bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9789: Transient Elevation of Highly Sensitive Troponin T Levels in Patients With Documented Coronary Artery Disease Following Stress Myocardial Perfusion Imaging
Authors: Pfeiffer Stefan P , Schnabel Teresa , Höpfner Wolfgang , Saadé Christiane , Zimmermann Rainer , Katus Hugo A
Published: July 2021

Introduction:
Cardiac troponins are the preferred biomarkers of myocardial injury. More sensitive assays led to the detection of circulating troponins not only in myocardial infarction, but also in apparently healthy subjects after prolonged exercise.

Hypothesis:
In the era of highly sensitive troponin T (hs-TnT) tests we assesed the hypothesis that brief but intense exercise during diagnostic tests might cause elevated troponin levels in patients with stable coronary artery disease (CAD).

Methods:
Seventy-two patients (71% male, age 64±10 years) with documented CAD, LVEF >45%, normal renal function and normal baseline hs-TnT levels (<14 ng/l) underwent myocardial perfusion imaging (MPI, Tc-99m sestamibi) using bicycle stress test (n=19) or adenosine stimulation (n=55). Hs-TnT levels were detected immediately before and immediately after stress, and again after 4 hours and 24 hours. The extent of stress-induced myocardial ischemia was estimated from perfusion scores derived from single-photon emission computed tomography (SPECT) post stress and rest images. Significant reversible myocardial ischemia was prospectively defined as regional perfusion abnormality ≥10% of the left ventricular myocardium.

Results:
Transient elevations of hs-TnT levels above the normal limit occurred in 5/72 patients (7%) after diagnostic stress testing with a peak level at 4 hours after stress. Hs-TnT elevations were more common in patients with stress-induced myocardial ischemia (3/12, 25%) compared to patients without ischemia (2/60, 3%; p=0.038). However, no relation between peak hs-TnT levels and the extent of reversible myocardial ischemia was found (r=-0.16, n=72, p=NS). Furthermore, peak hs-TnT levels were similar with both types of stress (bicycle 6.6 [4.0 – 10.5] pg/l versus adenosine 5.1 [3.1 – 8.6] pg/l, median [IQR]).

Conclusions:
Transient hs-TnT elevations are quite common after diagnostic stress testing and occur more frequently in patients with documented reversible ischemia. No relation between peak hs-TnT levels and the extent of reversible myocardial ischemia at MPI was obtained. In conclusion this suggests that hs-TNT elevation during stress testing depends on other factors then those leading to SPECT-detected myocardial ischemia.
Abstract 9796: Association of Unrecognized Myocardial Infarctions With Impaired Fasting Glucose in the Multi-Ethnic Study of Atherosclerosis
Authors: Stacey Richard B , Leaverton Paul E , Schocken Douglas D , Bertoni Alain G
Published: July 2021

Background:
It has been estimated that approximately 25% of initial myocardial infarctions (MI) are unrecognized (UMI). The prognostic implications of UMI’s have been shown to be as severe as those of symptomatic MI’s. Risk factors for UMI’s are not well understood. Because diabetes mellitus is known to be a risk factor for UMI, it is reasonable to investigate impaired fasting glucose (IFG) as a candidate risk factor. Additionally, it has recently been estimated that up to one-third of all adult Americans have IFG.

Methods:
The relationship between IFG and UMI was examined in the Multi-Ethnic Study of Atherosclerosis (MESA): a cohort of individuals aged 45 to 84 years without clinical cardiovascular disease. At baseline, participants with normal fasting glucose (NFG; n = 4955) and IFG (n=930) underwent a baseline 12-lead electrocardiogram (ECG). Using Minnesota code, an UMI was identified by the presence of pathological Q waves or minor Q waves with ST-T abnormalities. Crude and adjusted odds ratios (ORs) were calculated. Logistic regression was used to adjust for covariates in 2 models. Model 1 adjusted for age, race, gender, and body mass index. Model 2 adjusted for model 1 + systolic blood pressure, diastolic blood pressure, anti-hypertensive medication use, total cholesterol, HDL cholesterol, lipid-lowering medication use, and cigarette use.

Results:
The sample was 46% male, 41% white, 26% black, 20% Hispanic, and 12% Asian. There were 72 UMIs identified in the normal fasting glucose (NFG) subjects and 30 UMIs among the IFG subjects. The two corresponding prevalences (1.4% vs. 3.2%) resulted in a crude OR for UMI of 2.26 (95% Confidence Interval (CI): 1.47-3.48; p<0.001). With model 1 adjustments, the OR for UMI in IFG compared with NFG was 1.78 (95% CI: 1.12-2.8; p=0.015). With further adjustments in model 2, this relationship remained significant (OR: 1.63 (95% CI: 1.02-2.56); p=0.041).

Conclusion:
Unrecognized myocardial infarctions by electrocardiogram are associated with impaired fasting glucose in a population without overt cardiovascular disease. Because of the high prevalence of impaired fasting glucose, the implications of this finding may have ramifications for a large proportion of the adult population.
Abstract 04: Incident Heart Failure and Longitudinal Cognitive Trajectories in the Cardiovascular Health Study
Authors: Schank Christa , Blades Natalie J , Chaudhry Sarwat I , Dodson John A , Longstreth W T , Heckbert Susan R , Psaty Bruce M , Arnold Alice M , Dublin Sascha , Sitlani Colleen M , Gardin Julius M , Thielke Stephen M , Nanna Michael , Gottesman Rebecca F , Newman Anne B , Thacker Evan L
Published: July 2021

OBJECTIVE:
To determine whether older adults who develop incident heart failure (HF) experience faster cognitive decline than those without HF.

