bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P242: Carotid Plaque Characterization, Stenosis, and Intima-media Thickness According to Age and Gender in a Large Registry Cohort
Authors: Boulos Nancy M , Gardin Julius M , Malik Shaista , Postley John , Wong Nathan D
Published: July 2021

Background:
Carotid intima-media thickness (CIMT) is a well-established predictor of cardiovascular disease events. Not well described, however, is the prevalence of plaque and stenosis severity and how this varies according to extent of CIMT, age, and gender.

Methods:
We evaluated the extent of carotid plaque and stenosis severity according to CIMT, age and gender in a large CIMT screening registry. We studied 9347 women and 12676 men (n=22,023) who received carotid ultrasound scans. The presence and severity of both carotid plaque and stenosis was compared according to extent of CIMT (
>
1 mm vs. <1 mm), age, and gender using the Chi-square test of proportions.

Results:
Among those aged <45 to
>
80 years the prevalence of CIMT
>
1 mm ranged from 0.13 to 29.3% in women and 0.6 to 40.1% in men, stenosis >50% from 0.1% to 14.9% in women and 0.1% to 13.2% in men, and mixed/soft plaque from 7.1% to 66.5% in women and 9.2% to 65.8% in men (all p<0.001 across age). While 6.6% of women and 8.5% of men with CIMT <1mm had >30% stenosis, this increased to 48.6% and 46.0%, respectively, in those with CIMT
>
1 mm. Even when CIMT levels were <1 mm, >30% of persons demonstrated mixed or soft plaque. Of those with CIMT
>
1mm, more than 70% had such mixed or soft plaque (Figure) and over 40% demonstrated stenoses of 30% or greater.

Conclusions:
We describe in a large CIMT registry study a substantial age-related increase in both men and women of CIMT, plaque presence and severity, as well as stenosis. Even in those with normal CIMT, mixed or soft plaque potentially prone to rupture was common, demonstrating the value in assessing for plaque when doing carotid ultrasound.
Abstract P243: Sugar-sweetened Beverage Consumption is Not Associated with Calcified Atherosclerotic Plaques in the Coronary Arteries: The NHLBI Family Heart Study
Authors: Patel Yash R , Imran Tasnim F , Ellison R C , Heiss Geraldo , Hunt Steven C , Carr J J , Arnett Donna K , Pankow James S , Gaziano J M , Djousse Luc
Published: July 2021

Background:
Sugar-sweetened beverage (SSB) intake is associated with higher risk of weight gain, diabetes, hypertension, cardiovascular disease and cardiovascular mortality. However, the association of SSB with subclinical atherosclerosis in the general population is unknown.

Hypothesis:
Our primary hypothesis is that higher intake of SSB is associated with a higher prevalence of atherosclerotic plaque in coronary arteries in NHLBI Family Heart Study.

Methods:
In a cross-sectional design, we studied 1990 participants of the NHLBI Family Heart Study without known coronary heart disease. SSB was assessed through a semi-quantitative food frequency questionnaire by asking how often participants consumed 1 glass of regular soda, diet soda, and fruit punch/kool-aid. Coronary-artery calcium (CAC) was measured by cardiac CT. We defined prevalent CAC using an Agatston score of at least 100 and used generalized estimating equations to calculate adjusted prevalence ratios of CAC in SAS 9.3 software.

Results:
Mean age and BMI were 55.0 years and 29.5 kg/m2 respectively, and 60% were female. In adjusted analysis for age, sex, BMI, smoking, alcohol use, physical activity, total calories, and field center, higher SSB consumption was not associated with higher prevalence of CAC (Table1). In a sensitivity analysis, there was no evidence of association between SSB and prevalent CAC when CAC cut points of 0, 50, 150, 200, and 300 were used.

Conclusions:
These data do not provide evidence for an association between SSB consumption and prevalent CAC in adult men and women.
Abstract P244: Participation in a Community-based, Family-focused Lifestyle Intervention Improves the Home Food Environment: Athletes for Life Preliminary Findings
Authors: Vega-López Sonia , Ghan Emily , Todd Michael , Bruening Meg , Crespo Noe C
Published: July 2021

It is known that availability of food in the home influences dietary behaviors; however, few studies have assessed the effects of lifestyle behavioral interventions on the home food environment (HFE). We hypothesized that participation in Athletes for Life (AFL), a family-oriented lifestyle intervention for cardiometabolic disease prevention, would result in favorable changes in the home food environment of families with children aged 6-11 years. AFL is a 12-week community-based, family-focused behavioral intervention delivered at a community center located in an ethnically-diverse, underserved community within a Southwestern metropolitan area. Participants attend 90-minute sessions, twice per week. For children, AFL includes diverse activities aimed at improving fitness and sport skills. Parents participate in a physical activity session for 45 minutes followed by a 45-minute behavior change program focusing on strategies for diet improvement through increasing fruit and vegetable consumption and reducing sugar intake. Parent-child dyads (n=33) were randomized to an immediate AFL intervention or a wait-list control group. Of those, 26 consented to a home visit to assess the HFE and were included in this analysis (intervention n=13; control n=13). The HFE was assessed in both groups at baseline and again after 12 weeks using a modified version of the Home Food Inventory that focused on home availability and variety (measured as number of different items) of fruits, vegetables, and sugar-containing foods including sugar-sweetened beverages, prepared desserts, candy, and breakfast cereals. Intervention effects on home food availability were assessed using Poisson mixed model regressions controlling for days since the last food-shopping trip and household size. At baseline, intervention and control households had comparable home food environments. Relative to the control group, the intervention households had statistically greater increases in the number of vegetable items (+3.88±0.85 items vs. +0.08±0.63 items; p
Time*Group
=0.015) and WIC-approved breakfast cereal items (1.16±0.31 items vs. 0.00±0.28 items; p
Time*Group
=0.033). Changes related to home availability of fruit, prepared desserts, sugar sweetened beverages, candy, and non WIC-approved breakfast cereals were small and of comparable magnitude between groups (n.s.). These results suggest that AFL was successful in eliciting small but significant changes in the HFE, which could positively influence dietary intake among participants. Future assessments of how home food availability affects dietary intake and cardiometabolic disease risk are warranted.
Abstract P246: Influence of Latin Dance on Physical Activity Among Community Dwelling Older Latino Adults
Authors: Vasquez Priscilla , Aguinaga Susan , Wilson Robert S , Fogg Louis F , Wilbur JoEllen , Hughes Susan L , Marquez David X
Published: July 2021

