bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 04: Gender and Racial Inequalities in the Use of Statins for Secondary Prevention of Cardiovascular Disease Remains Despite Persistent Recommendations in Recent Guidelines - A Call to Action
Authors: Salami Joseph A , Saxena Anshul , Okunrintemi Victor , Ogunmoroti Oluseye , Bhatt Chintan B , Rubens Muni , Daniel Obinna , Benjamin Patrick , Michos Erin D , Veledar Emir
Published: March 2020

Introduction:
Statins use for secondary cardiovascular disease (CVD) prevention is associated with better health outcomes and lower cost among adults with ASCVD. We aimed to examine the prevalence of statin use among adults with ASCVD in the US and to assess for gender and racial differences in statin use.

Methods:
We identified adults aged 40-75 years with ASCVD (defined using ICD codes and self-reported history) from the 2008-17 Medical Expenditure Panel Survey (MEPS) data. We estimated the trends in statin use among them, and used joint point regression (JPR) to estimate the annual percentage change in statin use. Logistic regression was used to assess the racial variation in statin use. We applied the weights in the MEPS complex survey design to estimate population sizes, so all results are nationally representative.

Results:
Between 2008 and 2017, 24896 adults aged 40-75 years with ASCVD were identified. In 2017, there were 2445 patients with ASCVD (equivalent to 24.5 million adults). In 2017, the mean age [SE] was 62.2 [0.3] years, and 42.9% were females. The overall proportion of adults with ASCVD using statin increased from 50.0% in 2008 to 58.7% in 2017, with an average annual percentage change of 0.95% between 2010 and 2017 (
p=
0.01). As shown in
Figure 1a
, among those with ASCVD, statin use was persistently lower in women than in men. In 2017, compared to White adults with ASCVD, Blacks (OR=0.69; 95% CI: 0.51-0.92) and Hispanics (OR=0.62; 95% CI: 0.45-0.85) were less likely to be on statin. Each year, over 3 million women with ASCVD were not on statin, and majority of them were Blacks and Hispanics.
(Figure 1b)

Conclusion:
Millions of adults with ASCVD are not on statins in the US while gender and racial inequalities in statin use remains, despite persistent guideline recommendations. Herein lies an opportunity to improve CVD-related outcomes and cost by intensifying efforts to use statins for the secondary prevention of CVD and closing gender and racial gaps, especially with the 2030 sustainable development goals in view.
Abstract 05: Race and Hospitalization for Cardiovascular Disease in Patients With Systemic Lupus Erythematosus
Authors: Angley Meghan , Lewis Tene T , Howards Penelope P , Lim Sung
Published: March 2020

Background:
Patients diagnosed with systemic lupus erythematosus (SLE) are at greater risk of cardiovascular disease (CVD) and death at earlier ages than the general population, with African Americans (AA) at risk at earlier ages than non-AAs. However, the association between race and recurrent hospitalizations for CVD, which are associated with mortality, has not been explored.

Methods:
The Georgia Lupus Registry (GLR) is a population-based registry of individuals with SLE in 2002-2004 in Atlanta, Georgia. Both incident and prevalent cases were enrolled, and we included all cases diagnosed beginning in 2000. The GLR was matched to Georgia inpatient hospital discharge records from 2000-2013. Using ICD-9-CM codes, we identified hospitalizations classified as having coronary heart disease, peripheral artery disease, cerebrovascular disease or heart failure. The Prentice-Williams-Peterson Model with a total time scale measured from diagnosis was used to examine recurrent time to event data. We truncated the number of hospitalizations at 3 to maintain stable modeling estimates. Patients were censored at the time of death or at the end of 2013. Models were adjusted for sex and age at diagnosis.

Results:
A total of 556 participants in the GLR (87% female, 73% AA) had a median age at SLE diagnosis of 38 years and 27% experienced at least 1 CVD hospitalization, while 17% experienced ≥ 2. Overall, AA race was associated with recurrent hospitalizations (adjusted hazard ratio [aHR]: 1.7, 95% confidence interval [CI]: 1.2, 2.3). In an event-specific stratified analysis, the association between AA race and the hazard of recurrence became even more pronounced in later events (Event 1 aHR: 1.2, 95% CI: 1.0, 1.5; Event 2 aHR: 1.5, 95% CI: 1.2, 2.2; Event 3 aHR: 1.9, 95% CI: 1.1, 3.2).

