bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P266: The Association Of Recent Age-specific Growth Of The

>

65 Years Population With Heart Disease Mortality In The United States, 2005-2017
Authors: Sidney Stephen , Khan Sadiya S , Gerber Yariv , Lloyd-jones Donald M , Go Alan S , Rana Jamal S
Published: March 2020

Introduction:
In 2011, the number of deaths with an underlying cause of heart disease (HD) reached its lowest level in 56 years. However, there has subsequently been a steady increase in the annual number of total HD deaths, owing to a rapid increase (23%) in the size of the population ≥65 years of age in the U.S. To understand these trends, we sought to characterize differences between 2005-2011 and 2011-2017 in population and mortality by age subgroups among those ≥65 years.

Methods:
We determined age-specific population size, HD mortality rate, and absolute number of HD deaths in the ≥65 age group for the time periods 2005-2011 and 2011-2017, as well as for the <65 years age group, using the CDC WONDER online data set.

Results:
Age-specific population growth was greatest among those 65-74 years between 2005-2011 and 2011-2017, representing 76% of the total population growth among those ≥65 years old in both time periods (Table) and 51% of the growth for the entire population from 2011-2017. From 2005-2011, decreases in the mortality rate of 20% or greater in each of the age subgroups (65-74, 75-84, 85+) resulted in a decline in the number of total HD deaths in each of the age groups in spite of substantial population increases in the 65-74 and 85+ age groups. However, subsequent changes in the age-specific mortality rate among those ≥65 years were lower than population increases from 2011-2017, resulting in an increased number of total HD deaths in all
>
65 years age subgroups. This was most notable among those age 65-74 years in whom the 32% population increase with a 1.5% decline in the mortality rate resulted in a 30% increase in the number of HD deaths, representing 61.3% of the increase in number of HD deaths in the 65+ years age group and 53% of the increase of HD deaths in all age groups from 2011-2017.

Conclusions:
The rapid growth of the 65-74 years age group (baby boomers) accounts for most of the population growth in the ≥65 years age group and more than half the increase in both total population growth and the total number of HD deaths from 2011-2017.
Abstract P269: Physical Activity Relative Intensity is Inversely Associated With Mortality in Older Women
Authors: LaMonte Michael J , BELLETTIERE John , Di Chongzhi , LACROIX Andrea Z
Published: March 2020

Background:
Aerobic capacity and efficiency of movement reduce with aging, and do so at an accelerated rate. Consequently, the
relative
intensity (effort) of a defined physical activity (PA) task is higher at older compared with younger ages. The magnitude of association for PA relative intensity with health outcomes in older adults is unknown, and is a research priority identified in the 2018 PA Guidelines for Americans.

Methods and Results:
We followed 5,756 women, ages 63-99 years, for all-cause mortality (369 deaths) during a median of 4.3 years. Self-rated relative intensity during usual daily PA was determined using the Borg 0-10 point scale at baseline. PA relative intensity categories were “nothing to very weak” (Borg 0-2; n=1052; referent group), “weak” (Borg 3; n=2854), “moderate to maximal” (Borg ≥4; n=1850), over which numbers of deaths and crude mortality rates (per 1000 person-years) were 118 (25.7), 170 (13.0), 81 (9.5), respectively. In Cox regression analysis controlling for age, race-ethnicity, education, smoking, alcohol, use of assistive walking device, sleep duration, self-rated health status, number of comorbidities and BMI, hazard ratios (95% CI) across the above exposure categories were 1.00 (ref), 0.69 (0.54, 0.89), and 0.72 (0.53, 0.98), trend P=.03. The significant inverse association was evident in older women ≥80 years (HR: 1.00, 0.60, 0.68, trend P=.01) but not in women <80 years (HR: 1.00, 1.26, 0.99, trend P=.88; interaction P=.58).

Conclusions:
Self-rated PA relative intensity is inversely associated with mortality in older ambulatory women, and may provide a simple approach in epidemiologic studies to characterizing the relevance that age-related changes in aerobic fitness and energetics of movement have on health outcomes.
Abstract P272: Associations of an Epigenetic Biomarker of Aging and Healthspan With BMI Status and Metabolic Health in Adult African Americans: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Nguyen Steven , Guan Weihua , Bressler Jan , Grove Megan , Xia Rui , Wang Zhiying , Fernandez-rhodes Lindsay E , Justice Anne E , Li Yun , Whitsel Eric A , North Kari E , Fornage Myriam , Boerwinkle Eric , Pankow James S , Demerath Ellen W
Published: March 2020

Introduction:
Individuals with obesity are thought to be protected against some chronic disease as long as they do not incur metabolic health (MH) conditions. A new epigenetic biomarker of accelerated biological aging and health span, PhenoAge, was developed using DNA methylation (DNAm) markers. We hypothesized that obesity would be associated with higher PhenoAge than normal weight and overweight individuals only in the presence of MH conditions.

Methods:
DNAm was measured in leukocyte DNA for 2,454 African American participants (mean age=56.4 years) and used to calculate PhenoAge. BMI status was categorized as normal weight, overweight, and obese and MH was categorized by 0, 1, or at least 2 of the following: coronary heart disease, stroke, hypertension, type-2 diabetes, and hyperlipidemia. Linear regression tested the cross-sectional association of PhenoAge with BMI and MH, adjusting for sociodemographic variables, smoking, and technical variables. Stratified analyses by MH status were conducted to illustrate the statistical effects of BMI status in adults with and without MH conditions.

