bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP22: Ideal Cardiovascular Health and Lifetime Risk of Cardiovascular Disease: the Cardiovascular Disease Lifetime Risk Pooling Project
Authors: Bundy Joshua D , Ning Hongyan , Paluch Amanda E , Zhong Victor W , Lloyd-Jones Donald M , Wilkins John T , Allen Norrina B
Published: March 2019

Introduction:
Ideal cardiovascular health (CVH) is associated with lower risk of cardiovascular disease (CVD) compared with intermediate and poor CVH. Quantifying the associations of ideal, intermediate, and poor CVH with lifetime risk of CVD can improve estimation of future population disease burden.

Hypothesis:
Individuals with ideal CVH have lower lifetime risk of CVD compared with individuals with intermediate and poor CVH.

Methods:
We pooled individual-level data from 7 US cohort studies (n=34027) that are included in the Lifetime Risk Pooling Project. We defined CVH based on levels of 7 health factors: smoking status, body mass index, physical activity, dietary pattern, total cholesterol, blood pressure, and diabetes mellitus. Each factor is scored as ideal (2 points), intermediate (1 point), or poor (0 points). The total CVH score was used to define overall CVH according to categories of ideal (12-14 points), intermediate (9-11 points), or poor (0-8 points). We used a modified Kaplan-Meier analysis, accounting for the competing risk of death, to assess the lifetime risk of CVD (CVD deaths, myocardial infarction, stroke, heart failure) separately in men and women free of CVD at index age categories of <40, 40-59, and ≥60 years.

Results:
Over 553379 person-years of follow-up, we observed 6858 CVD events (103 events in ideal, 1514 in intermediate, and 5241 in poor CVH categories). Men had higher lifetime risk of CVD than women across all CVH categories. In the 40-59 years index age group (Figure), participants with ideal CVH had lower lifetime risk of CVD (men, 14.3%; women, 12.0%) compared with intermediate (men, 21.9%; women, 16.9%) and poor (men, 42.7%; women, 33.8%) CVH. Patterns were similar for the <40 and ≥60 years index age groups.

Conclusions:
Ideal CVH is associated with substantially lower lifetime risk of CVD in US men and women. Further research is warranted to investigate strategies for maintaining and restoring ideal CVH throughout the life course to prevent associated risk of CVD.
Abstract MP24: Women Experience Higher Rates of Surgical Repair and Mortality for Abdominal Aortic Aneurysm
Authors: Ramkumar Niveditta , Suckow Bjoern D , Sedrakyan Art , Goodney Philip P , Brown Jeremiah R
Published: March 2019

Background:
It is unknown how gender disparities in the clinical presentation of abdominal aortic aneurysm (AAA) affects AAA repair type and long-term survival. We assessed the hypothesis that compared to men, women face a higher risk of death after AAA repair due to differences in demographics, disease severity, and repair type.

Methods:
We analyzed all endovascular (EVAR) and open surgical (OPEN) AAA repairs from 2003-2015 in the Vascular Quality Initiative-Medicare linked registry. Using inverse probability weighting, we balanced patient demographics, comorbidities, and disease severity among men and women. Then, we evaluated the effect of gender on AAA treatment and subsequent survival using Poisson and Cox regression, respectively.

Results:
In this cohort (n=16,085), patients undergoing EVAR (79%) or OPEN (21%) had up to 12 years of follow-up. Women comprised 22% of the cohort and were older (mean age 77 ±6.6 vs. 75 ±6.5 years, p<0.001), less likely to smoke (28% vs. 33%, p<0.001), and had smaller aneurysms (58.7 ±18.5 mm vs 56.5 ±12 mm) than men (Figure). After balancing key risk factors, women were 1.6 times more likely to receive OPEN vs. EVAR (RR: 1.59, 95% CI: 1.46-1.72). The 12-year mortality rate after AAA repair was 74% in men vs 84% in women. After adjustment, women faced a 12% increased risk of death (HR: 1.12, 95% CI: 1.04-1.21). Sub-analysis by repair type revealed a gender discrepancy among EVAR patients, where women experienced poorer survival (HR: 1.18, 95% CI: 1.09-1.29), while men and women faced an equal risk of death after OPEN (HR: 1.00, 95% CI: 0.90-1.12).

Conclusion:
In conclusion, women were 1.6 times more likely to undergo OPEN repair than men, despite balancing key baseline AAA risk factors associated between men and women. After EVAR, women were 12% more likely to die than men, though no gender-based morality difference exists following OPEN repair. The differential treatment benefit of EVAR in women is concerning given the trend toward an endovascular-first treatment approach to AAA.
Abstract MP27: The Association Between Psychosocial Factors and Sleep Among African-American Men and Women, the Jackson Heart Sleep Study
Authors: Johnson Dayna A , Guo Na , Lewis Tené T , Sofer Tamar , Williams David R , Sims Mario , Wilson James G , Redline Susan
Published: March 2019

Background:
Emerging evidence suggests that sleep traits and disorders are strong predictors of cardiovascular disease (CVD), particularly among African-Americans. Identifying determinants of insufficient sleep among African-Americans may help to target interventions and potentially reduce CVD burden. Psychosocial factors may be particularly relevant to sleep health among African-Americans; however, more research is needed using objective and well-validated sleep assessments. We investigated associations of individual and aggregate psychosocial factors (e.g. stress, depression, anxiety) with objectively-measured sleep traits and insomnia; and examined differences by sex among African-Americans.

