bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P160: Contributing Factors to Prolonged Length of Hospital Stay After Readmission Among Patients With Cardiovascular Diseases in Rural Appalachia
Authors: Mamudu Hadii M , Orimaye Sylvester , Awasthi Manul , Alamian Arsham , Wang Liang , Stewart David , Awujoola Adeola , Oke Adekunle , Osedeme Fenose , Stepanov Nonna , Paul Timir K
Published: March 2020

Introduction:
The Appalachian region has a disproportionate rate of morbidity and mortality related to cardiovascular diseases (CVD), compared to other regions in the United States. Readmission after initial hospitalization for CVD is a major health and economic burden. However, little is known about the factors that contribute to a prolonged length of hospital stay (LOS) after readmission for CVD in rural Appalachia. This study aimed to identify factors associated with prolonged LOS after readmission of patients with CVD in rural Appalachian region.

Hypothesis:
It is hypothesized that certain demographic and CVD risk factors would be positively and significantly associated with prolonged LOS after readmission of patients with CVD.

Methods:
Study population consisted of 2,063 patients from Central Appalachia who were diagnosed with ≥1 CVD-related medical comorbidities (diabetes, hypertension, hypercholesterolemia, depressive symptoms, coronary artery disease, stroke, and heart failure) and readmitted between 2010 and 2016 to a large health system. The average LOS was assessed and the Cox Proportional Hazard Ratios (HR) were calculated to identify factors associated with prolonged LOS (defined as a LOS of six or more days) after readmission among CVD patients. The median LOS and probability of prolonged LOS for different sociodemographic risk groups in the study population were calculated.

Results:
The average LOS was 13.44±45.77 days. A one-year increase in the age of CVD patients tended to increase the risk of prolonged LOS by 0.6% (95% CI: 1.00-1.01; p=0.04). Additionally, being male was found to be associated with increased risk of prolonged LOS (HR: 1.20; 95% CI: 1.08-1.34; p<0.001). Similarly, having at least one CVD related comorbid condition increased the risk of prolonged LOS by 23.3% (95% CI: 1.03-1.47; p=0.02). Our findings also showed that both underweight and obese CVD patients were at 58.2% (95% CI: 0.52-0.65; p<0.0001) and 53.6% (95% CI: 0.50-0.56; p<0.0001) higher risk of having a prolonged LOS, respectively.

Conclusions:
In conclusion, increasing age, being male, having ≥1 comorbidities of CVD, and being underweight or obese were positively associated with prolonged LOS after hospital readmission in this rural population. These findings suggest that preventing and treating comorbid conditions and CVD risk factors may lower the likelihood of a prolonged LOS after readmission.
Abstract P163: Disparities By Patient Sex? Treatment Duration and Outcomes Of P2Y
12
Inhibitor Therapy in Women Compared to Men After an Acute Myocardial Infarction Among Medicare Beneficiaries
Authors: Hickson Ryan P , Kucharska-Newton Anna M , Rodgers Jo Ellen , Aiello Allison E , Sleath Betsy , Fang Gang
Published: March 2020

Introduction:
P2Y
12
inhibitors prevent ischemic events while increasing bleeding risk. It is unclear if clinical differences by sex justify different therapy durations after myocardial infarction (MI).

Hypothesis:
Women will discontinue P2Y
12
inhibitor therapy earlier than men after MI.

Methods:
MI hospitalizations in 2008-2013 were identified in a 20% Medicare administrative claims sample. Patients were ≥66 years old; had no recent P2Y
12
inhibitor indication; and had a P2Y
12
inhibitor prescription fill within 30 days post-MI. Therapy duration was measured using days supply and 30-day drug-free interval; duration was modeled as risk of discontinuation over time. Patients were followed up to 24 months. Adjusting for sociodemographics, clinical risks, prescriber characteristics, and contextual factors, disease risk scores (DRSs) were estimated from 4 hazard models predicting P2Y
12
inhibitor discontinuation and 3 competing risks: 1) death or hospice admission, 2) ischemic event (MI, ischemic stroke, revascularization), and 3) bleeding event. Male and female patients were matched 1:1 on the 4 DRSs using Mahalanobis distance. Cause-specific risk differences (RDs) were estimated with the Aalen-Johansen estimator and bootstrapped confidence intervals (CIs).

Results:
Median time on P2Y
12
inhibitor was 388 days (interquartile range 133-720). Of 30,613 patients (51.2% female), 20,002 were matched. At 24 months, women compared to men had a similar risk of treatment discontinuation (RD 0.84%; 95% CI -0.52, 2.19). While still on a P2Y
12
inhibitor, women were less likely to experience death/hospice admission (RD -0.82%; 95% CI -1.39, -0.24) or ischemic event (RD -0.92%; 95% CI -1.81, 0.06) at 24 months but had a similar bleeding risk (RD -0.07%; 95% CI -0.52, 0.39).

Conclusions:
Duration of P2Y
12
inhibitor use was similar in men and women. Risks for death/hospice admission and ischemic events while taking a P2Y
12
inhibitor were lower in women, suggesting a differential response to therapy that should be investigated further.
Abstract P166: Cardiovascular Disease Burden Among In-patients With Systemic Lupus Erythematosus
Authors: Kimble Laura P , Dunbar Sandra B , Corwin Elizabeth J , Mitchell Rebecca , Sanz Ignacio , Khosroshahi Arezou
Published: March 2020

Introduction:
Systemic lupus erythematosus (SLE) disproportionately affects minority women of childbearing age and is associated with increased cardiovascular risk. Understanding concomitant cardiovascular co-morbidities in the SLE population is essential to reduce their excess cardiovascular burden through targeted risk reduction.

