had a higher prevalence of many cardiovascular risk factors. The reasons for this disparity remain unclear.

Table 1.

Incidence Rates of AF among Women in CHS by Sex and Race

Age Group
White Women
Black Women
95% CI

AF Cases
Incidence (per 1,000)
95% CI
AF Cases
Incidence (per 1,000)

65-69
18

6.7

4.2
10.6
7

13.8

6.6
29.0

70-74
93

12.6

10.3
15.4
14

9.9

5.9
16.8

75-79
182

19.5

16.9
22.6
29

16.1

11.2
23.2

80-84
215

25.5

22.4
29.2
28

18.5

12.8
26.8

85-89
145

32.2

27.3
37.8
23

28.4

18.8
42.7

Age Group
White Men
Black Men
95% CI

AF Cases
Incidence (per 1,000)
95% CI
AF Cases
Incidence (per 1,000)

65-69
23

15.2

10.1
22.8
6

20.0

9.0
44.6

70-74
89

19.2

15.6
23.6
10

12.3

6.6
22.8

75-79
162

27.6

23.7
32.3
14

14.8

8.8
25.0

80-84
192

37.1

32.2
42.8
17

23.1

14.3
37.1

85-89
125

45.1

37.8
53.7
9

26.9

14.0
51.8
Abstract P120: Prevalence of Ventricular Premature Beats Decreases With Serum Magnesium in Adults with Type 2 Diabetes
Authors: Del Gobbo Liana C , Song Yiqing , Elin Ronald J , Dewailly Eric , Poirier Paul , Egeland Grace M
Published: July 2021

Introduction:
Ventricular premature beats (VPB) predict cardiovascular mortality among several adult populations. Controlled dietary magnesium (Mg) depletion studies demonstrated that diminished Mg intake and status induced VPB and other arrhythmias. Thus, we hypothesized that the prevalence of VPB is closely associated with serum Mg concentrations in a general adult population at high cardiovascular risk.

Methods:
Anthropometric, demographic and lifestyle characteristics were assessed in 750 Cree adults, >18yrs, who participated in an age-stratified, cross-sectional health survey in Quebec, Canada. Holter electrocardiograms recorded heart rate variability and cardiac arrhythmias for two consecutive hours. Multivariate logistic regression was used to evaluate potential associations between serum Mg and VPB.

Results:
VPB prevalence in adults with hypomagnesaemia (serum Mg ≤ 0.70mmol/L) was over twice that of adults without hypomagnesaemia (50% vs. 21%,
p
=0.015); results were not materially altered when adults with cardiovascular disease history were excluded. All hypomagnesaemic adults with VPB had type 2 diabetes. Prevalence of VPB declined across the serum Mg concentration gradient in adults with type 2 diabetes only (
p
<0.001). In multivariate logistic regressions adjusted for age, sex, community, body mass index, smoking, physical activity, alcohol consumption, kidney disease, antihypertensive and cholesterol lowering drug use, and blood docosahexaenoic acid concentrations, the odds of VPB among diabetics with serum Mg > 0.70 mmol/L was 0.24 (95%CI: 0.06-0.98;
p
=0.046).

Conclusions:
Prevalence of VPB significantly declined across the serum Mg concentration gradient in adults with type 2 diabetes, indicating that future interventions to increase levels of serum Mg among adults with type 2 diabetes may confer protection against cardiac arrhythmia.
Abstract P122: Plasma Fatty Acid Binding Protein 4 is Associated with the Incidence of Sudden Cardiac Death in Non-Diabetic Adults in the Cardiovascular Health Study
Authors: Djousse Luc , Maziarz Marlena , Biggs Mary L , Ix Joachim H , Kizer Jorge R , Mozaffarian Dariush , Mukamal Kenneth J , Tracy Russell P , Siscovick David S , Sotoodehnia Nona
Published: July 2021

Background:
Fatty acid binding protein 4 (FABP4) is an adipokine that plays a role in lipid transport. Previous studies have reported that FABP4 may increase the risk of diabetes and exert negative inotropy on the myocardium. It is unknown whether plasma FABP4 is associated with the risk of sudden cardiac death (SCD).

Objective:
To test the hypothesis that plasma FABP4 is associated with a higher incidence of SCD in older adults and determine if diabetes status modifies this association.

