bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 46: The Association between Acute Mental Stress and Changes in Left Atrial Electrophysiology
Authors: O’Neal Wesley T , Almuwaqqat Zakaria , Hammadah Muhammad , Gafeer Mohamad M , Abdelhadi Naser , Wilmot Kobina , Al Mheid Ibhar , Ramadan Ronnie , Bremmer J. D , Kutner Michael , Soliman Elsayed Z , Shah Amit J , Quyyumi Arshed A , Vaccarino Viola
Published: March 2022

Background:
Acute stress may trigger atrial fibrillation, but the mechanisms are not clear. We hypothesized that acute mental stress results in abnormal atrial remodeling via electrophysiologic effects.

Methods:
We examined our hypothesis in 168 patients (mean age=63±8.7 years; 74% men; 65% Caucasian) with stable coronary heart disease who underwent mental (speech task) stress testing. PTFV
1
duration (ms) times the value of the depth (μV) of the downward deflection (terminal portion) of the median P-wave in lead V
1
, and was automatically measured on digital electrocardiograms (ECG) at rest, stress, recovery. Electrocardiographic left atrial abnormality was defined as P-wave terminal force in lead V1 (PTFV1) ≤ -4000 μV*ms. The mean values of PTFV
1
during stress and recovery were compared with rest. Additionally, the percentage of participants who had left atrial abnormality during stress and recovery was compared with those at rest.

Results:
The mean PTFV
1
at rest was -2857±2459 μV*ms. There were 51 (30%) participants who had baseline left atrial abnormality. Compared with rest, PTFV
1
became more negative with stress [mean change=-474, 95%CI=(-103, -845); p=0.013] and during recovery [mean change=-420, 95%CI=(-79, -761); p=0.016]. A larger percentage of participants showed left atrial abnormality during stress (n=63, 38%) and recovery (n=67, 40%) compared with rest. Similar changes in PTFV
1
with stress [mean change=-833, 95%CI=(-372, -1295); p<0.001] and recovery [mean change=-796, 95%CI=(-389, -1204); p<0.001] were observed when we excluded those with baseline left atrial abnormality. No differences were noted in the PTFV
1
response based on age, gender, race, or hemodynamic response to stress.

Conclusion:
Acute mental stress alters left atrial electrophysiology, as measured by PTFV
1
, suggesting that stressful situations promote adverse atrial remodeling. This possibly explains the poor cardiovascular outcomes associated with acute mental stress that are triggered by left atrial abnormalities such as atrial arrhythmias and stroke.
Abstract MP001: The Number of Low and High Energy Dense Foods Consumed Affects Body Mass Index Reduction in a Randomized Controlled Weight Loss Trial
Authors: Vadiveloo Maya , Raynor Hollie
Published: March 2022

Background:
Decreasing dietary energy density is recommended to promote weight loss. However, it is unclear whether decreasing dietary energy density is best accomplished by increasing the number of low energy dense (LED) foods (≤1 kcal/g) or by decreasing the number of high energy dense (HED) foods (≥3 kcal/g) in the diet, and whether these actions have different effects on weight loss. We explored how the number of LED and HED foods consumed affected dietary energy density and change in BMI during the 6-month weight-loss phase of an 18-month weight loss trial.

Methods:
A secondary analysis of 202 adults 21-65y with a BMI between 27 and 45 kg/m
2
participating in a weight loss trial was conducted. Participants were randomized to 1 of 2 conditions – a standardized lifestyle intervention or a standardized lifestyle intervention plus a goal to limit consumption of non-nutrient-dense, energy-dense foods to 2 foods. Dietary intake, assessed via 3, 24-hour recalls, and BMI were measured at baseline and 6 months. Generalized linear models were used to examine the association between residualized changes in LED foods and HED foods and dietary energy density and change in BMI between baseline and 6 months. All analyses were adjusted for age, sex, race, education, treatment group, change in energy intake, and number of LED or HED foods.

Results:
At baseline, participants had a daily average energy density of 1.25 kcal/g, which decreased to 0.82 kcal/g at 6-months (p<0.0001). Similarly, daily number of LED foods consumed increased from 4.46 to 5.64 foods/day while daily HED foods consumed decreased from 4.02 to 2.98 foods/day (p<0.0001). In fully-adjusted models, a 1-unit increase in LED foods was associated with a 0.07 decrease in the overall energy density of the diet while a 1-unit decrease in HED foods was associated with a 0.08 decrease in energy density (p<0.05); no significant changes in BMI were detected. However, when we examined changes in BMI among those who decreased (>1 unit), maintained (< 1-unit), or increased (>1 unit) the number of LED or HED foods, significantly greater changes in BMI were observed among those with stable (-3.3 ± 0.4 kg/m
2
) or increased LED food intake (-3.5 ± 0.4 kg/m
2
) compared to those who decreased LED foods (-2.4 kg ± 0.5 kg/m
2
, p<0.05). No differences in BMI were observed among those who decreased, maintained, or increased the number of HED foods, though similar decreases in energy density were observed among those who decreased HED foods or increased LED foods (-0.6 kcal/g).

