bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P154: Blood Pressure and Lipid Control Variation in Faculty versus Trainee Clinics
Authors: Sachdev Sarina , Omar Bassam A , Malozzi Christopher , Awan G. Mustafa
Published: July 2021

Background:
Clinics run by trainees are often composed of indigent patients with challenging problems as to implementation of preventive measures.

Methods:
Charts were selected based on the inclusion of hypertension as a diagnosis; 100 visits were reviewed in each of two groups. The first group (clinic 1) included patients seen by a cardiologist faculty; all patients had insurance. The second group (clinic 2) included visits seen by cardiology fellows, and directly supervised by the same faculty physician; with the majority of these patients lacking insurance. The difference between the groups with regards to age, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and LDL cholesterol were analyzed using Student's t-Test.

Results:
The mean age of patients in clinic 1 was 62±14 years compared with 52±9 years in clinic 2 (P < 0.01). There was 100% documentation of weight, BP and HR on every visit. The mean weight in clinic 1 was insignificantly lower compared with clinic 2 (202±61 vs 218±60 lbs respectively; P = 0.06). SBP was similar in both clinics (132±18 vs 130±21 mmHg respectively; P = 0.38). HR was lower in clinic 1 compared with clinic 2 (67±10 vs 77±15 BPM respectively; P < 0.01). Lipid profiles, which required a separate visit to the lab and extra charge, were documented in 93% of patients in clinic 1 versus only 34% of patients in clinic 2. LDL cholesterol was lower in clinic 1 compared with clinic 2 (88±34 vs 106±35 mg/dL respectively; P=0.01). While HDL was similar in both clinics (48 ± 14 in clinic 1 versus 46 ± 15 mg/dL in clinic 2; P = NS), non-HDL was lower, at 115 ± 38 in clinic 1 versus 136 ± 40 mg/dL in clinic 2 (P < 0.01).

Discussion:
Hypertension and dyslipidemia are major health problem. Adequate control of blood pressure and LDL cholesterol correlate with better cardiovascular outcomes. Our data demonstrate that both faculty and fellow clinics achieved mean BP of < 140/90 mmHg, with 100% documentation. However, documentation and control of lipids appear to be more challenging in indigent patients due to the extra burden and cost of undergoing lab tests. Compliance with medications and the prescription of affordable generic, often less potent, lipid-lowering therapy to indigent patients in the fellow clinic may also play a role in the higher LDL levels compared with the faculty clinic. Efforts at improving the adherence of all patients to preventive therapy aimed at achieving guideline-based BP and lipid targets should be included in quality improvement projects during residency training.
Abstract P162: The Association Between Hypertension and Incident Heart Failure by Race and Gender
Authors: Mefford Matthew , Howard George , Durant Raegan , Dunlap Nancy , Goyal Parag , Safford Monika , Muntner Paul , Levitan Emily
Published: July 2021

Background:
Hypertension is a major risk factor for heart failure (HF), but associations of hypertension with HF may vary by race and gender.

Objective:
To assess race and gender differences in the association between hypertension and incident HF hospitalization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Methods:
REGARDS participants without suspected baseline HF (n = 25,759) were followed from study entry in 2003-2007 through 2014 with adjudication of incident HF hospitalizations (n = 855). Hypertension was defined as systolic or diastolic blood pressure ≥ 140/90 mmHg or self-reported antihypertensive medication use. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for the association between hypertension and HF hospitalization in subgroups separately by race or gender, with each subgroup model adjusted for race, gender, age, income, region of residence, health insurance, body mass index, smoking, history of coronary heart disease, diabetes, reduced estimated glomerular filtration rate, total cholesterol, statin use, physical activity, perceived stress, and depressive symptoms.

Results:
The mean age of the population was 64.5 years, 40.0% were black and 55.0% were female. The prevalence of hypertension was 57.1% and more common among blacks (69.3%) compared to whites (48.9%) but similar among males (56.5%) and females (57.6%). Over a median follow-up of 8.4 years, incidence rates for HF hospitalization were 4.19, 4.46, 5.14 and 4.29 per 1,000 person-years for whites, blacks, males and females, respectively. After multivariable adjustment, the association between hypertension and HF was stronger among blacks versus whites (HR 2.28 vs HR 1.50, p-interaction=0.04) and similar among males and females (HR 1.61 vs HR 1.83, p-interaction=0.19). (
Figure
)

Conclusion:
Hypertension may be a stronger risk factor for incident HF among blacks versus whites. This finding may be due to disparities in hypertension severity, control, or duration.
Abstract P192: Improving LDL Documentation and Control in Coronary Artery Disease Patients
Authors: Omar Mazen , Shofu Abimbola , Omar Bassam A , Malozzi Christopher , Awan G. Mustafa
Published: July 2021

Background:
Obtaining a fasting lipid profile prior to a scheduled clinic visit can facilitate decision making at the time of the visit. However, this places extra burden on patients and can decrease compliance.

Purpose:
To assess the frequency of lipid measurement in patients asked to have blood draw a week before clinic visit versus on the same day of clinic visit, and assess how this will affect achieving lipid targets.

Methods:
A University-based cardiology clinic notes were examined. Patients were scheduled for a fasting lipid profile a week prior to the clinic visit in year 1. Poor compliance was noted and prompted a same day as clinic visit measurement of lipids if a patient could not comply with laboratory appointment (fasting or non-fasting) in year 2, with further lipid management conducted by phone. Patients with documented coronary artery disease were included. A total of 200 encounters (100 in each year) were analyzed.

