bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P462: Myosteatosis: Differences in Association With Type 2 Diabetes by Anatomical Location
Authors: Tilves Curtis , Kuipers Allison , Zmuda Joseph , Carr J. J , Terry James G , Nair Sangeeta , Thyagarajan Bharat , Wheeler Victor , Miljkovic Iva
Published: March 2020

Background:
CT-derived muscle density (MD) reflects the degree of adiposity in muscle (i.e., myosteatosis) with lower MD indicating greater adiposity. Previous research indicates lower MD is associated with increased risk of type 2 diabetes (T2D). However, few studies have compared the association of simultaneously measured MD by anatomic location. The relationship between myosteatosis and cardiometabolic health may differ by body site and influence which location(s) is most useful for risk assessment. We investigated potential differential relationships between T2D and MD of the locomotor muscles of the abdomen (psoas), thigh, and calf among 539 African Caribbean men from Tobago.

Methods:
Men were aged 50-91 years (mean 64.4 years, mean BMI 27.5 kg/m
2
). Calf MD was measured at 66% of calf length using peripheral quantitative CT; calf MD was defined as the ratio of muscle mass to cross-sectional muscle area. Psoas MD was measured in the abdomen (between L3/L4) and thigh MD was measured in the mid-thigh using CT; for these, MD was defined as the average muscle attenuation across each site. MDs were converted to per-SD units for comparability. T2D was defined as a fasting serum glucose level of ≥126 mg/dL or currently taking antidiabetic medication.

Results:
Psoas and thigh MDs were more highly correlated (r = 0.70) than psoas and calf (r = 0.33) or thigh and calf (r = 0.53) MDs, and calf MD was moderately correlated with BMI (r = -0.38) compared to lower BMI correlations for thigh (r = -0.18) or psoas (r = -0.16) MDs (all significant p < 0.05). After age and lifestyle factor adjustment (Table), a 1-SD lower MD of the thigh or calf was significantly associated with higher odds of T2D. Additional adjustment for BMI completely attenuated the association with T2D for thigh MD, but not calf MD.

Conclusion:
In our study of African Ancestry men, only calf MD was associated with higher odds of T2D independent of BMI and other muscle groups. Longitudinal studies are needed to better characterize specific muscle myosteatosis and metabolic abnormalities.
Abstract P467: Premature Coronary Artery Disease Mortality in the Appalachian Region: Is the Problem Driven by Rural-urban or Socioeconomic Disparities?
Authors: Sergeev Alexander V
Published: March 2020

Background:
Premature mortality under the age of 75 years exacerbates the burden of coronary artery disease (CAD) as the leading cause of death in the nation, with particular concerns being raised about its disproportionate effect on the vulnerable population of the Appalachian region compared to other regions of the United States. It is unknown whether the problem of premature CAD mortality in the Appalachian residents is further aggravated by disparities across various population groups within the Appalachian region itself. We hypothesized that within-region socioeconomic and geographic (rural-urban) disparities, independently of each other, aggravate the premature CAD mortality problem in the Appalachian population.

Methods:
A population-based study of age-adjusted premature CAD mortality among 25-74 year old residents of the Appalachian region was conducted (n=63,630,221). Counties’ rurality status was defined using the U.S. Department of Agriculture Economic Research Service’s (USDA ERS) Rural-Urban Continuum Codes: of 420 Appalachian counties, 217 were classifies as rural and 203 - as urban. To adjust for multiple covariates, general linear modeling (GLM) analysis was conducted (SAS, ver. 9.4).

Results:
Age-adjusted premature CAD mortality rates were higher in rural than urban Appalachian counties: 99.0
+
40.2 vs. 78.8
+
26.4 per 100,000 (p<0.01). Compared to urban counties, their rural counterparts had a higher prevalence of poverty (30.8
+
7.3% vs. 24.4
+
5.7%, p<0.01), unemployment (8.1
+
2.0% vs. 6.7
+
1.2%, p<0.01), lack of insurance (18.4
+
3.5% vs. 16.0
+
3.6%, p<0.01), smoking (22.2
+
3.8% vs. 20.2
+
2.9%, p<0.01), obesity (33.1
+
3.8% vs. 32.0
+
3.5%, p<0.01), sedentary lifestyle (32.2
+
4.5% vs. 29.6
+
4.7%, p<0.01). In the multivariate-adjusted analysis, smoking (
beta
3.322, p<0.01), sedentary lifestyle (
beta
0.947, p<0.01), healthcare services accessibility and utilization (
beta
-0.532, p<0.05), unemployment (
beta
2.761, p<0.05) and poverty (
beta
0.652, p<0.05) were statistically significantly associated with age-adjusted premature CAD mortality.

Conclusions:
Premature CAD mortality in rural Appalachian counties is statistically significantly higher than in urban Appalachian counties. Socioeconomic disparities and modifiable CAD risk factors further aggravate the problem.
Abstract P468: Geographic and Socioeconomic Inequalities in Poor Cardiovascular Health in Canada
Authors: Singh Sarah , Stranges Saverio , Frisbee Stephanie J
Published: March 2020

Background:
Poor cardiovascular health (CVH), characterized by clinical risk and unhealthy lifestyle habits, is a leading cause of death and disease worldwide. Despite advances in healthcare and policy, there remains an inequitable burden of poor CVH among Canadian sub-populations based on socioeconomic status and geographic region. Using recently published data and a national toolkit, this study aimed to quantify inequalities in poor CVH across the Canadian population.

