bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P041: Serum Magnesium and the Incidence of Coronary Heart Disease Over 20 Years of Follow-up: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rooney Mary R , Misialek Jeffrey R , Alonso Alvaro , Folsom Aaron R , Michos Erin D , Rebholz Casey M , Chen Lin Y , Lutsey Pamela L
Published: July 2021

Introduction:
Low serum magnesium (Mg) levels have been associated with increased coronary heart disease (CHD) risk, likely acting through pathways such as hypertension, hyperglycemia or inflammation. An early (1998) ARIC paper evaluated this association, based on 319 events, and identified a sex-interaction whereby the inverse Mg-CHD association was stronger among women than men. Nearly 2,000 events have occurred since the prior publication. Hence, we sought to update the analysis.

Hypothesis:
We hypothesized serum Mg would be inversely and independently associated with long-term risk of CHD.

Methods:
A total of 14,465 ARIC study participants without CHD at visit 1 (baseline) were included. Serum Mg was measured at visit 1 (1987-89) and visit 2 (1990-92). Incident CHD events were identified through 2014 using annual telephone calls, hospital discharge lists and death certificates, and were adjudicated by physician review. Multivariable Cox proportional hazards regression models were used. Serum Mg was categorized into quintiles based on mean visit 1 and 2 concentrations. Based on prior findings in ARIC suggesting an interaction, we decided a priori to provide sex-stratified results.

Results:
Participants at baseline were mean±SD age 54±6y, 57% were women and 27% black. Serum Mg was 1.62±0.14 mEq/L overall, 1.62±0.14 mEq/L among women and 1.63±0.14 mEq/L among men. Over a median follow-up of 25 years, 1,939 CHD cases were identified. Overall, serum Mg was inversely and monotonically associated with CHD risk after adjustment for demographics, lifestyle factors and other CHD risk factors (Table, p-trend<0.001). The association was stronger among women (HR Q5 vs Q1=0.63) than men (HR=0.83), but the sex-interaction was not statistically significant (p>0.05).

Conclusions:
In this large community-based cohort, serum Mg was inversely associated with CHD risk. This association was slightly stronger among women than men. Further research is needed to understand if increasing Mg levels is a useful target for CHD prevention.
Abstract P048: Segment-Specific Pulse Wave Velocity and Subclinical Cardiac Overload and Damage in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Liu Shuiqing , Kim Esther , Wu Aozhou , Meyer Michelle L , Cheng Susan , Hoogeveen Ron C , Ballantyne Christie M , Tanaka Hirofumi , Heiss Gerardo , Selvin Elizabeth , Matsushita Kunihiro
Published: July 2021

Background:
Pulse wave velocity (PWV) independently predicts cardiovascular disease. However, few studies simultaneously explored the associations of segment-specific PWV measures with markers of both cardiac overload (natriuretic peptide [NT-proBNP]) and damage (high-sensitivity cardiac troponin T [hs-cTnT]) among adults without cardiac disease.

Methods:
We examined 2,845 whites and blacks (67-90 years) without clinical history of cardiac disease during ARIC visit 5 (2011-13). The association of PWV quartiles (cf [carotid-femoral], hc [heart-carotid], hf [heart-femoral], ha [heart-ankle], ba [brachial-ankle], and fa [femoral-ankle]) with log-transformed NT-proBNP and hs-cTnT was evaluated using linear and logistic regression models to adjust for potential confounders.

Results:
Most PWV measures demonstrated J- or U-shaped associations with NTpro-BNP and hs-cTnT [Figure]. The highest vs. the second lowest quartile of central PWV measures (cfPWV, hfPWV, and hcPWV) was associated with higher levels of NT-proBNP independently of demographic characteristics. The associations were weaker for hs-cTnT. These associations were attenuated after further adjustment, but hcPWV and NT-proBNP remained borderline significant (p=0.069). haPWV, baPWV, and faPWV including peripheral elements had less evident positive associations after adjusting for traditional risk.

Conclusion:
The positive associations between PWV and cardiac biomarkers were stronger for central vs. peripheral arterial stiffness and for NT-proBNP vs. hs-cTnT among older adults without prevalent cardiac disease. Our findings indicate the relative importance of central arterial stiffness behind subclinical cardiac overload.
Abstract P053: Cardiovascular Health is Associated With Incidence of Elevated C-Reactive Protein Over 18 Years of Follow-up: The Coronary Artery Risk Development in Young Adults Study
Authors: Ruiz-Ramie Jonathan J , Barber Jacob L , Lloyd-Jones Donald M , Lane-Cordova Abbi D , Gross Myron , Rana Jamal S , Sidney Stephen , Jacobs David R , Sarzynski Mark A
Published: July 2021

Introduction:
In 2010, the American Heart Association (AHA) established “Life’s Simple 7” a composite of metrics aimed at defining cardiovascular health (CVH). Seven positive health factors (blood cholesterol, blood pressure, and fasting plasma glucose) and behaviors (diet quality, physical activity, smoking, and body mass index) are emphasized within the construct, each being scored into ideal, intermediate, or poor categories. While multiple studies have explored the association between the individual components of CVH and markers of inflammation and atherogenesis, none have examined total CVH score as a predictor of elevated C-reactive protein (CRP) levels.

Purpose:
To assess the hypothesis that CVH score is inversely associated with future elevated CRP levels.