Results:
Only 64 (64%) of patients in year 1 had lipid measurements, compared to 84 (84%) of patients in year 2. LDL level in year 1 was 116 ± 36 mg/dL compared with 97 ± 32 mg/dL in year 2 (P < 0.01). Only 34% (22/64) of the patients in year 1 achieved LDL of < 100 mg/dL, compared with 56% (47/84) in year 2. No differences were observed in HDL, triglycerides or blood pressures during the concurrent visits.

Conclusion:
Improving documentation and control of LDL is achievable if lipid levels are done on clinic visit day, with less burden on patients who cannot comply with a separate laboratory appointment. Although there were many non-fasting levels as a result, the triglyceride levels where not significantly different among the two groups, probably reflecting an overall more intensive lipid management in year 2. Therefore, as has been shown by others, a lipid profile in most cases does not necessarily have to be fasting, especially in patients being treated for stricter targets such as our cohort, which may decrease the burden on patients unable to comply with a fasting state or added clinic visits.
Abstract P205: Quality of Reporting and Methods of Systematic Reviews and Meta-analysis Addressing High-intensity Interval Training Efficacy on Cardiorespiratory Fitness: A Meta-Epidemiological Study
Authors: Helal Lucas , Botton Cintia E , Domingues Marlos R , Umpierre Daniel
Published: July 2021

Introduction:
The efficacy of high-intensity interval training (HIIT) for cardiorespiratory fitness (VO
2
max) has been increasingly investigated in different populations, resulting in efforts to summarize intervention effects through generation of systematic reviews and meta-analysis (SRMAs). Despite of many available SRMAs, the quality of methods and reporting of these syntheses is still unknown. Thus, we aimed to quantify it by a meta-epidemiological design, in order to cover all eligible SRMAs.

Hypothesis:
We hypothesized that SRMAs would have low quality of reporting and methodology, based on previous findings on overall biomedical literature.

Methods:
We searched four electronic databases, grey-literature, and hand-searched relevant SRMAs. Eligibility criteria were any SRMA having HIIT/SIT on VO2max as one of addressed meta-analysis from individual studies including apparently healthy subjects as well as patients with cerebrovascular (stroke) or cardiovascular (CVD) diseases (coronary artery disease, heart failure, heart attack, and peripheral artery disease). No restriction was made regarding publication status or language. Eligibility assessment and data extraction were done in duplicate and discordances were solved by consensus. We used 14 items adapted from PRISMA and AMSTAR tools to assess methodological, quantitative and reporting practices in SRMAs. This SR is registered (CRD42017067269) and all documentation and raw data are available at https://github.com/lhelal/srma-hiit.git and osf.io/6xzyf. This abstract is the first report regarding our final analysis.

Results:
From 141 retrieved titles, 47 duplicates were excluded and 94 full-texts were assessed, resulting in 13 eligible SRMAs. Of these, 7 SRMAs were on CVD and 6 on apparently healthy patients. Median AMSTAR score was 4/11 (median ± IQR, 4 ± 2). Regarding reporting, none of the SRMAs reported registry (0%), 39% (5/13) self-reported as in accordance to PRISMA, 8/13 (62%) reported disclosure status, 46% (6/13) reported full eligibility and extraction process and 100% (13/13) referred to a comparator group. For methodology, database median number was 4 (4 ± 5), where 92% (12/13) restricted to English and 61.5% (8/13) restricted to publication status on their primary study eligibility criteria. Moreover, 69% (9/13) had a comparator group, 31% (4/13) provided full-search strategy that allows replication and 62% (8/13) analyzed primary study risk of bias.

Conclusions:
Only a low to modest proportion of SRMAs followed practices to provide adequate literature coverage, methodological transparency and assessment of potential biases. Since such syntheses are useful to decision making regarding exercise interventions, increased adherence to approaches that enhance methodological and reporting quality is warranted from authors and journal editors.
Abstract P208: Validation of a New Cardiovascular Risk Model: Performance of a Neural Network and the ACC/AHA Pooled Cohort Equations Across Four Diverse US Prospective Cohort Studies
Authors: Biryukov Stan , Afshin Ashkan
Published: July 2021

Introduction:
The American College of Cardiology/American Heart Association developed Pooled Cohort equations to predict the incidence of atherosclerotic cardiovascular disease (ASCVD). However, validation studies have shown that these equations may overestimate risk in more heterogeneous populations. Moreover, the equations do not fully consider lifestyle behaviors.

Objective:
To build a more accurate prediction model for ASCVD using a more holistic set of predictors by applying machine learning techniques that leverage the natural multi-dimensionality of risk factors across diverse cohorts.

Methods:
We pooled measured metabolic indicators including total triglycerides, high- and low-density lipoprotein, C-reactive protein, plasma glucose level, systolic blood pressure, height and weight, dietary consumption data, and other established behavioral risk factors from a total of 4 cohort studies: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study Offspring Cohort, and Multi-Ethnic Study of Atherosclerosis. Individuals with an ASCVD at baseline measurement, as well as those with missing covariates were excluded. Outcomes were defined as an ASVCD event within ten years of study inception. We built and trained a neural network model and evaluated out of sample performance by age, gender, and race. We considered feature interactions and performed hyperparameter tuning using grid search with cross-validation.

