bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P044: Repeated Measurement of Insulin Sensitivity is Increasing the Precision of Incident Dyslipidemia Prediction Compared to Single Baseline Measurement: The Ansan-Ansung Community Cohort Study
Authors: Lee Ju-mi , Kim Kyoung Min , Lim Soo , Kim Hyeon Chang
Published: March 2019

Introduction:
Medical data are commonly measured repeatedly. However, there is a lack of studies of the usability of trajectory as a repeated measurement on the prediction model compare to the single measurement.

Objectives:
This study aimed to evaluate whether repeated measurement of insulin sensitivity can improve the prediction of incident dyslipidemia beyond the single measurement.

Methods:
Participants (n=3899; aged 40-69 years, during visit 1 to 7, mean follow-up 12 years) were recruited from the Ansan-Ansung cohort study, a subset of Korean Genome Epidemiology Study. Oral glucose tolerance test (OGTT) were measured at every visit with a 2 year interval. Matsuda index of each visit was calculated by the formula 10
4
/((GLU0xINS0xGLU60xINS60)
0.5
). We used total seven times of OGTT (28 OGTT index) for trajectories. Latent mixture modeling was used to identify trajectories in Matsuda index for 12 years. We used tertiles of baseline Matsuda index for single measurement. Age, body mass index, alcohol drinking, cigarette smoking, c reactive protein, education level, and income were covariates. We compared two model’s discrminatory power using area under the curve of the receriver operating characteristics curve (AUROC).

Results:
In the trajectory model (repeated measurement), three distinct insulin sensitivity trajectories were identified: low-stable (Group 1; 88.8%), steady decreasing (Group 2; 9.7%), and fast decreasing (Group 3; 1.5%). In the baseline single measurement model, tertile groups were devided: low tertile(<6.25, N=1306, 33.50%), tertile2 (6.25-10.89, N=1277, 32.75%), and tertile 3(≥10.89, N=1316, 33.75%). Trajectory model showed better discrimination power compared to single measurement model in the total population (AUROC 0.6303 vs. 0.6234) and men (AUROC 0.6671 vs. 0.6470) but not in women (AUROC 0.6171 vs. 0.6176).

Conclusions:
Repeated measurement of insulin sensitivity can improve the prediction of incident dyslipidemia in the general population.
Abstract P045: Sun Exposure is Not Associated With Lower Cardiovascular Risk in Mexican Women
Authors: Aguilar Mercedes , Flores Mario , Cantú-Brito Carlos , Lajous Martín , López-Ridaura Ruy
Published: March 2019

Background:
Sun exposure has been associated with reduced risk of stroke and all-cause mortality possibly due to a decreased vascular tone related to vitamin D production. However, previous studies have measured sun exposure based on geographical estimations of radiation, and have been mostly conducted in latitudes far from the Equator where UV radiation is lower than in tropical and subtropical latitudes and where there is little variation in skin tone.

Hypothesis:
Sun exposure is inversely associated with subclinical cardiovascular disease in Mexican women.

Methods:
We conducted a cross-sectional analysis in 2,257 disease-free women from the Mexican Teachers‘ Cohort who were invited to clinical examinations in 4 different Mexican states. Participants responded to questions on sun exposure habits at 4 age periods (12-24, 25-35, 36-59, >60). Sun exposure was defined as the weighted average of weekly hours spent under the solar noon from age 12 to the age at clinical examination. Carotid intima-media thickness (c-IMT) was measured on both carotid arteries through ultrasound by standardized neurologists and log transformed. We defined carotid atherosclerosis as mean right or left c-IMT ≥0.8 mm or the presence of plaque. We used linear and logistic regression to evaluate the association between quartiles of sun exposure, c-IMT and carotid atherosclerosis, with quartile 1 as reference.

Results:
Mean age of participants was 49.6 (5.5) years and the prevalence of carotid atherosclerosis was 12.3% in quartile 1 vs 10.6% in quartile 4. The median weekly hours of exposure for each quartile were: 1 (Q1), 1.79 (Q2), 3 (Q3), 4 (Q4). The age-adjusted % mean difference in c-IMT comparing women in the first quartile to women in the fourth quartile was -1.5% (95% CI -2.9, -0.1). After further adjustment for site, socioeconomic status, smoking status, ethnicity and physical activity the % mean difference was no longer significant (-0.7%, 95% CI -2.0, 0.7). The age-adjusted OR for carotid atherosclerosis for women in the fourth quartile compared to women in the first quartile was 0.81 (95% CI 0.57, 0.95). However, in the multivariable model, the OR was non-significant (0.94, 95% CI 0.69, 1.2). Stratified analysis for ethnicity and obesity showed no difference between groups.

Conclusion:
Sun exposure was associated with neither cIMT nor carotid atherosclerosis in Mexican women. Atherosclerosis might not play a role in the biological mechanism explaining the inverse association between sun exposure and cardiovascular risk.
Abstract P046: Baseline Insulin Sensitivity From Oral Glucose Tolerance Test Are Associated With Incident Dyslipidemia: The Ansan-Ansung Community Cohort Study
Authors: Lee Ju-mi , Kim kyoung Min , Lim Soo
Published: March 2019

Introduction:
Insulin resistance and dyslipidemia are often comorbid. Although possible biochemical explanations exist, there is still too small community based longitudinal data to support the theory directly.