Conclusions:
African-Americans with SLE were more likely to experience recurrent hospitalizations for CVD than their non-AA counterparts, suggesting that AA individuals with SLE may be more vulnerable to CV complications of SLE. Figure 1. Survival curve for 1st event
Abstract 14: Cardiac Biomarkers are Associated With Findings on Brain MRI in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rawlings Andreea M , Ballantyne Christie M , Gottesman Rebecca F , Hoogeveen Ron C , Hughes Timothy M , Jack Clifford R , Knopman David , McEvoy John W , Mosley Thomas , Schneider Andrea L , Sharrett A Richey , Selvin Elizabeth
Published: March 2020

Background:
Cerebrovascular disease is often the consequence of cardiac disease. Our aim was to examine associations of biomarkers of cardiovascular disease, high sensitivity troponin T (hs-cTnT), NT-proBNP, and galectin-3, with cerebrovascular signs: lacunar infarcts, lobar and subcortical microhemorrhages, cortical infarcts, and white matter hyperintensity (WMH) volume. We also examined total cortical and Alzheimer’s Disease (AD) signature region volumes.

Methods:
We conducted a cross-sectional analysis of 1748 ARIC participants from the 2011-2013 exam who had biomarker measurements, completed a brain MRI, and did not have a clinical history of stroke. We used linear regression to model brain volumes, modeled as Z scores, and logistic regression for all other outcomes; biomarkers were log transformed. We repeated analyses excluding persons with coronary heart disease, atrial fibrillation, and heart failure.

Results:
The mean age of participants was 76, 62% were female, and 21% were Black. All biomarkers were associated with total cortical volume. Each standard deviation increase in log hs-cTnT was associated with lower total cortical volume (adjusted beta = -0.08, 95% CI: -0.12, -0.05); results for the other biomarkers were similar (Figure). All biomarkers were associated with lobar microhemorrhages. Hs-cTnT and NT-proBNP were associated with WMH volume, but galectin-3 was not. No biomarker was associated with subcortical microhemorrhages or cortical infarcts. Results were similar in persons without coronary heart disease, atrial fibrillation, or heart failure (conditions associated with cerebral thromboembolism).

Conclusions:
In persons free of clinical cardiovascular disease, biomarkers of cardiac stretch, strain, and fibrosis were associated cerebral small vessel disease and reduced cortical volume, but not in a specific pattern suggestive of AD pathogenesis. This suggests subclinical vascular insults affect brain structure through mixed pathogenic processes.
Abstract 23: Sexual Dimorphism In Genetic Associations Of Testosterone And Sex-hormone Binding Globulin With Coronary Heart Disease
Authors: Hu Jie , Li Jun , Chung Wonil , Rexrode Kathryn M , Liang Liming
Published: March 2020

Introduction:
Men have higher prevalence and mortality of coronary heart disease (CHD) than women. Sex differences in associations of testosterone (T) and sex-hormone binding globulin (SHBG) with CHD risk have been recognized. But mechanisms underlying sex differences in CHD are unknown.

Hypothesis:
Genetic regulations of T and SHBG may differ by sex; such genetic heterogeneity may contribute to sex differences in CHD.

Methods:
We carried out a sex-stratified genome-wide association study for T, SHBG, and CHD in 187,888 men and 221,014 women from the UK Biobank, to identify sex-specific (
P
<5х10
-8
in one sex and
P
≥5х10
-8
in the other) and sex-differed (
P
<5х10
-8
in both sexes but effects differed significantly by sex) loci for each trait. Plasma T and SHBG were measured by immunoassay. Genetic correlations were estimated using linkage disequilibrium score regressions. We used cross-traits meta-analyses to identify loci that coregulate a biomarker (T or SHBG) and CHD.