Results:
Our pooled dataset contained over 26,000 individuals with 4,066 events (15.4%), over an average follow-up time of 16.2 years. Our final risk model outperformed the pooled cohort equations across all demographic subgroups. Predicted incidence of ASCVD showed good discrimination and calibration with an area under the receiver operating characteristic curve of 0.75 for females and 0.74 for males.

Conclusion:
Our risk model demonstrates improved accuracy on held-out validation data over the ASCVD set of equations. By taking into account more proximal and modifiable risk factors, this model helps identify high-risk individuals with greater precision and inform CVD prevention efforts.
Abstract P211: A Method to Impute Life-course Trajectories of Cardiovascular Risk Factors from Pooled Cohorts Data
Authors: Zhang Yiyi , Vittinghoff Eric , Pletcher Mark J , Allen Norrina B , Zeki Al Hazzouri Adina , Yaffe Kristine , Balte Pallavi B , Alonso Alvaro , Newman Anne B , Ives Diane G , Rana Jamal S , Lloyd-Jones Donald , Vasan Ramachandran S , Oelsner Elizabeth C , Moran Andrew E
Published: July 2021

Introduction:
Cumulative exposure to cardiovascular disease (CVD) risk factors during young adulthood is associated with later life CVD risk. Few prospective cohort studies measured exposures in young adulthood. We sought to develop and validate a method to impute trajectories of CVD risk factors across the life course.

Methods:
36,546 participants (55% women, 25% black, average exams 5.1/participant) from 6 studies (ARIC, CARDIA, CHS, Framingham Offspring, Health ABC, and MESA) were included. Demographics and CVD risk factors (BMI, smoking, BP, lipids, glucose, medications for BP, lipids and glucose) were collected at each exam and harmonized across cohorts. We multiply imputed complete risk factor trajectories from age 18 to 99 years for each participant using an extension of linear mixed modeling (for continuous variables) and interval-censored survival modeling (for categorical variables), taking into account the multilevel structure of data. For validation, we randomly selected 25% of all participants and deleted their observed data for exam age 20-35, 50-65, or 80-95 years. We then imputed risk factor values for deleted age periods and compared imputed values with directly observed values.

Results:
Imputed values were relatively consistent with observed values for BMI, SBP, LDL, and glucose, particularly in young and middle ages (
Figure
). The mean (standard deviation) of the difference between imputed vs. observed values for BMI, SBP, LDL, and glucose were 0.1 (2.7) kg/m
2
, 0.9 (16.3) mm Hg, -1.1 (30.2) mg/dL, and -0.6 (23.0) mg/dL. The prevalence of imputed smoking, diabetes, and medications were also consistent with observed data.

Conclusions:
We demonstrated a validated method for estimating CVD risk factor trajectories across the life course. This approach may advance understanding of potential impact of cumulative early risk factor exposures on later life CVD risk, and inform primary prevention strategies over the life course.

Figure. Mean and prevalence of observed vs. imputed
risk factors
by age periods

2
Abstract P215: Plasma and Dietary Linoleic Acid and Diabetes Incidence After Myocardial Infarction
Authors: Harbers Marjolein C , Pertiwi Kamalita , Soedamah-Muthu Sabita S , de Goede Janette , Mölenberg Famke J , Wanders Anne J , Zock Peter L , Kromhout Daan , Geleijnse Johanna M
Published: July 2021

Background:
Plasma linoleic acid (C18:2n-6, LA) has been associated with a lower risk of type 2 diabetes mellitus (T2DM) in prospective cohort studies, but associations of dietary LA with T2DM risk are inconsistent.

Objective:
To study both plasma and dietary LA in relation to incident T2DM in post-myocardial infarction (MI) patients who received state-of-the-art drug treatment.

Methods:
We included 3,377 patients (80% male) from the Alpha Omega Cohort aged 60-80 y who had an MI <10 y before study enrollment and who were initially free of T2DM. At baseline, LA was measured in plasma cholesterol esters as a proportion of total fatty acids. Dietary LA intake was estimated from a validated 203-item food-frequency questionnaire that had been specifically designed for measuring fatty acid intake. Incident T2DM was ascertained through self-reported physician diagnosis and medication use. HRs for incident T2DM in quintiles of plasma LA and dietary LA were obtained from multivariable Cox models that included age, sex, lifestyle and dietary factors. For dietary LA, we used a substitution model in which LA was iso-calorically replaced with the sum of saturated plus trans fatty acids.

Results:
From the lowest to the highest quintile, dietary LA ranged from 3.5 to 8.8 percent of energy and the proportion of plasma LA ranged from 43.7 to 56.3%. Plasma and dietary LA were weakly correlated (Spearman
r
= 0.14,
P
<.0001). During a median follow-up of 3.4 years, 171 cases of T2DM occurred. Plasma LA was associated with a significantly lower risk of T2DM (HR
Q5vsQ1
: 0.45; 95% CI: 0.27 - 0.76;
P
for trend = 0.002). Dietary LA was not associated with T2DM risk (HR
Q5vsQ1:
0.97; 95% CI: 0.53 - 1.76;
P
for trend = 0.85).

