bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P320: Gender Disparities in Low Density Lipoprotein (LDL) Control for Secondary Prevention Among Patients with Coronary Heart Disease (CHD): Does Having a Caregiver Matter?
Authors: Hammond Gmerice , Mochari-Greenberger Heidi , Liao Ming , Mosca Lori
Published: July 2021

Background:
Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender.

Methods:
We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL<100 mg/dL) and aggressive target (LDL<70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities).

Results:
Males with CHD were more likely than females with CHD to be at target LDL <100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL<70 [48% (688/1446) vs 36% (271/744); p<0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an
informal
caregiver was significantly associated with LDL<70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL<100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an
informal
caregiver were more likely than men without a caregiver to have an LDL<70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women.

Conclusion:
Men with CHD were more likely to be at ATP III targets LDL <70 and <100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL <70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.
Abstract P324: Abdominal Visceral Adiposity and Liver Fat in Relation to Sex-Related Differences in Cardiometabolic Risk Profile: The INSPIRE ME IAA Study
Authors: Nazare Julie-Anne , Smith Jessica , Borel Anne-Laure , Haffner Steven M , Balkau Beverley , Ross Robert , Massien Christine , Alméras Natalie , Després Jean-Pierre
Published: July 2021

Objectives:
Sex differences in the cardiovascular risk profile are well established. The objectives of the present analyses were 1) to characterize sex differences in visceral adiposity (VA) and estimated liver fat content assessed by computed tomography (CT) and in the cardiometabolic risk (CMR) profile in a large international multiethnic cohort; 2) to determine whether differences between men and women in CMR factors remain after controlling for VA and/or liver fat.

Methods:
In the International Study of Prediction of Intra-abdominal adiposity and its Relationship with cardioMEtabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA), 297 primary care physicians, cardiologists, endocrinologists/diabetologists recruited 4504 patients from 29 countries. VA and liver attenuation (inversely correlated to liver fat) were assessed by CT. Cardiometabolic risk factors (triglyceride (TG), HDL-C, Apolipoprotein B (ApoB), HOMA, 2h-glucose (OGTT), adiponectin, C-Reactive Protein (CRP)) were assessed using standardized methods. The present cross-sectional analyses were performed in 1193 men and 1214 women free of type 2 diabetes.

Results:
Whereas mean BMI was similar in women and men (27.5±0.1 vs 27.5±0.1 kg/m2), men had higher waist circumference (98.1±0.4 vs 89.6±0.4 cm), higher VA (165±2 vs 131±2 cm2) and lower liver attenuation (54.9±0.3 vs 57.4±0.3 HU) (p<0.0001 for all) than women. Men displayed higher TG and HOMA but lower HDLc, CRP and adiponectin levels (p<0.001 for all) than women. In both sexes, VA and liver fat were significantly correlated positively with CMR variables: TG, HOMA and CRP and negatively with HDLc and adiponectin (p<0.05 simple regression analysis). In multiple regression analyses, VA and liver attenuation independently affected CMR variables. Sex differences in TG were eliminated after adjustment for VA or both variables simultaneously but HDLc remained higher in women even after such adjustment. HOMA was higher in women when adjusted for VA or for both variables and similar to men when adjusted for liver attenuation. Being not different between sexes before adjustment, 2h-glucose was higher in women when controlling for VA/liver fat. Adiponectin remained higher in women after all adjustments. Sex differences in CRP were magnified after adjustment for VA/liver fat and remained higher in women.

Conclusion:
In this large standardized international CT-imaging/cardiometabolic study, substantial sex differences in abdominal adiposity/liver fat and CMR factors were observed, with men presenting an overall more deteriorated CMR profile than women. Controlling for VA and liver fat was not sufficient to abolish sex differences in all inflammatory, insulin sensitivity or lipid factors.
Abstract P331: Secondary Prevention After Acute Coronary Syndrome with Microsize Myocardial Infarctions in the Reasons for Geographic and Racial Differences in Stroke-Myocardial Infarction (REGARDS-MI) Study
Authors: Nathani Niket , Safford Monika M , Gamboa Christopher , Mundkur Mallika , Preston Shannon , Shad Vikram , Brown Todd M
Published: July 2021

Background:
Studies have shown increased mortality after myocardial infarction (MI) with low level elevations of cardiac troponin (“microsize MI”) and subsequent risk reduction with intensive medical management. However, non-standard reporting and highly sensitive assays of cardiac troponin can make the clinical recognition of microsize MI difficult, creating barriers to the implementation of appropriate secondary prevention.

Methods:
REGARDS follows 30,239 community-dwelling participants of the 48 continental states age ≥45 years recruited from 2003-7; 41% of the sample was African American and 55% female by design. Following national consensus guidelines, experts adjudicated cases of acute coronary syndrome (ACS), defined as an admission for acute signs or symptoms of ischemia, and MI from hospital records. We studied first cases of ACS, classified as: 1) ACS without MI, 2) ACS+microsize MI (peak troponin <0.5), and 3) ACS+usual MI (peak troponin ≥0.5), to compare whether secondary prevention medications were prescribed at hospital discharge among these 3 groups. We used multivariable logistic regression to examine odds ratios for receipt of medications at discharge associated with microsize MI and no MI relative to usual MI.

Results:
The 1,238 cases of ACS were mean age 68.0+/-8.7 years, 59% male, and 66% white. Of these, 917 had discharge medications available. Compared to those with ACS+usual MI, individuals with ACS+microsize MI had lower odds of receiving beta-blockers and statins at discharge in a similar range as those without MI (
Table
).

