bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 54: Genome-Wide Association Analysis of Gene-Sodium Interactions on Blood Pressure Phenotypes: The GenSalt Study
Authors: Li Changwei , He Jiang , Hixson James , Gu Dongfeng , Rao Dabeeru , Shimmin Lawrence , Huang Jianfeng , Gu Charles , Chen Jichun , Li Jianxin , Jaquish Cashell , Kelly Tanika N
Published: July 2021

Background:
Elevated blood pressure (BP) is a major public health challenge. Although the heritability of BP has been long established, current findings can explain only a small proportion of the BP variability attributed to genetic factors. Recent studies indicate that gene-environmental interactions may help to identify novel BP loci. Hence, the current study aimed to identify genetic variants influencing BP regulation by conducting genome-wide gene-sodium interaction analyses among 1,906 participants of the Genetic Epidemiology Network of Salt-Sensitivity (GenSalt) study.

Methods:
GenSalt recruited 1,906 Chinese participants from 633 families. At baseline, one 24-hour and two 8-hour urine specimens were collected to measure urinary sodium excretion. Nine BP measurements were taken using a random zero sphygmomanometer. A total of 868,158 autosomal single nucleotide polymorphisms (SNPs) were genotyped using Affymetrix Genomewide Human SNP array 6.0 (Affymetrix, Inc, Santa Clara, CA). Mixed effects models were used to test genome-wide SNP-sodium interactions on BP, adjusting for age, gender, and body mass index. Promising findings (interaction term
P
<1.00х10
-6
) from GenSalt were further evaluated for replication among Chinese participants of the Multi-Ethnic Study of Atherosclerosis (MESA) with available data from the database of genotypes and phenotypes (dbGaP). SNP effects in GenSalt and MESA were meta-analyzed using inverse-variance weighted fixed effect models.

Results:
The meta-analyses identified 3 novel loci that significantly interacted with sodium to influence BP phenotypes. SNP-sodium interactions on systolic BP were identified for
NEK2
variant rs10494938 at 1q32.3 (GenSalt
P
=2.19х10
-6
, MESA
P
=4.35х10
-4
, and Meta-analysis
P
= 3.93х10
-8
). In addition,
CASP4
variant rs1944900 at 11q22.3 interacted with sodium to influence both systolic BP (GenSalt
P
=1.24х10
-9
, MESA
P
=4.22х10
-2
, and Meta-analysis
P
= 1.14х10
-10
) and mean arterial pressure (GenSalt
P
=1.68х10
-9
, MESA
P
=4.27х10
-2
, and Meta-analysis
P
= 1.91х10
-10
). Furthermore,
C9orf3
variant rs17679141 at 9q22.32 interacted with sodium to influence diastolic BP (GenSalt
P
=2.85х10
-8
, MESA
P
=4.55х10
-2
, and Meta-analysis
P
=4.61х10
-9
). The 3 variants all physically mapped to the intronic regions of their corresponding genes.

Conclusion:
The current study identified 3 novel loci which may interact with dietary sodium intake to influence BP phenotypes.
Abstract MP37: Macroeconomic Growth is Associated with Increases in Cardiovascular Mortality in Countries with Lower Social Protection Spending
Authors: Bilal Usama , Franco Manuel , Glass Thomas A
Published: July 2021

Background:
Macroeconomic growth has been shown to be associated with increases in cardiovascular (CVD) mortality. However, it is unclear whether concurrent social protection policies may mitigate the observed associations.

Objective:
To study if social protection expenditure modifies the association between macroeconomic growth and cardiovascular mortality.

Methods:
We included 21 OECD countries from 1980 to 2010 with available data in the Comparative Welfare States Data Set and the WHO Mortality Database. Gross Domestic Product (GDP) was used as a proxy for economic growth. Age-adjusted cardiovascular mortality rates were calculated. Countries were divided into tertiles of average Social Protection expenditure. We used fixed-effect models to study the association of GDP growth with CVD mortality stratified by tertile of social protection expenditure. We included four lagged GDP terms to account for the cyclical nature of GDP. A second fixed-effects model was fitted with time-varying linear and quadratic social protection expenditure and its interaction with GDP.

Results:
Overall, a 1% increase in GDP was associated with an increase in CVD mortality of 0.5% (95% CI: 0.21-0.83%, p=0.001). In countries with high and medium social protection expenditure, GDP increases were not associated with changes in CVD mortality (p=0.80 and p=0.52 respectively). In countries with the lowest social protection expenditure, a 1% GDP increase was associated with a significant increase in CVD mortality of 0.7% (95% CI: 0.04-1.32% p=0.03). These results were consistent in analysis using time-varying social protection expenditure (Figure).

Conclusion:
Our results highlight the need for social protection policies to accompany economic growth to mitigate its potential deleterious effects on cardiovascular diseases. Further research should study specific policies that mitigate the harmful effects of macroeconomic growth.
Abstract MP41: Implications of the Use of the New ACC/AHA Guidelines for Cardiovascular Disease Prevention in a Brazilian Cohort - The Elsa Brasil Study
Authors: Bittencourt Marcio S , Bensenor Isabela , Chor Dora , Vasconcelos Paulo , Lotufo Paulo
Published: July 2021

Introduction:
The 2013 American College of Cardiology / American Heart Association (ACC/AHA) guidelines developed a new prediction model for cardiovascular disease (CVD) and suggested the use of a lower threshold of 7.5% 10 year hard CVD risk for primary prevention. The implications of the use of this model in other cohort and admixed races has not yet been tested. The current study sought to evaluate the potential impact of its use in a large Brazilian cohort.