Objectives:
This study aimed to test the association between the baseline of insulin sensitivity from oral glucose tolerance test (OGTT) and the incidence of dyslipidemia in a community cohort. Secondly, we tested which lipidemia profile is associated with tertiles of Matsuda index.

Methods:
Participants (n=3899; aged 40-69 years, during visit1 to 7, mean follow-up for 12 years) were recruited from the Ansan-Ansung cohort study, a subset of Korean Genome Epidemiology Study. OGTT were measured at baseline examination. Baseline Matsuda index was calculated by the formula 10
4
/((GLU0xINS0xGLU60xINS60)
0.5
). We then used tertiles of Matsuda index. The associations of Matsuda index tertiles with the incidence of dyslipidemia and each component of the lipid profile during 12 years were assessed by logistic regression. Age, body mass index, alcohol drinking, cigarette smoking, c reactive protein, education level, and income were adjusted at the final model.

Results:
Tertile groups were divided: low tertile(<6.25, N=1306, 33.50%), tertile 2 (6.25-10.89, N=1277, 32.75%), and tertile 3(≥10.89, N=1316, 33.75%). Low tertile (referent: tertile2) was associated with greater incident dyslipidemia in total before (OR=1.39, 1.13-1.72) and after adjustment (OR=1.26, 1.02-1.57). Low tertile was associated with greater incident triglycerides≥200mg/dl in total (OR=1.33, 1.10-1.62), women (OR=1.35, 1.01-1.81) and men (OR=1.34, 1.03-1.74) before and adjustment. However low tertile was not associated with other dyslipidemia profiles such as HDL, LDL, and total cholesterol.

Conclusions:
Low tertile of insulin sensitivity at baseline had increased associations with future incidence of dyslipidemia especially with triglycerides component.
Abstract P049: Circulating Adiponectin Levels and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality in US Women
Authors: Hu Jie , Li Jun , Liang Liming , Huang Tianyi , Hu Frank B , Manson JoAnn E , Tworoger Shelley S , Rexrode Kathryn M
Published: March 2019

Introduction:
Adiponectin is an anti-inflammatory peptide hormone secreted by adipocytes and has been related with decreased risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), but longitudinal data are limited and inconsistent.

Hypothesis:
Higher circulating adiponectin levels are associated with lower risk of T2D, CVD, and all-cause mortality in healthy women.

Methods:
Baseline adiponectin levels, measured by an immunoassay, were available on 15,131 women from the Nurses’ Health study I and II, who were part of 11 separate nested case-control studies and free of T2D, CVD, and cancer at study baseline. Associations of adiponectin levels with incident T2D, CVD (including coronary heart disease [CHD], stroke, and CVD death), and all-cause mortality were estimated using Cox regressions adjusted for study design characters, established risk factors and confounders including menopausal status, hormone therapy, and continuous body mass index. We also analyzed associations of 26 adiponectin expression-associated variants (in adipose tissue) with T2D, CVD, and all-cause mortality in the UK Biobank study.

Results:
During up to 22 years (289,408 person-years) of follow-up, 2,578 T2D cases, 1,827 CVD cases (including 745 CHD, 1,108 stroke and 428 CVD deaths), and 2,741 deaths occurred. In multivariable models, hazard ratios (95% confidence intervals) comparing the highest quartile of plasma adiponectin to the lowest were 0.17 (0.14-0.21;
P
trend
<0.001) for T2D, 0.82 (0.69-0.96;
P
trend
=0.005) for CVD, 0.66 (0.51-0.86;
P
trend
<0.001) for CHD, 0.91 (0.73-1.12;
P
trend
=0.34) for stroke, 0.69 (0.48-0.98;
P
trend
=0.10) for CVD death, and 0.77 (0.66-0.90;
P
trend
=0.005) for all-cause mortality. Genetic alleles associated with increased adiponectin expression in adipose tissue were associated with decreased risk of CVD, but no associations were observed for T2D and all-cause mortality.

Conclusions:
Higher adiponectin levels are associated with decreased risk of cardiometabolic diseases and all-cause mortality.
Abstract P051: College Students’ Perception and Beliefs Regarding Cardiovascular Risk Factors: A Mixed-Methods Study
Authors: Tran Dieu-My T , Dingley Catherine , Arenas Rogelio
Published: March 2019

Background:
Many college students underestimate their cardiovascular risk while engaging in high-risk behaviors such as consumption of high-fat foods, smoking, alcohol abuse, and sedentary lifestyle.

Objective:
To explore the perceptions and beliefs regarding cardiovascular risk factors and lifestyle modifications among college students who have been identified as high risk for cardiovascular disease (CVD).

Methods:
Using a mixed-methods design, quantitative data was collected to identify participants with high CVD risk. Participants with a Framingham 30-year CVD risk of 10% or higher were invited to participate in the qualitative interviews. Of 148 college students who completed the quantitative portion, 16 were high risk and invited to participate in qualitative interviews. A conventional content analysis was used to analyze interview data.