Methods:
We prospectively analyzed data on 4,564 men and women aged 65+ years from the Cardiovascular Health Study. FABP4 was measured at baseline using ELISA and SCD events were adjudicated through review of medical records (inter-reviewer agreement of 88% and kappa of 0.74). We used Cox proportional hazards model to examine the association between FABP4 and SCD.

Results:
During a median follow up of 11.8 years, 146 new cases of SCD occurred. In a multivariable model adjusting for age, sex, race, clinic, education, glomerular filtration rate based on cystatin C, high-sensitive C-reactive protein, leisure time physical activity, hormone replacement therapy, alcohol intake, self-reported general health status, smoking, prevalent coronary heart disease, and prevalent heart failure, each higher standard deviation (SD) of plasma FABP4 was associated with a non-significant 14% (95% CI: -5% to 37%) higher risk of SCD. When stratified by prevalent diabetes status, FABP4 was associated with a higher risk of SCD in non-diabetic participants, [HR per SD of FABP4: 1.37 (95% CI: 1.11-1.67)] but not in diabetic participants [HR per SD of FABP4: 0.77 (95% CI: 0.52-1.15)], p for diabetes-FABP4 interaction was 0.026.

Conclusion:
A single measure of plasma FABP4 obtained later in life was associated with a higher risk of SCD among older adults without diabetes but not among those with diabetes. If confirmed in other studies, these data may point to novel mechanisms and opportunities for SCD prevention.
Abstract P123: Percentage of Deaths Attributable to Poor Cardiovascular Health Behaviors: Findings from the Aerobics Center Longitudinal Study
Authors: Sui Xuemei , Zhang Jiajia , Lee Duck-chul , Artero Enrique G , Blair Steven N
Published: July 2021

Introduction:
Although cigarette smoking, physical inactivity, obesity, and poor diet each have been linked to the risk of premature death, little is known about their relative individual and combined impact, adapted from the American Heart Association (AHA)’s new cardiovascular health construct, on mortality outcomes. We hypothesized that the individual and the combined health behaviors were inversely associated with all-cause mortality. The purpose of the study is to estimate the mortality effects of the 4 AHA defined cardiovascular health behaviors by examining the associated population attributable fractions (PAFs) of individual and combination factors.

Methods:
The study included 11240 (24% women) participants from the Aerobics Center Longitudinal Study (ACLS). Slightly modified AHA cardiovascular health behaviors (smoking, BMI, cardiorespiratory fitness and diet) were collected between 1987 and 1999 as part of the clinical examination. We used cardiorespiratory fitness as an objective marker of recent physical activity habits. Individuals with a history of a cardiovascular disease, or cancer were excluded. The cohort was followed to December 2003 or death. PAFs were calculated after adjusting for age, gender, hypertension, diabetes, hypercholesterolemia, family history of CVD, and the four health behaviors.

Results:
Two hundred and sixty-eight deaths were documented during an average 12 years of follow-up. Low fitness had the highest PAFs at the 5
th
, 10
th
, and 15
th
year of follow-up, respectively: 6.6% (95% CI: 1.6% - 11.4%), 6.4% (95% CI: 1.5% - 11.0%), and 5.5% (95% CI: 1.3% - 9.6%). Current smokers had the second highest PAFs at the 5
th
, 10
th
, and 15
th
year of follow-up, respectively: 5.4% (95% CI: 0.1% - 10.3%), 5.2% (95% CI: 0.1% - 9.9%), and 5.0% (95% CI: 0.2% - 9.5%). Additional adjustment for other confounders in the model did not change the above associations. The PAFs for overweight or obese and unhealthy diet were not significant in the current study.

Conclusion:
Assuming a causal relationship between smoking, low fitness and mortality, avoidance of these two cardiovascular health risk factors would have prevented 13% of the deaths in the ACLS population. Targeted interventions to increase fitness as well as stopping smoking would most likely promote longevity.
Abstract P129: FTO Genotype and 2-year Change in Body Composition and Fat Distribution in Response to Weight-loss Diets: The Pounds Lost Trial
Authors: Zhang Xiaomin , Qi Qibin , Hu Frank , Sacks Frank , Qi Lu
Published: July 2021

OBJECTIVE
The fat mass and obesity-associated gene (FTO) variant has shown the strongest association with obesity. Recent studies suggest that dietary intake may modify the genetic effects of FTO. We tested the effect of FTO variant on long-term weight loss and change in body composition in a 2-year randomized intervention trial.