Methods:
Between 2012 and 2016, Jackson Heart Sleep Study (JHSS) participants (N=913) underwent 7-day wrist actigraphy, had a clinic visit and completed questionnaires. Actigraphy-based measures included short sleep duration (<6 hours), low sleep efficiency (< 85%), and wake after sleep onset (WASO). Insomnia was assessed by the Women’s Health Initiative Insomnia Rating Scale (WHIIRS ≥10). A composite psychosocial factors variable was created based on the number of high-level factors that the participant reported: top quintile of stress (Perceived Stress Scale ≥ 18), high depressive symptoms (Center for Epidemiologic Studies Depression Scale-20, excluding restless sleep, ≥ 16), and top quintile of anxiety (State-Trait Anxiety Inventory score ≥ 38). Linear and logistic regression models were fit to test associations between psychosocial factors and sleep outcomes, adjusted for demographics, socioeconomic status, body mass index (BMI), and physical activity. Psychosocial factors and sex interactions were tested in adjusted models.

Results:
JHSS participants had a mean age of 63.4 years (standard deviation: 10.7), 33.6% were male, 53.6% had a college degree and the mean BMI was 31.9 kg/m
2
(6.9). Short sleep and low sleep efficiency were common, 26.1% and 30.0%, respectively. The average WASO was 54.5 (23.5) minutes. Psychosocial factors (composite and individually) were associated with insomnia. Adverse psychosocial factors were associated with a higher odds of insomnia, adjusted odds ratio (aOR)=1.65 (95% confidence interval: 1.39, 1.95). High anxiety, but not stress or depressive symptoms were associated with a short sleep duration, aOR=2.00 (1.34, 2.98). There was no evidence of associations between psychosocial factors and sleep efficiency or WASO in the overall sample. However, in males only, high anxiety and stress were associated with lower sleep efficiency,
P
≤0.05 for all.

Conclusion:
Stress and negative emotional state, anxiety and depressive symptoms were associated with insomnia. Short sleep duration was specifically associated with anxiety. Psychosocial factors may be a point of intervention for improving sleep health, particularly among men.
Abstract MP28: Early Menopause is Associated With Early-Onset Cardiovascular Disease Before Age of 60 Years
Authors: Zhu Dongshan , Chung Hsin-Fang , Pandeya Nirmala , Dobson Annette , Mishra Gita
Published: March 2019

Introduction:
Evidence has shown that early menopause is linked to higher risk of cardiovascular disease (CVD) in women. A prevailing view is that endogenous estrogen may confer protection against heart disease, so the reduction of endogenous estrogen at menopause triggers vascular ageing and accelerate the progression of coronary heart disease (CHD).

Hypothesis:
If estrogen protection against coronary heart disease is true, we hypothesized that earlier menopause might also lead to earlier onset of CVD, and years of exposure to low estrogen level after menopause may play a role. The higher risk of CVD with early menopause might be driven by a longer duration experienced after menopause.

Methods:
A total of 151 951 naturally postmenopausal women without experiencing CVD and had no use of menopause hormone therapy (MHT) before menopause were included. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the associations between age at natural menopause and subsequent incident CVD events (binominal model), as well as age at onset of CVD (multinomial model). Age at menopause was categorized as <40 (premature), 40-44 (early), 45-49, 50-51 (reference), 52-53, and 54 years and above. Age at onset of CVD (defined as the first occurrence of CHD or stroke, and validated by hospital record of diagnosis) was grouped as <60, 60-64, 65-69, ≥70 years and no CVD (reference). We also examined how the associations changed with number of years experienced after menopause (categorized as <5, 5-9, 10-14, 15-19, and ≥20 years). All ORs were adjusted for age at last follow-up, race/ethnicity, education level, body mass index, smoking status, hypertension status, and MHT status after menopause.

Results:
There were 6042 CVD events reported, including 4232 CHD and 2075 strokes. 1.7% and 6.5% of women experienced premature and early menopause respectively. Women who experienced premature or early menopause or menopause at 45-49 years had increased odds of experiencing incident CVD events compared with menopause at 50-51 years, with adjusted ORs (95% CI) of 1.86 (1.26, 2.75), 1.62 (1.31, 2.00) and 1.25 (1.10, 1.41) respectively. Women with early menopause (<45 years) had the highest likelihood of experiencing incident CVD before the age of 60 years (OR 2.20, 1.85-2.63), and the odds was attenuated to 1.30 (1.18-1.44) for onset of CVD at 60-64 years. Similar results were found when CHD and stroke were analyzed separately. The elevated odds of incident CVD in women with early menopause did not appear until 15 years after menopause.

Conclusions:
Premature and early menopause were significantly associated with higher odds of experiencing incident CVD, and were strongly associated with early-onset CVD before the age of 60 years. The elevated odds of incident CVD in women with early menopause did not appear until 15 years after menopause.
Abstract MP29: Body Fat and Cardiovascular Disease Risk in Postmenopausal Women With Normal Body Mass Index: the Women’s Health Initiative
Authors: Chen Guo-Chong , Arthur Rhonda , Iyengar Neil M , Kamensky Victor , Xue Xiaonan , Wassertheil-Smoller Sylvia , Allison Matthew A , Shadyab Aladdin H , Wild Robert A , Sun Yangbo , Banack Hailey R , Wactawski-Wende Jean , Manson JoAnn E , Stefanick Marcia L , Dannenberg Andrew J , Rohan Thomas E , Qi Qibin
Published: March 2019

Introduction:
Excess body weight characterized by higher BMI is associated with increased risk of cardiovascular disease (CVD). In individuals with normal BMI, the extent to which body fat distribution may impact CVD risk is unclear, particularly in postmenopausal women who often experience fat redistribution.

Hypothesis:
We hypothesized a detrimental impact of trunk fat and a favorable impact of leg fat on risk of CVD risk among postmenopausal women with normal BMI.