Background:
The American Heart Association’s 2020 goals target seven key risk factors including physical activity (PA) which can reduce risk for cardiovascular disease. Older Hispanic/Latino individuals are usually not physically active at recommended levels. Dance is a culturally appropriate form of PA for older Latinos and physically challenges individuals to engage in this activity.

Objective:
To test the impact of a dance program, BAILAMOS©, on lifestyle PA.

Methods:
Participants from a pilot clinical trial (N=57) were randomly assigned to a 4-month twice-weekly dance program or a weekly health education (control group). They completed the CHAMPS PA questionnaire to assess leisure activity and also engaged in a 400 meter walk test pre- and post-program.

Results:
Participants were low active, older [
M
(
SD
) age= 64.9 (5.9)], Spanish-speaking [81.8% Mexican, years in US= 31.2 (16.8), years of education = 7.0 (4.3)], majority were female [81.8%], and there were no statistically significant differences between groups. There was a main effect for time in minutes of light, moderate, and vigorous leisure physical activity (LMVLPA) per week F(5.2)= p<.05. The dance group reported 650.56 (472.54) minutes of LMVLPA at baseline and reported 817.78 (529.37) minutes of LMVLPA at post-testing. The health education group reported 522.78 (368.57) minutes of LMVLPA at baseline and reported 628.89 (387.46) minutes of LMVLPA at post-testing. A repeated measures ANOVA revealed a main effect for time F(9.25) = p<.05 for the 400 meter walk test. Dance participants completed the walk in 429.90 (66.28) seconds at baseline and 391.83 (58.80) seconds at post-testing. Health education participants completed the walk in 419.25 (93.78) seconds at baseline and 409.10 (74.31) seconds at post-testing.

Conclusion:
A culturally appropriate dance intervention is a viable approach for older Hispanic/Latino individuals to engage and increase PA, and it is possible that participation in regular dancing can improve physical function, such as walking.
Abstract P254: Genetic Risk Score for Height and the Incidence of Venous Thromboembolism: A Prospective Study
Authors: Roetker Nicholas S , Pankow James S , Lutsey Pamela L , Tang Weihong , Rosenberg Michael A , Heckbert Susan R , Cushman Mary , Folsom Aaron R
Published: July 2021

Introduction:
Several observational studies have shown that taller body height is associated with greater risk of venous thromboembolism (VTE), but it is not known whether the association is causal. We used instrumental variable analysis (Mendelian randomization) to explore the causal relationship between height and VTE using a genetic risk score (GRS) for height as the instrument.

Hypothesis:
There is a causal relationship between taller standing height and greater risk of VTE, as demonstrated by a Mendelian randomization approach.

Methods:
We created a weighted GRS for height in white men and women in the Longitudinal Investigation of Thromboembolism Etiology [consisting of two longitudinal cohort studies: Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS)] using 668 single nucleotide polymorphisms from a recently published meta-analysis. Incident hospitalized VTE events were identified and verified by physician review of medical records. We estimated the association and causal risk differences (RD) and 95% confidence intervals (CI) for VTE incidence per standard deviation (SD) increment in height (9.4 cm). The association models were adjusted for age, sex, waist circumference, and study site.

Results:
There were 9,137 ARIC and 3,163 CHS participants at risk for VTE at baseline and with genetic data, and they experienced 367 (ARIC) and 105 (CHS) incident VTE events over a median 22.7 and 11.8 years of follow-up, respectively. Baseline age ranges were 45-64 and 65-98 years and mean heights were 169 and 165 cm in ARIC and CHS, respectively. The GRS was a strong instrument for height (R
2
=0.08 in ARIC and R
2
=0.07 in CHS) and had little to no correlation with other measured VTE risk factors (all R
2
≤0.01). In ARIC, taller height was associated with greater risk of VTE [association VTE RD: 1.0% per SD in height (95% CI: 0.3 to 1.6%)]. The causal RD had the same magnitude as the association RD, but did not quite reach statistical significance [causal VTE RD per SD in height: 1.1% (95% CI: -0.3 to 2.5%)]. Predicted risks of VTE at the 10th and 90th percentiles of height (157 and 181 cm) were 2.6% and 5.4%, respectively, representing more than a doubling of risk. There was no association between height and VTE risk in CHS [association VTE RD per SD in height: 0.1% (95% CI: -1.0 to 1.2%); causal VTE RD per SD in height: -0.3% (95% CI: -2.5 to 1.9%)].