Purpose:
This study examined cardiovascular co-morbidities in persons with SLE admitted to an acute care hospital.

Method:
We conducted a secondary data analysis of de-identified electronic health record (EHR) data from a random sample of 1,000,000 patients who received care from a healthcare system in the southeastern US between the years of 2012 and 2018. We targeted the specific patient encounter of the first hospitalization in which SLE was included as a discharge diagnosis and examined cardiovascular co-morbidities present in the cohort.

Results:
We identified 320 patients (89% women n=285/320, 84.4% n=270/320 African-American) with a mean age of 47.1 ± 16.4 years and length of stay (LOS) of 6.7 ± 8.1 days. The majority were hospitalized on an emergent basis (61%, n=195/320) with 44.4% (n=143/320) admitted to hospital medicine/internal medicine specialties. Admission to cardiology/cardiovascular surgery specialties was noted for 7.5% (n=27/320). The majority were discharged to home for self-care (70.9%, n=227/320) or home health services (12.5%, n=40/320). Potential SLE complications were evident with 23.7% (n=76/320) noted to have renal failure. The most common cardiovascular diagnoses documented in the EHR included: hypertension (40%, n=192/320), heart failure (18.4%, n=59/320), coronary artery disease (16.6%, n=50/320), mitral valve disorders (9.7%,n=31/320), atrial fibrillation (8.7%, n=27/320), supraventricular tachycardia (6.6%,n=21/320), acute myocardial infarction (6.2%,n=20/320), cerebral vascular accident (5.9%, n=19/320), endocarditis (4.1%,n=13/320), and peripheral vascular disease (3.7%, n=12/320). Longer LOS was associated with renal failure (r= .25, p = .001), heart failure (r= .20, p = .001), and supraventricular tachycardia (r=.22, p = .001). A greater proportion of men had endocarditis (14.3%, n=5/35), PVD (11.4%,n = 4/35), and CAD (28.6%, n=10/35) compared to women (endocarditis: 2.8%, n=8/285, p =.008; PVD 2.8%, n=8/285, p= .032; CAD 14.0% n=40/285, p=.044).

Conclusion:
Cardiovascular disease burden was evident in this predominantly young, female, African-American SLE inpatients. Cardiac diagnoses were associated with increased LOS and men with SLE had greater cardiovascular burden related to CAD and PVD compared to women. These findings highlight the importance of cardiovascular risk reduction interventions and aggressive management of cardiovascular comorbidities in the SLE population.
Abstract P172: Relationship of Four Blood Pressure Indexes to Subclinical Cerebrovascular Diseases Assessed by Brain MRI in General Japanese Men
Authors: Salman Ebtehal , Kadota Aya , Hisamatsu Takashi , Segawa Hiroyoshi , Torii Sayuki , Fujiyoshi Akira , Kondo Keiko , Arima Hisatomi , Shiino Akihiko , Nozaki Kazuhiko , Miura Katsuyuki , Ueshima Hirotsugu ,   SESSA Rsch Group
Published: March 2020

Background:
Blood pressure (BP) indexes (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP]) shows association with subclinical cerebrovascular diseases (SCVDs). Although various studies reported this association, there are still controversy in the effect size of long period versus short period of these indexes to SCVDs.

Aim:
Identifying the effect size of four BP indexes measured at two visits on SCVDs assessed by magnetic resonance imaging (MRI) in general Japanese men.

Methods:
Four office BP indexes were measured at two visits 4.5 years apart in general Japanese men aged 40-79 years. Participants without myocardial infarction or stroke history were analyzed (N=629). MRI obtained at 3
rd
visit were investigated for prevalent of five SCVDs diagnosed as follows; lacunar infarction (LI)= any presence, periventricular hyperintensity (PVH)= Fazekas grade ≥2, deep subcortical white matter hyperintensity (DSWMH)= Fazekas grade ≥3, microbleeds= any presence, and intracranial arterial stenosis (ICAS)= ≥1% stenosis. Using multivariable logistic regression, we computed and compared odds ratio OR (95% CI) of each prevalent SCVD for 1 standard deviation higher of each of 4 BP indexes after adjusting for SCVDs’ conventional risk factors.

Results:
Participants’ mean age at Visit 1 was 63.9 years. Our results show all office BP indexes, except PP, similar association with MRI outcomes at both Visit 1 and Visit 2. SBP, DBP and MAP were associated with LI, PVH, DSWMH, microbleed and ICAS, while PP was associated with LI and ICAS only.

Conclusion:
In general Japanese men, BP indexes SBP, DBP and MAP measured at two distinct visits show similar association to all future MRI assessed SCVD, while PP shows association to LI and ICAS only.
Abstract P214: Emotional Intelligence Increases During 10-Day Intensive Lifestyle Program
Authors: Ramirez Francisco E , RENCK EDWIN , Nedley Neil
Published: March 2020

Background:
Emotional intelligence (EQ) has been linked with success in life. Previous studies have shown that EQ can be improved. EQ could be negatively affected by depression and/or anxiety. We document the effect that a multi lifestyle intervention together with cognitive behavioral therapy (CBT) can have on patients in 10 days. Healthy lifestyles that improve heart health could improve mental health.

Methods:
During the 10-day medical residential program that took place in the Sierra mountains in northern California, patients received are seen by a board certified physician which prescribes a custom plan for the 10 days. Patients stayed in the facilities during the 10 days. Each patient received CBT by a licensed clinical psychologist and chaplaincy with an emphasis in improving thinking patterns. The program included physical exercise sessions, buffet like whole foods plant-based meals rich in omega-3, bright light therapy, hydrotherapy, classical music therapy, improving circadian rhythm, among other prescriptions. All of the participants activities were monitored on a strict schedule, this included time for meals, activities, therapy, rest, and other activities. At the start and end of the program every participant filled out a 85-item questionnaire which included a standardized mini EQ test, and demographics.

