bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Co-Morbidities on Anticoagulation Rates Among Chronic Atrial Fibrillation Patients
Authors: Hernandez Maria T , Harper Carolyn V , Redberg Rita F
Published: March 2022

P50

Background: Anticoagulation (AC) with warfarin among patients with chronic atrial fibrillation (AF) continues to be underutilized despite proven effectiveness in stroke prevention and mortality reduction. The increased benefits of AC among patients with specific co-morbidities is also well established. However, concerns about negative health outcomes may be a barrier to AC in patients with co-morbidities. This study examines the effect of co-morbidities on AC rates. Methods: A random sample of 2,450 California Medicare fee-for-service inpatient records with a discharge date in 1998 and a diagnosis of AF was selected. We analyzed rates of co-morbidities associated with an increased risk for stroke among chronic AF patients (congestive heart failure (CHF), angina pectoris, myocardial infarction, diabetes, hypertension, and prior stroke/TIA). AC rates were analyzed by chi-square and multivariate logistic regression. Results: Data was available for 2369 records (96.7%). Cases were excluded for contraindications to AC (n=731), non-chronic AF (n=717), death (n=200) and age < 65 years (n=24). After exclusions, there were 697 (29.4%) cases for analysis. The majority of patients with chronic AF (56.8%, 396/697) were not prescribed warfarin at discharge. Crude rates of co-morbidities were: hypertension 70%, angina pectoris 63%, CHF 47%, myocardial infarction 37%, prior stroke/TIA 27%, diabetes 25%. Almost all patients (94%) had at least one co-morbidity. Multivariate analysis controlling for age, gender, and all co-morbidities identified prior stroke/TIA (OR 2.1, p<.01) and CHF (OR 1.9, p<.01) to be associated with increased AC rate. Conclusion: Although it is encouraging that AC rates were higher in high risk groups with prior stroke/TIA and CHF, prescription rates were still only about 50%, indicating many missed opportunities for stroke prevention. The markedly high prevalence of all co-morbidities in a randomized sample highlights the importance of continued education emphasizing the increased benefits of AC in patients with co-morbidities.
Estimating incidence of stroke using capture-recapture models
Authors: Tilling Kate , Sterne Jonathan AC , Wolfe Charles DA
Published: March 2022

P57

Background:Incidence of stroke (and other cardiovascular diseases) is often estimated using population-based registers. No register is 100% complete, and cases missed may differ from those registered, for example by having less severe disease. Failure to estimate the number of cases missed will lead to under-estimation of the true incidence of disease. Comparisons between areas, or examination of trends over time, will also be biased if the probability of being registered varies between them. Methods: Recently developed capture-recapture models including covariates were used to estimate incidence of stroke using data from a population-based register in South London, UK. The model parameters were used to estimate ascertainment-adjusted age-standardised incidence rates. Confidence intervals which allow for the uncertainty in the estimation of population size were calculated. Results:The crude capture-recapture model (not including covariates) under-estimated the number of non-fatal strokes. Probability of capture by the register was associated with both demographic variables and stroke-severity indicators. A capture-recapture model including these covariates led to more plausible estimates of the numbers of both fatal and non-fatal strokes, and suggested that the stroke register was approximately 88% complete. Adjusting for the number of cases missed increased the estimated incidence from 1.31 (95% confidence interval 1.21 to 1.42)to 1.49 (95% confidence interval 0.38 to 2.60) per 1,000 people. Conclusions: Using these methods, data from an incomplete register can be used to calculate both incidence and age-standardised incidence. However, sparse data in subgroups can lead to wide confidence intervals for adjusted rates. Routine registers might be made more cost-effective by using the combination of sources and covariates which most accurately estimates the population size, instead of aiming for 100% completeness. Comparisons of incidence between registers should be based on rates which are adjusted for the number and type of cases missed.
Dairy intake and the insulin resistance syndrome in the CARDIA Study.
Authors: Pereira Mark A , Jacobs David R , Hilner Joan E , Van Horn Linda , Slattery Martha L , Ludwig David S
Published: March 2022

P71

Little is known about the potential role of dairy consumption in the etiology of cardiovascular disease. We studied associations between reported dairy intake and components of the insulin resistance syndrome in a prospective study of young black and white adults. Participants attended up to five clinic examinations over a 10-year period beginning in 1985/6 (age = 18 to 35 years). The baseline and year-7 exam included a comprehensive diet history interview. Dependent variables include body mass index (BMI), waist-hip ratio (WHR), systolic blood pressure (SBP), and concentrations of fasting serum insulin, plasma triacylglycerol (Trg), and plasma HDL-cholesterol. Final sample size was 2929 after attrition and exclusions for diabetes, medication use, and pregnancy. Year 10 means of these variables were compared across quintiles of total dairy food and beverage intake with adjustment for their baseline values and for age, physical activity, smoking, education, race, sex, and intake of energy, alcohol, saturated fat, dietary fiber, and vitamin supplements. Dairy intake was associated with all components of the insulin resistance syndrome in a protective manner as follows: BMI: quintile 5 (> 28.4 times/wk) - quintile 1 (< 9.5 times/wk) = -0.5 kg/m2, p for linear trend across quintiles = .003; WHR: -0.01, p =.02; SBP: -1.9 mmHg, p=.02; insulin: -0.6 μU/ml, p = .02; Trg: -4.3 mg/dl, p = .04; HDL:+0.9 mg/dl, p = .12. Studies are needed to determine the mechanisms through which dairy intake may modify risk factors for cardiovascular disease.
Association between Hyperinsulinemia and Hypertension among White, Black, and Mexican American Adults. Results from the Third National Health and Nutrition Examination Survey, 1988-1994.
Authors: Brown David W , Lamar-Welch Verna , Giles Wayne H , Greenlund Kurt J , Croft Janet B
Published: March 2022

