bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP67: Reduction in Calories Purchased by Employees Two Years After Implementation of Cafeteria Traffic-light Labels and Choice Architecture
Authors: Thorndike Anne N , Gelsomin Emily D , Levy Douglas E
Published: March 2019

Background:
Point-of-purchase strategies, such as traffic-light labels and choice architecture, promote healthy food choices. However, there is little research to determine if these interventions reduce caloric intake and prevent weight gain.

Methods:
We previously demonstrated that a worksite cafeteria traffic-light labeling and choice architecture intervention increased employees’ green (healthy) purchases and reduced red (unhealthy) purchases over 2 years. The objective of the current study is to determine if the intervention reduced calories purchased. We analyzed cafeteria purchases of 5,695 employees who visited the cafeteria during the 3-mo baseline period (Dec 2009-Feb 2010) and the 24-mo intervention period (March 2010-Feb 2012). We compared mean calories purchased per transaction (kcal/transaction) during the baseline quarter to the kcal/transaction purchased during the same 1-year (Dec 2010-Feb 2011) and 2-year (Dec 2011-Feb 2012) quarters. All analyses were adjusted for employee age, gender, race/ethnicity, and job type. To assess potential impact of a change in purchased calories on weight, we analyzed the total calories purchased per quarter (kcal/quarter) by employees who visited the cafeteria frequently (≥36 times/quarter). We calculated the combined mean change from baseline in kcal/quarter at 1 and 2-years and divided this number by 90 days to estimate change in daily calories per employee. We predicted the effect of the change in daily calories on employees’ weight using a dynamic model of weight change (Hall, et al.
Lancet
, 2011).

Results:
Employees’ mean age was 34 yrs; 71% were female and 73% white. Mean kcal/transaction was 499.5 at baseline, 478.9 at 1 year, and 470.2 at 2 years (change from baseline to 2 years: -29.3 [95% CI, -33.7, -25.0], p<.001). The decrease in kcal/transaction at 2 years occurred for both food (-17.0, p<.001) and beverages (-17.6, p<.001). At 2 years compared to baseline, kcal/transaction increased for green-labeled items (13.3, p<.001) and decreased for red-labeled items (-42.0, p<.001). Among 461 employees with ≥36 transactions/quarter, mean total calories purchased during the baseline quarter was 37,198 kcal; this decreased by 4,380 kcal/quarter (p<.001) at 1 year and 5,666 kcal/quarter (p<.001) at 2 years relative to baseline. Assuming no other changes in employees’ dietary intake or activity, this equates to a reduction of 56 kcal/day; if maintained over time, the dynamic model of weight change predicts weight loss of 2.8 lbs at 1 year and 5.3 lbs at 3 years.

Conclusions:
A traffic-light labeling and choice architecture intervention reduced calories purchased by employees over 2 years. These findings have implications for helping employees manage their weight, particularly those who use the cafeteria regularly. Simple point-of-purchase interventions are important tools for addressing the obesity epidemic.
Abstract MP69: The Weight Loss by Using the Smartphone Application for People with Metabolic Abnormalities: A Randomized Controlled Trial
Authors: Lee Jung Hyun , Shim Jee-Seon , Yeom Hyungseon , Lee Su Jin , Kim Hyeon Chang
Published: March 2019

Introduction:
Obesity has been an important issue for global health. The use of the smartphone application might contribute to weight loss. However, there is still little evidence for the effectiveness among people without overt metabolic disorder.

Hypothesis:
We assessed the weight loss for people who used the smartphone application with and without personal coaching, with respect to people who did not use any.

Methods:
A total of 129 participants (aged 30-59 years; 63 men; 66 women) were recruited from the community-based cohort study in Korea during 2017-18. The inclusion criteria were as follows. 1) no cardiovascular disease; 2) no medication for hypertension, diabetes and dyslipidemia; 3) no current use of the application for behavior modification; 4) at least two components of metabolic syndrome (waist circumference ≥ 90/80 cm (men/women), SBP/DBP ≥ 135/85 mmHg, triglyceride ≥ 150 mg/dL, HDL cholesterol < 40/50 mg/dL (men/women), and fasting glucose ≥ 100 mg/dL). Participants were educated for behavior modification and randomly assigned to three groups; CO (control, no use of the application), AO (the application only; without personal coaching) and APC (the application with personal coaching). The weight was measured during a screening examination and follow-up examinations at 1.5, 3 and 6 months from a start date. A linear mixed model including the data from participants who attended the follow-up examination at least once was used to assess the weight loss.

Results:
A total of 111 participants attended the follow-up examination at least once. The mean (±SD) weight of those at screening was 71.6±12.2 kg. The mean weight loss of participants after 6 months was 0.11±1.6 kg (p = 0.67) in CO, 0.34±2.8 kg (p = 0.45) in AO, and 0.96±2.2 kg (p =0.02) in APC. Compared with the weight loss in CO, there was no significant additional weight loss in AO (0.35 kg; p = 0.41, 0.60 kg after 3 months; p = 0.16 and 0.24 kg after 6 months; p = 0.58), however, there was significant additional weight loss in APC for 3 and 6 months later (0.51 kg after 1.5 months; p = 0.23, 0.93 kg after 3 months; p = 0.03 and 0.87 kg after 6 months; p = 0.04).