Methods:
Black and White men and women (N=1096) from the Coronary Artery Risk Development in young Adults (CARDIA) study were examined at 4 different examinations across 18 years (1992, 2000, 2005,2010). At each examination, CRP and the components of CVH were measured. A 14-point CVH score was determined by summing points for each CVH metric at ideal (2 points), intermediate (1 point), and poor (0 points) levels. Three categories of CVH score were created: low (0-7), moderate (8-11), and high (12-14). Multivariable Cox proportional hazards regression models were used to test the association of both categorical and continuous CVH score with incidence of elevated CRP (>3.0 mg/L) over up to 18 years of follow-up. All models were adjusted for sex and race, and the following time-varying covariates: age, and current level of education.

Results:
Over the 18-year period, the incidence of elevated CRP was 33.6 per 1000 person years. Baseline CVH was associated with lower risk (hazard ratio (HR): 0.83; 95% CI: 0.80 to 0.86) of elevated CRP per 1point increment in CVH. When compared to the high CVH group at baseline, both low (HR: 2.80; 95% CI: 2.16 to 3.65) and moderate (HR: 1.63; 95%CI: 1.35 to 1.96) CVH groups had elevated risk of elevated CRP. Time-varying CVH was associated with a lower risk (HR: 0.88; 95% CI: 0.85 to 0.91) of elevated CRP per increment in CVH score. In models that entered CVH category as a time-varying covariate, both low (HR: 2.84; 95% CI: 2.08 to 3.87) and moderate (HR: 2.09; 95% CI: 1.56 to 2.79) CVH categories were associated with over twice the risk of elevated CRP compared to the optimal CVH group.

Conclusions:
Lower CVH is associated with elevated risk of elevated CRP during the transition from young adulthood to middle age.
Abstract P054: Endogenous Sex Hormone Levels and Endothelial Function Among Men and Post-Menopausal Women in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Mathews Lena , Subramanya Vinita , Zhao Di , Ouyang Pamela , Vaidya Dhanajay , Guallar Eliseo , Yeboah Joseph , Herrington David , Budoff Matthew J , Hays Allison G , Michos Erin D
Published: July 2021

Background:
Sex is a major determinant of cardiovascular disease (CVD). Endogenous sex hormones exert a variety of effects on the vascular endothelium, and changes in sex hormone levels after menopause may play a role in CVD risk in women. We hypothesized that a more androgenic sex hormone profile among post-menopausal women, but not among men, would be associated with reduced blood flow-mediated vasodilation (FMD) of the brachial artery, a marker of worse endothelial function.

Methods:
We examined 1396 post-menopausal women and 1707 men participating in MESA, who were free of clinical CVD at baseline. Sex hormone levels [total testosterone (T), sex hormone binding globulin (SHBG), estradiol (E2)] were measured at Exam 1 (2000-02); free T and T/E2 ratio were calculated. FMD was measured by high-resolution ultrasound. Using multivariable adjusted Poisson and linear regression methods, we tested the cross-sectional associations of sex hormones (log transformed) with FMD.

Results:
The mean age of men and women was 61 and 64 years, respectively. Of women, 34% were using hormone therapy (HT). Among women, after adjusting for demographics, CVD risk factors, and HT use, higher SHBG was associated with higher FMD, whereas higher free T was associated with lower FMD (Table, Model 2). In women, when examining the “best FMD response” (top decile vs. bottom 9 deciles), higher E2 was positively associated with a prevalent best response, whereas higher free T was inversely associated. Among men, a higher T/E2 ratio was marginally associated with lower FMD.

Conclusion:
The association between sex hormones and FMD differs in men and women. Higher E2 and SHBG and lower free T levels were associated with better FMD in post-menopausal women but not in men. Higher T/E2 ratio was associated with lower FMD in men. Further studies are needed to assess longitudinal changes in sex hormone levels and their association with vascular aging. Sex hormone levels may help identify individuals at increased CVD risk who may benefit from other risk reduction strategies.
Abstract P056: Prognostic Cut-Points of Prediabetic Plasma Glucose and HbA1c Values in Predicting Cardiovascular Disease Morbidity and Mortality: A Systematic Review and Meta-Analysis
Authors: Huang Minxuan , Gujral Unjali , He Siran , Staimez Lisa , Jagannathan Ram , Wei Jingkai , Narayan Venkat
Published: July 2021

Background:
Prediabetes are often characterized by various measurements of elevated but non-diabetic glucose values, including impaired fasting glucose (IFG), 2-hour impaired glucose tolerance (IGT), and glycosylated hemoglobin A1c (HbA1c), and represent increased risk for cardiovascular disease (CVD) morbidity and mortality. However, it remains unclear how each glucose measurement differs in their abilities to predict risk for CVD outcomes. Currently, the World Health Organization (WHO) and the American Diabetes Association (ADA) also differ in their IFG definitions, and there has been debate as to which definition best predicts future CVD risk.

Objectives:
In this systematic review and meta-analysis, we sought to evaluate the prognostic value of different cut-points of non-diabetic glucose measurements (IFG, IGT, and HbA1c) for predicting CVD morbidity and mortality in individuals at increased risk.

Methods:
We searched the MEDLINE, PubMed, Embase, Clinicaltrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform, and Cochrane database. We searched prospective cohort studies in adults without diabetes aged 18 years or older, or control groups in clinical trials, with a minimum follow-up of 3 years. We included studies that reported an association between any of the glucose measurements with CVD morbidity, including non-fatal myocardial infarction, non-fatal stroke, peripheral artery disease, a composite measure of any CVD outcomes, and CVD mortality. Retrospective cohort studies will only be investigated if there are not at least two prospective cohort studies for a given outcome. Data from eligible studies were pooled to synthesize results for each glucose measurement. Random effect model was used to calculate pooled hazard ratio or relative risk data.