Conclusions:
Decreasing HED foods and increasing LED foods both reduced the overall ED of the diet, but increasing LED foods was associated with significant reductions in BMI.
Abstract MP004: Feasibility of an Appetite Awareness Intervention to Reduce Cardiovascular Disease Risk Factors and Binge Eating in African-American Women with Obesity
Authors: Goode Rachel W , Kalarchian Melissa A , Conroy Molly , Craighead Linda , Sereika Susan , Mattos Meghan , Zheng Yaguang , Mancino Juliet , Burke Lora E
Published: March 2022

Background:
Currently, 82.1% of African-American (AA) women are overweight or obese, and 48.9% of AA women have cardiovascular disease (CVD), the leading cause of death. Binge eating disorder (BED) is associated with severe obesity, psychiatric morbidity, and increased risk for CVD. Among AA women, BED is the most common eating disorder and has a 33% prevalence among those seeking weight loss. Since many adults with BED report becoming overweight
after
binge eating on a regular basis, intervening with individuals at risk to develop BED may be a viable strategy to prevent CVD and further weight gain.

Purpose:
To investigate the feasibility of an 8-week, community-based Appetite Awareness Training intervention among AA women who are overweight and obese reporting monthly binge eating episodes, and examine preliminary changes in CVD risk, eating self-efficacy, and binge eating between the intervention and control group.

Methods:
Eligible individuals were randomized to Appetite Awareness Treatment (AAT, n=16) or Wait-List Control (WLC, n=15) with the WLC receiving the AAT after 8-weeks of observation. The goal of Appetite Awareness Treatment is to help participants relearn their biological signals of hunger and satiety. Participants attend group sessions, and receive weekly homework to self-monitor their appetite cues. Assessments were conducted at 0 and 8 weeks at a community-based site. Linear mixed modeling was used to examine the baseline to 8-week changes between AAT and WLC groups on CVD risk factors (body weight, waist circumference, blood pressure) self-efficacy by Weight Efficacy Lifestyle Questionnaire (WEL), and binge eating by the Binge Eating Scale (BES).

Results:
The sample (N=31), had a mean age of 48.8 (SD±12.8), and a BMI of 33.7 kg/m
2
(SD±3.90). Retention was 87.5%, session attendance 65.9%, and homework completion 55%. There were significant group differences over time in the WEL score (p<.01, d=1.06), and the BES score (p<.001, d=.52) at the end of the intervention. The AAT group had an increase in the WEL score (+25.14±6.67), with no changes in the WLC group (-1.27±4.15). Additionally, the AAT group had a decrease in the BES score (-5.87±0.61), with no changes in the WLC group (0 ±0.01). There were no significant differences within and between groups in CVD risk factors.

Conclusions:
Our pilot trial results suggest that AAT is feasible in this population, with good retention, attendance, and preliminary evidence of a positive impact on eating self-efficacy, binge eating behaviors, and weight gain prevention. Future research should investigate the effectiveness of AAT to reduce binge eating and CVD risk in a larger sample and study with a longer duration.
Abstract MP005: Do Worksite Wellness Programs Improve Dietary Behaviors and Adiposity? A Systematic Review and Meta-analysis
Authors: Penalvo Jose L , Micha Renata , Smith Jessica D , Rehm Colin D , Bishop Eve , Onopa Jennifer A , Uzhova Irina , Wu Jason H , Mozaffarian Dariush
Published: March 2022

Introduction:
Worksites are promising venues for promoting health, given considerable time spent at work and opportunities for environmental change. Yet, the impact of worksite wellness programs (WWPs) on diet and adiposity, as well as the most relevant WWP components, are not established.

Methods:
Following MOOSE and PRISMA guidelines, we conducted a systematic review and meta-analysis of the impact of multi-component WWP trials (RCT or quasi-experimental) on diet and adiposity. Data were extracted in duplicate and pooled using inverse variance random effects meta-analysis. Pre-specified sources of heterogeneity (study design, world region, worksite type, duration, WWP components) were analyzed by meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias.

Results:
From 6612 abstracts, we identified 48 studies assessing WWPs and diet or adiposity. Most were in the US (54%) or Europe (23%), with diet (64%) and exercise/weight loss (20%) as main targets. Intervention components were variable (Figure). Most common outcomes were intakes of fruits and vegetables (F&V) (19 studies), total fat or fat subtypes (18), and dietary fiber (4); and BMI (35) and waist circumference (WC) (10). Median duration was 12 months (range: 1-48 mo). In pooled analyses, WWP increased intake of F&V, especially fruits (Figure). Significant effects were not identified for dietary fiber, total fat, or fat subtypes. WWP also reduced BMI (Figure) and WC (-2.03 cm, 95% CI:-3.88,-0.20). Trial duration significantly modified effects on BMI (<12 mo duration: -0.64 kg/m
2
; 12+ mo: -0.16 kg/m
2
; P-interaction=0.046); but not WC or F&V intake. Additional findings for heterogeneity, including WWP components, and publication bias will be presented.

Conclusions:
These novel findings support effectiveness of WWP for increasing F&V and reducing BMI and WC.
Abstract MP009: Contemporary Risk Stratification After Myocardial Infarction in the Community: Performance of Scores and Incremental Value of ST2
Authors: Gerber Yariv , Weston Susan , Enriquez-Sarano Maurice , Jaffe Allan , Manemann Sheila , Jiang Ruoxiang , Roger Veronique L
Published: March 2022

Background:
Current AHA/ACC guidelines recommend the GRACE and TIMI scores for assessing myocardial infarction (MI) prognosis. With recent major changes in the epidemiology of MI and new biomarkers available for risk stratification, an updated assessment of the performance of these scores is needed in a real-world practice setting.

Objectives:
We assessed (a) the performance of GRACE and TIMI in predicting 1-year mortality among a community cohort of MI patients stratified by ST- and non-ST-segment elevation MI (STEMI/NSTEMI) and (b) the incremental discriminatory power of soluble ST2, a myocardial fibrosis biomarker.