RESEARCH DESIGN AND METHODS
FTO SNP rs1558902 was genotyped in 742 overweight or obese adults who were randomly assigned to one of four diets differing in the percentages of energy derived from fat, protein and carbohydrate (20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%) in the Pounds Lost Trial for 2 years. Body composition and fat distribution were measured in 424 and 195 participants by Dual-energy X-ray absorptiometry (DXA) and computed tomography (CT), respectively.

RESULTS
We found significant modification effects for diet intervention varying in protein (low vs high), but not in fat, on 2-year changes in total fat, fat free mass (FFM), fat mass% (FM%), trunk fat%, total adipose tissue mass (TAT), visceral adipose tissue mass (VAT) and superficial adipose tissue mass (SAT) (P for interactions=0.045, 0.036, 0.033, 0.048, 0.001, 0.008 and 0.002, respectively). Carriers of the risk allele (A allele) had a greater loss of weight and regional fat in response to high protein diet, while an opposite genetic effect was observed on changes in TAT and SAT in response to low protein diet at 2 years. Significant gene by diet interventions (low vs high protein) were also observed at 6 months of intervention, when the maximum of weight-loss was achieved, for changes in FFM, TAT, VAT and SAT (P for interactions=0.007, 0.019, 0.036 and 0.041, respectively). Patterns of change in body composition and fat distribution by diet intervention were similar at 6 month and 2 year.

CONCLUSIONS
Our data suggest that a high-protein diet may be beneficial for weight loss in individuals with the risk allele of the FTO variant rs1558902.
Abstract P131: The Effects of Weight Loss on Liver Function in Obese Hypertensive Patients
Authors: Masuo Kazuko , Rakugi Hiromi , Ogihara Toshio , Lambert Gavin W
Published: July 2021

Objective:
Insulin resistance and visceral adiposity are predisposing factors for fatty liver disease. This study was undertaken to evaluate the weight loss effects on liver function (ALT, AST, GGT).

Methods:
90 overweight/obese, mild hypertensive men without medications or liver dysfunction were randomized into the 3 weight loss (WL) regimens over 24 weeks. WL was achieved with i) a mild calorie restricted diet alone (D alone; 1800kcal/day, 55% carbohydrate, 30% protein, 15% fat), ii) mild exercise alone (EX alone; 1-hr walking), or iii) a combination with a mild calorie restricted diet + exercise (D+EX) over 24 weeks. BMI, waist/hip ratio (W/H), total body fat-mass, blood pressure (BP), plasma norepinephrine (NE), fasting insulin, glucose, HOMA-IR, total cholesterol (Tch), triglyceride (TG), and liver function (ALT, AST, GGT) were measured every 4 weeks over 24 weeks with WL.

Results:
At entry period, BMI, fat-mass, W/H, BP levels, plasma NE, HOMA-IR, Tch, TG, ALT, AST, and GGT were similar between the 3 groups. At 24 weeks, the D+EX group had significantly higher prevalence of normalizations of BMI and BP levels (53.3%, 56.7%, respectively) compared to the D alone (13.3%, 23.3%, 30.0%) or EX alone (26.6%, 23.3%). In the D alone group, significant decreases in plasma NE and TG was observed at 2 weeks followed by significant reductions in Tch, body weight, fat mass, and HOMA at 8 weeks. Significant reductions in W/H, BP and GGT were also observed at 8 weeks, and ALT and AST decreased gradually but significantly at 12 weeks. On the other hand, in the EX alone group, significant fat loss and significant reduction in W/H, HOMA-IR and GGT were observed at 4 weeks. Body weight and plasma NE decreased significantly at 8 weeks, and significant BP reduction and decreases in TG and Tch were occurred at 12 weeks followed by decreases in ALT and AST at 16 weeks. Reductions in GGT were similar between the D alone and D+EX groups, but the groups including D had greater reduction in GGT, ALT and AST compared to the EX alone group. In the combination group (D+EX group), every improvement was observed earlier and stronger. Significant suppression on plasma NE and TG was at 2 weeks, decreases in HOMA, Tch, weight, fat-mass, W/H, systolic BP and GGT were at 4 weeks, and diastolic BP, ALT, and AST were at 8 weeks. In all subjects, reductions in HOMA-IR preceded to decreases in liver function parameters (GGT, ALT, and AST), and reductions in GGT was followed by decreases in ALT or AST. In multiple regression analyses, at both period of entry and 24-week, HOMA-IR was a significant determinant for GGT, TG and Tch. At entry and 24-week periods, Tch, but not TG, was a significant determinant for GGT, ALT, and AST.

