bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P168: Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism
Authors: Walker Rob F , Maclehose Richard F , Claxton J'Neka , Adam Terrence , Alonso Alvaro , Zakai Neil A , Lutsey Pamela L
Published: December 2020

Introduction:
Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during the primary treatment of VTE.

Hypothesis:
Among anticoagulant-naïve VTE patients we tested the hypotheses that the number of hospitalizations, days hospitalized, emergency department visits, and outpatient office visits would be lower among users of rivaroxaban or apixaban than among users of warfarin.

Methods:
MarketScan databases for years 2016 and 2017 were used to identify VTE cases and comorbidities using international classification of disease codes, and prescriptions for OACs via outpatient pharmaceutical claims data. Healthcare utilization was identified in the first 6 months after initial VTE diagnoses.

Results:
The 23,864 individuals with VTE cases were on average (± standard deviation) 55.7 ± 16.1 years old and 50.6% female. Participants had on average 0.2 ± 0.5 hospitalizations, spent 1.3 ± 5.2 days in the hospital, had 5.7 ± 5.1 outpatient encounters, and visited an emergency department 0.4 ± 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, office visits and emergency department visits, after accounting for age, sex, comorbidities and medications (Table 1). For example, hospitalization rates were 24% lower [IRR: 0.76 (95% CI: 0.69, 0.83)] for patients prescribed rivaroxaban and 22% lower [IRR: 0.78 (95% CI: 0.71, 0.87)] for patients prescribed apixaban, as compared to those prescribed warfarin. When comparing apixaban to rivaroxaban, there were no differences in healthcare utilization.

Conclusions:
VTE patients prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of direct OACs over warfarin given their similar effectiveness, slightly better safety profile, and perceived lower patient burden.
Abstract P189: Metabolomic Signatures Of Serum Creatinine Among Hypertensive African Americans.
Authors: Chaudhary Ninad S , Tiwari Hemant K , Allred Nicholette , Hsu Fang-Chi , Bowden Donald , Freedman Barry , Arnett Donna K , Irvin Marguerite M
Published: December 2020

Background:
The prevalence of chronic kidney disease (CKD) in African Americans (AAs) is high. Although ancestry-specific biomarkers have been identified, few translate to the clinic. Metabolomic studies may identify novel biomarkers useful for prevention, diagnosis and treatment.

Methods:
Plasma from 300 AA Hypertension Genetic Epidemiology Network (HyperGEN) study participants age ≥40 years with serum creatinine (SCr) <2 mg/dL were assayed for an untargeted metabolomic study of SCr using an ultra-high performance liquid chromatography mass spectrometry platform (Metabolon
®
). SCr was measured using a thin-film adaptation of the amidohydrolase enzymatic method on fasting blood samples. Each metabolite was tested for normality and a rank-based inverse normal transformation was performed as appropriate. Multivariable linear regression was used to test for association between the metabolite (outcome) and SCr (exposure of interest) adjusting for age, gender, waist circumference and center. A Bonferroni correction was used to adjust for multiple testing using. The top 25 most significant metabolites were evaluated for replication in 367 participants from the African American-Diabetes Heart Study (AA-DHS). An exploratory pathway analysis was conducted among significant (p< 6.0*10
-5
6.0e
-5
metabolites in HyperGEN.

Results:
Among 300 participants from HyperGEN the mean age was 54.5 years (SD=9.5) and 58.7% were female. Mean SCr was 0.93 (SD=0.25). Eighty percent were treated for hypertension and 28% had diabetes. A total of 809 metabolites were annotated in HyperGEN samples. Of those, 391 were associated with SCr at p<0.05 and 256 metabolites met the Bonferroni significance criteria (p< 6.0*10
-5
). The top SCr associated metabolites were tartonate(hydroxymalonate)(β[SE]= 2.99[0.07], p=3.98e
-117
), 1-stearoyl-GPC(18:0)(β[SE]= 2.49[0.14], p=2.28e
-44
), 2S-3R-dihydroxybutyrate)(β[SE]= 2.36[0.14],p=1.53e
-40
) and isovalerate(C5)( β[SE]= 2.30[0.15], p = 2.78e
-36
). The association of these metabolites with SCr replicated in AA-DHS [(tartonate(hydroxymalonate)(β[SE]= 0.66[0.19], p=0.001), 1-stearoyl-GPC(18:0)(β[SE]= 1.30[0.20], p=1.61
-10
), 2S-3R-dihydroxybutyrate)(β[SE]= 1.20[0.18],p=4.69e
-11
) and isovalerate(C5)( β[SE]= 1.24[0.20], p = 1.91e
-09
)]. An exploratory pathway analysis highlighted xenobiotics and the lysophospholipid pathway.

Significance:
Tartronate is a xenobiotic that is related to BMI, insulin resistance and adiponectin. 1-stearoyl-GPC (18:0) is a lysophospholipid metabolite found to be associated with oxidative stress.

Conclusion:
The current study discovered and replicated metabolites associated with SCr in a population of AAs with a high prevalence of hypertension. If validated, these could provide new insights in kidney disease pathways or aid in the treatment and prevention of CKD in the AA population.
Abstract P194: Proteomic Analysis of Cardiac Troponin I And T in Older Adults Without Cardiovascular Disease
Authors: Tang Olive , Coresh Josef , Chen Jingsha , Tin Adrienne , Matsushita Kunihiro , Boerwinkle Eric , Yu Bing , Jia Xiaoming , Hoogeveen Ron C , Pankow James S , Ballantyne Christie M , Selvin Elizabeth
Published: December 2020

Background:
Minute elevations in cardiac troponins detected with high sensitivity assays are associated with cardiovascular disease (CVD) and mortality. The biology underlying these associations is uncertain. We identified plasma proteins associated with cardiac troponins and assessed the relation of troponin-associated proteins with CVD and all-cause mortality in adults without prevalent CVD.