Conclusions:
The use of the application with personal coaching had the effect of losing weight. These results support that the use of the application can be useful for people with metabolic abnormalities that require weight loss.
Abstract MP70: Impact of Systematic Approaches to Tobacco Treatment: The Ottawa Model for Smoking Cessation
Authors: Coja Mustafa , Mullen Kerri-Anne , Reid Robert , Pipe Andrew
Published: March 2019

Introduction:
Tobacco use is the largest preventable cause of death. It is a major risk factor for each of the leading chronic diseases, including cancer, heart disease, stroke, and respiratory illness. Smoking cessation is the single most powerful preventive intervention available. The Ottawa Model for Smoking Cessation (OMSC) is a systematic, comprehensive approach to clinical tobacco dependence treatment. It is designed to assist health professionals to transform clinical practice through knowledge translation, implementation support, and quality evaluation.

Hypothesis:
We assessed the hypothesis that with the addition of a systematic approach to addressing tobacco use, an increase in provider-level support would be realized.

Methods:
Using a detailed Workplan, OMSC Outreach Facilitators work with sites to adapt their clinical practices and to implement an evidence-based smoking cessation program. This process is comprised of six phases of step-by-step instructions for planning, implementing, evaluating and sustaining an evidence-based clinical cessation system. Metrics are collected on smoking status, brief yet strategic advice to stop smoking, rates of delivery of evidence-based cessation support, and patient quit rates. Data from Electronic Medical Records and from the OMSC patient database are used to measure program outcomes.

Results:
Over 440 organizations have implemented the OMSC resulting in thousands of healthcare providers across Canada being trained on the latest clinical approaches to smoking cessation. Collectively, the OMSC network has intervened with more than 400,000 patients, providing them with evidence-based interventions. An analysis of almost 4,000 patients within the OMSC primary care network has shown significant increases of rates of Ask, Advise and Act among providers after implementing the program. For patients referred to the OMSC follow-up program, smoking status was assessed for the primary care and hospital programs, respectively. In 2017-18, 60 day outcomes for primary care patients indicated that 22%-57% (125 of 561; 125 of 218) were smoke-free at this time point. For hospitalized patients who reached the 180 day time point, the range was found to be 18%-48% (1156 of 6473; 1156 of 2399). The lower range represents all patients, assuming those not reached have returned to smoking, while the upper range represents only those patients who were reached by the OMSC follow-up program.

Conclusions:
With the application of a systematic, evidence-based program, there was an increase in the rates of delivery of smoking cessation best practices by healthcare providers. As a result, more patients made further assisted quit attempts resulting in long-lasting quit rates. The OMSC program has shown to be effective in changing provider behaviour with respect to smoking cessation, and in turn, has helped to increase quit rates among patients who smoke.
Abstract P002: Seven-Year Changes in Cardiovascular Health in Older Adults: The Cardiovascular Health Study
Authors: Tounkara Mamadou D , MaWhinney Kristine , Evans Kirsten , Startup Emily , Ehlert Alexa , Covey Emarie , Westra Jordan , Blades Natalie J , Dhamoon Mandip S , Gonzalez Hector M , Imamura Fumiaki , Kuzma Elzbieta , Llewellyn David J , Novilla M Lelinneth B , Scrobotovici Monica , Longstreth W T , Thacker Evan L
Published: March 2019

Objective:
The AHA Life’s Simple 7 (LS7) defines cardiovascular health with smoking, physical activity, diet quality, body mass index (BMI), blood pressure, total cholesterol, and blood glucose. We examined changes in LS7 score and its components in older adults over seven years of follow-up.

Methods:
We analyzed 2,234 adults aged 65+ in the Cardiovascular Health Study who had all LS7 components measured at baseline (1989) and seven years later (1996). We scored each component as ideal (2), intermediate (1), or poor (0). LS7 score was the sum of components, ranging from 0 (worst) to 14 (best), then categorized as ideal (10-14), intermediate (5-9), or poor (0-4).

Results:
Mean LS7 score at baseline was 8.71, declining by 0.24 points (95% CI: 0.17, 0.31) to 8.47 seven years later. At baseline, LS7 score was ideal in 35% of participants, intermediate in 63%, and poor in 1.7%. Seven years later, the distribution shifted down, with 31% scoring ideal, 67% scoring intermediate, and 2.0% scoring poor. Of those scoring ideal at baseline, 57% (95% CI: 53%, 60%) maintained ideal scores seven years later (Figure, Panel A). Of those scoring intermediate at baseline (Panel B), 18% (95% CI: 16%, 20%) improved to ideal. Of those scoring poor at baseline (Panel C), 76% (95% CI: 63%, 90%) improved to intermediate, but none improved to ideal. For components, maintenance of baseline ideal status was 95% for smoking, 86% for glucose, 80% for BMI, 77% for cholesterol, and 55% for physical activity, but only 35% for blood pressure and 7% for diet (Panel A). Decline of baseline intermediate status to poor was 33% for blood pressure and 24% for diet (Panel B). Improvement of baseline poor status to intermediate or ideal was >50% for cholesterol and physical activity and >40% for smoking and diet (Panel C).

Conclusions:
While cardiovascular health declined on average in an aging population, some older adults improved their cardiovascular health as they aged. Declines in diet quality and blood pressure control contributed to overall declines in cardiovascular health.
Abstract P003: Evaluating Comprehensive Smoke Free Policy at the Community Level Using Systems Modeling
Authors: Garney Whitney R , Garcia Kristen M
Published: March 2019

Introduction:
Advocating for comprehensive smoke-free policies is a priority for many community-based organizations. However, it is difficult to appeal to law makers and gain community support without being able to estimate the population-level health outcomes that could result from new policy.

Hypothesis:
We expect that by using agent based modeling, we can estimate the effects of comprehensive smoke-free policy in a way that is useful for community-level decision making.