Conclusions:
Improvement of insulin resistance associated with WL may play an important role of improvement of liver function during lifestyle modifications. WL is an effective treatment for fatty liver disease associated with obesity.
Abstract P143: Young Women are Most Susceptible to the Effects of Smoking on Adverse Cardiovascular Events
Authors: Rooks Cherie R , Eapen Danny , Shah Amit , Manocha Pankaj , Patel Riyaz , Zafari A. Maziar , Quyyumi Arshed , Vaccarino Viola
Published: July 2021

Background
. Although overall rates of smoking have declined in the U.S. population, such decline has been less in women than in men, and sex differences in smoking-related morbidity and mortality from coronary artery disease (CAD) may also exist. The purpose of this study was to determine sex and age-specific differences in the relationship between smoking and adverse cardiovascular events in patients referred for CAD evaluation.

Methods
. We examined 261 current smokers and 1,561 non-smokers who underwent coronary angiography for suspected CAD. Patients were followed for repeat hospitalization or death related to major adverse cardiovascular events (MACE). CAD severity was scored based on the Coronary Artery Surgery Study scoring system.

Results
. Smokers were more likely to be men (64%) and <60 years of age (62%). After a median follow-up of 2.4 years, 148 (24%) women and 345 (29%) men experienced MACE. The adjusted hazard ratio for MACE was >10-fold in women smokers <60 yrs than non smoking counterparts (Table 1), and remained significant after adjusting for CAD severity. No significant association was found in men <60 yrs or in older women or older men (sex, age and smoking interaction: p=0.03).

Conclusions
. Younger women referred for coronary evaluation appear to be more susceptible to the adverse cardiovascular effects of smoking than men or older women. Our results suggest potential sex differences in CAD pathophysiology and prognosis and emphasize the need to address smoking behavior in all patients, particularly young women.
Abstract P145: Using an Activity Monitor to Motivate Physical Activity among Healthy Employees: A Randomized Controlled Trial
Authors: Thorndike Anne N , Mills Sarah , Sonnenberg Lillian , Regan Susan
Published: July 2021

Background:
Worksite physical activity programs have the potential to reduce sedentary behavior of large populations of employees. Activity monitors are promising tools for motivating individuals to increase physical activity, but it is unknown whether this is an effective strategy for a relatively healthy employee population.

Methods:
We conducted a 2-phase trial to assess the effectiveness of providing 102 internal medicine residents with an activity monitor for 12 weeks. The first phase (6 weeks) was a randomized controlled trial (RCT) with half of the residents randomized to wear a monitor with visible feedback (steps, calories, activity level) and half the residents randomized to wear a blinded monitor (control). The second phase (6 weeks) was a team competition (TC), and all residents were unblinded and divided into 3 teams (interns, juniors, seniors) that competed on weekly steps. To increase compliance over 12 weeks, we conducted a weekly lottery for two $10 gift cards among subjects who wore the monitor for at least 5 of 7 days. Pedometer use (defined as > 500 steps/day) was compared across groups using chi-squared tests. We compared mean daily steps on days when pedometer was worn between control and intervention groups using generalized linear mixed models with participant as a random effect.

Results:
Baseline demographics and weight did not differ between control and intervention. Mean age was 29, 54% were female, and mean BMI was 24.2. Mean daily steps at baseline (week 1) were 8,084 (SD 3565). During the RCT phase (6 weeks), control and intervention groups did not differ in mean daily steps, but over the entire study (12 weeks), the intervention group logged 403 more steps per day than control (p<.001). During the 6- week TC phase, subjects logged 297 more steps per day than during the 6-week RCT (p=.001). A similar proportion of subjects from both groups wore the pedometer during the 6-week RCT (75%), but despite unblinding during the second 6 weeks (TC), pedometer usage was lower in the control group compared to intervention (55% vs. 63%, p<.001).