Methods:
We analyzed data from 2683 normal-weight (BMI: 18.5-24.9 kg/m
2
) women in the Women’s Health Initiative study without known CVD at baseline (1993-1998). Body composition including whole body and regional fat mass (FM) were determined by dual-energy X-ray absorptiometry. Incident CVD events including coronary heart disease (coronary death, nonfatal myocardial infarction, or coronary revascularization) and stroke were ascertained through February 2017.

Results:
There were 291 incident cases of CVD during a median 17.9 years of follow-up. After multivariable adjustment, whole body FM or FM percentage was not significantly associated with CVD risk. Higher trunk FM percentage was associated with increased risk of CVD (HR comparing extreme quartiles = 1.91, 95% CI: 1.33-2.74,
P
-trend <0.001), while higher leg FM percentage was associated with lower risk of CVD (HR = 0.62, 95% CI: 0.43-0.89,
P
-trend = 0.008) (
Figure
). These associations were slightly attenuated but remained significant after further adjustment for waist circumference or waist-to-hip ratio. Higher trunk fat combined with lower leg fat was associated with particularly higher risk of CVD (HR comparing extreme groups = 3.33, 95% CI: 1.46-7.62). Similar significant associations of trunk fat and leg fat were observed for coronary heart disease but not for stroke.

Conclusions:
Among postmenopausal women with normal BMI, higher trunk fat was associated with increased risk of CVD, while higher leg fat was associated with decreased risk of CVD, independently of central adiposity measures.
Abstract MP31: Diurnal Patterns of Physical Activity and Cardiovascular Risk Factors Over 10 Years: Results From the Coronary Artery Risk Development in Young Adults Study
Authors: Paluch Amanda E , Pettee Gabriel Kelley , Montag Samantha , Siddique Juned , Schreiner Pamela , Lewis Cora E , Dutton Gareth , Sternfeld Barbara , Sidney Steve , Reis Jared , Carnethon Mercedes
Published: March 2019

Introduction:
Moderate to vigorous intensity physical activity (MVPA) is associated with lower cardiovascular (CV) disease risk. Cross-sectional studies has shown beneficial associations of morning MVPA with CV risk factors. We hypothesized that participants aged 38-50 yrs accumulating a greater proportion of MVPA earlier in the day will have lower risk of obesity, diabetes, and hypertension 10 years later.

Methods:
We included CARDIA participants with valid (≥4 of 7 days with ≥10 hr/d) accelerometer wear (ActiGraph 7164) at the year 20 exam (2005-2006) who performed at least 10 min/d MVPA (≥2020 counts per minute). Diurnal patterns were calculated from individual waking time, based on the first valid minute of wear after 4 AM. Diurnal patterns were operationalized as: 1) cumulative percent of MVPA counts within 4 hours after waking, and 2) time after waking when accumulating 50% MVPA counts. Logistic regression estimated odds of obesity, diabetes, and stage 2 hypertension and generalized linear models estimated the prevalence risk of stage 1 or above hypertension at the year 25 or 30 exam.

Results:
Participants (aged 45.2±3.6 yrs, 57.8% women) averaged 33.7±24.1 min/d MVPA, 34.1±1.3% MVPA was accumulated within 4 hours of waking, and 50% of MVPA was accumulated by 7.2±2.2 hours after waking. There were no statistically significant associations of diurnal patterns with obesity or hypertension (Table). However, every 10% greater MVPA accumulated within the first 4 hours was associated with a 20% higher odds of diabetes. Similarly, every 1 hour earlier accumulating 50% of MVPA was associated with 15% higher odds of diabetes. Total MVPA (min/d) was inversely associated with diabetes, obesity, and stage 2 hypertension.

Conclusions:
Total volume of MVPA is more important for cardiometabolic health than the time of day at which it is performed. In regards to diabetes risk, our findings showing higher odds with earlier accumulation of MVPA may be suggestive of a benefit in spreading activity throughout the entire day.
Abstract MP32: Mid-Life Fitness and Plasma Markers of Alzheimer’s Pathology
Authors: Jacob Mini E , O’Donnell Adrienne , Satizabal Claudia , Pase Matthew , Murabito Joanne , Beiser Alexa , Seshadri Sudha
Published: March 2019

Introduction:
Motor function in older adults is known to correlate with neurodegenerative changes and Alzheimer’s Disease (AD) pathology in the brain, however the relationship between mid-life fitness and AD pathology is unknown. AD pathology accumulates early and is difficult to measure; precise estimation requires brain imaging not accessible beyond research settings. Plasma Amyloid and Tau, on the other hand are easy to measure, and are markers of AD pathology and neuronal loss. We tested the association between physical fitness measures in mid-life (gait speed, grip strength and chair stand speed) and plasma markers of AD in the Framingham Heart Study (FHS) Offspring cohort. If these measures correlate with and predict plasma measures of AD burden, these could potentially be used to screen for risk of dementia.

Hypothesis:
We hypothesized that superior physical fitness will be cross-sectionally associated with higher plasma Amyloid Aβ42 and lower Tau; also, that physical fitness measures will be longitudinally associated with Tau measured at a later exam.