Methods:
Using an agent-based model, we were able to estimate the potential effects of comprehensive smoke-free policies both Arlington and Mesquite, Texas. The model simulates the intervention effects based on established effect sizes from published literature. The simulation was conducted in 2017 and was used to determine the effects of policy change on reducing CVD risk over a 10- and 20-year periods.

Results:
In Arlington, Texas, the smoke-free policy was estimated to decrease population rates for myocardial infarction from 4.9% to 4.7%, stroke from 3.0% to 2.7%, and diabetes from 20.3% to 20.2% over 10 years. The effect of the comprehensive smoke free policy was more pronounced over a 20-year period, with all effects being statistically significant (p<.001). In Mesquite, Texas, the policy did not have a significant impact on the proportion of population experiencing stroke in 10 years (p=.107). However, in 20 years, the policy was shown to decrease the rate of diabetes from 29.5% to 28.4%, myocardial infarction from 8.5% to 7.9%, and stroke from 3.3% to 3.0%, all of which are statistically significant (p<.001).

Conclusions:
This data is helpful in understanding the potential community-level impact of policy on cardiovascular health over time. Population-level health interventions are powerful tools, however, the length of time that they take to show an impact limits uptake. By using systems modeling, we can estimate the potential long-term impacts of policies and garner intervention support in a timelier manner. In conclusion, this tool can be used to build support for smoke-free policies or other CVD interventions in a variety of communities.
Abstract P005: Related Factors for Cognitive Impairment in Older Japanese Men in Hawaii and Japan
Authors: Miyagawa Naoko , Ohkubo Takayoshi , Fujiyoshi Akira , Shiino Akihiko , Chen Randi , Ross George W , Willcox Bradley , Miura Katsuyuki , Ueshima Hirotsugu , Masaki Kamal
Published: March 2019

Background:
The number of people with dementia is increasing in the world and it is of great public health concern. Previous observational studies, mainly from western countries, have reported that modifiable factors for development of dementia were cardiometabolic risk factors, related to genetically determined metabolic abilities and lifestyle. There are no studies comparing which modifiable factors relate to low cognitive scores among populations with the same genetic background but different lifestyle.

Objective:
The purpose of the present study is to describe factors related to low cognitive scores in Japanese men in two cohorts that are genetically similar but with different lifestyle exposures.

Methods:
Population-based cross-sectional data from the Kuakini Honolulu-Asia Aging Study (HAAS) in Hawaii and Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) in Japan were analyzed. Participants were Japanese men aged 71-81 years (2,628 men in Hawaii and 349 men in Japan). Cognitive function was assessed using the Cognitive Abilities Screening Instrument (CASI), with low CASI score < 82. Related factors were obtained by questionnaire and measurements. Multivariable adjusted odds ratios of low CASI score by different factors among the two cohorts were calculated by logistic regression analysis.

Results:
Low CASI score was more common in elderly men in Hawaii compared to Japan (21.2% or 556/2,628 versus 12.3% or 43/349, p<0.001). After adjustment for age and educational attainment, these differences were no longer significant (Hawaii 20.3% versus Japan 17.9%, p=0.328). Odds ratios for low cognitive scores were 1.65 in Hawaii with history of stroke, and 1.93 in Japan with history of CHD. Higher odds of low cognitive score were seen with diabetes in Hawaii (OR=1.20), and with BMI≥25 in Japan (OR=1.88).

Conclusion:
We found different strengths of associations between cardiovascular diseases and cardiometabolic factors with low cognitive scores among genetically similar men in Hawaii and Japan with different lifestyles.
Abstract P006: Association of Multimorbidity With Cardiovascular Endpoints in Elderly Patients With Atrial Fibrillation
Authors: Claxton J’Neka S , Chamberlain Alanna M , Lutsey Pamela L , Chen Lin Y , MacLehose Richard F , Bengtson Lindsay G , Alonso Alvaro
Published: March 2019

Introduction:
The prevalence of atrial fibrillation (AF) and multimorbidity increase with age; however, the burden imposed by concurrent conditions on outcomes is unknown. Therefore, we aimed to determine the effect of the number and type of comorbid conditions on outcomes in elderly individuals with incident AF.

Methods:
Patients with non-valvular AF 75 years and older were identified in the MarketScan Medicare Supplemental database from 2007-2015. Fourteen chronic conditions, defined by two occurrences of a diagnostic code from inpatient and outpatient claims prior to or at the time of AF diagnosis, were obtained and classified into two categories: cardiovascular (CV) or non-CV (listed in Table footnote). We used Cox regression to estimate the associations of the number and type of conditions with stroke, severe bleeding, and heart failure hospitalizations (HF).

Results:
Among 275,617 patients with AF (mean age 83 years, 51% women), 90% had at least one or more additional chronic conditions. The mean (SD) number of conditions per participant was 1.8 (0.9) for CV conditions and 2.1 (1.2) for non-CV conditions. Over a mean follow-up of 23 months, 7,814 strokes, 13,622 severe bleeds, and 19,252 HF events occurred. After adjustment for age, sex, the number of conditions in the other comorbidity group, an increase of one CV condition was associated with greater risk of stroke, severe bleeding, and HF (Table). In contrast, an increase in one non-CV condition was associated with a lower risk of stroke, and a small increase in bleeding and HF risk (Table). After further adjustments for frailty and medications, the strength of the associations within each group decreased across outcomes.