Conclusions:
Compliance with using an activity monitor in this young employee population was relatively high but started to decrease after 6 weeks. Although the effect size was small, providing an activity monitor and creating a team competition was effective for motivating employees to increase activity over the short term. Future study is needed to evaluate long-term effectiveness among a more sedentary population.
Abstract P148: C-Reactive Protein (CRP) and the Prediction of Cardiovascular Death Among Mexican-Americans
Authors: Lopez Lenny , Peralta Carmen A , Lee Anne , Aiello Allison , Haan Mary N
Published: July 2021

Background:
Addition of C-reactive protein (CRP) improves risk stratification provided by traditional Framingham risk factors (FRFs) in some populations, but findings vary by gender and by race/ethnicity. Whether CRP levels can improve risk prediction of cardiovascular mortality (CVD) among elderly Hispanics is unknown.

Hypothesis:
CRP will add incremental CVD risk prediction in addition to FRFs.

Methods:
We evaluated whether addition of baseline CRP to the Framingham risk score can improve CVD risk stratification for CVD death among 1,422 participants (536 males, 886 females) from the Sacramento Area Latino Study on Aging (SALSA). SALSA is a well-characterized, NIH funded cohort study of Mexican Americans aged > 60 followed since 1998–1999. Death was ascertained by participant contacts, obituary reviews and cause of death from death certificates. We evaluated the association of CRP levels with CVD death using Cox proportional hazards models adjusting for FRFs stratified by gender. We calculated gender stratified net reclassification improvement (NRI) in models with and without CRP to predict 10-year CVD risks using the established FRFs categories (<5%, 5–10%, 10–20%, > 20%).

Results:
Mean baseline age was 70.7 and mean CRP level was 5.86 ng/ml. There were 167 CVD male deaths (mortality rate 39.2 per 1,000 person years) and174 among women (mortality rate 27.8 per 1,000 person years). Higher CRP levels were significantly associated with higher CVD mortality risk in men, HR of 1.29 (95% CI 1.11 – 1.50) but not women, HR 0.94 (95% CI 0.81 – 1.08) after adjustment for covariates. Addition of CRP was useful in reclassifying CVD death risk among men defined by FRF alone, and this was due to correct reclassification of those who did not experience CVD death from the highest risk group to a lower risk category. The majority of male participants (619/745=83%) were classified as having >20%risk in the model without CRP. Mortality rate for men initially classified as having > 20% risk was 37.9 per 1,000 person years. After addition of CRP, 6% were reclassified into an intermediate risk category (NRI 7.4%, p< 0.001) and their mortality rate was 10.3 per 1,000 person years. Overall, NRI for men was 4.2% (p=0.05). In contrast, addition of CRP among women was associated with increased misclassification to a higher risk category (NRI= − 13.4%, p=0.0001).

Conclusion:
A risk prediction model that includes CRP improves cardiovascular risk classification among elderly Mexican-American men but not women as defined by traditional FRFs.
Abstract P151: The Association Between Perceived Discrimination And Behavioral Risk Factors Among African Americans In The Jackson Heart Study
Authors: Sims Mario , Diez-Roux Ana , Gebreab Samsom , Hickson DeMarc , Bruce Marino , Wyatt Sharon , Dubbert Patricia , Mosley Tom , Payne Tom , Williams David , Taylor Herman
Published: July 2021

Objectives.
Prior research has reported an association between perceived discrimination and health outcomes among African Americans, and there is growing interest in the pathways in which it gets ‘under the skin.’ One such pathway may be through the association with behavioral risk factors. Using Jackson Heart Study data, we examined whether perceived reports of discrimination were associated with behavioral risk factors among African Americans.

Methods.
Cross-sectional associations of perceived reports of everyday discrimination, lifetime discrimination, and burden of lifetime discrimination with smoking status, physical activity, percent calories from fat in diet, and hours of sleep were examined among 4,939 participants 20–95 years old (women=3,123; men=1,816). We estimated odds ratios (OR) of current smoking and mean differences in physical activity, fat in diet and hours of sleep with measures of discrimination and adjusted for age and socioeconomic status.