Methods:
The FHS Offspring cohort had plasma Aβ40 and Aβ42 measured at their 7th clinic exam (1998-01) and plasma total Tau measured at Exam 8 (2005-08). They had grip strength, gait speed and chair stand speed measured at Exam 7, and grip strength and gait speed measured at Exam 8. Grip strength was measured using the Jamar dynamometer, fast gait speed was measured over a 4-meter walkway and chair stand speed was assessed by asking the participants to stand up and down five times, as quickly as they can with their hands folded across their chest. Quantification of Aβ isoforms in plasma was performed using INNO-BIA assays and tau using Single Molecule Array technology.We used linear regression models to examine the association between physical fitness measures and plasma markers of AD adjusting for known confounders (diabetes, cardiovascular disease, atrial fibrillation, smoking, APOE4, systolic blood pressure, waist-to-hip ratio, total cholesterol level, physical activity index, and plasma homocysteine).

Results:
In this sample of 1886 community living adults (mean age 61, 54% women), hand grip strength was independently associated with plasma Aβ40 (Beta coefficient -0.28; SD 0.10; p value 0.003) and plasma Tau measured 5 years later (Beta coefficient -0.003; SD 0.001; p value 0.001). Gait speed and chair stand speed demonstrated associations with Aβ40 and total Tau which were attenuated by vascular risk factors.

Conclusions:
Hand grip strength is associated with AD pathology. Grip strength measurement could be a valid screening tool for identifying individuals at a higher risk for AD alongside other validated markers. Future research should examine the correlation between grip strength and AD burden measured by PET imaging.
Abstract MP33: Modes of Physical Activity Engagement Differ by Federal Poverty Level Among Men and Women: The National Health and Nutrition Examination Survey (NHANES) 2007-2014
Authors: Reesor Layton , Murillo Rosenda , Dao Ashley , Hernandez Daphne C
Published: March 2019

Introduction:
Research has consistently identified the health benefits of physical activity (PA) and that low-income populations engage in less PA than their more affluent counterparts and may differ by gender. However, research has focused on leisure time PA (LTPA) with less emphasis on PA engagement from employment and transportation. This study aims to determine if those in lower Federal Poverty Level (FPL) categories differ in their modes of PA engagement compared to those of higher FPL categories.

Hypothesis:
We hypothesized that individuals of lower FPL status would be more likely to meet PA guidelines (≥150 minutes moderate to vigorous PA) from employment and transportation PA and less likely to meet PA guidelines from LTPA compared to those of higher FPL status.

Methods:
We used cross-sectional data from NHANES 2007-2014 participants aged 21 to 59 years (females: n =6,736; males: n=6,047). Weighted logistic regression models were used to estimate the association between FPL (FPL ≤0.99, 1.00-1.99, 2.00-2.99 vs FPL ≥ 3.00) and meeting PA guidelines in three domains: employment, transportation, and LTPA. Models were stratified by sex and adjusted for weight status, age, race, nativity, marital status, education, employment, and health insurance.

Results:
Among women, those of lower FPL had increased odds of meeting PA guidelines from employment [(FPL ≤ 0.99: OR: 1.53; 95% CI: 1.13, 2.06), (FPL 1.00-1.99: OR: 1.41; 95% CI: 1.07, 1.88). Those in the 2.00-2.99 FPL category had similar odds of meeting PA guidelines from employment (OR: 1.39; 95% CI: 0.99, 1.94), compared to those FPL ≥ 3.00. Women of lower FPL had similar odds of meeting PA guidelines from transportation compared to those FPL ≥ 3.00 (
p
> .05). Further, women of lower FPL were significantly less likely to meet PA recommendations from LTPA [(FPL ≤ 0.99: OR: 0.47; 95% CI: 0.39, 0.57), (FPL 1.00-1.99: OR: 0.51; 95% CI: 0.41, 0.62), (FPL 2.00-2.99: OR: 0.72; 95% CI: 0.58, 0.90)]. Among men, only those in the 2.00-2.99 category having increased odds of meeting PA guidelines from employment (OR: 1.49; 95% CI: 1.19, 1.86). Only the lowest FPL category men (FPL ≤0.99) had increased odds of meeting PA guidelines from transportation (OR: 1.80; 95% CI: 1.29, 2.51). Similar to women, lower FPL men were significantly less likely to meet PA recommendations from LTPA [(FPL ≤ 0.99: OR: 0.63; 95% CI: 0.51, 0.79), (FPL 1.00-1.99: OR: 0.58; 95% CI: 0.48, 0.70), (FPL 2.00-2.99: OR: 0.68; 95% CI: 0.55, 0.84)].

Conclusions:
These findings suggest that modes of PA engagement differ by FPL category among men and women. Researchers studying PA among low-income populations must assess employment and transportation PA in addition to LTPA in order to accurately estimate PA engagement. Practitioners attempting to increase PA among low-income populations need to consider other modes of PA rather than solely focusing on LTPA.
Abstract MP36: Trends and Correlates of Physical Activity and Dietary Counseling for Adults With Cardiovascular Risk Factors: Medical Expenditure Panel Survey 2002-20015
Authors: Lobelo Felipe , Zhuo Tianyi , Frediani Jeniffer
Published: March 2019

Background:
In 2014 the United States Preventive Services Task Force (USPSTF) recommended offering overweight adults with additional cardiovascular disease (CVD) risk factors behavioral counseling to promote a healthful diet and physical activity (PA).

Methods:
Self-reported receipt of counseling, CVD risk (overweight/obesity, diabetes, smoking, high cholesterol and blood pressure) for adults were extracted from the Medical Expenditure Panel Survey (MEPS) household component (HC) 2002-2015. Prevalence rates for PA+diet counseling were calculated, adjusted by age, gender, insurance type, race/ethnicity, region, marital status, educational level, family income, number of health visits and CVD risk factors. To assess trends, we computed prevalence ratios (PR) at three time-points: 2002/03, 2009/10 and 2014/15, controlling for socio-demographics. Correlates of PA/diet counseling for 2014/15 were explored using adjusted PR.