Methods:
We included 3451 adults (62% female, 18% black, mean age: 75 years) in ARIC at Visit 5 (2011-2013). High sensitivity assays were used to measure troponins (hs-cTnI [Abbott], hs-cTnT [Roche]). We used linear regression to model the association of log2-transformed troponin and plasma proteins (SomaLogic aptamer assay). Upstream regulators of the troponin-associated proteins were identified using Ingenuity Pathway Analysis. Elastic net was used to extract troponin-associated protein signatures for principal component analysis and Cox models of CVD and all-cause mortality (median follow-up: 6 years).

Results:
Of the 4326 plasma proteins, there were 281 significantly (p<1.16e-5) associated with hs-cTnI and 576 with hs-cTnT (adjusted for age and sex). In models adjusted for CVD risk factors, there were 99 proteins associated with hs-cTnI and 118 associated with hs-cTnT (Figure), with 65 in common; the top upstream regulator associated with both hs-cTnI (p = 0.001) and hs-cTnT (p=0.006) was myocardin (MYOCD), a transcriptional activator in smooth and cardiac muscles. The first principal component derived from the troponin-associated proteins was significantly associated with both all-cause and CVD mortality. In models with both troponins and the first principal component, hs-cTnI, but not hs-cTnT, remained significantly associated with both outcomes (Table).

Conclusions:
Hs-cTnI and hs-cTnT have overlapping, but distinct, proteomic signatures. The underlying proteomic signature explains most of the mortality risk associated with hs-cTnT, but not hs-cTnI.
Abstract P251: Monitoring the Success of Smoking Cessation Using Dna Methylation Status at Cg05575921: Implications for Incentive Based Strategies for Quantitative Reduction of Harm
Authors: Philibert Robert , Dogan Meesha , Hoffman Eric
Published: December 2020

Cigarette smoking accounts for about 1/5 of all deaths from heart disease in the United States. Despite this grim fact, getting patients to quit smoking is extremely difficult. Encouragingly, several studies have shown that incentive based smoking cessation interventions may be more effective than traditional strategies. However, their implementation has been stymied by the lack of clinically implementable objective mechanisms to determine smoking cessation in those using nicotine replacement. Over the past several years, we and others have shown that DNA methylation status at a CpG site in the AHRR gene referred to as cg05575921 accurately classifies smoking status and predicts smoking intensity. In addition, we have developed a rapid clinically implementable digital PCR assay for assessing methylation at this locus using DNA prepared from blood or saliva. However, whether changes in DNA methylation at this locus occur quickly enough to allow the monitoring and possible incentivization of smoking cessation is unknown. To examine these possibilities, we followed 70 regular adult smokers as they underwent smoking cessation using a financial incentive based, pharmacologically assisted paradigm that stipulated no use of nicotine replacement. Consistent with prior reports, we found that as quantified by nondetectable serum cotinine levels at 1 month, 2 months and 3 months, 30% of all subjects who attempted to quit smoking in order to receive a $400 reward succeeded in quitting smoking. Over the course of their cessation trajectory, cg05575921 methylation demonstrated a stepwise increase commiserate with initial smoking intensity. Overall, the heaviest smokers, manifested a stepwise 14% increase in cg05575921 methylation while the lightest smokers manifested a 5% increase in cg05575921 methylation over the three month follow up period. Taken together with prior data, these new data demonstrate a robust reversion of cg05575921 in response to smoking cessation whose values can be used as objective evidence of smoking cessation even in those using nicotine replacement. In addition, because this method can detect and quantify partial cessation, these findings further suggest that the use of this technology together with incentive based approaches may also be useful in encouraging quantitative reduction of harm for cancer and smoking related cardiovascular risk in those who can reduce, but cannot fully quit smoking.
Abstract P273: Omega-3 Fatty Acids in Erythrocyte Membranes are Associated With Predictive Equations for Estimation of Cardiovascular Risk in Brazilian Individuals
Authors: Damasceno Nila T , Gocalinho Gustavo
Published: December 2020

Introduction:
Although several mechanisms confirm the cardioprotective role of omega-3 fatty acids (n-3 PUFA), there is still controversy regarding its impact on cardiovascular outcomes. We hypothesized that the n-3 PUFA in erythrocytes membranes reflect better intake and metabolization of these fatty acids, allowing identify their cardiovascular benefits.

Objective:
To evaluate the association of the n-3 PUFA with cardiometabolic biomarkers and absolute cardiovascular risk.

Methods:
A crossectional study based on the baseline time of CARDIONUTRI clinical trial (n = 356) with individuals of both sexes (30-74 years) who showed at least one of the following risk factors: smoking, hypertension, dyslipidemias, diabetes mellitus or obesity, but without previous cardiovascular events, monitored by clinical evaluation and ECG. By direct interviews, information about demographic data, medication, blood pressure, diet, and physical activity were investigated by physician and dietician. After 12h of fasting, the lipid profile, lipoprotein sub fractions, LDL(-), glucose, HbA1c, insulin, HOMA-IR and inflammation biomarkers were analyzed by standard and validated methods. After lipid extraction from erythrocytes, fatty acids were analyzed by gas chromatography using internal (C17) and external (FAME 37) standard. The 10-years projection of absolute cardiovascular risk was estimated by the Framingham (FRS), Reynolds (RRS) and ACC/AHA 2013 risk scores. Association between fatty acids, biomarkers and cardiovascular risk scores were performed by linear and logistic regression models and factorial analysis (SPSS v.20.0 and Stata v.14.0).