Methods:
We conducted a cross-sectional study on Canadian adults, ≥20 years, from the nationally representative Canadian Community Health Survey 2017. Using the American Heart Association’s CVH Index, CVH was defined for each individual as a summed score of 7 components, where 1 point was awarded for achieving ideal health in each component. A total score of 0-2 points indicated poor overall CVH. The Canadian Institute for Health Information (CIHI) Measuring Health Inequalities Toolkit, a standardized methodological approach to analyzing health inequalities in population-based data using pre-defined stratifications and second-level interactions, was used to quantify inequalities in poor CVH based on Toolkit-defined stratifications in sex, income, urban/rural status, and region of residence. The regional distribution of CVH was mapped using ArcGIS software.

Results:
Approximately 7% of Canadians had poor CVH, representing 2 million Canadians. Poor dietary habits were noted in 99.0% of the population, with poor body mass index and poor physical activity noted in 58.1% and 42.3%, respectively. The eastern provinces of Newfoundland and Labrador and New Brunswick had the greatest proportion of health regions with poor CVH. An examination of the largest CVH inequalities across provinces revealed that females in the lowest income tercile residing in Prince Edward Island were 8-times more likely to experience poor CVH than females in the highest income tercile (RR 8.43, 95%CI 7.09-10.04). Additionally, females in New Brunswick residing in rural regions were almost 3-times more likely to experience poor CVH than females residing in urban regions (RR 3.07, 95%CI 1.07-4.87). In most provinces, income and urban/rural inequalities among males were observed but were of smaller magnitude than the inequalities among females.

Conclusion:
The greatest inequalities in poor CVH were experienced by females in the lowest income groups. Urban/rural inequalities in CVH were complex and varied by geographic region. The CIHI toolkit is a robust and systematic approach to understanding health inequalities that will enable comparison between studies and health/disease states, and thus facilitate comparative policy evaluation and population health priority setting.
Abstract P471: Citizenship Status and the Prevalence, Treatment, and Control of Cardiovascular Disease Risk Factors Among Immigrants in United States, 2011-2016
Authors: Guadamuz Jenny S , Durazo-Arvizu Ramon A , DAVIGLUS Martha L , Calip Gregory , Nutescu Edith , Qato Dima
Published: March 2020

Introduction:
Immigrants without US citizenship, i.e., noncitizens, encounter barriers in accessing care which may contribute to disparities in cardiovascular disease (CVD), the leading cause of death among immigrants in the US. Despite this, little is known about whether the prevalence, treatment, and control of CVD risk factors differ by citizenship status This study estimates the prevalence, treatment, and control of CVD risk factors (hypercholesterolemia, hypertension, and diabetes) among US immigrants by citizenship status.

Methods:
We used nationally representative, cross-sectional data from the National Health and Nutrition Examination Survey (2011/12 to 2015/16), restricted to 5,306 immigrant adults (≥20 years). Citizenship status (exposure) was categorized as either citizen or noncitizen. CVD risk factor prevalence (age-standardized), treatment, and control were defined per national guidelines and determined using examinations and prescription-medication inventories. Treatment was estimated among persons with relevant conditions and control was estimated among persons who were receiving treatment. Associations were evaluated using Poisson regressions (prevalence ratios, PR).

Results:
Hypercholesterolemia (42.0%), hypertension (29.0%), and diabetes (15.7%) were common among immigrants and marginal differences were observed between citizens and noncitizens. However, noncitizens were less likely to be treated for hypercholesterolemia (16.4% vs. 43.3%, PR 0.38 [CI 0.31-0.46],
P
<0.001), hypertension (60.3% vs. 79.6%, PR 0.76 [CI 0.70-0.84],
P
<0.001), and diabetes (51.2% vs. 66.6%, PR 0.77 [CI 0.66-0.90],
P
<0.001) than citizens. Because noncitizens disproportionally lack a usual source of care (30.2% vs. 16.6%,
P
<0.001) and health insurance (48.8% vs. 19.1%,
P
<0.001), adjusting for access to care largely explained differences in the treatment of CVD risk factors. Among those treated for CVD risk factors, citizens and noncitizens achieved similar control of hypercholesterolemia (36.2%) and hypertension (67.5%), but disparities in diabetes control were observed (35.3% vs. 46.9%
, P
=0.04).

Conclusions:
While CVD risk factors were common in citizens and noncitizens, treatment rates were significantly lower among noncitizens due to poor access to care. Efforts to prevent CVD morbidity and mortality among immigrants should address the undertreatment of risk factors by ensuring access to care among immigrants, regardless of citizenship status.
Abstract P481: Early Recognition of Heart Failure With Preserved Ejection Fraction (HFpEF): Ventricular Elastance as a Predictive Marker for Prevention and Treatment
Authors: Lekavich Carolyn L , Kraus William E
Published: March 2020

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, carries a 50% mortality rate within 3 years of diagnosis with evidence to support early lifestyle behavioral modification as beneficial. Developing an understanding of markers that identify patients early, promotes early recognition and treatment.

Objective:
Use of a predictive marker, ventricular elastance, enables early identification of patients at-risk for HFpEF.

Methods:
Patients previously diagnosed with HFpEF were retrospectively identified. Through case-control and hierarchical linear regression modeling, biomarkers were identified that preceded the onset of HFpEF. Using Cox regression, we conducted a survival analysis to determine time to onset of HFpEF for each biomarker. Using repeated measures logistic regression, continuous variables were tested for interval progression toward disease onset, controlling for co-variates: age, race and sex.