Methods:
We have included 15105 participants of the (Brazilian Longitudinal Study of Adult Health) ELSA-Brasil study, a multicenter prospective study that enrolled civil servants aged 35 to 74 years in 6 different urban areas in brazil. We have calculated the both the Framingham risk score (FRS) and the new risk prediction model to the entire cohort, and estimated the impact of changing current recommendations based on the FRS and lipid targets to the new recommendations based on the absolute risk estimated by the new model.

Results:
The mean age was 52±9.1 years, with 8218 (54%) women. The race distribution included 52% white, 16% black, 28% mixed (brown), and 4% of other. While 19.2% (95% CI: 18.4 to 19.6) of the cohort would require statins for primary prevention accordion to prior recommendations, the new guidelines would recommend treatment for approximately 40.2% (95%CI: 39.4 to 41.0) of the cohort. A substantial increase in the population in whom statins are recommended occurred for males, from 23.3% (95%CI: 22.6 to 24.0%) to 55.7% (95%CI: 54.9 to 56.5), as well as females, from 16.6 (95%CI: 16.0 to 17.2) to 27.1 (95%CI: 26.4 to 27.8), and across all races and age levels (figure).

Conclusion:
The new ACC/AHA guidelines for primary prevention would approximately double the proportion of Brazilian adults in whom statins are indicated, mostly among older individuals. The epidemiological and economical impact of this changes are not yet known.
Abstract MP76: The Effect of Exercise Training Modality on 30-Year Cardiovascular Mortality Risk in Individuals with Type 2 Diabetes
Authors: Swift Damon , Johannsen Neil M , Lavie Carl J , Berry Jarett D , Earnest Conrad P , Dunn Logan B , Blair Steven N , Church Timothy S
Published: July 2021

Introduction:
Current calculators to estimate risk of cardiovascular (CV) disease mortality do not include cardiorespiratory fitness (CRF) or physical activity (PA) measures. This is problematic as CRF is an independent risk factor for CV mortality. To address this issue, Wickramasinghe et al. developed a calculator which includes CRF along with other traditional CV risk factors. The purpose of the present study is to determine the effect of aerobic (AER), resistance (RES) or combination (COMB) exercise training on 30-year CV mortality risk in individuals with type 2 diabetes (T2D).

Methods:
The present study is an ancillary analysis of the Health Benefits of Aerobic and Resistance Training Study (HART-D). Adults with type 2 diabetes (T2D) (n=196) were randomized to 9 months of AER, RES, COMB exercise training or a control group (CON). Thirty-year CV mortality risk was evaluated by entering each participant’s sex, age, blood pressure, smoking status, T2D status, cholesterol, and BMI into a risk calculator developed by Wickramasinghe et al. at baseline and follow-up. CRF was quantified as the highest metabolic equivalent level (estimated from the final speed and grade using American College of Sports Medicine equations) achieved during a maximal treadmill test at baseline and follow-up. Analysis of covariance was used to evaluate change in CV risk with adjustments for age, sex and baseline CV risk.

Results:
Participants in the present analysis had a mean (SD) 30-year CV risk of 30.4% (17.8). A significant reduction in 30-year CV risk was observed in the AERO (-2.9%, CI: -4.7 to -1.0) and COMB groups (-2.8%, CI: -4.5 to -1.0), but not in the RES group (0.0%, CI: -1.8 to 1.7) compared to CON (2.1%, CI: -0.1 to 4.3). In the AERO and COMB groups, change in CV risk was associated with change in fat mass (r= -0.19, p=0.04), but not change in lean mass or hemoglobin A1c (all ps>0.05).

Conclusions:
The present study suggests that 9 months of aerobic exercise training or combination of resistance with aerobic exercise training resulted in a ~3% reduction in absolute 30-year CV risk (~11% relative risk), and further validates the importance of aerobic exercise in the treatment of individuals with T2D.
Abstract MP79: Pre-Admission History of Depression and Mortality After Acute Myocardial Infarction
Authors: Salmoirago-Blotcher Elena , Lessard Darleen , Gore Joel , Goldberg Robert
Published: July 2021

Background:
Whether a diagnosis of depression after developing an acute myocardial infarction (AMI) is linked to a worse prognosis remains a matter of debate after several RCTs of interventions to treat post-AMI depression have yielded negative results. A possible explanation is that depressive symptoms after AMI may be part of the normal adjustment to an adverse life event. A pre-admission history of depression could better identify patients who may derive the most benefit from depression treatment. The objective of this study was to evaluate whether a pre-admission history of depression was associated with a worse post-discharge prognosis among patients with AMI.

Methods:
This was a secondary analysis conducted among patients included (biennial basis between 1999-2009) in the Worcester Heart Attack Study, an ongoing epidemiologic study examining long-term trends in the clinical outcomes of AMI among residents of the Worcester, MA metropolitan area. The exposure was defined as a physician-recorded diagnosis of depression preceding the index hospitalization for AMI based on the review of hospital medical records (MR). The outcome was all-cause death rates in-hospital and 1-year post discharge. Information regarding demographics, medical history, in-hospital treatment, and discharge status was abstracted from the MR by trained study physicians and nurses. Survival status after discharge was obtained from the MR and from death certificates. Univariate and multivariate logistic regression models were used to assess associations between depression and the outcome.