Results:
Individuals with n-3 PUFA > 6.24% and n-6/n-3 ≤ 1.27 had less plasma non-HDL cholesterol, Apo B, TG, LDL(-) and highest LDL size. Regarding FRS, the total n-3 PUFA had association with lower cardiovascular risk (OR=0.811; IC95%=0.675- 0.976) and the membrane 1 model rich in n-6 was and poor in n-3 PUFA was associated with higher risk (OR=1.469; IC95%=1.056-2.043). Regarding RRS, the same membrane model was associated with higher risk (OR: 1.276; IC95%=1.010-1.612) while the opposite pattern was observed for membrane 2 model (rich in n-3 and poor in n-6 PUFA), had association with lower risk (OR=0,747; IC95%=0,589-0,948).

Conclusion:
High content of n-3 in erythrocyte membranes containing was associated with a lipid profile characterized by less plasma atherogenic lipoproteins, reduced TG and modified LDL. This profile was associated with reduced chance to be classified as moderate or higher cardiovascular risk by the Reynolds and Framingham Risk Scores.
Abstract P348: Long-term Cognitive Decline in Older Adults After Incident Coronary Heart Disease or After First Receipt of Coronary Artery Bypass Grafting Surgery or Percutaneous Coronary Intervention
Authors: Kunzelman Jacqueline E , Gabor Rachel M , Scrobotovici Monica , Blades Natalie J , Longstreth W T , Heckbert Susan R , Psaty Bruce M , Arnold Alice M , Fitzpatrick Annette L , Llewellyn David J , Kuzma Elzbieta , Kamel Hooman , Dhamoon Mandip S , Chaudhry Sarwat I , Dodson John A , Hedges Dawson W , Gale Shawn D , Erickson Lance D , Brown Bruce L , Thacker Evan L
Published: December 2020

Objective:
We investigated two hypotheses: First, incident CHD, defined as myocardial infarction or definite angina, leads to faster long-term cognitive decline. Second, among those with CHD, treatment with CABG surgery or PCI leads to slower long-term cognitive decline.

Methods:
The Cardiovascular Health Study is a cohort of US adults aged 65+. Global cognitive ability was assessed annually up to 9 times from 1990 to 1998 with the 100-point Modified Mini-Mental State Examination (3MS). We estimated trajectories of 3MS scores in the absence of stroke, adjusting for demographics, health behaviors, and comorbidities. For hypothesis 1, we compared 3MS trajectory after incident CHD with 3MS trajectory in the absence of CHD, censoring at first receipt of CABG/PCI. For hypothesis 2, among participants with CHD, we compared 3MS trajectory after first receipt of CABG/PCI with 3MS trajectory without CABG/PCI.

Results:
For hypothesis 1, of 4,122 participants, 398 had incident CHD during a mean of 5.9 years of follow-up.
Figure Panel A
shows model-predicted mean 3MS trajectories without CHD (blue) and after incident CHD (red) diagnosed at ages 70, 75, 80, or 85. Model-predicted 3MS score declined faster after incident CHD, especially for CHD diagnosed at age 80 or later. For example, after incident CHD at age 85, predicted 5-year decline in mean 3MS score through age 90 was 13.9 points (95% CI: 11.0, 16.7) versus 8.9 points (95% CI: 8.1, 9.7) among those without CHD. For hypothesis 2, of 1,183 participants who had prevalent or incident CHD, 118 had their first CABG/PCI during a mean of 4.1 years of follow-up. Model-predicted 3MS score declined faster after first receipt of CABG/PCI (
Figure Panel B
).

Conclusions:
Older adults diagnosed with incident CHD had faster average cognitive decline than those without CHD. However, treatment with CABG/PCI did not slow cognitive decline among those with CHD. This finding may be due to adverse effects of CABG/PCI on brain health or CABG/PCI recipients having more severe CHD or more cerebral atherosclerosis.
Abstract P351: Longitudinal Association Between Low-to-moderate Alcohol Drinking and Cognition Trajectory in US Adults
Authors: Zhang Ruiyuan , Shen Luqi , Miles Toni , Shen Ye , Cordero Jose , Qi Yanling , Liang lirong , Li Changwei
Published: December 2020

Background:
Findings on the effect of alcohol drinking on cognitive function are mixed. The present study aimed to investigate the longitudinal associations of low-to-moderate alcohol drinking with cognition trajectories and changing rates among a nationally representative sample of middle-aged and older Americans.

Method:
A total of 19,887 participants in the Health and Retirement Study were included in the analyses. Performance of cognitive function was assessed every two years in 3 domains: mental status (MS), word recall (WR), and vocabulary (VOC). Trajectories of the total cognitive function (TCF) and individual domains were constructed using the SAS proc traj procedure. Age at cognition measurement was used as a time scale. Age related annual changing rates of cognition measures were estimated by regressing cognition scores over age for all individuals. Due to very few people, heavy drinkers were excluded. Multivariate logistic regression and linear regression were used to estimate the effect of low to moderate drinking on the cognition trajectories and annual changing rates after adjusting for baseline age, gender, race, years of education, marital status, smoking and body mass index.