Results.
Men were more likely to smoke than women, and had higher physical activity scores. Women reported slightly more hours of sleep than men. Men and women reported similar percentages of calories from fat in diet. After adjustment for age and socioeconomic status, perceived everyday discrimination was associated with more smoking and a greater percentage of calories from fat in diet in men and women (OR for smoking: 1.13, 95%CI 1.00–1.28 and 1.19, 95%CI 1.05–1.34; mean difference in percent calories from fat in diet: 0.37, p<.05,0.43, p<.01, in men and women respectively). Everyday discrimination was associated with higher physical activity scores in women (0.11, p<.05) but not men. Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (everyday discrimination: −0.08, p<.05 and −0.18, p<.001, respectively; and lifetime discrimination: −0.08, p<.05, and −0.24, p<.001, respectively). Lifetime discrimination was associated with more smoking and higher physical activity scores in women only in fully-adjusted models (OR for smoking: 1.17, 95%CI 1.03–1.33; mean difference in physical activity: 0.14, p<.01), and lifetime discrimination was positively associated with percent calories from fat in diet in men only in the fully-adjusted model (0.46, p <.01). Burden of lifetime discrimination was associated with more smoking in women and fewer hours of sleep in women.

Conclusions.
Behavioral risk factors offer a potential mechanism through which perceived discrimination affects health in African Americans.
Abstract P153: Racial Disparities in Diabetic Complications in a Middle and Low Income Population of Louisiana
Authors: Wang Yujie , Li Wei , Chen Liwei , Horswell Ronald , Xie Wenting , Xiao Ke , Besse Jay , Johnson Jolene , Katzmarzyk Peter , Ryan Donna , Hu Gang
Published: July 2021

Background:
Although coronary heart disease (CHD), heart failure (HF), stroke, and end-stage renal disease (ESRD) are major microvascular and macrovascular complications of diabetes, they are less clear for diabetic subgroups especially on those with middle and low income.

Aim:
To investigate racial disparities in the incidence of diabetic complications in middle and low income adults.

Methods:
We performed a prospective cohort study (1985-2010) on diabetic patients enrolled in the LSU Hospital-Based Longitudinal Study. Study cohorts included 89,353 diabetic patients (16,326 White men, 21,496 White women, 19,422 African American men and 32,109 African American women) who were 30 to 96 years of age. We calculated the gender specific age-standardized incident rates using the direct method to the year 2010 Census population. Cox proportional hazard models were used to compare racial or gender specific hazard ratios for CHD, HF, stroke and ESRD after adjustment for age, race, type of health insurance, family income, body mass index, smoking, systolic blood pressure, LDL cholesterol, HDL cholesterol, HbA
1c
, estimated GFR, albuminuria, and drug treatments for diabetes, hypertension and hyperlipidemia.

Results:
During an average 4.0 years of follow-up, 16,935 CHD, 13,421 HF, 6,804 stroke, and 13,281 ESRD incident cases were ascertained. The age-standardized incident rates of the four diabetic complications are presented in
table 1
. Compared with White diabetic patients, African Americans experienced higher rates of ESRD and lower rates of CHD, HF, and stroke. Female diabetic patients had lower rates of the four complications than males. Results of the Cox proportional hazard models confirmed the racial disparity and gender difference we found in the age-standardized incident rates.

Conclusions:
The results support the existence of racial differences in the incidence of diabetic complications in this population.

Table 1

Age-adjusted incident rates of type 2 diabetes complications in the LSUHLS study

Age-standardized incident rates
White
African American

Male
Female
Male
Female

Coronary Heart Disease
101.6 (98.8-104.5)
62.0 (60.4-63.7)
50.7 (49.2-52.2)
44.4 (43.4-45.5)

Heart Failure
54.9 (52.9-56.8)
41.9 (40.6-43.1)
43.4 (42.0-44.8)
38.4 (37.4-39.3)

Stroke
22.1 (20.9-23.3)
20.7 (19.8-21.6)
19.9 (19.0-20.8)
18.5 (17.8-19.1)

End-stage Renal Disease
43.3 (41.6-45.0)
33.4 (32.2-34.5)
51.4 (50.0-52.9)
35.2 (34.3-36.1)