Methods:
Olmsted County, Minnesota residents with incident MI (N=1,401) were recruited prospectively from 2002-2012 (mean age, 67 years; 61% men; 79% NSTEMI). Baseline data were used for calculating risk scores; stored plasma samples obtained shortly after MI were used for ST2 measurement.
C
-statistics adapted to survival data were used to assess the discriminatory power of GRACE and TIMI and the improvement gained by incorporating additional variables.

Results:
During the first year of follow-up, 190 (14%) patients died. The overall discriminatory performance in predicting death was reasonable for GRACE and poor for TIMI, and was generally worse in NSTEMI vs STEMI. In NSTEMI, sequential addition of comorbidities and ST2 substantially improved the
c
-statistic over GRACE (from 0.78 to 0.80 to 0.84) and TIMI (from 0.61 to 0.73 to 0.81), respectively (all P ≤ 0.05).

Conclusions:
Guidelines-recommended scores for risk assessment post-MI underperform in contemporary community patients with NSTEMI, which now represent the majority of infarcts. Incorporating comorbidities and ST2 substantially improves risk prediction thereby delineating opportunity to improve clinical care.
Abstract MP018: Performance of 1,5-anhydroglucitol Compared to the Oral Glucose Tolerance Test and Fasting Glucose for Identification of Diabetes in the Community
Authors: Warren Bethany , Lee Alexandra K , Ballantyne Christie , Hoogeveen Ron , Pankow James S , Kottgen Anna , Selvin Elizabeth
Published: March 2022

Introduction:
The oral glucose tolerance test has been a long-standing gold standard for diabetes diagnosis. The oral glucose tolerance test measures glycemic response to a glucose challenge, but has fallen out of favor due to its high patient burden. There is growing interest in 1,5-anhydroglucitol (1,5-AG), a non-fasting test that does not require a carbohydrate challenge, for use in clinical practice. There is currently no consensus on clinical cut points for 1,5-AG, although low levels of 1,5-AG reflect recent (~2 week) glycemic excursions. Our objective was to evaluate the performance of 1,5-AG to identify cases of undiagnosed diabetes defined by the oral glucose tolerance test or fasting glucose in a community-based population.

Methods:
We included 7,754 Atherosclerosis Risk in Communities (ARIC) Study participants without diagnosed diabetes who attended visit 4 (1996-98). We calculated ROC curves, Youden’s index, sensitivity, and specificity to investigate the performance of 1,5-AG to identify cases of undiagnosed diabetes defined by an oral glucose tolerance test ≥ 200 mg/dL or fasting glucose ≥ 126 mg/dL.

Results:
The ROC curve of 1,5-AG compared to the oral glucose tolerance test as the gold standard was 0.658 and 1,5-AG compared to fasting glucose as the gold standard was 0.714. Youden’s index identified “optimal” 1,5-AG cut-points of 16 μg/mL and 17 μg/mL to identify diabetes defined by oral glucose tolerance test and fasting glucose, respectively. Decreasing values of 1,5-AG were more specific and less sensitive for detection of oral glucose tolerance test and fasting glucose-defined diabetes (Table).

Conclusion:
1,5-AG is currently approved for clinical use but its utility is unclear. Given its low sensitivity for detection of diabetes, 1,5-AG may not be able to substitute for fasting glucose or the oral glucose tolerance test for screening of diabetes.
Abstract MP029: Sleep Duration and Sedentary Behavior as Predictors of Cardiovascular Disease in Mid-Life
Authors: Hoffmann Coles , Petrov Megan E , Davis Mary C , Zautra Alex J
Published: March 2022

Introduction:
Sedentary behavior and short sleep duration are independently associated with cardiovascular disease (CVD), but there is limited research on the interaction between sedentary behavior and sleep duration on CVD.

Hypothesis:
Short sleep duration combined with greater sedentary behavior will be significantly associated with CVD.

Methods:
Middle-aged (40-65), community-dwelling adults were recruited to participate in a healthy aging study. Participants completed questionnaires on demographics, medical history, and habitual sleep duration. Sleep duration was categorized as < 6 vs. ≥ 6 hours. Sedentary behavior, measured with the International Physical Activity Questionnaire, was defined as sitting in hours/day dichotomized at the 75
th
percentile (< 9 vs. ≥ 9 hrs). CVD was defined as reported diagnosis of one or more of five conditions including coronary artery disease, congestive heart failure, myocardial infarction, arrhythmias, and stroke. Of the total sample of 770 individuals, 731 who had complete data on sleep, sitting, and CVD were included in the analysis. We conducted logistic regression models predicting CVD from sleep duration and sitting time groups adjusting sequentially for demographics (age, sex, education level) and CVD risk factors (reported high blood pressure and diabetes) (see Table).

Results:
CVD was present in 21% of the sample (n = 162). Participants who reported < 6 hrs sleep duration and sitting < 9 hrs/day were at significantly greater risk for CVD events compared to participants obtaining ≥ 6 hrs sleep duration and sitting < 9 hrs/day in the demographic model (see Table). Adjustment for CVD risk factors attenuated the relationship to borderline significance.