Results:
The MEPS-HC response rate averaged 57.1% and included 116,048 observations across the 14-year period. The adjusted PA/diet counseling prevalence ranged from 43% to 63% (Figure 1). Compared to the 2002/03, PA+diet counseling increased in 2009/10 (PR=1.09 (1.07-1.12)). In 2014/15, compared to adults with private insurance, those with no insurance or Medicare reported lower PA+diet counseling (PR=0.91 (0.84-0.99); PR=0.77; (0.73-0.82), respectively). Females (PR=1.07 (1.03-1.11) and racial minorities reported higher PA+diet counseling (PR=1.31 (1.24-1.38); PR=1.11 (1.05-1.18); PR=1.12 (1.01-1.24), for Hispanic, Black and Asians, respectively). Compared to adults with 2 CVD risk factors, those with 3, 4 or 5 CVD risk factors reported higher PA+diet counseling (PR=1.46 (1.39-1.54); PR=1.74 (1.63-1.85); PR=1.89 (1.67-2.15), respectively).

Conclusions:
Modest increases in PA and diet counseling have occurred, primarily before ACA passing. However, half of eligible patients report not receiving counseling, particularly those with no insurance or Medicare.
Abstract MP40: Higher Intakes of Animal Protein Helps Maintain Functional Status and Grip Strength in Older Adults in the Framingham Offspring Study
Authors: Yuan Mengjie , Pickering Richard T , Singer Martha R , Bradlee Margaret L , Moore Lynn L
Published: March 2019

Introduction:
Dietary protein has been shown to prevent age-related functional decline and strength loss, but few studies have examined the separate effects of animal and plant proteins on these outcomes.

Hypothesis:
We hypothesized that animal protein might provide greater protection against strength loss and functional decline than plant protein in older adults (aged ≥ 50 years) in the Framingham Offspring Study (FOS).

Methods:
Dietary protein was assessed using 3-day diet records at exams 3 and 5 in the prospective FOS; intakes were adjusted for body weight using the residual method. Functional status scores (median follow-up 17.3 years) was derived from standardized questionnaires at exams 5-9, while grip strength (median follow-up 10.3 years) was measured by hand-held dynamometer at exams 7-9. Multivariable analyses included Cox proportional hazards modeling, repeated-measures mixed models, and analysis of covariance to adjust for sex, age, education, percent of calories from saturated fats, and physical activity. Models for animal protein were adjusted for plant protein intake and vice versa.

Results:
Subjects were categorized into 3 categories of sex-specific intakes of animal protein (<50, 50-<70, and ≥70 g/day for men; <45, 45-<65, and ≥65 g/day for women) and plant protein (<20, 20-<26 and ≥26 g/day for men; <17, 17-<22, and ≥22 g/day for women). At the end of follow-up, those with the highest (vs. lowest) animal protein intakes maintained the highest functional status levels (functional score: 20.4 vs.19.0, respectively p=0.0036). Similar results were observed for plant proteins (20.2 vs.18.4 for highest vs. lowest intakes, p ≤.0001). In stratified analyses, higher intakes of both animal and plant proteins, especially in combination with higher levels of activity, were associated with greater preservation of functional status over time. Among more sedentary individuals, dietary protein alone (from both animal and plant sources) protected against functional decline over time (p=0.0015 and p=0.0008 for animal and plant protein, respectively). For grip strength, however, only animal protein protected against decline over 10.3 years (change in grip strength: -0.41 vs. -0.60 kg/yr for highest vs. lowest intakes in men, p=0.0273; -0.15 vs. -0.29 kg/yr for highest vs. lowest intakes in women, p=0.0487). Higher plant protein intake was not associated preservation of grip strength over time.

Conclusions:
Higher intakes of both animal and plant protein were protective of self-reported functional status in these analyses while only animal protein was associated with the preservation of grip strength among older adults.
Abstract MP43: Monounsaturated Fatty Acids From Plant or Animal Sources and Risk of Type 2 Diabetes in Three Large Prospective Cohorts of Men and Women
Authors: Qian Frank , Zong Geng , Li Yanping , Sun Qi
Published: March 2019

Background:
Existing evidence on the relationship between intakes of monounsaturated fatty acids (MUFAs) and risk of developing type 2 diabetes (T2D) is conflicting. Few studies have examined whether MUFAs from plant or animal sources exhibit differential associations with T2D.

Aims:
To examine the association of intake of total, plant-based (MUFA-Ps), and animal-based MUFAs (MUFA-As) with T2D risk.

Methods:
We used data from three prospective cohorts which included 54,518 women in Nurses’ Health Study (1990-2012), 88,613 women in Nurses’ Health Study II (1991-2013), and 29,520 men in Health Professionals Follow-up Study (1990-2012). Using validated food-frequency questionnaires and food composition tables, we calculated the average MUFA-Ps and MUFA-As intake in every 4-year period and modeled their association with T2D using Cox regression models.

Results:
During 3,682,622 person-years of follow-up, we documented 13,077 incident cases of T2D. After multivariate adjustment, total MUFA intake was not associated with risk of T2D. In contrast, MUFA-Ps were associated with a lower risk of T2D, whereas MUFA-As were associated with a higher risk. In iso-caloric substitution analyses, the pooled hazard ratios (HRs) and 95% confidence intervals (CI) were 0.99 (0.88, 1.12;
P
=0.89) for saturated fat (SFAs, 5% of energy), 0.91 (0.85, 0.98;
P
=0.01) for refined carbohydrates (5% of energy), and 0.87 (0.80, 0.94;
P
=0.0006) for
trans
fats (2% of energy), when replaced by MUFA-Ps (
Table 1
). Additionally, the HRs (95% CIs) were 0.67 (0.61, 0.73;
P
<0.0001) and 0.78 (0.73, 0.83;
P
<0.0001), respectively, for replacing 5% of energy in MUFA-As or the sum of SFAs and MUFA-As with MUFA-Ps.