P72

Objective: To examine the association between hyperinsulinemia and blood pressure independent of body mass among nondiabetic white non-Hispanic, black non-Hispanic, and Mexican American adults. Methods: We examined this relationship using data from 8004 adults aged ≥20 years from the Third National Health and Nutrition Examination Survey (1988-1994). Univariate differences in body mass index (BMI), waist-to-hip ratio (WHR), glycosylated hemoglobin (HbA

1c

), fasting plasma glucose and C-peptide were examined between normotensives and hypertensives within each racial or ethnic group. Logistic regression was used to obtain the likelihood of being hypertensive across race specific tertiles of C-peptide adjusting for age, sex, education, BMI, and WHR. Results: The prevalence of hypertension was 21.1% among whites, 24.6% among blacks, and 10.9% among Mexican Americans. Hypertensives were older, with higher BMI, WHR, HbA

1c

, fasting plasma glucose, and fasting C-peptide levels than normotensives. Also, the prevalence of hypertension increased significantly with C-peptide level for each of the racial or ethnic groups. Persons with a C-peptide in the upper tertile were more likely to be hypertensive than those with a C-peptide level in the lower tertile after adjustment for age, sex, education, and BMI (Mexican Americans OR=3.3, 95% CI=2.2-4.8; whites OR=2.0, 95% CI=1.5-2.7, blacks OR=2.0, 95% CI=1.3-3.0). Adjustment for WHR attenuated the association between C-peptide and hypertension (Mexican Americans OR=3.0, 95% CI=2.0-4.5; whites OR=1.6,95% CI=1.2-2.2; blacks OR=1.7, 95% CI=1.1-2.6). Conclusion: These results suggest that hyperinsulinemia is associated with hypertension independent of BMI and diabetes. Further, WHR was identified as a confounder and should be taken into account in addition to BMI when evaluating the relationship between C-peptide and hypertension.
Caloric intake, exercise, body mass index and cardiovascular mortality: NHANES I
Authors: Fang Jing , Cohen Hillel , Wylie-Rosett Judith , Kaplan Robert , Alderman Michael H
Published: March 2022

P75

The relationships of exercise and body mass index (BMI) to cardiovascular disease (CVD) risk are well established. While animal studies suggest that caloric restriction extend life, observational data in human has paradoxically equated longer life with higher energy intake. To further explore these relationships, we analyzed the NHANES I and 1992 follow-up study. Of 14,407 NHANES I participants, 9997 subjects with complete data, no heart disease, stroke and cancer, follow-up≥2 years were included. Mean age was 49±16 years. Mean caloric intake was 1760±851 Kcal/day. During an average of 17 years follow-up, of 3183 deaths, 1531 were CVD deaths (9.11/1000 person-years). From the highest to the lowest tertile of caloric intake, age- gender- race-adjusted CVD mortality rates were: 7.5, 9.1 and 10.9/1000 person-years respectively (p=0.02). In Cox regression analysis, adjusting for sociodemographic and CVD risk factors, lower caloric intake was associated with higher CVD mortality, as were lower exercise level and high BMI (

Table). Furthermore, subjects with history of diabetes, kidney disease or hypertension (n=5292) had lower caloric intake than those without these conditions. Excluding subjects with these diseases, after adjustment, no association was found between caloric intake and CVD mortality, while the associations of exercise and BMI with CVD persisted (

Table). In summary, the expected positive relationship of high BMI and low exercise to CVD mortality is again demonstrated in this national sample population. However, the surprising paradoxical association sometimes noted for caloric intake is found to be the result of confounding by chronic disease history.

Table 1.
Progression of Early Atherosclerosis and Intake of Vitamin C and Vitamin E from Supplements and Food. The
Los Angeles Atherosclerosis Study
Authors: Dwyer James H , Merz C. Noel Bairey , Shirocre Anne M , Nordstrom Cheryl K , Dwyer Kathleen M
Published: March 2022

P77

Background. In a previous report on antioxidant intake and 1.5 year progression of carotid intima-media thickness (IMT), we reported the unexpected finding that intake of vitamin C supplements was associated with increased IMT progression. The current paper extends those analyses to 3 years of follow-up. Methods. The cohort of 573 employed women and men was aged 40-60 years and free of CVD at entry. Common carotid IMT (by B-mode ultrasound), supplement intake (by questionnaire) and food intake (by 24-hr recalls) were measured over 3 examinations at 1.5 year intervals. IMT progression at the follow-ups (microns per year) was regressed on intake of antioxidants from different sources (average of baseline and 1.5 year follow-up) in a repeated measures model. Results. IMT progressed an average of 10.0 μm/yr (SD=16.5) among the 500 (87%) members of the cohort with follow-up. After adjustment for CVD risk factors, energy intake, and antioxidant intake from other sources, IMT progression (mean±SE) increased from 7.6±1.8 μm/yr among persons reporting no intake of vitamin C supplements to 20.3±2.6 μm/yr in the highest quartile of vitamin C supplement intake (≥857 mg/day)(p-trend=0.0005). In contrast, IMT progression declined from 10.2±1.4 μm/yr among persons reporting no intake of vitamin E supplements to 1.5±2.8 μm/yr among those in the highest quartile of vitamin E supplement intake (≥443 IU/day)(p-trend=0.02). Reduced progression was observed only in this top quartile of vitamin E supplement intake. Smaller reductions in IMT progression were also observed for high intake of vitamin C from food (indicative of a diet rich in fruits and vegetables) and intake of multiple vitamins (≥ 1 tablet/wk). Vitamin E from food was not associated with IMT progression. Conclusion. Vitamin C supplements may promote early atherosclerosis at higher doses, while vitamin E supplement intake above 450 IU/day may block early atherosclerotic progression. Our findings suggest that completed trials of vitamin E and CHD may have failed to detect benefits because of insufficient dose and intervention at later, rather than earlier, stages of disease.
Dietary Vitamin E Intake and Risk of Coronary Heart Disease in a Representative Sample of US Adults: NHANES I Epidemiologic Follow-up Study
Authors: Bazzano Lydia A , He Jiang , Ogden Lorraine G , Vupputuri Suma , Loria Catherine , Myers Leann , Whelton Paul K
Published: March 2022