Results:
Ten participants completed the interviews (mean 30-year CVD risk was 19.0% (ranges 10% to 39%). All participants were overweight or obese, 70% consumed alcohol, 60% had elevated blood pressure, 50% had a family history of heart disease, and 20% were current smokers while none had diabetes or hyperlipidemia. Analysis of the in-depth interviews revealed a thematic structure consisting of five primary categories: 1) recognizing risk, 2) lifestyle trajectories, 3) factors influencing lifestyles, 4) ideal healthy lifestyle modifications, and 5) perceived benefits of healthy lifestyles. Recognizing risk, participants had varied responses to the news that they were at risk for CVD, some were not surprised to learn of their cardiovascular risk status while others found this information to be unexpected. Lifestyle trajectory, participants often used their previous lifestyle and behaviors as a context for their current lifestyles. The influencing factors, both facilitators and barriers, are categorized as environmental, relational, financial, work/life/school balance, and internal/intrinsic motivation. Participants described their conceptualizations of an ideal healthy lifestyle modification program and the necessary components for success. The benefits and results of a healthy lifestyle were clearly described as feeling better and experiencing improved physical tolerance, looking better, reaping the rewards of experiencing results, positive feedback from others, and social acceptance and validation.

Conclusions:
Understanding high-risk college students’ beliefs and perceptions regarding CVD risk factors, barriers, facilitators, and strategies for implementing a healthy lifestyle, is the first step to assessing the problem facilitating early intervention which may result in improved long-term cardiovascular health outcomes in the young population.
Abstract P054: Associations Between Lifestyle Behaviors and Body Composition in 9 -11 Year Old New Zealand Children: The Moderating Effect of Parental Resilience
Authors: Stoner Lee , Harding Rebecca , Hszard Jillian , Meredith-Jones Kim , Saedi Pouya , Skidmore Paula
Published: March 2019

Introduction:
Obesity prevalence continues to rise for all age groups, particularly in those experiencing adversity or hardship. However, not all those experiencing adversity are obese. Previous research has focused on whether resilience in adults is associated with a healthy body composition, through increased ability to make healthier lifestyle choices. However, there is no research on how parental resilience relates to the lifestyle choices and body composition of their children.

Hypothesis:
Higher parental resilience is associated with better lifestyle (moderate to vigorous physical activity (MVPA), sedentary time, sleep duration, fruit & vegetable consumption) choices and healthier body composition.

Methods:
This cross-sectional study recruited 408 children (9.7 [SD:0.69] y, 50% F) and their primary caregiver (41 [SD: 5.5] y, 84% F) from Otago, New Zealand. Three dependant variables were calculated: body mass index z-score (zBMI) using WHO criteria, fat mass index (FMI, kg/m
2
) using bio-impedance analysis (BIA), and central adiposity (waist circumference, WC, cm). The four independent variables were: time (hours) spent asleep, sedentary or in MVPA using accelerometery, and fruit and vegetable dietary pattern derived from a food frequency questionnaire. Parental resilience was measured using the 10 item Conner-Davidson questionnaire. Associations between children’s lifestyle behaviours and body composition were examined using mixed effects regression models, with school as a random effect. Models were adjusted for child age, sex, ethnicity, level of deprivation, and parent age and sex. To explore the moderation effects of resiliency an interaction term was included, where resilience was split into low and high resilience by the median.

Results:
For the fully adjusted models, MVPA was not significantly associated with zBMI (p=0.760), FMI (p=0.984) or WC (p=0.785), nor were these relationships moderated by resiliency. Sedentary time was not associated with zBMI (p=0.447), FMI (p=0.210) or WC (p=0.380). However, resiliency moderated the association between sedentary time and WC (P=0.048), with a negative association for low resiliency (ß=-0.2, 95%CI: -1.1, 0.7), and positive association for high resiliency (ß=-1.2, 95%CI: -0.1, 2.5). Sleep duration was negatively associated with zBMI (ß=-0.1, 95%CI: -0.31, -0.0), FMI (ß=-0.3, 95%CI: -0.6, -0.1) and WC (ß=-1.1, 95%CI: =2.0, -1.6); resiliency did not moderate these relationships. Higher fruit and vegetable consumption was not associated with zBMI, but was positively associated with FMI (ß=0.2, 95%CI: 0.1, 0.3) and WC (ß=0.9, 95%CI: 0.5, 1.4); resiliency was not a significant moderator of these relationships.

Conclusions:
Parental resilience moderated the relationship between sedentary time and WC, with a positive relationship between sedentary time and WC for the high resiliency group.
Abstract P056: Adolescent Self-Reported School Environment and Obesity Prevalence, the Fragile Families and Child Wellbeing Study
Authors: Quader Zerleen S , Suglia Shakira F
Published: March 2019

Introduction:
Childhood obesity continues be a major public health concern in the United States, and disproportionately affects racial/ethnic minorities and children of lower socioeconomic status. Social environments such as schools are particularly influential in shaping child and adolescent health, and represent an important target for interventions to improve health behaviors. Positive school environments, those that are safe, supportive, respectful, and engaging, have been shown to be associated with adolescent health behaviors; however, few studies have examined whether a positive school climate can influence physical health, such as obesity status.

Hypothesis:
We hypothesized that adolescents’ self-reported positive school environment would be associated with a lower prevalence of obesity in a disadvantaged population and that this association may differ by sex.

Methods:
Data were from the sixth wave of the Fragile Families and Child Wellbeing Study, a cohort of children born between 1998 and 2000, approximately two-thirds of whom were born to unmarried parents. Adolescents were, on average, 15 years of age at the time of the assessment and had height and weight measured during a home visit. Positive school environment was operationalized using adolescent self-reported responses to survey questions examining school connectedness, school climate (teacher quality and student behavior towards teachers), and presence of bullying behaviors in the past month. A cumulative school environment score was created, ranging from zero to five, with a score of four or five defined as a positive school environment (i.e. high levels of connectedness, positive climate, and no bullying). The final analytic sample size was 1,044 adolescents. Log binomial regression was used to estimate prevalence ratios for obesity.