Results:
Through retrospective analysis, 251 patients and 775 echocardiograms spanning nearly 20 years were identified. Through mixed linear regression, for the entire model, 7 biomarkers were identified as statistically significant and 1 biomarker, ventricular elastance (Ees), progressively increased leading to the time of HFpEF hospitalization.

Conclusion:
This study provides the methodology for testing a predictive marker, ventricular elastance, that enables early recognition of HFpEF.
Abstract P484: The Role of Excessive Body Weight in Hypertension Risk Among Youth
Authors: Koebnick Corinna , Sidell Margo , Daley Matthew , Li Xia , Riewerts Robert , Kuizon Beatriz
Published: March 2020

Objective:
To determine the hypertension risk associated with elevated body mass index (BMI) for age in children.

Study design:
In a retrospective cohort of 706,903 children ages 3-18 years in an integrated health care system in Southern California between 2008 and 2017, Cox proportional hazard models with age as time scale were fitted to assess the risk of hypertension (based on 2017 Blood Pressure Guidelines by the American Academy of Pediatrics using 3 blood pressures of independent consecutive visits), by baseline BMI-for-age category (starting at their first available BMI) and BMI change over time, adjusted for sex, race, socioeconomic status and baseline year. Children were followed up until end of membership, onset of hypertension, death, or end of study period.

Results:
During 3,121,299 person-years, we identified 19,158 youth with incident hypertension. The adjusted hazard ratio (HR) for hypertension was 0.842 (95%CI 0.755, 0.938) for children with a baseline BMI-for-age <5th percentile, 0.864 (95%CI 0.814, 0.917) for 5-39th percentile, 1.00 (reference) for 40-59th percentile, 1.216 (95%CI 1.153, 1.282) for 60-84th percentile, 1.721 (95%CI 1.629, 1.817) for 85-94th percentile, 2.418 (95%CI 2.261, 2.586) for 95-96th percentile, and 3.816 (95%CI 3.624, 4.019) for ≥97th percentile. The adjusted HR for change in BMI over time was 1.095 (95%CI 1.090, 1.100) per kg/m2.

Conclusions:
In this large cohort study, we found that even moderate elevations in BMI-for age percentile conferred an increased risk of hypertension in children. Results also indicate an escalation of hypertension risk as BMI increased over time. Our results suggest that normal body weight in children ranging from the 5th to the 85th percentile of BMI-for-age and modest increases in BMI over time may increase the risk for hypertension.
Abstract P489: Association of Fasting Triglyceride Levels With Long-Term Competing Risks for Cause-Specific Cardiovascular Disease Events Among Middle-aged White and Black Men and Women
Authors: Khan Sadiya S , Ning Hongyan , Allen Norrina B , Carnethon Mercedes R , Lloyd-jones Donald M , Wilkins John T
Published: March 2020

Introduction:
Hypertriglyceridemia is common and reflects poor metabolic health, but conflicting data exist regarding the independent association of triglycerides (TG) and cardiovascular disease (CVD). In addition, whether elevated TG are associated with differential long-term risks for CVD subtypes and whether this varies by sex and race, is not well-established. Therefore, we sought to examine the incidence of coronary heart disease, stroke, or heart failure in white and black US men and women by baseline TG levels.

Methods:
We included individual-level pooled data from 5 population-based cohorts and stratified middle-aged participants (index ages 40-59 years) who were free of CVD at baseline by sex and race. We categorized fasting TG levels as optimal (<100 mg/dL), intermediate (100 to 150 mg/dL), or elevated (>150mg/dL). We performed 1) Irwin’s restricted mean to estimate years lived free of and with CVD and 2) competing Cox models (adjusted for age, education, smoking, obesity, hypertension, diabetes, total cholesterol, and HDL-cholesterol) to estimate joint cumulative risks for CVD events (overall and by subtype) and non-CVD death.

Results:
Among the 20,406 participants, 26% were black and 55% were women. Elevated TG was associated with significantly fewer healthy years lived free of CVD in all race-sex groups (p<0.05 compared with optimal TG). Overall, competing cumulative incidence of CVD as well as non-CVD death was higher in intermediate and elevated TG subgroups compared with the optimal TG group. After adjustment for other risk factors, elevated TG were not associated with risks for any CVD subtype in black adults; among whites, elevated TG were associated with risk for stroke as a first event in men, and with all CVD subtypes in women
(TABLE)
.

Discussion:
Using pooled individual-level data from 5 large cohorts of middle-aged individuals, we observed differential competing risks by sex and race group for CVD subtypes associated with elevated TG. White women especially may have independent risk from elevated TG.
Abstract P492: Circulating Sphingolipids and Risk of Mortality: The Cardiovascular Health Study
Authors: Fretts Amanda M , Jensen Paul , Hoofnagle Andrew , McKnight Barbara , Sitlani Colleen , Siscovick David S , King Irena , Psaty Bruce M , Sotoodehnia Nona , Lemaitre Rozenn
Published: March 2020

Introduction:
Recent studies suggest that the type of saturated fatty acid bound to sphingolipids influences sphingolipid activity, and that associations of ceramides (Cer) and sphingomyelins (SM) with cardiovascular outcomes may differ by lipid species. The purpose of this study was to assess associations of Cer and SM species with mortality among 4,612 older adults from the Cardiovascular Health Study, a population-based prospective study of adults aged ≥65 y who were followed from 1992-2015.