P78

Epidemiologic studies suggest that dietary vitamin E intake is inversely related to the risk of coronary heart disease (CHD). We examined the relationship between dietary intake of vitamin E and incidence of and mortality from CHD and cardiovascular disease (CVD) in 9,766 men and women who participated in the NHANES I Epidemiologic Follow-up Study and were free of CVD at their baseline examination. A 24-hour dietary recall was conducted at the baseline examination and nutrient intakes were recalculated using ESHA Food Processor software. Other important risk factors for CVD including age, sex, race, serum cholesterol, blood pressure, body mass index, history of diabetes, education, physical activity, cigarette smoking, and alcohol consumption were also measured at baseline. Those risk factors and dietary intake of saturated fat and total energy were used for adjustment in multivariate analyses. Incidence and mortality data for CHD and CVD were obtained from medical records and death certificates. Cox proportional hazard models were used to examine the relationship between dietary vitamin E intake and the incidence of and mortality from CHD and CVD. Over an average of 19 years of follow-up, 1,845 incident cases of CHD (669 fatal) and 3,760 incident cases of CVD (1,197 fatal) were documented. The adjusted relative risk (RR) was 0.89 (95% confidence interval [CI], 0.77-1.02, p=0.03 for trend) for incident CHD events, 0.69 (95% CI: 0.55−.86, p=0.001 for trend) for fatal CHD events, and 0.85 (95% CI: 0.70-1.02, p=0.03 for trend) for fatal CVD events among those in the highest quartile of dietary vitamin E intake (median, 17.5 mg/d) compared with those in the lowest quartile (median, 3.0 mg/d). These findings support the hypothesis that increasing vitamin E intake may be an important element of dietary approaches to reducing the incidence of and mortality from CHD in the US population.
Association of Dietary Fish and Omega-3 Intake with Plasma Glucose
Authors: Daviglus Martha L , Liu Kiang , Siscovick David , Iribarren Carlos , Jacobs David , Archer Sujata
Published: March 2022

P88

OBJECTIVE: Dietary fish and omega-3 fatty acids (n-3 FAs) are associated with a reduced risk of CHD mortality. However, enthusiasm for the intake of fish and n-3 FAs in type 2 diabetics has been tempered by reports of impaired glucose homeostasis. Most studies showing this negative impact of fish intake and n-3 FAs on glycemic control have been feeding or supplement studies conducted for short time periods. There are little data on the relationship of fish and n-3 FA intake to glucose levels in free-living diabetic populations. This study examines the associations of dietary fish and n-3 FAs with blood glucose levels among participants with type 2 diabetes from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS: A total of 43 diabetic (i.e., fasting glucose levels >125 mg/dl) black and white men and women average age 33.6 years in 1992-1993 were included in analyses. Data on fish and n-3 FAs [α-linolenic acid (ALA, 18:3n-3), eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3)] were obtained from an interviewer administered diet history questionnaire. RESULTS: Average amount of fish consumed was 25.34 oz/mo. Mean intake of ALA, EPA, and DHA was 2.2 g/d, 0.07 g/d, and 0.13 g/d, respectively. Spearman rho correlations show a nonsignificant direct association of glucose with intake of fish (ρ=0.10), ALA (ρ=0.18), EPA (ρ=0.24), and DHA (ρ=0.11). For diabetics who consumed fish (n=29), mean glucose was 196.1 mg/dl compared to 208.9 mg/dl for the nonconsumers (n=14). Average glucose levels were highest for the highest tertile of n-3 FAs, e.g., for DHA intake (from lowest to highest) 191.1 mg/dl, 211.5 mg/dl, and 213.0 mg/dl. However, with adjustment for age, BMI, race, sex, education, alcohol and smoking this pattern changed, mean glucose levels were lowest for highest tertile of DHA intake, i.e, (from lowest to highest) 202.1 mg/dl, 215.9 mg/dl, and 196.3 mg/dl. CONCLUSION: In this cohort of free living young diabetics with typical low to moderate fish consumption, no significant differences in blood glucose levels were observed with intake of fish or n-3 FAs. Fish consumption at moderate levels does not appear to be associated with poor glycemic control.
Aerobic Exercise and Resting Blood Pressure in Older Adults: A Meta-Analytic Review of Randomized Controlled Trials
Authors: Kelley George A. , Kelley Kristi S.
Published: March 2022