Conclusion:
Plasma LA but not dietary LA was associated with lower T2DM risk in post-MI patients. The utility of plasma LA as a biomarker of dietary LA warrants further investigation.
Abstract P230: Vitamin E Supplementation and Cardiovascular Disease: Is There Effect Modification by Baseline Diet Quality and Vitamin E Intake?
Authors: Rautiainen Susanne , Gaziano J. Michael , Christen William G , Bubes Vadim , Kotler Gregory , Glynn Robert J , Manson JoAnn E , Buring Julie E , Sesso Howard D
Published: July 2021

Background:
Large-scale trials have not supported a role of vitamin E supplementation in reducing the risk of cardiovascular disease (CVD). We investigated whether baseline diet quality and vitamin E intake modified the effect of randomized vitamin E supplementation on the risk of CVD in the Physicians’ Health Study II (PHS II).

Methods:
The PHS II was a randomized, double-blind, placebo-controlled trial testing 400 IU synthetic α-tocopherol on alternate days. 14,641 men aged ≥50 years were included. 13,316 men (91%) completed a 116-item food frequency questionnaire and were included in our intention-to-treat analysis. We examined effect modification by baseline diet quality as assessed by dietary patterns (tertiles of the Alternate Healthy Eating Index [AHEI] and Alternate Mediterranean Diet [AMED]), and by dietary and supplemental vitamin E intake.

Results:
During a mean 8.0 years of follow-up, baseline diet quality or vitamin E intake did not modify the effect of vitamin E use on the primary endpoint of major CVD events (
Table
). However, AHEI modified the effect of randomized vitamin E use on the secondary endpoint of MI (P, interaction=0.02), with a statistically significant 39% lower risk among men in the lowest tertile of the AHEI. A similar and statistically significant 37% lower risk of MI was observed in the lowest category of the AMED (P, interaction=0.08). There was no evidence that diet quality modified the effect of vitamin E use on risks of stroke or CVD mortality, and baseline dietary and supplemental vitamin E intake did not modify the effects on any outcome.

Conclusion:
Diet quality did not modify the effect of vitamin E supplementation on most CVD outcomes but did modify its effect on MI. Given concerns about multiple comparisons and the need for replication, our findings should be interpreted with caution.
Abstract P240: Eating Behavior and Body Composition in Chilean Young Adults: Results From the Santiago Longitudinal Study
Authors: Pacheco Lorena S , Blanco Estela , Burrows Raquel , Correa-Burrows Paulina , Santos Jose L , Gahagan Sheila
Published: July 2021

Introduction:
Causes of obesity, a leading risk factor for chronic disease morbidity/mortality, are multi-faceted and encompass behavioral and psychological factors. Understanding eating behavior can help target behavioral obesity interventions. The aim of this cross-sectional study was to examine cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE) behaviors and body composition in a sample of Chilean young adults.

Methods:
Using data from 429 participants of the Santiago Longitudinal Study (mean age 22.5±0.4 years), evaluated from 2016-2017, linear and logistic regression models assessed the independent associations between three eating behavior dimensions, using the Three Factor Eating Questionnaire (1-4 range per dimension), and BMI, % body fat (measured by dual-energy x-ray absorptiometry), and central obesity, accounting for demographic covariates, stratified by sex.

Results:
The sample was 51% female and had a mean BMI of 26.9±6.1. Mean % body fat was 30.5±7.6 in males and 41.8±6.9 in females. CR and EE eating behaviors were associated with body composition measures as shown in the Table 1. CR was related to a 2.4 (95% CI 1.2, 4.8) and 2.5 (95% CI 1.4, 4.5), respectively, greater odds of being an obese male (>25% body fat) and obese female (>37% body fat). The EE dimension was also significantly associated with percent body fat in both sexes. The greatest effect size in the linear regression models was observed for central obesity. For every point increase in CR, waist circumference increased by 5.1 cm (95% CI 2.1-8.1) and 4.1 cm (95% CI 1.5-6.7) in males and females, respectively. EE was positively associated with central obesity in females.

Conclusions:
In this sample of Chilean young adults, CR and EE eating behavior dimensions were associated with obesity, central obesity and% body fat. The UE dimension was not associated with body composition. Understanding the dynamics of and interplay of eating behaviors and body composition can provide evidence for future effective interventions.
Abstract P241: Culinary Herbs and Spices and the Effects on Cardiovascular Disease Risk Factors in Adults
Authors: Maxwell Savannah E , Dickinson Kacie M
Published: July 2021

Introduction:
There is growing attention toward the role of culinary herbs and spices in improving heart health. Bioactive compounds of culinary herbs and spices have been found to exert potential health benefits in people at risk of CVD, but no recent review has been conducted to evaluate the types of herbs and spices and their effects in this population.

Objectives:
The purpose of the review was to evaluate the effects of culinary herbs and spices on biomarkers of cardiovascular disease in adults with risk factors for CVD.

Methods:
A systematic literature search was conducted using six electronic databases, including Medline (Ovid), Scopus, Cochrane Database of Systematic Reviews, CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trial and Web of Science in February 2017. Studies including subjects who had associated non-modifiable risk factors (older people >70 y, menopausal women), cardiovascular disease or an associated cardiovascular event (stroke or heart attack) and associated liver or kidney complications or disease, were excluded from the review. Seventeen studies were eligible for inclusion in the review. The Cochrane Collaboration risk of bias tool was used to assess bias of the included studies.