Hypothesis:
Higher levels of circulating Cer and SM with palmitic acid (Cer-16) are associated with a higher risk of mortality (i.e., deaths from cardiovascular disease (CVD) and non-cardiovascular causes) while higher levels of Cer and SM with very-long chain saturated fatty acids arachidic acid (Cer-20 and SM-20), behenic acid (Cer-22 and SM-22), and lignoceric acid (Cer-24 and SM-24) are associated with a lower risk.

Methods:
The associations of each sphingolipid with mortality were assessed using Cox proportional hazards models. Models adjusted for age, sex, self-reported race, geographic area, education, smoking, alcohol use, BMI, activities of daily living, HDL and LDL cholesterol, triglycerides, systolic blood pressure, physical activity, use of hypertension or lipid-lowering drugs, self-reported health status, prevalent diabetes, CVD, heart failure (HF), and other sphingolipids species.

Results:
During a median follow-up of 10.2 years (range 0-23 years), 4,099 deaths occurred. At each time, higher levels of Cer-16 and SM-16 were associated with a higher risk of mortality, while higher levels of Cer-22, Cer-24, SM-20, SM-22, and SM-24 were associated with a lower risk of mortality (Figure). Models that did not adjust for diabetes, CVD, and HF produced similar results.

Conclusions:
These findings suggest that the associations of Cer and SM with the risk of death differ according to the length of their acylated saturated fatty acid, and support the need for future studies to explore mechanisms underlying these relations.
Abstract P493: Small Dense Low-density Lipoprotein Cholesterol and Carotid Intimal Medial Thickness Progression
Authors: Ikezaki Hiroaki , Yokota Yuya , Ai Masumi , Asztalos Bela F , Murata Masayuki , Hayashi Jun , Schaefer Ernst J
Published: March 2020

Introduction:
Carotid intimal medical thickness (cIMT) is associated with cardiovascular disease (CVD). The association between atherogenic lipoproteins including small dense low-density lipoprotein cholesterol (sdLDL-C) and carotid intimal medial thickness (cIMT) progression has not been fully evaluated in a prospective cohort study.

Hypothesis:
We assessed the hypothesis that sdLDL-C is the most atherogenic lipoproteins with regard to cIMT progression.

Methods:
Kyushu and Okinawa Population Study (KOPS) is a community-based, prospective, and observational study in Japan which has been underway since 2004 and a total of 18,762 participants have been enrolled. For this study, we included 2,030 male and female participants (median age 59 years at baseline) who were free of CVD and off cholesterol lowering medication, and had cIMT measured at both baseline and after 5 years follow-up survey. Using plasma samples obtained from those subjects after overnight fast, we measured total cholesterol, direct low-density lipoprotein cholesterol (LDL-C), sdLDL-C, LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, triglycerides, Lp(a), adiponectin and high sensitivity C reactive protein (hs CRP). Their cIMT levels were measured by B-mode ultrasonography with a 10 MHz probe at far walls of their both right and left common carotid arteries.

Results:
Median cIMT at baseline was 0.63 mm and median 5 year progression was 0.18 mm. After adjustment for standard CVD risk factor including age, gender, systolic blood pressure, total cholesterol, HDL-C, smoking, diabetes, and hypertension treatment, only LDL-C, sdLDL-C, and the sdLDL-C/LDL-C ratio were associated with cIMT progression. Even in subjects with direct LDL-C < 100 mg/dL, considered to be at low CVD risk, elevated sdLDL-C were associated with cIMT progression (
P
for trend = 0.009) in a model with established CVD risk factors, although the sdLDL-C/LDL-C ratio did not.

Conclusions:
In conclusion, both sdLDL-C and direct LDL-C are significantly associated with cIMT progression. Moreover sdLDL-C has stronger relationship with cIMT progression than does LDL-C; therefore, measurement of sdLDL-C may allow for the formulation of optimal therapy to cIMT progression.
Abstract P495: Trends in Physical Activity Among US Older Adults With Heart Failure 2007-2016
Authors: Ye Fan , Zhou Li , Yeboah Joseph , Brubaker Peter H , Bertoni Alain G
Published: March 2020

Introduction:
Heart failure (HF) is a growing public health problem which is the leading cause of hospitalization. About half of people who develop HF die within 5 years of diagnosis. Recent evidence suggests that physical inactivity may be an important risk for HF. However, the importance of physical activity in the prevention and treatment have not been adequately recognized. Self-reported physical activity can provide insights into the impact of lifestyle behaviors on mortality. The objective of this study was to determine the relationship between physical activity and HF in a nationally representative sample of United States (US) adults.

Methods:
The 2007-2016 National Health and Nutrition Examination Survey data collection cycles were used for this analysis. Participants aged 65 and older with HF were defined as those who answered “yes” to the question: “Has a doctor or other health professional ever told you that you had congestive HF?” Frequency and duration of self-reported moderate-intensity (“Days moderate recreational activities” and “Minutes moderate recreational activities”) and vigorous-intensity Days vigorous recreational activities” and “Minutes vigorous recreational activities”) physical activity were collected through questionnaires as well in all data cycles. We used 2018 Physical Activity Guidelines for Americans Older Adults, which recommended that most older adults (age≥65 years) participate in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week as our cut-off points for calculating moderate-to-vigorous physical activity.