P98

OBJECTIVE: Use the meta-analytic approach to examine the effects of aerobic exercise on resting systolic and diastolic blood pressure in older adults. METHODS: Studies were retrieved from (1) computer searches (MEDLINE, Current Contents, Sport Discus), (2) cross-referencing from bibliographies of retrieved studies and review articles, and (3) expert review of reference list. Inclusion criteria for this study were (1) randomized trials, (2) aerobic activity as the only intervention, (3) nonexercise control group included, (4) changes in resting systolic and/or diastolic blood pressure assessed, (5) within study ages of subjects ≥ 50 years, (6) English-language studies published in journals between January 1966 and January 1998. All studies were coded by both authors, independent of each other. The authors then met and reviewed every item coded. Discrepancies were resolved by consensus. Net changes in blood pressure were calculated as the exercise minus control group difference. RESULTS: A total of 14 primary outcomes were derived from 7 studies. Using a random-effects model, decreases of approximately 2% and 1% were found for resting systolic and diastolic blood pressure, respectively, with only changes in systolic blood pressure statistically significant (systolic, mean ± SD = -2 ± 3 mmHg, 95% confidence interval = -4 to -1; diastolic, mean ± SD = -1 ± 2 mmHg, 95% confidence interval = -2 to 0 mmHg). No statistically significant publication bias was observed for changes in either resting systolic or diastolic blood pressure. Regression analyses revealed a statistically significant association between changes in resting systolic blood pressure and initial systolic blood pressure (R = 0.73, SEE = 0.57, p = 0.003). Changes in blood pressure were independent of changes in body weight, body fat, and body mass index. CONCLUSIONS: Aerobic exercise is efficacious for reducing resting systolic blood pressure in older adults. However, a need exists for additional studies that address the effectiveness of this intervention for reducing resting blood pressure in older adults.
Vigorous physical activity, cardiorespiratory fitness and a diet low in saturated relative to polyunsaturated fat may protect against development of the metabolic syndrome in middle-aged men.
Authors: Laaksonen David E. , Lakka Timo A. , Lakka Hanna-Maaria , Nyyssonen Kristiina , Niskanen Leo K. , Rauramaa Rainer , Kaplan George A. , Salonen Jukka T.
Published: March 2022

0012

Few studies have prospectively addressed the role of physical activity, fitness and dietary fat type in the development of the metabolic syndrome (MS), a condition that markedly increases the risk for diabetes and cardiovascular disease. We examined the development of MS in 453 normoglycemic men participating in the Kuopio Ischemic Heart Disease Risk Factor Study who had no more than 2 features of MS at baseline. Leisure-time physical activity for the preceding 12 mo was measured at baseline with a validated questionnaire. Maximum oxygen uptake was measured directly during an exercise stress test. Long-term dietary fat composition was estimated from lipid-standardized proportions of saturated and polyunsaturated fatty acids measured from fasting whole serum. After 4 y 145 men had developed 3 or more features of MS as defined by the presence of impaired fasting glucose or diabetes (fasting blood glucose ≥5.6 mM), overweight or obesity (BMI ≥27 kg/m

2

), waist-hip ratio ≥0.90, hypertension (blood pressure ≥140/90) or dyslipidemia (serum triglycerides ≥1.7 mM or HDL <0.9 mM). In logistic regression analyses adjusting for confounding factors, the serum palmitate proportion (OR 2.7, 95%CI 1.4-5.1 for upper vs lower third) and palmitate/linoleate ratio (OR 2.3, 95%CI 1.2-4.4 for upper vs lower third) was positively and the α-linolenate proportion (OR 0.44, 95%CI 0.23-0.84) negatively associated with development of MS. The serum linoleate proportion tended to protect against development of MS (OR 0.55, 95%CI 0.28-1.04). Cardiorespiratory fitness (OR 0.37, 95%CI 0.28-0.97 for highest vs lowest fourth) and at least 20 min vigorous exercise/wk (OR 0.53, 95%CI 0.28-1.00) protected against development of MS independently of confounding factors. Although genetic and other factors may also play a role, these findings underscore the importance of dietary fat modification and physical exercise for primary prevention of the metabolic syndrome and its consequences even in apparently low-risk middle-aged men.
Coronary Artery Calcification in Type 2 Diabetes and Insulin Resistance: the Framingham Offspring Study
Authors: Meigs James B , Larson Martin G , Clouse Melvin E , Nathan David M , Wilson Peter WF
Published: March 2022

0002

Risk for clinical atherosclerosis is increased in people with type 2 diabetes (DM). We assessed subclinical atherosclerosis (SCA) of the coronary arteries using electron beam computed tomography (EBCT) in subjects classified with normal or impaired glucose tolerance (NGT or IGT) or DM, or with or without insulin resistance (IR). Glucose tolerance was categorized by DM therapy (diagnosed [Dx] DM) or with an oral glucose tolerance test (IGT and new DM; 1997 ADA criteria) and IR as >90th percentile fasting insulin in subjects with NGT, in subjects of the Framingham Offspring Study attending the 5th exam (1991-95). A subset free of clinical CVD were selected for EBCT in 1998-99 from age-stratified sex-specific quintiles of the Framingham coronary heart disease risk score. Coronary SCA was quantified by Agatston scores, with the top quartile of score distributions defined as presence of SCA. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for IGT and DM (Dx, new, or both), or IR, predicting SCA. Models were adjusted for age and sex, these and smoking, total/HDL cholesterol ratio and systolic blood pressure, and finally for IGT and DM together with IR. Of 325 subjects aged 31-73 years, 51% were men; 11.2% had IGT and 9.9% had DM (2.8% Dx DM); 14.5% had IR. Compared with NGT, subjects with IGT tended to be more likely (adjusted OR 1.5, 95% CI 0.7-3.4) and those with DM were significantly more likely (2.7, 1.2-6.1) to have coronary SCA. In age-,sex-adjusted models those with IR were more likely to have coronary SCA compared with those without IR (2.1, 1.0-4.2), but further risk factor adjustment weakened this effect. In adjusted models including IR, DM remained associated with risk for coronary SCA, (2.8, 1.2-6.7); Dx DM (6.0, 1.4-25.2) having a larger effect than new DM (2.1, 0.8-5.5). We conclude that subjects with DM have an elevated burden of coronary SCA independent of IR. IR or CVD risk factors may partially explain effects of new DM. Although sample size limits analytic power, there was a trend for subjects with subclinical glucose intolerance to have increased coronary SCA, supporting the hypothesis of a common DM/CVD risk state.
The association between orthostatic hypotension and the six-year incidence of hypertension:
Authors: Rose Kathryn M , Light Kathleen C , Sharrett A R , Tyroler Herman A
Published: March 2022