Conclusions:
Contrary to prediction, short sleep duration combined with short to moderate sitting time was associated with CVD events. Interpretation of the results should be done cautiously given our analysis was limited by a small sample size and a lack of adjustment for other potential CVD risk factors.
Abstract MP030: The Association Between Objectively Measured Sleep, Physical Activity and Sedentary Behaviour on Cardiorespiratory Fitness and Health in 9 - 11 Year Old New Zealand Children
Authors: Skidmore Paula M , Black Katherine E , Skeaff Sheila , Stoner Lee , Quigg Robin , Harrex Harriet A , Saeedi Pouya , Davison Brittany , Meredith-Jones Kim
Published: March 2022

Background:
The role of activity, sedentary behaviour and sleep in cardiorespiratory fitness (CRF) or cardiovascular health, has been primarily studied in adults. Therefore we assessed the hypothesis that longer sleep duration, more time spent in moderate to vigorous activity (MVPA), less sedentary time and a lower ratio of sedentary time to MVPA (Sedentary: MVPA) would be associated with higher CRF and lower pulse wave velocity (PWV) in children aged nine to 11 years from Dunedin, New Zealand.

Methods:
A cross-sectional study. Information on demographics and lifestyle was collected by questionnaire. Data on sleep, sedentary and MVPA time were collected using Actigraph wGT3X-BT accelerometers, worn over eight days. PWV was obtained using the SphygmoCor Xcel. VO
2
max values, from a multi-stage 20-metre shuttle run test, were used as the measure of CRF. Generalised estimating equations were undertaken to investigate relationships between accelerometer derived variables and CRF and PWV separately in 404 participants. Analyses were adjusted for age, socioeconomic status, ethnicity and age and sex specific BMI Z scores.

Results:
Mean (SD) VO
2
max was 47.5 (4.1) Ml/Kg/min for girls and 49.9 (5.20) for boys and mean (SD) PWV was 5.72 (0.79) for girls and 5.85 (0.79) for boys. In multivariate models, a one hour increase in sedentary time was associated with a 0.81 (CI: -1.19, -0.42) Ml/Kg/min increase in VO
2
max in all participants. In boys only, a one hour increase in MVPA associated with a 3.50 (CI: 2.76, 4.20) Ml/Kg/min increase in VO
2
max. Sedentary: MVPA was associated with lower VO
2
max in boys and girls. Sedentary time (β 0.15 m/s per hour increase, CI: 0.02, 0.27) and MVPA (β 0.25 m/s per hour decrease, CI: 0.04, 0.46) were only significantly associated with PWV in boys. No significant assocaitions were seen between sleep and CRF or PWV.

Conclusions:
In conclusion, sedentary behavior, MVPA and Sedentary: MVPA were both associated with CRF and PWV. Our results suggest that future interventions aimed at improving heart health in this age group need to target both increasing physical activity and reducing sedentary time.

Funding sources:
The National Heart Foundation of New Zealand and The University of Otago.
Abstract MP037: Blood Pressure Genetic Risk Score Predicts Blood Pressure Responses to Dietary Sodium and Potassium Interventions: The GenSalt Study
Authors: Nierenberg Jovia , Li Changwei , He Jiang , Gu Dongfeng , Hixon James E , Rao Dabeeru C , Kelly Tanika N
Published: March 2022

Salt-sensitivity of blood pressure (BP) is a risk factor for hypertension, cardiovascular disease and all-cause mortality. Although documented as an important BP endophenotype, the relationship between genetic loci implicated in BP and BP salt-sensitivity remains unexamined. We assessed the hypothesis that weighted genetic risk scores (GRS), based on SNPs identified in previous BP genome-wide association study meta-analyses, would predict BP salt-sensitivity among participants of the Genetic Epidemiology Network of Salt-Sensitivity (GenSalt) study. The GenSalt study was conducted among 1,906 participants from 633 Han Chinese families. Participants underwent a 7-day low sodium (51.3 mmol sodium/day), 7-day high sodium (307.8 mmol sodium/day), and 7-day high sodium plus potassium (60 mmol potassium/day) feeding study. BP was measured nine times at baseline and at the end of each intervention period using a random-zero sphygmomanometer. The relationships between systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) GRS and respective SBP, DBP and MAP responses to the dietary interventions were assessed using mixed linear regression models that accounted for familial dependencies and adjusted for age, gender, field center, and baseline body mass index and BP. As expected, baseline SBP, DBP, and MAP significantly increased per quartile increase in GRS(p=5.6 х 10
-11
, p=1.3 х 10
-7
, and p=9.9 х 10
-5
). In contrast, increasing GRS quartile conferred smaller SBP, DBP, and MAP responses to the low sodium intervention (p=4.2 х 10
-3
, p=0.02, and p=7.3 х 10
-3
, respectively) and smaller SBP responses to the high sodium and potassium interventions (p=0.05 and p=0.03, respectively) (
Figure
). Similar results were obtained when the data were analyzed per standard deviation increase in GRS. In summary, we identified an inverse relationship between BP GRS and BP salt-sensitivity. Further studies will be needed to elucidate the biological mechanisms contributing to this novel finding.
Abstract MP051: Circulating Dairy Fatty Acids and Total and Cause-specific Mortality: the Cardiovascular Health Study
Authors: de Oliveira Otto Marcia C , Lemaitre Rozenn N , Song Xiaoling , King Irena B , Siscovick David , Mozaffarian Dariush
Published: March 2022

Background:
Controversy has emerged about cardiovascular benefits versus harms of dairy fat consumption. Further, little data are available on potential long-term noncardiovascular effects. In addition, most observational studies to date assessed self-reported estimates of dairy fat consumption, which may not capture all dietary sources; and the few studies using objective biomarkers included only one baseline measure, which may lead to poor estimation of long-term risk.

Aims:
To investigate prospective associations of serial measures of dairy plasma phospholipid fatty acids (15:0, 17:0,
trans
16:1n-7) with cause-specific and total mortality among older adults in the Cardiovascular Health Study.