Results:
We screened over 4,000 abstracts and identified 170 eligible prospective cohort studies with 2,826,296 individuals, with a mean follow-up of 10.2 years. Compared to individuals with normal glycaemia, individuals with IFG defined by the WHO criteria had 1.11 and 1.21 times increased risk for CVD morbidity and mortality, respectively. There was no significant increase in risk among those with IFG diagnosed by the ADA criteria compared to those with normal glycaemia. Compared to those with normal glycaemia, individuals with IGT had 1.15 and 1.24 times higher risk for CVD morbidity and mortality, respectively. HbA1c as low as 5.5% was associated with an increased risk of CVD outcomes.

Conclusions:
The WHO criteria for IFG seems to be a better predictor of CVD outcomes than the ADA criteria. The current criteria for IGT is a slightly strong predictor for CVD events and mortality than IFG. HbA1c levels as low as 5.5% could be used as a predictor for adverse health outcomes in non-diabetic individuals.
Abstract P058: Diabetes, Frequency of Exercise, and Mortality Over 12 Years
Authors: Kim Hyeon Chang , Shin Woo Young , Lee Taehee , Jeon Da-Hye
Published: July 2021

The goal of this study was to analyze the relationship between exercise frequency and all-cause mortality for individuals diagnosed with and without diabetes mellitus (DM). We analyzed data for 505,677 participants (53.9% men) in the National Health Insurance Service - National Health Screening (NHIS-HEALS) cohort. The study endpoint variable was all-cause mortality. Frequency of exercise and covariates including age, sex, smoking status, household income, blood pressure, fasting glucose, body mass index, total cholesterol, and Charlson Comorbidity Index were determined at baseline. Cox’s proportional hazard regression models were developed to assess the effects of exercise frequency (0, 1-2, 3-4, 5-6, and 7 days per week) on mortality, separately in individuals with and without DM. We found a U-shaped association between exercise frequency and mortality in individuals with and without DM. However, the frequency of exercise associated with the lowest risk of all-cause mortality was 3-4 times per week (hazard ratio [HR] 0.69; 95% confidence interval [CI]: 0.65-0.73) in individuals without DM, and 5-6 times per week in those with DM (HR 0.93; 95%: CI 0.78-1.10). A moderate frequency of exercise may reduce mortality regardless of the presence or absence of DM; however, when compared to those without the condition, people with DM may need to exercise more often.
Abstract P059: Utilizing Electronic Health Records to Evaluate Racial Disparities in Metabolic Syndrome
Authors: Danos Denise , Kepper Maura , Ferguson Tekeda , Leonardi Claudia , Scribner Richard
Published: July 2021

Purpose:
Metabolic syndrome is defined as a clustering of clinical metabolic conditions (increased blood pressure, high blood sugar, increased body fat, abnormal cholesterol or triglycerides) and has been associated with an increased risk for several chronic diseases, such as cardiovascular disease. The aim of this project was to identify individuals presenting with metabolic syndrome using a computational patient phenotype definition derived from electronic medical records (EHR) clinical outcomes data. Secondly, this project evaluated racial disparities in metabolic syndrome across Southeast Louisiana.

Methods:
Data was obtained through Research Action for Health Network (REACHnet). Using the National Patient-Centered Clinical Research Network Common Data Model, REACHnet has standardized and made usable EHR data for patient-centered research across Louisiana and Texas. The computational patient phenotype definition for metabolic syndrome was developed based on the National Cholesterol Education Program Expert Panel in Adult Treatment Panel III (NCEP III) guidelines. The presence of metabolic conditions was established using ICD9 Diagnosis codes, patient vitals and lab results that are routinely available in EHR data. Logistic regression models to assess racial disparities were executed using SAS 9.4.

Results:
We analyzed 18,664 patient EHRs for individuals 18 years or older with complete clinical data spanning the years 2013 to 2014. The sample was 43.28% male (n=8,077) and 29.35% black (n=5,477). Based on the patient phenotype definition, the prevalence of metabolic syndrome in the sample was 39.09%. Controlling for age, the odds of metabolic syndrome were twice as high for black women than for white women (OR= 2 (1.83, 2.18)), while the odds were 15% greater for black men than for white men (OR: 1.15 (1.04, 1.28)).

Conclusion:
We observed significant disparities in the prevalence of clinically evident metabolic syndrome in southeast Louisiana. Racial disparities were greatest among women. It has been increasingly recognized that differential exposure to chronic social and nutritive stress from living in a disadvantaged neighborhood may be contributing to racial health disparities. Further research in this sample will link ancillary sources of neighborhood data to the successfully developed metabolic syndrome phenotype to explore potential mechanisms for racial disparities in cardiovascular disease among a clinically-rich, state-wide sample.
Abstract P060: Poorer Lung Function Associated With Higher Risk of Type II Diabetes (DM) Among Chinese Adults With Silicosis
Authors: Cheng Ho Yu , Chair Sek Ying , Sit Janet Wing Hung , Choi Kai Chow
Published: July 2021

Background:
Development of silicosis is a global occupational hazard, characterized by progressive and irreversible deterioration of lung function. Established associations between the decreased lung function and low-grade systemic inflammation place adults with silicosis at extreme risk of developing DM, but little is known about the prevalence of DM and potential risk factors of DM among adults with silicosis.

Methods:
We enrolled 390 Chinese adults (mean age=68.7±7.8, men=99.5%) with confirmed silicosis by the Pneumoconiosis Medical Board. The Compensation Ordinance determines the degree of incapacity (DOI), according to lung function loss based on the forced vital capacity. Diagnosed DM by a medical practitioner/physician. Occupational information included job type and duration of dust exposure. Validated questionnaires were used to measure respiratory symptoms, activity limitation and physical activity level. Insulin resistance, fasting glucose, high sensitivity C-reactive protein (hs-CRP), lipid profiles, and vitamin C were via 8-hour fasting venous sample. Body mass index, waist circumference, body fat mass percentage and blood pressure were measured. Logistic regression model was used to adjust covariates of DM.