Results:
Participants with obesity had approximately 8 months higher PhenoAge compared to normal weight (β=0.68, 95% CI=0.21, 1.14, p=4.1E-3), and those with one (β=0.55, 95% CI=0.15, 0.94, p=6.4E-3) or at least 2 (β=0.81, 95% CI=0.38, 1.25, p=2E-4) MH conditions also had higher PhenoAge compared to those with 0 conditions. Figure 1 shows increments in PhenoAge with increments in number of MH conditions regardless of BMI. PhenoAge was significantly higher for obese compared to overweight for 0 and 1 MH conditions, but not compared to normal weight.

Conclusions:
In African American adults, both obesity status and presence of MH conditions were associated with a higher PhenoAge, suggesting metabolically healthy obesity is not entirely benign. Further phenotyping of the “metabolic health” obese condition is warranted to understand its relevance for healthspan.
Abstract P281: Examining Allostatic Load Among Marijuana Users In The United States: An Analysis Of The National Health And Nutrition Examination Surveys, 2007-2010
Authors: Johnson Amber J , Cuffee Yendelela , Vidot Denise , Jones Lenette M
Published: March 2020

Introduction:
Allostatic Load (AL) has been associated with cardiovascular risk and subsequent cardiovascular disease disparities. Recent studies have investigated pharmacological approaches to reduce and/or reverse AL. One particular area of interest lies in the utility of the cannabinoid system in regulating the physiological irregularities associated with AL. The purpose of this study was to describe AL among marijuana users vs. non-marijuana users in a United States sample.

Hypothesis:
We hypothesized that AL scores and AL prevalence would be lower among marijuana users compared to non-marijuana users.

Methods:
Data from adults (20-to-65 years) who completed the National Health and Nutrition Examination Surveys between 2007 and 2010 (
N
=6,994) were examined. Marijuana use was defined via computer-assisted self-report of lifetime use (had ever smoked marijuana, yes/no) and current use (had used marijuana at least once in the past 30-days). AL scores were calculated using clinical cut-points for BMI, systolic blood pressure, diastolic blood pressure, pulse, C-reactive protein, high-density lipoprotein, total cholesterol, Glycohemoglobin, albumin, and creatinine clearance. An independent samples t-test was conducted to compare AL scores among lifetime and current marijuana users. Pearson Chi-square analysis was employed to determine whether the prevalence of AL (i.e., AL scores 4 or above) significantly differed between low and high frequency marijuana users.

Results:
Over half of the sample (58%) reported lifetime use of marijuana. Among current users of marijuana (17.0%), participants reported having used marijuana an average of 12 times in the last month. There was a significant difference in mean AL scores, such that means for those who had ever smoked marijuana (M= 1.67, SD= 1.49) were lower than those who had never smoked marijuana (M=1.84, SD= 1.54;
p
< .001). Current marijuana users with low frequency of marijuana use in the last 30 days (i.e., less than 12 times) had a significantly higher AL score (M= 1.59, SD= 1.51) than those with high frequency of marijuana use (M=1.37, SD= 1.34;
p
= .01). The prevalence of AL was significantly higher among participants with low frequency of marijuana use (12.4%) versus those with high frequency (7.0%) (
p
= .01).

Conclusion:
The findings of this analysis describe the relationship between marijuana use and allostatic load. Specifically, allostatic load was lower among individuals reporting lifetime marijuana use and those reporting a higher frequency of current marijuana use. Additional research is needed, in particular - longitudinal studies that examine diverse patterns of marijuana use and variations in allostatic load.
Abstract P291: Effects of a Multidisciplinary Lifestyle Intervention on HDL Cholesterol Efflux Capacities in Adolescents With Obesity
Authors: Gagnon Katherine , Boyer Marjorie , J. Arsenault Benoit , Desrosiers Dominique , Harvey Johanne , Blackburn Patricia
Published: March 2020

Studies have suggested that a reduced HDL cholesterol efflux capacities (CECs) may be associated with an increased risk of coronary heart disease. However, only few studies have evaluated the impact of a lifestyle modification program on HDL-CEC in adolescents with obesity. The objective of this study was to determine if a 16-week lifestyle modification program would improve HDL-CECs in adolescents with obesity. Twenty-nine adolescents with obesity (16 boys and 13 girls) from 11 to 16 years of age (14.0 ± 1.6 years) were selected to participate in this study. The aim of the lifestyle modification program was to improve eating habits and physical activity levels. During the study, each adolescent was followed by a multidisciplinary team and trained three sessions per week for 16 weeks. The exercise program focused on endurance type activities and all training sessions were supervised and performed in groups. Anthropometric data, metabolic variables and HDL-CECs were measured at baseline and at the end of the intervention. HDL-CECs were measured using (
3
H)cholesterol-labeled J774 macrophages and HepG2 hepatocytes. Body mass index (33.6 to 32.7 kg/m
2
, p<0.0001) and waist circumference (102.4 to 100.5 cm, p=0.001) were significantly reduced after the 16-week intervention program. We also found a significant decrease in triglyceride concentrations (1.28 to 1.04 mmol/L, p=0.02) as well as in total cholesterol/HDL cholesterol ratio (4.42 to 3.91, p=0.0007) whereas HDL cholesterol levels increased (1.03 to 1.14 mmol/L, p=0.002). J774-HDL-CECs and HepG2-HDL-CECs were not significantly modified after the intervention. In order to further explore the impact of intervention-induced changes in HDL cholesterol levels on exercise-induced changes in HDL-CECs, adolescents were divided into two groups according to their changes in HDL cholesterol levels during the study (low or high intervention-induced changes in HDL cholesterol levels). Adolescents with low HDL cholesterol levels intervention-induced changes did not show an increased in HepG2-HDL-CECs. However, a significant improvement in HepG2-HDL-CEC after the intervention was observed among adolescents characterized by the highest intervention-induced changes in HDL cholesterol levels (p=0.03). Intervention-induced changes in HDL cholesterol levels were also significantly associated with changes in HepG2-HDL-CEC (r=0.55; p=0.002). No association was found between changes in HDL cholesterol levels and changes in J774-HDL-CECs. In conclusion, we found that a structured lifestyle modification program leads to significant improvements in cardiometabolic risk profile and in HepG2-HDL-CEC in obese adolescents.
Abstract P296: Investigation Of Geographic Disparities Of Pre-diabetes And Diabetes And Associated County-level Risk Factors In Florida, 2016
Authors: Lord Jennifer E , Roberson Shamarial L , Odoi Agricola
Published: March 2020