Conclusion:
In three large prospective cohort studies, higher intakes of MUFA-Ps were associated with a lower risk of T2D, whereas increased intakes of MUFA-As was associated with higher risk. Replacing refined carbohydrates,
trans
fats, and MUFA-As with MUFA-Ps may be beneficial for the prevention of T2D.
Abstract MP44: Association of High-Sensitivity Troponin With Peripheral Neuropathy in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Hicks Caitlin W , Wang Dan , Daya Natalie , Windham Beverly G , Ballantyne Christie M , Matsushita Kunihiro , Selvin Elizabeth
Published: March 2019

Introduction:
High-sensitivity cardiac troponin (hs-cTnT) is a marker of myocardial damage and has been associated with diabetes and its major complications, particularly those with a microvascular etiology. The aim of this study was to assess the association of hs-cTnT and other cardiac, kidney, inflammation, and hyperglycemia biomarkers with peripheral neuropathy (PN) in both diabetic and non-diabetic populations.

Methods:
We conducted a cross-sectional analysis of 3,019 black and white participants in the ARIC study who underwent monofilament PN testing and had hs-cTnT and other nontraditional measures [NT-proBNP, high-sensitivity C-reactive protein, β-2 microglobulin, creatinine-based estimated glomerular filtration rate (eGFR), cystatin C-based eGFR, urine albumin:creatinine ratio, fructosamine, glycated albumin, and 1,5-anhydroglucitol] assessed at ARIC visit 6 (2016-2017, age 71-94 years). We used logistic regression models to assess the associations of these biomarkers with the presence of PN in older adults with and without diabetes after adjusting for traditional diabetes and cardiovascular risk factors.

Results:
Overall, 38.0% of the 3,019 participants had evidence of PN (42.0% in persons with diabetes and 36.4% in persons without diabetes). After adjusting for traditional risk factors, there were significant and robust associations of hs-cTnT, NT-proBNP, and β-2 microglobulin with PN (
Table, Model 2
). After further adjusting for hemoglobin A1c, only the association of hs-cTnT with PN remained significant (P=0.02;
Model 3
). Elevated hs-cTnT (≥14 ng/L) was associated with prevalent PN in persons with diabetes (OR 2.10, 95%CI 1.24-3.56) and without diabetes (OR 2.61, 95% CI 1.59-4.28) compared to persons without diabetes and non-elevated hs-cTnT (<6 ng/L).

Conclusions:
Hs-cTnT is associated with the presence of PN in older adults independent of cardiovascular risk factors and glycemic control. These findings support the hypothesis that hs-cTnT may be a global marker of end organ damage.
Abstract MP45: Cardiovascular Health in Early Adulthood Predicts the Development of Coronary Artery Disease: 25 Year Follow Up in Individuals With Type 1 Diabetes From the Pittsburgh Epidemiology of Diabetes Complications Study
Authors: Devaraj Susan M
Published: March 2019

Introduction:
Coronary artery disease (CAD) is especially burdensome among individuals with type 1 diabetes (TID). The AHA created metrics to monitor cardiovascular health (CVH) to promote primordial prevention. CVH metrics define 3 health behaviors (diet, physical activity, and smoking), and 4 health factors (BMI, total cholesterol, blood pressure and fasting glucose) as ideal, intermediate or poor based on set criteria. These CVH metrics have been shown to be related to cardiovascular outcomes in the general population. The purpose of this research is to describe the prevalence of CVH metrics in young adults with T1D,
a group at particularly high risk for CAD
, and assess the
hypothesis
that more favorable metrics protect against future hard CAD outcomes.

Methods:
Data are from the longitudinal Pittsburgh Epidemiology of Diabetes Complications (EDC) study. CVH metrics are defined by an average of measures taken at first visit and first follow up visit (1986-1990, “baseline”) for participants age ≥20 at study entry without prevalent CAD. CVH metrics were scored according to AHA criteria, with HbA1c in place of fasting glucose. Total CVH score (possible range 0-14) is the sum of subscores for each metric where poor=0, intermediate=1 and ideal=2. Cox proportional hazards models were used to assess the association between baseline CVH and CAD incidence during 25 years of follow-up.

Results:
Characteristics of the 463 individuals analyzed after exclusions (179 age <20 or prevalent CAD, 15 missing data) are shown in Table 1. No participants achieved ideal status for all 7 CVH metrics. Each unit increase in ideal CVH score was associated with 28% lower risk (95% CI: 0.63-0.82, p<0.01), while each unit increase in total CVH score was associated with 23% lower risk of CAD (95% CI: 0.71-0.84, p<0.01), adjusting for baseline diabetes duration, sex, race, albumin excretion rate, and triglycerides.

Conclusions:
CVH metric scores appear to be predictive of CAD in adults with T1D, demonstrating the value of promoting ideal CVH for CAD prevention.
Abstract MP50: Regional Income and Relative Individual Income, but Not Income Inequality, is Associated With Cardiovascular Health
Authors: Singh Sarah S , Frisbee Stephanie J
Published: March 2019

Background:
Result from many studies support that the associations between income, income inequality, and mortality, including CVD mortality, are very complex. Given the urgent need for greater CVD prevention in populations, it is essential to understand how income inequality and income, both in individuals and the regions in which they live, can affect cardiovascular health (CVH).