Results:
The prevalence of DM among adults with silicosis was 18.5% (n=72), which is higher than the general Chinese male population (Hong Kong=11.4%; China=12.1%). Participant characteristics according to DOI are presented in Table 1. After adjusting for hs-CRP, age, education and physical activity level, body fat mass percentage, medication use for lipid and blood pressure control, higher DOI was significantly associated with higher odds of DM (OR=1.65, 95%CI=1.08-2.53).

Conclusion:
Adults with longer duration of silicosis have an intensifying risk of DM development. Rehabilitation programs for this vulnerable group with impaired lung function need to target cardiometabolic risk factors to reduce development of CVD.
Abstract P061: Determinants of Incident Metabolic Syndrome and Type 2 Diabetes in Normal Weight: The Jackson Heart Study
Authors: Mongraw-Chaffin Morgana , Saldana Santiago , Carnethon Mercedes R , Chen Haiying , Effoe Valery S , Golden Sherita H , Joseph Joshua J , Kalyani Rita R , Norwood Arnita , Bertoni Alain G
Published: July 2021

New evidence suggests that individuals with normal weight at diagnosis of type 2 diabetes (T2D) are at higher risk for all-cause mortality than those who were overweight or obese at diagnosis. While investigation of the determinants of different diabetes risk categories among those with obesity has become more common, explanations beyond genetic predisposition for the heterogeneity in risk among those without obesity are lacking. We hypothesized that visceral fat and insulin resistance would be associated with incident metabolic syndrome (MetS) and T2D among African American individuals with normal weight.

In 1,032 participants of the Jackson Heart Study with normal weight (BMI 18.5 – 24.9 kg/m
2
), we used logistic regression to investigate the determinants of incident MetS and T2D, separately. T2D and MetS were assessed at study visit 3 for the CT scan variables, and visits 2 and 3 for all other variables. We used the harmonized International Diabetes Federation criteria to define MetS. We excluded participants with prevalent MetS or T2D, and those with missing exposure or outcome data.

Normal weight participants with MetS or T2D were more likely to be older, male, have lower socioeconomic status, caloric, fiber, saturated fat intake, and higher CRP and visceral fat. Higher HOMA-IR and subcutaneous fat were seen only in those with MetS. Higher visceral fat, subcutaneous fat, BMI, and HOMA-IR were significantly associated with incident MetS after adjustment for age, sex, education, and income (Figure). Only visceral fat and HOMA-IR were significantly associated with incident T2D. Estimates for BMI, but not visceral fat, were strongly attenuated with mutual adjustment. Physical activity was not associated with MetS or T2D in any model.

In conclusion, visceral fat is more strongly associated with incident MetS and T2D than subcutaneous fat or physical activity, even in normal weight individuals, suggesting that

adiposity plays a role in the development of cardiometabolic dysfunction even in the absence of obesity.
Abstract P064: Progression From Prediabetes to Diabetes in Hispanics/Latinos. Results From the Hispanic Community Health Study / Study of Latinos (HCHS/SOL)
Authors: Pasquel Francisco J , Loop Matthew S , Menke Andy , O'Brien Matthew J , Vidot Denise C , Sotres-Alvarez Daniela , Corsino Leonor , Talavera Gregory A , Gallo Linda C , Kaplan Robert C , Schneiderman Neil , Daviglus Martha L , Cowie Catherine C , Aviles-Santa Larissa
Published: July 2021

Introduction:
There is limited data on longitudinal assessments of diabetes incidence according to baseline glycemic status among Hispanics/Latinos in the US.

Hypothesis:
We hypothesized that diabetes risk in Hispanics/Latino adults varies by baseline glycemic status.

Methods:
We examined the progression to diabetes among Hispanic/Latinos enrolled in HCHS/SOL; a population-based longitudinal study of 16,415 individuals of varying Hispanic/Latino background aged 18 - 74. We used Poisson regression models that accounted for the complex sampling strategy in HCHS/SOL to compare the rates of diabetes incidence by baseline prediabetes criteria [impaired glycated hemoglobin (IA1c, 5.7-6.4%), impaired fasting glucose (IFG, 100-125 mg/dl), and impaired glucose tolerance (IGT, 140-199 mg/dl on OGTT)], as well as any of these two criteria, or all prediabetes criteria, compared to normoglycemia.

Results:
A total of 8014 individuals attended both Visit 1 (2008-2011) and Visit 2 (2014-2017) and were free of diabetes at Visit 1. Persons who developed diabetes were older, had lower education and had higher blood pressure, adiposity (waist circumference, BMI), dyslipidemia, HOMA-IR, and C-reactive protein (all p<0.001). The proportion of participants who developed diabetes on visit 2 varied significantly according to baseline prediabetes categories (IFG 7.4±1.5%, IGT=10.6±2.0%, impaired A1c=9.0±1.1%, two criteria=23.9±1.8%, all prediabetes criteria=43.1±3.7%). After adjusting for potential confounders, including demographics and risk factors for diabetes, meeting more prediabetes criteria was associated with a significantly higher risk of diabetes compared to baseline normoglycemic status, (Table).