Results:
Between 2007-2008 and 2015-2016, the percentage of US adults ≥65 years with HF increased from 2.76% to 3.69% (p=0.04). Although a similar percentage of participants who met the criteria of at least 150 minutes of moderate-intensity activity per week was noted in both groups from 2007 to 2016 (on average, HF: 56.9% vs. HF-free: 56.7%, respectively, p>0.05), more HF-free participants reported at least 75 minutes of vigorous-intensity recreational activities per week compared to HF participants in each calendar year (82.8% vs. 66.7%, 85.0% vs. 70.0%, 83.5% vs. 55.0%, 87.0% vs.75%, 85.2% vs. 63.6%, respectively, p<0.01). Additionally, among those who reported activities, older adults with HF were less than 20 times as likely to report moderate or vigorous recreational activities compared to those without HF.

Conclusions:
Our findings illustrate lower self-reported physical recreational activities, especially vigorous activities, in older participants who report a diagnosis of HF and more participants without HF report vigorous-intensity recreational activities. Future study should focus on understanding the physical limitations of HF patients, which is paramount in developing cardiac rehabilitation strategies to improve their function capacity.
Abstract P499:
24-month Follow-up Of The ‘Stand And Move At Work’
Sedentary Behavior Intervention: Effects On Workplace Sitting Time
Authors: Larouche Miranda , Toledo Meynard J , Mullane Sarah L , Rydell Sarah A , Vuong Brenna J , Feltes Linda H , Mitchell Nathan R , de Brito Junia N , Hasanaj Kristina , Carlson Neil , Gaesser Glenn A , Crespo Noe C , Oakes J. M , Pereira Mark A , Buman Matthew P
Published: March 2020

Multicomponent interventions that use sit-stand workstations (SSW) to reduce workplace sitting time have been largely successful. However, the long-term maintenance (i.e., >12 months) of this behavior change is relatively unknown. We aimed to evaluate the 24-month maintenance of reductions in workplace sitting time, along with the effects of introducing the SSW after 12 months of multicomponent intervention only. We used data from
Stand and Move at Work,
a two-arm multi-site group randomized trial of 24 worksites (12 worksites per arm; N=630, 74% female, 45±11 years of age). Worksites in the
STAND+
arm received 12 months of a multilevel (i.e., worksite policy, environmental, and individual-level strategies) intervention to increase light-intensity physical activity, along with a SSW, to increase standing time. Worksites in the
MOVE+
arm (i.e., comparator) received the same multilevel intervention but were not provided with the SSW until after the intervention ended at 12 months. Sitting time was assessed for 7 consecutive days using the activPAL3c micro accelerometer at baseline, 12, and 24 months. Results are presented below in table form. In
STAND+
, sitting time at 24 months, relative to baseline, was significantly reduced and similar in magnitude of change to what was observed at 12 months. In
MOVE+
, sitting time at 24 months (a year after the SSW was introduced), relative to baseline, was significantly reduced but markedly smaller in magnitude of change than observed during the
STAND+
active intervention period (i.e., 0 to 12 months). These results support the use of SSW coupled with a multicomponent intervention for optimal and long-term maintenance of reductions in workplace sitting time.

Hierarchical regression models were adjusted for worksite clustering, age, sex, and baseline BMI.
Abstract P503: Continuous Diurnal Patterns of Atrial Fibrillation Onset by Chronic Kidney Disease Status: The Atherosclerosis Risk in Communities (aric) Study
Authors: Kim Esther , Zipunnikov Vadim , Soliman Elsayed Z , Coresh Josef , Matsushita Kunihiro , Chen Lin Y
Published: March 2020

Background:
Chronic kidney disease (CKD) is associated with atrial fibrillation (AF); however, most studies have looked at its presence or occurrence as a dichotomous outcome, and diurnal patterns of AF by CKD status have not yet been characterized.

Methods:
Of 2257 adults (71-94 years) who underwent 2 weeks of non-invasive continuous heart rhythm monitoring using the Zio XT Patch, we examined 61 participants with paroxysmal AF and characterized the probability of AF onset over the course of 24 hours using a generalized function-on-scalar regression model. CKD status was defined using eGFR and albuminuria.

Results:
The median device wear-time was 13.7 (12.6, 13.9) days, and the majority (57%) had CKD. In non-CKD, the probability of AF onset fluctuated over 24 hours with two nadir periods occurring in late morning (~10am) and late evening (~10pm), and somewhat prominent peaks occurring in early morning (~8am) and early evening (~6pm)
[figure]
. Overall, CKD had a higher probability of AF compared to non-CKD. CKD also demonstrated a less pronounced nadir in late evening, and was significantly more likely to experience AF during this time (OR 2.80; 95% CI 1.05, 11.94) compared to non-CKD. This observation was consistent even after adjusting for various potential confounders such as age, sex, race, diabetes, and a history of cardiovascular disease.

Conclusion:
Based on 2-week monitoring, AF onset seems to exhibit a diurnal pattern throughout the day with peaks in the early morning and evening, and nadir in late morning and evening. Compared to those without CKD, those with CKD are more likely to experience AF in late evening, suggesting a potential high-risk time window for monitoring. Further studies are needed to evaluate prognostic value of AF diurnal patterns.
Abstract P507: Interplay Between Diet and Gut Microbiota, and Circulating Levels of Trimethylamine N-oxide: Findings From the Men’s Lifestyle Validation Study
Authors: Li Jun , Li Yanping , Ivey Kerry , Wang Dong , Wilkinson Jeremy , Franke Adrian , Chan Andrew , Huttenhower Curtis , Hu Frank B , Rimm Eric , Sun Qi
Published: March 2020

Background:
Trimethylamine N-oxide (TMAO) is proposed as a possible culprit linking red meat intake and poor cardiovascular health. The relationship between diet, microbial metabolism, circulating TMAO levels, and cardiometabolic health in free-living individuals, is yet to be elucidated.