Result:
Participants were clustered into a consistently low trajectory and a consistently high trajectory for each cognition measure. Low-to-moderate drinking was associated with a better trajectory and lower declining rate. Compared to never drinkers, current low-to-moderate drinkers were 0.67 (95% confidence interval [CI]: 0.59-0.75,
P
<0.0001), 0.69 (95% CI: 0.61-0.79,
P
<0.0001), 0.75 (95% CI: 0.69-0.81,
P
<0.0001), and 0.63 (95% CI: 0.54-0.72,
P
<0.0001) less likely to have a consistently low trajectory for TCF, MS, WR, and VOC, respectively. Meanwhile, current low-to-moderate drinking was associated with 0.05 (95% CI: 0.03-0.08,
P
<0.0001), 0.02 (95% CI: 0.01-0.03,
P
=0.0001), 0.005 (95% CI: -0.003-0.01,
P
=0.23), 0.01 (95% CI: 0-0.02,
P
=0.04) units lower annual changing rates for those cognition measures. Racial differences were observed for trajectories of MS (
P
=0.01), in which, low-to-moderate drinking was associated with the consistently low trajectory among whites (odds ratio=0.67, 95% CI: 0.58-0.76) but not among blacks (odds ratio =1.07, 95% CI: 0.79-1.45). There was no gender difference was observed.

Conclusion:
Current low-to-moderate alcohol drinkers associated with total cognitive function, word recall, mental status, and vocabulary in both men and women.
Abstract P381: Diabetes Prevention Program Football Club: A 6-month Intervention Among Latino Men
Authors: Frediani Jennifer K , Li Jianheng , Lobelo Felipe
Published: December 2020

Purpose:
One third of the U.S. adult population is estimated to have prediabetes. Hispanics have a 50% higher type 2 diabetes (T2DM) death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention efforts. The purpose of this study was to determine the effects of an intervention implementing the Center for Disease Control and Prevention (CDC) National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men.

Methods:
Overweight and obese Hispanic men, aged 30-57 years with prediabetes at screening were recruited from the community. Enrolled participants were divided into three cohorts. Trained soccer coaches led 30-minute facilitated discussion of the NDPP modules after each RS session, with two sessions per week for 3 months and once per week for the following 3 months. The 1-hour RS sessions followed the Football Fitness curriculum structure. Standardized study assessments included body mass index, waist circumference, multi-frequency bioelectrical impedance analysis (InBody 270), blood pressure, hemoglobin A1c, and validated field physical fitness tests (figure of 8 run, handgrip strength, vertical jump, modified sit-ups, dynamic push-ups, one leg stand and Yo-Yo intermittent sprint test). Mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the difference between baseline and 6 months. All analyses were conducted as intent-to-treat and generated using SAS v 9.4.

Results:
Hispanic males (n=41; mean age 41.7 [0.1] years) were obese at baseline (mean BMI 32.7, standard error [0.7], mean weight 93.9 [2.2] kg). After 6 months of the NDPP+RS intervention, there were significant changes in systolic and diastolic blood pressure (-6.6 [2.4]; p=0.01 and -6.1 [1.7] mmHg; p<0.001, respectively), HbA1c -0.2 [0.1]; p=0.005, figure of 8-agility run (-0.5 [0.1] sec; p<0.0001), number of modified push-ups in 40 seconds (3.9 [0.6]; p<0.0001), dynamic sit-ups (1.9 [0.4]; p<0.0001), and predicted VO
2
(ml/kg/min) (0.4 [0.2]; p=0.04. Despite significant reductions in weight (-3.8 kg [0.7]; p<0.0001), waist circumference (-6.6 [0.7] cm; p<0.0001), body fat % (-1.9 kg [0.5]; p=0.0002), lean body mass was mostly preserved [-0.9 [0.3]; p=0.009].

Conclusion:
Among middle-aged Latino men, broad-ranging significant improvements in body composition, physical fitness, HbA1c and blood pressure were observed after 6 months of participating in lifestyle education plus RS.
Abstract P409: Thyroid Function and Cognitive Decline in Middle-aged and Older Adults: The Elsa-Brasil Study
Authors: Szlejf Claudia , Suemoto Claudia K , Janovsky Carolina , LOTUFO Paulo A , Bensenor Isabela M
Published: December 2020

Introduction:
The role of subtle thyroid alterations on cognitive decline is controversial. We aimed to investigate the association of thyrotropin (TSH) and free thyroxine (FT4) with baseline performance on cognitive tests and with cognitive decline in middle-aged and older adults without overt thyroid disease.

Methods:
This is a longitudinal analysis of the Brazilian Longitudinal Study of Adult Health baseline and second wave, after 4 years of follow-up. We included participants aged ≥ 55 years without over thyroid disease, prevalent stroke and use of drugs that could affect thyroid function and cognition. TSH and FT4 were assessed at baseline. Cognition was evaluated at baseline and at the second wave using delayed word recall test (DWR), semantic verbal fluency test (SVF), and trail making test version B (TMT). Baseline and longitudinal associations of TSH tertiles and FT4 tertiles with cognitive performance were investigated with generalized estimating equations, adjusted for sociodemographic characteristics, lifestyle, cardiovascular risk factors, and depression.

Results:
The baseline mean age of the 4675 participants was 62.4 ± 5.8 years, 52.3% women (2445 out of 4675). At baseline, TSH levels were not associated with cognitive performance in any test, although the highest FT4 tertile was associated with poorer performance on DWR (β = -0.087, 95% CI = -0.155; -0.019) and SVF (β = -0.076, 95%CI = -0.143; -0.010) after adjustment. Additionally, the lowest FT4 tertile was associated with poorer performance on SVF (β = -0.090, 95%CI = -0.152; -0.028). Cognitive performance did not change after 4 years of follow-up and there was no effect of time on the association of thyroid hormone levels with cognitive performance.