Results:
This analysis included 5,068 patients (mean age 70 years, 44% women). Approximately 16% of patients had a history of depression pre-admission. No significant differences were found between patients with and without a history of depression with regard to in-hospital mortality (11.5% vs. 9.9%; unadjusted OR=1.18; 95% CI: 0.95, 1.48). At 1 year after discharge all-cause mortality was significantly higher among patients with a pre-admission history of depression (27.5% vs. 18.2%; unadjusted OR=1.71; 95% CI: 1.44, 2.02). While the association between history of depression and in-hospital mortality was largely explained by confounding, the association with 1 year mortality remained significant even after adjustment for demographics, coronary risk factors, co-morbidities, clinical characteristics and medications at discharge (OR=1.57; CI: 1.24, 1.98).

Conclusions:
In this community-based cohort of patients hospitalized with AMI at different hospitals in central MA, a pre-admission history of depression was an independent predictor of all-cause mortality 1 year after MI. Documentation of a history of depression in the medical record could be a simple tool for cardiologists and primary care physicians to identify high-risk patients who may benefit from depression treatment.
Abstract MP88: Dehydroepiandrosterone (DHEAS) and Risk of Stroke in Black and White Americans: The Reasons for Geographic and Racial Differences in Stroke Cohort (REGARDS)
Authors: Degirmenci Markus , Callas Peter W , Judd Suzanne E , Howard Virginia , Jenny Nancy S , Kissela Brett , Kim Catherine , Cushman Mary
Published: July 2021

Introduction:
The association of DHEAS with coronary risk has been extensively studied, but little information is available on stroke risk. DHEAS levels are lower with stroke risk factors such as atrial fibrillation, arterial stiffness and atherosclerosis, but only one paper evaluated stroke risk and showed an inverse association of DHEAS and stroke risk in female nurses.

Hypothesis:
We assessed the hypothesis that lower DHEAS level is associated with increased ischemic stroke risk.

Methods:
REGARDS enrolled 30,239 US participants aged 45 and older in 2003-07 (41% black, 59% white, 55% living in the southeastern stroke belt). Baseline serum DHEAS was measured in 1,578 participants; 963 in a cohort random sample and 544 with first-time ischemic stroke during 5.4 years of follow up. Cox proportional hazard models with weights to account for the case cohort design were used to calculate hazard ratios (HR) of stroke by quartiles of DHEAS levels.

Results:
DHEAS was significantly lower with older age, white race, female sex, and history of heart disease. DHEAS in the first compared to the fourth quartile was associated with increased risk of stroke (HR 1.7, CI: 1.2-2.4), although this association was not present after adjusting for age (or other stroke risk factors: HR 1.0, CI: 0.7-1.6). These findings were similar in men and women. Stratifying on age, as shown in the table, in those <65 at baseline, lower DHEAS was associated with increased stroke after adjustment for sex, race, and Framingham stroke risk factors (HR 3.1, CI: 1.3-7.6), but there was no association in those >65 years (HR 0.8, CI: 0.5-1.4).

Conclusion:
There was no overall association of lower DHEAS and stroke risk in this bi-racial cohort of men and women from across the US, although a possible difference by age was observed. More research is needed to determine association of DHEAS with stroke risk.
Abstract P012: Hypertension and Alterations in Left Ventricular Geometry in African Americans: The Jackson Heart Study
Authors: Abdalla Marwah , Booth John N , Diaz Keith M , Sims Mario , Muntner Paul , Shimbo Daichi
Published: July 2021

Introduction:
Compared with whites, African Americans (AAs) have a higher risk for hypertension-related cardiovascular disease outcomes, which may be related to alterations in left ventricular geometry. Scarce data exist on how the left ventricle remodels in response to hypertension among AAs.

Hypothesis:
We hypothesized that among AAs, hypertension will be associated with abnormal echocardiographic–derived left ventricular geometric patterns defined as concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).

Methods:
We analyzed data from the Jackson Heart Study, a community-based AA cohort who completed a baseline exam that included clinic blood pressure (CBP) and 2D echocardiography (n=5,301). CR, CH, EH, and normal patterns were defined according to left ventricular mass index and relative wall thickness defined using standard American Society of Echocardiography recommendations. The analysis was restricted to 4,572 participants with complete CBP, information on antihypertensive medication, and echocardiographic data.

Results:
Mean ± SD age was 55.5 ± 12.7 years; 64% were female. Mean ± SD systolic and diastolic CBP was 127 ± 18 and 79 ± 11 mmHg, respectively; 2,785 (61%) of participants had hypertension (CBP ≥140/90 mmHg and/or taking antihypertensive medications). The prevalence of CR, CH, and EH were 10.1%, 5.2%, and 8.2%, respectively. In a multivariable-adjusted model with a normal pattern as the referent group, hypertension was associated with a greater risk of CR, CH, and EH: odds ratio 1.85 (95% confidence interval (CI) 1.43-2.38), 4.16 (95% CI 2.53-6.86), and 1.67 (95% CI: 1.26-2.23) respectively. Among hypertensive participants, older age was significantly associated with CR, CH, and EH after multivariable adjustment. Higher systolic CBP, current smoking and a higher number of classes of antihypertensive medications were additionally significantly associated with CH and EH. Male sex, and heavy and moderate alcohol consumption versus none were also significantly associated with CR.

