bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 012: Psoriasis is Associated With Atherogenic Lipoprotein Particle Concentration and Size Independent of Cardiometabolic Risk Factors
Authors: Li Ron C , Krishnamoorthy Parasuram , Yu YiDing , Antigua Jules , Raper Anna , Baer Amanda , Derohannessian Stephanie , Wilcox Mackenzie , Van Vorohees Abby S , Gelfand Joel M , Mehta Nehal N
Published: July 2021

Introduction:
Psoriasis is a chronic inflammatory skin disease associated with increased risk of cardiovascular disease (CVD). We have previously shown that psoriasis is associated with atherogenic lipoprotein particle concentration and size. However, it is unknown whether this association is independent of traditional CVD risk factors or insulin resistance (IR).

Methods:
We prospectively enrolled a consecutive sample of patients with psoriasis (n=122) and compared cardiometabolic risk factors with an asymptomatic sample without psoriasis from our practice (n=129). Fasting lipids, insulin, glucose were measured by standard assays, and lipoprotein concentration and size were measured by nuclear magnetic resonance (NMR) (LipoScience, North Carolina). HOMA-IR, an estimation of IR, was calculated by standard methods. Multivariable linear regression for adjusted models was performed using STATA12 software.

Results:
LDL-C and HDL-C were lower in psoriasis compared to controls [106.9 mg/dL (90-132.5) vs 128 (110.2-145.6), p<0.01 and 43 mg/dL (36-58) vs 50 (42-62), p<0.01] with no difference in triglycerides. However, NMR showed an atherogenic profile in psoriasis similar to that observed in diabetes, with significant increase in LDL [1210.5 (1002-1498) vs 1115 (935-1291), p=0.03] particle concentration with a concomitant decrease in LDL size [20.6 (20.3-21.1) vs 21.3 (20.6-21.1), p<0.001] even after adjusting for obesity, tobacco use, hypertension, lipids, and HOMA-IR (p=0.001). An increase in VLDL particle concentration was also seen before [61.9 (38.3-95.3) vs 53.4 (30.4-84.5), p=0.05] and after adjusting for cardiometabolic risk factors (p=0.018).

Conclusions:
Despite normal lipids, we demonstrate a more atherogenic lipoprotein profile by NMR in psoriasis compared to healthy controls after adjustment for CVD risk factors and IR. These findings suggest that traditional risk factor analysis and lipid testing may not ideally capture the increased CVD risk observed in psoriasis.
Abstract 013: An Environment-wide Association Study Identifies Novel and Replicated Nutrients and Pollutants Associated with Serum Lipid Levels
Authors: Patel Chirag J , Cullen Mark R , Ioannidis John P , Butte Atul J
Published: July 2021

Introduction:
Both genetic and environmental factors contribute to triglyceride, LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C) levels. While genome-wide association studies test the genetic factors systematically, testing and reporting a few factors may lead to fragmented literature for environmental correlates.

Hypothesis:
We hypothesize that one may systematically screen environmental factors to discover and replicate robust correlations with serum lipid levels. To address this hypothesis, we conduct an environment-wide association study (EWAS) to comprehensively and systematically associate multiple environmental factors with serum lipid levels.

Methods:
We utilized four independent surveys from the National Health and Nutrition Examination Survey (NHANES), collected between 1999 and 2006. 322 urine and blood markers of environmental factors were assayed in 500 to 7000 individuals. We used linear regression to associate each standardized environmental factor (mean subtracted and divided by the standard deviation) to triglycerides, LDL-C, and HDL-C adjusting for age, age-squared, sex, ethnicity, socioeconomic status (SES), and body mass index (BMI). Final estimates were additionally adjusted for waist circumference, diabetes status, blood pressure, and cohort. Multiple comparisons were controlled for the false discovery rate (the estimated ratio of false positives among statistically significant findings). Significant findings were tentatively validated across surveys. Finally, we conducted sensitivity analyses adjusting for 62 questionnaire-based variables in order to assess the degree of bias.

Results:
We identified and validated 22, 8, and 17 environmental factors correlated with triglycerides, LDL-C and HDL-C levels, respectively. Novel associations include markers of air pollution associated with lower HDL-C (p=0.006, 3% lower, N=2000) and vitamin E (-tocopherol) associated with unfavorable lipid levels (triglycerides: p=10
-17
, 17% higher, N=3000; LDL-C: p=3x10
-14
, 6% higher, N=3,000; HDL-C: p=6x10
-6
, 3% lower, N=7000). We also confirmed many known or previously speculated associations, such as lower levels in HDL-C with a marker of nicotine, cotinine, and higher triglycerides and lower HDL-C with levels of persistent fat-soluble contaminants, and lower triglycerides and higher HDL-C levels with nutrient markers such as iron, folate, vitamin C, and vitamin D, and enterolactone.

Conclusions:
EWAS is a way to create hypothesis regarding the association of environmental factors to serum lipids. Due to the cross-sectional nature of the surveys, findings may be biased by confounders or may be reverse causal. Nonetheless, we document a wide array of both known and novel associations, such as nutrients, vitamins, and persistent pollutants, with lipid levels that should be examined in depth in longitudinal studies.
Abstract 015: Very-High Levels of HDL-C and Risks for CHD: The Lifetime Risk Pooling Project
Authors: Wilkins John T , Ning Hongyan , Dyer Alan R , Lloyd-Jones Donald M
Published: July 2021

Background:
Whereas observational cohort data suggest the association between HDL-C and coronary heart disease (CHD) is inverse and linear, data are sparse at HDL-C values > 80mg/dL.

Methods:
We therefore pooled data from the NHLBI public-funded datasets of the Framingham, Framingham Offspring, and Atherosclerosis Risk in Communities studies. We used multivariable Cox Proportional-Hazards Models to adjust for age, systolic blood pressure, body mass index, smoking status, prevalent diabetes, non-HDL-C, antihypertension and lipid medication use. We calculated adjusted hazard ratios (HR) to assess the association between a priori strata of HDL-C (<30; >30-40; >40-50; >50-60; >60-70; >70-80; >80mg/dL) and CHD death and non-fatal myocardial infarction using HDL-C >40-50mg/dL as the referent.