Conclusion:
CV conditions in AF patients 75 years and older are more strongly associated with stroke, HF, and bleeding than non-CV conditions. This underscores the effect of CV conditions on CV outcomes in a population in which multimorbidity is most common and health care management and delivery is complex.
Abstract P012: Cardiovascular Risk Scores Predict Fatigability Among Older Adults
Authors: Qiao Yujia , Martinez-Amezcua Pablo , Urbanek Jacek K , Simonsick Eleanor M , Schrack Jennifer A
Published: March 2019

Introduction:
Efforts to prevent CVD and its associated health outcomes are paramount to preserving health and functional status in a rapidly aging population. Fatigue is a common side-effect of CVD, but is difficult to measure due to its subjectivity and situational dependence. Fatigability anchors fatigue perception to a standardized walking task, and has been associated with poor functional outcomes with aging. Given the modifiable properties of most CVD risk factors, efforts to prevent the onset and progression of fatigability with aging may benefit from evaluation of -and interventions to treat- components of cardiovascular risk.

Hypothesis:
Older adults with greater CVD risk have higher fatigability, which is primarily contributed by hypertension.

Methods:
From 2007-2015, 623 participants of the Baltimore Longitudinal Study of Aging (BLSA) underwent ≥ 2 perceived fatigability and health history assessments. The mean follow-up time is 4.5 years. At baseline, the sex-specific predicted 10-year CVD risk scores were calculated using the Framingham CVD risk score (Framingham) and the Pooled Cohort Equation (ASCVD). At the most recent visit, perceived fatigability was assessed immediately following a slow-paced 5-minute treadmill walk (1.5 mph; 0.67 m/s; 0% grade) using the Borg rating of perceived exertion (RPE; range 6-20). Linear model was used to conduct a cross-sectional analysis.

Results:
At baseline, participants ranged in age from 32-95 years (mean 68.1±12.0, 56.8% women, 27.6% black), with average CVD risk scores of 17.5±10.5 (Framingham) and 16.8±12.8 (ASCVD), and average fatigability RPE of 8.7±2.4. In crude continuous models, a 5% increase in CVD risk score corresponded to a 0.43 higher RPE (Framingham (p<0.001)) and 0.40 higher RPE (ASCVD (p<0.001)). After adjusting for age, sex, BMI, number of chronic diseases and alcohol intake, the association with the ASCVD score remained essentially unchanged (β=0.16, p=0.010), but the association with the Framingham score was attenuated (β=0.08, p=0.198). Among the primary CVD risk predictors, older age was the largest contributor to higher perceived fatigability (β=0.47, p<0.001), followed by female sex (β=0.12, p=0.001), and hypertension (β=0.10, p=0.005), with diabetes showing a trend (β=0.06, p=0.11). Stratified analyses suggested this association was stronger among those aged ≤70 years (p<0.008) and those with obesity (p<0.002).

Conclusions:
Perceived fatigability was higher among participants with greater 10-year CVD risk as measured using the Framingham and the ASCVD risk scores. The strong associations with hypertension and obesity suggest interventions to reduce CVD risk may also lower fatigability, particularly among those aged ≤70 years or living with obesity.
Abstract P014: Aortic Stiffness and Late-life Depression: the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)
Authors: Wei Jingkai , Palta Priya , Butler Kenneth R , Lazo Mariana , Capistrant Benjamin D , Mosley Thomas H , Heiss Gerardo
Published: March 2019

Introduction:
Late-life depression, which occurs at the age of 65 years or older, is a heterogeneous syndrome associated with cognitive decline and dementia. Aortic stiffness increases pulsatility, which damages microvascular circulation, resulting in poor vasoreactivity and cerebral hypoperfusion that is related to late-life depression. However, only few studies that relate aortic stiffness to late-life depression.

Hypothesis:
Higher aortic stiffness is associated with greater depressive symptoms and a higher prevalence of late-life depression.

Methods:
A total of 4,392 ARIC-NCS participants (mean age: 75.2±5.0 years; 40% male; 21% Black) with measurements of aortic stiffness and depressive symptoms in 2011-2013 were included in this cross-sectional analysis. Aortic stiffness was assessed as carotid-femoral pulse wave velocity (cfPWV) using the VP-1000 plus system (Omron Co., Ltd., Japan). cfPWV was dichotomized based on the upper 25th percentile. The 11-item short form of the Center for Epidemiological Studies Depression Scale (CES-D) was used to assess depressive symptoms. Depressive symptoms were calculated as the sum of scores obtained from the 11 items addressing appetite, depressed feelings, sense of effort, restless sleep, feeling happy, sad, or lonely, perceiving others as unfriendly, enjoying life, feeling disliked, and not able to get going (score range:0 to 22). The CES-D score was quantified as both a binary and a continuous variable. Individuals were categorized as depressed if CES-D score≥8. The total CES-D was log-transformed due to right skewed distribution (mean: 3.1; median: 2.0). Multivariable linear regression was used to estimate the association between high cfPWV and CES-D score, and multivariable logistic regression was used to estimate the association between high cfPWV and odds of depression. All models were adjusted for age, sex, race-center, education, self-reported financial situation, smoking, alcohol use, body mass index, LDL cholesterol, prevalent hypertension, diabetes and coronary heart disease. Race and sex were tested as potential effect measure modifiers.

Results:
A total of 412 (9.4%) participants were depressed. Compared to participants with less stiff aortas (cfPWV<13.11 m/s), those with stiffer aortas (cfPWV≥13.11m/s) had higher average CES-D scores (3.5 vs. 2.9, respectively) and a higher prevalence of depression (12.9% vs 8.2%, respectively). High cfPWV was associated with 6% higher depressive symptoms (beta (β): 0.06, 95% confidence interval (CI): 0.002, 0.13), and greater odds of depression (odds ratio (OR): 1.32, 95% CI: 1.03, 1.69). No significant interactions were found by race or sex.