METHODS:
We analyzed longitudinal cognitive test data from the Cardiovascular Health Study, a community-based study of adults aged 65 years and older. Participants in this analysis did not have HF or history of stroke at baseline and were censored when they experienced incident clinical stroke. Incident HF was identified by self-report of physician-diagnosed HF and confirmed by adjudicated review of inpatient and outpatient medical records and medication use. Outcomes were mean score and rate of decline in mean score on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to nine times from 1990 to 1998. A linear mixed effects model was used to model the relationship of cognitive decline with HF and age, adjusted for demographics, health behaviors, and comorbid conditions including hypertension and diabetes.

RESULTS:
Analyses included 5,211 participants with mean age 74 years at baseline, of whom 545 (10.5%) developed incident HF over a median follow-up of 7.8 years. Mean 3MSE score was lower at the time of HF diagnosis compared with no HF, and declined faster after incident HF compared with no HF. For example, at age 80, covariate-adjusted predicted mean 3MSE score was 88.6 points (95% CI: 88.3, 89.0) in participants without HF, but 87.6 points (95% CI: 87.3, 87.9) in those with newly diagnosed HF. Predicted five-year decline in mean 3MSE score from age 80 to age 85 was 5.9 points (95% CI: 5.7, 6.0) in participants without HF, but 10.0 points (95% CI: 8.6, 11.3) in those diagnosed with incident HF at age 80. Faster decline in 3MSE score after HF diagnosis was seen at all ages studied. The figure shows predicted mean 3MSE score trajectories without HF (solid line) and after HF diagnosed at ages 70, 75, 80, and 85 (dashed lines), with 95% CI shaded.

CONCLUSIONS:
Older adults diagnosed with incident HF experience faster average cognitive decline than those without HF.
Abstract 13: Relations of Midlife Exercise Blood Pressure, Heart Rate and Fitness to Late Life Brain Structure and Function
Authors: Spartano Nicole L , Himali Jayandra J , Beiser Alexa S , DeCarli Charles , Vasan Ramachandran S , Seshadri Sudha
Published: July 2021

Background:
Exaggerated blood pressure (BP) and vascular stiffness have been associated with lower cognitive performance and brain atrophy in older age. The brain is a high-flow, low impedance organ that is susceptible to fluctuation in BP. Poor cardiovascular (CV) fitness is also emerging as a factor associated with cognitive decline in older age. The BP and heart rate (HR) response to exercise are impacted by CV fitness; and exercise BP is also highly determined by vascular stiffness. The objective of this investigation was to examine whether poor fitness and exaggerated BP and HR response to exercise in midlife are associated with worse brain morphology in later life.

Methods:
A subset of Framingham Offspring Study participants (n=1340, 54.5% F) free from dementia and CV disease underwent an exercise treadmill test (the modified Bruce protocol) in midlife [mean age of 41±9 y] and continued until exhaustion or until 85% HR maximum (age- and sex- predicted) was reached. Exercise test duration was used to estimate VO2max. BP and HR were measured during stage 2. MRI scans of the brain and neurocognitive tests (Trail Making Tests [Trails] B-A) were administered in later life [mean age of 59±9 y].

Results:
A greater exercise systolic (S)BP and HR response at midlife was associated with smaller total cerebral brain volume (TCBV) in later life (β=-0.09 ±0.04, p=0.042; β=-0.10 ±0.05, p=0.033) after adjustment models including resting SBP and HR; an effect equal to approximately 0.5 y brain aging for every 11.1 mm Hg increase in SBP or 10 beats per min increase in HR. Higher estimated VO2max at midlife was associated with larger TCBV in later life (β=0.03 ±0.01, p=0.014). Additionally, greater exercise HR response at midlife was associated with smaller frontal lobe volume in later life (β=-0.012 ±0.05, p=0.002). Exercise diastolic (D)BP at midlife was associated with poorer performance on Trails B-A in later life (β=-0.009 ±0.004, p=0.017) and the achievement of target HR during exercise was associated with better performance on Trails B-A in later life (β=0.03 ±0.01, p=0.044). Resting SBP at midlife was associated with greater white matter hyperintensity volume in later life (β=0.05 ±0.02, p=0.031); and resting SBP and DBP at midlife were also associated with smaller frontal lobe volume in later life (β=-0.17 ±0.07, p=0.011; β=-0.21 ±0.10, p=0.030).

Conclusion:
Our investigation provides new evidence that lower midlife fitness and worse exercise BP and HR responses are associated with smaller brain volumes and poorer cognitive performance nearly two decades later. Promotion of midlife physical fitness may be an important step towards ensuring healthy brain aging in the population.
Abstract 19: Dietary Lipophilic Load and Dietary Lipophilic Index with Risk of Coronary Heart Disease in Middle-Aged Women: Beyond Conventional Fat Classifications
Authors: Ding Eric L , De Vito Katerina M , Wu Hongyu , Sun Qi , Pan An , Campos Hannia , O'Reilly Eilis J , Manson JoAnn E
Published: July 2021

Introduction:
Studies indicate dietary types of fats are associated with risk of coronary heart disease (CHD). Traditional broad classifications may incompletely capture the diversity of fatty acids on CHD. The novel lipid index Dietary Lipophilic Load (DLL) reflects a unique combination of fatty acid fluidity, intermolecular attraction, plus relative fat quantity, while Dietary Lipophilic Index (DLI) is a measure of average fat fluidity, regardless of fat quantity. Thus, we evaluated the association, DLL and DLI, with risk of incident CHD.