Results:
Over 118,716 person*years of follow up, there were 562 events in 9,226 participants. As expected, hazard ratios for CHD events are greatest in the lowest category of HDL-C (HR 1.68, 95%CI: 1.31, 2.21) and there was generally a stepwise inverse trend in CHD hazards up to 80mg/dL. (See Figure) At HDL-C > 80mg/dL the hazard point estimate for CHD events was insignificantly higher (HR 0.52, 95% CI 0.29, 0.95) than the hazard observed at HDL-C >70-80mg/dl (HR 0.35, 95% CI 0.18-0.66). However, the hazard for CHD events for HDL-C > 80mg/dL was still significantly lower than the referent.

Conclusions:
These data suggest that the association between HDL-C and CHD risk may not be inverse and linear at HDL-C values > 80mg/dL. These data support investigation into qualitative differences in HDL molecules in individuals with very high levels of HDL-C.
Abstract 021: Retinol Binding Protein-4 and Fetuin-A Predict Incident Metabolic Syndrome and Metabolic Tracking Prospectively in Younger Adults: A Multimarker Adipokine Panel Approach from the Framingham Study
Authors: Quiroz Rene , Nelson Kerrie P , Keaney John F , Benjamin Emelia J , Sullivan Lisa M , Vasan Ramachandran S
Published: July 2021

Introduction:
Recent investigations have highlighted the central role of mediators produced by adipose tissue in the pathogenesis of metabolic dysregulation. We evaluated a multimarker panel of 6 adipokines (adiponectin, leptin, leptin receptor, fetuin-A, adipocyte-fatty acid binding proteins, retinol binding protein-4 [RBP4]) and related them prospectively to the incidence of metabolic syndrome (MetS) and change in metabolic traits on follow-up in a community-based sample of younger adults. We hypothesized that these adipokines would be associated with incidence of MetS and with longitudinal tracking of its components.

Methods and Results:
We evaluated the adipokine panel measured in 2208 Framingham third generation cohort participants (55% women; mean age 40 years). On follow-up (mean 6 years), 253 individuals developed new-onset MetS. After adjustment for standard clinical risk factors, the multimarker adipokine panel was associated with incident MetS (P = 0.002). Using a backward elimination process, both RBP4 and fetuin-A were significantly associated with development of MetS (multivariable-adjusted OR per 1-SD increment log marker, 1.23 [P= 0.01] and 1.17 [P= 0.03], respectively). Using the group with both the RBP4 and fetuin-A under the median serving as the referent, individuals with levels of both RBP4 and fetuin-A above the median experienced an increased risk for developing MetS (multivariable adjusted OR = 1.7 [95% CI, 1.10 - 2.65], P = 0.01). In multivariable adjusted logistic regression models, both RBP4 and fetuin-A were significantly associated with an increase in systolic BP (P =0.004 and P = 0.045, respectively) and increased fasting glucose. In addition, RBP4 was significantly associated with longitudinal increase in diastolic BP (P = 0.007).

Conclusions:
Our findings, based on prospective follow-up of a large community-based sample of younger adults, suggest higher levels of RBP4 and fetuin-A are associated with incident MetS and may constitute potential future therapeutic targets.
Abstract 026: Adherence to Weight Loss Treatment Across Three Self-Monitoring Approaches and the Association with Weight Change
Authors: Burke Lora E , Styn Mindi A , Conroy Molly B , Ye Le , Glanz Karen , Sevick Mary Ann , Ewing Linda J , Sereika Susan M
Published: July 2021

Background:
Adherence to the multiple components of a weight loss intervention is critical for successful short- and long-term outcomes. The purpose of this analysis was to determine if there was a difference in adherence to the five components of a standard behavioral weight loss intervention across three methods of self-monitoring diet and exercise in the 24-month SMART trial.

Methods:
In the SMART trial, 210 adults were randomized with equal allocation to one of three self-monitoring methods: 1) paper diary, 2) personal digital assistant (PDA) and 3) PDA + daily tailored feedback message (PDA+FB). The five treatment components included: attending group sessions; meeting the daily energy and fat goals and the weekly exercise goal; and self-monitoring eating and exercise behaviors. The cognitive-behavioral intervention was delivered in 39 group sessions over 18 months plus a maintenance session in the 21
st
month. Attendance was measured objectively, whereas adherence to the other four components was based on self-report. Generalized mixed modeling was used to examine adherence over time and among the three groups as well as the association of adherence with weight loss.

Results:
The sample was predominantly female (84.8%), White (78.6%) and well educated (Mean±SD: 15.7±3.0 years). Mean BMI was 34.01±4.48 kg/m
2
. Initially, adherence was 100% for attendance, nearly 100% for self-monitoring, 60-80% for exercise, and less than 60% for the dietary goals. On average, participants in the PDA+FB and the PDA groups were more adherent to the treatment protocol than participants in the paper diary group for attendance (p<.05), self-monitoring (p<.05), energy goals (p<.05), fat goals (p=.07), and exercise goals (p<.05). Over time, there was a non-linear decline in adherence to all five components in all three groups. We also found a significant group by time interaction for adherence to each of the five components and a significant association between adherence to each component and weight change (ps<.0001).