Conclusion:
At baseline, FT4 levels were associated with worse cognitive performance in a relatively young sample. Neither baseline FT4 nor TSH were associated with cognitive decline after 4 years.
Abstract P470: Heterogeneity In Prevalence Of Cardiovascular Disease Risk Factors Among Hispanic Ethnic Groups: Evidence From The 2010-2018 National Health Interview Survey
Authors: Elias Sabrina , Turkson-ocran Ruth-alma N , Koirala Binu , Byiringiro Samuel , Miller Hailey , Baptiste Diana , Dennison-Himmelfarb Cheryl , Commodore-mensah Yvonne
Published: December 2020

Introduction:
Persons of Hispanic origin are a growing share of the U.S. population but include diverse ethnic groups with unique cultures, lifestyles, exposures, and countries of origin. Hispanics are disproportionately affected by cardiovascular disease (CVD) risk factors in comparison to non-Hispanics. However, few studies have examined the heterogeneity in their burden of CVD risk.

Hypothesis:
We hypothesized that there would be significant heterogeneity in the prevalence of CVD risk factors among ethnic subgroups of Hispanic adults.

Methods:
We used a cross-sectional design to examine the prevalence of CVD risk factors, defined per national guidelines, among Hispanic adults in the 2010-2018 National Health Interview Surveys. Generalized linear models using Poisson distribution were fitted to obtain adjusted predicted probabilities and risk of self-reported hypertension, overweight/obesity, diabetes, high cholesterol, physical inactivity, and current smoking by Hispanic ethnic subgroup.

Results:
We included 185,511 participants with mean(±sd) age 31(0.2) years and 50% male. Most were Mexican (65.1%) whereas, few were Dominican (3.0%). Prevalence of hypertension (28.4%), diabetes (12.9%), high cholesterol (25.0%), and current smoking (6.1%) was highest among Puerto Ricans. Prevalence of overweight/obesity was highest among Mexicans (74.5%) and physical inactivity was highest among Dominicans (62.3%). Compared to Mexicans, Central Americans were less likely to smoke and have hypertension, overweight/obesity, and diabetes (ps<0.05). (
Table
)

Conclusion:
We observed striking heterogeneity in the prevalence of CVD risk factors across Hispanic ethnic subgroups, especially for diabetes, physical inactivity, and smoking. These results suggest that aggregating data on Hispanics may mask differences in CVD risk and hinder efforts to reduce health disparities in this population. Our findings provide actionable information on CVD risk factors for specific Hispanic ethnic subgroups.
Abstract P485: Association of Hypertension With the Gut Microbiome and Serum Short-chain Fatty Acids
Authors: Differding Moira K , Appel Lawrence J , Maruthur Nisa , Juraschek Stephen , Miller Edgar R , Yeh Hsin-Chieh , Mueller Noel T
Published: December 2020

Background:
Murine models indicate that gut microbiota, and the short chain fatty acids (SCFAs) they produce from fermentation of fiber, play a role in blood pressure (BP) regulation. However, few human studies have examined how gut microbiota and serum SCFAs are associated with hypertension.

Objective:
We examined associations of gut microbiota composition and serum SCFAs with hypertension and BP, hypothesizing an inverse association with serum SCFAs.

Methods:
We performed a cross-sectional analysis of baseline data from a trial of overweight and obese adult cancer survivors. We measured
1
) the gut microbiome by extracting microbial DNA from stool and sequencing the 16S rRNA V4 region and
2
) serum SCFA using liquid chromatography mass spectrometry. Hypertension was defined as systolic BP ≥ 130, diastolic BP ≥ 80 mmHg, self-report, or use of hypertension medications. We used beta-binomial models to test differential abundance of microbial amplicon sequence variants by hypertension
,
and linear regression to examine log-transformed SCFAs with BP. We adjusted models for age, sex, race, fiber, BMI and medications (in BP models).

Results:
Of 111 participants with complete data, 73 had hypertension. Hypertensive participants differed by age (mean 62 vs. 56y) and sex (73% vs. 90% female), but not race (46% black) or BMI (mean 35 kg/m
2
). Alpha and beta diversity were not associated with hypertension (Ps>0.05). Hypertensive participants had higher abundance of
Bacteroides, Parabacteroides, Bifidobacterium
and
Escherichia
, and lower
Lachnospiraceae, Haemophilus
and
Faecalibacterium
(
Figure)
. Serum acetate was negatively associated with systolic BP (β=-3.3 mmHg difference per 1 SD increment acetate, 95% CI: -6.1, -0.6); other SCFAs were not associated (Ps>0.05).

Conclusion:
A
Bacteroides
dominated microbiota was positively associated with hypertension. Acetate, the most abundant circulating SCFA, was negatively associated with BP. Determining whether the associations are causal or not warrants further investigation.
Abstract P508: Association of Egg and Dietary Cholesterol Intake With Incident Cardiovascular Disease and All-cause Mortality
Authors: Chen Guochong , Chen Li-Hua , Mossavar-Rahmani Yasmin , Kamensky Victor , Shadyab Aladdin , Silver Brian , Wild Robert A , Sun Yangbo , Haring Bernhard , Neuhouser Marian , Kuller Lewis H , Howard Barbara V , Saquib Nazmus , Snetselaar Linda , Allison Matthew A , VAN HORN Linda , Manson Joann E , Wassertheil-Smoller Sylvia W , Qi Qibin
Published: December 2020

Introduction:
The association of egg or dietary cholesterol intake with risk of cardiovascular disease (CVD) and overall mortality remains a topic of active debate.