0020

This study examined the association between orthostatic hypotension (OH) and the six-year incidence of hypertension and isolated systolic hypertension (ISH) in 6,951 normotensive men and women free of CHD who participated in the baseline examination of the Atherosclerosis Risk in Communities (ARIC) study. OH, measured at baseline, was defined as a decrease in SBP ≥ 20 mm Hg or a decrease in DBP ≥ 10 mm Hg after changing from the supine to the standing position. Hypertension (SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg or current use of antihypertensive medications) and ISH (SBP ≥ 140 mm Hg and DBP < 90 mm Hg) status were ascertained at the second follow-up examination, which occurred approximately six years later. In unadjusted analyses, OH was associated with an increased risk of both hypertension (Odds Ratio (OR)= 2.07, 95% confidence interval (CI) = 1.51, 2.84) and ISH (OR=2.28, 95% CI = 1.53, 3.41). These associations were modestly attenuated after controlling for age, race, gender, BMI, and carotid intima media thickness. Baseline seated SBP was a significant effect modifier of both the OH - hypertension and the OH - ISH associations. Specifically, associations of OH with each of the outcomes were strongest among those with the lowest levels of baseline seated SBP (e.g., seated SBP of 90 mm Hg: OR = 4.8 for hyperetnsion and OR = 9.4 for ISH) and did not persist among those with the highest levels of baseline seated SBP (e.g., seated SBP of 130 mm Hg: OR = 1.1 for hypertension and OR = 1.0 for ISH). We conclude that OH is a strong predictor of hypertension and ISH in persons with low normal blood pressure at baseline and that OH in combination with low normal blood pressure may be an early indicator of impaired blood pressure regulatory systems.
Blood Pressure Control in Hispanic Participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
Authors: Margolis Karen L , Piller Linda B , Lewis Cora E , Goff David C , Cushman William C , Wright Jackson T , Colon Pedro J , Ford Charles E
Published: March 2022

0021

In contrast to Black non-Hispanics (BNH), Hispanic Americans have a prevalence of hypertension that is similar to the White non-Hispanic (WNH)population. However, compared to BNH and WNH, hypertension awareness, treatment and control are much lower in Hispanics. ALLHAT is a double-blind randomized controlled trial in high-risk hypertensives age >=55, comparing the effects of treatment with chlorthalidone, amlodipine, doxazosin and lisinopril (Step 1) on cardiovascular events. Open label treatment with atenolol, clonidine, reserpine (Step 2), and hydralazine (Step 3) may be added as necessary to achieve the goal of <140 systolic (SBP) and <90 diastolic (DBP). There are 32,398 participants with follow-up data at 24 months. Both White and Black Hispanics had similar SBP and BP control to WNH at 24 months of followup. Fewer Hispanics were taking maximal dose Step 1 or Step 2/3 medications. These results suggest that equal access to care can lead to equal BP control in White non-Hispanic and Hispanic Americans.

Table 1.
Serum albumin is related to the incidence of stroke -
Authors: Chambless Lloyd E
Published: March 2022

0025

We previously reported an inverse association between serum albumin and prevalent stroke. To examine the risk of future stroke associated with serum albumin we conducted a prospective analysis of 15,271 stroke-free individuals, participants in the population-based bi-ethnic Atherosclerosis Risk in Communities (ARIC) study baseline examination (1987-1989). Over an average follow-up of 7 years, 218 incident hospitalized ischemic stroke cases were identified by standardized methods. The baseline mean levels (SD) of serum albumin were 3.77 (0.31) and 3.87 (0.27) g/dl respectively, for the incident stroke group and for those who remained free of stroke. Multivariable adjusted proportional hazard ratios (HR) and 95% CI of stroke per 1 SD (0.27 g/dl) lower albumin are presented in the

table. Interactions of albumin and each of the stroke risk factors in the

table were tested, and none were statistically significant. These data suggest that serum albumin is prospectively and inversely associated with the risk of ischemic stroke. This association is partially, but not fully, accounted for by the conventional risk factors, especially the hemostatic factors.