Conclusions:
Diabetes incidence among Hispanic/Latino adults varied markedly by glycemic category at baseline. Each additional criterion of prediabetes magnified in a dose-response relationship the risk of diabetes in this population.
Abstract P088: Trends in Serum Lipids in US Youth Ages 6 to 19 Years: National Health and Nutrition Examination Survey 2003 to 2014
Authors: Perak Amanda M , Ning Hongyan , Van Horn Linda V , de Ferranti Sarah D , Lloyd-Jones Donald M
Published: July 2021

Introduction:
Between 1988-94 and 2007-10, total cholesterol (TC), non-HDL-C, HDL-C, LDL-C, and triglycerides (TG) showed favorable trends in US youth. We tested the hypotheses that these favorable trends continued in the more recent period 2003-14 and that favorable trends were also seen in apolipoprotein B (apoB).

Methods:
We analyzed cross-sectional data in 15,712 youths aged 6-19 years from 6 NHANES surveys: 2003-04, 2005-06, 2007-08, 2009-10, 2011-12, and 2013-14. We applied survey weights to generate US population-level estimates and used multivariate linear regression to test for time-dependent trends in lipid levels, separately by sex and age group (6-11 vs. 12-19 years). Fasting LDL-C, TG and apoB were available only at ages ≥12 years; pubertal stage was not available.

Results:
See Figure. TC and non-HDL-C generally showed significant decreasing linear trends in mean levels and favorable linear trends in the prevalence of ideal versus adverse levels, but these improvements were smaller and not significant in 12-19 year-old females. Conversely, HDL-C generally showed an unfavorable downward trend over time, a finding that reached borderline significance in 12-19 year-old females (β=-0.3 mg/dL per year, p=0.054), and the prevalence of HDL-C <40 mg/dL increased significantly in this group (β=0.6%, p=0.02). Despite the unfavorable HDL-C trend, TG showed significant favorable linear trends in mean levels and patterns of ideal versus adverse levels in both male and female 12-19 year-olds. LDL-C and apoB showed neutral to favorable patterns, with significant linear trends for an increase in the prevalence of LDL-C<110 mg/dL (β=0.5%, p=0.02) and a decrease in the prevalence of apoB ≥110 mg/dL (β=-0.9%, p=0.03) for 12-19 year-old females.

Conclusions:
Favorable trends in lipids were generally seen in US youth from 2003-14, with a notable exception for HDL-C. It will be important to understand factors contributing to these trends.
Abstract P099: Longitudinal Associations Between Plasma Levels of Perfluoroalkyl Substances and Cardiometabolic Risk Factors
Authors: Donat-Vargas Carolina , Bergdahl Ingvar A , Tornevi Andreas , Wennberg Maria , Sommar Johan , Kiviranta Hannu , Koponen Jani , Åkesson Agneta
Published: July 2021

Background:
Perfluoroalkyl substances (PFAS) are highly persistent synthetic chemicals with high global demand. Although PFAS may affect different components of cardiometabolic risk through the peroxisome proliferator-activated receptor (a master regulator of lipid and glucose metabolism), evidence remains scarce and inconsistent.

Objective:
Our aim was to evaluate plasma levels of six PFAS in association with cardiometabolic risk factors in a longitudinal setting among 40-50 year old women and men.

Methods:
Participants in the Västerbotten Intervention Programme visited their health center twice, 10 years apart: during 1990 to 2003 (baseline) and during 2001 to 2013 (follow-up). Participant underwent a medical examination, and measurements of systolic and diastolic blood pressure, total cholesterol and triglycerides were performed twice 10 years apart. PFAS were measured in 374 participants. The PFAS analysed were perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorohexanesulfonic acid (PFHxS), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnA). A generalized estimated equations method was used to assess repeated measurements and to provide beta coefficients (β) with their 95% confidence intervals (CI).

Results:
Overall, we observed little or no evidence of associations between PFAS and cardiometabolic risk factors. Exceptions were statistically significant inverse associations between PFOS and PFHxS with total cholesterol (β~-
0.30
; mmol/L, comparing 3
rd
tertile vs 1
st
) and PFOS, PFOA and PFDA with triglycerides (β from
-0.17
to
-0.26
mmol/L, comparing 3
rd
tertile vs 1
st
), when analysis were restricted to those who did not develop diabetes during the follow-up.

Conclusions:
Our findings did not support the emerging premise that PFAS might increase cardiovascular risk through disrupting lipid metabolism and/or vascular system.
Abstract P110: Sex Differences in the Prevalence of Cardiovascular Risk Factors Among United States- and Foreign-born Adults in the 2011-2016 National Health and Nutrition Examination Surveys
Authors: Turkson-Ocran Ruth-Alma N , Ukonu Nwakaego A , Commodore-Mensah Yvonne
Published: July 2021

Background:
Cardiovascular disease (CVD) is the leading cause of death worldwide and in the United States (US). Foreign-born (FB) persons in the US are a rapidly increasing population. Despite increased awareness of important sex differences in CVD risk factors (CVDRF), few studies have examined this phenomenon among FB- and US-born adults

Hypothesis:
We hypothesize that sex differences exist in the prevalence of overweight/obesity, hypertension, diabetes, and hypercholesterolemia among FB- and US-Born participants.

Methods:
A retrospective cross-sectional design was used to examine the 2011-2016 National Health and Nutrition Examination Surveys. A generalized linear model using Poisson distribution was fitted to obtain age-adjusted predicted probabilities and risk of overweight/obesity, hypertension, diabetes, and hypercholesterolemia by place of birth. These CVD risk factors were defined according to national guidelines.

Results:
A total of 22429 participants were included with 29.68% (6658/22429) FB and 69.3% (15771/22429) US-born. The mean age was 47.5(±18.6 SD) years; 48.5% (10875/22429) were male. Overall, US-borns had higher prevalence of overweight/obesity (69.8% vs 63.8.0%; p<0.05) and hypertension (32.6% vs 22.2%; p<0.05), but lower prevalence of diabetes (11.3% vs 12.4%; p<0.05), and hypercholesterolemia (39.3% vs 43.3%; p<0.05) compared to FB-born participants. The sex differences in the prevalence and the prevalence ratios of CVDRF are presented in Table 1.