Objective:
To examine the associations between regional income and income inequality and individual relative income and individual CVH.

Setting:
This study was carried out in a nationally representative sample of Canadian adults aged 20 years and older residing in 113 health regions (HR) across Canada.

Data and Methods:
This study is a cross-sectional design using data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care utilization, and health determinants of the Canadian population. The study outcome was individual CVH, defined using the AHA CVH Index (CVHI) and determined using self-reported responses in CCHS. Regional income inequality was measured as the Gini coefficient of the HR. Regional income was measured as the median household income in the HR. Individual income was measured as relative, not absolute, income representing the individual’s household income compared to those in the HR. Multilevel models were used to examine the associations between regional income and income inequality and individual relative income and individual CVH, controlling for individual age, sex, race and education. Analyses were conducted using SAS 9.4 software.

Results:
The majority of the population were males (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, mean CVH for individuals was 4.5. The national average Gini coefficient across HRs was 0.4. The average individual fell within the 6
th
decile for relative household income. Living in a HR with greater income inequality was not associated with lower individual CVH (β= -0.04 p-value=0.91), though living in an HR with higher median household income was associated with better individual CVH (β= 0.32 p=0.004). Finally, having higher relative household income was associated with better individual CVH (β= 0.05 p<0.0001), regardless of the median income of the region of residence.

Conclusion:
While the inequality of income within a HR did not significantly affect CVH, higher regional income and relative individual income was associated with better CVH. Results of this study contribute to the growing body of evidence attempting to disentangle the true associations between income, income inequality, and CVH.
Abstract MP55: Racial Differences in Metabolomic Profiles Between African Americans and Whites in the Women’s Health Initiative
Authors: Hu Jie , Balasubramanian Raji , Li Jun , Clish Clary B , Paynter Nina P , Albert Christine M , Liu Simin , Rosal Milagros C , Nassir Rami , Rexrode Kathryn M
Published: March 2019

Introduction:
In the US, African Americans (AA) have higher cardiovascular disease (CVD) morbidity and mortality than whites. Recent evidence suggests that the CVD development may be related to circulating metabolite alterations, which might contribute to racial disparities in CVD risk.

Hypothesis:
We tested the hypothesis that metabolomic profile of AAs differ from that of whites.

Methods:
Metabolomic profiling in plasma samples of 2,128 women from the Women’s Health Initiative (WHI) was performed using liquid chromatography-tandem mass spectrometry, and 422 known metabolites were measured. The discovery set included 834 women (138 AAs) from the WHI Observational Study. The replication set included 1,294 women (156 AAs) from the WHI Hormone Therapy Trials. Linear regression models were applied to individually estimate the association of race (AA vs. white) with each metabolite, adjusting for age, body mass index, education, income, healthy eating index-2005, physical activity, smoking, alcohol intake, hypertension, diabetes, depression, and medications. Metabolites with a false discovery rate-adjusted
P
<0.05 in the discovery set were then replicated in the replication set with a Bonferroni corrected
P
<0.05 indicating statistical significance.

Results:
We identified 178 metabolites that significantly differed between AAs and whites in both discovery and replication sets, the majority of which were lipids, followed by amino acids and their derivatives (Panel A). For the 178 metabolites, the mean levels of 126 metabolites differed between AAs and Whites by at least 0.5 standard deviation units; 9 of these metabolites (1 triacylglycerol, 3 phosphatidylcholines, 2 phosphatidylethanolamine plasmalogens, and 3 cholesteryl esters) had mean differences exceeding 1-standard deviation unit (Panel B).

Conclusions:
Metabolomic profiles significantly differed between AAs and whites, especially lipid metabolites, and these race-associated alterations may contribute to racial disparities in cardiovascular risk.
Abstract MP56: Length of Stay and Allostatic Load in Immigrants to the United States-Evidence From the 2011 - 2016 National Health and Nutrition Examination Surveys
Authors: Turkson-Ocran Ruth-Alma N , Nmezi Nwakaego A , Perrin Nancy , Commodore-Mensah Yvonne Y , Szanton Sarah L
Published: March 2019

Introduction:
Stress alters the cardiometabolic and inflammatory systems. Allostatic load, a measure of chronic and cumulative stress is associated with cardiovascular events and mortality. Immigration is known to be a stressful experience; however, it is unclear how length of stay, a proxy for acculturation, is associated with allostatic load in US immigrants.

Hypothesis:
We hypothesized that greater length of stay will be associated with higher allostatic load among US immigrants.

Methods:
We used a cross-sectional design to examine the 2011-2016 National Health and Nutrition Examination Surveys. Allostatic load was defined by a count of the number of high-risk classifications for 10 cardiovascular, metabolic, and immune system biomarkers: systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, glycated hemoglobin, albumin, creatinine clearance, body mass index, waist circumference, and white blood cells. Logistic regression was used to examine the odds of a high allostatic load score (≥ 4) as in previous literature, adjusting for survey weights.

Results:
We included 7318 immigrants with mean age (±se) 44(±0.52); 49% were male. Half of the sample was of Mexican/Hispanic origin, 26% were Asian and 7% were Black. The median allostatic load score was 2.2. The odds of high allostatic load decreased with longer stay in the US. After adjusting for age, race, education, income, insurance status, and routine place for healthcare, those who had resided in the US for 10 to 20 years were 45% (95% CI: 1.1-1.9) more likely to have a high allostatic load than those who had been in the US <10 years. The unadjusted and adjusted results are presented in the Table.