Conclusion:
Individuals hospitalized for ACS and microsize MI were less likely to receive guideline appropriate secondary prevention measures than those with usual MI.
Abstract P336: Are Post-Operative Length-of-Stay and Rehospitalization Linked to Caregiving among Cardiac Surgery Patients?
Authors: Mochari-Greenberger Heidi , Mosca Matthew , Aggarwal Brooke , Umann Tianna M , Mosca Lori
Published: July 2021

Background:
Cardiac surgery patients are frequently cared for by family members or paid aides, potentially impacting clinical outcomes, yet data are sparse. The purpose of this study was to evaluate the association between access to paid or informal (unpaid) caregiving among cardiac surgery patients and post-operative length-of-stay, and death or rehospitalization at 1 year.

Methods:
We prospectively studied 665 consecutive patients admitted for cardiac surgery at a university hospital as part of a NHLBI-sponsored clinical outcomes study (93% participation rate). Participants (mean age 65 years; 35% female; 21% minority) completed an interviewer-assisted questionnaire at baseline to determine if they had a caregiver and the extent of care received. A hospital-based clinical information system was used to document post-operative length-of-stay and death or rehospitalization at 1 year (supplemented by standardized questionnaire). Demographics and comorbid conditions were documented by electronic chart assessment; comorbidity score was calculated using the Ghali comorbidity index. Associations between caregiving and clinical outcomes were evaluated by multiple logistic regression, adjusted for demographics (age, race, sex, marital status, health insurance) and comorbid conditions.

Results:
At baseline, 28% (183/665) of cardiac surgery patients reported having a caregiver (8% paid; 20% informal only). Having a caregiver was significantly associated with longer (>7 days) post-operative length-of-stay (OR=1.86; 95%CI=1.30−2.65). This association varied by whether patients had a
paid
(OR=3.00; 95%CI=1.57−5.74) or
informal
caregiver (OR=1.55; 95%CI=1.04−2.31) versus none and was attenuated after multivariable adjustment (
paid
caregiver OR=2.15; 95%CI=1.02−4.52,
informal
caregiver OR=1.23;95%CI=0.78−1.95). Having a
paid
caregiver was significantly associated with death or rehospitalization at 1 year in univariate analysis (OR=2.09; 95%CI=1.18−3.69) and was significantly attenuated after multivariable adjustment (OR=1.40; 95%CI=0.74−2.62). There was a non-significant univariate association between having an
informal
caregiver and death or rehospitalization at 1 year (OR=1.39; 95%CI=0.94−2.06).

Conclusions:
Cardiac surgery patients who identified having a caregiver had longer post-operative stays and a higher rate of death or rehospitalization at 1 year compared to those without a caregiver, not fully explained by comorbidities/confounders. These data suggest that assessment of caregiver status may be a powerful predictor and a simple method to identify cardiac surgery patients at risk for adverse clinical outcomes.
Abstract P337: Identifying Abnormal Cholesterol in Underserved Urban Communities through Health Fairs
Authors: Landy David C
Published: July 2021

Introduction:
Cholesterol screening at health fairs in underserved urban communities is becoming common, though little evidence guides these efforts. We sought to describe the proportion of patients identified with elevated low-density lipoprotein cholesterol (LDL) and reduced high-density lipoprotein cholesterol (HDL) at such fairs and the changes in LDL and HDL over time for returning patients. We hypothesized that patients would reduce their LDL in association with weight loss.

Methods:
DOCS is a medical student run service organization providing free screening services, health education, and when indicated referrals to low cost clinics. We reviewed the records of new patients receiving cholesterol screening at an annual DOCS fair in an underserved urban community in South Florida (Little Haiti, Hialeah, and Pompano Beach) in 2007 and any future visits.

Results:
In 2007, 223 new patients received cholesterol screening, of whom 111 (50%) were 45 to 64 yrs old, 136 (61%) Hispanic, 50 (22%) Haitian, and 142 (80%) uninsured. Of the 221 new patients, 102 (46%) had an LDL above 129 mg/dL (59 from 130-159, 30 from 160−189, and 13 >189) and 82 (37%) had an HDL below 40 mg/dL for males or 50 for females. An LDL above 129 mg/dL was common across all ages, sexes, and BMIs (
Figure
) and not associated with age (Spearman’s rho=.08, P=.22), BMI (rho=.08, P=.27), or sex (P=.38). Among patients with an LDL above 129 mg/dL, 14 (14%) returned for a screening in 2008 or 2009 and 9 (64%) reduced their LDL by at least 20 mg/dL (6 by >30) though only 2 (14%) increased HDL by at least 5 mg/dL. LDL and BMI reductions were not associated (rho = .10, P=.77).

Conclusions:
Cholesterol screening at fairs in underserved urban communities identified patients with elevated LDL and reduced HDL across all ages, sexes, and BMIs. While few patients returned to a subsequent fair, most who did lowered their LDL substantially without a change in BMI or HDL. This may suggest that referrals to low cost clinics and pharmacotherapy play an important role in the potential of fairs to reduce LDL.

Funding(This research has received full or partial funding support from the American Heart Association, Greater Southeast Affiliate (Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico&Tennessee)
Abstract P345: A Diet-Wide Association Study on Blood Pressure- the INTERMAP Study
Authors: Tzoulaki Ioanna , Patel Chirag J , Stamler Jeremiah , Brown Ian J , Chan Queenie , Butte Atul J , Ioannidis John P , Elliott Paul
Published: July 2021

Background:
Epidemiological studies have examined the relationship between dietary habits and blood pressure. However, studies often test one or only a few factors at a time or examine food patterns (e.g. the Mediterranean diet) not well assessed or defined. Here we use the previously suggested Environmental-wide Association Study (EWAS) paradigm, which evaluates multiple factors concurrently for associations, adjusting for multiplicity of comparisons.