Conclusion:
Males were more likely to be overweight/obese and be hypertensive than females regardless of place of birth. US-born males were more likely to be diabetic but less likely to have hypercholesterolemia compared to their female counterparts. It is important to consider place of birth when examining sex-differences in CVD risk in the US population.
Abstract P111: Racial Disparity and Outcomes Among Parturients Undergoing Cesarean Section With Epidural Anesthesia
Authors: Hsieh Ya-Ching , Doucette John , Thanik Erin , Balasubramaniam Pradeep
Published: July 2021

Introduction:
In obstetrical health care, racial disparities have been documented in different aspects of maternal care and outcomes. We aimed to examine the effect of race as a factor in affecting outcomes of cesarean section done under epidural analgesia (CS under EA).

Methods:
We performed a population-based retrospective analysis of the Nationwide Inpatient Sample (NIS) (years 2003-2013) in adult hospitalizations for women undergoing CS with EA to determine outcomes [cost, length of stay (LOS), discharge destination (DD)] and complications (hematoma, surgical site infection, postpartum haemorrhage, blood transfusion, severe anaesthesia complications, amniotic fluid embolism, disseminated intravascular coagulation (DIC), and pulmonary edema) using ICD-9-CM codes. Weighted univariate analysis by chi-square test was performed to analyze the associations between race and outcomes with complications. Multivariate linear regression was used to analyze the cost and LOS.

Results:
Out of 87,076 women underwent CS with EA, 63% were Caucasians, 13% were African Americans (AA), 20% were Hispanics, 3% were Asians and 1% were Native Americans. The majority of health care coverage for Caucasians and Asians was private insurance, while AA, Hispanics and Native Americans were utilized Medicare and Medicaid. The AA had higher numbers of comorbid conditions including hypertension, obesity, diabetes and renal failure, except for congestive heart failure that was highest in Asians. Though AA had highest DD to home, but cost and LOS were slightly higher in comparison to other races. Though rates of adverse events were very small in the overall cohort, hematoma was highest in Hispanics, anaesthesia complications were highest among Native Americans, and DIC was highest in Asians. (Table)

Conclusion:
Parturients undergoing CS under EA in minority groups especially AA had higher numbers of comorbidities. Risk stratifications among AA before CS procedure might improve outcome and reduce the cost burden and complications.
Abstract P114: Association of Subjective Social Status With Cardiovascular Health in Hispanics/Latinos
Authors: Piedra Lissette ,   SSS/CVH Co-Authors
Published: July 2021

Introduction:
Evidence suggests that subjective social status (SSS)—perceived status in the social hierarchy—may be more strongly associated with health than objective markers of social status (OSS), income and education. Compared to persons with high SSS, those with low SSS report poorer self-rated physical health and have higher rates of medical comorbidities. Little is known about the relationship between SSS and ideal cardiovascular health (CVH) profiles defined by the American Heart Association (AHA), particularly among diverse Hispanic/Latino adults.

Hypothesis:
Higher SSS will be associated with more favorable CVH profiles.

Methods:
We analyzed baseline HCHS/SOL data
†
on adults ages 18-74 in 2008-11 (N=15,440). SSS was assessed using the McArthur Scale, a 10-rung “social ladder” to specify social rank (scores range from 1-10; higher scores indicate higher SSS). CVH was defined based on levels of 7 metrics: diet, body mass index (BMI), physical activity, cholesterol, blood pressure, fasting glucose, and smoking status; levels of each metric were categorized as ideal, intermediate and poor using AHA criteria. A composite CVH score was calculated by summing across metrics (scores range from 0-14; higher scores indicate better CVH). Linear and logistic regressions were used to examine cross-sectional associations of SSS with CVH (overall and single metrics), after adjusting for OSS, demographics, Hispanic/Latino group, study center, marital status, insurance, prevalent coronary heart disease, and depressive symptoms (CESD).

Results:
In multivariate-adjusted models, each one unit increase in SSS* was associated with a higher overall CVH score (β = 0.03, 95% CI 0.004, 0.057, p <0.05); higher SSS was also positively associated with ideal levels of BMI, physical activity, and fasting blood glucose levels (see Table 1).

Conclusions:
These findings suggest an association between SSS and CVH among diverse Hispanic/Latino adults. Future studies will explore the mechanisms through which SSS may influence CVH.
Abstract P130: Infant Growth as an Effect Modifier of Genetic-lipid Associations: Evidence From a Chilean Infancy Cohort
Authors: Von Holle Ann , North Kari E , Gahagan Sheila , Blanco Estela , Graff Misa , Justice Anne , Lozoff Betsy , Santos José , Angel Bárbara , Burrows Raquel , Voruganti Saroja , Green Howard Annie
Published: July 2021

Background:
The postnatal period can function as a window of time for metabolic programming. As evidence from human observational studies is scarce, we examined the role of postnatal weight, length (linear growth), and weight-for-length (WFL) growth trajectories as effect modifiers of established single nucleotide polymorphism (SNP) associations on lipid levels in a cohort of adolescents from the Santiago Longitudinal Study (SLS) (n=484).

Methods:
Growth trajectories were characterized via two different approaches: nonlinear mixed effects model (SITAR) and a latent growth mixture model (LGMM). We assessed gene-environment interaction in an additive model within: 1) SITAR including product terms that accurately reflects the trichotomous genetic term, and 2) LGMM using stratified SNP-lipid associations by latent growth patterns. Bonferroni-corrected significant findings are reported.