METHODS:
Participants included 30,932 women in the Women’s Health Study (WHS), who were free of major chronic diseases at baseline. DLL was calculated by weighted summation of the multiplicative product of each fatty acid’s intakes (g/day) and its melting points (Celcius); DLI was calculated by dividing DLL by total fat intake (g/day). Hazard ratios (HRs) were adjusted for established risk factors, with updated dietary data, and potential mediators. We also investigated hypothesized interactions with C-Reactive Protein (CRP).

RESULTS:
There were 1137 cases of incident CHD in 525,828 person-years over 19 years follow-up. At baseline in over 27,000 women with blood samples, DLL and DLI were not correlated with serum cholesterol, triglyceride, HbA1c, ICAM-1, or CRP biomarkers (r<0.02 for all). In overall multivariate analysis, DLL was associated with higher risk of CHD (extreme quintile HR=1.40, 95%CI: 1.11-1.76, P trend=0.0002), while DLI was not (HR=0.83, 95%CI: 0.67-1.03, P trend=0.75). DLL results were independent beyond adjustment for dietary trans, saturated, monounsaturated, and polyunsaturated fats, nor their aggregate adjustment or the P:S ratio. DLL effects persisted even adjusting for CRP (HR=1.29, P-trend=1 mg/dL for DLL (extreme quintile HR=1.38, 1.02-1.88), than among individuals with low CRP <1 mg/dl for DLL (HR=1.08, 0.68-1.72), with P-interaction<0.0001. Furthermore, CRP also modified DLI, where effects again diverged among higher CRP (HR=0.98, 0.73-1.31) versus low CRP (HR=0.45, 0.27-0.74), with P-interaction<0.0001. Moreover, adjustment of triglycerides, HbA1c, ICAM-1, LDL or HDL cholesterol also did not materially affect overall results.

CONCLUSION:
Results indicate that DLL is associated with increased risk of incident CHD, independent of traditional risk factors, conventional dietary fat classifications, and major CHD biomarkers. Effects of DLL and DLI appear to be modified by levels of CRP. DLL appears to be an important novel dietary fat index that captures additional CHD risk information beyond biomarkers and traditional dietary fat categories. Further studies are warranted.
Abstract 51: Heart Rate Variability and its Association with Cognitive Decline Over 20 years: The Atherosclerosis Risk in Communities - Neurocognitive Study
Authors: Lopez Faye L , Chen Lin Y , Soliman Elsayed Z , Deal Jennifer A , Gottesman Rebecca F , Heiss Gerardo , Mosley Thomas H , Alonso Alvaro
Published: July 2021

Background:
Heart rate variability (HRV) reflects activity of the sympathetic and parasympathetic nervous systems. Low HRV is associated with an increased risk of heart disease and mortality, and risk factors for lower HRV are also linked to cognitive impairment. We assessed whether HRV measures are associated with cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study.

Methods:
We studied 10,623 individuals (23% African-American, 57% female, mean age 54). HRV measures were obtained from 2-minute electrocardiogram rhythm strips in 1987-89 and include the standard deviation of all normal RR intervals (SDNN), root mean square of successive differences (rMSSD), low frequency (LF) and high frequency (HF) spectral power, and the LF/HF ratio. Cognitive function was measured in 1990-92, 1996-98 and 2011-2013 using 3 neuropsychological tests: Delayed Word Recall (DWR), Digit Symbol Substitution (DSS), and Word Fluency (WF). Scores were standardized and their average was used as a test of global cognitive function. HRV measures were log-transformed and we used linear regression models fit with generalized estimating equations to evaluate associations with cognitive performance over time, which was modeled as a linear spline with a knot at year 6 of follow-up.

Results:
At baseline, lower levels of HRV were significantly associated with reduced scores in all cognitive tests. Lower baseline levels of HRV measures of sympathetic activity (LF and LF/HF ratio) were associated with faster decline in tests evaluating executive function and language (DSST and WF) (table). We did not observe associations between parasympathetic nervous system measures (rMSSD and HF) and cognitive decline.

Conclusion:
In this large population-based study, markers of cardiac sympathetic dysfunction measured in mid-life were associated with a faster decline in executive function, which is more frequently affected in cognitive impairment of vascular origin. Additional research should explore the mechanism for this association.
Abstract MP04: 25 year Physical Activity Trajectories and Development of Subclinical Coronary Artery Disease as Measured by Coronary Artery Calcium: the CARDIA Study
Authors: Rana Jamal S , Murillo Rosenda , Quesenberry Charles P , Sorel Michael E , Sternfeld Barbara , Gabriel Kelley P , Carnethon Mercedes R , Liu Kiang , Reis Jared P , Allen Norrina B , Lloyd-Jones Donald , Carr J. Jeffrey , Sidney Stephen
Published: July 2021

Background:
Physical activity (PA) has been shown to be protective against the development of clinical cardiovascular disease. There is paucity of data regarding the association of long term PA patterns and development of subclinical atherosclerosis, as measured by coronary artery calcium (CAC). Studies so far are limited by evaluation of PA only at baseline. The goal of this study was to identify 25 year patterns of PA from young to middle age and its association with development of CAC.

Methods:
CARDIA is a prospective longitudinal study of black and white men and women, ages 18-30 years at baseline in 1985-86, with up to 7 follow-up exams over 25 years of follow-up. PA was determined at each exam by a questionnaire that assessed typical PA during the past 12 months for 13 types of activities. Men and women who had at least 3 measures of PA during the 25 years of follow up and CAC assessment at the Year 25 exam were included (N= 3178). CARDIA Physical Activity Score > 300 units is approximately equivalent to >150 min/week of moderate or vigorous physical activity and was considered as meeting PA guidelines (MPAG). Latent class modeling was used to identify unique trajectories of PA. Odds ratios for CAC were estimated from a multivariable logistic model controlling for age, sex, ethnicity, hypertension, diabetes, BMI, smoking status and education.