Table 1.
Predictors of falling cholesterol levels in older adults:
Authors: Manolio Teri A , Kuller Lewis H , Kronmal Richard A
Published: March 2022

0028

Declining cholesterol levels are common in older persons and are often considered a harbinger of serious illness or death, but factors related to short-term decline in cholesterol remain poorly described. Prospective data from 1,684 women and 1,155 men aged > 66, not taking lipid-lowering medications and with serum cholesterol measured in 1992-93 and 1996-97 were examined for distribution and correlates of four-year change in cholesterol level. Mean serum cholesterol changed an average of -6.3 mg/dl between examinations after correction for measurement error due to laboratory and within person variability. Declines were greater in white (-7.3 mg/dl) than black (-1.4 mg/dl) participants and in those in good/ excellent health (-6.9 mg/dl) vs. fair/poor health (-3.2 mg/dl; both p < 0.01). Subjects in the highest quartile of decline (-22 through -150 mg/dl) had higher prevalences of cancer, coronary disease, and claudication at entry than those in the other three quartiles. Factors associated with decline > 16 mg/dl on multivariate analysis included age, male gender, white race, weight loss between exams, and higher levels of albumin, cholesterol, and white blood cell count in 1992-93 (all p < 0.03). Cholesterol declined 6.8 mg/dl more in men than in women and 3.0 mg/dl more in whites than blacks in multivariate analyses adjusting for age, weight change, gender, low cholesterol diet, internal carotid thickness, and levels of albumin, fibrinogen, cholesterol, and white blood cell count. In this same analysis, a 5.1 kg decrement in weight was associated with a 5.1 mg/dl decline in cholesterol level (p < 0.001). Higher carotid thickness and fibrinogen levels were associated with rises in cholesterol between exams, all other factors held constant. Substantial four-year declines in cholesterol levels occur in older adults and appear primarily related to unmodifiable factors such as advancedage and male gender. The relationship between weight loss, which is often unintentional in the elderly, and declining serum cholesterol should be further explored to clarify the mechanisms of the sometimes marked age-related declines in cholesterol levels observed at advanced ages.
Monitoring Behavioral Risk Factors for Cardiovascular Disease in Russia
Authors: Schmid Thomas L
Published: March 2022

0008

The purpose of the project was to provide assistance to Russia in establishing a national surveillance system for monitoring CVD risk factors. The Behavioral Risk Factor Surveillance System, which was developed in the US and is used by all State Health Departments, served as a template for the Russian system. Personal interviews, mail-based and telephone-based surveys were reviewed and considered. Questions were taken from previous Russian, European, and US surveys to collect information on smoking, alcohol use, fruit and vegetable consumption, physical activity, blood pressure, self-reported CVD symptoms and previously diagnosed diseases. This was the first Russian phone-based health survey and was piloted in Moscow where a random sample of 6065 was selected from the 2,560,633 private phone listings. Initial analysis found that in general, prevalence of CVD risk factors was higher than in similar American surveys. The current smoking rate reached 52%, 30% had a BMI below 24 kg/m

2

, 60% reported average daily fruit consumption of less then 1/4 of a pound (200 g) per person in the summer, elevated, untreated blood pressure (more then 140/90 mm Hg) was reported by 25 % while another 10 % received medication for hypertension, 18% of men and 4% of women reported heavy drinking. Though duration of walking was rather high compared with the US (about 90 min per day), only 5 % engaged in other moderate physical activity on a regular basis; 20% of respondents said that they experienced CVD symptoms or were diagnosed with CVD. In general, CVD risk factors were more prevalent among men. Next year 11 additional sites will conduct the survey. These data help fill the gap in public health knowledge related to prevalence of CVD risk factors in Russia and demonstrate the value of establishing a monitoring system. They also indicate that immediate preventive measures are needed to improve the health status of the population.
Abstract 5771: Aortic Root Dilatation is a Phenotypic Manifestation of the Bicuspid Aortic Valve Disease Prevalent in Relatives with Normal Aortic Valve.
Authors: Biner Simon , Rafique Asim , Ray Indraneil , Cuk Olivera , Siegel Robert , Tolstrup Kirsten
Published: March 2022

Background:
Bicuspid aortic valve (BAV) and dilated ascending aorta frequently coexist. 10% of first degree relatives (FDRs) of probands with BAV inherit a valvular abnormality, however there is limited data concerning the occurrence of dilated aortic root in families of affected subjects. We evaluated the prevalence of aortic root dilatation among FDRs with a tricuspid aortic valve.

Methods:
Aortic root dimensions were measured by 2D echocardiography in BAV probands (n=48), their FDRs (n = 49) and controls without structural heart disease matched by age and gender (n=44). Aortic root was measured at: annulus, sinuses of Valsalva, sino-tubular junction and proximal ascending aorta. The dimensions were indexed by body surface area (BSA). Presence of dilatation was determined using published confidence intervals relating normal aortic diameters to BSA and age.

Results:
Five subjects (10%) in FDR group were found to have BAV, thus they were included in BAV group. Indexed aortic diameter was significantly different in 3 groups namely BAV>FDR>Control at annulus (2.0±0.3, 1.7±0.2, 1.6±0.1, p<0.001) and sinuses of Valsalva (2.8±0.5, 2.4±0.4, 2.2±0.3, p<0.001) Figure

. BAV subjects showed significantly larger dimensions in the ascending aorta compared to FDRs and controls (p<0.001). The prevalence of aortic root dilatation at all levels was 51% in BAV subjects, 25% in FDRs and 0% in controls (p<0.001).