Results:
The average age of the n=186 study participants was 44 years, with a minimum of 12 and maximum of 97. Patients from various countries participated. EQ was measured at the beginning and end of the program. The mean EQ value at start was 95.1, SD 15.0, median 94, and mode 92. The mean EQ at the end of the program was 118.4, SD 16.0, median 120, mode 120. On average a participant increased their EQ by 23 points, the change showed statistical significance (p<0.001, one-tailed t-test).

Conclusions:
It seems the lifestyle program increases EQ in 10 days, a follow up is necessary to evaluate if this increase in EQ remain long-term.
Abstract P216: Co-ingestion of Dietary Nitrate and Caffeine Elevates Submaximal Oxygen Consumption and Oxygen-pulse Compared to Nitrate or Caffeine Alone
Authors: Armentrout Phillip M , Smoliga James M , Marshall Kennedy , Carriker Colin R
Published: March 2020

Introduction:
Previous studies have examined dietary nitrate's and caffeine’s combined effects on time-trial and peak power output with caffeine improving performance while nitrate exhibits no additive benefit with co-ingestion. However, less is known about their combined effect on submaximal intensity exercise. Dietary nitrate may reduce submaximal oxygen cost while caffeine may increase submaximal cost.

Hypothesis:
Co-ingestion of dietary nitrate may attenuate the rise in oxygen consumption following caffeine intake.

Methods:
Ten healthy individuals (4 males; 28 ± 10 years of age) and (6 females; 21 ± 3 years of age) participated in a double-blind, placebo controlled, crossover experiment. The first of five visits consisted of a maximal oxygen consumption (VO
2max
) treadmill test. Prior to visits 2 - 5, participants consumed either a dietary nitrate (~12.4 mmol, NIT) or placebo nitrate supplement (PLN) combined with either a caffeine (3 mg/kg, CAF) or placebo caffeine (PLC) dose for a total of 4 days. The final dose of NIT or PLN and CAF or PLC was consumed 2.5 and 1-hr pre-exercise, respectively. Visits 2 - 5 consisted of a 30-min treadmill run at ~65% VO
2max
. During exercise, VO
2
and heart rate (HR) were measured continuously. A linear mixed effects model analysis was performed to determine how each supplementation influenced each dependent variable. Treatments (NIT+CAF, CAF+PLN, NIT+PLC, PLN+PLC) and exercise timepoints (10 and 30 min) served as fixed factors. If p<0.05, p
ost-hoc
pairwise comparisons were performed.

Results:
Exercise VO
2
was significantly elevated for NIT+CAF at 10 and 30 minutes (36.2±4.1 and 37.7±5.0 ml/kg/min, respectively) compared to placebo (33.4±3.4 and 35.3±3.8 ml/kg/min, respectively) (p<0.05). However, there was no difference in VO2 at either timepoint (10 or 30 minutes) for conditions CAF+PLN (34.3±3.9, 35.4±3.6, and 36.3±3.2 ml/kg/min, respectively) (p=0.07) and NIT+PLC (34.8±3.9, 36.0±4.2, and 36.6±4.4 ml/kg/min, respectively) (p=0.08) compared to PLN+PLC. No difference was observed for heart rate between conditions at any timepoint. However, oxygen-pulse (VO
2
/HR) at the end of exercise was elevated in NIT+CAF (15.1±2.5 ml/beat) compared to CAF+PLN, NIT+PLC, PLN+PLC (14.5±2.5, 14.2±2.5, 13.8±2.5 ml/beat, respectively).

Conclusion:
When consumed independently, a low-moderate dose of caffeine or dietary nitrate had no impact on oxygen consumption during 30 minutes of moderate intensity exercise. However, co-ingestion of dietary nitrate and caffeine elevated submaximal oxygen consumption compared to a placebo control; both overall (main effect) and at individual time points of 10 and 30 minutes. Additionally, oxygen-pulse was elevated with co-ingestion compared to all treatments perhaps due to enhanced tissue uptake or altered mitochondrial efficiency. Future work may examine such mechanisms.
Abstract P230: Association of Accelerometer-Measured Physical Activity and Cardiovascular Health in the Hispanic Community Health Study/Study of Latinos
Authors: Vasquez Priscilla , Durazo-Arvizu Ramon A , Marquez David , Argos Maria , Lamar Melissa , Odoms-Young Angela , Gallo Linda , Sotres-Alvarez Daniela , Castaneda Sheila F , Perreira Krista , Vidot Denise , Isasi Carmen R , Gellman Marc , Daviglus Martha L
Published: March 2020

Background:
Detailed information on associations between accelerometer-measured moderate-vigorous physical activity (MVPA) and cardiovascular (CV) health among Hispanic/Latino adults are unavailable.

Methods:
Cross-sectional data from 12,008 Hispanic/Latino adults aged 18-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) 2008-2011 were analyzed using complex survey design methods. Poisson regression models were used to examine the associations between accelerometer-measured MVPA and CV health indicators (blood glucose, total cholesterol, blood pressure, body mass index [BMI], and smoking) and a composite of low CV risk.

Results:
Compared to high MVPA, low MVPA was associated with a higher prevalence of diabetes, hypercholesterolemia, obesity, smoking, but not hypertension. Low MVPA was associated with lower prevalence of ideal blood glucose, blood pressure, BMI and low CV risk. Similar results were observed with non-adherence of PA guideline recommendations.