Results:
Our analyses showed 5 unique PA trajectories (figure). 1. Maintaining-not MPAG (46.5%); 2. maintaining-MPAG (35.6%); 3 increasing-MPAG (8.5%); 4. decreasing-MPAG (6.5%), and 5. maintaining- > 3 fold MPAG (2.4%). Compared with the maintaining-not MPAG, the multivariable adjusted odds ratio for presence of CAC (non-zero CAC score) was 1.02 (95% CI, 0.84-1.24) for maintaining-MPAG, 1.07 (95% CI, 0.78-1.44) for increasing-MPAG , 1.01(95% CI, 0.72- 1.41) for decreasing-MPAG , and 1.37 (95% CI, 0.82-2.27) for maintaining- > 3 fold MPAG.

Conclusion:
Long-term trajectories for levels of PA through young adulthood are not associated with development of subclinical atherosclerosis by middle age.
Abstract MP05: Leisure-Time Running and Incident Type 2 Diabetes
Authors: Lee Duck-chul , Lavie Carl J. , Church Timothy S. , Sui Xuemei , Blair Steven N.
Published: July 2021

Introduction:
There is still little evidence on the dose-response relation between leisure-time running and incident type 2 diabetes (T2D).

Hypothesis:
We examined the hypothesis that running reduces the risk of developing T2D.

Methods:
Participants were 19,347 adults aged 18 to 100 years (mean age, 44) who received an extensive preventive medical examination during 1974-2006 in the Aerobics Center Longitudinal Study. Participants were free of cardiovascular disease, cancer, and T2D at baseline. Running and other physical activities were assessed on the medical history questionnaire by self-reported leisure-time activities during the past 3 months. We defined T2D as fasting glucose ≥126 mg/dl, insulin use, or physician-diagnosis during follow-up medical examinations. Cox regression was used to quantify the association between running and T2D after adjusting for baseline age, sex, examination year, body mass index, smoking status, heavy alcohol drinking, abnormal electrocardiogram, hypertension, hypercholesterolemia, and levels of other physical activities.

Results:
During an average follow-up of 6.5 years, 1,015 adults developed T2D. Approximately 30% of adults participated in leisure-time running. Runners had a 29% lower risk of developing T2D compared with non-runners. The hazard ratios (95% confidence intervals) of T2D were 0.97 (0.74-1.27), 0.66 (0.49-0.89), 0.62 (0.45-0.85), 0.78 (0.58-1.03), and 0.57 (0.42-0.79) across quintiles (Q) of running time (minutes/week); 0.99 (0.76-1.30), 0.60 (0.44-0.82), 0.72 (0.55-0.94), 0.65 (0.47-0.90), and 0.63 (0.47-0.86) across Q of running distance (miles/week); 1.08 (0.83-1.40), 0.67 (0.50-0.90), 0.70 (0.53-0.93), 0.61 (0.45-0.83), and 0.53 (0.36-0.76) across Q of running frequency (times/week); 0.95 (0.73-1.24), 0.70 (0.52-0.94), 0.62 (0.45-0.84), 0.73 (0.55-0.97), and 0.58 (0.42-0.80) across Q of total amount of running (MET-minutes/week); and 0.95 (0.71-1.28), 0.76 (0.59-0.99), 0.59 (0.42-0.83), 0.66 (0.51-0.85), and 0.62 (0.43-0.90) across Q of running speed (mph), respectively, compared with no running after adjusting for confounders including levels of other physical activities.

Conclusions:
Participating in leisure-time running is associated with markedly lower risk of developing T2D in adults. Except for those in the very lowest Q for running doses, even relatively low running doses (starting with Q 2) were associated with marked reductions in T2D risk over time, supporting the prescription of running to reduce T2D.
Abstract MP12: Electronic Health Record-Based Assessment of Cardiovascular Health
Authors: Foraker Randi E , Shoben Abigail B , Lai Albert M , Payne Philip R , Kelley Marjorie , Lopetegui Marcelo A , Langan Michael , Tindle Hilary A , Jackson Rebecca D
Published: July 2021

INTRODUCTION:
An electronic health record (EHR)-based visualization tool was developed to facilitate patient-provider communication around the American Heart Association’s (AHA) Life’s Simple 7™ for cardiovascular health (CVH). The tool automatically populates with patient data from the EHR and utilizes a stoplight color scheme to indicate “ideal” (green), “intermediate” (yellow), and “poor” (red) CVH.

METHODS:
CVH was defined for smoking, body mass index, blood pressure, and cholesterol according to AHA criteria. For this analysis, diabetes was characterized as either yellow (treated) or green (untreated), as most patients were missing fasting glucose values. An overall CVH score was calculated and ranged from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. The CVH tool first launched within the EHR of our outpatient intervention clinic in October 2013. The change in CVH of female patients ages 65 and older seen in the clinic during the pre-intervention period (May 1 - July 31, 2013) and the post-intervention period (May 1 - July 31, 2014) was described.

RESULTS:
One hundred nine women (average age 74 years; 35% black), seen pre- and post-intervention, were enrolled in the study. The mean CVH score was 6.0 and the mean fractional score (actual score/maximum possible) was 0.63 at both time points, and neither differed significantly by race. Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor in 2013 and 2014. From 2013 to 2014, the proportion of obese women decreased from 47% to 43%, and the proportion of normal-weight women increased from 15% to 19%. Favorable changes were also seen for diabetes.