Conclusion:
Taller height was associated with greater VTE risk with some supporting causal evidence in middle-aged adults from ARIC, but there was no relation between height and VTE in older adults from CHS. Future studies should further explore the causal relation between height and VTE among different age groups.
Abstract P264: Association of D-dimer with Incident Cardiovascular Disease Events and F3 Gene Variants in African Americans: Results From the Jackson Heart Study
Authors: Raffield Laura M , Tracy Russell P , Duan Qing , Durda Peter , Wilson James G , Lange Ethan M , Lange Leslie A , Reiner Alex P
Published: July 2021

Plasma D-dimer, a fibrin degradation product, is a biomarker of both coagulation and fibrinolysis and a risk factor for both arterial and venous thrombosis. African Americans (AAs) have increased risk of thrombosis and higher levels of D-dimer as compared to European populations, but little is known about the genetic architecture of D-dimer in AAs. D-dimer was assessed in 4163 AAs from the Jackson Heart Study (mean age 55 years, 62.1% female). We hypothesized that D-dimer levels would associate with incident cardiovascular disease events and with both coding and noncoding genetic variants. Median (interquartile range) D-dimer in the cohort was 0.40 (0.26-0.64) μg/ml. D-dimer was associated with increased risk of coronary heart disease (hazard ratio (HR) per standard deviation (SD)=1.26, p=0.012), stroke (HR=1.27, p=0.018), heart failure (HR=1.33, p=0.001), and mortality (HR=1.25, p<0.0001) in models adjusted for age, sex, BMI, current smoking, diabetes, hypertension, systolic blood pressure, and low-density lipoprotein cholesterol. Using data from the Affymetrix Genome-Wide Human SNP Array 6.0, imputation based on the 1000 Genomes project reference panel (Phase I, Version 3, March 2012 release) was completed using MACH 1.0 and minimac in 2709 participants with D-dimer. Associations were assessed using MACH2QTL v.1.13, with models adjusted for age, sex, and the first ten principal components for global ancestry calculated using EIGENSOFT. The most significant signal was for an intergenic locus near
F3
(top variant rs2022030, p=5.71x10
-12
, minor allele frequency=10.6%, imputation r
2
=1).
F3
codes for tissue factor, a necessary co-factor for factor VIIa in the initiation of the extrinsic blood coagulation pathway. The
F3
locus had been previously associated with D-dimer levels in European populations but has not been reported for AAs. Data were also available from the Illumina HumanExome Beadchip, version 1.1, in 2502 individuals; single variant analyses and gene-based tests for nonsynonymous, splicing, and nonsense variants with a minor allele frequency <5% were performed using RAREMETAL, adjusted for age, sex, and the first ten principal components. For single variant analyses, a nonsynonymous variant in
GPRASP1
(G protein-coupled receptor associated sorting protein 1, rs145805077, p= 1.84x10
-7
, minor allele frequency=0.3%) was significantly associated with decreased D-dimer. No gene-based test result met the strict multiple comparison significance threshold; the top gene-based result with the sequence kernel association test (SKAT) was for six variants in
PPM1M
(protein phosphatase, Mg2+/Mn2+ dependent, 1M, p=6.09x10
-6
). These results highlight D-dimer as an important predictor of cardiovascular disease risk in AAs and that levels of this biomarker are associated with the
F3
locus.
Abstract P284: Role of a Genetic Risk Score with Dietary Intake and Physical Activity in Relation to Metabolic Syndrome
Authors: Hardy Dale S , Mersha Tesfaye , Xu Hongyan , Racette Susan
Published: July 2021

Background:
Studies have found associations between genetic polymorphisms, food intake, physical activity, body mass index, and metabolic syndrome (METs).

Objective:
We hypothesized that a genetic risk score (GRS) with food intake and physical activity are influenced by mediational and interaction effects to increase METs among White and African American adults.

Methods:
We used the Atherosclerosis Risk In Communities (ARIC) study data at the third visit from 1996-1998. Data included 8,416 Whites and 2,061 African Americans aged 41-71y with 1,484 and 517 cases of METs, respectively. METs was defined according to the International Diabetes Federation criteria. Dietary data were obtained from the ARIC study food frequency questionnaire. The GRS was composed of eight single nucleotide polymorphisms involved in cardiovascular and lipid metabolism, known to have defects in protein binding and function. Mediational path analysis using linear-and-logistic regression was used to test simultaneous associations, and interaction using multivariate logistic regression tested relationships between the GRS, food intake, physical activity and METs. In mediational path analysis, Root Mean Square Error of Approximation, p>0.05, Comparative Factor Index, p>0.90, Tucker-Lewis Index, p>0.90, and chi-square test, p>0.05 were used to assess statistical significance. For interaction using logistic regression analysis, odds ratios (OR) and 95% confidence intervals with p<0.05 were used to judge statistical significance.

Results:
In multivariate logistic regression, the GRS was associated with a 22% increased risk for METs among Whites (OR=1.22; 1.03-1.44), while this association was not significant in African Americans. After adjustment for Bonferonni correction for mass significance (p<0.001), we found among Whites that energy-adjusted total fat, animal fat, caloric intake, sugar-sweetened drinks, red meat, fried foods, and processed meats were associated with higher risk for METs, while energy-adjusted total carbohydrates, crude fiber, dietary fiber, and cereal fiber had a protective association with METs. These results were similar in African Americans but did not meet Bonferonni significance. In mediational analysis, we observed insignificant mediational effects, but significant direct effects for the GRS to METs for physical activity (OR=1.164; p=0.047) and fish intake (OR=1.161; p=0.050) among Whites and for carbohydrate intake (OR=1.164; p=0.058) and drinks consumed (OR=4.445; p<0.0000) among overweight/obese Whites. In interaction models, energy-adjusted carbohydrate, protein, animal fat, fructose, and sugary drinks interacted with the GRS to affect METs among Whites, but not African Americans.