Background:
Diabetes and its complications represent a significant public health burden in the United States, with evidence of geographic disparities. Identifying these disparities and their determinants is useful for guiding control programs. Therefore, this study investigated geographic disparities of pre-diabetes and diabetes prevalence in Florida in 2016, and identified predictors of the observed spatial patterns. Additionally, we investigated changes in geographic distribution of the two conditions between 2013 and 2016.

Methods:
The 2013 and 2016 Behavioral Risk Factor Surveillance System data were obtained from the Florida Department of Health. Flexible scan statistics were used to identify significant high prevalence geographic clusters. Global ordinary least squares regression and local Poisson geographically weighted generalized linear models were used to investigate predictors of the identified spatial patterns. Counties with significant changes in prevalence of the two conditions between 2013 and 2016 were identified using tests for equality of proportions adjusted for multiple comparisons using Simes method.

Results:
The state-wide diabetes prevalence was 11.2% in 2013, and 11.8% in 2016. Statistically significant (
p
≤0.05) increases in prevalence were identified in 73% (49/67) of the counties. Similarly, the state-wide prevalence of pre-diabetes was 7.1% in 2013 and 9.2% in 2016 with 76% (51/67) of the counties reporting statistically significant increases. Significant local hotspots were identified for both conditions. Predictors of county-level diabetes prevalence were: proportion of the obese population, number of physicians per 1000 persons, proportion of the population living below the poverty level, and proportion of the population with arthritis. Predictors of pre-diabetes prevalence included proportion of the population with arthritis and proportion of the population that identified as non-Hispanic black. There was evidence of geographical variability of all regression coefficients for both the pre-diabetes and diabetes models indicating that the strength of association of the relationships between the predictors and outcomes varied by geographic area.

Conclusions:
Geographic disparities of both conditions continue to exist in Florida. Moreover, there was a state-wide increase in the burden of both conditions between 2013 and 2016. The fact that the strength of association of the relationships between the predictors and outcomes varied across the counties implies that some predictors may be more important in some counties than others. These findings imply that local models provide useful information to guide public health decision-making and resource allocation. Identifying high-risk geographic areas and location-specific determinants of chronic disease prevalence should be used to inform targeted intervention programs.
Abstract P298: Racial Differences in Diabetes Care Practices: Prevalence and Determinants in Older Adults
Authors: Fang Michael , Windham B Gwen , Pankow James S , Selvin Elizabeth
Published: March 2020

Background:
The burden of complications among older adults with diabetes is high and disproportionately affects racial/ethnic minorities. Differences in diabetes care practices may be an important contributor to disparities. Our study examined whether engagement in diabetes care practices varies by race/ethnicity in older adults.

Methods:
We conducted a cross-sectional analysis of the prevalence of diabetes care practices using data from visit 6 (2016-2017) of the Atherosclerosis Risk in Communities (ARIC) study. Participants with previously diagnosed diabetes self-reported receipt of four annual examinations/tests (HbA1c testing, urine protein testing, eye examination, foot examination) and two types of vaccinations (influenza [annual], pneumonia [ever]). We assessed crude differences across race using chi-square tests. For care practices that differed significantly, we conducted a mediational analysis using logistic regression models to explore potential mechanisms.

Results:
Among the 886 participants with previously diagnosed diabetes (62% white, 58% female, mean age 79), the receipt of recommended annual tests or examinations (HbA1c and urine protein testing, eye and foot exams) was high (73%-94%) and did not differ significantly across race (
Figure
). In contrast, whites were more likely than blacks to have received vaccinations for influenza (83% versus 69%, P<0.001) and pneumonia (90% versus 73%, P<0.001), respectively (
Figure
). Differences in sociodemographic characteristics and health status explained ~52% and ~15% of the difference in influenza and pneumonia vaccinations, with household income emerging as the most important mediator for both outcomes.

Conclusion:
Engagement in diabetes care practices among older adults was high, but whites were more likely than blacks to receive recommended vaccinations. Ensuring vaccination coverage among racial/ethnic minorities with diabetes is important and may reduce disparities in development of complications.
Abstract P299: Changes in Race-Sex Specific Population Attributable Fraction for Obesity-Related Diabetes, 2001-2016
Authors: Cameron Natalie , McCabe Megan , Petito Lucia , Allen Norrina B , Carnethon Mercedes R , Khan Sadiya S
Published: March 2020

Introduction:
Estimating effects of population-level increases in obesity on diabetes has important implications for public health policy. Therefore, we used the population attributable fraction (PAF) to quantify trends in the burden of obesity on incident diabetes in key sex and race/ethnicity subgroups over time.