Conclusions:
Overall in Hispanic/Latino adults, high accelerometer-measured MVPA and meeting PA guideline recommendations were associated with favorable CV health.
Abstract P235: Racial/ethnic and Geographic Disparities in Cardiovascular Health Among Pregnant Women in The United States
Authors: Zheng Yi , Bian Jiang , Lipkind Heather , Zhao Jinying , Pearson Thomas A , Hu Hui
Published: March 2020

Life’s Simple 7 (LS7) developed by the American Heart Association (AHA) reframes cardiovascular disease (CVD) into terms of cardiovascular health (CVH). Large disparities in CVH exist in the general population. However, little is known about the CVH status and its disparities among pregnant women. We used data from two nationally representative surveys to assess racial/ethnic and geographic disparities in pregnancy CVH. Racial/ethnic disparities were examined using data from the 1999-2016 National Health and Nutrition Examination Survey (NHANES). Following LS7, each CVH metric was categorized into poor, intermediate, or ideal. Women with ≥ 4 ideal metrics were determined as having ideal pregnancy CVH. Data from the 2001-2017 Behavioral Risk Factor Surveillance System (BRFSS) were used to identify geographic disparities in pregnancy CVH as determined by self-report and categorized into poor or ideal. Women with > 3 poor metrics were considered as having poor pregnancy CVH. Among the 1,310 pregnant women identified from the NHANES, a lower ideal CVH rate was observed among non-Hispanic Blacks (27.6%), while there were small differences among other racial/ethnic groups (non-Hispanic Whites: 40.5%, Hispanics: 39.7%, and others: 34.7%). Comparing with Non-Hispanic Whites, non-Hispanic Blacks had significantly lower odds to meet an ideal CVH (OR: 0.55, 95% CI: 0.31, 0.97) after adjusting for sociodemographic status. A total of 19,259 pregnant women were identified from the BRFSS. Large geographic disparities in poor pregnancy CVH at the state-level were observed with substantial temporal variations, ranging from 11.7% (Vermont, 2001-2006) to 49.8% (Arkansas, 2013-2017). Continuously increasing rates of poor pregnancy CVH were found in 22 states, while only 2 states (i.e. Kentucky and Washington DC) had continuously decreasing rates in 2001-2017. More efforts are warranted to understand and address these large and increasing disparities in pregnancy CVH.
Abstract P239: Longitudinal Measurement Of Maternal Plasma Polyunsaturated Fatty Acids In Relation To Physical Activity Throughout Pregnancy-a Prospective Study Within The Nichd Fetal Growth Studies
Authors: Chen Liwei , Liu Xinyue , Xia Tong , Rahman Mohammad L , Zhu Yeyi , Hinkle Stefanie , Li Mengying , Wu Jing , Weir Natalie , Tsai Michael Y , Zhang Cuilin
Published: March 2020

Background:
Physical activity (PA) is a key components of energy expenditure and can alter fat metabolism. Maternal polyunsaturated fatty acids (PUFA), particularly endogenous PUFA, plays critical roles on maternal health and fetal development. However, studies investigating the longitudinal association of PA with PUFA during pregnancy are scarce.

Objective:
To examine the prospective associations of PA with PUFA among pregnant women.

Methods:
This study used longitudinal data from a nested gestational diabetes mellitus case-control study (n=321) within the NICHD Fetal Growth Studies-Singletons. Plasma phospholipid PUFA and PA were measured at 4 time-points during pregnancy (10-14, 15-26, 23-31, and 33-39 GW). Total PA was calculated as energy expenditure in metabolic equivalent (METs-hour) and physically active was defined as spending ≥150 min on moderate-to-vigorous exercise per week. Associations of PA with total n-3, n-6, and individual PUFAs were examined using generalized linear models where the sample was weighted to represent the entire cohort.

Results:
Total PA was positively associated with EDA, but inversely associated with ALA and GLA, independent of maternal age, race, parity, pre-pregnancy BMI, and dietary intake of FA. Being physically active was inversely associated with total n-3 PUFA but positively associated with total n-6 PUFA. However, the direction of the associations of individual PUFA varied: an inverse association for ALA (n-3) and LA (n-6); a positive association for DHA (n-3), AA (n-6) and DPA (n-6).

Conclusions:
Findings from this study indicate that PA may alter PUFA metabolism in pregnant women. The inverse association between total PA and GLA (an endogenous PUFA) is novel and merits confirmation in future studies.
Abstract P242: Aspirin Awareness and Use for Cardiovascular Disease Prevention in a Community of Color
Authors: Van't Hof Jeremy R , Misialek Jeffrey , Oldenburg Niki C , Eder Milton , Luepker Russell V , Duval Sue
Published: March 2020

Background:
Cardiovascular disease (CVD) and CVD risk factors are high among people of color. Aspirin (ASA) can reduce CVD risk. Yet little is known about primary prevention ASA use and its determinants among people of color. This study examined associations for ASA-related health beliefs and social norms, CVD risk factors and ASA use among Hispanic/Latino (HL) and African American (AA) adults without CVD history.

Methods:
In-person surveys were administered to adults ages 45-79 years at health fairs and community events in the Minneapolis-St. Paul metro querying demographics, CVD history, CVD risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4-point Likert scale. Poisson regression with adjustment for age, sex and risk factors was used to examine associations with ASA use. Surveys were offered in English or Spanish.