Methods:
We used data from the INTERMAP cross-sectional epidemiological Study with 4680 persons ages 40 to 59 years from 17 random population samples in China, Japan, the United Kingdom, and the United States. BP was measured 8 times at 4 visits; dietary data (83 nutrients) were obtained from 4 standardized, multipass, 24-hour dietary recalls and 2 timed 24-hour urine collections. We examined association between each nutrient and systolic and diastolic blood pressure in separate linear regression models using a random 50% test sample, stratified across centers, of the INTERMAP population. The most significant results were subsequently validated in the remaining 50%. The false discovery rate (FDR), the expected proportion of false positive results among statistically significant hypotheses, was calculated. We considered an examined nutrient as validated when the FDR was 5% in the training set and P-value for association was <0.05 in the validation set.

Results:
In models adjusted for multiple confounders, dietary alcohol and urinary sodium-to-potassium ratio had positive associations and non-heme iron intake, dietary phosphorus, vegetable protein, magnesium, total carbohydrate, pantothenic acid, folacin, thiamin, riboflavin and urinary calcium inverse associations with systolic blood pressure (FDR<5% in training and P<0.05 in validation). With the same set of confounders, dietary alcohol had positive and non-heme iron intake, dietary calcium, phosphorus, protein, thiamin and glutamic acid and urinary potassium and magnesium, inverse associations with diastolic blood pressure (FDR<5% in training and P<0.05 in validation).

Conclusions:
Using the methodology originally proposed for genome-wide association studies studies (GWAS), we replicated previously reported associations between dietary habits and blood pressure, also found some novel associations for B vitamins. As epidemiological studies increasingly collect large amount of data, it is essential to report transparently all analyses, account for multiple tests, and replicate findings.
Abstract P351: White Rice Consumption and Risk of Type 2 Diabetes: A Meta-analysis and Systematic Review
Authors: Hu Emily A , Sun Qi , Pan An , Malik Vasanti
Published: July 2021

Objectives:
To summarize evidence regarding the association between white rice consumption and risk of type 2 diabetes and to quantify the potential dose-response relationship.

Design:
Meta-analysis of prospective cohort studies.

Data Sources:
We searched MEDLINE and EMBASE databases for articles published through July 2011 using keywords that included both rice intake and diabetes. We further searched references of included original studies.

Study Selection:
Prospective cohort studies that reported risk estimates of type 2 diabetes by white rice intake levels were selected for inclusion.

Data Synthesis:
Relative risks were pooled using a fixed-effects model. We also modeled the dose-response relationship utilizing data from all white rice intake categories in each study.

Results:
We identified 4 articles that included 7 distinct prospective cohort analyses for this study. A total of 13,284 incident cases of type 2 diabetes were ascertained among 352,384 participants with follow-up periods ranging from 4 to 22 years. The pooled relative risk (RR) for type 2 diabetes was 1.21 (95% confidence interval [CI], 1.08-1.34) comparing the highest with the lowest category of white rice intake. In addition, the dose-response meta-analysis suggested a linear association between white rice consumption and risk of type 2 diabetes: the RR (95% CI) was 1.10 (1.07, 1.14;
P
<0.001) for each serving/d (∼158 grams for a serving of cooked rice) increased intake of white rice.

Conclusion:
Frequent consumption of white rice is associated with a moderately increased risk of type 2 diabetes. These findings support the recommendation that consumption of white rice should be reduced in place of healthier options such as brown rice and other whole grains to lower risk of diabetes.
Abstract P354: Impact of a Single Mixed Mediterranean-type Meal Compared to a High-Saturated Fat Meal on Postprandial Endothelial Function and Metabolic Markers
Authors: Lacroix Sebastien , DesRosiers Christine , Gayda Mathieu , Nigam Anil
Published: July 2021

Background:
Endothelial dysfunction is considered to be a precursor of atherosclerosis and is an independent predictor of cardiovascular events. A high-saturated fat meal (HFM) has been shown to induce postprandial endothelial dysfunction. However, no studies have evaluated the acute endothelial effect of a single mixed Mediterranean-type meal (MMM). Our objective was to evaluate postprandial endothelial and metabolic function in response to a MMM in comparison to an isocaloric HFM.

Methods:
In this ongoing crossover study, 22 of 28 healthy non-smoking males have completed the research protocol. In random order on two separate days during a 1-week interval, subjects were fed two isocaloric meals after a 12-hour overnight fast. The MMM (885 kcal) consisted of fresh salmon, almonds and vegetables baked in olive oil providing 51% of total calories from fat (7.87g SFA and 2.29g of omega-3, 2:1 DHA:EPA). The HFM consisted of a McDonald's sausage, egg and cheese McMuffin and three hashbrowns (858 kcal) providing 58% of total energy from fat (14.78g SFA and no omega-3). Endothelial function was evaluated by measuring brachial artery flow-mediated dilation (%FMD) at baseline and at two (T2) and four (T4) hours postprandial.