Conclusion:
Compared to the paper diary group, adherence was usually higher in the groups using a PDA to self-monitor. Better weight loss was associated with better adherence to the five treatment components. These results suggest that using an electronic diary such as the PDA improves treatment adherence. The increasing availability of additional mobile devices for self-monitoring lifestyle and receiving real time feedback offers potential opportunity to build on these findings and possibly improve adherence and weight loss outcomes.
Abstract 033: Does Persistent Poverty Elevate Risk for Obesity More Than Occasional Poverty in Youth? Evidence From a Quebec Birth Cohort
Authors: Kakinami Lisa , Lambert Marie , Gauvin Lise , Séguin Louise , Nikiéma Béatrice , Paradis Gilles
Published: July 2021

Background:
Childhood poverty heightens the risk of obesity in adulthood, but its effect during childhood is poorly understood. We analyzed the relationship between poverty trajectories across the ages of 6, 8, 10, and 12 years with BMI Z-scores and the risk of being overweight in a birth cohort of children.

Methods:
Data were from 703 participants in the 1998-2010 ″Quebec Longitudinal Study of Child Development″ (n=2,120) birth cohort. Household income was measured annually with poverty defined as income below the low-income thresholds established by Statistics Canada adjusted for household size and geographic region. Children’s height and weight at ages 6, 8, 10, and 12 years were measured by trained study staff. Body mass index (BMI) was converted to age- and sex- standardized BMI Z-scores and percentiles and were classified as overweight or obese (BMI percentile > 85th) based on CDC growth curves. Trajectories of poverty across the ages of 6, 8, 10, and 12 years were characterized with a latent class group analysis using maximum likelihood in a semiparametric mixture model. Multivariable linear regressions predicted BMI Z-scores at different ages, and logistic regression predicted the risk of being overweight or obese based on poverty trajectories after adjusting for sex. Because all children at ages 6 and 8 years were pre-pubertal, and all children at age 12 were in puberty, only the model for BMI at age 10 adjusted for puberty.

Results:
Poverty trajectories were fairly stable across time and fell into 1 lower exposure category (consistently low exposure (approximately 70%, n=487)) and 3 higher exposure categories (increasing: 8%, n=55; decreasing: 10%, n=70; or consistently high exposure: 13%, n=91)). After adjusting for covariates, compared to children experiencing lower exposure to poverty, BMI Z-scores of children with consistently high exposure to poverty were 0.05 (p=NS), 0.12 (p=NS), 0.37 (p=0.02), and 0.42 (p=0.003) higher at ages 6, 8, 10, and 12 years, respectively. After adjustment, children experiencing consistently high exposure to poverty were at a significantly increased risk for being overweight or obese at age 8 (OR: 2.0, 95% CI: 1.2-3.3, p=0.01), age 10 (OR: 2.1, CI: 1.2-3.5, p=0.005), and at age 12 years (OR: 2.8, CI: 1.7-4.7, p<0.001) compared to children experiencing lower exposure to poverty. Children experiencing decreasing exposure to poverty at all ages, or increasing exposure at age 10 and 12 years were at an increased risk for being overweight or obese, but the results were not statistically significant.

Conclusion:
Findings suggest that there is a latency period for the detrimental effects of poverty on weight, but that previous exposure can still impact future weight even at a young age. Whether the disparity in weight status according to poverty trajectories widens as the children continue to age should be investigated.
Abstract 034: Gestational Diabetes Mellitus Pregnancy is Associated with Subsequent Atherosclerosis in Women During Midlife: CARDIA.
Authors: Gunderson Erica P , Chiang Vicky , Pletcher Mark J , Jacobs David R , Quesenberry Charles P , Sidney Stephen , Lewis Cora E
Published: July 2021

Background:
Women who develop gestational diabetes mellitus (GDM) during pregnancy have a 7-fold greater risk of type 2 diabetes and 2.5-times greater risk of the metabolic syndrome several years after delivery than women without a history of GDM. Yet, little is known about whether GDM status contributes to early subclinical atherosclerosis after pregnancy. We hypothesize that a history of GDM is a predictor of early atherosclerosis in women during mid-life.

Methods:
We examined 883 women (47% Black), aged 18-30 years at enrollment in 1985-1986 (baseline) in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Women selected for this analysis delivered 1 or more live births (total of 1,572 births) during the 20-year follow-up, reported GDM status for pregnancies, had no history of heart disease, and had common carotid intima media thickness (maximum ccIMT; average of the maximum wall thickness of the respective carotid artery segment based on 4 ultrasonic measurements for the common carotid arteries) obtained after 20 years of follow-up in 2005–2006.

Results:
We classified 121 (14%) women as GDM, and 762 women as non-GDM. Among GDM and non-GDM groups, average age at last birth was 31 years, and average age at the year 20 exam was 44 years. Multivariable linear regression models estimated mean (95%CI) ccIMT (mm) among GDM and non-GDM groups adjusted for baseline parity and follow-up covariates including number of post-baseline births, smoking, education, hypertension status, lipid-lowering medication use, and menopausal status. Unadjusted and fully adjusted mean ccIMT was higher for GDM versus non-GDM groups: (0.791 vs 0.758; p=0.002), and (0.813 vs 0.787;p=0.011), respectively. Adjustment for baseline BMI (a mediator of both GDM and IMT), modestly attenuated the difference in ccIMT means between GDM (0.799) and non-GDM (0.781); p=0.084. Race and age did not act as confounders or as effect modifiers of associations, and BMI was not an effect modifier. Addition of weight gain, and pregnancy-related hypertension during 20 years of follow-up in separate models had little impact on these findings.

Conclusions:
Among women of reproductive age, GDM during pregnancy may unmask future risk of subclinical atherosclerosis during midlife. Development of GDM during pregnancy serves as an important harbinger of future cardiometabolic diseases in young women long before disease onset.
Abstract 035: Ideal Cardiovascular Health in Young Adulthood and Cognitive Functioning 25 Years Later: The CARDIA Study
Authors: Reis Jared P , Loria Catherine M , Launer Lenore J , Sidney Stephen , Liu Kiang , Yaffe Kristine
Published: July 2021

Background:
Accumulating evidence suggests the presence of cardiovascular risk factors in middle-age is associated with later adulthood cognitive dysfunction; however, the consequences of suboptimal cardiovascular health in young adulthood are unclear.