Hypothesis:
Specific microbial taxa may modulate associations of choline/L-carnitine and red meat intake with plasma TMAO levels and cardiometabolic traits.

Method:
We collected 2 pairs of fecal samples (n=925) and, simultaneously, 2 blood samples (n=473), 6 months apart, from 307 healthy men in the Men’s Lifestyle Validation Study in 2012. We performed Shotgun metagenomic sequencing using fecal samples and identified microbial taxonomic features using MetaPhlAn2. We measured hemoglobin A1c (HBA1c), and plasma levels of TMAO, lipids, and other cardiometabolic risk markers. Diet was assessed repeatedly using validated food-frequency questionnaires and dietary records.

Results:
Multivariable random-effect linear regressions identified 10 bacterial species that were significantly associated with TMAO levels (
FDR
<0.05;
Figure A
), and these species significantly modified the associations of dietary choline/L-carnitine and/or red meat intake with TMAO levels (
P
interaction
<0.05). In particular,
Alistipes
s
hahii
and
Clostridium
c
itroniae
significantly strengthened the association between red meat intake and TMAO levels, whereas
Eubacterium
b
iforme
attenuated this association (
P
interaction
<0.05). Consistently, the associations of higher red meat intake with higher HBA1c and lower high-density lipoprotein cholesterol levels were more pronounced in the presence of
A.
s
hahii
and
C.
c
itroniae
or in the absence of
E.
b
ifome
(
Figure B
).

Conclusions:
We identified microbial taxa that modify the associations of red meat intake with circulating TMAO levels and cardiometabolic traits, in free-living men, suggesting an interplay between diet and microbial metabolism in producing TMAO and affecting cardiometabolic health.
Abstract P510: Association of Animal and Plant Protein Intake With Mortality Among US Adults: A Prospective Cohort Study
Authors: Shan Zhilei , Haslam Danielle E , Rehm Colin D , Song Mingyang , Hu Frank B , Zhang Fang Fang , Bhupathiraju Shilpa N
Published: March 2020

Introduction:
Animal protein sources, especially red and processed meat, have been associated with adverse health outcomes. Epidemiological evidence on the isocaloric substitution of plant for animal protein on mortality risk remains limited.

Hypothesis:
We hypothesized that substituting plant protein for carbohydrates and animal protein would be associated with lower mortality.

Method:
We included a nationally representative sample of 37 233 US adults ≥20 years with 24-h dietary recall data from eight National Health and Nutrition Examination Survey (NHANES) cycles (1999-2014). Mortality from all causes, heart disease, and cancer were identified through National Death Index linkage (until December 31, 2015). We used Cox proportional hazards regression to estimate the association between plant and animal protein intake and mortality after adjustment for potential confounding factors.

Results:
During 297 768 person-years of follow-up, 4 866 total deaths occurred, including 849 deaths from heart disease and 1 068 deaths from cancer. After multivariable adjustment, higher intake of total animal protein was not associated with total mortality. Plant protein was associated with lower total mortality; when comparing the lowest with highest quintiles of plant protein intake, the multivariable adjusted HR (95% CIs) of total mortality was 0.73 (0.61, 0.88);
P
for trend <0.001. The HRs (95% CIs) comparing extreme quintiles were 0.71 (0.48, 1.05) for heart disease mortality, and 0.74 (0.53, 1.04) for cancer mortality. When isocalorically replacing 5% of energy from total animal protein with plant protein, the multivariable HRs were 0.49 (0.32, 0.74) for total mortality, 0.51 (0.28, 0.95) for heart disease mortality, and 0.53 (0.28, 1.00) for cancer mortality. For different food sources of animal protein, isocaloric substitution of 2% of energy from plant protein for protein in unprocessed red meat (0.74, 95% CI: 0.63, 0.87), processed meat (0.68, 95% CI: 0.53, 0.89), total dairy (0.74, 95% CI: 0.58, 0.94), and 1% of energy from plant protein for seafood (0.86, 95% CI: 0.79, 0.93) was each associated with a lower risk of total mortality.

Conclusions:
Higher plant protein intake was associated with lower total mortality. Isocalorically replacing animal protein with plant protein was associated with lower total mortality.
Abstract P513: Alcohol Type and Ideal Cardiovascular Health in The Multi-Ethnic Study of Atherosclerosis
Authors: Ogunmoroti Oluseye , Osibogun Olatokunbo , McClelland Robyn L , Lazo Mariana , Mathews Lena , Okunrintemi Victor , Oni Ebenezer , Burke Gregory L , Michos Erin D
Published: March 2020

Background:
Light to moderate alcohol consumption is associated with lower incidence of cardiovascular disease (CVD) and favorable cardiovascular health (CVH). However, the association between alcohol type and ideal CVH is yet to be established. This study examined the relationship between alcohol type and ideal CVH as measured by the American Heart Association Life’s Simple 7 (LS7) metrics.

Methods:
We analyzed data from 6,389 men and women aged 45-84 years from a multi-ethnic cohort free of CVD at baseline. Alcohol type (wine, beer and liquor), assessed from a food frequency questionnaire, was categorized as never, >0 but <1 drink/day, 1-2 drinks/day and >2 drinks/day. Each LS7 metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) was scored 0-2 points, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. The maximum CVH score attainable ranged from 0-14 points (inadequate score, 0-8; average, 9-10; optimal, 11-14). We used multinomial logistic regression to examine the association between alcohol type and CVH adjusted for age, sex, race/ethnicity, education, income, health insurance and study site.