Results:
Twenty-six percent of the sample was obese, and 45% reported a positive school environment. Crude and adjusted models were similar. After adjustment for race/ethnicity, parent marital status at first wave, and student receipt of free lunch, there did not appear to be an association between positive school environment and prevalence of obesity among boys (PR: 1.1; (0.8, 1.4)). Among girls, there was a slight inverse association between positive school environment and prevalence of obesity (PR: 0.8; (0.6, 1.1)), however this was not statistically significant.

Conclusions:
Results suggest that a more positive school environment could be associated with a lower prevalence of obesity among adolescent girls in a high-risk population. However, because of the cross-sectional nature of this analysis, results should be interpreted with caution, as temporality cannot be established. Future work should explore the use of validated measures of school environment to improve measurement and explore whether interactions exist between school environment and adolescents’ sex.
Abstract P058: Cardiometabolic Risk Factors From a School-Based Cross-Sectional Screening Program
Authors: Pyles Lee A , Lilly Christa , Joseph Amy , Mosimah Charles , Elliott Eloise , Neal William A , Mullett Charles
Published: March 2019

Introduction:
Coronary Artery Risk Detection in Appalachian Communities is a school-based cross-sectional screening program to detect significant cardiometabolic disease risk factors (CMRFs) in WV children. Fifth graders have undergone school screening for family history, anthropometrics and lipid panel values since 1999 including screening for Acanthosis Nigricans (AN Pos or Neg). Our hypothesis is that presence of AN can predict need to screen for CMRFs.

Methods:
Parental consent and child assent were obtained before screening day using an IRB-approved protocol. Height and weight were used to calculate BMI and BMI%ile. Systolic blood pressure over 95%ile, triglyceride over 150 mg/dl, HDL under 40 mg/dl and BMI over 95%ile were tabulated and correlated. Glucose and HOMA IR were only checked for AN Pos subjects and thus not considered in analysis.

Results:
102,930 5
th
graders participated in CARDIAC up to 2017. 101,101 had BMI determination, 100,000 blood pressures, 67,710 lipid panels were checked. 27.9% of children (28715) were obese, defined as BMI over 95%ile and 18.4% (18,931 subjects) were overweight. 10.8% of AN pos children vs. 1.9% of all children exhibited 4 CMRFs (Obese BMI, Htn, high TG, low HDL, OR 7.31, 95% CL 6.4-8.35).

Conclusion:
AN correlated to CMRF clustering but many CMRF pos subjects were AN Neg (79.5% or 1236/1555 of those with 4 CMRFs). Multifactoral screening of lipids, BMI, blood pressure are indicated to identify risk for cardiovascular disease.
Abstract P061: Incidence of Major Cardiovascular Disease and Subsequent Risk of End-stage Renal Disease: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ishigami Junichi , Cowan Logan , Demmer Ryan , Lutsey Pamela , Grams Morgan , Coresh Josef , Matsushita Kunihiro
Published: March 2019

Background:
Cardiorenal syndrome is a well-known concept. However, in contrast to extensive investigations of chronic kidney disease (CKD) as a risk factor of cardiovascular disease (CVD), whether CVD increases long-term risk of end-stage renal disease (ESRD) is much less studied.

Methods:
In 8,881 participants of the Atherosclerosis Risk in Communities Study who attended visit 4 (1996-1998), we assessed the association of incident hospitalization with major CVD (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESRD. Hospitalization with CVD was entered into multivariable Cox models as a time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CI).

Results:
Baseline mean age was 62 years, 59% were female, 22% were black, and 5.5% had eGFR 15-60 ml/min/1.73m
2
. During a median follow-up of 15.9 years, there were 141 cases of ESRD. In multivariable Cox analysis, each incident CVD subtype was independently associated with increased risk of ESRD, with the highest HR for heart failure (HR, 16.9 [95%CI, 11.6-24.7]), followed by coronary heart disease, atrial fibrillation, and stroke (Model 2 in
Table
). The association remained significant across CVD subtypes except for atrial fibrillation, when all CVD subtypes were simultaneously entered into a Cox model as time-varying exposures (Model 3 in
Table
). The results were similar when modeling death as a competing risk, and consistent across subgroups of age, sex, race, diabetes, and CKD. When analyzing confirmed events of heart failure with preserved ejection fraction (HFpEF) (n=205) and reduced ejection fraction (HFrEF) (n=190), the association was particularly evident for HFpEF (10.8 [5.9-19.7]) compared to HFrEF (4.9 [2.0-11.7]).

Conclusions:
These findings support CVD as a potent risk factor of ESRD. Patients with CVD, particularly heart failure, should be recognized as a high risk population for ESRD. Distinct contribution of HFpEF vs. HFrEF to ESRD deserves future investigations.
Abstract P067: A Co-Design Approach to Validate a Text Message Bank for Use With Older Adults at Risk of Cardiovascular Disease
Authors: Ardo Jessica C , Lee Jung-Ah , Hildebrand Janet , Guijarro Diana , Ghasemzadeh Hassan G , Evangelista Lorraine S
Published: March 2019

Purpose/Aims:
To describe the design and validation of a text message bank that will be used for an mHealth behavioral change intervention -- Fitness Intensive Therapy (
Get FIT+
) in order to improve healthy eating and enhance physical activity in a sample of older adults (≥ 60 years) at risk for cardiovascular disease.