Hypothesis:
Higher egg or dietary cholesterol intake is associated with elevated risk of CVD and all-cause mortality.

Methods:
We analyzed data from 96,755 women aged 50-79 years who were free of CVD and cancer at baseline (1993-1998)(Women’s Health Initiative). Baseline dietary data were collected using a validated food frequency questionnaire. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals of CVD or mortality ascertained through February, 2018.

Results:
After multivariable adjustment (model 1 in
Figure
), higher intakes of egg and dietary cholesterol both were associated with increased risk of CVD (HRs: 1.09 [1.06-1.13] for ½ eggs/day and 1.13 [1.09-1.17] for cholesterol intake of 100 mg/1000 Kcal/day) and all-cause mortality (HRs: 1.10 [1.07-1.12] for egg and 1.16 [1.12-1.19] for cholesterol intake). These associations persisted with further adjustment for other major food groups (e.g. red/processed meat) or nutrients (e.g. saturated fat), or for several potential intermediators (model 2 in
Figure
). For both egg and cholesterol intakes, the positive associations with CVD were limited to obese individuals and the associations with all-cause mortality were more pronounced in individuals with diabetes (all
P
-interaction≤0.002). Among 9451 participants with blood cholesterol measurements, egg or cholesterol intake remained associated with increased CVD and mortality, and the associations were not altered by further adjustment for LDL and HDL cholesterol despite the expected associations of both lipid measures with CVD and mortality (
Figure
).

Conclusions:
A higher intake of eggs or dietary cholesterol was associated with higher risk of CVD in obese women and overall mortality predominantly in women diagnosed with diabetes. These associations appeared not attributable to blood cholesterol.
Abstract P521: Dairy Consumption and Risk of Cardiovascular Disease and Mortality in the Million Veteran Program
Authors: Al-Ramady Omar , Tarko Laura , Schubert Petra , Gagnon David R , Cho Kelly , Gaziano John M , DJOUSSE Luc ,   on behalf of the Million Veteran Program
Published: December 2020

Background:
Dietary habits are a major determinant of cardiovascular disease (CVD) and mortality risk. However, data on the role of dairy intake on the risk of CVD and death has been inconsistent.

Objective:
The primary objective is to assess whether total consumption of dairy products is associated with a lower risk of CVD and/or total mortality among US Veterans.

Methods:
In a prospective cohort study of US Veterans from the Million Veteran Program (MVP), dairy intake was collected through a self-reported food frequency questionnaire at baseline. Incidence of composite CVD (including MI, stroke, and cardiovascular death) and total mortality were measured via electronic health records and the National Death Index database. Cox Proportional hazard models were used to compute the multivariable adjusted hazard ratio of CVD and total mortality.

Results:
A total of 188,833 Veterans were studied with a mean age of 63.3 ± 12.3 years. After a mean follow-up of 3.2 years for CVD and 3.3 years for total mortality, 9,898 cases of CVD and 6,826 deaths occurred. Median dairy consumption was 1.2 servings/day. In a multivariable Cox regression adjusted for age, gender, race, body mass index (BMI), smoking, alcohol use, exercise, diet quality, diabetes mellitus, and level of education; hazard ratios (95% CI) for CVD were 1.00 (0.89-1.14) for dairy intake of 1-2 servings/week, 1.05 (0.92-1.20) for 2-3 servings/week, 1.01 (0.90-1.12) for 3-5 servings/week, 0.97 (0.87-1.08) for 5-7 servings/week, 0.96 (0.87-1.05) for 1-2 servings/day, 1.02 (0.91-1.13) for 2-3 servings/day, 1.02 (0.90-1.15) for 3-4 servings/day, and 1.11 (0.98-1.26) for 4+ servings/day as compared to <1 serving/week. For total mortality, the hazard ratios across consecutive categories of dairy intake were 0.85 (0.73-0.99), 0.83 (0.70-0.99), 0.87 (0.76-0.99), 0.84 (0.74-0.96), 0.94 (0.84-1.06), 1.10 (0.97-1.25), 1.12 (1.04-1.39), and 1.36 (1.18-1.58).

Conclusion:
Dairy intake was not associated with composite CVD. However, there was suggestive evidence for J-shaped relation of dairy intake with total mortality.
Abstract P527: Body Mass Index (bmi, Kg/m
2
) vs. Body Fat % (bf%): Battle of Obesity Classification Metrics to Inform Underlying Cardiometabolic Risk
Authors: Odegaard Andrew O , Carnethon Mercedes R , Camhi Sarah M , Chow Lisa , Gross Myron D , Jacobs David R
Published: December 2020

Introduction:
The WHO defines overweight and obesity as abnormal or excessive fat accumulation that may impair health. However, for population and clinical classification of overweight and obesity BMI is most commonly used as a proxy for adiposity. Despite the strength of the association between higher BMI and cardiometabolic disease risk across populations, and minimal direct comparison of BMI v. BF%, BMI draws significant criticism as a metric to classify obesity and screen for cardiometabolic risk.

Hypothesis:
BF% defined obesity classification categories have higher underlying cardiometabolic risk compared to equivalent BMI categories.

Methods:
We analyzed data from CARDIA study participants from the year 20 exam with concurrent measures of BMI, and BF% measured by Dual-energy X-ray absorptiometry (DXA), plus clinical measures. Sex specific BF% obesity classification categories were defined by evidence-based diagnostic and classification performance measures vs. standard BMI cut points. Underlying cardiometabolic risk was defined by a continuous metabolic syndrome risk score (MetS), consisting of the averaged standardized deviates of the 5 ATP III components. Higher MetS z-scores indicate higher overall risk. MetS z-scores between categories (e.g. obesity defined by BMI v. BF%) were compared by z-tests.