Results:
Mean postprandial %FMD tends to be less impaired following the MMM than the HFM (variation at T4 -0.15±3.6% vs -2.83±3.3% respectively, p<0.1). Postprandial insulin response was less important following the MMM than the HFM (at T2 72.42±94.8% vs 253.89±291.5% respectively, p≤0.1). Postprandial variations of TG and TG/HDL ratio at T4 were also less severe with the MMM than the HFM (p≤0.05). When dividing the subjects on the basis of the median fasting TG levels (0.90 mmol/L), the HFM led to a more severe endothelial impairment in subjects with high (variation in %FMD at T4 -4.36±2.9% p<0.005) vs low fasting TG levels (variation in %FMD at T4 -0.965±2.99%, ns).

Conclusion:
Our data suggest that a single MMM exerts less of a deleterious effect on postprandial endothelial function and metabolic markers than does a HFM. A single MMM could thus be less atherogenic than a HFM. Moreover, subjects with moderate fasting TG levels (avg. 1.54±0.59 mmol/L, well bellow hypertriglyceridemia threshold) could be at higher risk of endothelial injury following a single HFM. Data on all 28 subjects will be available in March 2012.
Abstract P355: Sodium and Potassium 24 Hours Excretion in The Italian Adult Population: Preliminary Results of The MINISAL-GIRCSI Study
Authors: Donfrancesco Chiara , Ippolito Renato , Lo Noce Cinzia , Palmieri Luigi , Iacone Roberto , Russo Ornella , Vanuzzo Diego , Galletti Ferruccio , Giampaoli Simona , Strazzullo Pasquale ,   The MINISAL-GIRCSI Program Study Group
Published: July 2021

Background:
According to the recommendation of the High Level Group of the European Union within the “Gaining health: make healthy choices easy choice” Preventive Program of the Italian Ministry of Health, the agreement with bread makers' associations was signed for the gradual reduction of the salt content in bread. In Italy, information about habitual sodium and potassium intake is scanty. In order to monitor preventive actions of this Preventive Programme the MINISAL-GIRCSI Study is to assess the dietary intake of sodium and potassium in representative samples of the Italian adult population.

Methods:
Baseline data from 12 different random samples collected within the MINISAL-GIRCSI-Health Examination Survey started in 2008, with completed screening and laboratory determinations, were considered: 1196 men and 1231 women aged 35-79 years. Sodium and potassium daily intakes were assessed through 24-hour urine collection using standardized procedures. Determinations of sodium, potassium and creatinine were assessed in a centralized laboratory. Information on habit of adding salt to food and the consumption of high salt content food were collected through a questionnaire.

Results:
Mean of sodium chloride per day resulted 11 g in men and 8 g in women with a range of 1-27 g and 2-27 g respectively. Mean of potassium chloride per day resulted 5 g in men and 4 g in women with a range of 1-13 g and 1-9 g respectively. Mean of creatinine per day resulted 1463 mg in men and 942 mg in women. Mean of urine volume per day resulted 1861 ml in men and 1827 ml in women. In both men and women, higher intake of sodium chloride was found in Southern regions; no geographical differences were found for potassium chloride. Sodium and potassium chloride excretions were not found higher with increasing age. Most of persons (72%) eat three slices of bread per day and 22% eat cheese and processed meat more than 4 times per week. Thirteen percent of persons usually add salt during meals and 19% are usually thirsty after meals.

Conclusions:
Preliminary results show that Italian adult population take more than double of WHO recommended salt intake; this is typical in industrialized countries. Further analyses considering data from other Italian regions are needed to confirm these values. The prevention actions at population level should include recommendations for reducing salt intake.
Abstract P362: Validation of a Simple Method to Estimate Populational 24-h Urinary Sodium Excretion Based on a Casual Urine Specimen in an Adult Danish Population
Authors: Toft Ulla , Cerquira Charlotte , Jørgensen Torben
Published: July 2021

Background:
Tanaka et al (J Hum Hypert 2002; 16: 97-103) developed a simple method to estimate populational 24-h urinary sodium excretion using a casual urine specimen. However, this method was developed and validated in a Japanese population and thus this method might not be valid in populations that differ markedly from this population.

Hypothesis:
We assessed the hypothesis that the 24 hour urinary sodium excretion can be estimated from a casual spot urine using the Tanaka prediction method in a Danish general population.

Methods:
Overall 473 Danish individuals provided both a 24h urine collection and a spot urine sample. Data were collected in the Danthyr study (248 women aged 25-30 years and 60-65 years) and the Inter99 study (102 men and 113 women aged 30-60 years), respectively. Only participants with complete 24h urine collection (validated by the PABA method) were included. We compared the estimated daily sodium excretion through 24h urine (the gold standard) with the predicted 24 h sodium excretion from a causal urine specimen, using the Tanaka prediction method.

Results:
The predicted median 24 h sodium excretion (median [5 and 95 percentile]) was 8.6 gram [3.7;17.5] compared with a median measured 24 h sodium excretion of 8.9 [5.4; 13:1]. The mean (sd) residual (measured minus predicted 24 h sodium excretion) was 0.08 (3.7). The correlation (Spearman) between predicted and measured 24 h sodium excretion was 0.39 and the R
2
was 0.17. The proportion of individuals classified in the same or adjacent quintiles was 67%. Gross misclassification was found for 3% of the individuals. However, a Bland-Altman plot indicated a tendency of underestimation the sodium excretion for individuals with a high level of sodium excretion (>14 g per day).