Conclusions:
In conclusion, abnormal left ventricular geometry was present in almost 25% of AAs. Hypertension was associated with each abnormal geometric pattern, with approximately a four-fold greater odds for CH. Future studies should examine whether abnormal left ventricular geometric patterns, particularly CH, explains the increased risk of cardiovascular disease outcomes associated with hypertension in AAs.
Abstract P022: Uncontrolled Hypertension and Lifestyle Factors among US Adults with Disabilities
Authors: Stevens Alissa , Courtney-Long Elizabeth , Carroll Dianna , Gillespie Cathleen , Armour Brian
Published: July 2021

Introduction:
While hypertension is a key treatable risk factor for cardiovascular disease, it is not controlled in an estimated 36 million US adults. Previous research has shown that nearly half of adults with disabilities have hypertension and that adults with disabilities are more likely to have hypertension than those without disabilities. However, no study has documented the prevalence of uncontrolled hypertension among the disability population. Our objectives were 1) to determine the prevalence of uncontrolled hypertension among adults with a disability, and 2) estimate the prevalence of awareness, treatment with blood pressure (BP)-lowering medication, and lifestyle factors among adults with disabilities who have uncontrolled hypertension.

Methods:
Using nationally-representative data from the 2001-2010 National Health and Nutrition Examination Survey for 10,805 participants aged ≥20 years with a disability (self-reported limitation in cognition, hearing, vision, or mobility), we examined the prevalence of hypertension (measured systolic BP ≥140, diastolic BP ≥90 or self-reported use of BP-lowering medication) and uncontrolled hypertension (systolic BP ≥140 or diastolic BP ≥90).

Among those with uncontrolled hypertension, we estimated the prevalence of awareness (ever told by a doctor that had hypertension), treatment (self-reported use of BP-lowering medication), and lifestyle factors (measured body mass index and dietary sodium intake and self-reported aerobic physical activity and cigarette smoking).

Results:
Nearly 38% of US adults have a disability. Overall 46.0% (nearly 37 million) of US adults with disabilities have hypertension. Of those, nearly 20 million (52.4%) had uncontrolled hypertension. Over half of those with uncontrolled hypertension were aware and treated (52.9%), 13.6% were aware but untreated, and 33.4% were unaware. Among those with uncontrolled hypertension 40.5% were obese, 52.1% were physically inactive (had no bouts of aerobic physical activity per week that lasted ≥10 minutes), 18.2% were current smokers, and 62.0% had an average sodium intake of ≥2,300 mg per day.

Conclusion:
Over half of the 37 million adults with disabilities who have hypertension do not have it controlled; and of those, one third are unaware they have hypertension. This study highlights the need to regularly measure and monitor blood pressure among adults with disabilities. It also identifies adults with disabilities as an important population to include in public health efforts that support and encourage healthy behaviors that might improve BP control and lower risk for cardiovascular disease.
Abstract P031: Significant Predicted Change in Usual Sodium Intake for the U.S. Population From Meeting Sodium Standards for Commercially-Packaged and Restaurant Foods: National Health and Nutrition Examination Survey, 2007-2010
Authors: Cogswell Mary , Patel Sheena , Yuan Keming , Gillespie Cathleen , Juan WenYen , Johnson Christine , Vigneault Michel , Clapp Jenifer , Roach Paula , Moshfegh Alanna , Ahuja Jaspreet , Pehrsson Pamela , Merrritt Robert
Published: July 2021

Background:
A 400 mg daily reduction in the average sodium intake of the U.S. population is projected to save up to 28,000 lives and $7 billion health care dollars annually. In 2010, the Institute of Medicine recommended setting standards for the sodium content of commercially-packaged and restaurant foods to reduce U.S.sodium intake given the majority of sodium intake is from these foods. We assessed this hypothesis.

Methods:
We developed models using 2007-2010 data for 17,979 participants one year and older participating in two 24-hour dietary recalls, a part of the
What We Eat in America
component of the National Health and Nutrition Examination Survey. We projected the sodium content in foods reported by survey respondents based on percent changes in sales weighted averages from baseline for specific food categories using New York City’s National Salt Reduction Initiative (NSRI) 2014 targets or Health Canada’s 2016 sodium benchmarks. To predict the changes in usual sodium intake from foods for the U.S. population aged
>
1 year we used analyses accounting for the complex survey design with measurement error models to adjust for within person day-to-day variation in intake.

Results:
Based on a conservative estimate of the foods included in specific categories, if NSRI targets had been met in 2007-10, we estimated that the U.S. population aged
>
1 year could have reduced their average usual daily mean sodium intake of 3343 mg by 14%, or 484 mg (95% Confidence Interval [CI], 471 mg, 498 mg). If Health Canada’s benchmarks were met, the US population could have reduced their average usual daily sodium intake by 18% or 612 mg (95% CI, 594 mg, 630 mg). Across age, sex, and race-ethnic population subgroups, the average predicted relative reductions in sodium intake by group ranged from 13% -15% using NSRI targets and 16%-19% using Health Canada’s benchmarks. If sodium standards had been met, we estimated the proportion of adults aged 19 years and older consuming
>
2300 mg daily would have declined from 87% (95% CI, 84%, 89%) to 75% (95% CI, 72%, 77%) using NSRI targets or to 70% (95% CI, 68%, 73%) using Health Canada benchmarks. The proportion of adults consuming
>
1500 mg daily would have declined from 99% to 96%-97%.