CONCLUSIONS:
This is the first study to develop and implement an EHR-based CVH visualization tool. Our study demonstrates that it is feasible to implement patient-centered EHR-based tools at the point-of-care in the primary care setting. Future work is needed to assess how to best harness the potential of such tools.
Abstract MP24: Comparison of Predictive Ability of Dietary and Lifestyle Scores For 10-Year Risk of Cardiovascular Mortality in a Pan-European Cohort Study
Authors: Lassale Camille , Van der Schouw Yvonne , Beulens Joline , Fagherazzi Guy , Roswall Nina , Buijsse Brian , Trichopoulou Antonia , Weiderpass Elizabete , Freisling Heinz , Romaguera Dora , Wark Petra , Riboli Elio , Tzoulaki Ioanna
Published: July 2021

Introduction:
Diet quality indexes and lifestyle indexes (which also include other lifestyle characteristics such as smoking and obesity) have recently received increased attention in disease prevention.

Hypothesis:
We aimed to investigate the comparative predictive performance of a comprehensive list of dietary and lifestyle indexes in relation to cardiovascular (CVD) mortality.

Methods:
We applied these indexes to men and women from 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study and examined their association with 10-year CVD mortality risk. We computed 10 dietary indexes and 2 diet and lifestyle indexes and calculated quartiles. Cox proportional hazard models stratified by age and study centre, adjusted for age, BMI, energy intake, smoking status, physical activity and educational level were fit to estimate Hazard Ratios (HR) and 95% CI. Harrell’s C-statistic, a discrimination measure of predictive performance, was calculated for each model.

Results:
After 10 years of follow up, 3761 CVD deaths were observed among 451 256 participants. All dietary indexes, except one, were significantly associated with CVD mortality with HR ranging from 0.75 to 0.84 for the fully adjusted model when comparing top vs bottom quartile (Table 1). Stronger effect size was observed for the diet and lifestyle indexes, particularly the Healthy Lifestyle Index (HLI). Discrimination of the full models was high and did not vary between scores. We found no heterogeneity in HRs across countries for most scores, except a modest heterogeneity for Mediterranean diet scores (I
2
=48%) and HLI (75%); however, heterogeneity across countries of the C-statistics was high for all scores (I
2
= 87%).

Conclusion:
Our results show that diet quality as a whole, or a cluster of lifestyle behaviours including diet, are consistently associated with a reduction of 10-year CVD mortality risk and that models comprising only age, sex and lifestyle risk factors could serve as predictors of CVD mortality.
Abstract MP45: Liver Fat Content Does Not Account for the Strong Association of Fetuin-A with Diabetes Risk in Women: The Multi-Ethnic Study of Atherosclerosis
Authors: Aroner Sarah A , Mukamal Kenneth J , St-Jules David E , Budoff Matthew J , Katz Ronit , Criqui Michael H , Allison Matthew A , de Boer Ian H , Siscovick David S , Ix Joachim H , Jensen Majken K
Published: July 2021

Introduction:
Fetuin-A, a hepatic secretory protein, has been associated with risk of diabetes. However, liver fat content may be an important confounder or effect modifier not fully accounted for in previous studies. Further, it remains unclear whether associations differ between women and men.

Aim: In an ethnically diverse cohort of women and men, we assessed the association of fetuin-A with risk of diabetes and investigated the role of liver fat in this association.

Methods:
We conducted a case-cohort study nested in the Multi-Ethnic Study of Atherosclerosis among 1,957 subcohort members and 455 cases (265 of whom belonged to the subcohort) with follow-up from 2000-2012. Fetuin-A was measured from baseline plasma samples by enzyme-linked immunosorbent assay, and liver fat was assessed via computed tomography. Associations were estimated using multivariable-adjusted Cox models, with weighting to account for the case-cohort design.

Results:
The association of fetuin-A with risk of diabetes differed between women and men (p-interaction = 0.001). Each standard deviation (SD) higher fetuin-A concentration (0.10 g/L) was associated with a hazard ratio (HR) of 1.51 (95% CI: 1.32-1.74, p <0.0001) among women and an HR of 1.12 (95% CI: 0.94-1.32, p = 0.20) among men. With additional adjustment for liver fat, associations were slightly attenuated in both women (HR per SD fetuin-A = 1.37, 95% CI: 1.19-1.59, p<0.0001) and men (HR = 1.06, 95% CI: 0.90-1.24, p = 0.40). Additional adjustment for other clinical variables had minimal impact on multivariable-adjusted estimates (Figure). Associations did not differ by degree of liver fat content (p-heterogeneity >0.25 for both women and men).

Conclusions:
Fetuin-A was associated with diabetes risk, particularly in women, even after adjustment for liver fat.
Abstract MP61: Comparing the Influence of Individual vs. Community Socioeconomic Factors on Cardiovascular Health
Authors: Pilkerton Courtney , Singh Sarah , Christian Adam , Bias Thomas K , Frisbee Stephanie J
Published: July 2021