Hypothesis:
PAFs for obesity attributable incident diabetes will be greatest for women, differ by race/ethnicity and increase over time.

Methods:
Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we estimated unadjusted and adjusted hazard ratios (HRs) of obesity on incident diabetes mellitus (DM). We included non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic-Mexican (MA) MESA participants with available data on body mass index and key covariates and without DM at baseline. Next, we estimated the prevalence of obesity in four pooled groups of NHANES survey cycles from 2001-2016 with similar characteristics to MESA participants (age 45-80 years, NHW, NHB, and MA without cardiovascular disease). Lastly, we combined estimates from MESA and NHANES to quantify unadjusted and adjusted PAFs (adjusted for age, income, education, physical activity and diet). Leveraging the objective longitudinal assessment of incident DM in MESA and a nationally representative sample of NHANES, we estimated broadly generalizable PAF estimates over time.

Results:
Of 3869 MESA participants, mean age was 61 (± 10) years with 47% men, 56% NHW, 31% NHB, and 13% MA. Incidence of DM was 11% with overall adjusted HR of 2.75 (95% CI 2.26, 3.34) for obesity. Prevalence of obesity increased from 34% (32, 37) in 2001-2004 to 41% (39, 44) in 2013-2016. Overall adjusted PAFs ranged from 0.23 to 0.52 over the study period (TABLE), with greatest estimates in NHW women.

Conclusions:
In conclusion, over time, the proportion of diabetes due to obesity has increased across multiple subgroups of the population, further highlighting the health burden of obesity in the population.
Abstract P303: Use of Community Health Workers for Community-based Hypertension Screening in Urban Haiti
Authors: Smith Caleigh , Rivera Vanessa , Victor Jean Joscar , Pierre Lookens , Preval Fabyola , Secours Rode , Tilus Rosie , Joseph Inddy , Raynold Jean Baptiste , Exantus Serfine , Benedict Charles , Tymejczyk Olga , Nash Denis , Fitzgerald Daniel , Pape Jean W , Safford Monika M , McNairy Margaret
Published: March 2020

Background:
Cardiovascular disease is the leading cause of mortality among Haitian adults, and hypertension (HTN) is the most important CVD risk factor, as in other resource-poor countries. The majority of Haitians have never been screened for hypertension and access to clinic-based services is limited.

Methods:
Twenty-eight Haitian community health workers (CHW) conducted household-based HTN screening within a population-based longitudinal cohort study of 3,000 adults in metropolitan Port-au-Prince. Randomly selected GPS locations across census blocks were selected in proportion to the estimated population of each block. One household at each waypoint was selected systematically and CHW collected household information and conducted three blood pressure measurements the same day on all adult household members (≥ 18 years) present at the time of the survey using AHA guidelines. Adults with HTN were referred to the GHESKIO clinic for repeat BP measurement and treatment.

Results:
Between March and September 2019, 585 households provided verbal consent for surveys and BP screening (97% response rate). These households had a total of 2542 people (1777 adults) with the median number of adults per household being 3 (IQR 2-4; range 1-9). A total of 913 adults (51%) were present at the time of survey, and all agreed to blood pressure screening. The majority were women (70%) with a median age of 36 years (IQR 27-52). Hypertension prevalence (SBP
>
140 and/or DBP
>
90) was 25.3% (15.5% Stage I, 9.8% Stage II). Figure 1 reports HTN prevalence by age group (18-30, 31-45, 46-60, >60) and by sex, with HTN increasing by age group but without significant variation by sex.

Conclusion:
Community blood pressure screening is feasible and highly acceptable in Port-au-Prince, Haiti. Preliminary results show high rates of HTN among a population with limited access to screening, diagnosis and treatment. Further research is urgently needed to design linkage to care strategies and effective treatment interventions to curb the HTN epidemic in Haiti.
Abstract P316: Sleep Timing Correlates With Incident Congestive Heart Failure: A Community-based Cohort Study
Authors: Yan Bin , Li Ruohan , Jin Xuting , Gao Ya , Zhang Jingjing , Li Jiamei , Wang Gang
Published: March 2020

Introduction:
Previous studies have suggested that sleep habits were associated with cardiovascular risk factors. However, there is no evidence about the relationship between sleep timing and congestive heart failure (CHF).

Hypothesis:
We assessed the hypothesis that the bedtime and wake-up time on weekday and weekend may be associated with incident CHF.

Methods:
From the Sleep Heart Health Study (registration number, NCT00005275), participants without previous heart failure were enrolled in the present prospective study. Sleep timing including bedtime and wake-up time on weekday and weekend was acquired from a self-reported Sleep Habits Questionnaire. Bedtime on weekdays and weekend was divided into >24:00, 23:01 to 24:00, 22:01 to 23:00 and ≤22:00. Wake-up time on weekdays and weekend was classified as >8:00, 7:01 to 8:00, 6:01 to 7:00 and ≤6:00. Further subgroup analysis was conducted according to sleep duration of <6h, 6-8h and >8h. Participants were followed up until the first CHF diagnosed between the date of the completed questionnaire and the final censoring date. Cox regression analysis was used to investigate the association between sleep timing and CHF.