Conclusion:
The Tanaka prediction model gives a reasonable estimate of sodium intake in a Danish population using casual spot urines. However, the validation study showed a tendency of underestimation of the sodium intake for individuals with a high sodium excretion (>14 g per day).
Abstract P372: Association of Pre-pregnancy Body Mass Index with Stroke and Coronary Heart Disease Mortality
Authors: Mongraw-Chaffin Morgana L , Bennett Wendy L
Published: July 2021

Background:
Few studies have investigated the relationship between body mass index (BMI) measured before middle age and cardiovascular disease mortality in women. We hypothesized that higher pre-pregnancy BMI would be associated with increased stroke and coronary heart disease (CHD) mortality.

Methods:
We conducted a retrospective cohort study using the Child Health and Development Studies cohort of 10,889 women enrolled between 1959 and 1967 at the time of pregnancy diagnosis. Stroke and CHD death were assessed annually by matching study participants to the California Department of Motor Vehicles and the California Vital Status Records. We calculated pre-pregnancy BMI using self-reported pre-pregnancy weight and height measured at enrollment. Self-reported weights were similar to weights measured at the first visit. Covariates included age, race/ethnicity, education, total family income, smoking status, parity, and co-morbid conditions such as chronic hypertension, pre-pregnancy diabetes, and kidney disease. We used parametric survival analysis to calculate hazard ratios for stroke and CHD death for each BMI category.

Results:
At enrollment, mean age was 26.9 years, 66% (7190 of 10,889) were Caucasian, and 24% (2632 of 10,889) were African American. During a mean follow-up of 28.5 years, 1518 participants died. Among these, 79 participants died from stroke and 205 from CHD. Classified by pre-pregnancy BMI, 1008 women had a BMI <18.5, 8406 had a BMI 18.5-24.9, 1143 had a BMI 25-29.9, and 332 had a BMI ≥ 30. With increasing BMI, participants had higher prevalence of pre-pregnancy co-morbid conditions, higher age and parity, and lower family income. In adjusted models, higher pre-pregnancy BMI was associated with increased stroke and CHD risk compared to normal BMI (
Table 1
).

Conclusion:
We identified an association between pre-pregnancy BMI and cardiovascular mortality. Pregnancy may offer an opportunity to promote behavior change in women with elevated BMI to reduce later life risk for cardiovascular disease.

Table 1.

Adjusted hazard ratios for stroke and CHD mortality by pre-pregnancy BMI

BMI Category
Stroke
Coronary Heart Disease

<18.5
1.33 (0.57, 3.13)
0.91 (0.48, 1.75)

18.5 - 24.9
1.0 (REF)
1.0 (REF)

25.0 - 29.9
1.75 (0.97, 3.14)
2.20 (1.53, 3.16)

≥ 30.0
3.61 (1.69, 7.69)
4.35 (2.70, 7.01)
Abstract P375: Vitamin D Deficiency is Associated with Hypertriglyceridemic Waist Phenotype
Authors: Shenoy Maithili , Tuliani Tushar , Veeranna Vikas , Zalawadiya Sandip , Patel Krunal H. , Afonso Luis
Published: July 2021

Introduction:
Hypertriglyceridemic waist phenotype (TGW) is a clinical indicator of visceral obesity. Studies have shown that TGW predicts adverse cardiovascular outcomes. Vitamin D (Vit D) deficiency is a novel and reversible nutritional risk factor for metabolic syndrome and cardiovascular disease. This is the first study of its kind, looking at whether Vit D deficiency predicted TGW.

Methods:
We did a post-hoc analysis of 2301 subjects from the National Health and Nutrition Examination Survey III (1988-1994). Patients without Vit D, waist circumference (WC) and serum triglycerides (TG) measurements were excluded. TGW was defined as WC ≤85 cm and 90 cm and TG ≤1.5 mmol/l (132 mg/dl) and 2 mmol/l (177 mg/dl) in females and males respectively. Subjects were divided into equal quartiles based on serum vit D levels. Stata 11 was used to perform chi-square test for categorical variables, t-test for continuous variables and univariate and step-wise multivariate logistic and linear regression.

Results:
Out of 2301 subjects, 35% (798) met the definition of TGW. Patients with TGW were older (61±12 vs. 60±13 yrs, p 0.01), males (43% vs. 56%, p<0.001), dyslipidemic (58% vs. 42%, p<0.001), diabetic (17% vs. 10%, p<0.001), hypertensive (63% vs. 51%, p<0.001) and had lower serum vit D levels (22.1±8.7 vs. 23.2±9.2, p 0.008). Vit D level was negatively associated with TGW (coef -0.024, CI -0.036 to -0.013, p<0.001). Patients having serum vit D level >28 ng/ml (highest quartile) were significantly less likely to have TGW than patients having vit D level <17 ng/ml (lowest quartile) after adjusting for age, sex, race, GFR, calcium, parathyroid hormone, hypertension, hypertension medications, hyperlipidemia, hyperlipidemia medications, diabetes, end stage renal disease and hemodialysis (OR 0.56, CI 0.42-0.75, p<0.001).

Conclusion:
Vit D deficiency is an independent predictor of TGW. Randomized controlled trials are needed to determine whether supplementation will improve cardiovascular outcomes.

Table 1.