Results:
Of the 583 survey participants with no CVD history, 152 identified as HL and 431 as Non-Hispanic-AA. Compared with AA, the HL sample was younger, mean (SD) age of 53.0 (8.6) years vs 59.3 (9.3) years; 54.6% vs 65.7% were female. Risk factors were common among HL and AA, including diabetes (37.5% and 29.0%), hyperlipidemia (28.3% and 36.7%), hypertension (36.8% and 61.0%) and smoking (13.8% and 21.1%). Twenty-two percent of HL and 34% of AA participants regularly used ASA. When asked questions regarding health beliefs and social norms, HL adults had a high frequency of “Don’t Know” responses compared with AA’s (Figure). Participants with more “Don’t Know” responses were less likely to use ASA—RR of 0.87 (95% CI 0.77-0.99). Conversely, ASA use was positively associated with “Agree” responses (RR 1.40, 95% CI 1.29-1.52) and CVD risk factors (RR 1.43 95% CI 1.28-1.59). Associations did not differ by race/ethnicity (interaction p >0.05).

Conclusion:
ASA uncertainty is more pronounced among HL adults than AA and is associated with less preventive ASA use. Efforts should be made to improve knowledge regarding the appropriate use of ASA in this population.
Abstract P248: Smoking, Smoking Cessation, and Risk of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities Study
Authors: Ding Ning , Sang Yingying , Van't Hof Jeremy , Kalbaugh Corey A , Hall Michael E , Coresh Josef , Salameh Maya , Blaha Michael J , Tang Weihong , Matsushita Kunihiro
Published: March 2020

Introduction:
Smoking is the strongest risk factor for abdominal aortic aneurysm (AAA), and male ever smokers who are recommended for one-time screening for AAA with ultrasonography at age of 65 to 75 years. However, the proportion of eligible individuals who receive this screening remains small (~1%). Few studies have evaluated the association of key smoking parameters with incident AAA by sex.

Methods:
In 14,889 ARIC participants free of a history of AAA at baseline (1987-89), we quantified the associations of smoking parameters (pack-years, duration, and intensity [pack/day]) with incident AAA (hospitalizations with AAA diagnosis [ICD code: 441.3, 441.4, 38.44, 39.71] or a death certificate ICD code: 441.3, 441.4, I71.3, I71.4) using Cox models. Years since quitting in former smokers were explored as time-varying variables.

Results:
Over a median follow-up of 20 years, there were 567 cases of AAA. The incident rate of AAA was 5.98 per 1,000 person-years in male current smokers and 2.65 per 1,000 person-years in female current smokers. Pack-years was significantly associated with incident AAA (HR 7.31 [95% CI 5.48-9.74] for those smoked ≥40 pack-years vs. never smokers) and the association was stronger in women than men (8.53 [5.03-14.45] vs. 5.97 [4.21-8.47], p-for-interaction =0.02). Both smoking duration and intensity showed significant associations with AAA. Smoking cessation demonstrated a graded association with lower risk of AAA in both sexes, but significantly increased risk lasted longer in men (2.16 [1.39-3.36] in 30-<40 years after cessation) than in women (1.84 [0.76-4.46] in 20-<30 years after cessation) (Table).

Conclusions:
All smoking parameters tested consistently show significant associations with incident AAA in both sexes. After cessation, the residual risk lasted at least 40 years in men and 20 years in women. Our results further emphasize the importance of smoking prevention and early cessation for preventing AAA and the potential need of AAA screening in female current smokers and recent quitters.
Abstract P250: The Impact of Recreational Cannabis Legalization on All-cause Hospitalizations and Acute Cardiovascular Event Hospitalizations in Colorado
Authors: Jeffers Abra M , Lightwood James , Keyhani Salomeh
Published: March 2020

Background:
Cannabis may have adverse consequences for cardiovascular health. Colorado decriminalized cannabis on November 2012 and retail sales of cannabis began in January 2014. We examined whether the overall rate of hospitalizations and hospitalizations for acute cardiovascular events (ACE) increased in Colorado after legalization.

Hypothesis:
We hypothesized that the rates of all-cause hospitalizations and ACE would increase post legalization of recreational cannabis.

Methods:
The State Inpatient Database (SID) for Colorado, available through Healthcare Cost and Utilization Project was analyzed using interrupted time-series methods to assess whether increases in sales of marijuana affected the rates of overall hospitalization and hospitalization for ACE, post legalization of cannabis. The time analyzed included January 2008 through September 2015. We ended the data of analysis on October 1 2015, because ICD-10 codes were implemented in October 2015. The primary outcome, rate of hospitalizations, was measured by total unique inpatient admissions within the SID for each monthly time period. The secondary outcome, ACE, was identified using ICD-9 diagnostic codes for myocardial infarction (410), stroke (430, 431, 433, 434, 436), and ICD-9 procedure codes for coronary artery bypass surgery (36.1x), and percutaneous coronary intervention (36.0x, 0.66). In the interrupted time series regression models we accounted for seasonality and consumption of cigarettes and alcohol using a proxy of sales tax collected each month for cigarettes and alcohol. In the ACE models, we controlled for seasonality, sales of cigarettes and average monthly air temperature. We also examined the effect of legalization on the same outcomes in men and women and different age subgroups.

Results:
While overall rates of hospitalizations decreased somewhat over the study period, there was no statistically significant difference in hospitalizations rates, neither in the regression intercept (for immediate change) (p=0.94) or slope (p=0.97), after the legalization of recreational cannabis. Similarly, ACE rates decreased over the time frame, but there were no significant changes in rate intercept (p=0.80) or slope (p=0.71) post legalization. The subgroup analyses by age category and gender for hospitalizations and ACE also showed no significant differences in rates pre and post legalization.