Conclusion:
Results suggest that if U.S. commercially-packaged and restaurant foods had met established sodium standards, a significant reduction in sodium intake could have occurred across age, sex, and race-ethnic groups in the U.S. population.
Abstract P064: Association of Cardiorespiratory Fitness and Submaximal Blood Pressure Among Young Healthy Men- A Reverse J-curve Pattern Relationship
Authors: Prasad Vivek K , Drenowatz Clemens , Hand Gregory A , Lavie Carl C , Sui Xuemei , Demello Madison , Blair Steven N
Published: July 2021

Objectives:
Exaggerated blood pressure (BP) response during exercise is an important marker of cardiovascular events that are associated with incident hypertension, atherosclerosis, myocardial infarction, coronary artery disease and stroke. Cardiorespiratory fitness (CRF) is associated with a lower risk of all-cause and cardiovascular disease (CVD) mortality. The purpose of this study was to examine the association between CRF and submaximal BP at various stages of Graded Exercise Test (GXT) in young healthy men.

Methods:
GXT using a Modified Bruce protocol on a treadmill was performed on 191 normotensive (resting BP < 140/90 mm Hg) men aged 20-35years. BP was recorded at each stage of the protocol. Quintiles of fitness were established on the basis of peak Vo2 with the 1
st
quintile being the lowest fit group and 5
th
quintile being the highest fit group.

Results:
The mean peak Vo2 in quintiles 1, 2, 3, 4 and 5 were 32.3, 39.1, 43.4, 48.1 and 55.5 respectively. A reverse J-curve pattern relationship was evident between CRF and submaximal systolic BP. Men in the 3
rd
quintile displayed the lowest submaximal systolic BP levels across all the stages of GXT. There was a substantial decrease in submaximal BP from quintile 1 to 3 followed by an increase in higher quintiles, although still lower than quintile 1. The J-shaped relationship remained significant after controlling for potential confounders, including age, race, body fat percentage, resting systolic BP, smoking and alcohol intake (Quadratic trend P value< 0.05).

Conclusion:
These findings suggest that in young healthy men, there is a reverse J-curve pattern relationship between submaximal BP and CRF. Improving the CRF from low to average to high will progressively decrease submaximal systolic BP and CVD risks. However, the benefits from improvements in the CRF and prevention of increased submaximal systolic BP plateau at a point, beyond which there are no additional benefits or loss of the benefits (in a reverse J-curve pattern).
Abstract P079: Disparities in Heart Failure in Older Age: Do Individual or Neighbourhood Measures of Deprivation Affect Incidence Over a 10-Year Follow-up?
Authors: Ramsay Sheena , Whincup P H , Morris R W , Papacosta A.O. , Lennon L T , Wannamethee S G
Published: July 2021

Background:
Few studies have examined the prospective associations between socioeconomic measures and incident heart failure, and in particular effects of neighbourhood deprivation. The aim of this study was to investigate the association of socioeconomic measures (individual and neighbourhood-level) with incident heart failure in older adults and to examine possible underlying pathways.

Methods:
A socially and geographically representative cohort of men aged 60-79 years in 1998-2000 from 24 British towns was followed for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Individual-level socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) - a cumulative score of adverse socioeconomic measures from 0 to ≥4 was used. Index of multiple deprivation (IMD) was the small area-level socioeconomic measure (based on income, employment, health, housing, education, access to services and crime) grouped into quintiles of increasing deprivation. Prevalent myocardial infarctions and heart failures were excluded.Results:

Among 3839 men, 232 incident cases of heart failure occurred over 10 years. Heart failure risk increased with increasing cumulative score of adverse (individual-level) socioeconomic measures (p for trend=0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.19 (95%CI 1.34-3.55) which weakened to 1.99 (95%CI 1.16-3.45), but remained significant after adjusting for neighbourhood deprivation (IMD), systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.78 (95%CI 1.01-3.13). Hazard ratio per IMD quintile (neighbourhood deprivation) was 1.04 (95%CI 0.95-1.14).

Conclusions:
Disparities in heart failure in older populations need to be addressed - the risk of heart failure in older age was greater in the lowest socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure. This increased risk of heart failure according to individual-level socioeconomic measures was independent of neighbourhood-level deprivation. Neighbourhood level deprivation does not in itself appear to influence risk of heart failure.
Abstract P081: Neighborhood Social Environments and Incident Obesity: the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Mujahid Mahasin , Auchincloss Amy , Elboudwarej Emon , Carnethon Mercedes , Barrientos-Gutierrez Tonatiuh , Powell-Wiley Tiffany , Diez Roux Ana
Published: July 2021

Introduction:
The public health burden of obesity in the United States is well documented and obesogenic environments, including the neighborhoods in which individuals live, have emerged as important determinants of obesity risk. Studies examining the association between neighborhood context and obesity have primarily focused on the socioeconomic and built/physical environment and have been mostly cross-sectional.

Objective:
To investigate associations between neighborhood social environment and incident obesity and to determine if these associations are modified by gender.

Methods:
Study participants were enrolled in MESA from 2000-2002 and followed for an average of 9.5 years. Obesity was defined as body mass index of ≥30 kg/m
2
using weight and height measurement obtained at baseline and 4 follow-up examinations. Neighborhood social environment was assessed using a survey of area residents and MESA participants that asked them to rate their neighborhood (1-mile area surrounding the home) across dimensions of safety, social cohesion, and aesthetic quality. Cox proportional hazards models, with a robust covariance matrix estimator to adjust for clustering within neighborhoods, were used to test study hypotheses.

Results:
Among the 3965 participants free from obesity at baseline and with complete data on study covariates, the mean age was 62 (SD=10) and 508 participants developed obesity over the study follow-up. In multivariable models, there were significant associations between neighborhood social environment indicators (Table 1) and incident obesity among men, independent of individual and neighborhood-level confounders (age, gender, race/ethnicity, education, income, neighborhood socioeconomic factors, and neighborhood physical environment). No associations were present among women.