Results:
The mean (SD) age of study participants was 62 (10) years and 53% were women. Participants who consumed 1-2 drinks/day of wine had higher odds of having optimal CVH scores compared to those who never drank wine [prevalence odds ratio (POR) 1.50 (1.02-2.20),
Table
]. In comparison to participants who never drank beer, those who consumed 1-2 and >2 drinks/day of beer had lower odds of having optimal scores [POR 0.49 (0.27-0.86) & 0.27 (0.12-0.58), respectively]. Additionally, those who consumed 1-2 and >2 drinks/day of liquor had lower odds of having optimal scores compared to those who never drank liquor [POR 0.52 (0.30-0.89) & 0.28 (0.14-0.55), respectively].

Conclusion:
In this cross sectional analysis, moderate consumption of wine was associated with favorable CVH. However, consumption of beer or liquor was associated with poorer CVH.
Abstract P519: Multivitamin Use And Arterial Stiffness In Older Women And Men
Authors: Matsumoto Chisa , Rautiainen Susanne , Roche Elise , Manson JoAnn E , Sesso Howard D
Published: March 2020

Introduction:
A multivitamin (MV) is the most commonly taken supplement in older U.S. adults. Arterial stiffness is an important intermediate marker of cardiovascular disease (CVD). However, few studies have examined the association of MV use and arterial stiffness.

Hypothesis:
Regular multivitamin use is associated with lower levels of arterial stiffness.

Methods:
A subcohort of participants enrolled in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), a large scale randomized clinical trial testing a MV and a cocoa extract supplement on CVD and cancer, completed baseline measurement of arterial stiffness assessed by pulse wave velocity (PWV), augmentation index (AI), and central blood pressure (CBP). Frequency and duration of MV use was assessed via self-report questionnaire at baseline. The cross-sectional association of MV use and arterial stiffness was evaluated by multivariate linear regression with adjustment for conventional CVD risk factors. We also performed subgroup analyses to evaluate effect modification between MV use and sex, age, body mass index (BMI), and hypertension.

Results:
A total of 470 (229 women and 241 men) COSMOS participants were included in this study, with mean age 69.1±5.2 years, of whom 150 (32%) reported current MV use at baseline. Multivariate linear regression analysis revealed that current MV use (yes versus no) was significantly associated with lower PWV (β:-0.59±1.02, p=0.004) but not associated with other measures of arterial stiffness, including AI or CBP. There were also no consistent associations between frequency and duration of MV use with any of the measures of arterial stiffness. Also, there was no effect modification by sex, age, BMI, or hypertension on the association between MV use and arterial stiffness.

Conclusions:
MV use was associated with lower PWV in older subjects. Further results from the COSMOS trial on randomized MV supplementation and changes in arterial stiffness over 2 years will further elucidate the effects of MV on arterial stiffness.
Abstract P520: Associations of Dietary Patterns and Risk of Sudden Cardiac Death in the Reasons for Geographic and Racial Differences in Stroke Study Differ by History of Coronary Heart Disease
Authors: Shikany James M , Safford Monika M , Soroka Orysya , Newby PK , Brown Todd M , Durant Raegan W , Judd Suzanne E
Published: March 2020

Introduction:
Previous investigations of the association of a healthy dietary pattern, the Mediterranean (Med) diet, and risk of sudden cardiac death (SCD) are limited and generally have not examined possible differences in those with and without a history of coronary heart disease (CHD). Studies of the associations of
a posteriori
-derived dietary patterns and risk of SCD are lacking. We conducted analyses of the associations of these dietary patterns with risk of SCD in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Hypothesis:
We hypothesized that the Med diet score and adherence to the plant-based dietary pattern would be inversely associated with risk of SCD, adherence to the convenience and Southern dietary patterns would be positively associated with risk of SCD, and that these associations would differ by history of CHD.

Methods:
REGARDS enrolled 30,239 white and black adults aged ≥45 years from 2003-2007. Participants completed a food frequency questionnaire at baseline, from which 5 dietary patterns were derived through factor analysis: convenience, plant-based, sweets, Southern, and alcohol and salads. Med diet scores were calculated and categorized into 3 groups. SCD events were expert adjudicated. Cox proportional hazards regression was used to model the associations of the dietary patterns and score with SCD events, adjusting for sociodemographics, lifestyle factors, energy intake, anthropometrics, medical conditions, and medications, and stratifying by history of CHD.

Results:
After excluding participants with missing diet and covariate data and those lost to follow-up, 21,066 participants were included in the analysis. Mean (SD) age was 64.9 (9.3) years, 56.0% were women, 33.2% were black, and 385 (1.8%) experienced SCD during a mean (SD) follow-up of 9.2 (3.4) years. In those without a history of CHD, Med diet score was significantly and inversely associated with risk of SCD (hazard ratio [HR] for group 3 vs. group 1 [referent]: 0.55; 95% confidence interval [CI]: 0.35-0.89; p trend = 0.02), but none of the
a posteriori
-derived dietary patterns were associated with risk of SCD. However, in those with a history of CHD, Med diet score was not associated with risk of SCD, but the convenience dietary pattern was significantly and positively associated with risk of SCD (HR for quartile 4 vs. quartile 1 [referent]: 1.74; 95% CI: 1.08-2.78; p trend = 0.04), and the sweets dietary pattern was significantly and inversely associated with risk of SCD (HR for quartile 4 vs. quartile 1: 0.56; 95% CI: 0.33-0.94; p trend = 0.01).