Conclusions:
We found no evidence that overall hospitalizations and hospitalizations for ACE increased due to legalizing recreational cannabis in Colorado. A limitation of our study was that Colorado had already implemented a medical marijuana program in 2000. Recreational legalization may not have led to a significant increase in users. Future studies should examine the link between legalization and cardiovascular events in other states with a different trajectory of legalization.
Abstract P255: Moderate Alcohol Consumption and the Risk of Acute Ischemic Stroke and All-Cause Mortality: The Million Veteran Program
Authors: Song Rebecca , Aparicio Hugo J , Seshadri Sudha , Cho Kelly , Wilson Peter W , Gaziano J. M , Djousse Luc ,   on behalf of the Million Veteran Program
Published: March 2020

Introduction:
Moderate alcohol consumption has been associated with lower risk of acute ischemic stroke (AIS) in the general population, but this relation has not been examined among U.S. Veterans. Furthermore, inconsistent data are available on the relation of alcohol and all-cause mortality.

Methods:
Million Veteran Program (MVP) participants who completed a lifestyle survey were eligible for analysis (n=335,754). We combined grams of ethanol in wine, beer, and spirits from the food frequency questionnaire to estimate grams/day (g/d). Participants were categorized into categories of: Never, former, or current drinkers of ≤6 g/d, >6-12 g/d, >12-24 g/d, >24-36 g/d, >36-48 g/d, and >48 g/d. We defined incident AIS as 1 inpatient or 2 outpatient codes (ICD-9 433-434.XX, 436.XX, 437.0, 437.6; ICD-10 codes I63.XX, I65-I66.XX, I67.2, I67.6, I67.8) using the VA electronic health record. Participants with prevalent CVD (n=93,496), missing alcohol data (n=24,871), no follow-up time (n=18,948) or missing age or sex (n=135) were excluded. We used a Cox Proportional Hazards model to relate alcohol consumption and AIS and mortality (separately) adjusting for age, sex, race, body mass index, smoking, education, exercise, DASH score, diabetes, and hypertension status. A sensitivity analysis using simulation reclassifying never drinkers with prevalent comorbidities assessed the impact of potential exposure misclassification on effect estimates.

Results:
Among 198,304 participants, the mean age was 64y (SD=12), and 10% were women. During a mean follow up of 3.3 years, 3,834 AIS and 7,020 deaths occurred. Using never drinkers as the reference group, we identified a 20-26% (95% CI range: 0.42-0.93) lower risk of AIS, and a 29-39% (95% CI range: 0.46-0.80) lower risk of mortality among drinkers of >0-36 g/d, respectively (Figure 1). In sensitivity analyses, HRs were attenuated but the effects remained robust.

Conclusion:
Our data show a lower risk of AIS and all-cause mortality with moderate alcohol consumption among MVP participants.
Abstract P270: Prediction of Telomere Shortening Using a Genetic Risk Score: The Multi-ethnic Study of Atherosclerosis (mesa)
Authors: Castro-Diehl Cecilia , Smith Jennifer , Zhao Wei , Wang Xu , Epel Elissa , Mukherjee Bhramar , Sanchez Brisa , Seeman Teresa , Needham Belinda
Published: March 2020

In epidemiological studies, telomere shortening has been associated with age-related diseases and mortality. We assessed whether a genetic risk score (GRS) combining seven telomere length (TL)-associated genetic variants identified in a European-American genome-wide association study (GWAS) predicts TL and change in TL over 10 years in a multi-ethnic sample.

Research Hypotheses:
1. In cross-sectional analysis, the GRS will be inversely associated with TL.

2. In longitudinal analysis, the GRS will be associated with change in TL over a 10-year period.

Methods:
TL was assessed on a sample of 1198 white, African-American and Hispanic participants, who attended both, MESA Exam 1 and 5, 10 years apart. Participants were 45-84 years at Exam 1. We used MESA measured or imputed genotype data to create the TL GRS and constructed the GRS using weighted estimates from the prior GWAS. Our main exposure was TL GRS.

For hypothesis 1, we used linear mixed-effects model (LMEM) including all valid observations from both exams and adjusted for an exam indicator, age, sex and specific genetic principal components (PC). For hypothesis 2, we used LMEM with time-varying covariates and adjusted for follow-up time since Exam 1, age, sex and PC. We stratified our analysis by race/ethnic group and used the top three race/ethnic-specific genetic PC to account for population stratification.

Results:
In cross-sectional analysis, we observed a significant inverse association between GRS and TL (estimates= -0.18 (S.E.=0.08),
P
=0.02 for white; -0.18 (0.07),
P
<0.01 for black; and -0.13 (0.05),
P
=0.01 for Hispanic) after full adjustment. In the longitudinal analysis, only among Hispanics, higher TL GRS predicted a reduction in TL over a 10-year period (-0.22 (0.06,
P
<0.001)), but after adjustment for PC, the association became not statistically significant.

Conclusion:
In the cross-sectional analysis, higher TL GRS was associated with shorter TL in the three race/ethnic groups studied. TL GRS did not predict telomere attrition in any of the race/ethnic groups.
Abstract P276: Discordance Between Changes in NT-proBNP and Cardiac Function Following Bariatric Surgery
Authors: Wallace Amelia S , Hamo Carine E , Shah Amil M , Florido Roberta , Echouffo Tcheugui Justin B , Matsushita Kunihiro , Hoogeveen Ron C , Gerstenblith Gary , Ballantyne Christie M , Selvin Elizabeth , Coresh Josef , Ndumele Chiadi E
Published: March 2020

Background:
The N-Terminal of pro-B-type natriuretic peptide (NT-proBNP) is a potent biomarker for heart failure (HF), reflecting left ventricular dilation and stress. The association among obesity, HF, and NT-proBNP is complex, with paradoxically lower levels of NT-proBNP in obese individuals, despite their elevated HF risk. Furthermore, a few studies have reported decreased HF risk, but also increases in NT-proBNP, after weight loss via bariatric surgery. However, studies have not simultaneously evaluated changes in NT-proBNP and cardiac function after bariatric surgery.