Results:
A total of 4765 participants including 2207 males and 2558 females with a mean age of 63.6±11.0 years were recruited in the study. During the mean follow-up period of 11 years, 519 participants were diagnosed with CHF. The incidence of CHF in participants with weekday bedtime at >24:00 was 15.6% (69 of 441), which is higher than those with bedtime at 23:01 to 24:00 [12.7% (166 of 1306)], 22:01 to 23:00 [7.0% (128 of 1837)], and ≤22:00 [13.2% (156 of 1181)]. Participants with wake-up time on weekday at > 8:00 also had the highest incidence of CHF [19.7% (45 of 229)] than those with wake-up time at 7:01 to 8:00 [14.2% (89 of 627)], 6:01 to 7:00 [11.5% (171 of 1485)], and ≤6:00 [8.8% (214 of 2424)]. After multivariate Cox regression analyses, individuals with bedtime at >24:00 on weekdays was associated with a higher incidence of CHF (HR 1.559, 95% CI 1.151-2.113,
P
= 0.004) than those with bedtime at 22:01 to 23:00. And compared with participants with wake-up time at ≤6:00, those with wake-up time at > 8:00 also had an increased risk of incident CHF (HR 1.525, 95% CI 1.074-2.166,
P
=0.018). After further subgroup analysis, the association between bedtime at >24:00 on weekdays and incident CHF were strengthened in the participants with 6-8 hours’ sleep duration (HR 2.087, 95% CI 1.446-3.013,
P
<0.001).

Conclusion:
In conclusion, late bedtime (>24:00) and late wake-up time (>8:00) on weekdays may correlate with an increased risk of CHF. The impact of sleep timing on incident cardiovascular diseases may be worth further prospective study.
Abstract P318: Prevalence and Trends of Type 2 Diabetes Mellitus and Prediabetes Among Community-Dwelling Heart Failure Patients in the U.S. 2005-2016: A National Health and Nutrition Examination Survey (NHANES) Analysis
Authors: Ishikawa Yuta , Lewis Richard D , Laing Emma M , Anderson Alex K , Zhang Donglan , Quyyumi Arshed A , Dunbar Sandra B , Trivedi Rupal , Sattler Elisabeth L
Published: March 2020

Introduction:
Recent scientific statements highlight the importance of understanding the effects of the coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) on disease management decisions and patient outcomes. Various prevalence estimates of the T2DM burden among HF patients have been reported; however, national estimates are not available. The objective of the study was to assess the prevalence and trends of T2DM (total, diagnosed, and undiagnosed) and prediabetes among community-dwelling HF patients using nationally representative data.

Methods:
We included 473 participants (20+ years) with a diagnosis of HF using data from the 2005-2016 NHANES survey cycles. Diagnosed T2DM was defined by self-report of a previous physician diagnosis. Undiagnosed T2DM was defined by the absence of a physician diagnosis and the presence of ≥ 1 of 3 criteria: 1) Two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) ≥ 200 mg/dL, 2) Hemoglobin A1c (HbA1c) ≥ 6.5%, 3) Fasting plasma glucose (FPG) ≥ 126 mg/dL. Total T2DM was defined as having diagnosed or undiagnosed T2DM. Prediabetes was defined by the absence of T2DM and the presence of ≥ 1 of 3 criteria: 1) 2hPG after OGTT of 140 mg/dL to 199 mg/dL, 2) HbA1c of 5.7% to 6.4%, 3) FPG of 100 mg/dL to 125mg/dL. We stratified estimates by age-standardized socio-demographic characteristics. Trends of the prevalence of T2DM and prediabetes were examined using logistic regressions.

Results:
The prevalence rates of total, diagnosed, and undiagnosed T2DM and prediabetes among HF patients were 51.4% (95% CI, 46.0%-56.7%), 37.5% (31.7%-43.6%), 13.8% (10.0%-18.2%), and 36.0% (30.2%-42.1%), respectively. The prevalence of T2DM and prediabetes did not significantly change across individual survey cycles.

Conclusion:
Rates of T2DM and prediabetes among community-dwelling HF patients in the U.S have been persistently high over the past decade. These findings support the need for the prevention and targeted intervention of T2DM in HF patients.
Abstract P326: Multilevel Analysis Of Concentrated Neighborhood Disadvantage And Cardiometabolic Factors In People Living With Hiv
Authors: Ferguson Tekeda F , Theal Katherine , Welsh David , Molina Patricia E
Published: March 2020

Aging persons living with HIV (PLWH) are a vulnerable population at higher risk for chronic illnesses such as metabolic alterations, diabetes, cardiovascular disease, and cancer. Community and specifically, neighborhood, factors may play a key role in the development of comorbidities. Availability of healthy food stores, physical activity resources, walking/physical activity environment, and neighborhood socioeconomic status have all been individually associated with a higher odds of having ideal cardiovascular health scores. We hypothesized that exposure concentrated disadvantage at the community level impact cardio metabolic outcomes in PLWH. We examined this hypothesis in a cross-sectional analysis of the
N
ew
O
rleans
A
lcohol use in
H
IV [NOAH] Study of adult PLWH under care (n=365). Hypertension (HTN) was defined as a mean systolic ≥130-139 or diastolic blood pressure ≥80-89 mmHg. Metabolic syndrome (MS) was defined as having 3 of 5 conditions: HTN, low high-density lipoproteins (≤40 (men)/50 (women)), high triglycerides (≥ 150mg/dl), high glucose (≥100 mg/dl), waist circumference >88(women)/102(men). Multivariable logistic regression and multilevel binomial regression analyses were performed adjusting for age, race, smoking, and viral load. The majority of participants were African American (83.6%) with a mean age 48.2 ±10.4, 68.8% male and 31.2% female. MS was prevalent in 36.1%, HTN 66.0%, diabetes 14%, dyslipidemia 28.2%, and 27.4% were obese. There was substantial clustering of cardiometabolic outcomes by neighborhood, with intra-class correlations (ICC) near or greater than 20% for BMI, diabetes, hypertension, and metabolic syndrome. Neighborhood concentrated disadvantage explained a significant proportion of the variance in diabetes (ICC drop from 18% to 8%) and the likelihood of having diabetes increases by 33% for each unit increase in neighborhood concentrated disadvantage (odds ratio = 1.33, 95% CI=1.02, 1.74). Our results suggest a significant role of environmental factors on cardio metabolic comorbidities among PLWH. There is a critical need for a deeper understanding of the roles that social determinants at the community and interpersonal levels play in chronic comorbidities in PLWH. Neighborhoods and social spaces are important contexts through which social determinants act to shape health and health behavior.