Vitamin D Quartile Q1 (<17 ng/ml) reference category
Odds ratio
95% CI
P value

Q2 (17-22)
0.84
0.65 to 1.09
0.19

Q3 (23-28)
0.63
0.48 to 0.83
0.001

Q4 (>28)
0.56
0.42 to 0.75
<0.001
Abstract P376: Cardiometabolic Abnormalities, Systemic Inflammation, and Oxidative Stress in Children
Authors: Frisbee Stephanie J , Frisbee Jefferson C , Ducatman Alan
Published: July 2021

The increasing prevalence of childhood obesity has been well documented & is predictive of increased severity in obesity-related CVD risk factors & metabolic disorders, such as systemic inflammation & oxidative stress. While the poor long-term vascular consequences of these conditions are better understood in adults, the consequences of these obesity-associated metabolic disturbances are less studied in children. This study utilized the 12,476 children (<18 years) enrolled in the C8 Health Project, which resulted from the pretrial settlement of a class action lawsuit pursuant to contamination of the drinking water supply; we have recently published a complete description of this study (Frisbee et al, 2009). The current analysis used the large sample size available from this study to determine the severity of chronic inflammation & oxidative stress associated with cardiometabolic abnormalities, including obesity, dyslipidemia, & hyperglycemia, present either singly or in combination, in children. In this population, median age was 11.6 years, 48% were female, 40% were overweight or obese (OWT-OB; BMI≥85th percentile), 2% had glucose ≥126 mg/dL (HypGly), & 34% had total cholesterol ≥170 mg/dL or LDL cholesterol ≥110 mg/dL (DysLip), Additionally, median CRP, a biomarker of systemic inflammation, was 0.4 mg/L with 16% having CRP≥2 mg/L, & median GGT, a biomarker of oxidative stress, was 12.0 IU/L with 1.7% having GGT≥35 IU/L. In univariate analysis: CRP & GGT were statistically significantly higher in participants with OWT-OB; GGT but not CRP was higher in children with HypGly or DysLip; & both CRP & GGT were higher in children with any cardiometabolic abnormality. In linear regression analysis controlling for age, gender, SES (household income), a regular exercise program, & while simultaneously considering OWT-OB, HypGly, & DysLip: OWT-OB statistically significantly predicted CRP (b-coefficient±SE/adj R-square; 1.0±0.1/1.4%) though HypGly & DysLip were not, ceteris paribus, associated with CRP; OWT-OB (3.5±0.2/16.6%), HypGly (1.2±0.6/16.6%), & DysLip (2.1±0.2/16.6%) were all simultaneously predictive of GGT. In logistic regression analysis controlling for the same covariates & also simultaneously considering the same cardiometabolic abnormalities: OWT-OB (OR (95%CI); 3.8 (3.4-4.4)) & DysLip (1.2 (1.0=1.3)) but not HypGly increased the risk for CRP≥2 mg/L; similarly, OWT-OB (5.6 (3.5-8.7)) & DysLip (3.4 (2.3-5.0)) but not HypGly were associated with increased for oxidative stress (GGT≥35 IU/L). This study suggests that different cardiometabolic abnormalities have different associations with systemic inflammation & oxidative stress; obesity & dyslipidemia rather than hyperglycemia are more strongly associated with systemic inflammation & oxidative stress in children. Futher study is needed to elucidate gender & age-related differences in these associations.
Abstract P379: Adiposity Tracking and Its Heritability: A Longitudinal Study of Rural Chinese Children and Adolescents
Authors: Arguelles Lester M , Ouyang Fengxiu , Xu Xiping , Wang Xiaobin
Published: July 2021

Objectives:
Examine adiposity tracking and estimate its heritability in a large prospective cohort of pre-pubertal and pubertal rural Chinese children.

Methods:
This report included 1317 children and adolescents from the Anqing region of China, aged 6 to 18 years at baseline, who also completed follow-up visit 6 years later. Anthropometric measures included body mass index (BMI), waist circumference (WC), total body fat (TBF), percent body fat (%BF), trunk fat (TRF), and percent trunk fat (%TRF). Adiposity measures were obtained by dual-energy X-ray absorptiometry (DEXA). Locally weighted nonparametric smoothing function (SAS LOESS, SAS Institute, Cary, NC, USA) were used to describe (1) “tracking” of adiposity measurements from baseline to 6-year follow-up, and (2) gender differences in the growth of adiposity measurements across age. Structural equation modeling was used to estimate the heritability of tracking using the software Mx.

Results:
All anthropometric measures, except for %TRF, tracked significantly from baseline to follow-up in both genders. The middle baseline tertile, in general, had the lowest degree of tracking. Subjects in a high baseline tertile for BMI, TBF, %TBF, WC, and TRF were significantly more likely to be in the high tertile of TBF, %TBF, TRF at the follow-up. There was no good predictor for %TRF. Gender and pubertal status did not affect tracking, for TBF in females, and WC in the older age-group. The genetic correlation of BMI=0.60 (0.46-0.72); TBF=0.43 (0.29-0.55); %TBF=0.37 (0.23-0.50); WC=0.35 (0.11-0.56); TR=0.41 (0.27-0.54); and %TR=0.33 (0.07-0.59).

Conclusion:
The strong tracking of adiposity measures in this pediatric population underscores the importance of closely monitoring individuals with high BMI or adiposity over time; those in the medium tertile should also be monitored for upward trend due to their “mobility”. Only BMI showed a strong genetic correlation between baseline and followup, suggesting that environmental changes can influence adiposity depots. Our data raises the possibility that individuals at risk of adult obesity can be identified at early age so that early intervention can be initiated to prevent or mitigate obesity and related complications.
Abstract P388: Trends in Socioeconomic Disparities in Ideal Cardiovascular Health: NHANES 1999–2006
Authors: Allen Norrina B , Ning Hongyan , Lloyd-Jones Donald
Published: July 2021

Background:
Socioeconomic status (SES) has been shown to be associated with many cardiovascular (CV) risk factors. Prior studies have identified differences by SES, but have not summarized trends in these disparities across multiple SES subgroups, which could allow us to assess the extent to which we are achieving disparity-related goals.