Background:
Short message service (SMS) has been widely used in patient follow-up and disease management, showing improvements in medication adherence, symptom monitoring, appointment attendance and satisfaction with health services. However, most studies usually focus on the effectiveness of SMS and lack information regarding the development and validation of their content to guarantee adequate understanding and appeal of SMS strategies by end users.

Methods:
An initial bank of 68 SMS text messages was developed to focus on healthy eating, physical activity and provide motivational feedback through an extant literature review for promoting behavior change to engage in healthy lifestyles. The messages were organized into three subsets [e.g., healthy eating (24 messages), physical activity (24 messages), other goals and compliance (20 messages)] for field validation. An expert panel (N = 5) evaluated each subset of SMS text messages. Consistent with the
Get FIT+
project that will utilize the text messages, additional validation was conducted with 5 older adults (≥ 60 years old) from diverse ethnic backgrounds representative of the population in Orange County. Two to three people evaluated each of the three SMS text message subsets (N = 5, 40% male). User demographics, phone literacy, understanding and appeal of each SMS text message was assessed using a 27-item questionnaire.

Results:
The text message content included educational, motivational and goal progress feedback on the topics of nutrition, physical activity and compliance/other goals. Overall, the three SMS datasets received a total of 10 evaluations each. All evaluations—10 out of 10 (100%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. The older adults’ average appeal score of the three datasets was 9.0 (SD±0.2) of 10 points. Participants did not make significant suggestions to change the wording of the messages, but provided excellent and useful feedback to optimize the messaging.

Implications:
The final set of SMS text messages produced had very high rates of understanding and appeal among an expert panel and older adults who represented the potential recipient. This study highlights the importance of developing and validating a database of simple, feedback-oriented SMS text messages, grounded in evidence and theory, with an expert panel and active engagement of potential end users.
Abstract P068: Associations Between Taste and Smell Alterations and Diabetes-Related Comorbidities Among US Adults: The National Health and Nutrition Examination Surveys 2011-2014
Authors: Li Jing , Song Yiqing
Published: March 2019

There is evidence that taste and smell dysfunctions may be associated with type 2 diabetes. Due to sparse data, it remains unclear to what extent taste and smell impairment is related to diabetic complications. We thus aimed to examine the associations between smell and taste alterations and diabetes/prediabetes with and without comorbidities by utilizing the nationally representative data from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2014. Analyses were conducted on 7,027 participants aged 40 to 80 years, of whom 2609 were healthy people, 2625 pre-diabetic patients, and 1793 diabetic patients. Either taste or smell disorder was, respectively, defined as at least one adverse alteration through self-reported questions. Crude prevalence of taste and smell disorders among healthy population, diabetic/prediabetic patients with and without comorbidities were calculated. Weighted logistic regression analyses were performed to examine the associations between declined ability of taste, smell senses and diabetes/prediabetes with and without comorbidities, including cancer, cardiovascular disease, chronic kidney disease, neuropathy, and retinopathy. The multivariate-adjusted models controlled for age, sex, race, BMI, education, cigarette smoking, alcohol intake, and family history of diabetes. Compared to healthy people (prevalence was 15.5% for taste and 19.4% for smell impairment), prediabetic/diabetic patients without comorbidities (taste: 19.2%; smell: 21.1%), and prediabetic/diabetic patients with comorbidities (taste: 22.8%; smell: 28.0%) had higher prevalence of diminished capacity in taste and smell. After adjustment for confounders in our models, significant associations remained between taste and smell impairment and prediabetes/diabetes with comorbidities (taste: OR 1.79, 95% CI (1.31, 2.45); smell: OR 1.52, 95%CI (1.17, 1.97)), but not without comorbidities versus healthy people (taste: OR 1.15, 95% CI (0.85, 1.54); smell: OR 1.10, 95% CI(0.89, 1.37)), and were not modified by age, sex, and race. Furthermore, we conducted sensitivity analyses for individual comorbidities and found that cardiovascular disease and neuropathy were consistently associated with reduced ability in both taste and smell. In conclusion, our results from national data indicate that taste and smell alterations may be possible predictors of the presence and progression of prediabetes/diabetes.
Abstract P072: Elevated Liver Enzymes Are Associated With Incident Diabetes in Hispanic/Latino Adults: Results From HCHS/SOL
Authors: Hua Simin , Qi Qibin , Parrinello Christina M , Kizer Jorge R , Strickler Howard , Thyagarajan Bharat , Daviglus Martha , Talavera Gregory A , Schneiderman Neil , Cotler Scott J , Cai Jianwen , Kaplan Robert , Isasi Carmen R
Published: March 2019

Introduction:
Non-alcoholic fatty liver disease (NAFLD) as measured by ultrasonography or elevated liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT), has been associated with increased risk of incident diabetes. But such evidence is lacking in the Hispanic/Latino population, which has high prevalence of obesity and NAFLD.

Methods:
We conducted a prospective cohort study of 6928 adults of Hispanic/Latino background who had no diabetes at baseline (2008-2011). Incident diabetes was defined by self-reported diagnosis of diabetes, glucose measurements or antidiabetic medication use at repeat visits on average 6 years from baseline. We examined the associations of baseline liver enzymes (sex-specific quartiles of ALT, AST, GGT) with incident diabetes using survey-weighted Poisson regression with follow-up time as an offset.