Conclusion:
A GRS operates through interaction with dietary factors and physical activity rather than by their mediational effects on METs among White adults.
Abstract P288: Utility of BMI in Determining Excess Adiposity in Children and Adolescents Across the Obesity Spectrum: NHANES 1999-2006
Authors: Ryder Justin R , Kaiser Alex , Rudser Kyle D , Daniels Stephen R , Kelly Aaron S
Published: July 2021

Introduction:
Excess adiposity in youth is associated with a number of cardiometabolic complications. However, normative data defining excess adiposity cut-points utilizing gold-standard measures of adiposity [e.g. dual energy X-ray absorptiometry (DXA)] are lacking in youth. Moreover, the proportion of youth within a given BMI-based obesity category with excess adiposity is not well described. Therefore, we generated pediatric body fat distribution curves using DXA data from the National Health and Nutrition Examination Survey (NHANES) to identify cut-points and evaluate the accuracy of BMI in determining excess adiposity among youth.

Hypothesis:
A high proportion of youth with severe obesity using BMI based definitions (class 2 and 3) will have excess adiposity as measured by DXA. Heterogeneity and misclassification will be increasingly common across youth with obesity (class 1), overweight, and normal-weight.

Methods:
DXA data from NHANES 1999-2006 (Males (M) = 5,933; Females (F) = 4,532) were utilized for this analysis. Normal-weight (<85th BMI-percentile), overweight (≥85th-<95th BMI-percentile), class 1 obesity (≥95th BMI-percentile-<1.2 times the 95th percentile), class 2 obesity (≥1.2-<1.4 times the 95th BMI-percentile), and class 3 obesity (≥1.4 times the 95th percentile) were defined using Center for Disease Control based definitions for age and sex. Excess adiposity was defined using cohort-specific cut-points of the 75th, 85th, and 90th percentile for DXA-derived body fat by age and sex determined using quantile regression models with natural cubic splines (df=6).

Results:
Nearly all youth with class 3 obesity (100% M, 100% F; 97% M, 99.3% F; and 94.7% M, 95.9% F; for 75th, 85th, and 90th DXA-percentile respectively) and a high proportion of those with class 2 obesity (98% M, 99% F; 92.2% M, 90.6% F; and 76.2% M, 76.3% F; for 75th, 85th, and 90th DXA-percentile respectively) had excess adiposity. A high degree of discordance was observed between BMI and DXA-derived excess adiposity among youth with class 1 obesity (81.4% M, 85.5% F; 52.7% M, 59.6% F; and 32.9% M, 36.9% F; for 75th, 85th, and 90th DXA-percentile respectively). Only a small proportion of youth with overweight or normal weight had excess adiposity.

Conclusions:
The vast majority of youth with severe obesity defined by BMI-based obesity categories have excess adiposity, regardless of the cut-point used. Significant discordance was observed between DXA-derived excess adiposity in youth with obesity and overweight suggesting a high degree of misclassification using BMI-based definitions.
Abstract P297: Depressive Symptoms, Weight Gain and Risk of Obesity in U.S. Black Women
Authors: Ruiz-Narváez Edward A , Palmer Julie R , Gerlovin Hanna , Wise Lauren A , Rosenberg Lynn
Published: July 2021

Background:
Depression may lead to weight gain and obesity. Few prospective studies have examined the relation of depression to weight gain and obesity among African-American women, though obesity disproportionately affects this population.

Methods:
We assessed the association of depressive symptoms with weight gain and risk of obesity in the Black Women’s Health Study (BWHS), an ongoing prospective cohort study initiated in 1995. We included 22,240 non-obese women who completed the Center for Epidemiologic Studies Depression Scale (CES-D) in 1999 and followed them for weight change through 2013. We categorized depressive symptoms into CES-D <16, 16-22, 23-32, and ≥33; values of ≥16 have a moderate to high sensitivity for major depression. We used generalized estimating equations to estimate mean weight change in relation to symptoms of depression and Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between depressive symptoms and incident obesity. The basic multivariate model was adjusted for age, time period, height, antidepressants use, education, and marital status. To this model, we added lifestyle factors (dietary patterns, energy intake, exercise, hours of TV watching, smoking, and alcohol drinking) to assess whether the association of depressive symptoms with weight gain and obesity was independent of these factors.

Results:
Relative to CES-D <16, mean weight-gain difference (95% CI) during 14 years of follow-up for CES-D 16-22, 23-32, and ≥33 were 0.88 kg (0.40, 1.36), 0.28 kg (-0.35, 0.90), and 1.15 kg (0.07, 2.22) (P-trend = 0.001), respectively. After adjustment for lifestyle factors, the respective differences decreased to 0.80 kg (0.32, 1.27), 0.15 kg (-0.48, 0.78), and 1.01 kg (-0.06, 2.09) (P-trend = 0.008). Participants with CES-D ≥16 had a mean weight difference of 0.73 kg (0.34, 1.12) in the basic multivariate model, and 0.62 kg (0.24, 1.01) in the lifestyle-adjusted model compared to subjects with CES-D <16. Regarding incident obesity, in the basic multivariate model, HRs (95% CI) of obesity for CES-D 16-22, 23-32, and ≥33 were 1.17 (1.10, 1.25), 1.07 (0.98, 1.16), and 1.21 (1.08, 1.37) (P-trend <0.0001), respectively. Corresponding HRs decreased to 1.14 (1.07, 1.22), 1.03 (0.95, 1.12), and 1.16 (1.03, 1.31) (P-trend = 0.001) after adjustment for dietary and physical activity covariates. Women with CES-D ≥16 had a HR of obesity equal to 1.14 (1.08, 1.20) in the basic multivariate model, and 1.11 (1.05, 1.17) in the lifestyle-adjusted model.