Conclusion:
Aortic stiffness is associated with late-life depression. These results suggest a role for age-related hemodynamic properties as targets for the study of late-life depression and the mitigation of its burden.
Abstract P017: Biomarkers Representing Aging-Related Biological Pathways Are Associated With All-Cause Mortality: The Framingham Study
Authors: Castro-Diehl Cecilia , Ehrbar Rachel Q , Vasan Ramachandran S. , Xanthakis Vanessa
Published: March 2019

Background:
Chronological aging is the result of different biological processes and molecular mechanisms that, if identified, may increase our ability to mitigate aging-related decline in body functions. We hypothesized that aging-related biomarkers reflecting multiple biological pathways are associated with all-cause mortality.

Methods and Results:
We related leukocyte telomere length (LTL) expressed by terminal restriction fragment (TRF) length, urinary concentrations of creatinine-corrected isoprostanes, circulating concentrations of insulin-like growth factor (IGF)-1, and asymmetrical dimethylarginine (ADMA) in up to 2314 Framingham Offspring Study participants attending routine examination cycles (mean age 58 yrs, 55% women) to all-cause mortality using Cox proportional hazards regression models. Biomarkers were modeled individually and in combination, adjusting for age, sex, body mass index, systolic blood pressure, diabetes, smoking status, hypertension medication, total cholesterol/HDL. We created also a biomarker score as a composite of biomarkers associated with mortality risk. Kaplan Meier curves were created (
Figure
) to graphically present the survival time as a function of tertiles of the biomarker score. There were 593 deaths (274 women) during a median follow-up of 20 years. TRF and IGF-1 values were inversely related to all-cause mortality (multivariable-adjusted hazard ratios [HR] per SD increase, 0.86, 95% confidence interval [CI], 0.75-0.998 and 0.89, 95% CI 0.81-0.97 for TRF and IGF-1, respectively). Isoprostanes and ADMA values were positively related to all-cause mortality (multivariable-adjusted HR per SD increase, 1.17, 95% CI, 1.11-1.23, and 1.09, 95% CI, 1.01-1.18, respectively).

Conclusion:
In our prospective community-based study, aging-related biomarkers were associated with all-cause mortality, supporting the concept that molecular pathways represented by these biomarkers may reflect the processing of aging in the community.
Abstract P018: Smoking and Cognitive Decline at Older Age: Using Surveillance and Imputation to Deal With Differential Mortality
Authors: Wu Aozhou , Sharrett A. R , Deal Jennifer A , Bandeen-Roche Karen , Rawlings Andreea , Power Melinda C , Gross Alden L , Couper David , Griswold Michael , Mosley Thomas , Gottesman Rebecca F , Coresh Josef
Published: March 2019

Background:
Smoking is a risk factor for vascular diseases and likely associated with cognitive decline. However, observed associations may be impacted by higher cohort attrition, particularly mortality, among smokers. We incorporated surveillance data between visits using multiple imputation by chained equations (MICE) and assumed the Missing At Random mechanism in missing cognitive function. We assessed the impact of addressing the influence of differential visit attendance driven by mortality on the association of smoking with cognitive decline.

Methods:
We studied 4,960 participants in Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study, who were free from dementia at baseline (2011-2013) with cognitive batteries at baseline and follow-up (2016-2017, N = 3,078). Cognitive decline was measured as change in standardized global cognitive factor scores. Self-reported smoking was collected at previous visits (1987-1998) and annual follow-up interviews (1998 to 2011) of the ARIC study, and pack years were estimated. We used baseline factor scores, dementia risk factors, and cognitive function screening at annual follow-ups and dementia surveillance information after baseline to impute missing factor scores. Cognitive decline was analyzed using linear regression on both complete data and using MICE.

Results:
Participants had a mean age of 75.7 (SD: 5.1) at the index visit. 59.6% (2956 of 4960) were female and 18.6% (921 of 4960) were African American. Smoking ≥25 pack-years prior to baseline was associated with moderately lower visit attendance and higher mortality at older age. The association of smoking with cognitive decline was stronger after addressing differential attrition driven by mortality using MICE for smoking ≥25 pack-years, with two-fold increase in the effect size (Table 1).

Conclusions:
Smoking, particularly of longer duration and intensity, is a risk factor for cognitive decline, with larger effect size when dealing with the differentially higher mortality among heavier smokers.
Abstract P019: Albuminuria in Mid-Life and Older-Age and Risk of Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Scheppach Johannes B , Wu Aozhou , Gottesman Rebecca F , Knopman David S , Koton Silvia , Mosley Thomas H , Grams Morgan E , Sharrett Richey , Coresh Josef
Published: March 2019

Background:
Dementia is increasingly appreciated to have important vascular disease contributions. Albuminuria and decreased estimated glomerular filtration rate (eGFR) define chronic kidney disease (CKD) and are related to the risk of its consequences as well as microvascular disease and endothelial damage across multiple vascular beds. We extend previous studies by examining albuminuria and eGFR measured at both mid-life and older age as risk factors for dementia.

Methods:
We studied 10,876 adult participants in the Atherosclerosis Risk in Communities (ARIC) Study excluding participants with end-stage renal disease, stroke and incident dementia at baseline. We analyzed the adjusted relative hazard of incident dementia as a function of eGFR (linear spine with a knot at 60 ml/min per 1.73m
2
) and log urinary albumin-creatinine-ratio (UACR) adjusting for age, sex, race, education level, Apolipoprotein E4 level, smoking, alcohol consumption, body mass index, diabetes and hypertension. We used two different baseline visits: (1) Starting in 1996-1999 (Visit 4, age 54-74 years); (2) Starting 2011-2013 (Visit 5, age 70-90 years) with follow-up to 2017.