Methods:
The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a cohort of white and black men and women who were 18-30 years when a series of health behaviors (smoking status, body mass index, physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose) were measured during a baseline clinic examination in 1985-1986. Included in the current study were 2,577 participants who completed an examination 25 years later when a cognitive battery to assess psychomotor speed (Digit Symbol Substitution Test [DSST]), executive function (modified Stroop Test), and verbal memory (Rey Auditory Verbal Learning Test [RAVLT]) were administered. Ideal levels for each behavior and factor were defined according to the 2020 American Heart Association Goals for Cardiovascular Health. Associations were adjusted for age, sex, race, midlife educational attainment, and study center.

Results:
At baseline, the percentage of participants with 0-1, 2, 3, 4, 5, and 6-7 ideal health factors were 1.2%, 7.2%, 19.6%, 34.9%, 29.2%, and 7.8%, respectively. Adjusted mean DSST and RAVLT scores were higher among those with a greater number of ideal health factors (
Table
). Each additional factor at the ideal level was associated with a 0.78-point higher DSST score (95% CI: 0.28 to 1.28) and a 0.13-point higher memory score (95% CI: 0.02 to 0.25). Results did not differ by race or sex (p-interaction > 0.05). The ideal cardiovascular health score was not associated with performance on the Stroop Test.

Conclusion:
In this population-based sample, ideal cardiovascular health in young adulthood was independently associated with cognitive functioning in midlife.

Table.

Adjusted
*
mean (standard error) cognitive function scores at Year 25 by number of ideal health behaviors and factors at baseline: CARDIA (n=2,577).

No. of Ideal Health Factors at Baseline (% of population)

0-1 (1.2%)
2 (7.2%)
3 (19.6%)
4 (34.9%)
5 (29.2%)
6-7 (7.8%)
p-trend

DSST
70.0 (2.5)
65.7 (1.0)
68.7 (0.6)
69.4 (0.5)
70.0 (0.5)
69.9 (1.0)
0.003

Stroop Test
21.5 (1.6)
21.2 (0.6)
21.0 (0.3)
20.6 (0.3)
20.6 (0.3)
20.4 (0.5)
0.14

RAVLT
7.4 (0.6)
7.6 (0.2)
8.0 (0.1)
8.2 (0.1)
8.3 (0.1)
8.1 (0.2)
0.02

*

Adjusted for age, sex, race, midlife educational attainment, and study center.

DSST=Digit Symbol Substitution Test; RAVLT=Rey Auditory Verbal Learning Test
Abstract MP003: Alpha-linolenic Acid Intake and Biomarker in Relation to Risk of Cardiovascular Disease: A Meta-analysis and Systematic Review
Authors: Pan An , Chen Mu , Chowdhury Rajiv , Wu Jason , Sun Qi , Mozaffarian Dariush , Hu Frank B
Published: July 2021

Introduction:
Several studies have investigated the association between the plant-based omega-3 alpha-linolenic acid (ALA) and risk of cardiovascular disease (CVD); however, results remain largely inconsistent. We have conducted a meta-analysis of all available epidemiological studies reporting on association between ALA consumption or its biomarker composition and risk of CVD.

Methods:
A search of MEDLINE, EMBASE, Web of Science, Cochrane Library and clinical trial registry databases (to February 2011) was supplemented by manual searches of bibliographies of retrieved articles and relevant reviews. Prospective cohort or case-control studies were included if they reported the association between ALA (assessed in dietary intake, and as circulating blood or adipose tissue biomarker) and CVD (including myocardial infarction [MI], sudden cardiac arrest, acute coronary syndrome, and stroke). Multivariate-adjusted risk estimate in each study was converted to relative risk (RR) comparing the top vs. bottom thirds of ALA, and were combined using fixed-effect models given that heterogeneity was not detected in most situations. A fixed-effect dose-response meta-analysis was conducted if data were available.

Results:
Fifteen prospective cohort and 12 case-control studies were identified with aggregate data on 188,896 individuals and 12,233 total CVD events. Comparing the top to bottom thirds, a higher ALA intake was associated with a lower risk of CVD death (RR=0.80; 95% CI 0.67–0.96; 6 cohort studies), but not non-fatal MI (RR=0.95; 95% CI 0.85–1.06; 1 cohort and 2 case-control studies), or total CVD (RR=0.93; 95% CI 0.85–1.02; 1 case-control and 6 cohort studies). Higher ALA biomarker levels in adipose tissues, plasma or serum (top vs. bottom thirds) were inversely associated with non-fatal MI (RR=0.75; 95% CI 0.62–0.92; 7 case-control studies), but not CVD death (RR=1.20; 95% CI 0.98–1.46; 1 case-control and 2 cohort studies) or total CVD (RR=0.89; 95% CI 0.75–1.04; 4 cohort and 3 case-control studies). In the dose-response meta-analyses, each 1 g/d increment of ALA intake was associated with a 10% lower risk of CVD death (RR=0.90; 95% CI 0.83–0.99; 5 cohort studies), and each 0.5% increment of adipose tissue ALA concentration was associated with a 21% (RR=0.79; 95% CI 0.70–0.89; 5 case-control studies) lower risk of non-fatal MI.

Conclusion:
Higher dietary ALA intakes are associated with a lower risk of CVD death, while higher ALA biomarker levels are associated with a lower risk of non-fatal MI. These findings highlight the need for additional well-designed observational studies as well as large randomized clinical trials to evaluate effects of ALA on CVD.
Abstract MP004: Dietary Intakes of Saturated Fat and Cardiovascular Disease: Results from the Multi-Ethnic Study of Atherosclerosis
Authors: Otto Marcia , Jacobs David R , Mozaffarian Dariush , Kromhout Daan , Bertoni Alain G , Sibley Christopher T , Nettleton Jennifer A
Published: July 2021

Background:
Prospective studies have shown generally null associations between overall saturated fat consumption and CVD events. Understanding whether food sources of saturated fatty acids (SF) influence these relationships may help explain inconsistencies and provide insights as to underlying mechanisms.