Conclusion:
Neighborhood-level risk factors are complex and future research is necessary to better understand the increased risk of obesity among men living in better neighborhood social environments.
Abstract P094: Gender Difference of Left Ventricular Geometry and Prolonged QRS Duration on Electrocardiogram: MESA (Multi-Ethnic Study of Atherosclerosis)
Authors: Inoue Yuko , Ashikaga Hiroshi , Ohyama Yoshiaki , Volpe Gustavo , Ambale-Venkatesh Bharath , Lima João
Published: July 2021

Backgrounds:
Prolonged QRS duration (QRSd) on electrocardiogram (ECG) is commonly found in otherwise healthy individuals. However, geometrical factors of the ventricles that determine QRSd are poorly defined. T1 time by cardiovascular magnetic resonance (CMR) is good parameter to estimate extracellular expansion (ECE). Our objective was to evaluate the relationship between QRSd and CMR measures of tissue composition in a large community-based multiethnic population.

Methods:
A total of 1,615 participants (52% women; age range 44 to 84 years) of the MESA cohort were evaluated with T1 mapping by using 1.5-T CMR scanners. We excluded the participants with focal scar on delayed enhancement CMR and bundle branch block. Midventricular short-axis T1 maps were acquired before and at 12- and 25-min after administration of gadolinium contrast using Modified Look-Locker Inversion Recovery sequence.

Results:
Longer QRSd was associated with greater LV end diastolic volume (LVEDV) index (p <0.001), LV mass index (p <0.001), and stroke volume index (p <0.01) in both women and men. In addition, longer QRSd was associated with lower ejection fraction (p<0.001), circumferential shortening (p = 0.04), torsion (p <0.001), and longer post-contrast T1 times at 12 min indicating less ECE (p = 0.001) in women only. Longer T1 time remained significant after adjusting for LVEDV, LV mass and QRS voltage.

Conclusions:
In a large multiethnic population, longer QRSd was associated with lower ECE and LV dysfunction in women. However, these relationships were sex dependent and were absent in men.
Abstract P096: Effectiveness of a Comprehensive Care Delivery System on Readmission Rates and Self-Care in Older Adult Patients with Heart Failure
Authors: Tavares Linda L
Published: July 2021

Background:
Telemedicine interventions to prevent readmissions in patients with heart failure (HF) have shown inconsistent results in their effectiveness on HF-related and all-cause rehospitalization. Team-based interventions geared toward patient-centric care delivery in concert with comprehensive care coordination that enhances patient self-care may help to prevent unplanned hospitalizations in patients with HF.

Objective:
To evaluate the outcomes of a comprehensive care delivery system using a team-based high-touch coaching and remote patient monitoring intervention designed for older adult patients with heart failure in a community hospital setting.

Design:
A descriptive cross-sectional observational design was used to measure readmission rates. A one-group pretest-posttest design using the Self-care of Heart Failure Index was used to measure self-care outcomes. Correlation analysis was performed to determine relationships between the coaching and outcomes.

Patients:
Participants were older adult patient hospitalized with heart failure and followed for 30-days. Patients were excluded if they were unwilling to participate, non- English speaking, had end-stage renal disease, a terminal illness, debilitating neuro-psychological disorder, or lived greater than 30 miles away.

Results:
The 30-patients were primarily Caucasian, female with a mean age of 77.5 years. The majority of patients had medically optimized NYHA class II or III HF with an ejection fraction ≤ 40%. HF readmission rate was zero, and 6% for all cause. Patient self-care scores improved (p < .0001). Team based coaching was correlated with improvement in self-care maintenance scores (p =.009).

Conclusion:
A comprehensive care delivery system leveraging remote patient monitoring and health coaching significantly reduced 30-day readmission and enhanced patient self-care management.

Implications:
Patient centric team based care models leveraging technology should continue to be developed and implemented to transform care delivery for older adults with HF.

Table 1.
Change in Mean Self-Care of Heart Failure Index Scores p < .0001 p < .0001 p < .0001
Abstract P118: Changes in Physical Activity by Self-Weighing Trajectory Groups
Authors: Zheng Yaguang , Sereika Susan M , Ewing Linda J , Danford Cynthia A , Rockette-Wagner Bonny , Imes Christopher C , Lu Hu , Sun Ran , Burke Lora E
Published: July 2021

Introduction:
Numerous studies have established a significant association between regular self-weighing and weight loss; however, few studies have examined how self-weighing patterns are associated with lifestyle changes, e.g. physical activity (PA). The aim was to examine the association between frequency of self-weighing and changes in PA levels.

Hypothesis:
We hypothesized that higher frequencies of self-weighing are associated with greater increases in PA levels.

Methods:
This was an analysis of data from a 12-mo behavioral weight loss intervention study. Each subject was given a Wi-Fi scale and instructed to weigh daily. The scale transmitted weight values to a central server. PA was objectively assessed by an accelerometer (ActiGraph GT3x) at 0 and 6 mos. Participants were instructed to wear the accelerometer for ≥ 3 weekdays, one weekend day, ≥10 hours/day. General linear model was used for data analysis.