Results:
We observed 2,001 dementia cases over 16 years of follow-up (446 after Visit 5). Risk of dementia increased with higher levels of albuminuria with a stronger magnitude at older-age than in midlife (
see table
). Estimated GFR was more weakly associated with dementia (p>0.05 at both baselines). The albuminuria association was consistent across sex and race (p-interaction>0.05).

Conclusion:
Albuminuria, a marker of kidney disease and endothelial damage, is strongly related to dementia incidence. Albuminuria’s association with dementia is stronger in late-life unlike other vascular risk factors, where the association is weaker at older age.
Abstract P021: Cardiac Biomarkers, Electrolytes, and Anemia with Arrhythmias over Two Weeks in Chronic Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Kim Esther , Hoogeveen Ron C , Selvin Elizabeth , Ballantyne Christie M , Soliman Elsayed Z , Coresh Josef , Matsushita Kunihiro , Chen Lin Y
Published: March 2019

Background:
Chronic kidney disease (CKD) increases the risk of arrhythmias and sudden cardiac death; however, it is unclear whether this association is due to cardiac overload, cardiac injury, electrolyte abnormalities, anemia, or all of the above. We therefore investigated the relationships between several biomarkers representing these conditions with various arrhythmias among CKD.

Methods:
In 2016-17 (visit 5), 2187 older participants (71-94 years) in the ARIC Study underwent 2-week continuous heart rhythm monitoring (Zio XT Patch). We conducted a cross-sectional study of 1276 participants with CKD. We used modified Poisson regression to examine the associations of natriuretic peptide (NT-proBNP) representing cardiac overload, high-sensitivity cardiac troponin-T (hs-cTnT) reflecting cardiac injury, potassium and magnesium (electrolyte abnormalities), and hemoglobin (anemia) with arrhythmias detected during the 2-week period: atrial fibrillation (AF), non-sustained ventricular tachycardia (NSVT), long pause (>3 sec), Mobitz II or complete atrioventricular block (AVB), and ventricular ectopy (VE).

Results:
There were 9% with AF, 33% with NSVT, 4% with long pause, 2% with AVB, and 29% with VE. NT-proBNP was associated with all arrhythmias except AVB (
Table 1
). Higher hs-cTnT was associated with AF, NSVT, and VE. Lower potassium below 4.2 mmol/L was associated with AF while lower magnesium below <2 mg/dL was associated with VE. Hemoglobin showed no associations with arrhythmias.

Conclusions:
Of the plausible mechanisms contributing to arrhythmias in CKD, biomarkers of cardiac overload and injury were associated with most arrhythmias tested. Lower potassium and lower magnesium demonstrated a significant relationship with AF and VE, respectively. Our results suggest cardiac alterations as key conditions behind high arrhythmic burden in CKD, with somewhat limited contributions of electrolytes and anemia.
Abstract P025: Urinary Level of Trimethylamine-N-Oxide Predicts an Increased Risk of Coronary Heart Disease Among Urban Chinese Adults
Authors: Yu Danxia , Shu Xiao-Ou , Rivera Emilio , Zhang Xianglan , Cai Qiuyin , Calcutt Marion , Xiang Yong-Bing , Li Honglan , Gao Yu-Tang , Wang Thomas , Zheng Wei
Published: March 2019

Introduction:
Trimethylamine-N-oxide (TMAO), a diet-derived, gut microbial-host co-metabolite, has been associated with adverse cardiovascular outcomes in patient populations. However, the evidence is lacking from prospective studies conducted in general populations and in non-Western populations.

Hypothesis:
TMAO level is associated with risk of coronary heart disease (CHD) in general populations.

Methods:
We examined associations of urinary TMAO and its precursors (i.e., choline, betaine, and carnitine) with risk of CHD in a case-control study nested within two prospective cohorts of Chinese adults, including 275 incident CHD cases and 275 individually matched controls.

Results:
Urinary TMAO, but not its precursors, was associated with risk of CHD. Odds ratio (OR, 95% CI) for the highest vs. lowest quartiles of TMAO was 1.91 (1.08-3.35; p-trend=0.008) after adjusting for CHD risk factors including obesity, diet, lifestyles, and metabolic diseases and 1.75 (0.96-3.18; p-trend=0.03) after further adjusting for potential confounders/mediators including central obesity, dyslipidemia, low-grade inflammation, and intakes of seafood and deep-fried meat/fish, which were associated with TMAO level in our study. OR was 1.30 (1.03-1.63) per standard deviation increase in log-TMAO in the fully-adjusted model. History of diabetes modified the TMAO-CHD association. A high TMAO level (≥ vs. <median) showed ORs of 6.21 (1.64-23.6) and 1.56 (1.00-2.43) among diabetic and non-diabetic participants, respectively (p-interaction=0.02). History of diabetes also modified the associations of choline, betaine, and carnitine with risk of CHD with significant positive associations being found among diabetics but null associations among total and non-diabetic participants.

Conclusions:
Our study suggests that TMAO may play a role in the development of CHD, highlighting the importance of diet-gut microbiota-host interplay in cardiometabolic health.
Abstract P026: Sex Differences in the Association Between Ideal Cardiovascular Health and Biomarkers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Osibogun Olatokunbo I , Ogunmoroti Oluseye , Benson Eve-Marie , Tibuakuu Martin , Michos Erin D
Published: March 2019

Background:
Several biomarkers have been shown to be useful clinical tools for the early detection and prognostication of incident cardiovascular disease (CVD) among women and men. The American Heart Association Life’s Simple 7 metrics are a useful construct for the promotion of ideal cardiovascular health (CVH). However, little is known about sex differences in the relation of CVH with these CVD-related biomarkers. We examined the association between CVH and CVD-related biomarkers among women and men free of clinical CVD.