(Supported by: NIH P60AA009803)
Abstract P334: The Relationship Between Urinary Sodium-to-Potassium Ratio And High Blood Pressure: TMM CommCohort Study
Authors: Kogure Mana , Nakamura Tomohiro , Tsuchiya Naho , Hirata Takumi , Narita Akira , Nakaya Naoki , Kikuya Masahiro , Metoki Hirohito , Obara Taku , Tanno Kozo , Sugawara Junichi , Kuriyama Shinichi , Tsuji Ichiro , Kure Shigeo , Hozawa Atsushi
Published: March 2020

Introduction:
Recently, the balance between sodium and potassium intake, i.e. sodium-to-potassium (Na/K) ratio, has received significant attention for prevention of hypertension. Previous studies reported the positive association between urinary Na/K (uNa/K) ratio and hypertension. However, even the same uNa/K ratio value, there might be high Na/ high K ratio or low Na/ low K ratio.

Hypothesis:
We assessed the hypothesis that blood pressure (BP) is higher in high Na/ high K group than that in low Na/ low K group even at the same uNa/K ratio in general population in cross-sectional study.

Methods:
The subjects were 20 to 74 years old who participated in The Tohoku Medical Megabank Project Community-based Cohort Study. Of these participants, we targeted 54,011 subjects (men: 20,505 women: 33,506 mean age: 59.9 years) who had information of BP, urinary Na and K. We estimated 24-h urinary excretion of Na and K using Tanaka formula. Urinary Na and K were each classified into quartiles (Na; Q1~Q4, K; Q1~Q4), and set all 16 groups of uNa/K ratio by combining Na and K respectively. To assess the relationship between casual uNa/K ratio and BP, we performed an analysis of covariance to calculate the adjusted mean systolic BP (SBP). We included covariate factors as age, sex, BMI and alcohol intake. We also assessed the relationship between uNa/K ratio and SBP using multiple regression analyses adjusted for covariate factors. We stratified the participants into two groups: ‘under treatment for hypertension’ (n=17,091) and ‘without treatment for hypertension (n=36,920)’.

Results:
The mean of uNa/K ratio for each group of Na (Q1)/K(Q1), Na (Q2)/K(Q2), Na (Q3)/K(Q3) and Na (Q4)/K(Q4) was all 4.0. As previous report showed, higher uNa/K ratio group showed higher SBP and lower uNa/K group showed lower BP. When we compared adjusted mean SBP of Na (Q1)/K(Q1) and Na (Q4)/K(Q4) the value were comparable, but the value were significantly higher in Na (Q4)/K(Q4) group (The adjusted mean SBP of Na (Q1)/K(Q1), Na (Q2)/K(Q2), Na (Q3)/K(Q3) and Na (Q4)/K(Q4) was 123.6, 124.9, 124.7 and 125.5 mmHg, respectively). The uNa/K was significantly positively associated with SBP independently of age, sex, BMI, and alcohol intake. The finding was unchanged the results in under treatment group.

Conclusions:
BP was significantly higher in high Na/ high K group than in low Na/ low K group even at the same uNa/K ratio. We suggested that not only increasing K intake but also reducing salt is important for preventing hypertension.
Abstract P335: Using Cardiovascular Disease Risk Versus Blood Pressure To Guide The Initiation Of Antihypertensive Medication Among Us Adults
Authors: Sakhuja Swati , Hardy Shakia T , Akinyelure Philip , Jaeger Byron C , Shimbo Daichi , Bress Adam P , Muntner Paul
Published: March 2020

Introduction:
The primary goal of initiating antihypertensive medication is to prevent cardiovascular disease (CVD). It has been hypothesized that using CVD risk to guide the decision to initiate antihypertensive medication may prevent more CVD events than treatment guided by blood pressure (BP) alone.

Methods:
We estimated the number of CVD and all-cause deaths that could be prevented among US adults through the initiation of antihypertensive medication based on high CVD risk versus high BP. CVD and all-cause mortality rates were calculated using data from 4,390 participants 40 to 79 years of age not taking antihypertensive medication from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES) mortality follow-up study. High BP was defined by systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. High CVD risk was defined by 10-year predicted CVD risk ≥10% using the Pooled Cohort risk equations or a history of CVD. Relative risks and 95% confidence limits for CVD and all-cause mortality with antihypertensive medication of 0.75 (0.57-0.98) and 0.76 (0.63-0.91), respectively, were obtained from the Blood Pressure Lowering Treatment Trialists Collaboration.