BACKGROUND:
Despite advances in treatment and decreases in risk factors, cardiovascular disease remains the cause of 1/3 deaths. Both prevalence and cost of cardiovascular disease are expected to increase over the coming decades. In supporting health efforts to reduce cardiovascular disease burden, the AHA developed a comprehensive cardiovascular health index (CVHI) incorporating behavioral and biological factors. A thorough understanding of health determinants requires inclusion of factors at multiple levels of proximity to individuals and communities. The objective of this study was to identify the demographic characteristics of individuals and areas in which they live that promote cardiovascular health. METHODS: Data from 2011 BRFSS were used to calculate CVHI. Participants were ineligible if missing information necessary to calculate CVHI (n = 156,973), if pregnant or pregnancy status was unknown (n = 3,693), or if missing county code (n = 37,163). Poisson model was used to determine change in the expected number of ideal factors an individual had due to various individual and county demographic characteristics. County demographic variables were abstracted from the Area Health Resource File. RESULTS: The effect of a 10 year increase in an individual’s age decreased the expected number of ideal CVHI factors by 6.31% (6.14, 6.47). Females had a 12.09% (11.48, 12.70) increase in expected number of ideal CVHI factors over males. Non-Hispanic blacks had a 7.42% (6.39, 8.44) decrease in expected number of ideal CVHI factors compared to other race/ethnicities. An individual’s education and income level had a dose response association with CVHI. Compared to having less than a high school education, those with a high school education had a 5.15% increase in the expected number of ideal CVHI factors and an 11.64% increase for those with a 4 year degree. As an individual’s income category increased there was a 7.89%, 10.79%, and 16.34% increase respectively in the expected number of ideal CVHI factors. For county demographics increases in the expected number of ideal factors was seen with increases in Hispanic population (0.93% per 10% increase) and increasing socioeconomic index (0.14% per 10 unit increase). A 10% increase in the population with no health insurance decreased the expected number of factors 1.49% (0.75, 2.22). There was a significant interaction (p <0.01) between an individual’s income level and the socioeconomic status of the county lived in, with those in lower income categories benefiting more from living in higher socioeconomic areas than those with higher incomes. In conclusion, both individual and county demographic characteristics were associated with changes in an individual’s CVHI. CONCLUSION: This information can assist public health and government agencies in developing priorities and evaluating the potential effectiveness of policies and programs.
Abstract P035: Simple Cooking With Heart Culinary Literacy Program: Skill Acquisition, Attitudinal Change, Intention and Efficacy Lead to Improved Dietary Consumption Patters
Authors: McKnight Liz , Vafiadis Dorothea K
Published: July 2021

Introduction:
Less than 1% of Americans consume a diet that is consistent with the American Heart Association (AHA) definition for ideal cardiovascular health. In-home food preparation is associated with healthier dietary patterns and is more likely to align with current AHA recommendations for healthy eating.

Hypothesis:
The AHA’s Simple Cooking with Heart (SCwH) program aims to increase the healthfulness of family meals by addressing common barriers to cooking at home (lack of time, lack of skill, lack of budget). By increasing self-efficacy, individuals will demonstrate changes in attitudes and intention to choose wisely when shopping, as well as prepare and consume more meals at home, resulting in improved diet quality. Exposure to a “live” demonstration program that engages participants will improve cooking confidence and change attitudes in low-socioeconomic populations, compared to an online only, skills-building video exposure. The theoretical framework for this intervention is based upon the Health Belief Model.

Methods:
A 4-week, 2-cell controlled exposure study design measured the discrete impact of SCwH on low-income individuals exposed to a live cooking demonstration experience compared to individuals who received an online only exposure. All individuals were assessed via questionnaire post baseline for changes in attitude/intention, skill acquisition, frequency of meals prepared in home, dietary consumption and relevance of materials and information received; 337 participants completed the 4 week study.

Results:
Participation in “live” cooking demonstrations had a near immediate positive impact on participants’ intentions to: increase number of meals at home, reduce added salt and sugar/sweeteners, eat more fruits/vegetables/whole grains, and decrease unhealthy items. Participants who receive a “live” exposure have increased outcomes compared to those who received an online-only exposure. Demonstration participants, compared to web-only participants, reported: more often using new information in-home and reported a significant increase in the frequency of consuming healthy food items and a decrease in unhealthy items. Online-only cell respondents reported no significant difference in the mean frequency an item (healthy or unhealthy) was consumed. Both cells reported learning new information/skills.

Conclusions:
Culinary skill development, changing perceptions about affordable meals and addressing barriers to preparing and consuming meals in-home can be an effective way to improve dietary quality in low-socioeconomic populations. Exposure to “live” demonstration programs can increase effectiveness and promote healthier cooking at home; however, online-only intervention can still have a positive impact.
Abstract P038: Dietary Capsaicin May Decrease Blood Pressure Through Enhancing NO With eNOS Activation in 2-Kidney, 1-Clip Hypertensive Rats
Authors: Segawa Yukiko , Hashimoto Hiroko , Osera Tomoko , Kurihara Nobutaka
Published: July 2021

Objective:
Capsaicin, a component of chili peppers, is reported to have beneficial effects on cardiovascular system through the vasodilative effects. We recently demonstrated the alleviation of blood pressure (BP) elevation by consuming a low concentration of capsaicin diet in 2-kidney, 1-clip (2K1C) hypertensive rats. Since the alleviation was diminished when 2K1C rats took NG-nitro-L-arginine methyl ester, a NO synthase (NOS) inhibitor, during the protocol, we hypothesized that NO has a key role in the effect of capsaicin in 2K1C rats. In this study, we observed eNOS mRNA expression and protein expressions of eNOS and phosphorylated eNOS in 2K1C rats fed a diet containing capsaicin.

Methods:
Six-week old male Sprague-Dawley rats were treated with sham operation (SHAM) or clipping the left renal artery (2K1C). One week after the surgery, each group of rats were further divided into 2 groups randomly, which received either a control diet (CTL) or a diet containing 0.006% capsaicin (CAP) for 6 weeks. The systolic BP was measured by a tail-cuff method once per week throughout the protocol. At the end of the protocol, rats were euthanized and the abdominal aortas were collected for extracting mRNA and protein. Then, the expression of eNOS mRNA and protein in aorta was evaluated in each group of rats by real time RT-PCR and Western blotting.