Methods:
This is a cross-sectional study of 5,388 participants aged 45 to 84 years enrolled in the Multi-Ethnic Study of Atherosclerosis. The CVH score ranged from 0 to 14 and was derived from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose). Each metric category was scored as 0 points (poor), 1 point (intermediate) and 2 points (ideal). The CVD-related biomarkers (C-reactive protein, D-dimer, fibrinogen, homocysteine, cardiac troponin T and NT-proBNP) were logarithmically transformed for the analyses. We examined the association between the CVH score (higher score = more favorable) and CVD-related biomarkers using multivariable linear regression.

Results:
Mean age (SD) was 62 (10) and 52% were women. In adjusted regression analyses, higher CVH scores were associated with lower concentrations of all biomarkers, except for NT-proBNP where there was a positive association
(Table).
For example, in the overall population, a 1-unit increment in the CVH score corresponded to a 0.13 mg/L lower log (CRP) concentration. Interactions by sex for all biomarkers examined were significant at p <0.001, but results were qualitatively similar between women and men.

Conclusion:
A more favorable CVH score was associated with lower levels of multiple CVD-related biomarkers for women and men, except for NT-proBNP. These data suggest that promotion of ideal CVH would have similarly favorable impact on the reduction of biomarkers of risk among both women and men
Abstract P035: Habitual Aerobic Exercise-Induced Decrease in Circulating C1q Level is Associated With Reduction of Cardiovascular Diseases Risks in the Elderly
Authors: Hasegawa Natsuki , Horii Naoki , Fujie Shumpei , Uchida Masataka , Sanada Kiyoshi , Hamaoka Takafumi , Iemitsu Motoyuki
Published: March 2019

Introduction:
Habitual aerobic exercise leads to reduction of arterial wall thickness and arterial stiffness with aging. Recently, C1q has been identified as a novel myokine, and the expression of muscle C1q mRNA increases with aging. Additionally, in vivo and in vitro studies, C1q induces proliferation of vascular smooth muscle cells. However, it remains unclear whether the secretion of myokines, C1q, TNF-alpha and IL-6 are related to the changes in cardiovascular disease risk by aging and regular exercise.
PURPOSE:
This study aimed to clarify whether serum C1q, TNF-alpha and IL-6 levels are associated with the changes in cardiovascular disease risks with aging and regular aerobic exercise.

Methods:
In a cross-sectional study, 127 healthy male and female subjects (18-81 years) were enrolled in this study. Subjects were divided into two groups; young (<40 year) and middle-aged and older (≥40 year) groups. Serum C1q, TNF-alpha, IL-6 levels were determined by ELISA. Risks of cardiovascular disease were estimated by using carotid-femoral pulse wave velocity (cfPWV) and common carotid intima-media thickness (ccIMT). Additionally, in an intervention study, thirteen older male subjects were randomly divided into two groups: aerobic training group (AT: n=6) and a sedentary control group (Con: n=7). subjects in the AT group completed 8 wk of aerobic exercise training (60-70% peak oxygen uptake for 45 min, 3 days/wk).

Results:
In the cross-sectional study, serum C1q, TNF-alpha and IL-6 levels, cfPWV and ccIMT were significantly higher in middle-aged and older group as compared with young group (respectively p<0.05). Positive correlations between cfPWV and serum C1q (r=0.41, p<0.05), TNF-alpha (r=0.28, p<0.05) or IL-6 (r=0.26, p<0.05) levels were seen. Additionally, ccIMT was positively correlated with only serum C1q (r=0.67, p<0.05). After adjusting for TNF-alpha and IL-6, the association between the serum C1q and cfPWV (ß=0.44, p<0.05) or ccIMT (ß=0.83, p<0.05) remained statistically significant. Additionally, in the intervention study, cfPWV and serum C1q level significantly decreased after AT intervention (each P<0.05). Furthermore, the AT-induced change in serum C1q level was positively correlated with AT-induced change in cfPWV (r=0.65, P<0.05) and ccIMT (r=0.59, P<0.05).

Conclusion:
These results suggest that circulating C1q level may reflect the changes of arterial stiffness and thickness with aging and regular exercise, and the reduction of serum C1q level in response to regular aerobic exercise may contribute to the reduction in cardiovascular disease risks in the elderly.
Abstract P040: Body Mass Index, Sedentary Lifestyle, and Incidence of Coronary Heart Disease
Authors: Li Xiang , Zhou Tao , Sun Dianjianyi , Heianza Yoriko , Qi Lu
Published: March 2019

Importance:
Obesity has been related to sedentary lifestyle, and an increased risk of coronary heart disease (CHD); however, no study has assessed the causal link between obesity, sedentary lifestyle, and CHD.

Objective:
To examine whether BMI is causally associated with sedentary lifestyle, and quantify the mediation effects of sedentary lifestyle in the relation between BMI and CHD.

Method:
Sedentary lifestyle was quantified by hours spent on sedentary behaviors including TV watching, using computer (not at work) and driving. We tested the causality between BMI and sedentary lifestyle by Mendelian randomization (MR) analysis using 77 BMI related single-nucleotide polymorphisms (SNP) as the instrumental variable, among 401,876 white British participants (enrolled from 2006 to 2010) from the UK Biobank. A further mediation analysis was performed to assess the relations between BMI, sedentary lifestyle, and CHD risk among 366,370 participants with 3,816 incident CHD cases (followed up to 2016).