Conclusions:
Our results suggest a modest association of symptoms of depression with higher weight gain and risk of obesity. The association was attenuated but persisted after successive adjustment for lifestyle factors, suggesting an independent effect of depression on weight gain and obesity.
Abstract P298: Neck Circumference is Associated with Carotid Intimal-media Thickness but Not with Coronary Artery Calcium: Results From the Brazilian Longitudinal Study of Adult Health ELSA-Brasil
Authors: Baena Cristina P , Lotufo Paulo , Santos Itamar , Goulart Alessandra , Bittencourt Marcio S , Duncan Bruce B , Liu Simin , Benseñor Isabela
Published: July 2021

Introduction:
Neck circumference has been independently associated with cardiovascular risk factors in various populations. Whether neck circumference can be a risk indicator for subclinical atherosclerosis remains uncertain.

Hypothesis:
Neck circumference can be a marker of local subclinical atherosclerosis in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods:
In cross-sectional and sex-specific analyses of 2,266 women (50.6 ±8.4 yrs) and 1,886 men (50.7 ±9.0 yrs) with both cc-IMT and CAC, free from previous coronary heart disease at baseline, we built logistic models using diverse cut-off points for CAC score (0vs>0, <100 vs ≥100, <400 vs ≥400 Agatston units) and cc-IMT ( < 75th percentile vs ≥75 th ; < 90th percentile vs ≥90 th ) as dependent variables, after which adjustments for age and traditional cardiovascular risk factors were made.

Results:
Mean (standard deviation) neck circumference was 33.6 (±2.4 cm) for women and 38.8 (±2.6 cm) for men. In fully adjusted models including sociodemographic, cardiovascular risk factors and body-mass index (BMI) and waist circumference, for each 1 standard deviation increase in neck circumference we found an odds ratio (OR, 95% CI) for having IMT above the 75th percentile of [1.52, 1.16; 1.99)]for women and [1.66, 1.28; 2.14)] for men, and above the 90th cc-IMT percentile [1.66 (1.19; 2.32)]for men but not for women [1.21 (0.80; 1.82)]. We found no association between neck circumference and CAC using several different cut-off points (p>0.05 for all).

Conclusion:
Neck circumference was significantly and independently associated with cc-IMT but not with CAC in women and men, indicating a possible effect of perivascular fat tissue on atherosclerosis.
Abstract P304: The Association of Sleep Duration and Severe Obesity in a Working Population: The Baptist Health South Florida Employee Study
Authors: Osondu Chukwuemeka U , Aneni Ehimen C , Rouseff Maribeth , Das Sankalp , Parris Don , Guzman Henry , Tran Thinh , Younus Adnan , Ahmad Rameez , Ali Shozab , Latif Muhammad A , Feldman Theodore , Veledar Emir , Nasir Khurram
Published: July 2021

Background:
Although studies have described an inverse relationship between sleep duration and obesity, there is limited knowledge about the association between sleep duration and severe obesity in the work place. In this study, we evaluated the relationship between self-reported sleep duration and severe obesity in a large, healthcare employee population.

Methods:
Employees of Baptist Health South Florida (BHSF), a large nonprofit healthcare organization participated in an annual Health Risk Assessment in 2014, from which data for this study was obtained. Average sleep duration was self-reported while weight, height and other biometric measures were captured in person. Obesity status was categorized as BMI <30, 30 - 34.9 and ≥35kg/m2, while average sleep duration was also categorized (as < 6 hours, 6 - 8 hours and > 8 hours).

Results:
A total of 10363 participants (mean age 42.8 ± 12.1 years, 75% females, 57% Hispanic) had complete information on the variables of interest. Almost one-quarter (24%) of employees who slept less than 6 hours a day were severely obese, compared to about 13% and 14% of employees who sleep between 6-8 hours and 8 or more hours of sleep respectively. Compared to those who slept for 6 - 8 hours, persons who slept for less than 6 hours had almost a 2-fold increase in odds of severe obesity (OR= 1.9; 1.6 - 2.2).

Conclusion:
In this large diverse employee population, short sleep duration is associated with a significantly increased risk of severe forms of obesity. Workplace-based programs should be encouraged to place more emphasis on adequate sleep as an important factor associated with weight control and cardiovascular health. Further studies are needed to define a temporal relationship between sleep duration and obesity severity.
Abstract P322: Goals for Cardiometabolic Risk Factors are Still Not Being Attained in the Long Term After Stroke or Transient Ischaemic Attack
Authors: Olaiya Muideen T , Cadilhac Dominique A , Kim Joosup , Nelson Mark R , Srikanth Velandai K , Bladin Christopher F , Gerraty Richard P , Fitzgerald Sharyn M , Phan Thanh , Frayne Judith , Thrift Amanda G
Published: July 2021

Introduction:
Clinical guidelines for patients with stroke or TIA have focused on modification of lifestyle and treatment to achieve cardometabolic risk factor goals. However, there is limited evidence on effective attainment of these goals in this high-risk population.