Conclusions:
There is high prevalence of aortic root dilatation in the FDRs of subjects with BAV despite having normal tricuspid aortic valve. This finding suggests that aortic root dilatation is another phenotypic manifestation of BAV disease that is inherited independent of BAV.
Abstract 104: Elevated Serum Cortisol Levels As A Risk Factor For Developing Coronary Artery Abnormalities In Kawasaki Disease
Authors: Toyoda Rina , Takatsuki Shinichi , Aso Keiko , Sato Mari , Saji Tsutomu
Published: March 2022

Background and objectives:
Endogenous cortisol (CRS) increases in a variety of inflammatory diseases and vasculitis syndrome, and recognized as a one of risk factors of disease progression. Although only one previous study reported that CRS level is elevated in acute Kawasaki disease (KD), the predictive value of CRS in KD has not been fully investigated. The aim of this study is to evaluate whether serum CRS levels can predict initial treatment response and development of coronary artery abnormalities (CAAs) in the acute phase of KD.

Materials and Methods:
A retrospective study was designed to evaluate serum CRS levels in 92 children with acute KD who were admitted between December 2011 and May 2014. The subjects consisted of 46 males and 46 females aged from 1 month to 12 years (median, 2 years). Serum CRS levels were measured before the initial treatment of IVIG. With Kobayashi score for predicting IVIG resistance, patients were divided into high (Kobayashi Score≧5) and low risk (Kobayashi Score <5) group. Coronary artery diameter was measured at weeks 1, 2, 4 and we calculated maximum Z-score. CAAs were defined as equal to greater than 2.5 of Z-score.

Results:
Serum CRS level was 32.7μg/dl (median, 6.2 to 139μg/dl) which is higher than healthy children (5 to 25μg/dl), and significantly elevated in high risk group (median, 41.3μg/dl ) than those in low risk group (median, 27.1μg/dl, p=0.003).

In patients with CAAs CRS level was higher than those without CAAs (Z<2.5 vs Z≧2.5, median 30.4 vs 37.3μg/dl, p=0.052). Additionally, 1 patient who had maximum cortisol level (139μg/dl) showed CAAs (Z-score, seg1: 9.1, seg5: 10.2 at week 4). CRP, WBC counts, and albumin level had no significant correlation with CRS.

Conclusions:
We conclude that serum CRS before IVIG were significantly higher in patients with high risk group. CRS may be a potential predictor for developing CAAs.
Abstract 109: Predictors Of Unresponsiveness To Initial Immunoglobulin In Patients With Kawasaki Disease
Authors: Yu Jeong Jin , Cho Eun Kyung , Jun Hyun Ok , Kang So Yeon , Seo Chang Deok , Baek Jae Suk , Kim Young-Hwue , Ko Jae-Kon
Published: March 2022

Background:
Recently, several studies to predict the unresponsiveness to initial intravenous immunoglobulin (IVIG) treatment during the acute phase of Kawasaki disease have been conducted. However, reported predictors are varied in those studies. The racial difference was assumed as the cause of such diversity. The aim of this study is to find predictors of unresponsiveness to initial IVIG in Korean children with Kawasaki disease.

Subjects and methods:
Subjects were 424 patients with Kawasaki disease who had been admitted to Asan Medical Center from January 2006 to December 2012. Demographic, clinical, and laboratory data were investigated through a review of medical records. Laboratory data before initial IVIG treatment and within 10 days after fever onset were selected. Forty one patients (9.7%) were non responders to initial IVIG treatment. Univariate and multivariate logistic regression analyses were performed to find predictors of unresponsiveness to initial IVIG treatment.

Results:
Median age was 30.0 months (range 1.6-186.0 months) in IVIG-responders, and 30.9 months (range 2.9-107.8 months) in IVIG-nonresponders (P=0.819). Number of females was 156 (40.7%) and 15 (36.6%) respectively (P=0.607). No other demographic and clinical variables were different between two groups. Univariate analyses showed that neutrophil percentage (P<0.001), serum C-reactive protein (P=0.008) and total bilirubin (P<0.001) were higher, and that serum protein level (P=0.001), albumin level (P<0.001), sodium concentration (P<0.001), and chloride concentration (P=0.002) were lower in IVIG-nonresponders. Neutrophil percentage (OR 1.075, 95% confidence interval 1.027~1.125. P=0.002) and serum total bilirubin(OR 1.845, 95% interval 1.284~2.650. P=0.001) were significant predictors in Multivariate analyses.

Conclusion:
The results of this study were inconsistent with the results of previously conducted studies with the same purpose in other countries. Therefore future study with more number of subjects is needed for confirmative identification of predictors of unresponsiveness to initial IVIG treatment in patients with Kawasaki disease.
Abstract 121: Outcome Of Patients With Kawasaki Disease Treated With Intravenous Pulse Methylprednisolone As Primary Therapy: An 8 Year Single Center Experience
Authors: Bernal Christine B , Cuaso Charles , Ngo Joenavin
Published: March 2022

Kawasaki disease (KD) is a medium vessel vasculitis with predilection to affect the coronary arteries. While intravenous immunoglobulin (IVIG) remains the standard primary treatment, the cost remains a big burden for parents of patients in developing countries. Steroids do have a role in IVIG-resistant KD but studies on its benefit in addition to IVIG as primary treatment are conflicting. In our institution, parents who cannot afford IVIG consented to intravenous pulse methylprednisolone (IV MP) as an alternative primary treatment.

Objective:
To review the outcome of KD patients treated with IV MP as primary treatment.

Methods:
Retrospective chart review of patients who fulfilled the diagnostic criteria for KD and treated with IV MP (30 mg/kg/dose, maximum of 1 gm/dose, given once daily for 3 consecutive days) plus high dose Aspirin from January 2006 to December 2013.