Methods:
Among 2,638 U.S. adults aged ≥65y and free of CVD at baseline, circulating fatty acid levels were measured serially at baseline, 6 years and 13 years using standardized methods. All-cause and cause-specific deaths were assessed and adjudicated centrally. Prospective associations were assessed by multivariate-adjusted Cox models incorporating time-dependent fatty acid measures and covariates.

Results:
During 36,486 person-years of follow-up (1992-2015), 2,619 deaths occurred (930 CVD deaths, 1,689 non-CVD deaths), with 603 CHD deaths and 208 stroke deaths. After adjustment for demographic and lifestyle factors, higher plasma phospholipid 17:0 and
trans
16:1n-7 were associated with lower cause-specific and total mortality (see Table). There were no statistically significant associations with 15:0.

Conclusion:
Plasma phospholipid 17:0 and
trans
16:1n-7, two objective biomarkers of dairy fat consumption, measured serially over 13 years, were associated with lower all-cause and especially CVD mortality among older adults. A third biomarker, 15:0, was not significantly associated with mortality. These novel findings highlight the need for detailed mechanistic and interventional investigation of long-term health effects of dairy fat, dairy-specific fatty acids, and dairy foods.
Abstract MP053: Dietary Trimethylamine Intake and Cardiovascular Mortality Among Urban Chinese Adults
Authors: Yu Danxia , Yang Gong , Xiang Yong-Bing , Li Honglan , Gao Yu-Tang , Zheng Wei , Shu Xiao-Ou
Published: March 2022

Background:
Trimethylamine (TMA)-containing nutrients (choline, betaine and carnitine) are dietary precursors of a gut microbial-derived metabolite, trimethylamine-N-oxide (TMAO). Studies have suggested that elevated TMAO contributes to atherosclerosis and increased mortality in cardiovascular disease (CVD) patients. However, epidemiological evidence remains limited regarding whether high TMA intake may increase CVD mortality. No population-based study has evaluated animal vs. plant food-derived TMA in relation to CVD.

Objective:
We examined dietary TMA, from animal-source foods (e.g., eggs, red meat and fish) and/or from plant foods (e.g., soy foods, legumes and vegetables), in association with total CVD mortality and mortality from coronary heart disease (CHD) and ischemic and hemorrhagic stroke. We also evaluated whether the associations were modified by food sources of TMA and by major CVD risk factors.

Methods:
Included were 73216 women and 61190 men from two prospective cohort studies of Chinese adults. They were 40-74 years of age, free of cancer and with a plausible energy intake at baseline. Usual diets were assessed using food-frequency questionnaires. Dietary TMA intake was calculated using the USDA database. Vital status and cause of death were obtained via linkages with the vital statistics registry. Cox model was used to estimate HRs and 95% CIs.

Results:
During a mean follow-up of 12.5 years, we documented 3740 CVD deaths. After adjusting for potential confounders, including sociodemographics, lifestyle, disease history, and other dietary risk factors, high TMA intake was associated with increased mortality from total CVD and CHD–HR (95% CI) in the highest vs. lowest quintile of TMA intake was 1.33 (1.15, 1.53) for CVD mortality and 1.60 (1.25, 2.06) for CHD mortality; both p-trend=0.0001. A positive trend of association was also observed for ischemic stroke mortality (HR [95% CI] =1.31 [0.99, 1.74]), but not for hemorrhagic stroke mortality. With mutual adjustment, animal- and plant-sourced TMA showed similar magnitude of positive associations with CVD and CHD mortality–HR (95% CI) in the highest vs. lowest quintile was 1.13 (0.99, 1.29) for animal-TMA and 1.19 (1.07, 1.33) for plant-TMA related to CVD mortality, and 1.33 (1.05, 1.67) for animal-TMA and 1.29 (1.07, 1.57) for plant-TMA related to CHD mortality. The TMA-CVD mortality association seemed more evident in men than in women and among adults with higher socioeconomic status, higher waist-hip ratios, higher refined carbohydrate intakes, or diabetes, although no interactions were statistically significant.

Conclusion:
Our study suggests that high TMA intake, from either animal or plant food sources, is associated with increased mortality from atherosclerotic CVD among urban Chinese adults. Potential mechanism involving gut microbial production of TMAO needs to be investigated in future studies.
Abstract MP055: T- Wave Axis Deviation, Coronary Artery Disease, Atrial Fibrillation, Heart Failure, Stroke and Cardiovascular Mortality: The MOLI-SANI Study
Authors: Di Castelnuovo Augusto , Bonaccio Marialaura , Costanzo Simona , Rago Livia , De Curtis Amalia , Assanelli Deodato , Badilini Fabio , Vaglio Martino , Persichillo Mariarosaria , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: March 2022

Background:
Deviation of frontal plane T-wave axis (TDev) is a reliable measure of ventricular repolarisation abnormality.

Objectives:
We investigated the associations and possible mediators between TDev and the risk of coronary artery disease (CHD), atrial fibrillation (AF), heart failure (HF), stroke and cardiovascular mortality.

Methods:
A large sample of 21,287 Moli-sani participants (54.0±10 years, 46% women), randomly recruited from the general adult population of Southern Italy and free of clinically and ECG recognized vascular disease (including HF), were followed for a median of 4.3 years. TDev was measured from a standard 12-lead resting electrocardiogram. ECG abnormalities were identified by the MINNESOTA codes.