Hypothesis:
We hypothesised that a one-year intervention program will improve the attainment of cardiometabolic risk factor goals in community-dwelling survivors of stroke or TIA.

Methods:
Shared Team Approach between Nurses and Doctors For Improved Risk Factor Management (STANDFIRM) trial is an on-going prospective, randomised controlled trial of risk factor management in people with stroke or TIA. Patients hospitalised for stroke/TIA, and aged ≥18 years, were provided an intervention comprising an individualised, evidence-based secondary prevention program, including nurse education visits, and management plan with specialist oversight. The study outcome was attainment of blood pressure, blood cholesterol, blood sugar, body composition, kidney function goals, and smoking cessation at 12 months, based on guideline recommendations. We assessed whether lifestyle or other factors were associated with achieving an increased number of goals. Data collection comprised surveys, anthropometric and biochemical measurements. Differences in the proportion of patients meeting the set goals at baseline and 12 months were determined using McNemar’s chi-square test. The association between baseline factors and goal attainment was determined using multivariable linear regression.

Results:
Between January 2010 and November 2013, 233 patients (66% male, median age 69 years, 77% ischaemic stroke) were recruited into the intervention arm of the trial. Between baseline and 12 months, there was no difference in the proportion of patients achieving each of the set goals. Overall, only 14 patients (3%) achieved all six measured goals. A total of 90 patients (34%) met ≥4 goals, 89 (34%) met 3 goals, and 84 (32%) met ≤2 goals. In multivariable analyses, factors independently associated with achieving more goals included being female (OR 1.70, 95% CI 1.27, 2.20), having vocational or higher education (OR 1.37, 95% CI 1.05, 1.80), and lower salt intake at baseline (OR 0.98, 95% CI 0.97, 1.00).

Conclusion:
The 12-month intervention did not have an impact on the attainment of cardiometabolic goals in patients with stroke or TIA. With few individual factors identified, further investigation of system-level factors is warranted to ascertain factors that could facilitate improved risk factor management in patients with stroke or TIA.
Abstract 01: The Impact of School Food Environment Policies on Child Dietary Intake and BMI and Future Cardiometabolic Outcomes in the United States
Authors: Rosettie Katherine L , Micha Renata , Peñalvo Jose L , Cudhea Frederick , Mozaffarian Dariush
Published: July 2021

Introduction:
Promising school food environment policies include providing fresh fruits and vegetables (F&V provision) and competitive food restrictions on sugar-sweetened beverages (SSB restriction). Yet, the impact of these policies on diet and BMI in children and future cardiometabolic disease (CMD) outcomes is not established.

Methods:
We used a comparative risk assessment model to estimate the effects of F&V provision and SSB restriction on diet and BMI in US children age 5-18 yrs. We used national data from NHANES 2009-12 on baseline BMI and intakes of fruits, vegetables, and SSBs; impacts of these policies on diet from meta-analyses of interventions; and estimated effects of dietary changes on BMI from trials and cohorts. We also estimated the effects of these school policies on CMD in current US adults if such policies had been implemented in their childhood, based on meta-analysis of long-term within-person correlations of childhood and adult diets, meta-analyses of diet and CMD, and data on national CMD deaths. Model inputs were stratified by age, sex, and race, where appropriate. Point estimates and 95% uncertainty intervals were derived from probabilistic sensitivity analyses using 1000 Monte Carlo simulations.

Results:
F&V provision would increase overall fruit intake in children by ~ 14-21% and would not significantly increase vegetable intake (
Table
). SSB restriction would decrease overall SSB intake by ~ 6-11% and BMI (kg/m
2
) by 0.2-0.3%. Among these dietary factors, reducing SSBs had the largest estimated impact on CMD (2418 deaths averted/year), followed by providing fruits (2121) and vegetables (165). If US adults had been exposed to both policies, an estimated 4703 CMD deaths/year would be averted, representing 0.67% of all CMD deaths.

Conclusions:
Specific US school food environment policies involving F&V provision and SSB restriction would modestly improve diet and BMI in children, and could prevent up to 0.7% of all CMD deaths.
Abstract 07: Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes in Later Life
Authors: Zheng Yan , Manson JoAnn , Yuan Changzheng , Liang Matthew , Grodstein Francine , Stampfer Meir , Willett Walter , Hu Frank
Published: July 2021

Background:
The association of weight gain from early to middle adulthood with a wide range of health outcomes later in life has not been systematically examined.

Methods:
We included 93,873 women from the Nurses’ Health Study and 25,374 men from the Health Professionals Follow-up Study who recalled weight at early adulthood (18 years in women, 21 years in men) and reported current weight in middle adulthood (55 years). Beginning from 55 years old, we prospectively followed them for incident cases of type 2 diabetes, hypertension, cardiovascular disease, cancer, three other medical conditions, and all-cause mortality. Among 51,185 women and 17,694 men who were at least 64 years of age in 2010, we also considered “healthy aging”, defined as no diagnosis of 11 major chronic diseases and no major cognitive impairment, physical impairment, or mental health limitations.