Results:
The figure reports the distribution of obesity classification categories by the different metrics and underlying cardiometabolic risk. The MetS risk score was significantly higher in BMI defined overweight and obesity compared to BF% defined categories; and BF% defined obesity categories classify a greater prevalence of the population as obese compared to BMI. Results for MetS risk did not differ by race/sex or when including prevalent cardiometabolic disease.

Conclusions:
Physiologically defined BF% obesity categories classify a greater prevalence of obesity in CARDIA at year 20, whereas there was higher underlying cardiometabolic risk in BMI defined obesity classification categories.
Female Athlete’s Heart
Authors: D’Ascenzi Flavio , Biella Federico , Lemme Erika , Maestrini Viviana , Di Giacinto Barbara , Pelliccia Antonio
Published: December 2020

Background:

Most of our knowledge on training-induced cardiac remodeling is derived from men, with the paucity of data from women representing an important gap in knowledge. The aim of the study was to define the electrocardiographic and morphological features of female athlete’s heart, with special attention to differences related to sex and sport.

Methods:

Seven hundred twenty Olympic athletes (360 females and 360 age- and sport-matched males, mean age: 23±5 years) were evaluated by clinical, resting, and exercise electrocardiography and echocardiography.

Results:

Anterior T-wave inversion was more common in females than males (
P
<0.05). Left ventricular (LV) wall thickness and LV mass were greater in men (
P
<0.001). Females had smaller absolute but greater indexed LV and right ventricular (RV) dimensions as compared to males. Most women had normal LV geometry (80.8%). A progressive increase in LV/RV dimensions was observed in women from those engaged in skill, power, to mixed and endurance disciplines, with the endurance ones demonstrating the greatest degree of RV dilatation. Women had a peculiar biventricular adaptation, with higher LV/RV (1.41±0.16 versus 1.36±0.15,
P
<0.0001) and lower RV inflow/outflow ratio (
P
<0.001), as compared to men.

Conclusions:

Sex significantly affects cardiac remodeling in athletes, with females presenting a different electrical and structural remodeling. Women maintain a normal LV geometry, with relative larger increase of cavity dimensions compared with men. Type of sport has a relevant impact, with endurance athletes exhibiting the greatest degree of RV and LV dimensional remodeling. The present study confirms the need for a sex-based approach for interpreting the complex features of athlete’s heart in women.
Observations of daytime activity in the nocturnal northern giant mouse lemur (Mirza zaza)
Authors: Hending Daniel , Randrianarison Heriniaina , Cotton Sam , Holderied Marc , McCabe Grainne
Published: December 2020

We provide an anecdote of daytime activity within the northern giant mouse lemur (Mirza zaza), a small threatened primate that has always been considered strictly nocturnal, in the Anabohazo forest of northwestern Madagascar. During the dry season, we witnessed two individual M. zaza travelling separately in the afternoon period of three different days. Our observations indicate that M. zaza may undertake activity that is essential for their survival within both the light and dark periods of a day-cycle, and our findings suggest that the activity cycle of this species may be highly flexible. These observations have important implications to understand the evolution of activity patterns in M. zaza, and these findings warrant future, long term studies to establish the annual activity patterns of M. zaza and to determine whether this species is potentially cathemeral and why.
Navigating Human Rights in a ‘Post-Human Rights’ Era
Authors: Smith Rhona , Molloy Sean
Published: December 2020

International human rights law and mechanisms tasked with promoting state compliance with it are being increasingly challenged. Opposition is originating from, amongst others, countries that have historically supported the global human rights project. These new trends and sites of contestation bolster opposition from other countries and regions that have consistently diverged from international human rights norms. Examining the relationship between the United Nations human rights system and states of the Association of Southeast Asian Nations in this broader context of opposition to human rights, this article argues that existing theories on why states do, or ought to, comply with international human rights law are often inadequate to either explain or inspire state adherence to human rights norms. What is required, this article will argue, is not another theory but rather more targeted and incremental efforts to address the gap between rhetoric and compliance.
Big Data and Competition Policy in the European Union
Authors: Miskolczi-Bodnár Éva
Published: December 2020

Because of the specific features of digital markets and the emergence of new business models in the digital economy, competition often takes on a rather distinctive form, challenging competition authorities in the assessment of merger controls and anticompetitive behaviour. Several competition authorities have concluded recently that although generically formulated competition law provisions can be adapted to the particularities of a data-driven market, big data may require the use of somewhat specialized tools and methods in law enforcement, especially in the assessment of market power during merger control proceedings. One particular issue is whether data protection concerns might be covered by the scope of competition law. Recent case law suggests that national law enforcers are becoming increasingly flexible regarding privacy policies as a non-price competition factor in merger control in order to prevent future anti-competitive practices and a general reduction of competition in the relevant market.
Antitrust After Big Data
Authors: Yun John M.
Published: December 2020