Results:
Among US adults not taking antihypertensive medication, 19.4% (23.5 million) had high BP and 25.5% (30.9 million) had high CVD risk. CVD mortality rates were 5.3 and 3.9 per 1,000 person-years among US adults with high CVD risk versus high BP, respectively (Table). Using high CVD risk to guide antihypertensive medication initiation is projected to prevent 403,093 deaths from CVD over 10 years compared with 224,312 deaths from CVD projected to be prevented using a BP-guided treatment approach. More all-cause deaths are projected to be prevented by using high CVD risk (2.2 million deaths) rather than high BP (1.1 million deaths) to guide the decision to initiate antihypertensive medication.

Conclusions:
Using predicted CVD risk instead of BP alone to guide antihypertensive medication initiation is projected to prevent more CVD and all-cause deaths.
Abstract P353: Dietary Sodium Intake and Sodium Density in The United States: Estimates From Nhanes 2005-2006 and 2015-2016
Authors: Hu Jiun-ruey , Sahni Shivani , Mukamal Kenneth J , Millar Courtney , Wu Yingfei , Juraschek Stephen P
Published: March 2020

Introduction:
Current guidelines for sodium reduction focus on total daily sodium consumption (<2300 mg/d) for an intake of 2100 kcal. However, calorie consumption varies substantially. Here, we quantify mean sodium intake, calorie intake, and sodium density across demographic groups in the US and over time.

Hypothesis:
We hypothesized that, compared to sodium density, total sodium may overestimate adherence to sodium recommendations, especially in older adults.

Methods:
In the National Health and Nutrition Examination Survey (NHANES), weighted mean sodium and energy intake was estimated in US adults as the average of two 24-hour dietary recalls. Sodium density was calculated as the mg of sodium per 1,000 kcal consumed. The prevalence of adherence to sodium intake (<2300 mg/d) and sodium density (<1.1 mg/kcal) limits was quantified by age group, self-reported sex, self-reported race/ethnicity, Calorie level (<2100 kcal, ≥2100 kcal), and self-reported high blood pressure. Adherence prevalence estimates were compared between 2005-2006 and 2015-2016 survey periods by logistic regression adjusted for age, sex, and race/ethnicity.

Methods:
In 2015-2016, 24.8% of the US population (mean age 38 yr, 51% female, 12% black) adhered to the recommended <2300 mg/d sodium intake, but only 5.6% achieved the recommended 1.1 mg/kcal sodium density (Table). In 2005-2006, these figures were 26.5% and 8.9%, respectively. While there was no change in adherence by total sodium consumption (P = 0.11), adherence by sodium density was significantly lower in 2015-2016 than 2005-2006 (P < 0.001). The difference in adherence between total sodium and sodium density goals was greater among older adults (≥70 years), women, Hispanic adults, and adults consuming <2100 kcal per day.

Conclusions:
In 2015-2016, <6% of US adults consumed sodium densities at recommended levels. The prevalence of those achieving these goals is lower compared to 10 years prior. Further efforts to regulate population sodium intake are urgently needed.
Abstract P355: Development and Validation of a Nutrient Density Score That Includes Foods Groups
Authors: Smith Jessica D , Fulgoni Victor , Drewnowski Adam
Published: March 2020

Introduction:
There has been considerable work performed on nutrient profiling to assess the nutritional contribution of a food to a healthy dietary pattern. Most profiling approaches have focused on nutrients to limit and nutrients to encourage. A few profiling approaches have also included certain food groups in the profiling algorithm.

Objectives:
The objective of this study was to develop a nutrient density score, based on the Nutrient Rich Food Index (NRF) 6.3, that includes food groups and validate the score against a gold-standard marker of diet quality, the Healthy Eating Index (HEI) 2015.

Methods:
Stepwise regression was used to develop a nutrient density score based on the day 1 total dietary intake of the U.S. population 2 years and older (excluding pregnant and lactating women) from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 (n=23,743). Intake of food groups was taken from the Food Patterns Equivalent Database (FPED) 2011-2016. Sixteen nutrients (as a percent of the Daily Value) as well as five food groups (as a percentage of recommended intake in 2015-2020 Dietary Guidelines) were considered in the score.

Results:
When only the 16 nutrients were included in the score, 66% of the variability in the HEI 2015 could be accounted for (R
2
= 0.66). When only the five food groups were considered, the maximum R
2
with the HEI 2015 was 0.50. However, when both nutrients and foods groups were considered, the model explained 74% of the variability in the HEI 2015 (Table). The increase in the R
2
begins to plateau after the inclusion of 10 elements: 3 nutrients to encourage (fiber, potassium and unsaturated fat), 4 food groups (dairy, fruit, whole grains, and nuts and seeds) and 3 nutrients to limit (added sugar, saturated fat, sodium).