Results:
The weighted mean age was 38 years at baseline. A total of 793 adults developed diabetes during 6 years of follow-up. After adjusting for demographics and socioeconomic status, versus the lowest quartile, highest quartiles of ALT, AST and GGT were significantly associated with 1.5 to 3.5-fold increased risk of incident diabetes. Further adjusting for behavioral variables including diet and exercise, cardiovascular risk factors and cardiovascular medication use, the associations were attenuated and remained statistically significant for ALT (RR quartile 4 vs 1: 1.42[95% CI 1.07-1.90], P-trend=0.001) and GGT (RR quartile 4 vs 1: 1.97[1.34-2.88], P-trend<0.001) but not AST (RR quartile 4 vs 1: 1.28[0.96-1.70], P-trend=0.02). Adjusting for HOMA-IR further attenuated the associations, and GGT but not ALT remained significantly associated with incident diabetes.

Conclusion:
Elevated ALT and GGT levels are associated with increased risk of developing diabetes among Hispanics/Latinos. Additional work is needed to understand the relationship between NAFLD and diabetes risk in this population.
Abstract P074: Epidemiology of Diabetes Phenotypes and Association with Cardiovascular Risk in the National Health and Nutrition Examination Survey (NHANES)
Authors: Bancks Michael , Casanova Ramon , Gregg Edward , Bertoni Alain
Published: March 2019

Introduction:
A recent study among Scandinavian adults identified novel unique diabetes phenotypes using data on traditional diabetes characteristics. Our objective was to assess whether unique diabetes phenotypes are present in a multi-ethnic US sample and, if so, are differentially associated with cardiovascular disease (CVD) risk factors.

Methods:
We included 4300 NHANES participants (age ≥20 years) from exams 2003-04 to 2013-14 identified as having diabetes by any of the following: self-report of previous diabetes diagnosis, self-report of diabetes medication use, fasting glucose ≥126 mg/dL (≥8 hours fasting), random glucose ≥200 mg/dl, and glycated hemoglobin (HbA1c) ≥6.5%. We used an iterative data-driven method (
k-
means clustering) to partition the sex-stratified sample into unique groups based on data for each of the following: self-reported age of diabetes diagnosis, body mass index (BMI), waist circumference, HbA1c, and years of insulin use. We estimated the association between diabetes subgroup with traditional CVD risk factors, accounting for demographics and NHANES sampling methods.

Results:
We identified four unique subgroups of diabetes phenotypes related to age (AR), insulin use (IU), severe obesity (SOR), and severe hyperglycemia (SHG). Of the 4300 diabetes cases, 51.3% were AR, 5.9% were IU, 30.3% were SOR, and 12.5% were SHG (Table). We observed differences in subgroup prevalence by race/ethnicity. Compared to the AR phenotype, all groups had higher HbA1c and BMI, the IU and SOR groups had greater blood pressure and cholesterol medication use, and the IU group had worse profiles for renal, eye, and neuropathy complications.

Conclusion:
Our findings corroborate that diabetes is a heterogeneous disease with unique subgroups and, a novel aspect of our work, differentially distributed across race/ethnicity. Our findings challenge whether diabetes prevention and treatment strategies should be reconsidered to phenotype-specific in order to reduce diabetes incidence, morbidity, and mortality.
Abstract P075: Control of Cardiovascular Risk Factors Among Older Adults With Incident Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Malla Gargya , Cherrington Andrea , Zhu Sha , Cummings Doyle M , Clay Olivio , Brown Todd M , Lee Loretta T , Kimokoti Ruth , Cushman Mary , Safford Monika M , Carson April P
Published: March 2019

Background:
Control of risk factors is important for the primary prevention of cardiovascular disease among adults with diabetes. The objective of this study was to determine whether management of clinical (hemoglobin A1c <8%; BP <130/80 mm Hg; and statin use) and lifestyle factors (not currently smoking; physical activity on 4+ days/week; and moderate or no alcohol use) varied by race and sex among older adults with incident diabetes.

Methods:
This study included 1,420 Black and White adults from the REGARDS Study with incident diabetes at the follow-up exam (2014-16). Incident diabetes was defined as fasting glucose>=126 mg/dL, random glucose>=200 mg/dL, or use of diabetes medications among those without diabetes at baseline (2003-07). Modified Poisson regression was used to obtain prevalence ratios (PR) for the control of risk factors for Black versus White adults and assess race-sex interactions.

Results:
The mean age was 71.5 years, 53.6% were female, 46.1% were Black and 85.7% reported they were aware of their diabetes. BP control was lower for Black males than White males (p=0.0036), whereas statin use was lower for Black females than White females (p=0.0241). For lifestyle factors, not smoking was lower for Black males than White males (p=0.0187), whereas moderate or no alcohol use was higher for Black females than White females (p<0.0001). (Figure) Race-sex interactions were not statistically significant. In age and sex-adjusted models, Black adults were less likely to have BP controlled (PR=0.89; 95% CI=0.81, 0.99) or use statins (PR=0.88; 95% CI=0.80, 0.97) and more likely to report moderate or no alcohol use (PR=1.05; 95% CI=1.03, 1.07) than White adults. Control of other factors was similar.

Conclusion:
Although control of individual risk factors was generally high among older adults with incident diabetes, racial differences in BP control and statin use were apparent. Assessment and management of cardiovascular risk factors in this high-risk population remains important for prevention.
Abstract P077: Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Black Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Recent Cardiovascular Outcome Trials
Authors: Koutroumpakis Efstratios , Taegtmeyer Heinrich , Aguilar David
Published: March 2019

Introduction:
The prevalence of type 2 diabetes mellitus (T2DM) is higher in black individuals than non-Hispanic white individuals. Recent cardiovascular (CV) outcome trials have demonstrated CV benefit of glucagon-like peptide 1 (GLP-1) receptor agonists in patients with T2DM and high CV risk. Whether the benefit seen in the overall trial population extends to the subgroup of black individuals is not known given the limited sample size.