Objective and Hypothesis:
We investigated associations between SF consumption from different major dietary sources (SF from each of meat, dairy, fats/oils, and plants) and CVD incidence in the Multi-Ethnic Study of Atherosclerosis (MESA). We hypothesized that associations between SF and CVD incidence would be influenced by the food sources delivering SF.

Methods:
Participants 45–84 years of age at baseline (n = 5,209) were followed between 2000 and 2007. Dietary intake was assessed using a 120-item food frequency questionnaire. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% CIs for incident CVD (275 cases) across categories of energy-adjusted intakes of SF by food source. Energy density substitution models were used to estimate the effect of substituting a percentage of energy intake from a specific SF source for the same amount of SF from another source. All models were adjusted for demographics, behavioral and dietary confounders such as intakes of fruit and vegetables, fiber, trans-fat and PUFA.

Results:
After multivariable adjustment, each 1-g greater intake of meat SF corresponded to 5% higher risk of CVD (HR [CI] per 1-g: 1.05 [1.01– 1.10]). In contrast, each 1-g greater intake of dairy SF intake corresponded to 4% lower risk of CVD (HR [CI] per 1-g: 0.96 [0.93– 0.99]). Substituting 1% of energy from meat SF with energy from dairy SF was associated with a 14% reduction in CVD risk (HR [CI]: 0.86 [0.78–0.95]). The replacements of energy from meat SF with fats/oils SF or with plant SF did not show statistically significant impacts on relative estimates of CVD risk (HR [CI]: 0.93 [0.83–1.05] and 0.93 [0.59 to 1.46], respectively), and neither intake of fats/oils SF nor intake of plant SF was independently associated with CVD risk.

Conclusion:
These findings suggest that associations between SF and CVD may depend on known differences in type of saturated fatty acids contained in specific food sources or other non-SF constituents in these sources.
Abstract MP013: Strong Inverse Relation between Physical Activity and Incidence of Cardiovascular Disease in African Americans: the Atherosclerosis Risk in Communities Study
Authors: Bell Elizabeth J
Published: July 2021

Introduction:
Although there is substantial evidence that physical activity reduces risk of cardiovascular disease (CVD), the few studies that included African Americans offer inconclusive evidence and did not study stroke and heart failure separately.

Objective:
We examined, in African Americans and Caucasians in the Atherosclerosis Risk in Communities study (ARIC), the association of physical activity with CVD incidence (n=1,039) and its major components - stroke (n=350), heart failure (n=633), and coronary heart disease (n=442) - over a follow-up period of 21 years.

Methods:
ARIC is a population-based biracial cohort study of 45– to 64-yr-old adults at the baseline visit in 1987–89. Physical activity was assessed using the modified Baecke physical activity questionnaire and categorized by the American Heart Association’s ideal CVD health guidelines: poor, intermediate, and ideal physical activity. An incident CVD event was defined as the
first
occurrence of 1) heart failure, 2) definite or probable stroke, or 3) coronary heart disease, defined as a definite or probable myocardial infarction or definite fatal coronary heart disease.

Results:
We included 3,707 African Americans and 10,018 Caucasians free of CVD at the baseline visit. After adjustment for age, sex, cigarette smoking, alcohol intake, hormone therapy use, education, and ‘Western’ and ‘Prudent’ dietary pattern scores, higher physical activity was inversely related to CVD, heart failure, and coronary heart disease incidence in African Americans and Caucasians (p-values for trend tests <.0001), and with stroke in African Americans. Hazard ratios (95% confidence intervals) for CVD for intermediate and ideal physical activity, respectively, compared to poor, were similar by race: 0.65 (0.56, 0.75) and 0.59 (0.49, 0.71) for African Americans, and 0.74 (0.66, 0.83) and 0.67 (0.59, 0.75) for Caucasians (p-value for interaction = 0.38). Physical activity was also associated similarly in African Americans and Caucasians for each of the individual CVD outcomes (coronary heart disease, heart failure, and stroke), with an approximate one-third reduction in risk for intermediate and ideal physical activity versus poor physical activity- this reduction was statistically significant.

Conclusions:
In conclusion, our findings reinforce public health recommendations that regular physical activity is important for CVD risk reduction, including reductions in stroke and heart failure. They provide strong new evidence that this risk reduction applies to African Americans as well as Caucasians and support the idea that some physical activity is better than none.
Abstract MP029: Higher Television Viewing Relates to Less Exercise in a Representative Sample of Irish 9 Year Olds
Authors: Harrington Deirdre , Katzmarzyk Peter T
Published: July 2021

INTRODUCTION:
Television (TV) viewing is blamed as a contributor to low physical activity levels in children, yet it is unclear if such a sedentary behavior actually displaces exercise. HYPOTHESIS: Children who engage in higher levels of TV viewing will be less active than children who watch <1 hour of TV/day.

METHODS:
This study utilized the ‘Growing up in Ireland’ (2008) first wave of data which is a longitudinal study of a representative sample of over 8,000 9 year olds. The main caregiver reported the number of hours/day the child spent watching TV/video/DVDs and responses were then classified as: <1, 1-3 and >3 hours. The number of days out of the previous 14 that the child had engaged in ‘hard’ and ‘light’ exercise for at least 20 minutes was also reported. Responses were classified as ≥9 days (highest possible answer) or ≤8 days out of 14. Odds ratios were calculated using logistic regression.

RESULTS:
The sample consisted of 3956 male and 4152 female 9 year olds. Overall, 12.4% of males and 14.1% of females, 32.0% of males and 32.6% of females and 4.4% of males and 4.5% of females watched <1 hour, 1-3 hours and >3 hours of TV/day respectively. Compared to children who watched less than 1 hour of TV/day, children who watched 1-3 or >3 hours/day had significantly lower odds of engaging in exercise (
Table 1
).