Conclusions:
The associations of dietary patterns with risk of SCD in REGARDS participants differed by history of CHD.
Abstract P525: The Effect of Weight Loss Combined With Aerobic Exercise Training on Arterial Stiffness: Results From the PREVAIL Pilot Study
Authors: Swift Damon L , McGee Joshua E , Clunan Marie C , Huff Anna C , Osborne Briceida G , Gniewek Nicole R , Brown Taylor T , Bucher Colleen , Carels Robert , Houmard Joseph A , Pories Walter , Matarese Laura
Published: March 2020

Objective:
The OPTIFAST diet has known effects for weight loss, but little data exists on the effects of the diet on arterial stiffness.

Methods:
Overweight and obese (BMI: 34.5
+
4.0) adults (N=17) participated in a 10-week OPTIFAST™ weight loss program and supervised aerobic exercise training (50%-75% VO
2
max). The diet consisted of OPTIFAST meal replacement products with a goal of reducing total caloric intake to 800 kcals/day and attending a weekly weight management class. Aerobic exercise was performed 3 times per week and the exercise volume was progressed from 300 to 700 MET mins. per week at an intensity of 50%-75% VO2 max. The goal of study participants was to achieve a 7% weight loss. Carotid-to-femoral pulse wave velocity, blood pressure (aortic and brachial), vascular age, augmentation index and blood samples were measured in the morning after an overnight fast at baseline and follow-up. A paired t-test was performed to evaluate the change in outcomes variables.

Results:
The mean percent weight loss in the sample was 9.0% (-8.5 kg), with 83.3% of participants achieving 7% weight loss (94.1% achieving ≥5%). The adherence to the exercise program was 94.9% and attendance in the weight loss classes was 81.8%. There was a reduction in pulse wave velocity (-0.44 m/s, p=0.030), aortic systolic blood pressure (-10.5 mmHg, p<0.001), aortic diastolic blood pressure (-7.8 mmHg, p<0.001), brachial systolic blood pressure (-11.2 mmHg , p<0.001), brachial diastolic blood pressure (-7.7 mmHg, p<0.001), vascular age (-13.4 yrs., p=0.008), resting heart rate (-4.7 bpm, p=0.005), and augmentation index (-7.5%, p=0.008) after the intervention. Change in resting heart rate from the intervention was associated with improvements in augmentation index (r=0.60, p=0.010) and approached significance for pulse wave velocity (r=0.45, p=0.07). Weight loss was associated with reduction in augmentation index (r= 0.56, p=0.02), but not change in PWV (r=-0.07, p=0.78). Changes in other cardiometabolic risk factors (e.g. glucose, insulin, lipids, and body fat) were not associated with improvements in arterial stiffness or blood pressure measures (all ps>0.05).

Discussion:
A hypo-caloric dietary program in combination with aerobic exercise training improves arterial stiffness, aortic blood pressure, and brachial blood pressure in overweight and obese adults An important limitation of the present study is that we cannot separate the health benefits of the diet from the exercise.
Abstract P532: The Italian Pilot of the Health Literacy Survey 2019 in the Cuore Project for the Who Action Network on Measuring Population and Organizational Health Literacy (m-pohl)
Authors: Palmieri Luigi , Cadeddu Chiara , Rosano Aldo , Donfrancesco Chiara , D Elia Roberto , Mastrilli Valeria , De Castro Paola , Lo Noce Cinzia , Acampora Anna , Giampaoli Simona , GALEONE DANIELA
Published: March 2020

Background:
Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to the funds of the Italian Center for Diseases Control and Prevention-CCM of the Ministry of Health, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS.

Objective:
A pilot study was conducted to evaluate the feasibility of the M-PHOL international questionnaire HLS-EU using the Italian version of the short form (HLS-EU-Q16 items), during the CUORE Project-Health Examination Survey 2018-2019.

Methods:
One hundred people aged 35-74 years, resident in the South of Italy, were face-to-face interviewed following consecutive access to the HES. The 4 Likert-type responses were grouped in 2 classes: 0 (zero) for fairly difficult/very difficult and 1 for fairly easy/very easy. According to the HLS-EU-Q16 sum score (range: 0–16), three levels of HL were defined: ‘Inadequate’ (0–8), ‘Problematic’ (9–12), ‘Sufficient’ (13–16). HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES. Means and prevalence were age and gender standardised using the European standard population.

Results:
Ninety-eight persons completed the questionnaire (47 men, 51 women); HL mean score was 13.1 (SD=3.2) with no sex difference; prevalence of persons with ‘Inadequate’ HL was 11.2%, ‘Problematic’ 26.5%, ‘Sufficient’ 62.3%. For persons with the highest educational level (Tertiary) the highest prevalence was in the ‘Sufficient’ HL (20.5%); in the same HL category, only 3.4% was the prevalence of those with the lowest educational level (Primary). Hypertension was lower in the ‘Sufficient’ HL category (37.9% vs. 45.1% in the ‘Inadequate’ HL). Smoking habit decreased with increasing HL level (21.3%, 19.0%, 5.4% in the three HL categories, respectively).

Conclusion:
More than one third of interviewed adult population had ‘Inadequate’/’Problematic’ HL. Preliminary results from the Italian pilot of the HLS-EU-Q16 within the HES of the CUORE Project suggest that the survey is an important opportunity for the possibility of linking HL data with HES measured data. A national survey on HL will be implemented in the Italian general population in the framework of the M-POHL network.