Methods:
We performed a meta-analysis of randomized CV outcome trials published after the issuance of Food and Drug Administration Guidance on antihyperglycemic medications in 2008.

Results:
Five trials assessing the CV benefit of GLP-1 receptor agonists in T2DM were identified (ELIXA, LEADER, SUSTAIN-6, EXSCEL, and HARMONY). ELIXA was excluded given the different primary outcome studied and the lack of complete outcome data by race. The four trials included in this meta-analysis enrolled 36,852 individuals, including 2,101 black participants (6%). The prevalence of black patients in the individual clinical trials ranged from 2% in the HARMONY trial to 8% in the LEADER trial. The composite primary outcome of CV death, non-fatal MI, or non-fatal stroke was recorded in 114 out of 1,031 black patients (11%) treated with a GLP-1 analogue compared to 136/1070 (13%) treated with placebo (Hazard Ratio 0.96, 95% Confidence Interval 0.57-1.62). The test for heterogeneity was significant (p=0.04).

Conclusions:
Despite the high prevalence of T2DM in black individuals, they remain underrepresented in the clinical trials assessing the effect of GLP-1 receptor agonists on CV outcomes in T2DM. The results of this meta-analysis suggest heterogeneity in the studies that have been performed to date. Future studies are needed to confirm the benefit of GLP-1 receptor agonists in black individuals with T2DM and high CV risk.

Figure: Hazard ratios of cardiovascular death, non-fatal MI, or non-fatal stroke in black patients with diabetes type 2 treated with a glucagon-like peptide-1 analogue versus placebo
Abstract P083: Relationship Between Prevalent Cardiovascular Disease and 6-Year Incidence of Diabetes: Findings From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Missikpode Celestin , Durazo-Arvizu Ramon A , Cooper Richard S , Castaneda Sheila F , Talavera Gregory A , Gallo Linda C , Llabre Maria M , Perera Marisa J , Perreira Krista M , Daviglus Martha , Lash James P
Published: March 2019

Introduction:
Cardiovascular disease (CVD) may prevent the adoption of healthy lifestyle habits such as physical activity, and thus may lead to weight gain and increased risk for lifestyle-related conditions such as diabetes mellitus (DM). Evidence suggests that medications commonly used in the management of CVD such as diuretics, β blockers, and statins are also associated with increased risk of diabetes. We examined the association of CVD with incident DM and investigated whether this association is mediated by change in BMI or medication use.

Methods:
Data from the HCHS/SOL Visit 1 (2008-2011) and Visit 2 (2014-2017) examinations were used to compare incidence of DM among persons with and without CVD at Visit 1. DM was defined using the American Diabetes Association criteria, and prevalent CVD using the Framingham Heart Study definition (i.e., self-reported history of coronary heart disease, cerebrovascular events, peripheral artery disease, or heart failure). Of the 8672 participants free of DM at Visit 1 and with complete data on DM at Visit 2 and on key covariates of interest, 2191 (25.3%) had prevalent CVD at baseline. A total of 2050 participants with CVD were matched to controls free of CVD at Visit 1 using 1:1 propensity matching. Covariates included in the propensity model were age, gender, educational attainment, marital status, Hispanic background, history of hypertension, family history of diabetes, health insurance coverage, chronic kidney disease at baseline, gestational diabetes, high cholesterol, metabolic syndrome, alcohol use, cigarette pack years, physical activity level, diet quality based on alternative healthy eating index, baseline BMI, baseline prediabetes. Matched pairs were analyzed. McNemar’s test was used to compare incidence of DM among cases and controls. The mediating effects of change in BMI and medication use were examined.

Results:
Covariate distributions were similar among participants with and without CVD. The incidence of DM among persons with CVD was 15.7% vs. 13.6% among those without CVD (p=0.06). No natural direct effect of CVD on DM was found. The association between CVD and incidence of DM was not mediated by change in BMI. On average, BMI increased by 0.38 (SE=2.56) and 0.33 (SE=2.50) among persons with and without CVD, respectively (p=0.55). The association between CVD and DM was indirectly mediated by the use of beta-blockers (percent mediated=24.8%), statins (percent mediated=9.8%), and diuretics (percent mediated=8.9%).

Conclusion:
There is slight evidence that medications used to treat CVD increase risk for new onset diabetes.
Abstract P087: Dietary Flavonoids Intake Reduced the C-Reactive Protein Concentration, Yet Did Not Associate With the Risk of Metabolic Syndrome Among Taiwanese Adults: A Representative National Study
Authors: Chien Kuo-Liong , Wang Jui , Hsieh Cheng-Tzu
Published: March 2019

Background and Hypothesis:
Evidence about the role of various flavonoids in atherosclerosis prevention was still controversial. We investigated the association between dietary flavonoid intakes and the level of C-reactive protein as well as the risk of metabolic syndrome among a national representative sample from the Nutrition and Health Surveys in Taiwan during 2005 and 2008.