Results:
As shown in Table, capsaicin diet alleviated BP elevation in 2K1C rats. After the dietary protocol, eNOS mRNA expression in 2K1C-CAP was significantly higher than in 2K1C-CTL. Although there were no significant differences in eNOS protein expression among four groups, phosphorylated eNOS protein expression in 2K1C-CAP was marginally significantly higher than in 2K1C-CTL. The expression was also significantly higher in 2K1C rats than in SHAM.

Discussion:
The present data suggested that dietary capsaicin decreases BP through enhancing NO with activation of eNOS in 2K1C hypertensive rats. It may be a clue for developing a dietary therapy for prevention of hypertension.
Abstract P041: Relations of Three Types of Low Carbohydrate Diet to Cardiometabolic Risk Factors and C-Reactive Protein: The INTERLIPID Study
Authors: Nakamura Yasuyuki , Ueshima Hirotsugu , Okuda Nagako , Miura Katsuyuki , Kita Yoshikuni , Miyagawa Naoko , Yoshita Katsushi , Nakagawa Hideaki , Sakata Kiyomi , Saitoh Shigeyuki , Okamura Tomonori , Okayama Akira , Choudhry Sohel R , Rodriguez Beatriz , Masaki Kamal H , Chan Queenie , Stamler Jeremiah
Published: July 2021

Introduction:
Sizable numbers of people have tried low carbohydrate diets (LCD) of varied types; data are sparse on effects on cardiometabolic risk factors with different types of LCD.

Hypothesis:
We assessed the hypothesis that relationships of LCD score to cardiometabolic risk factors and an inflammatory marker, high-sensitivity C-reactive protein (CRP), are different among usual, animal-based, and plant-based LCD.

Methods:
We assessed serum concentrations of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), high sensitivity C-reactive protein (CRP), and nutrient intakes by standardized methods in men and women ages 40 to 59 years from four population samples of Japanese in Japan (553 men and 544 women, combined). For people consuming usual, animal-based, and plant-based LCDs, we calculated LCD scores, based on relative level of fat, protein, and carbohydrate, by modifying the methods of Halton, et al. Instead of calculating scores based on animal or vegetable fat, we used saturated fatty acids (SFA) or monounsaturated fatty acids (MUFA) +polyunsaturated fatty acids (PUFA). Multiple linear regression analyses were used to examine relations of LCD scores to log-CRP and cardiometabolic risk factors.

Results:
In multivariate regression analyses with adjustment for site, age, sex, BMI, smoking, alcohol intake, physical activity, years of education, and Keys dietary lipid score, all three LCD scores were significantly directly related to HDLc (all Ps<0.001), but not to LDLc. The plant-based LCD score was significantly inversely related to log-CRP (coefficient=-0.011, P=0.017).

Conclusions:
All three LCD scores were significantly directly related to HDLc, but not to LDLc. The plant-based LCD score, associated with higher PUFA and lower SFA and dietary cholesterol in comparison with the other two LCD scores, was significantly inversely related to log-CRP.
Abstract P043: Alcohol Consumption, Transferrin Saturation and Risk of All-Cause Mortality in The National Health and Nutrition Examination Surveys
Authors: James Laurence O , Kiage James N , Lipworth Loren , Sampson Uchechukwu K , Kabagambe Edmond K
Published: July 2021

Background:
Moderate alcohol consumers have a reduced risk for cardiovascular and all-cause mortality. Alcohol intake improves iron absorption and also has a profound effect on iron metabolism and thus could in part explain the observed inverse association between moderate alcohol intake and mortality. We sought to investigate whether moderate alcohol confers mortality benefits in part through improvement in iron status.

Methods:
Publicly available data from two consecutive National Health and Nutrition Examination Survey (NHANES) cycles (1999/2000 and 2001/2002) were obtained and linked to public data on all-cause mortality. Study participants were grouped as never, past, moderate (≤2 drinks/day for men, ≤ 1 drink/day for women) and heavy drinkers (>2 drinks/day for men, >1 drink/day for women). To assess the quality of alcohol data in NHANES, we tested whether self-reported alcohol consumption was associated with biomarkers of alcohol intake (HDL-C and γ-glutamyl transferase (GGT)). Cox-models, weighted using four-year sampling weights, were fitted to determine whether alcohol intake was associated with all-cause mortality. Measures of iron status, particularly serum ferritin, transferrin saturation, hemoglobin and free erythrocyte protoporphyrin were evaluated as potential mediators of the association between alcohol consumption and risk of all-cause mortality.

Results:
Among 7,532 men and women with complete data, 17% were never drinkers, 20% were past drinkers, 30% were moderate drinkers and 33% were heavy drinkers. We found an increase in HDL-C and GGT with increased alcohol intake, suggesting that self-reported alcohol intake is reliable in this population. In the weighted analysis, the hazard ratio (95% CI) for all-cause mortality among moderate alcohol users compared to never users was 0.56 (0.37-0.85), in models adjusted for age, race, smoking, statin use and history of diabetes, among other variables. Adjustment for transferrin saturation as a measure of iron status attenuated the benefit from moderate alcohol (HR = 0.69; 95% CI: 0.41-1.14), suggesting that moderate alcohol consumption may in part confer a benefit on mortality through improvement in iron status. These results warrant further evaluation in rigorous formal mediation analyses.