Table 1.

Odds ratios (95% Confidence Intervals) for TV viewing and likelihood of engaging in 20 minutes of ‘hard’ and ‘light’ exercise on 9 or greater days out of 14 days.

Hours of TV/Video/DVD

‘Hard Exercise’

‘Light Exercise’

Male

Female

Male

Female

<1

Referent
Referent
Referent
Referent

1 to 3

0.8 (0.7-0.9)
0.7 (0.6-0.9)
0.7 (0.6-0.8)
0.8 (0.7-0.9)

>3

0.4 (0.3-0.6)
0.5 (0.4-0.6)
0.4 (0.3-0.5)
0.5 (0.4-0.6)

Analysis controlled for social class (defined from the parent’s occupation and categorized under professional managers, non-manual/skilled manual and semi-skilled/unskilled manual) CONCLUSION: Children with higher levels of TV viewing were less likely to engage in hard or light exercise. These findings support the displacement hypothesis where sedentary behaviors reduce children’s amount of exercise.
Abstract MP041: Menopausal Age, Reproductive Lifespan And Type 2 Diabetes Risk: A Case-cohort Study (InterAct)
Authors: Brand Judith , van der Schouw Yvonne T , Onland-Moret N C , Sharp Stephen , Ong Ken , Ardanaz Eva , Khaw Kay-Tee , Wareham Nicholas J ,   InterAct Consortium
Published: July 2021

Background:
Early menopause and estrogen deficiency are important determinants of future health outcomes. While experimental data suggest a role for estrogens in glucose homeostasis, the relationship between menopausal age and type 2 diabetes (T2D) risk is relatively unexplored.

Objective:
To investigate associations of menopausal age and reproductive lifespan (defined as menopausal age minus age at menarche) with T2D risk.

Methods:
A case cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), including 3691 incident T2D cases and a random subcohort of 4408 postmenopausal women (including 235 incident diabetes cases). Prentice weighted Cox regression and random effect meta-analyses were used to investigate the associations between menopausal age, reproductive lifespan and T2D risk.

Results:
Earlier age at menopause was associated with an increased T2D risk. After adjustment for reproductive and classical T2D risk factors, the HRs across categories of menopausal age (< 40, 40–44, 45–49, 50–54 and ≥ 55 years) were 1.31 (1.01–1.69), 1.10 (0.91–1.34), 1.00 (0.88–1.13), 1.00 (reference) and 0.86 (0.70–1.05) respectively (
P
trend = 0.01). The association between reproductive lifespan and T2D risk was weaker: HRs across quartiles of reproductive lifespan were 1.18 (0.98–1.41), 1.02 (0.86–1.22), 0.96 (0.81–1.14) and 1.00 (reference) respectively (
P
trend = 0.02). No effect modification with body mass index, waist circumference or smoking status was observed (
P
interaction all > 0.05).

Conclusion:
Earlier age at menopause and a shorter reproductive lifespan are associated with an increased T2D risk, supporting a protective role for estrogens in metabolic disease risk.
Abstract MP045: Global and Regional Consumption of Major Food Groups in 1990 and 2005: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide.
Authors: Micha Renata , Khatibzadeh Shahab , Giovannucci Edward , Powles John , Shi Peilin , Ezzati Majid , Mozaffarian Dariush
Published: July 2021

Background:
Food-based research and policy recommendations are highly relevant in the modern era to understand and reduce the pandemics of chronic disease occurring in nearly all nations. Unfortunately, reliable and systematically assessed individual consumption data (as opposed to disappearance data) on food habits and trends have not been available on a global scale.

Objective:
To produce comprehensive data on consumption of major foods and their uncertainties by country, region, age, and sex in 1990 and 2005. Methods. We developed methods to identify, assess, and obtain exposure data (mean, SD) by age and sex from nationally representative diet surveys worldwide on fruits, vegetables, legumes, nuts/seeds, whole grains, seafood, red meats, processed meats, milk, and sugar-sweetened beverages. To address missing data and estimate mean intake, we developed and applied a multi-level hierarchical imputation Bayesian model that accounted for country- and region-level data, measurement comparability, study representativeness, and diet assessment method. Time-varying country-level covariates were used to inform estimates, including FAO food availability data, population, GDP, latitude, metabolic risks, and other diet covariates. Uncertainty of the estimates accounted for uncertainty from sampling and statistical modeling.

Results:
We obtained relevant data (85% by direct author contact) from 165 nationally and 40 non-nationally representative surveys from 109 countries in 20 regions, covering 79% of the global population. Data were most frequently available for fruits and vegetables (Figure). Findings for other foods will be presented at the meeting.

Conclusions:
Our systematic analysis of representative country-specific nutrition surveys on a global scale has produced estimates of the exposure distribution of major foods by age, sex, country, region, and time period. Such global assessment is crucial to estimate the impact of diet on chronic diseases worldwide.
Abstract MP051: A Novel Genetic Locus for Coronary Heart Disease in Type 2 Diabetes
Authors: Qi Lu , Qi Qibin , Mendonca Christine , Prudente Sabrina , Andreozzi Francesco , Gervino Ernest , Hauser Thomas , Sesti Giorgio , Trischitta Vincenzo , Hu Frank , Doria Alessandro
Published: July 2021