Hypothesis:
There will be discordance between improvements in cardiac filling pressures (as reflected by E/e’) and increases in NT-proBNP with weight loss following bariatric surgery.

Methods:
We conducted a single-center analysis of participants in the BARI-Heart Study who underwent bariatric surgery and attended study visits 3-6 months and 2 weeks before surgery, and 6 and 12 months after surgery. We examined pre- and post-surgery changes in NT-proBNP and in echocardiographic measures of cardiac function. We also assessed the correlation between NT-pro-BNP and E/e’, at 2 weeks pre- and 6 months post-surgery.

Results:
Among 71 BARI-Heart participants (mean age 45 years, 74% female, 87% white, mean BMI 47.0 kg/m
2
), there were no significant pre-surgery changes in BMI, NT-proBNP, or E/e’. By 6-12 months, there were marked reductions in BMI and significant increases in NT-proBNP, but decreases in E/e’ (
Figure
). Changes from surgery to the 6 month visit in NT-proBNP and E/e’ were associated (r=0.295; p=0.02). There was a tendency towards stronger correlations between NT-proBNP and E/e’ post- (r= 0.436; p<0.001) versus pre-surgery (r = 0.209; p=0.09).

Conclusions:
Weight loss is associated with increases in NT-proBNP despite reduced LV filling pressures, suggesting a non-cardiac etiology underlying increases in NT-proBNP after weight loss. The interpretation of NT-proBNP for cardiac dysfunction may change with decreasing adiposity.
Abstract P278: Association of Alcohol Use With Poor Outcomes in Takotsubo Cardiomyopathy
Authors: Abe Temidayo , Ogbuchi Samuel , Ajose Taiwo , Babatunde Ajibola , Nwagbara Chinonyelum , Abe Tolulope , Tobun Temitope , Bakinde Nicolas
Published: March 2020

Introduction:
Recent studies have demonstrated poor outcomes in patients with takotsubo cardiomyopathy (TCM). It is important to determine the predictors of these outcomes for appropriate risk stratification and to decrease the overall disease burden. Physical stressors and preexisting heart failure have been associated with poorer outcomes, however, the impact of alcohol use (ETOH) has not been discussed.

Aim:
To determine if underlying alcohol use is associated with poorer outcomes in patients with TCM.

Methods:
We recruited 6750 patients from 2011, 2012 National Inpatient Sample, 6325 had TCM alone while 425 had TCM and ETOH use. Our outcomes of interest were overall mortality, mechanical hemodynamic support (MHS) acute respiratory failure(ARF), cardiac arrest (SCA), cardiogenic shock, and atrial fibrillation. All clinical characteristics were defined as per the International Classification of Diseases 9th revision (ICD-9) codes. Logistic regression was used to estimate the odds ratio of the outcomes in the study compared to the control group while stratified analysis was used to adjust for age and sex both accounting for underlying comorbidities.

Results:
There was no significant difference between the two groups in the rates of atrial fibrillation (11.1% vs 10.4%; P= 0.656), cardiogenic shock (6.2% vs 4.7%; P= 0.201), MHS (2.3% vs 1.4%; P= 0.221) and overall mortality (4.1% vs 3.8%; p=0.702). Rates of ARF (29.9%, vs 18.2%; P< 0.0001) and SCA (4.9% vs 3.0%; P=0.025) were higher in patients with TCM+ETOH compared to TCM alone. Table 1 displays the adjusted odds ratios for the outcomes. Compared to the participants with TCM alone, odd ratios of ARF was significantly higher in patients with TCM+ETOH. Table 2 displays the stratified analysis based sex. Compared with TCM alone, female patients with TCM+ETOH are more likely to develop ARF, cardiogenic shock and SCA.

Conclusion:
Preexisting alcohol use is associated with poorer outcomes in female patients with TCM.
Abstract P279: Prevalence and Independent Metabolic Factors of Non-alcoholic Fatty Liver Disease in Acute Stroke Patients Aged 40-79 Years
Authors: Mori Takahisa , Yoshioka Kazuhiro
Published: March 2020

Introduction:
Non-alcoholic fatty liver disease (NAFLD) is reported to be a predictor of cardiovascular disease (CD). NAFLD is probably associated with stroke in middle and old-aged patients.

Hypothesis:
In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission is high and its metabolic factors are body mass index (BMI), triglycerides (TG), some fatty acids, blood sugar or HbA1c and aspartate aminotransferase / alanine aminotransferase ratio (AST/ALT ratio) as well as reported in ischemic heart disease.

Methods:
We included acute stroke patients aged 40-79 years who 1) were admitted from August 2016 to July 2019 within 24 hours of onset, 2) underwent abdominal ultrasonography and 3) took blood examination of serum fatty acids on admission. We evaluated prevalence and associated metabolic factors of non-alcoholic fatty liver disease.

Results:
Among 1672 acute stroke patients, 676 patients met our inclusive criteria. Their median age was 70 years, 267 patients (39.5%) had NAFLD. In NAFLD and non-NAFLD patients, median age was 68 and 71 years (p<0.0001), BMI was 24.8 and 21.6 kg/m
2
(p<0.0001), Alb was 4.2 and 4.0 g/dl (p<0.0001), HbA1c was 6.0 and 5.8 % (p<0.0001), T-CHO was 206 and 198 mg/dl (p<0.05), TG was 135 and 93 mg/dl (p<0.0001), palmitic acid (PA) was 727 and 627.4 μg/ml (p<0.0001), oleic acid (OA) was 672.6 and 563.1 μg/ml (p<0.0001), linoleic acid (LiA) was 772.3 and 730.2 μg/ml (p<0.05), dihomo-gamma-linolenic acid (DGLA) was 34.1 and 26.5 μg/ml (p<0.0001) and AST/ALT ratio was 1.09 and 1.36 (p<0.0001), respectively.