Results:
SITAR models did not reveal any evidence of gene-environment interaction. In contrast, given three LGMM patterns of growth, gene-environment interactions emerge for both weight and WFL trajectories. One group of infants had lower velocity but higher acceleration; another group had medium velocity and lower acceleration; a third group had high velocity and lower acceleration. The association between the rs7412 (APOE) variant and HDL (mg/dL) was negative for the low velocity/high acceleration weight trajectory group (mean= -10.2; 95% CI = -16.0, -4.5; n~23) compared to the high velocity/low acceleration group (mean = 11.3; 95% CI = 2.6, 20; n~152). Similarly, the association (95% CI) between the rs78536982 (BAI3, LMBRD1) variant and triglycerides (log(mg/dL) was lower for the low velocity/high acceleration WFL group (-0.61; 0.84, -0.37; n~24) when compared to both the medium velocity/low acceleration (-0.09; -0.23, 0.05; n~271) and high velocity/low acceleration (0.001; -0.11, 0.11; n~189). In sex-stratified analyses, the high velocity/low acceleration group for males (n=254) had a negative association (95% CI) between the rs11076175 (CETP) variant and LDL (mg/dL) (-10.6; -16.7, -4.5; n~140) versus a positive association for the low velocity/high acceleration (12.6; 2.93, 22.2; n~114).

Summary:
These results demonstrate potential heterogeneity in the genetic association between lipid loci and adolescent lipid levels across different patterns of growth from 0 to 5 months. Future work to examine the role of infant growth as a causal factor in direct and indirect effects is of interest.
Abstract P132: Genome-wide Linkage Analysis of Carotid Artery Traits in Exceptionally Long-Lived Families
Authors: Kuipers Allison L , Barinas-Mitchell Emma J , Minster Ryan L , Wojczynski Mary , Cristiansen Lene , Kulminski Alexander , Thyagarajan Bharat , Newman Anne B
Published: July 2021

The extent to which genetics plays a role in vascular health in exceptional aging has not been established. We performed genetic heritability and genome-wide linkage analysis of carotid artery ultrasound derived traits in 1931 individuals (3913 relative pairs) from the Long Life Family Study (LLFS). The LLFS is a longitudinal family-based cohort study that recruited long-lived individuals and at least 1 of their long-lived siblings, as well as, all offspring and offspring spouses. Participants had a home visit that included B-mode carotid artery ultrasound to assess inter-adventitial diameter (IAD), common carotid artery far wall (FW) intima-media thickness (IMT), lumen diameter (LD), and carotid plaque prevalence and burden. We conducted residual heritability analyses for each of these traits, adjusted for age, age
2
, sex, and field center (4 sites) using pedigree-based maximum-likelihood methods in SOLAR. Linkage markers were haplotypes generated from genotypes typed on the Human Omni Chip 2.5 v1 (Illumina, CA) and multipoint identity-by-descent estimates were calculated by Loki. Multipoint genome-wide (chr 1-22) linkage analysis was conducted in SOLAR. Chromosomal regions were considered significant if the logarithm of the odds (LOD) score was ≥3.0 (suggestive: LOD ≥2.0). Proband and offspring generations, respectively, were 59% and 55% female and had mean ages of 97.3 and 73.5 years. Carotid traits were significantly heritable, ranging from 0.37 for mean FW IMT to 0.67 for mean IAD. We found significant evidence of linkage on chromosome 3 at 125 cM (max LOD=3.57; Table). We also found 4 peaks suggestive of linkage with other carotid traits (Table). There are many genes of interest underlying these peaks with previous association with vascular disease, and fine-mapping the associations will require further refinement via sequence analysis. This is the first study to show that genetics appear to play a very strong role in determining variation in carotid artery traits in families with exceptionally long-lived members.
Abstract P135: Prevalence of Peripheral Vascular Disease: Results of the Global Burden of Disease 2016 Study
Authors: Johnson Catherine O , Nguyen Minh , Zipkin Benjamin , Alam Tahiya , Roth Gregory A
Published: July 2021

Introduction:
Peripheral arterial disease (PAD) is a common condition among older adults. While many patients are asymptomatic, a substantial proportion experience intermittent claudication or critical limb ischemia and require revascularization or bypass surgery. PAD has also been associated with higher rates of cardiovascular and all-cause mortality. Estimates of the prevalence of PAD are essential to a complete understanding of the burden of atherosclerotic disease. We produced national and global estimates of PAD as part of the Global Burden of Disease 2016 Study.

Methods:
We used national health surveys which assessed ankle-brachial index, commercial insurance claims databases, and published literature on population-based studies as input data. Our analyses corrected for readmission rates and variation in the use of diagnosis codes. Geospatial disease meta-regression software (DisMod-MR 2.1) was used to generate models separately by sex, location, and year to produce consistent estimates of prevalence. Uncertainty intervals (UI) were estimated using 1000 draws from the posterior distribution of each model. A country-level socio-demographic index (SDI), combining national income per capita, mean years of schooling, and total fertility rate, was used to examine disease burden by level of development.

Results:
In 1990, there were an estimated 395 (95%UI: 345 to 453) million prevalent cases of PAD globally in women and 265 (95%UI: 231 to 307) million cases in men. By 2016, these numbers had increased to 695 (95%UI: 613 to 797) million cases in women and 506 (95%UI: 444 to 583) million cases in men. Age-standardized global rates in 1990 were 2106 (95%UI 1847 to 2415) per 100,000 and 1773 (95%UI: 1561 to 2037) per 100,000 in women and men, respectively. In 2016, these rates were 1930 (95%UI: 1702 to 2202) per 100,000 for women and 1658 (95%UI: 1457 to 1900) per 100,000 for men. The largest change in total number of prevalent cases from 1990 to 2016 was seen in middle-SDI countries with a 136% (95%UI: 131% to 137%) change in women and 140% (95%UI: 137% to 143%) change in men, indicating that the overall atherosclerotic burden in these countries is increasing. Comparisons indicate that these changes are largely being driven by population aging in high-SDI countries and by population growth in other locations.