Results:
A total of 36 patients were included in the study with a mean age of 4.2 years (range 0.4-12.6). The F:M ratio was 1:1. Majority (75% - 27/36) of the patients received the treatment before the tenth day of illness. There was clinical improvement in all patients with lysis of fever and resolution of all signs and symptoms immediately after the first dose of IV MP. None of the patients had a relapse of KD. The CRP significantly decreased after the treatment in all patients. For all patients, baseline echocardiography was done by a single pediatric cardiologist and was repeated after 2 months, 6 months, then yearly. At baseline, 36 patients had pericardial effusion, 13 with perivascular brightness, 15 with coronary ectasia and 8 with valvular abnormalities (MR, AR, TR). Follow up evaluation after 2 months showed no echocardiographic abnormalities in all patients, up until the yearly echo. None of the patients developed coronary aneursysm. There was no reported immediate nor long term side effects from the steroid therapy.

Conclusion:
Intravenous methylprednisolone is effective in controlling the clinical manifestations of KD and in preventing cardiac complications. It is safe and well-tolerated by patients. It can be an alternative first line treatment for KD patients whose parents cannot afford the high cost of IVIG.
Abstract 126: A Case Of Slowly Progressing Giant Coronary Aneurysm In A Patient With Intractable Kawasaki Disease
Authors: Han Ji Whan , Seo Yu Mi , Lee Kyu Jin , Kim Joo Hyun , Lee Jae Young , Oh Jin Hee , Lee Soon Ju
Published: March 2022

Background:
Some patients with intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) do not respond to intravenous methylprednisolone (IVMP). Infliximab (IFX; anti-TNF-α antibody) is an alternative medication for intractable KD. Its effectiveness in preventing coronary aneurysms from progressing is being reported. We herein report a case of intractable KD that slowly progressed to giant aneurysm despite a second IFX infusion.

Methods:
A 2-year-old boy visited our hospital with a 2-day history of fever. On day 3 after fever onset, a swollen cervical lymph node, redness of the BCG (bacilli Calmette Guérin) inoculation site, and indurated erythema of the palms with soles were observed. On day 5, conjunctival injection, strawberry tongue, red lips and truncal rash were present. The patient was diagnosed with KD and treated with IVIG and acetylsalicylic acid (ASA).

Results:
The fever persisted for 24 h after IVIG treatment. A second dose of IVIG was infused. However, the fever continued. Then IVMP was infused. On day 9, the fever resolved. On day 10, two-dimensional echocardiography (2DE) showed mild dilations (Φ 3.0 mm) of both coronary arteries (CAs). On day 18, the fever recurred. Follow-up 2DE showed dilated CAs (left main coronary artery [LM], Φ 4.0 mm; right coronary artery [RCA], Φ 4.0 mm). Therefore, IFX was intravenously infused. On day 19, the fever had resolved and the patient went home. On day 22, the fever recurred. Thus, a second infusion of IFX was done. On day 24, the fever resolved. Follow-up 2DE showed that the diameters of the CAs were 4.0 mm (LM), 7.0 mm (left anterior descending coronary artery [LAD]), 3.0 mm (RCA). On day 28, a mild fever was still present. On day 47, follow-up 2DE indicated that the diameters of the CAs were 3.0 mm (LM), 8.0 mm (LAD), 2.5 mm (RCA). On day 159, follow-up 2DE showed slightly increased regression of CAs. The patient has been undergoing regular 2DE and taking ASA since he left the hospital.

Conclusions:
This was a very rare case of KD that was resistant to standard treatment comprising high-dose steroids and TNF-α blockade. We have reported this case to inform clinicians who may encounter such patients with KD in the future. A high index of suspicion and keen observations are strongly recommended for cases of intractable KD.
Abstract 127: Usefulness Of Kawasaki Disease Risk-scoring Systems For Initial Intravenous Immunoglobulin Resistance In Korean Patients with Kawasaki Disease
Authors: Han Mi Young , Koo Jae Hoe , Cho Jung Yoon , Yoon Kyung Lim , Cha Sung Ho
Published: March 2022

Intravenous immunoglobulin (IVIG) infusion in the acute stage is the standard therapy in patients with Kawasaki disease (KD). Although some risk-scoring system made in Japan are widely used, there are few reports that describe the usefulness of risk-scoring systems to predict initial IVIG resistance. This study aimed to investigate which risk-scoring system of KD is the most useful. And this study evaluated the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) as an additional criteria of risk-scoring system. In this study, 228 patients with a diagnosis of KD who received IVIG treatment were viewed retrospectively. Of these 228 patients, 27 were nonresponders who received additional rescue therapy. The Kobayashi score (responders n=201, non-responders n=27) showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 83 % and specificity of 67 %. The Egami score (responders n=201, non-responders n=27) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 38 % and specificity of 92 %. The Sano score (responders n=108, non-responders n=15) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 52 % and specificity of 90 %. The new risk-scoring system ( Kobayashi risk-scoring + NT-proBNP > 1093 pg/mL, responders n=201, non-responders n=27, high risk ≥ 5 points ) also showed statistically significant difference between IVIG-sensitive and IVIG-resistant patients, yielding a sensitivity of 83 % and specificity of 71 %. This findings show the new risk-scoring system is helpful in determining patients at risk for non-responders to initial IVIG treatment. This study suggest that in patients with high risk defined as ≥ 5 points, risk calculation by new scoring system are likely to fail to the initial IVIG therapy and may require further rescue therapy in Korean Kawasaki disease patients .