Results:
Twelve randomized controlled trials, 2 randomized trials, 1 non-randomized trial, 1 randomized crossover trial and 1 single-arm met inclusion criteria. In patients with Type 2 diabetes, Cinnamon at 1-1.5g/d and dichrostahys glomerata (DG), at 0.8g/d showed significant decreases in fasting blood glucose, systolic and diastolic blood pressure, triglycerides and LDC-cholesterol and HbA1c and cinnamon showed increased HDL-C while DG showed significant decrease in total cholesterol. Fenugreek at 10g/d doses resulted in significant reductions in fasting glucose and total cholesterol. Nigella satvia (NS) at doses of 1-3g/d showed significant reductions in triglycerides, LDL-cholesterol, total cholesterol and increases in HDL-cholesterol. Ginger at 1-2g/d doses significantly reduced fasting glucose, triglycerides, MDA, Apo B and increase Apo A-1. In obese subjects DG and ginger resulted in significant decreases in TG and DG significantly reduced systolic blood pressure, fasting glucose, total cholesterol, LDL-cholesterol and increased HDL-cholesterol. In subjects with hyperlipidaemia and hypercholesterolemia garlic at 5g/d and 20g/d doses resulted in significant decrease in TG, cholesterol and increases in HDL-C and 20g/d doses resulted in significant reductions in FBG.

Conclusion:
The evidence does suggest that the use of culinary herbs and spices may have beneficial effects on risk factors for CVD. Due to the presence of bias of studies there is insufficient evidence to conclude that culinary herbs and spices have significant benefits on biomarkers for CVD and that higher quality studies are needed in future research.
Abstract P244: Relations Between Residential Fast-food Environment and Individual Risk of Cardiovascular Disease
Authors: Vaartjes Ilonca , Vaartjes Ilonca , Poelman Maartje , Poelman Maartje
Published: July 2021

Background:
The food environment has been hypothesized to influence cardiovascular diseases (CVD) such as hypertension and coronary heart disease (CHD). This study determines the relation between fast-food outlet density (FFD) and the individual risk for CVD, among a nationwide Dutch sample.

Methods:
After linkage of three national registers
,
a cohort of 2,472,004 adults (≥35 year), free from CVD at January 1
st
2009, and living at the same address for ≥15 years was constructed. Participants were followed for one year to determine incidence of CVD, including CHD, stroke and heart failure. FFD within 500m, 1000m and 3000m from residential addresses was related to CVD using logistic regression, stratifying models by degree of urbanisation and adjusting for age, sex, ethnicity, marital status, comorbidity, neighbourhood-level income and population density.

Results:
In urban areas, fully adjusted models indicated that the incidence of CVD and CHD was significantly higher within 500m buffers containing one or more fast food outlets compared to areas without outlets. An elevated FFD within 1000m was associated with a significantly increased incidence of CVD and CHD. Evidence was less pronounced for 3000m buffers, or for stroke and heart-failure incidence.

Conclusions:
Elevated FFD in the urban residential environment (≤1000m) was related with an increased incidence of CVD and CHD. To better understand how FFD is associated with CVD, future studies should account for a wider range of lifestyle and environmental confounders than was achieved in this study.
Abstract P245: High Consumption of Caffeinated Tea is Associated With Increased Risk of Coronary Artery Disease but Caffeinated Coffee Consumption is Not
Authors: Wolfrum Sarah G , Nguyen Xuan-Mai T , Ward Rachel E , Ho Yuk-Lam , Song Rebecca J , Gagnon David R , Cho Kelly , Gaziano J. Michael , Djousse Luc
Published: July 2021

Introduction:
Prior studies have suggested a link between diet and Coronary Artery Disease (CAD), but there have been mixed findings on the risks and benefits of coffee and tea consumption. We assessed whether there is an association and dose response between coffee and tea intake on CAD incidence among Veterans.

Methods:
Million Veteran Program (MVP) is a national, representative longitudinal study of Veterans for genomic and non-genomic research that combines data from self-reported surveys, electronic health records, and biospecimens. Using food frequency data collected from 2011-2017 and CAD outcomes obtained from electronic health records, we used cox proportional hazard ratios (HR) to evaluate the association of coffee or tea intake with CAD incidence among Veterans with complete data. Follow-up began at the completion of the food frequency survey. Tea and coffee were evaluated separately, with intake categorized as never or less than one cup/month, 1-3 cups/month, one cup/week, 2-4 cups/week, 5-6 cups/week, one cup/day, 2-3 cups/day, 4-5 cups/day, or 6+ cups/day. For tea, the last two categories were combined to obtain stable estimates. Multivariate models were adjusted for known CAD risk factors (age, smoking status, physical activity, and education) and other caffeine use (e.g. tea for coffee). We plan to use restricted cubic splines to assess dose-response relationships.

Results:
Among 139,549 participants (90.3% male, mean age 64 ± 12 years), 74.2% consumed 1+ cups of coffee a month and 53.7% consumed 1+ cups of tea a month. During a median follow up of 3.2 years, we observed 4,715 new cases of CAD. Compared to those who drank less than one cup of coffee/month, adjusted HRs (95% CI) for CAD were 1.06 (0.92-1.22) for 1-3 cups/month, 1.09 (0.91-1.29) for one cup/week, 0.96 (0.84-1.10) for 2-4 cups/week, 0.92 (0.81-1.04) for 5-6 cups/week, 0.93 (0.85-1.01) for one cup/day, 0.99 (0.91-1.07) for 2-3 cups/day, 1.05 (0.93-1.19) for 4-5 cups/day, and 1.08 (0.92-1.28) for 6+ cups/day (p-linear trend=0.24). Compared to those who drank less than one cup of caffeinated tea/month, adjusted HRs (95% CI) for CAD were 1.08 (0.99-1.17) for 1-3 cups/month, 1.11 (0.99-1.23) for one cup/week, 1.01 (0.91-1.12) for 2-4 cups/week, 1.03 (0.89-1.17) for 5-6 cups/week, 1.04 (0.93-1.17) for one cup/day, 1.12 (0.98-1.28) for 2-3 cups/day, and 1.27 (1.04-1.58) for 4+ cups/day (p-linear trend=0.14).