Conclusions:
In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission was high and metabolic factors of NAFLD were younger Age, higher BMI, higher serum concentrations of Alb, T-CHO, TG and fatty acids, higher HbA1c and lower AST/ALT ratio.
Abstract P293: Work Ability in Adults With Diabetes: A Mixed Methods Study
Authors: McCarthy Margaret M , Vorderstrasse Allison , Yan Joeyee , Portillo Angie , Dickson Victoria V
Published: March 2020

Introduction:
Over 30 million Americans have a diagnosis of diabetes. The estimated cost of diagnosed diabetes in 2012 was $245 billion, including $69 billion in reduced productivity. Although many adults with diabetes are productive members of the workforce, loss of work productivity has been associated with the presence of diabetes.

Hypothesis:
We tested the hypothesis that work-related factors were associated with work ability in a sample of working adults with diabetes.

Methods:
This was a cross-sectional mixed methods descriptive design used to study a national convenience sample of 101 working adults with diabetes. Subjects were recruited through the online tool ResearchMatch, and completed surveys using the secure web application REDCap. Valid surveys assessed job content, work-life balance, work limitations and work ability, followed by qualitative telephone interviews in a sub-sample of 30 adults. Adjusting for hemoglobin A1c and diabetes duration, factors significant in the bivariate statistics were included in the stepwise logistic regression with the outcome of excellent work ability. Lastly, quantitative and qualitative data were integrated for analysis.

Results:
The sample was 65% female with mean age 54.1±10.5. The majority were White (74%), non-Hispanic (93%), married (51%), worked full-time (65%) and had type 2 diabetes (87%) with a mean duration of 12.4±9.5 years. Less than half (42%) reported their most recent hemoglobin A1c was <7%. They worked 36±14 hours per week and the majority rated their current work ability as either good (42%) or excellent (33%). Factors associated with work ability included co-worker support (p=.007), work-life balance (p<.0001), skill discretion (p=.02), psychological demands (p=.006), and supervisor support (p=.03). Two factors were independently associated with self-reported excellent work ability: increasing co-worker support improved the odds of excellent work ability (OR: 1.4; 95% CI: 1.04-1.9; p=0.025) and poorer work-life balance decreased the odds or excellent work ability (OR: 0.77; 95% CI: 0.67-0.89; p <.0001).

Qualitative:
Several themes emerged from the data. Most reported no impact of work on keeping medical appointments or managing diabetes at work, and diabetes management was better during a work day since they were on a schedule. Very few report wellness programs at work, and if they exist (e.g. exercise or weight loss program), most do not engage in them.

Data integration:
Those who reported an excellent work ability also expressed less stress and more control over their daily routine.

Conclusions:
The majority of the sample reported good or excellent work ability which was related to less stress and more job control. Workers may benefit from wellness programs that address not only diabetes self-management but also job stress, ways to improve co-worker support, and maintaining optimal work-life balance.
Abstract P301: Differences in Stress Related Behavior According to Age of Immigration: Insight From the Africans in America Study
Authors: Hormenu Thomas , Hobabagabo Arsene F , Shoup Elyssa , Dubose Christopher W , Sumner Anne E
Published: March 2020

Background:
Adjusting to the stress of life in the United States is associated with unhealthy assimilation behaviors, such as cigarette smoking and alcohol consumption. Allostatic load score (ALS) is a measure of the accumulative effect of stress due to overactivation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic adrenal medullary (SAM) axes. It is unknown if stress related behaviors vary according to whether immigration occurred as a child (<18y) or as an adult (≥18y).

Objective:
Our goal was to measure stress by ALS in 382 African-born blacks living in the Washington, DC metropolitan area (age 39±10y, range 20 to 65y) and compare social and behavioral factors in Africans who migrated to the United States as children versus as adults.

Methods:
ALS was calculated using 10 biomarkers from the 3 physiological systems affected by the HPA and SAM axes: cardiovascular (systolic BP, diastolic BP, pulse, cholesterol, HDL, homocysteine), metabolic (BMI, A1C, albumin) and inflammatory (hsCRP). One point was assigned if a variable was determined to be in the high-risk range and 0 if not. High-risk was defined by being in the highest quartile for the population distribution of each variable, except for albumin and HDL, which required the lowest quartile.

Results:
Of the 382 enrollees, 18% (68/382) came to the United States as children and 82% (314/382) were adults. Compared to adulthood immigrants, childhood immigrants were younger (31±9 vs. 41±10y,
P
<0.001) and had been in the United States longer (22±9 vs.11±10y,
P
<0.001). After adjusting for age, ALS was similar in the child and adult immigrants (2.6±0.02 vs.2.6±0.01,
P
=0.84). Alcohol intake was higher in immigrants who came as children than immigrants who came as adults (40% vs. 25%,
P
=0.02). Cigarette smoking, sedentary behavior and number of meals outside of the home all tended to be higher in the childhood immigrants (
P
<0.2). In addition, childhood immigrants were more likely to self-identify as African-Americans than Africans (16% vs. 7%,
P
=0.05).

Conclusion:
Independent of whether Africans came to the United States as children or adults, degree of stress as measured by ALS is similar. However, Africans who arrived as children were more likely to develop unhealthy assimilation behaviors. Whether these behaviors are due to longer duration of stay in the United States or a generational difference remains to be determined.