Results:
The sample (N=89) was largely female (89.9%), White (82%), with a mean age (±SD) of 51.9±9.3 years, and a mean BMI of 33.6±4.5 kg/m2. Our previous analysis using group-based trajectory modeling identified 3 self-weighing patterns: high/consistent (self-weighed 5-6 days/week regularly); moderate/declined (declined from 4-5 to 2 days/week); minimal/declined (declined from 5-6 to 0 days/week). As shown in the table, compared with minimal/declined self-weighing group, the high/consistent group had a significant increase in energy expenditure, steps, light and moderate PA levels as well as average activity/day, while the moderate/declined group had a significant increase in steps and average activity/day.

Conclusions:
The differences in PA level changes across the trajectory groups suggest that improved adherence to self-weighing carried over to improved PA behavior changes. It is unclear if self-monitoring weight and observing the results led participants to regulate their PA behavior accordingly. Future research needs to examine the mechanisms of how daily weighing impacts the level of daily PA.
Abstract P155: Weight Gain and Insulin Sensitivity in Adults With and Without Type 1 Diabetes
Authors: Duca Lindsey M , Schauer Irene E , Snell-Bergeon Janet K
Published: July 2021

People with type 1 diabetes mellitus (T1D) have reduced insulin sensitivity (IS), which partially explains their increased risk of cardiovascular disease. However, there is limited data on how weight gain alters IS in T1D, and so this study aimed to analyze the effect of weight change on IS components in T1D and non-diabetic (non-DM) adults.

This study included 1133 adults (T1D=528 and non-DM n=605) with a mean ± SD age of 38 ± 9 years from the Coronary Artery Calcification in Type 1 Diabetes cohort, examined at baseline and after 6.2±0.6 years. Weight change was categorized as follows: weight loss (WL), lost > 2%), weight stable (WS), within 2% of baseline, and weight gain (WG), > 2%. Estimated IS (eIS) was calculated by a model derived from a clamp study (Table) at each visit. Multiple age and sex adjusted least squares means were calculated by weight change group and diabetes status, and progression of coronary artery calcium (CAC) was examined by logistic regression.

There was a significant improvement in eIS in the T1D WL group, along with a greater reduction in triglycerides and insulin dose and increase in adiponectin compared to the other weight change groups (Table). There was significant increase in eIS among the non-DM WL group, along with a reduction in triglycerides, fasting glucose, HbA1c and DBP and an increase in adiponectin. For each 2% increase in weight, the odds ratio (OR) for progression of CAC was 1.23 (95% CI 1.1-1.4, p=0.002), after adjusting for age, sex, diabetes status, and baseline BMI and CAC. The odds of CAC progression were decreased by 40% (OR 0.6, 95% CI 0.5-0.8, p=0.0007) for each SD increase in eIS, adjusting for the same variables.

In conclusion, over 6 years of follow-up, weight loss increased eIS and related factors in both people with and without T1D, but was not associated with improved Hba1c in T1D. Additionally, weight gain was associated with a greater risk and eIS with a lower risk for CAC progression, demonstrating the importance of avoiding weight gain in prevention of subclinical cardiovascular disease.
Abstract P196: Bidirectional Association Between Hypertension and Gout: The Singapore Chinese Health Study
Authors: Pan An , Teng Gim Gee , Yuan Jian-Min , Koh Woon-Puay
Published: July 2021

Introduction:
Although it has been hypothesized that the hypertension-gout relation is bidirectional, few studies have addressed this hypothesis in a prospective setting, particularly in the Asian populations.

Methods:
We analyzed data from the Singapore Chinese Health Study (SCHS), a cohort of 63,257 Chinese aged 45-74 years at recruitment from 1993-98. The information about self reports of physician-diagnosed hypertension and gout was enquired at follow-ups I (1999-2004) and II (2006-2010). We included participants with complete data for both follow-ups and who were free of heart disease, stroke and cancer at follow-up I. For the analysis of hypertension and risk of incident gout, participants with prevalent gout were further excluded and the final analysis included 31,694 participants. For the analysis of gout and risk of incident hypertension, participants with prevalent hypertension were further excluded and the final analysis included 20,490 participants. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) with adjustment for age, sex, years of interview, dialect group, education, smoking status, alcohol intake, physical activity, body mass index (BMI) and history of diabetes.

Results:
The mean age of the participants at baseline was 60.1 (SD 7.3) years, and the average follow-up year was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 836 incident cases were identified. Compared to normotensive participants, hypertensive patients had a 93% increased risk of developing gout (RR 1.93; 95% CI 1.66-2.24). The association was slightly stronger in women (RR 2.09; 95% CI 1.69-2.58) compared to men (RR 1.72; 95% CI 1.39-2.14; P for interaction=0.056). The association was also stronger in normal weight adults (BMI <24 kg/m2; RR 2.25; 95% CI 1.82-2.77) compared to overweight/obese individuals (BMI ≥24 kg/m2; RR 1.66; 95% CI 1.34-2.04; P for interaction=0.03). In the parallel analysis of gout and risk of hypertension, 5491 participants reported to have newly diagnosed hypertension during the follow-up. Compared to participants without gout, those with gout had a 17% increased risk of developing hypertension (RR 1.17; 95% CI 1.01-1.35). The association was evident in men (RR 1.29; 95% CI 1.07-1.55) but not in women (RR 0.94; 95% CI 0.73-1.20; P for interaction=0.03). The association was present in normal weight adults (RR 1.34; 95% CI 1.09-1.64) but not among overweight/obese individuals (RR 0.99; 95% CI 0.80-1.23; P for interaction=0.03).