Results:
After adjusting for a large panel of covariates (see the Table), subjects with abnormal TDev showed a significant increase in the risk of CHD, AF, HF and CVD mortality, but not with stroke (Table). Associations with CHD and HF (but not AF or CVD mortality) were slightly reduced but remained significant after further adjustment for other ECG abnormalities (Table). Subjects with abnormal TDev showed higher levels of subclinical inflammation (measured by C-reactive protein, WBC, platelet counts and ratio of granulocytes to lymphocytes), hs-troponin I and hs-NT-proBNP (p<0.001 for all). However, while additional adjustment for inflammation markers did not change the association of TDev with any clinical outcome, further adjustment for troponin I or NT-proBNP or both determined a reduction ranging from 7.9 to 23.7% for the association of TDev with HF and from 20.7 to 33.8% for the association of TDev with CHD.

Conclusions:
Deviation of TDev is associated with an increased risk of HF or CHD, independently from a large panel of covariates and other ECG abnormalities. The association was partially explained by the increase in hs-troponin I and hs-NT-proBNP levels.
Abstract MP069: Dietary Factors Associated with Cardiovascular Outcomes: 25 Year Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Van Horn Linda , Ning Hongyan , Steffen Lyn , Jacobs David , Shikany James , Miedema Michael , Rana Jamal S , Liu Kiang
Published: March 2022

Background:
Recommendations to prevent risk of atherosclerotic cardiovascular disease (ASCVD) include reduced intakes of saturated fat, excess sodium and added sugars. Coronary artery calcium (CAC) develops over many years and is a strong predictor of future ASCVD but data regarding diet and CAC are limited.

Methods:
Participants from CARDIA with Y25 CAC measurement were included (n= 3,121). CAC presence (Agatston score >0) and incident ASCVD including coronary heart disease (CHD), heart failure (HF) and stroke were assessed from baseline (ages 18-30 y) over a 25 y follow up along with baseline diet assessed by diet history.

Results:
Mean (SD) age at baseline was 25.1 (3.6) y; 56.7% female, 46.7% black. Prevalence of CAC at Y25 was 28.4% and more likely male (64.7 % vs 34.8%) and white (58.7% vs 51.1%). There were 53 (3.0%) and 75 (5.7%) cases of ASCVD events in women and men respectively over 28.4 y (median: 27.1 y). Intake of saturated fat was not, but added sugars were associated with CAC presence. Intake of butter was seemingly protective for both CAC and ASCVD while sugar-sweetened beverages (SSBs) and sodium (borderline) were associated with incident ASCVD. SSBs were specifically associated with CHD, stroke, and HF.

Conclusions:
Dietary factors play an important role in development of ASCVD, but the same dietary factors may not necessarily be associated with CAC development. Adverse synergistic effects of sodium and added sugars may be especially related to CVD. Whether source of SFA e.g. meat/processed meat, vs dairy foods confers different ASCVD risks and whether added sugars directly or indirectly in SSB’s increase CAC and a CVD event, especially combined with high sodium intake, need further consideration.
Abstract MP071: Genetic Modification of Triggers of Acute Myocardial Infarction: Results From a Case-crossover Study in Costa Rica
Authors: Wang Dongqing , Mostofsky Elizabeth , Mittleman Murray , Kardia Sharon L , Campos Hannia , Baylin Ana
Published: March 2022

Background:
Coffee intake and heavy physical exertion are triggers of acute myocardial infarction (AMI). It is hypothesized that their triggering effects can be modified by genetic variation.

Methods:
The study population consisted of incident cases (n=1354 for coffee intake, and n=1101 for heavy physical exertion) of nonfatal AMI recruited in Costa Rica between 1994 and 2004. Coffee intake and heavy physical exertion were assessed with validated questionnaires. Blood samples were collected and genotyping was conducted. We used a case-crossover design to estimate the relative risks (RRs) and 95% confidence intervals (CIs) of AMI associated with each trigger stratified by the genotypes of each SNP included. Chi-square tests of homogeneity of RR across genotypic strata were used to assess effect modification by genetic factors. We included SNPs from both candidate genes (candidate SNPs) and previous genome-wide association studies (GWAS SNPs) related to the pathophysiological pathways of the triggering effects. Specifically, the candidate SNPs were from select genes related to sympathetic nervous system, renin-angiotensin system, caffeine metabolism, and habitual coffee consumption. The GWAS SNPs were those previously found to be associated with AMI/coronary artery disease, lipid metabolism, blood pressure, heart rate, blood coagulation, matrix metalloproteinase, and adhesion molecules. A p-value of 0.05 was considered statistically significant at first. We then performed Bonferroni correction and false discovery rate (FDR) adjustment to account for multiple testing.

Results:
Among the SNPs associated with AMI/coronary artery disease, rs10483853 significantly modified the triggering effect of coffee, and rs10507130 was significant for heavy physical exertion. Among the SNPs associated with blood pressure, rs935334 was significant for both triggers. Among the SNPs associated with heart rate, rs9398652, rs1541010 and rs1395479 were significant for coffee intake, and rs17287293 and rs223116 were significant for heavy physical exertion. Among the SNPs associated with blood coagulation, rs4460176, rs565229, and rs12367822 were significant for coffee intake, and rs2731672, rs10489087, rs647316, rs2138852, rs1473247, rs12367822 and rs1671152 were significant for heavy physical exertion. The two SNPs associated with serum matrix metalloproteinase (rs11225434 and rs495366) both significantly modified the triggering effect of heavy physical exertion. No SNPs remained statistically significant after Bonferroni correction or FDR adjustment.