Results:
On average, female participants gained 12.55 kg (interquartile range: 14.36 kg) of body weight and males gained 9.68 kg (interquartile range: 11.19 kg) from early to middle adulthood. During a median follow-up of 18 years in women and 14 years in men, we documented 9360 incident cases of type 2 diabetes, 37,298 of hypertension, 9220 of cardiovascular disease, 20,222 of cancer (including 9458 of obesity-related cancers), 7438 of symptomatic cholelithiasis, 2702 of severe osteoarthritis, 31,960 of cataract extraction, and 27,250 deaths. In multivariate models, compared to those maintained stable weight (weight change <2.5kg), participants who gained 20+ kg had increased risks of: diabetes (hazard ratio [HR, 95%CI], 10.93[9.65–12.39] in women, 8.19[6.41–10.46] in men), hypertension (2.24[2.15–2.34] in women, 2.11[1.91–2.33] in men), cardiovascular disease (1.87[1.72–2.04] in women, 1.72[1.40–2.11] in men), obesity-related cancers (1.53[1.41–1.66] in women, 1.27[0.95–1.69] in men), and mortality (1.43[1.37–1.50] in women, 1.34[1.18–1.51] in men); they had decreased odds of healthy aging (odds ratio [OR, 95%CI], 0.36[0.32–0.40] in women and 0.50[0.43–0.57] in men). In a meta-analysis combing both sexes, the increase in risk associated with each 10 kg weight gain was 71% for type 2 diabetes, 27% for hypertension, 17% for cardiovascular disease, 31% for symptomatic cholelithiasis, 15% for obesity-related cancers, 9% for severe osteoarthritis, 5% for cataract extraction, and 9% for mortality; for the same weight gain the odds of healthy aging was 28% lower.

Conclusions:
Our data provide strong evidence that weight gain from early to middle adulthood is associated with substantially increased risk of major chronic diseases and mortality, and overall decreased odds of aging with good health and well-being among women and men.
Abstract 39: Statin Use is Associated with Elevated Serum Glucose and Incidence of Type 2 Diabetes in US Veterans
Authors: Djousse Luc , Deane Brittany , Charest Brian , Nelson Constance , Cho Kelly , Gaziano J M , Gagnon David R
Published: July 2021

Background:
While some but not all trial data have suggested a slightly elevated risk of type 2 diabetes (T2D), limited data are available on the relation of statin use with glycemia among US veterans.

Objective:
To test the hypothesis that treatment with a statin is associated with elevated serum glucose and a higher risk of T2D among US veterans.

Methods:
We studied 549,143 US veterans with electronic health records from 1998 to 2016. We used the VA Corporate Data Warehouse to obtain information on glucose (fasting and non-fasting). Statin use was captured using the pharmacy database. T2D was defined as having at least one inpatient diagnosis or at least 2 outpatient diagnoses of T2D using ICD 9 codes 250.xx, or the use of hypoglycemic agents. We addressed confounding by indication using propensity score (included 444 variables/interactions) for receiving statin and inverse probability weighting in the Cox regression.

Results:
The mean age was 60±12.8 y; 94.3% were men; 77.1% were white; and 15.4% were black. In this cohort, simvastatin was the most prescribed statin (84%) followed by lovastatin (7%). During a median follow-up of 4.4 years, 130,819 new cases of T2D occurred. Among 418,847 veterans receiving statin, we observed a 2 mg/dl increase in serum glucose when comparing serum glucose measured at the time of statin initiation and short-term <1 y as well as long-term glucose values (all p <0.01). In crude analysis, statin use was associated with a 53% higher risk of T2D compared with non-users of statin [HR=1.53 (95% CI: 1.51-1.54)]. In a multivariable adjusted model, hazard ratio (95% CI) for T2D was 1.25 (95% CI: 1.24-1.26) after adjustment for propensity score for being on statin. There was a borderline statistically significant interaction between statin and triglycerides on T2D risk (p=0.09): HR=1.15 (95% CI: 1.14-1.16) for people with triglecerides below 150 mg/dl and HR=1.36 (95% CI: 1.35-1.38) for people with triglycerides of at least 150 mg/dl in the adjusted model. We did not have enough data to stratify by type of statin given the predominance of simvastatin in this population.

Conclusions:
Our data show a positive association between statin use and increase in both serum glucose and incidence of T2D among US veterans. If confirmed by others, this suggests closer monitoring of patients at risk of T2D when statin therapy is initiated.
Abstract 40: Duration of Prediabetes is Associated with Subclinical Atherosclerosis and Cardiac Dysfunction in Middle-Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Reis Jared P , Allen Norrina B , Bancks Michael P , Carr Jeffrey J , Lewis Cora E , Lima Joao A , Rana Jamal S , Schreiner Pamela J
Published: July 2021

Background:
A prolonged duration of diabetes has been shown to be independently associated with incident cardiovascular disease (CVD). Whether duration of prediabetes is similarly associated with CVD is unknown. We sought to determine whether the duration of prediabetes during young adulthood is associated with the presence of coronary artery calcified plaque (CAC) and cardiac structure/function in middle-age.

Methods:
Participants were 3244 white and black adults aged 18-30 years without prediabetes or diabetes at baseline (1985-86) or diabetes during follow-up in the multicenter community-based CARDIA Study. Prediabetes was defined at follow-up examinations 7, 10, 15, 20, and 25 years after baseline as fasting glucose 100-125 mg/dL, 2-hour oral glucose tolerance 140-199 mg/dL or HbA1c 5.7-6.4%. Presence of CAC was measured by computed tomography at follow-up years 15, 20, and 25. Measures of cardiac structure and function were obtained from echocardiography performed at year 25.