Conclusions:
Our results provide compelling evidence that the hypertension-gout association is bidirectional in Chinese population. The potential interactions of the bidirectional association with sex and obesity deserve further investigations.
Abstract P224: The Haptoglobin (Hp) Genotype Predicts Coronary Artery Disease (CAD) During 25 Years of Follow-up in Type 1 Diabetes: Potential Pole of Impaired HDL Cholesterol Efflux Capacity
Authors: Costacou Tina , Heinecke Jay W , Vaisar Tomas , Orchard Trevor J
Published: July 2021

Background:
The Hp 2-2 genotype has been associated with increased cardiovascular risk in type 2 diabetes, potentially relating to dysfunctional HDL mediated cholesterol efflux. We have shown that the Hp 2 allele predicts the development of both coronary artery disease (CAD) and kidney dysfunction also in childhood onset type 1 diabetes over 18 years of follow-up in the Epidemiology of Diabetes Complications (EDC) study. We now present results on the Hp-CAD association after an additional 7 year follow-up and Hp’s relation to impaired sterol efflux capacity, a proposed cardioprotective effect of HDL.

Methods:
Participants free of CAD at baseline and with Hp determined were studied (n=565; mean age, 27 and duration, 19 years; 11.5% Hp 1-1, 42.5% Hp 2-2). CAD was defined as EDC physician diagnosed angina, ischemic ECG changes (MC 1.3, 4.1-4.3, 5.1-5.3, 7.1), confirmed MI (MC 1.1, 1.2 or validated medical records), stenosis >50%, revascularization or CAD death. In a pilot study, serum HDL sterol efflux was assessed in Mifepristone stimulated ABCA1-BHK cells among 20 individuals (6 Hp 1-1; 7 Hp 2-1; 7 Hp 2-2) attending the 25 year exam.

Results:
During follow-up, 186 (32.9%) developed CAD. Incidence increased with the number of Hp 2 alleles (24.6% in Hp 1-1, 31.1% in Hp 2-1 and 37.1% in Hp 2-2, p-trend=0.04; Fig. 1). Multivariably, Hp 2-2 significantly increased risk by almost 80% (HR=1.79, 1.03-3.09). The risk associated with Hp 2-1 did not reach significance (HR=1.46, 0.85-2.53). In the pilot study, serum HDL sterol efflux was lower in Hp 2 allele carriers: 14.0% in Hp 1-1, 12.5% in Hp 2-1, 12.4% in Hp 2-2, p-trend=0.06, p-value Hp 1-1 vs Hp 2-1/2-2 =0.04.

Conclusion:
These results extend our previous findings of increased CAD risk associated with the Hp 2 allele in type 1 diabetes and further suggest that this allele associates with impaired sterol efflux capacity. These results support the hypothesis that sterol efflux explains the increased Hp 2 risk for CAD and should be confirmed prospectively.

Figure 1. CAD-free survival curves by Hp genotype
Abstract P293: Relations of Abdominal Subcutaneous and Visceral Fat Quality with a Panel of Metabolic Regulatory Biomarkers
Authors: Lee Jane J , Pedley Alison , Hoffmann Udo , Keaney John F , Vasan Ramachandran S , Fox Caroline S
Published: July 2021

Introduction:
Excess accumulation of abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) is associated with metabolic regulatory biomarkers and an increased risk for developing type 2 diabetes, dyslipidemia and cardiovascular disease. Abdominal fat quality is related to cardiovascular disease risk factors above and beyond fat quantity. However, whether fat quality is associated with biomarkers of metabolic regulation has not been firmly established.

Hypothesis:
We hypothesized that SAT and VAT attenuation, an indirect measure of fat quality, would be associated with a panel of metabolic regulatory biomarkers secreted by adipose tissue or liver, independently of absolute fat volumes.

Methods:
We evaluated 1,829 Framingham Heart Study participants (44.9% women, mean age 45.0 years) with available data on abdominal fat attenuation and metabolic biomarkers. SAT and VAT fat attenuation was determined by multidetector computed tomography (CT) and denoted in Hounsfield units (HU). Panels of circulating biomarkers included adiponectin, leptin, leptin receptor, fatty acid binding protein-4 (FABP-4), retinol binding protein-4 (RBP-4) and fetuin-A. The relationships between SAT or VAT HU and each of the biomarkers were modeled using sex-specific linear regression model, adjusting for age, hormone replacement therapy (women), smoking status, alcohol use, and physical activity score. Biomarkers were log-transformed to normalize their distribution.

Results:
In both sexes, SAT and VAT attenuation were associated with all the biomarkers evaluated, except fetuin-A. Lower (i.e., more negative) attenuation of SAT and VAT was associated with lower circulating adiponectin and leptin receptor levels but higher leptin and FABP-4 levels in both women and men (all
p
<0.0001). SAT attenuation was inversely associated with RPB-4 levels in both sexes; whereas, the association between VAT attenuation and RPB-4 was only observed in men (
p
<0.0001). In women, after additional adjustment for the respective fat volume, SAT HU retained the statistically significant associations with adiponectin, leptin, FABP, and RBP-4; and VAT HU with adiponectin only (all
p
<0.0001). In men, associations remained significant after additional adjustment for the respective fat volume (all
p
<0.005).

Conclusions:
Lower attenuation of abdominal fat was associated with a profile of biomarkers suggestive of greater cardiometabolic risks. These observations suggest that fat attenuation may be a valid biomarker of cardiometabolic risk. Further study is required to identify whether the quality of abdominal fat has a pathogenic impact on metabolism via its relationship with biomarkers secreted by adipose tissue or the liver.