Methods:
We used NHANES Surveys from cycles 1999–2000, 2001–2002, 2003–2004, and 2005–2006 to examine the age-adjusted prevalence of ideal levels of CV health components by SES. Ideal levels of BMI, cholesterol, glucose, blood pressure, diet, physical activity and smoking were defined according to the AHA 2020 strategic goals. SES was defined by poverty: income ratio and categorized as <1.00, 1.00-2.99, and 3.00+. Both absolute (Absolute Concentration Index- ACI) and relative measures (Relative Concentration Index -RCI) of disparities were calculated, all calculations were weighted by population share. The percentage change in disparities relative to 1999–2000 was examined.

Results:
Age-adjusted rates of ideal CV health components and the percentage change from 1999–2006 varied by SES (see Table). Among women, disparities in the prevalence rates of ideal levels of CV risk factors have increased between SES groups from 1999 through 2006. Among men, disparities in blood pressure (ACI=503%, RCI=477%) and diet (ACI=405%, RCI=143%) have increased most dramatically. More moderate increases were seen in disparities in smoking and cholesterol for men. Disparities in BMI and physical activity remained relatively constant among men throughout the study period. Findings were generally similar for both absolute and relative measures of disparities.

Conclusions:
Representative national data on these summary measures of disparities suggest that disparities between SES groups have increased among men. Understanding the issues underlying these increasing disparities and addressing them will be critical to improving the cardiovascular health of all Americans by 2020 and beyond.
Abstract P393: Recent Decrease in Ischemic Stroke Mortality in the Netherlands Not Explained by Changes in Incidence
Authors: Vaartjes Ilonca , O'Flaherty Martin , Capewell Simon , Bots Michiel
Published: July 2021

Background:
The decline in ischemic stroke (IS) mortality in the Netherlands briefly slowed in the 1990s, but then accelerated in the new millennium. IS mortality reflects case fatality, secondary prevention and, crucially, IS incidence. In the present study we determined nationwide IS incidence from 1997 to 2005.

Methods:
Out-of-hospital deaths for IS were identified in the national cause of death register using ICD-10 codes I63 and I64. First hospitalized IS patients were identified through linkage of the national hospital discharge register and the population register (using ICD-9 codes 434 and 436). We calculated age-sex specific incidence rates and age standardized incidence rates for every year. We identified trends in time series using Mann-Kendall tests.

Results:
Between 1997 and 2005, we identified 173,293 new IS cases (45% men). Twenty-six percent were out-of-hospital deaths. Age standardized incidence rates increased significantly between 1997 and 2005, from 111 to 119 per 100,000 in 2005 in men, and from 90 to 105 per 100,000 in women (fig 1).

Conclusions:
Ischemic stroke mortality rapidly declined in the new millennium. This decline however cannot be explained by changes in the incidence of IS which remained stable or even increased between 1997 and 2005. More detailed analysis of trends in case fatality and secondary prevention after IS is therefore needed to examine the welcome decline in IS mortality. However, the increasing trends in IS incidence are worrisome. Recent trends in cardiovascular risk factors should be urgently investigated.
Abstract 031: Predictors and Cardiovascular Outcomes Associated with ECG-Evident Left Ventricular Hypertrophy in a Large Population
Authors: Iribarren Carlos , Round Alfred D , Lu Meng , Okin Peter M , McNulty Edward J
Published: July 2021

Left ventricular hypertrophy that is evident on the electrocardiogram (ECG LVH) is a common condition affecting 1-5% of the general population and up to one third of patients with hypertension. However, there have been no studies examining the prevalence, correlates and associated cardiovascular disease (CVD) outcomes associated with ECG LVH in a very large and ethnically diverse population. In this study, we aimed to determine the prevalence of ECG LVH, its demographic and clinical correlates as well as its association with longitudinal CVD outcomes among members of Kaiser Permanente of Northern California. We performed a retrospective observational cohort study using an existing database of randomly selected, single ECGs taken on 1.4 million persons over age 30 as part of routine medical care between 1995 and 2009. We linked the index ECG data with other health plan databases, including hospitalizations and vital status through 8/31/12. The total accumulated follow-up time was 9.8 million person-years. ECG LVH was defined by sex-specific Cornell voltage Criteria (for men: S in V3 plus R in aVL >2.8 mV [28 mm]; for women: S in V3 + R in aVL >2.0 mV [20 mm] derived by processing raw ECG measurements from these two leads. The overall prevalence of ECG LVH was 5.1% (71,745 / 1,398,524), it was higher among women (7.4%; 55,296 / 743,466) than in men (2.5%; 16,449 / 655,058); in blacks (10%; 11,258 / 112,230) compared to whites (4.9%; 37,692 / 763,445), Asians (4.6%; 7,014 / 153,780) and Latinos (4.3%; 7,253 / 168,686); in persons over age 65 (9.3 %; 37,071 / 398,666) and in patients with a history of hypertension (9.2%; 46,415 / 502,462). In Cox regression, after excluding persons with prior cardiovascular events and after adjusting for age, gender, race/ethnicity, smoking status, obesity, diabetes, hypertension and hyperlipidemia, ECG LVH was independently associated with subsequent acute coronary syndrome (n=38,239; HR [hazard ratio]=1.66; 95% CI 1.60 to 1.73), cardiac arrest (n=12,144; HR=2.02; 95% CI 1.90 to 2.14), total stroke (n=49,518; HR=1.67; 95% CI 1.62 to 1.72), heart failure (n=47,294; HR=2.43; 95% CI, 2.37 to 2.50) and all cause-mortality (n=127,036; HR=1.78; 95% CI, 1.74 to 1.81). In conclusion ECG LVH is a relatively common ECG finding and a robust independent predictor of cardiovascular events and all-cause mortality in the largest population yet examined.
Abstract 038: Association of 20-Year Changes in Cardiorespiratory Fitness with Incident Dyslipidemia Between Years 20 and 25 in the CARDIA Fitness Study
Authors: Sarzynski Mark A , Sternfeld Barbara , Carnethon Mercedes R , Sidney Stephen , Quesenberry Charles P , Haskell William L , Jacobs David R , Lewis Cora E , Schreiner Pamela J , Williams O. D
Published: July 2021