Conclusion:
A nutrient density score that includes both nutrients and foods groups best predicts diet quality as measured by the HEI 2015.
Abstract P357: Relative Validity and Reliability of a Diet Risk Screener (DRS) for Clinical Practice
Authors: Johnston Emily A , Petersen Kristina S , VAN HORN Linda , Mitchell Diane C , Beasley Jeannette M , Kris-etherton Penny M
Published: March 2020

Poor diet quality contributes significantly to cardiometabolic mortality in the US. Diet assessment methodology is burdensome and non-standardized. Screeners for clinical use that rapidly assess dietary choices associated with cardiometabolic risk could enhance prevention. This study evaluated the relative validity and reliability of the Diet Risk Screener (DRS) in a sample of US adults with the hypothesis that the DRS would correlate with a validated measure of diet quality. The DRS includes nine questions related to foods/food groups strongly associated with cardiometabolic mortality based on previous evidence. Adults ages 35-75 were recruited through a national health volunteer registry (ResearchMatch.org). Participants completed the DRS and a validated food frequency questionnaire (FFQ) (Vioscreen.com) in random order on one occasion. To assess reliability, participants who completed the DRS were asked to repeat it within three months. The DRS was scored 0 (low risk) to 27 (high risk) and compared with the Healthy Eating Index (HEI)-2015 calculated from the FFQ (max. score 100). The DRS was moderately correlated with HEI-2015 [(n=126, 87% female; mean HEI-2015: 63.3 (95% CI: 61.1, 65.4); mean DRS: 11.8 (95% CI: 10.8, 12.8); r=-0.6, p<0.001; R
2
=0.36]. Furthermore, the DRS ranked 37% (n=47) of subjects in the same quintile and 41% (n=52) within ± 1 quintile of the HEI-2015 (weighted kappa=0.27). The DRS had high reliability (n=102, ICC: 0.83). Mean completion time was two minutes. The DRS may be useful in clinical or other time-limited settings to quickly identify individuals at high risk of diet-related preventable cardiometabolic mortality.
Abstract P359: Assessment of Household Salt Types, Iodine Intake, and Iodine Status in 2019-2020 NHANES
Authors: Ershow Abby G , Gahche Jaime , Potischman Nancy , Spungen Judith , Pehrsson Pamela
Published: March 2020

Background:
Iodine is an essential nutrient required for normal thyroid function in all age groups as well as healthy fetal, infant, and child development and growth. Because iodine levels in most foods are low, iodine usually must be provided through dietary supplements or fortified foods (such as salt). In recent NHANES cycles, sub-optimal iodine status has been observed in some U.S. populations, most notably pregnant women. Recent health campaigns have emphasized consuming less sodium and have focused on the primary source of the excess sodium in the U.S. diet: commercially prepared foods, most of which are made with non-iodized salt. Also, recent secular trends towards less home cooking and more use of non-iodized table salts may be contributing to relatively low usage of iodized salt, which was estimated in 2014 to comprise only half of retail salt sales. Therefore, for individuals who also limit their home use of salt in food preparation or at the table, an unintended consequence may be a decline in iodine intake. Population-level data thus are needed on the relative contributions of various foods to iodine intake in relation to iodine status markers, to characterize population groups at risk and develop guidance on appropriate dietary and supplementation strategies.

Objective:
Describe new measures of iodine intake and iodine status added into NHANES 2019-20, which is a nationally representative survey of the U.S. population.

Methods:
Iodine intake is being assessed through a questionnaire about household salt types (such as iodized salt or sea salt) and measured iodine content of household iodized salt, as well as individual 24-hour dietary recalls and use of iodine containing dietary supplements. This will be the first time NHANES will estimate dietary iodine intake using a newly developed USDA Special Interest Database on Iodine Content of Foods. Biomarkers include a thyroid panel (including thyroglobulin), inhibitors of iodine uptake in the thyroid (e.g., perchlorates), and urinary iodine concentration.

Conclusions:
The upcoming NHANES cycle will yield novel data on U.S. population coverage of household iodized salt, as well as individual thyroid and iodine status in relation to dietary iodine intake. Groups at risk from increased physiologic need or dietary preferences that limit iodine sources will be identified. A key tool in undertaking this work will be a new food composition database on the iodine content of U.S. foods. Clarification of key sources of iodine in the U.S. diet will be important in developing dietary guidance.
Abstract P363: Regional And Racial Variation In The Prevalence Of Concomitant Diabetes And Peripheral Artery Disease
Authors: Barnes J Aaron , Eid Mark A , Wanken Zachary J , Powell Richard J , Stone David H , Suckow Bjoern D , Gladders Barbara , Creager Mark A , Goodney Philip P
Published: March 2020

Introduction and Objectives:
Prior research has demonstrated regional and racial variation in the prevalence of concomitant diabetes and peripheral artery disease (PAD). However, trends in prevalence of diabetes and PAD across races has not been well explored in recent patient cohorts.

Methods:
Using data from the Centers for Medicare and Medicaid Services from 2003-2016, we identified patients concurrently diagnosed with both diabetes and PAD (n=10,506,254). Overall prevalence of concomitant diabetes and PAD was determined. Regional variation at the state and hospital referral region (HRR) level was then identified using zip code data. Racial demographics within Medicare data were used to stratify prevalence by race.

Results:
The overall prevalence of diabetes and PAD across the entire cohort was 15.3 per 1,000 Medicare patients. When stratified by HRR, prevalence of patients with concomitant diabetes and PAD varied by nearly 7-fold with a low of 5.0 and a high of 33.2 per 1,000 Medicare patients. When stratified by race, the number of new patients concomitantly diagnosed with diabetes and PAD decreased across all races, with the greatest decline seen in the Hispanic population (absolute decrease 1.84%, relative reduction 63%). The number of new black patients decreased as well (absolute decrease 1.40%, relative reduction 52%), but blacks continue to comprise the highest proportion of newly diagnosed patients at 1.29% (Figure 1).

Conclusion:
Significant regional and racial variation exists in the prevalence of concomitant diabetes and PAD diagnoses among Medicare patients with black patients remaining disproportionately affected. Efforts to improve prevention and care management should target these endemic regions and populations.