Conclusion:
While coffee intake was not associated with incidence of CAD, there was an elevated risk of CAD restricted to Veterans consuming 4+ cups of caffeinated tea per day.
Abstract P253: Adiposity Indicators and Blood Pressure in South Asian Children and Adolescents
Authors: Fowokan Adeleke , Punthakee Zubin , Lear Scott
Published: July 2021

Background:
The prevalence of childhood obesity is increasing globally. This has severe implications for cardiometabolic risk including hypertension. South Asian children are particularly vulnerable given their unique phenotype which results in higher body fat at similar body mass index (BMI) levels compared to Europeans. As a result, we sought to explore the association between adiposity indicators and blood pressure, and to compare the strength of these indicators in determining hypertension in South Asian children and adolescents.

Methods:
Children ages 7-8 and 14-15 with South Asian origin were recruited from two Canadian cities. They were then assessed for height, weight and waist circumference (WC). Waist to height ratio (WHtR), and BMI were calculated. Body fat percentage was determined by bioelectrical impedance analysis. Blood pressure (BP) was assessed three times using an automated device. All variables (except body fat percentage) were transformed to z-scores using published standards. Unadjusted and adjusted (age, sex, household income, exposure to bullying or violence) logistic regression was used to explore associations between adiposity and hypertension. Subsequently, area under the curve (AUC) analysis was used to explore the strength of the adiposity metrics in determining hypertension.

Results:
This study consisted of 306 boys and 402 girls (n=762) with mean age 9.5 (S.D 3.2) years. Significant association were detected in unadjusted models between the adiposity indicators with systolic and diastolic hypertension (p<0.0001 for all). In the fully adjusted model, the association between adiposity with systolic and diastolic hypertension remained after adjusting for covariates (p<0.01 for all). BMI was the strongest predictor of systolic hypertension (AUC= 0.791), while body fat percentage was the strongest for diastolic hypertension (AUC= 0.712). The other indicators were within close ranges in their ability to predict both systolic and diastolic hypertension.

Conclusion:
Significant associations were observed between adiposity indicators and hypertension. Moreover, the adiposity indicators were observed to be strong predictors of hypertension in AUC analysis. This highlights the relationship between adiposity and hypertension, and suggests that BMI, WC, WHtR and body fat percentage are good indicators of hypertension in South Asian children.
Abstract P280: Neighborhood Social Cohesion Does Not Moderate the Association of Neighborhood Walkability With Aerobic Physical Activity in Latino Adults: The National Health Interview Survey (NHIS) 2015
Authors: Murillo Rosenda , Reesor Layton M , Hernandez Daphne C , Obasi Ezemenari M
Published: July 2021

Introduction:
Neighborhood walkability and neighborhood social cohesion have been shown to contribute to physical activity. However, limited research has examined neighborhood social cohesion as a moderator in the association between neighborhood walkability and aerobic physical activity among Latino adults. We examined associations of neighborhood walkability using measures assessing built environment and safety, with meeting the aerobic activity guideline among a large nationally representative diverse sample of Latino adults.

Methods:
We used cross-sectional data from 4,765 NHIS 2015 Latino participants 18 years of age and older. Neighborhood walkability was assessed based on self-reported measures of built environment (e.g., presence of sidewalks, presence of paths/trails) and neighborhood safety (e.g., presence of traffic, crime). A neighborhood walkability score was created by combining the built environment and neighborhood safety items, with a higher score indicating higher walkability. Aerobic activity was categorized as meeting versus not meeting the aerobic activity guideline, based on
2008 Physical Activity Guidelines for Americans
. Neighborhood social cohesion was measured based on self-reported items assessing perceived neighborhood social cohesion. Survey logistic regression was used to compute odds ratios [OR] and 95% confidence intervals [CI], with covariates adjusting for age, sex, education, acculturation, and neighborhood social cohesion. Effect modification by neighborhood social cohesion was tested by inclusion of a neighborhood walkability and neighborhood social cohesion interaction term.

Results:
On average the sample was 44 years old, 44% were male, 36% had less than a high school education, and 58% were foreign-born. After adjusting for age, sex, education, and acculturation, a one-unit higher neighborhood walkability score was associated with significantly higher odds of meeting the aerobic physical activity guideline (OR: 1.08; 95% CI: 1.05, 1.11), relative to not meeting the aerobic activity guideline. After adding neighborhood social cohesion to the adjusted model, the association between neighborhood walkability and meeting the aerobic activity guideline was slightly attenuated, but remained significant (OR: 1.07; 95% CI: 1.03, 1.11). Results from the effect modification test indicated that the neighborhood walkability and neighborhood social cohesion interaction term was not significant.

Conclusions:
These findings suggest that neighborhood walkability contributes to meeting the aerobic physical activity guideline among Latino adults. However, neighborhood social cohesion does not moderate the association between neighborhood walkability and meeting the aerobic activity guideline.
Abstract P289: Social Determinants of Long Term Maintenance of Physical Activity: The Jackson Heart Study
Authors: Min Yuan-I , Norwood Arnita F , Sims Mario
Published: July 2021

Background:
Data showing long term efficacy and sustained active lifestyle change are scant. Identifying social determinants for maintaining an active lifestyle overtime may help pinpoint barriers/facilitators for sustaining an active lifestyle change.