Genetic susceptibility to cardiovascular disease in type 2 diabetes is influenced by abnormal metabolic status in the affected diabetic patients; and the implicated genes may differ from those in the non-diabetic populations. We conducted 3-stage genome-wide association analysis to detect the genetic factors for coronary heart disease (CHD) in existing type 2 diabetes. We analyzed 2.4 million SNPs in 1,249 diabetic women from the Nurses’ Health Study (273 CHD cases and 976 controls) and 984 diabetic men from the Health Professionals’ Follow-up Study (319 CHD cases and 665 controls), all of European ancestry. The first-stage replication was performed in Joslin Heart Study (420 CHD cases and 431 controls); and the second-stage replication was performed in Gargano Heart Study (314 CHD cases and 384 controls), and Catanzaro study (114 CHD cases and 215 controls). All the replication samples were of European ancestry and also affected by type 2 diabetes. We observed associations of genome-wide significance (the best p=2.04 * 10
-8
) between CHD and SNPs on chromosome 1, between genes ZNF648 (
zinc finger protein
648;
1q25
.3) and GLUL (glutamate-ammonia ligase; 1q31). eQTL analysis indicates suggestive association between the associated SNPs and a potential CHD gene PPAP2B on chromosome 1 with marginal significance (p=1 * 10
-5
). The identified SNP showed a significant association with the plasma levels of vascular cell adhesion molecule 1 (
VCAM1
) in patients with type 2 diabetes but not in non-diabetic healthy controls. Our findings indicate that specific genetic predisposition may determine cardiovascular risk in patients with type 2 diabetes. The findings may inform the development of novel therapies for reduction of cardiovascular complications in diabetes.
Abstract MP058: Longitudinal Determinants of LV Mass and Geometry: The CARDIA Study
Authors: Gidding Samuel S , Liu Kiang , Colangelo Laura , Cook Nakela , Gardin Julius , Lima Joao
Published: July 2021

There is little long term data on LV mass and geometry. The Coronary Artery Disease in Young Adults Study (CARDIA), a longitudinal study of the evolution of cardiovascular disease risk factors in young adults, performed echocardiograms in years 5 and 25. The purpose of this study is to assess change in prevalence of LV hypertrophy and LV geometry categories (LV mass > 51g/m
2.7
= LV hypertrophy; LV relative (wall thickness/LV diastolic diameter ratio) > 0.41 = concentric geometry) over 20 years of follow up and to identify determinants of change in LV mass and geometry over that time interval. We used preliminary data on 1469 black and white men and women aged 43-55 years with complete data from the year 5 and 25 examinations for this analysis. Regression models had year 25 LV mass or relative wall thickness as the dependent variable and year 5 LV mass or relative wall thickness, age, gender, race, BMI, change in BMI, SBP, change in SBP, heart rate (HR), change in (HR), tobacco use, presence of diabetes, alcohol use, and physical activity score as independent variables. LV mass and relative wall thickness increased in each race/gender group (Table). Prevalence of normal LV mass/eccentric geometry decreased (84 to 63%) whereas concentric LV geometry increased (11 to 16%), as did LV hypertrophy (concentric (1 to 10%) and eccentric (3 to 11%) geometry). Significant determinants of year 25 LV mass/m
2.7
were baseline LV mass, baseline and change in BMI, baseline and change in SBP, baseline and change in HR, presence of diabetes, and year 5 tobacco and/or alcohol use (r
2
= 0.39). Significant determinants of year 25 LV wall thickness/diameter ratio were baseline ratio, black race, baseline and change in BMI, baseline and change in SBP, and presence of diabetes.(r
2
= 0.08). We conclude prevalence of abnormal LV hypertrophy/geometry increased dramatically from young adulthood to middle age. Both young adult risk traits and change in these traits predicted change in LV mass/geometry. DM, for the first time, emerged in this analysis as a significant determinant.

LV mass and relative wall thickness at years 5 and 25

LV mass (g)
LV mass (g/m2.7)
Relative Wall Thickness

Black Men
Yr 5
176.2 (43.3)
37.4 (8.7)
0.37 (0.07)

n=262
Yr 25
216.5 (68.3)
46.1 (15.5)
0.39 (0.09)

White Men
Yr 5
166.7 (39.0)
35.1 (8.2)
0.34 (0.06)

n=362
Yr 25
198.8 (54.8)
42.0 (11.4)
0.35 (0.07)

Black Women
Yr 5
133.7 (37.6)
35.2 (9.7)
0.35 (0.06)

n=439
Yr 25
174.2 (53.9)
45.5 (14.0)
0.38 (0.08)

White Women
Yr 5
122.0 (29.8)
31.5 (7.9)
0.33 (0.05)

n=406
Yr 25
149.4 (42.7)
38.8 (11.1)
0.35 (0.08)

values are mean (SD)
Abstract MP070: Genetic Predisposition to High Blood Pressure Associates With Cardiovascular Complications Among Patients With Type 2 Diabetes: Two Independent Studies
Authors: Qi Qibin , Hu Frank B , Qi Lu
Published: July 2021

Background
Hypertension has been associated with an increased risk of cardiovascular disease (CVD).We examined the effect of the genetic predisposition to high blood pressure and its potential interactions with diet and lifestyle factors on risk of cardiovascular complications among diabetic patients.

Methods
The present study included 1005 men and 1299 women with type 2 diabetes from the Health Professionals Follow-up Study and Nurses’ Health Study: 732 (380 men and 352 women) CVD cases (coronary heart disease [CHD] or stroke) and 1572 non-CVD controls. Genetic predisposition to high blood pressure was estimated by a genetic risk score on basis of 29 blood pressure-predisposing variants identified by a recent GWAS meta-analysis in ∼200,000 Europeans.

Results
The genetic risk score was associated with prevalent hypertension in both men and women, with a combined OR of 1.07 (95% CI 1.04-1.09) for each additional risk allele. Restricted cubic spline regression analysis indicated a linear relationship between the genetic risk score and increased CVD risk in both men (
P
=0.002) and women. (
P
=0.028) (
Figure
). The results from the 2 cohorts were combined since the genetic risk score showed consistent associations in men and women. After adjustment for age, BMI, and diet and lifestyle risk factors, each additional risk allele in the genetic risk score was associated with a 5% increased risk of developing CVD (OR 1.05 [95% CI 1.02-1.09]). The OR was 1.49 (1.08-2.07) for CVD when comparing the extreme quartiles of the genetic risk score (
P
for trend =0.007). We did not observe significant interactions of the genetic risk score with Dietary Approach to Stop Hypertension diet score, and other lifestyle risk factors such as BMI, physical activity, alcohol intake, use of nonnarcotic analgesics and supplemental folic acid intake.