Conclusions:
We identified several potential genetic modifiers of the triggering effects of coffee intake and heavy physical exertion on AMI. Among them, heart rate and blood coagulation traits appeared to be more important. Replication studies in other populations will help confirm and expand our findings.
Abstract MP072: Low Vitamin K Status is Prospectively Associated With Greater Left Ventricular Mass
Authors: van Ballegooijen Hanne , Brouwer Ingeborg A , Visser Marjolein , Nijpels Giel , Dekker Jacqueline M , Rennenberg Roger J , Vermeer Cees , Stehouwer Coen D , Beulens Joline W
Published: March 2022

Introduction:
Vitamin K is a fat soluble vitamin and is required as a co-factor for the carboxylation of several proteins. Matrix gla-protein (MGP) requires vitamin K for its activation and is a potent vascular calcification inhibitor. High concentrations of dephosphorylated uncarboxylated MGP (dp-ucMGP) -a functional marker of vitamin K status- are associated with increased coronary artery calcification and cardiovascular disease, but the underlying mechanism remains unclear.

Hypothesis:
We hypothesized that higher levels of dp-ucMGP (indicating low vitamin K status) are associated with unfavorable measures of cardiac structure and function after 7 years of follow-up.

Methods:
In the Hoorn Study, a population-based cohort, 598 participants mean age 70.1±6.6 years, 51% female, had physical examinations in 2000-2001 (baseline for the current analyses), of whom 249 had a follow-up in 2007-2009. Plasma dp-ucMGP levels were measured with ELISA in baseline samples. We studied the cross-sectional and prospective association of dp-ucMGP with echocardiographic measures of left ventricular mass index (LVMI), ejection fraction and left atrium volume index using linear regression analyses, adjusted for age, sex, BMI, education, smoking, type 2 diabetes and LDL-cholesterol.

Results:
Median plasma dp-ucMGP was 567 (392-701) pmol/l and mean follow-up time was 7.0±0.7 year. Cross-sectionally, the highest dp-ucMGP quartile ≥701 pmol/l compared to the lowest quartile <392 pmol/l was associated with a 2.7 g/m
2.7
(95% CI -0.8, 6.2) greater LVMI. In the prospective analysis adjusting for baseline LVMI and follow-up time, the association was more pronounced and became significant 6.5 g/m
2.7
(95% CI 1.5, 11.4). This result was confirmed by the continuous association (Figure 1). No significant associations were observed between dp-ucMGP with ejection fraction and left atrium volume index.

Conclusion:
In conclusion, these results suggest that a low vitamin K status is prospectively associated with a greater LVMI.
Abstract MP081: Short-long-short Sequence of RR Intervals is Associated With Increased Risk of Sudden Cardiac Death: the Atherosclerosis Risk in Community Study
Authors: Kabir Muammar , Thomas Jason , Sedaghat Golriz , Waks Jonathan , Mukundan Srini V , Henrikson Charles , Post Wendy , Sotoodehnia Nona , Solomon Scott , Soliman Elsayed , Siscovick David , Buxton Alfred , Josephson Mark , Tereshchenko Larisa G
Published: March 2022

Introduction:
A Short-long-short sequence of RR’ intervals frequently precedes ventricular tachyarrhythmia. However, an association of RR’ alternans with sudden cardiac death (SCD) in the general population has not been previously studied.

Hypothesis:
We hypothesized that RR’ alternans is associated with SCD.

Methods:
We analyzed baseline visit 10-second ECG in 14,250 participants of the Atherosclerosis Risk in Communities (ARIC) cohort (mean age 54.1±5.87y; 45% men; 74% white). Only normal sinus beats were included in the semi-automated analysis. Digital 12-lead ECG was transformed into orthogonal ECG, from which respiratory signal was derived. Joint symbolic analysis was used to assess increase or decrease in successive RR’ intervals and R-instant respiratory phases calculated using the Hilbert transform. Short-long-short or long-short-long RR’ sequence was defined as RR’ alternans. RR’ alternans occurring during respiratory phase transitions were not considered. SCD, non-SCD, and non-cardiac death served as competing outcomes. Three competing risks models were constructed. Model 1 was adjusted for age, sex, race, and study center. Model 2 was in addition adjusted for prevalent CVD. Model 3 was further adjusted for subclinical CVD, its risk factors, including traditional ECG predictors, and medications affecting SA or AV nodes.

Results:
Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95%CI 1.52-1.82], 742 non-sudden cardiac deaths (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95%CI 12.1-13.0]) per 1,000 person-years. RR alternans was present in 1,679(11.8%) participants. In competing risks analysis (Table) the presence of RR’ alternans, excluding those occurring due to respiratory phase changes, was independently associated with increased risk of SCD.

Conclusion:
In competing risks analysis the presence of RR’ alternans that are not due to respiratory phase transition is associated with SCD. Further study of RR’ alternans is warranted.
Abstract MP084: Associations of Left Ventricular Structure and Function in Early Adulthood With Incident Adverse Geometry and Systolic Dysfunction in Middle Age: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Perak Amanda M , Colangelo Laura A , Armstrong Anderson C , Gidding Samuel S , Lewis Cora E , Lima Joao , Liu Kiang J , Reis Jared P , Schreiner Pamela J , Sidney Stephen , Lloyd-Jones Donald M
Published: March 2022

Introduction:
Cardiac remodeling occurs across the lifespan and predicts clinical outcomes. We hypothesized that inter-individual variability in left ventricular (LV) structure and function parameters in early adulthood would be independently associated with incident adverse LV geometry and ejection fraction (EF) <50% in middle age.