With the rise of digital markets, the conventional wisdom was that big data was a new economic phenomenon that would allow incumbent firms with market power to entrench their market positions, foreclose competitors, and serve as a virtually insurmountable barrier to entry. This led to calls for greater antitrust enforcement and regulation of big data practices. Since that time, with the benefit of substantial growth in the theoretical and empirical economic literature involving big data, it is appropriate to revisit our understanding of big data’s implications for antitrust. This paper contributes to the discussion by detailing three things we have learned about big data as it applies to competition policy. First, we now have a better understanding of the role that big data plays in the production and innovation process. Second, it makes little sense to reflexively label big data as a barrier to entry. Competition policy is better served by considering actual entry conditions rather than basing competitive effects analysis on determining whether access to certain inputs are or are not barriers to entry. Third, competition authorities now have a sizeable level of experience in assessing big data in actual cases. It is notable that, thus far, big data alone has not fuelled a theory of harm that has led to an agency challenge in the U.S.A. or Europe. All these considerations suggest that we are perhaps in a new, more mature, era regarding big data in competition policy – not because big data is any less important to innovation – but because researchers and regulators have consistently found that big data in and of itself does not represent a relevant antitrust concern.
Development of Consumer Collective Redress in the EU: a Light at the End of the Tunnel?
Authors: Vlahek Ana
Published: December 2020

The development of collective redress in the EU started in the 1980s and first resulted in adoption of legislation on collective injunctive and declaratory relief for the protection of specific interests, in particular consumer interests, and later focused on expanding the rules in other areas of law as well as accompanying them with rules on collective compensatory redress. As in recent years ever more mass harm cases without a proper procedural framework for tackling them have been detected, the EU has intensified its collective redress regulation activities, in particular with a view to safeguarding consumers’ interests. Although collective redress as such is generally perceived as a common feature of modern European judicial systems, the EU institutions have been tackling how best to regulate it in the European legal environment. They have produced a plethora of rather uncontrollable acts with different effects and scope of application that have introduced different and at times ambiguous definitions and concepts without enough valuable interpretation and insight into the reasons behind them. Referring to insufficient ms reaction to the 2013 Recommendation, in 2018 the Commission drafted a new, binding regime for consumer collective redress that may well require prudent ms that have already introduced compensatory collective redress to amend their recently adopted legislation. The paper presents the development of (consumer) collective redress in the EU by analysing four stages of legislative activity at the EU level and the principles and solutions of the relevant acts adopted within them.
Geo-blocking Regulation: Antitrust or Consumer Protection?
Authors: Podobnik Klemen
Published: December 2020

The author attempts to show that the seeming absorption of a large-scale, general geo-blocking prohibition in the field of competition law (antitrust) is unsystematic, and can negatively influence the further development of European competition law and policy and related goals. The positive implications of the GBR regime in the area of consumer protection law (and for trade regulation as such) are not negated. The author, however, attempts to underscore the fact that, in certain constellations, legislative instruments should be very clearly designated, their nature and scope concisely labelled. Formal oversights, such as omission of clear denominations or even plain wrong designations can – in certain circumstances – lead to functional consequences. For this reason the author stresses the view that the GBR is a legislative instrument of market regulation and consumer protection and has no real appreciable link to antitrust.
Blue Ice, Meteorites, Fossil Penguins and Rare Minerals: The Case for Enhanced Protection of Antarctica’s Unique Geoheritage – An International Legal Analysis
Authors: Leary David
Published: December 2020

Its isolation and extreme climate means Antarctica is one of the world’s richest regions for untouched geoheritage. The potential of mining in Antarctica is often talked of in public discourse as a future threat to Antarctica even though the prohibition on mining is absolute and is likely to stay so indefinitely. As such mining does not pose a realistic threat to Antarctica’s geoheritage. The impacts of scientific research and tourism pose more pressing challenges to Antarctica’s geoheritage. This paper considers emerging debates in the Antarctic Treaty System on the need for further protection of Antarctica’s geoheritage. After considering the concept of geoheritage the paper considers key threats to Antarctic geoheritage. The role of Antarctic Specially Protected Area system in the protection of Antarctica’s geoheritage is then considered as is the draft code of conduct on geosciences field research currently being developed within the Antarctic Treaty System. The final part of the paper then goes on to examine how the Antarctic Treaty system could in part draw on the experience of other international initiatives, including the frameworks associated with the UNESCO Global Geoparks movement in developing an Antarctic System for protection of geoheritage.
An Overview of the Antarctic Treaty System and Applicable New Zealand Law
Authors: Daya-Winterbottom Trevor
Published: December 2020

The Antarctic Treaty 1959 has now been in place for 60 years and is regarded by informed commentators as one of the most successful multi-party international treaty systems. This paper provides an opportunity to look back and take stock of previous success, and more importantly, an opportunity to assess the future prospects of the treaty system. New Zealand has played a key role in the Antarctic Treaty system and has had a long involvement with Antarctica since accepting the transfer of sovereignty over the Ross Dependency in 1923. This paper therefore focuses on the effectiveness of the Antarctic Treaty system through a New Zealand lens.
The Long Grass at the North Pole
Authors: Serdy Andrew
Published: December 2020

Though legally no more significant than any other point in the Arctic Ocean, into which State’s continental shelf the geographic North Pole will ultimately fall is politically charged for the three States involved – Canada, Denmark (Greenland) and Russia – that have submitted to the Commission on the Limits of the Continental Shelf outer limits within which the Pole falls. The 2014 Danish submission, for an area extending beyond the equidistance line with Canada, was in that sense paradoxically helpful to Canada, as Denmark, with the northernmost land territory, is by definition closest to the Pole, which must therefore lie on its side of any such line drawn between itself and any other State; thus Denmark gave cover to Canada which needed to take a similar approach to define its continental shelf entitlement as including the North Pole. Boundaries will eventually have to be delimited, but as it likely to be 20 years before the Commission examines the last of the submissions, the three States have ample pretext to postpone this step until then, a solution likely to suit them all.