Methods:
We evaluated the associations between social determinants of health (SDH) and changes in physical activity (PA). The analysis dataset included 3,741 participants in the Jackson Heart Study (JHS) who completed the PA questionnaire at exams 1 and 3, approximately 8 years apart. Participants were classified into 3 PA groups-poor (0 minutes/week moderate/vigorous activity), intermediate (some moderate/vigorous activity), or ideal (≥75 minutes/week vigorous or ≥150 minutes/week moderate or ≥150 minutes/week combined moderate/vigorous activity). SDH evaluated were individual level socioeconomic status (SES), social support, perceived stress and neighborhood characteristics. Other covariates included age, sex and body mass index (BMI). Unadjusted analyses followed by multivariable logistic regression analyses with backward selection were performed to explore the most significant SDH associated with changes in PA.

Results:
Twenty-eight percent (28%) participants had poor PA at both exams; 35.5% had at least intermediate PA at both exams; 19.2% changed from poor to intermediate/ideal PA and 17.8% changed from intermediate/ideal to poor PA overtime. In unadjusted analyses, among participants with intermediate/ideal PA at exam 1, younger age, higher levels of SES and greater social support; as well as higher neighborhood SES, greater social cohesion, fewer neighborhood problems and violence were positively associated with maintaining intermediate/ideal PA at exam 3. Among those with poor PA at exam 1, the same factors other than social cohesion were associated with improved PA to moderate/ideal level at exam 3. Sex, perceived stress, number of PA facilities in the neighborhood or being overweight/obese at either exam was not associated with changes in physical activity levels. Exploratory multivariable logistic regression with backward selection suggested that all three individual SES indicators were important factors for maintaining moderate/ideal PA levels at exam 3; and younger age, higher education, and higher neighborhood SES were important factors for improving PA levels from poor to intermediate/ideal.

Conclusions:
Individual SES indicators were significantly associated with maintaining an intermediate/ideal PA overtime; whereas younger age, higher educational attainment and higher neighborhood SES were significantly associated with changes in PA from poor to intermediate/ideal. Targeting individual education and environmental factors (e.g., neighborhood problems, violence) associated with neighborhood SES may provide most benefit both in initiating and maintaining an active lifestyle.
Abstract P328: Cardiovascular Disease and Risk Factors Are Associated With Poor Health-Related Quality of Life Among Hispanic/Latino Adults With Arthritis Symptoms: Findings From the Hispanic Community Health Study/ Study of Latinos
Authors: Rosenberg Natalya , Estrella Mayra L , Durazo-Arvizu Ramon A , Lash James P , Talavera Gregory A , Eldeirawi Kamal , Zeng Donglin , Daviglus Martha L
Published: July 2021

Introduction:
Despite greater longevity, Hispanics/Latinos have shorter functional limitations-free life and greater prevalence of arthritis-attributable functional limitations compared to non-Hispanic Whites. We assessed the hypothesis that CVD and CVD risk factors (RFs) are independently associated with poor health-related quality of life (HRQOL) among Hispanics/Latinos with arthritis.

Methods:
HCHS/SOL is a multi-center prospective population-based study of 16,415 diverse Hispanic/Latino adults ages 18-74 years at baseline (2008-11). Data from 2,083 men and women with self-reported arthritis-related symptoms were analyzed. Self-reported HRQOL was assessed using the 12-item Short-Form (SF-12) survey: self-reported health status (fair/poor vs. excellent/very good/good); and physical and mental health component summary scores (PCS and MCS; standardized z scores ranging from 0-100; higher scores indicate better HRQOL). Prevalent CVD (yes/ no) was defined using Framingham CVD Composite Criterion. CVD RFs were diabetes, obesity, hypercholesterolemia, hypertension, smoking, and physical activity. Logistic and linear regression models were used to examine cross-sectional associations of CVD and CVD RFs with HRQOL, after adjustment for relevant covariates and other CVD or CVD RFs. All analyses accounted for the complex study design.

Results:
In multivariable-adjusted models, CVD, diabetes, and current smoking were associated with 1.73, 2.04, and 1.48 times higher odds of fair/poor general health, compared to absence of CVD, normal glycemic status, and never-smoking, respectively. CVD, diabetes, obesity, physical inactivity, and low activity were associated with lower PCS scores. CVD, obesity, overweight, and current and former smoking were associated with lower MCS scores (
Table
).

Conclusions:
CVD and CVD RFs are independently associated with poorer HRQOL among Hispanic/Latino adults with arthritis, suggesting presence of unmet health and lifestyle management needs in this group.
Abstract P351: Evaluation of Analytic Approaches to Ceiling Effect in Patient-Reported Functional Status After Stroke
Authors: DeBarmore Bailey M , Schilsky Samantha R , Psioda Matthew A , Jones Sara B , Kucharska-Newton Anna M , Rosamond Wayne D
Published: July 2021

Setting:
Researchers use several tools to measure functional status in stroke patients. Analyses often use simple linear models, which assume a common treatment effect regardless of stroke severity. However, patients with mild stroke or TIA may perform at the maximum of an instrument, or the ceiling. The presence of a so-called ceiling effect conflicts with the normality assumption of linear models and can diminish the ability to detect efficacy, unless addressed in study design and analyses.