Cardiorespiratory fitness levels are inversely associated with plasma levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) and directly associated with high-density lipoprotein cholesterol (HDL-C) levels. However, few population-based studies have examined the association of fitness or changes in fitness on the risk of developing dyslipidemias.

PURPOSE:
To test the association of fitness at age 18-30 years with 25-year incidence of dyslipidemias, and to test the association of fitness changes over 20 years on the development of dyslipidemias in adults aged 43-55 years.

METHODS:
Fitness was determined based on the duration of a symptom-limited graded exercise treadmill test (modified Balke protocol) at baseline and Year 20 in Black and White men and women from the Coronary Artery Risk Development in young Adults (CARDIA) study. Lipid measurements were taken from fasting samples at baseline and years 5, 7, 10, 15, 20, and 25. Dyslipidemias were defined as: low HDL-C = <40 mg/dl, high TG = ≥200 mg/dl, and high LDL-C = ≥160 mg/dl (or self-reported use of lipid lowering medication). Cox proportional hazards regression models were used to test the association of baseline fitness with the incidence of dyslipidemias over 25 years (N ~4,000) in participants who did not have dyslipidemia at baseline. ANOVA modeling was used to test whether the mean 20-year changes in fitness differed between participants who developed incident dyslipidemia at Year 25 and those who did not (N= 2504).

RESULTS:
The 25-year incidence per 1000 person-years was 13.4 (N=1,096) for low HDL-C, 7.6 (N=711) for high TG, and 6.4 (N=569) for high LDL-C. Baseline fitness (SD 2.8 min) was inversely associated with 25-year incidence of low HDL-C (hazard ratio (HR): 0.94; 95% CI: 0.91 to 0.97 per SD in baseline fitness), high TG (HR: 0.90; 95% CI: 0.87 to 0.94 per SD), and high LDL-C (HR: 0.93; 95% CI: 0.89 to 0.97 per SD) in models that adjusted for age, sex, race, center, baseline BMI, and weight change and smoking status at time of event. After adjustment for age, sex, race, center, weight change, baseline treadmill time and BMI, participants who developed low HDL-C, high TG, and high LDL-C between Years 20 and 25 experienced larger 20-year declines in fitness than those who did not: (results shown as 20-year change in fitness in participants experiencing incident dyslipidemia at Year 25 vs participants who were normolipidemic at both time points) HDL-C: -3.1 vs -2.7 min, P=0.03; TG: -3.1 vs -2.8 min, P=0.004; LDL-C: -3.1 vs -2.8 min, P=0.04.

CONCLUSIONS:
Low fitness in young adults and larger decreases in fitness with aging are associated with the incidence of dyslipidemias.
Abstract 056: Normative Accelerometer-determined Steps/day from 6-85 Years of Age: NHANES 2005-2006
Authors: Tudor-Locke Catrine , Schuna John M , Barreira Tiago V , Mire Emily F , Broyles Stephanie T , Katzmarzyk Peter T , Johnson William D
Published: July 2021

Introduction:
Reference values used to interpret objectively monitored ambulatory activity (steps/day) represent summarized data collected with different instruments and protocols and aggregated across typically small, select, and disparate samples (e.g., sex composition and age groupings). A full distribution of nationally representative normative data presented by sex-age year collected using a single instrument and a standardized protocol is preferred. The purpose of this analysis of the 2005-2006 National Health and Nutrition Examination Survey (NHANES) accelerometer data is to provide smoothed (i.e., using LMS curve analyses) sex-age rankings from 6-85 years of age.

Hypothesis:
We hypothesized that, across the lifespan, accelerometer-determined steps/day would be 1) higher in males than females; and 2) lower with higher ages.

Methods:
Objectively monitored steps/day were measured using the ActiGraph accelerometer (model 7164) worn for 7 consecutive days. The analysis sample was comprised of 6,354 (51.8% female) individuals with valid accelerometer data (≤1 days with ≤10 monitored hours). Percentile values (25
th
, 50
th
, 75
th
, 95
th
) were computed for each single-year age by sex using the LMS method (LMS Chartmaker Pro Version 2.3). To avoid artificially creating sex/age differences through modeling procedures, the L, M and S parameters were chosen using the entire sample then applied to males and females separately to create the curves. Apparent differences by sex and age were noted.

Results:
LMS curves for steps/day percentile values are presented in the Figure. Steps/day were higher for males than females at every age. A distinct pattern of incrementally reduced steps/day was apparent with higher age across the lifespan.

Conclusions:
Sex and age are apparent modifiers of steps/day. These normative accelerometer-determined steps/day values can be used for multiple purposes including screening, program development and evaluation, comparison between populations, and tracking change.