Methods:
We included CARDIA participants with echocardiograms at study years (Y) 5, 25, and 30. Geometry and EF analyses included only participants free of the outcome at Y5 (i.e., normal geometry or EF≥50%, respectively). We assessed associations of indexed Y5 LV parameters, including end-systolic (ESD/ht) and -diastolic (EDD/ht) dimensions, mass (M/ht
2.7
), septal and posterior wall thicknesses, and EF, with incident Y30 adverse geometry (defined as LV concentric remodeling [CR], concentric hypertrophy [cLVH], or eccentric hypertrophy [eLVH]) and EF <50%. We used multivariate polytomous (for geometry) or dichotomous (for EF) logistic regression, adjusting for demographics, heart rate, and cumulative (Y5-Y25) clinical risk factor burden.

Results:
Participants (N=2335) were 56% female, 44% black, and ages 23 to 35 and 48 to 60 in Y5 and Y30, respectively. With increasing age across the 3 study echocardiograms (Y5, Y25, and Y30), unadjusted mean LV M/ht
2.7
and EDD/ht generally increased, while ESD/ht and EF changed minimally. Y5 LV ESD/ht and M/ht
2.7
were most consistently associated with the odds for incident abnormalities in Y30 LV geometry and EF (Table). For example, Y5 LV ESD/ht and M/ht
2.7
were each associated with incident eLVH by Y30 (OR 1.48 [1.25-1.74] and 1.55 [1.28-1.88] per 1 SD increment, respectively). Y5 ESD/ht was also associated with EF <50% by Y30 (OR 1.84 [1.46-2.31]).

Conclusions:
In young adults with categorically normal LV geometry and systolic function, inter-individual variation in LV parameters is associated with incident concentric remodeling, hypertrophy, and EF <50% over 25 years, independent of demographics and cumulative clinical risk factor burden.
Abstract MP086: Cross-sectional and Longitudinal Predictors of Poor Sleep Among Adolescent Girls and Young Adult Women
Authors: Young Deborah R , Troxel Wendy , Sidell Margo A , Grandner Michael A , Mohan Yasmina D
Published: March 2022

Sleep is important for the psychosocial and physical health of adolescents and young adults. Predictors of poor sleep include family demographics and living situation, neighborhood factors, psychosocial health and health behaviors. Previous studies have examined these associations across the range of adolescence, without considering how they may differ across adolescent stages or into young adulthood. We examined the cross-sectional and longitudinal predictors of poor sleep among a cohort of 474 girls at 3 distinct ages: 14, 17, and 22 years. We used the item “during the past week my sleep was restless” to define sleep quality. Responses were categorized as poor sleep “no” (restless sleep “rarely or none of the time” or “some or a little of the time”) or “yes” (restless sleep “a lot of the time” or most or all of the time”). Independent variables were chosen from previous research examining demographic, psychosocial, and behavioral predictors of sleep quality among adolescents; race/ethnicity, family structure, socioeconomic status, neighborhood crime, depressive symptoms (excluding the sleep item) (all assessed from self-report), and physical activity and sedentary time (assessed from accelerometers). About 46% of the cohort was white, 25% Black, and 20% Hispanic. At each age, about 25% reported poor sleep, with 50% reporting no restless sleep at any time and 4.2% reporting restless sleep at all 3 time points. Cross-sectional correlates are displayed in the Table. Fully-adjusted longitudinal predictors of restless sleep were higher depression scores (OR: 1.10, 95% CI: 1.08, 1.11) and fewer sedentary minutes (OR: 0.99, 95% CI: 0.99, 0.99). Results demonstrate that sleep problems are prevalent across adolescence and persist into early adulthood. While correlates change over time, depressive symptoms and sedentary time are consistently predictive of sleep quality. Interventions that focus on improving mental health and increasing physical activity may also benefit sleep quality among adolescents and young adults.
Abstract MP087: Sleep Quality is Associated with Subclinical Cardiovascular Disease in Mid-Life Mexican Women
Authors: Merino Pablo , Catzín-Kuhlmann Andrés , Monge Adriana , Yunes Elsa , Espinosa Luis , Cantú-Brito Carlos , Lajous Martín , Lopez-Ridaura Ruy
Published: March 2022

Introduction:
Sleep quantity has been associated with higher risk of cardiovascular disease (CVD), however little is known about the impact of sleep quality on subclinical CVD.

Hypothesis:
Poor sleep quality is associated with subclinical CVD.

Methods:
We assessed the relationship between sleep quality and common carotid artery intima media thickness (IMT) through a cross-sectional analysis of a sub sample of 442 disease-free women from the Mexican Teacher’s Cohort. Sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in an online questionnaire applied to participants in 2014-2016. We defined poor sleep quality as a PSQI score above 5. Right and left carotid IMT was measured at clinical visits in 2012, 2013 and 2016 through carotid ultrasound performed by trained neurologists; results were log-transformed. Subclinical CVD was defined as the mean of right and left IMT ≥0.8mm or the presence of an atherosclerotic plaque. Multivariable linear and logistic regression models were used to evaluate the association of sleep quality with IMT or subclinical CVD, respectively.

Results:
In women of 49±5 years, the prevalence of poor sleep quality was 41% (185 of 442) and of subclinical CVD was 12.2% (54 of 442). The multivariable-adjusted percent difference of IMT was 2.4% (95% CI 0.03, 4.9), greater amongst those with poor sleep versus adequate sleep quality. The odds of developing subclinical CVD in women with poor sleep quality were 2.2 (95% CI 1.2, 4.1) times greater than those with adequate sleep quality (figure). Additionally, further adjustments for stress and depressive symptoms attenuated the results and were no longer statistically significant.

Conclusion:
Poor sleep quality is associated with IMT and subclinical CVD in a population of middle-aged women and this association is potentially mediated by stress and depression. Further analysis is needed regarding this association.