Objectives:
Our objectives were to (1) review the literature describing the instruments used to measure functional status and the analytic methods used in the presence of ceiling effect; and to (2) valuate methods which may be used to account for treatment effect heterogeneity induced by ceiling effect in comparative effectiveness trials of post-stroke functional status outcomes.

Methods:
The literature review was conducted by two reviewers using PubMed. To compare type I error control and power in the presence of a ceiling effect, we used simulation studies and compared linear, logistic, and cumulative logistic models. Data were simulated to mirror the empirical distribution of instrumental activities of daily living (IADL) scores found in the published data from the Secondary Prevention of Small Subcortical Strokes (SPS3) clinical trial, a study of lacunar stroke patients, in which there was a pronounced ceiling effect. To accommodate treatment effect heterogeneity induced by ceiling effect, we explored stratification by stroke severity.

Results:
Our literature review yielded 262 stroke clinical trials that included patient reported outcomes. Only 41% of trials cited ceiling effect in the functional status instrument used; most did not account for it in their analyses. Our simulation studies demonstrate that while linear modeling may result in well controlled type 1 error rates in the presence of pronounced ceiling effect, study power may be unacceptably low. Dichotomizing the outcome and directly modeling the probability of maximum scores with logistic models may be preferred. In contrast, when outcome scores in the untreated group cover the range of the instrument, use of a linear model may be advantageous over logistic models that categorize the outcome.

Conclusions:
It is important to consider the distribution of functional outcome scores in target stroke population when developing the analysis strategy for a study, perhaps by conducting a pilot study. Specifically, it is important to evaluate if the instrument being used can identify change in outcomes in low-severity groups. Lastly, powering the study to identify lesser treatment effect in low-severity patients may be useful as a secondary trial aim rather than attempting to establish benefit in all patients as a primary outcome.
Abstract P355: Socioeconomic Factors and Race Negatively Impact Performance Based Motor Skills Following Stroke: Evidence From the Health and Retirement Study
Authors: Buie Joy N
Published: July 2021

Background:
Evidence suggests that racial and ethnic minorities consistently have poorer post-stroke functional outcomes.

Hypothesis:
We hypothesized that race in addition to socioeconomic status (SES) would correlate with poorer measures of functional outcomes in stroke patients.

Methods:
Our aim was to identify factors that contribute to disparate functional outcomes among middle- and retirement-aged non-Hispanic whites (white) and non-Hispanic African Americans (AA). Through retrospective analysis of data from the Health and Retirement Study (HRS), we analyzed 2,831 respondents who reported incident stroke between 1999 and 2014. Respondents were asked to report perceived difficulty with gross and fine motor function and basic activities of daily living (ADL). Linear and logistic regression analysis determined independent predictors of post-stroke motor function and ADL.

Results:
The analysis included 2,314 (82%) whites and 517 (18%) AA adults with stroke. The AA median age was 71± 11.3 while the white median age was 76 ± 10.5 (p<0.0001). Factors associated with more difficulty with ADL, fine motor function, and gross motor function included older age, female gender, AA race, and higher numbers of household residents. Surprisingly, the comorbidity score was only associated with difficulty in gross motor function. Moreover, the time since stroke did not associate with any performance measure. Increased difficulty with performance-based ADL, fine, and gross motor skills in AAs relative to whites, was associated with younger age, more residents in the home, and less household income. Although our analysis was limited due to the lack of long-term follow-up in the HRS study, these data can help direct future stroke recovery health disparity studies.

Conclusions:
Our findings highlight the importance of examining contributing factors to racial disparities in post stroke outcomes.
Abstract 17060: Effect of Septal Myectomy on Obstructive Sleep Apnea Syndrome in Patients With Hypertrophic Obstructive Cardiomyopathy
Authors: shengwei Wang , shuiyun Wang
Published: July 2021

Introduction:
Hypertrophic cardiomyopathy (HCM) has a higher prevalence of OSA. The impact of obstructive sleep apnea on perioperative complications in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing septal myectomy and the impact of septal myectomy on OSA are not yet clear. Therefore, we sought to examine the association between HOCM and OSA before and after septal myectomy.

Methods:
We studied 69 consecutive patents with a confirmed diagnosis of HOCM who underwent septal myectomy. All patients performed polysomnography before and three months after operation.

Results:
Of all the patients, 41 (59.4%) were diagnosed with OSA. Compared to patients without OSA, patients with OSA were significantly older. The incidence of atrial fibrillation increased significantly during perioperative period in patients with OSA (31.7% vs 10.7%, p=0.048). Three months after operation, the severity of OSA increased significantly, as reflected by AHI, OAI and HI (11.7[7.2-22.1] vs 25.6(17.7-33.8), p<0.001; 11.6[6.8-17.6] vs 15.1[9.5-20.8], p=0.024;) 4.4[2.5-7.1] vs 8.3[4.1-12.0], p=0.003) while the CAI decreased (0.4[0.0-2.1] vs 0.2[0.0-0.8], p=0.008). In a multivariate linear regression analysis, mean oxygen desaturation and time% with Spo2 <90% during sleep were significantly associated with an increased AHI independently of sex, BMI and gender (p=0.026 and p=0.007, adjusted R
2
=0.365).

Conclusions:
The severity of OSA increased significantly three months after septal myectomy as reflected by AHI, OAI and HI. The mean oxygen saturation and time% with Spo2 <90% during sleep are independently associated with the increase of AHI.