Conclusions
Genetic predisposition to high blood pressure is associated with an increased risk of cardiovascular complications in diabetic patients, independent of diet and lifestyle risk factors for hypertension.
Abstract MP088: Consumption of Specific Foods, Leukocyte Telomere Length, and Leukocyte Telomere Attrition: the Cardiovascular Health Study
Authors: Burnett-Hartman Andrea , Fitzpatrick Annette L , Aviv Abraham , Mozaffarian Dariush
Published: July 2021

Introduction:
Leukocyte telomere length (LTL) is a complex genetic trait that is linked to higher risks of CVD, diabetes and other age-related disease. Little is known about the relationship between the intake of specific foods and LTL.
Hypothesis:
Foods that generally increase cardiometabolic risk, such as processed meat, will be associated with shorter LTL and higher rate of LTL attrition; foods that decrease risk, such as seafood, will have inverse associations with LTL and LTL attrition.

Methods:
We evaluated the relation between LTL and specific foods in 1,515 US adults age 65+ y participating in the Cardiovascular Health Study. Usual dietary habits were assessed by detailed food frequency questionnaires (FFQs) at baseline and year 6. Leukocyte DNA was extracted, and LTL measured via Southern blots of terminal restriction fragments, in blood samples collected at years 3 and 8. Clustered linear regression analysis was used to assess the multivariable-adjusted, cross-sectional relationship between specific foods and LTL (baseline FFQ vs. year 3 LTL and year 6 FFQ vs. year 8 LTL). Baseline diet was also evaluated in relation to the rate of LTL attrition over time.

Results:
In multivariate analyses, higher red and processed meat intakes were each associated with shorter LTL (p-trend <0.01) (
Table
). Intakes of seafood and vegetables were associated with non-significant trends toward longer LTL In the subset with both baseline diet and change in LTL (n=617), a significant association between processed meats and greater 5-year LTL attrition was observed (p-trend=0.03). Higher nut intake was also associated with less LTL attrition across quintiles (p=0.05), although not monotonically (p-trend=0.35).

Conclusions:
Diet, in particular red meat and processed meat consumption, may play a role in telomere dynamics. Our findings support the need for further investigation of prospective relations in larger samples.

Mean LTL
LTL difference Q5 vs. Q1 (SE)

Wald p-value
*
Q5 vs. Q1

p-trend
*

Q1
Q2
Q3
Q4
Q5

Fruits

6.33
6.35
6.30
6.35
6.28
−0.07 (0.04)
0.10
0.11

Vegetables

6.26
6.31
6.35
6.30
6.39
0.06 (0.04)
0.16
0.33

Nuts

6.34
6.31
6.33
6.32
6.27
−0.06 (0.06)
0.20
0.27

Whole grains

6.33
6.31
6.31
6.33
6.32
−0.04 (0.06)
0.39
0.63

Dairy

6.36
6.33
6.30
6.32
6.30
−0.07 (0.04)
0.11
0.09

Red meats

6.42
6.32
6.30
6.27
6.27
−0.14 (0.05)
<0.01
<0.01

Processed meats

6.43
6.34
6.30
6.28
6.23
−0.15 (0.05)
<0.01
<0.01

Seafood

6.30
6.28
6.32
6.34
6.37
0.05 (0.04)
0.29
0.16

*

Adjusted for age, sex, race, education, smoking status, body mass index, and physical activity.
Abstract MP092: Community-Based, Primary Prevention Programs Decrease the Rate of Metabolic Syndrome in Low Income and Minority Women
Authors: Gilstrap Lauren G , Fernandez-Golarz Carina P , Malhotra Rajeev , Pineda Eliana M , Peltier-Saxe Donna , Culhane-Herman Catherine , Slicis Donna , Wood Malissa J
Published: July 2021

Background:
Metabolic Syndrome (MetSyn), a composite of waist circumference, blood pressure, triglycerides, HDL and insulin sensitivity, is one of the strongest predictors of type 2 diabetes (DM) and cardiovascular disease (CVD). It is associated with a 4-10 fold increased risk of DM and a 2-3 fold increased risk of CVD. Low income and minority women have some of the highest rates of MetSyn. This study examines the effect of a community based, primary prevention program on the rates of MetSyn in this population.

Methods:
64 low income and minority women, with at least two preexisting risk factors, were enrolled in the HAPPY (Health Awareness and Primary Prevention in Your neighborhood) Heart Program in a suburb of Boston. Over this 2 year period, patients were evaluated by an interdisciplinary medical team: their primary physician, cardiologist, nutritionist, physical therapist and health coach. The rate of MetSyn was measured at baseline, year 1 and 2. Comparisons were made either using the paired t test for normally distributed variables or the Wilcoxon Sign test for non-normal variables.

Results:
We examined the 5 components of the MetSyn individually and the overall MetSyn score (see table). The increase in HDL from baseline to year 1 was not significant, but by year 2, the average HDL had increased from 44.5 to 49.3 (p<0.001). Similarly, by year 2, we observed a decrease of 6.8 mmHg in systolic blood pressure (p=0.05). Finally, by year 2, the average decrease in HbA1c was 0.2 (p<0.001). From baseline to year 1, the average MetSyn score decreased by 0.33 (p=0.017) and by year 2, the improvements were sustained and improved, with an average reduction in score of 0.63 (p<0.001).

Conclusion:
Our results demonstrate that a comprehensive, lifestyle intervention program is effective at decreasing MetSyn in a high risk minority female population. These improvements may take at least two years to become evident; however, when shepherded by a community based, interdisciplinary team, not only are the improvements significant, they are sustained.