Conclusions:
Moderate alcohol consumption was associated with higher transferrin saturation and with reduced risk of mortality. Adjusting for iron status attenuated the association between moderate alcohol consumption and all-cause mortality suggesting that the effects of moderate alcohol on mortality may in part be via improvement in iron status.
Abstract P063: Defects in Well-Being Psychological Factors Rather Than Ill-Being Factors Are Predictors of Acute Coronary Syndrome: A Comprehensive Lifestyle Analysis
Authors: Chung Ick-Mo , So Jisun , Seo Jihyeon , Chun Hyejin , Kim Byungmi , Chung Kyong-Mee , Han Sung Nim
Published: July 2021

Introduction:
An increasing body of evidence suggests that development of coronary artery disease (CAD) is probably affected by a variety of lifestyle factors. However, most studies have not assessed comprehensive lifestyle factors including well-being psychological factors simultaneously, therefore relative contribution of each factors is obscure.
Hypothesis:
A variety of lifestyle factors including defect in well-being psychological factors may contribute to development of CAD through interacting muturally.
Methods and Results:
A case-control, cross-sectional study analyzing comprehensive lifestyle factors of patients with acute coronary syndrome (ACS) and healthy control was conducted. 92 patients with ACS (73 male; 53.2 yr; 30 acute MI, 62 unstable angina) and 69 healthy control (43 male; 48.7yr) were recruited. For dietary analysis, food frequency questionnaire (FFQ) and 2 days of 24 hour dietary recall were used. Anxiety, depression, stress, job stress, and hostility were analyzed to assess psychological ill-being factors. Primary and secondary control strategies, health-related quality of life (HRQoL), and satisfaction degree in 7 life domains such as marriage, leisure, standard of living, job, family, sex life, and self were analyzed to assess well-being factors. Univariate analysis showed that ACS group vs. control group had more current/ex-smoker and exercised less (all, p<0.05). FFQ analysis showed that ACS group vs. control consumed more energy intake, fats, proteins, seafoods, and sweets (all, p<0.05). Psychological analysis showed that the ACS group had more depressive score, less mean satisfaction score in all 7 life domains, and less physical domain of HRQoL especially in the fields of 1) general health perceptrion and 2) bodily pain (all p<0.05). The ACS group vs. control tended to use more primary control strategy, although not reaching statistical signifcance. Logistic regression analysis, after adjustment of age and gender, identified that mean satisfaction score in 7 life domains (OR: 9.66), primary control strategy (OR: 1.92), greater intake of sea foods (OR 6.53) and sweets (OR: 7.40), exercise (OR: 0.26), and smoking (OR:7.53) were determined as significant independent predictors of ACS (all, p<0.05).

Conclusions:
Defects in well-being psychological factors rather than ill-being factors are closely associated with ACS. A variety of lifestyle factors, especially, poor satisfaction in 7 life domains, use of primary control strategy, greater intake of sea foods and sweets, smoking, and poor exercise are independent predictors of ACS. Therefore preventive intervention trial of ACS should include modification of comprehensive lifestyle factors including defects in well-being factors.
Abstract P065: Cross-Sectional and Prospective Associations of the Cortisol/testosterone and Cortisol/ Sex Hormone Binding Globulin Ratios With Atherosclerosis in Women
Authors: Lee Ju-Mi , Colangelo Laura A , Schwartz Joseph E , Yano Yuichiro , Siscovick David S , Seeman Teresa , Schreiner Pamela J , Liu Kiang J , Lloyd-Jones Donald M , Philip Philip
Published: July 2021

Introduction:
The ability to study chronic stress in humans is complicated due to measurement error of questionnaires and the inability of short-term measures of stress hormones to reflect the chronic state. Therefore considerable controversy remains about whether chronic stress influences atherosclerosis or not. The cortisol/testosterone (C/T) ratio was suggested to be a better predictor of heart disease in men than cortisol alone, as gonadotropin and cortisol are derived from the same biochemical precursor. This ratio has never been studied in a U.S. epidemiologic study, especially in women.

Study question: Are C/T and C/sex hormone binding globulin (SHBG) ratio associated with subclinical atherosclerosis in women?

Methods:
In the Coronary Artery Risk Development in Young Adults (CARDIA) study, 367 women (age range 32 to 51, mean age 40 years old) who had both cortisol from year (Y) 15 and sex hormones from serum specimen Y16 measured are included. Intima-media thickness (IMT) from Y20 was assessed cross-sectionally. Coronary artery calcium (CAC) incidence from Y15-25 was assessed prospectively where available (n=299). Due to the instability and diurnal characteristics of cortisol, area under the curve (AUC) of six samples and slope of 1st (or 3rd) and 6th (or 5th when 6th is not available) sample of salivary cortisol collected over one day were calculated. Ratios of AUC and of slope of cortisol to total testosterone (TT), free testosterone (FT), and sex hormone binding globulin (SHBG) were computed: AUC/TT, AUC/FT, AUC/SHBG, Slope/TT, Slope/FT, and Slope/SHBG. The associations of these variables categorized into tertiles with CAC and IMT were assessed by logistic regression analysis (CAC) and multiple linear regression (IMT). Model I controlled for age and race. Model II controlled for model I variables plus BMI, systolic BP, menopause, oral contraceptive usage, diabetes mellitus, alcohol consumption, and cigarette smoking.

Results:
The highest tertile of AUC/FT ratio was associated with Y20 carotid bulb IMT max in model I (β=0.07, p=0.031) and model II (β=0.09, p=0.006). This ratio also had moderate OR with incident CAC from Y15 to Y25 in model I (OR 2.22, 95% CI 0.89-5.51) and had significant association in model II (OR 3.45, 95% CI 1.18-10.06).

Conclusions:
Findings suggest that AUC/FT ratio is cross-sectionally and prospectively associated with subclinical atherosclerosis in women.