Methods:
A total of 2439 adult participants (51.9% women, 54.3±17.6 years) who provided detailed food frequency questionnaire and clinical as well as biochemical data were recruited. We measured total and six flavonoids, including flavone, flavonol, flavanones, flavan_3_ol, anthocyanidins, and isoflavones from the USDA Database for the Flavonoid Content of Selected Foods. C-reactive protein was measured by nephelometry. Definition of metabolic syndrome was followed using the Third Adult Treatment Panel criteria, with a modification of the criteria for Asian population.

Results:
The mean dietary total flavonoid intake was 142.6±306.0 mg/day (median, 42.9, interquartile range, 11.2-137.2 mg/day). C-reactive protein was inversely related to various dietary intakes, including flavone, flavonol, flavan_3_ol, anthocyanidins, and total flavonoids (coefficients ranging from -0.04 to -0.06, all
P
<0.05). After adjusted for age and gender, participants among the highest quantile of dietary flavonol intake has a significant lower C-reactive protein concentration (-0.075±0.037 mg/dL), compared with those among the lowest quartile (
P
test for trend, 0.07). Participants among the highest total flavonoid intake have a lower C-reactive protein level (-0.096±0.037 mg/dL,
P
test for trend, 0.046). With regards to the risk of the metabolic syndrome, a higher dietary flavonoid intake was not associated with metabolic syndrome status (adjusted odds ratio, 0.96, 95% confidence interval, 0.73-1.89 for flavonol,
P
test for trend, 0.57).

Conclusions:
We demonstrated that dietary flavonoid intakes were inversely associated with the C-reactive protein concentration. Further intervention trials are warranted to elucidate the biological mechanism of protective effect of flavonoids.
Abstract P088: Assessing the Use of a Preventive Cardiology Lifestyle Screening (PCLS) Tool in a Pediatric Sub-Specialty Lipid Clinic
Authors: Griggs Suzanne Skylar
Published: March 2019

Objective:
Lifestyle modification is recommended to improve cholesterol levels in the pediatric population with the goal of reducing CVD risk. Existing tools assessing pediatric lifestyle habits are cumbersome and lack specificity. We developed the Preventive Cardiology Lifestyle Screen (PCLS) to assess behaviors relevant to CVD risk, and evaluated its use in a subspecialty lipid clinic at a large pediatric teaching hospital.

Methods:
Eligible participants were 2-21 years old, English speaking and presenting for care in a pediatric lipid clinic. We evaluated test-retest agreement using weighted kappa statistics, and validity of PCLS compared to longer research questionnaires [Block Food and Activity Questionnaires and Rapid Eating Assessment for Patients (REAP)] using Spearman correlation coefficients.

Results:
Participants (n = 138) had a mean age of 13 years; 50% were female, 22% reported a household income <$50,000. Median non-HDL cholesterol was 149.2 mg/dL and HDL cholesterol was 48 mg/dL. Of participants 2-17 years old (n=122), 15% were overweight and 46% were obese. Test re-test agreement for those ≥10 years (n=24) was good (weighted kappa >.75) for fruits and vegetables (0.83, 0.82 respectively), chicken no skin (0.89), processed meats (0.78) and sports drinks (.75). Test-retest agreement was poor (weighted kappa <.50) for regular soda intake (0.40), regular fat dairy (0.47), and eating lunch (0.45). Activity (sports 0.94 gym class 0.77) and inactivity (weekend video games 0.88 hours of sleep 0.78) overall had high test-retest agreement for most questions. Examining across dietary domains, the PCLS performed well at baseline compared to the BLOCK and REAP surveys in the domains of saturated fat, glycemic index, sodium and fiber
(Table 1).

Conclusion:
The PCLS performed well on test re-test agreement, and responses correlated with previously validated research tools in most domains. This tool shows promise for use in the care of children with CVD lipid disorders.
Abstract P096: Factors Related to Added Sugars Intake Among US Adults With or Without Cardiovascular Diseases
Authors: Lee-Kwan Seung Hee , Lundeen Elizabeth , Jackson Sandra L , Blanck Heidi M , Park Sohyun
Published: March 2019

Added sugars intake increases risk of obesity, hypertension, dyslipidemia, and cardiovascular diseases (CVD) and may impact disease management. We examined factors related to added sugars intake among US adults with or without CVD and risk factors using 2015 National Health Interview Survey (NHIS) (n=30616). NHIS used the National Cancer Institute (NCI) Dietary Screener Questionnaire (DSQ) to assess individual’s dietary intake. The DSQ used 8 questions to assess added sugar intake over the last 30 days. We used the NCI’s scoring algorithm to convert screener responses to estimate total added sugars intake (tsp/day) by characteristics within 3 strata—adults with a history of heart disease/stroke (CVD, n=4658), adults with hypertension/high cholesterol but without CVD (HTHC, n=10476), and adults without CVD or HTHC (no CVD, n=15482). Because our goal was not to look at association between added sugar and CVD risk, comparisons among the groups were not made. Characteristics included age, sex, race/ethnicity, education, income, marital status, smoking, and weight status. We used multiple linear regression to assess independent associations between intake and characteristics. Added sugars intake was similar in magnitude across all 3 strata (CVD 16.9, HTHC 17.0, and no CVD 17.3 tsp, respectively). We found increased added sugars intake with younger age, lower education, lower income, and smoking among adults regardless of CVD status. Having obesity was positively related to increased intake for adults without CVD, but no association was found between the weight status and intake in adults with CVD or HTHC. Improving diet may prevent CVD and aid disease self-management. Product reformulation to reduce added sugars and strategies to counsel and support individuals to reduce dietary added sugars may be needed to optimize heart health.