Results:
Of the 3244 individuals, 1561 (48.2%) developed prediabetes during follow-up. Among those who developed prediabetes, the median (IQR) duration was 10 (5-12) years. After adjustment for age, sex, race, education, study center, and CVD risk factors, the hazard ratio for the presence of CAC was 1.21 times higher for each 10-year increase in duration of prediabetes (95% CI: 1.06, 1.37). Duration of prediabetes was also associated with worse global longitudinal strain (per 10 years: 0.2%; 95% CI: 0.1, 0.4; P=.005), e′ (-0.2 cm/s; 95% CI: -0.3, -0.1; P < .001), and E/e′ ratio (0.113; 95% CI: -0.007, 0.233; P=.06) (
Table
). These results did not differ significantly by race or sex.

Conclusions:
Exposure to a longer duration of prediabetes is associated with subclinical atherosclerosis and cardiac dysfunction in middle-age. Further research is needed to better understand the pathophysiology of these relationships.
Abstract MP006: A Feasible and Effective Mobile Health Weight Loss Lifestyle Intervention for Filipinos With Type 2 Diabetes
Authors: Bender Melinda S , Cooper Bruce , Arai Shoshana
Published: July 2021

Introduction:
Filipino Americans have the highest prevalence of obesity and type 2 diabetes (T2D) compared to Asian American subgroups placing them at high risk for cardiometabolic disease. Effective interventions are needed to reduce these health disparities. Mobile health (mHealth) weight loss lifestyle interventions have been effective in reducing cardiometabolic risks, but are untested among Filipinos, particularly with T2D. As prolific users of digital technology, Filipinos are ideal candidates for mHealth lifestyle interventions. Therefore, we conducted the PilAm Go4Health intervention study - a culturally adapted weight loss lifestyle intervention using mobile technology to reduce cardiometabolic risks among Filipinos with T2D.

Objective:
To demonstrate intervention feasibility and potential efficacy.

Hypothesis:
1) participant retention rate will be greater than 80%; 2) Compared to the control, intervention group will have significantly greater reduction in: % weight loss, waist circumference, fasting plasma glucose, and HbA1; and greater increase in step-counts.

Methods:
Two-arm (intervention +active control groups) RCT compared a 3-month intervention (Fitbit accelerometer +mHealth app/diary +Facebook group) and control (Fitbit accelerometer). N=45 overweight Filipino adults with T2D were recruited from Northern California communities. Between group differences from baseline to 3-months were analyzed using: 1) multilevel regression for within-person change in weight and step-counts using a nonparametric bias-corrected bootstrapped 95% CI for the multilevel models, and 2) T-tests, ANOVA for waist circumference, fasting plasma glucose, and HbA1c (significance =p<0.05, 2-sided). Cohen’s d was used for effect size analyses.

Results:
Randomized N=45 Filipinos (intervention =22 and control =23). Mean age was 58±10 years, 62% women, and retention rate=100%. There was significantly greater reduction in the intervention group compared to the control for: % weight (2.3% greater decrease, d=0.46); waist circumference (-2.68cm; d= 0.88); and fasting plasma glucose (-18.52mg/dl; d= -0.86). HbA1c group difference was not significant (-0.34%; p< 0.19). Step-counts significantly increased in the intervention group compared to control (3432 steps at endpoint; d=1.44).

Conclusion:
PilAm Go4Health intervention demonstrated excellent feasibility in recruitment and retention, and potential efficacy for reducing cardiometabolic risks in Filipinos with T2D. Results warrant further testing of this lifestyle intervention that may support translation to other at-risk diverse populations living with T2D.
Abstract MP022: Cost-effectiveness of the Non-laboratory Based Framingham Algorithm in Primary Prevention of Cardiovascular Disease: a Simulated Analysis of a Cohort of African American Adults
Authors: Kariuki Jacob , Leveille Susan , Gona Philimon , Stuart-Shor Eileen , Cromwell Jerry
Published: July 2021

Background:
The non-laboratory based (non-LB) Framingham algorithm, which substitutes body mass index for lipids, has been validated for screening cardiovascular disease (CVD) risk among African Americans (AA). However, its marginal cost and benefit tradeoffs have not been contrasted with the established laboratory based (LB) Framingham algorithm. This study examines the incremental cost-effectiveness ratio (ICER) of a simulated CVD prevention program guided by the non-LB versus LB Framingham algorithm.

Methods:
We simulated the World Health Organization CVD prevention guidelines on AA participants of the Atherosclerosis Risk in Communities (ARIC) cohort. Treatment intensity was tailored according to absolute CVD risk scores calculated by non-LB and LB Framingham algorithms. Costs were estimated using Medicare fee schedules (diagnostic tests, drugs and visits), Bureau of Labor Statistics (RN wages), and Chapman’s estimates for initial and follow-up costs of managing incident CVD events. Outcomes were assumed to be true positive cases detected at the treatment threshold. ICER was calculated using Drummond’s framework.

Results:
Among 2690 AA (mean age 53.3 ± 5.8 yrs, 59% female) the simulation under the non-LB vs LB Framingham algorithm had an ICER of -$46,240 per true positive case detected. The average 12-year discounted costs under the LB Framingham algorithm were 18.3% higher ($29,991 vs $25,357) and identified 6.5% fewer cases (309 vs 329) compared to the non-LB Framingham algorithm.

Conclusion:
The approach guided by the non-LB Framingham algorithm dominated the LB Framingham strategy with respect to both costs and predictive ability. Consequently, the non-LB Framingham algorithm could potentially provide a lower cost but a highly effective tool to address the high burden of CVD in AA and other resource constrained settings.