Conclusion:
Length of stay in immigrants is associated with having a high allostatic load. The odds of increased allostatic load declines with longer length of US residence. Additional research is needed to further understand the process and impact of cumulative stress among immigrants to reduce racial/ethnic health disparities.
Abstract MP59: The Differential Effects of Amount and Intensity of Aerobic Exercise Training on MVX, a Novel Mortality Risk Multimarker
Authors: Ross Leanna M , Slentz Cris A , Shalaurova Irina , Connelly Margery A , Otvos James D , Houmard Joseph A , Kraus William E
Published: March 2019

Introduction:
Metabolic Vulnerability Index (MVX) is a novel spectroscopic multimarker of mortality risk. MVX reflects components of nutrition and systemic inflammation status and is hypothesized to enhance disease and mortality risk stratification. As Studies Targeting Risk Reduction Interventions through Defined Exercise (STRRIDE) has previously demonstrated the ability of aerobic exercise training to improve traditional markers of cardiometabolic health, we hypothesized that aerobic exercise intervention also would result in beneficial changes in the components of MVX.

Methods:
Participants (n=222, previously sedentary, overweight men and women with mild to moderate dyslipidemia from STRRIDE) were randomized to either a 6-month control group or to one of three supervised aerobic exercise groups for 8-months: 1) low amount moderate intensity (LM): 14 kcal/kg/wk at 40-55% VO
2peak
; 2) low amount vigorous intensity (LV): 14 kcal/kg/wk at 65-80% VO
2peak
; 3) high amount vigorous intensity (HV): 21 kcal/kg/wk at 65-80% VO
2peak
. Blood samples were obtained after an overnight fast at both baseline and study completion (16-24 hr after the final training bout for exercisers). Nuclear magnetic resonance spectroscopy was performed on the Vantera
®
clinical analyzer at LabCorp to determine MVX score. MVX has two components: inflammation index [INFX; combined concentrations of GlycA and small HDL particle subspecies (diameters < 9 nm)] and metabolic malnutrition index (MALNX; combined concentrations of total branched chain amino acids and ketone bodies). MVX, INFX, and MALNX are all scaled from 1 (lowest risk) to 100 (highest risk). Paired t-tests determined whether the post- minus pre- intervention change scores within each group were significant (p<0.05). We used analysis of covariance accounting for baseline values to determine difference between groups.

Results:
The inactive control group did not exhibit significant changes in any of the multimarkers. After 8-months of exercise training, the LM group experienced significant decreases in all three scores: INFX (-2.1 ± 5.2), MALNX (-3.1 ± 11.3), and MVX (-3.9 ± 9.1). The LV group significantly decreased their INFX score (-1.5 ± 3.8), yet significantly increased MALNX (2.2 ± 6.8). The HV group significantly decreased their INFX (-1.6 ± 4.8) and MVX scores (-1.9 ± 5.6). For the LM group, the beneficial changes in MALNX and MVX were significantly greater than the LV group.

Conclusion:
Aerobic exercise improved components of the novel risk-prediction multimarker MVX, with the LM group displaying the best responses across all three scores. As ongoing research investigates the clinical utility of these mulitmarkers, this study provides evidence for the ability of exercise intervention to beneficially change MVX score.
Abstract MP65: Maternal Vascular Lesions in the Placenta May Identify Women Susceptible to Masked Hypertension a Decade After Pregnancy
Authors: Catov Janet M , Assibey-Mensah Vanessa , Muldoon Matthew , Sun Baiyang , Parks W. Tony
Published: March 2019

Introduction:
Women with placentally mediated pregnancy complications such as preeclampsia have excess hypertension and cardiovascular disease later in life, but the underlying pathophysiology linking these conditions is unknown.

Hypothesis:
We considered that histological examination of the placenta may reveal maternal vascular impairments that identify a group susceptible to blood pressure (BP) elevations a decade after delivery, including elevations that may only be detectable using out of office BP measurement.

Method:
Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years after delivery (n=248). Pregnancy features and placental pathology were abstracted from medical records. Women with placental vasculopathy (several related lesions arising from impaired remodeling of maternal myometrial and decidual arteries, n=24) or infarcts (n=32) were compared to women with neither lesion (n=192). Clinic BP was measured three times by trained research staff using a standard protocol and a validated home BP device. Women were trained to measure their BP twice daily for 7 days using the same device mentioned above. Subsequently, time and date stamped BP measures were downloaded (mean 12.2 measures ± 4.5). BP status (elevated, stage 1, stage 2) was identified using the 2018 ACC/AHA guidelines for clinic and home BP measures. Sustained normotensive, white coat, masked, and sustained hypertension status were classified.

Results:
Women were, on average, 37 years of age at measurement. In analysis controlled for age and race (p-value < 0.05) those with placental vasculopathy had higher mean diastolic BP in clinic and at home (80.5 ± 13.3 mmHg, 79.9 ± 10.4, respectively) than women without vascular lesions in the placenta (75.4 ± 9.8 mmHg and 74.3 ±8.6, respectively). In addition, women with placental vasculopathy had a higher prevalence of masked hypertension (higher elevated BP status measured at home vs. in clinic; 37.5% vs. 14.1%) that persisted after accounting for maternal age and race (adjusted OR 4.7, 95% confidence interval 1.6, 13.8). Vasculopathy associations were similar after excluding women with preeclampsia (n=42), the pregnancy complication most strongly associated with placental vascular pathology. There were modest, non-significant associations between placental infarcts and all measures of maternal blood pressure.

Conclusions:
Irrespective of prior preecclampsia, women with placental evidence of vasculopathy have excess hypertension and particularly masked hypertension in the decade after pregnancy. Our results emphasize the value of out of office blood pressure measurement, and indicate that placental vasculopathy may be pathophysiologically related to development of hypertension before age 50.