Result:
The MR analysis showed that there was a causal relation between BMI and sedentary lifestyle. One standard deviation increment in BMI causally resulted in 0.38 increase in the sedentary hour (p<0.001), independent of age, sex, physical activity, alcohol intake, smoking, and the socioeconomic status. In addition, our mediation analysis indicated that 7% and 26% of the effect of high BMI on incident CHD risk were mediated by 4-5 hours (p=0.02), and ≥ 6 hours (p<0.001) of sedentary lifestyle, compared with < 2 sedentary hours, respectively.

Conclusion:
Our results indicate that high BMI is causally associated with increased hours of sedentary lifestyle, which mediate a significant proportion of the CHD risk associated with high BMI.
Abstract P041: Adipose Inflammation as Assessed by Adipose FDG Uptake is Associated With Aortic Vascular Inflammation in Psoriasis
Authors: Choi Harry , Dey Amit , Goyal Aditya , Rodante Justin , Keel Andrew , Aksentijevich Milena , Khalil Noor , Argueta-Ameya Jenis , Reddy Aarthi , Playford Martin , Ahlman Mark , Powell-Wiley Tiffany , Gelfand Joel , Mehta Nehal
Published: March 2019

Background:
Psoriasis, a chronic inflammatory disease, is associated with accelerated vascular inflammation (VI) by FDG PET/CT and increased cardiometabolic dysfunction, including adipose tissue dysregulation. Both visceral and subcutaneous adipose volume are associated with sub-clinical aortic VI as well as future cardiovascular events, however, the relationship of adipose inflammation (assessed as adipose FDG uptake) with sub-clinical aortic VI has never been characterized in psoriasis.

Methods:
104 consecutive biologic naïve psoriasis patients underwent FDG PET/CT scans to measure VI and adipose FDG uptake, represented as target-to-background ratio (TBR) and standardized uptake value (SUV) respectively. After identification of anatomical location (vertebral level T10), a single 3D-volume region of interest with a fixed volume (4.0 cm
3
) was placed in the subcutaneous adipose to measure FDG uptake as standardized uptake value (SUV) using a dedicated software (OsiriX MD, Geneva, Switzerland).

Results:
The cohort was middle-aged, predominantly male, low CV risk by Framingham risk score and mild-moderate psoriasis. Adipose FDG uptake significantly associated with skin disease severity as well as aortic VI even beyond traditional risk factors (β=0.33, p=0.001 and β=0.24, p=0.014 respectively). Additionally, adipose FDG uptake mediated the association between psoriasis skin disease severity and aortic VI accounting for 23% of the total effect (Figure).

Conclusions:
Our study demonstrated that adipose inflammation is positively associated with psoriasis severity as well as aortic VI. Moreover, adipose inflammation also mediated the relationship between skin disease severity and aortic VI, suggesting that it may contribute to the potential link between psoriasis and CV disease. However, larger studies are needed to confirm our findings.
Abstract P043: Twelve-Year Trajectories of Insulin Sensitivity from Oral Glucose Tolerance Tests Are Associated With Incident Dyslipidemia: The Ansan-Ansung Community Cohort Study
Authors: Lee Ju-mi , Kim Kyoungmin , Lim Soo
Published: March 2019

Introduction:
Insulin resistance and dyslipidemia are often comorbid. Although possible biochemical explanations exist, there are inadequate longitudinal data to support the theory directly.

Objectives:
This study aimed to test the association between twelve-year trajectories of insulin sensitivity from oral glucose tolerance test (OGTT) and the incidence of dyslipidemia in a community cohort. Secondly, we tested which lipidemia profile is associated with trajectories.

Methods:
Participants (n=3899; aged 40-69 years, during 1 to 7 visit, mean follow-up 12 years) were recruited from the Ansan-Ansung cohort study, a subset of Korean Genome Epidemiology Study. OGTT were measured at every visit. Matsuda index of each visit was calculated by the formula 10
4
/((GLU0xINS0xGLU60xINS60)
0.5
). We used total seven times of OGTT (28 OGTT index) for trajectories. Latent mixture modeling was used to identify trajectories in Matsuda index for 12 years. The associations of Matsuda index trajectories with the incidence of dyslipidemia and each component of the lipid profile during 12 years were assessed by logistic regression. Age, body mass index, alcohol drinking, cigarette smoking, c reactive protein, education level, and income were adjusted at the final model.

Results:
Three distinct insulin sensitivity trajectories were identified: low-stable (Group 1; 88.8%), steady decreasing (Group 2; 9.7%), and fast decreasing (Group 3; 1.5%). Low stable cluster (referent: steady decreasing) was associated with greater incident dyslipidemia in total (OR=1.61, 1.25-2.07), and men (OR=2.03, 1.45-2.86) before and after adjustment (OR=2.03, 1.32-3.12, OR=2.08, 1.35-3.22). The low stable cluster was associated with the greater incidence of triglycerides≥200mg/dl in total (OR=1.61, 1.18-2.19), and men (OR=1.59, 1.06-2.40). Also, the low stable cluster was associated with greater incident HDL<40mg/dl in total (OR=1.35, 1.06-1.71), and men (OR=1.81, 1.30-2.53). However low stable cluster was not associated with LDL and total cholesterol.

Conclusions:
Longterm low stable insulin sensitivity trajectory had increased associations with future incident dyslipidemia especially TG and HDL component.