Conclusions:
The prevalence of PAD is increasing worldwide, with large increases in low- and middle-SDI countries in particular. These estimates of prevalence provide important estimates of the number of people who may benefit from medical therapies to reduce cardiovascular events.
Abstract P139: Association of a Potentially Functional Wnt Pathway Mutation With Carotid Artery Wall Traits in African Ancestry Men
Authors: Kuipers Allison L , Miljkovic Iva , Barinas-Mitchell Emma , Cvejkus Ryan , Bunker Clareann H , Wheeler Victor W , Zmuda Joseph M
Published: July 2021

The wingless (Wnt) pathway is known to regulate many human systems, including embryonic development, bone mineralization, and cancer. There is emerging basic research evidence that the Wnt pathway is also involved in angiogenesis, atherosclerosis, and vascular damage repair. However, there have been no studies of the Wnt pathway and cardiovascular disease (CVD) in human populations. In a cohort of Afro-Caribbean men (the Tobago Health Study (THS)), we previously identified a potentially functional coding mutation (Ala64Thr) in the Frizzled-1 (
FZD1
) gene, which acts as a co-receptor with the low-density lipoprotein receptor protein (LRP) to initiate the Wnt signaling cascade. This mutation has a carrier frequency of ~4% in the THS and additional studies reported in the 1000 genomes project have found similar frequencies in other predominantly West African populations. In order to investigate the phenotypic consequences of this Wnt pathway mutation on subclinical CVD, we measured carotid artery wall traits using B-mode ultrasonography in 64 Ala64Thr mutation carriers and 395 controls from the THS. For this analysis, carotid artery measures of interest included carotid plaque prevalence, and common carotid mean intima-media thickness (IMT), inter-adventitial diameter (IAD), and lumen diameter (LD). We assessed differences in carotid traits by Ala64Thr status using multiple linear regression adjusting for CVD risk factors, including age, BMI, smoking, hypertension, diabetes, alcohol intake, physical activity, and sedentary behavior. Men were aged 64 years and were overweight (BMI: 27.5kg/m
2
), on average. Prevalence of hypertension and type 2 diabetes is high in this sample (66% and 24%, respectively). Men with Ala64Thr tended to be older and had higher prevalence of hypertension than non-carriers (P<0.05 for both). Carrying the Ala64Thr mutation was associated with significantly wider carotid diameters and, after adjustment for traditional CVD risk factors, mutation carriers had >1/3 of a SD greater LD than non-carriers (P=0.01). The effect magnitude of this mutation was similar for IAD, though not statistically significant (P=0.08). There was no significant difference in carotid IMT or plaque prevalence. While this mutation is not expected to be severely deleterious using
in silico
prediction software, Ala64 is highly conserved and located in a putative signaling peptide sequence. Carriers of a low frequency
FZD1
coding mutation show greater remodeling of the carotid artery compared to non-carriers, suggesting that the Wnt pathway may be involved in vascular changes that occur early in the atherosclerotic disease process.
Abstract P147: Statin Therapy is Associated With a Lower Risk of Death in Patients Post Myocardial Infarction
Authors: Honerlaw Jacqueline P , Ho Yuk-Lam , Lu Bing , Vassy Jason L , Djousse Luc , O'Donnell Christopher J , Gaziano J M , Gagnon David R , Cho Kelly , Wilson Peter W
Published: July 2021

Introduction:
The use of statins after acute myocardial infarction (MI) has been shown to reduce the risk of recurrent MI and mortality. We examined the association between statin therapy and the risk of 1 year mortality after MI hospitalization.

Methods:
Data from the Veterans Health Administration was used to create a national sample of Veterans hospitalized for their first MI event between 2002 and 2015. Veterans with prevalent heart failure, stroke, or cancer diagnoses at the time of discharge for the index MI and prolonged hospitalization (greater than 30 days) were excluded. The statin therapy group was defined as Veterans having any statin prescription at the time of discharge. The primary outcome was all-cause mortality obtained from the National Death Index. We fitted a Cox regression model adjusted for age, length of hospital stay, peak cardiac troponin I ratio (the ratio of the peak measurement to the reference upper limit of normal for the assay) during hospitalization, statin use before admission, beta blocker prescription at discharge, liver disease, peripheral arterial disease, estimated glomerular filtration rate, high-density lipoprotein and total cholesterol levels. Billing codes were used to define exclusion criteria and co-morbidities.

Results:
Among 16,263 Veterans hospitalized for MI, mean age was 62 years and 98% were men. During 350 days mean follow up, 966 deaths occurred. In the statin therapy group 709/13,334 (5.3%) of Veterans died compared to 257/2,929 (8.8%) of Veterans without statin therapy. In an age-adjusted model, 1-year mortality was 35% lower (HR 0.65, 95%CI 0.56 - 0.75) for patients that were prescribed a statin at discharge compared to Veterans who did not receive a statin at discharge. In a multivariable model we observed a 27% (HR 0.73, 95% CI 0.63 - 0.85) lower risk of death for users of statin therapy compared to non-users (Figure).

Conclusions:
Statin therapy prescribed after a first MI event may reduce the 1 year risk of all-cause mortality.