Results:
The median T levels in men were 10-12 times higher than that in women across all age groups. Women had higher SHBG levels. We identified 344 sex-specific/sex-differed loci for T and 89 for SHBG (
Fig. A
). Genetic correlations between sexes were 0.02 for T, suggesting mostly sex-specific genetic regulation, and were 0.86 for SHBG and 0.94 for CHD, suggesting partially sex-differed genetic regulation. We observed a significant inverse genetic correlation between T and CHD in men (

r
g

=-0.15;
P
=1.4х10
-5
) but not in women. The inverse genetic correlation between SHBG and CHD was stronger in women (

r
g

=-0.33;
P
=5.2х10
-11
) than men (

r
g

=-0.18;
P
=2.8х10
-7
). We identified 31 sex-specific loci coregulating T and CHD (26 for men and 5 for women), and 48 sex-specific loci coregulating SHBG and CHD (35 for men and 13 for women) (
Fig. B
). Tissue-specific gene expression regulations at some loci (e.g.
LPA
) were also differed by sex (
Fig. C
).

Conclusions:
The between-sex heterogeneity in genetic coregulations of T and SHBG with CHD may contribute to the sex-differences in CHD etiology.
Abstract 31: Higher Levels of Light Intensity Physical Activity and Lower Sedentary Time are Associated With a Lower Risk of All-cause Mortality in Older Adults: The Framingham Heart Study
Authors: Lee Joowon , Spartano Nicole L , Vasan Ramachandran S , Xanthakis Vanessa
Published: March 2020

Introduction:
Habitual physical activity (PA) and less sedentary behavior have been associated with a lower risk of mortality in middle-aged adults. However, little is known about the associations of objectively-assessed PA of varying levels and sedentary time with mortality in community-dwelling older adults.

Hypothesis:
We hypothesized that higher overall PA and less sedentary time will be associated with a lower risk of all-cause mortality in older adults.

Methods:
We evaluated 1,262 Framingham Offspring Study participants (mean age 69 yrs, 54% women) with accelerometry-derived PA data (wear time ≥10 hours/day for at least 4 days using an Actical device) at their ninth examination (2011-2014). Multivariable Cox proportional hazards regression models were used to relate PA and sedentary time (separate model for each) with all-cause mortality adjusting for potential confounders. In sensitivity analysis to mitigate the potential impact of frailty on the associations evaluated, we excluded those with frailty at baseline.

Results:
Overall, 67 participants died during a median follow-up of 4.8 years (25
th
-75
th
percentiles: 4.3 - 5.3 [years]). Higher total PA, light intensity PA (LIPA), adherence to PA guidelines, and lower sedentary time were associated with a lower risk of all-cause mortality (
Table
). The results remained statistically significant even after excluding those with frailty. Higher LIPA and lower sedentary time were associated with a lower risk of all-cause mortality regardless of MVPA in both models including all participants and excluding those with frailty.

Conclusions:
In our investigation of a moderate-size sample of community-dwelling older adults, we confirmed that being physically active substantially lowered mortality risk. Additionally, our findings suggest that reducing sedentary time and increasing LIPA (regardless of MVPA) may be sufficient to reduce mortality risk in older adults. Additional studies of larger multi-ethnic samples of older adults are warranted to confirm our findings.
Abstract 35: Estimated Impact of Achieving Optimal Cardiovascular Health in the US Adult Population on Cardiovascular Disease Events
Authors: Bundy Joshua D , Zhu Zhengbao , Ning Hongyan , Zhong Victor W , Paluch Amanda E , Whelton Paul K , Lloyd-jones Donald M , Wilkins John T , He Jiang , Allen Norrina B
Published: March 2020

Introduction:
Quantifying the potential impact of achieving optimal cardiovascular health (CVH) in US adults could aid researchers, clinicians, and policymakers in developing and implementing strategies to reduce the burden of cardiovascular disease (CVD).

Hypothesis:
CVH is suboptimal in US adults. Attaining an optimal level of CVH in all US adults would prevent a substantial number of CVD events.

Methods:
We pooled individual-level data from 7 US cohort studies (n=30447) included in the Lifetime Risk Pooling Project to estimate annual incidence rates of major CVD (CVD deaths, myocardial infarction, stroke, heart failure) by sex, race, and age. Using data from the National Health and Nutrition Examination Survey 2013 to 2016, we estimated the proportions of US adults in different CVH groups, defined by levels of 7 health factors: smoking status, body mass index, physical activity, dietary pattern, total cholesterol, blood pressure, and fasting glucose. Each factor was scored as ideal (2 points), intermediate (1 point), or poor (0 points). We defined overall CVH as optimal (12-14 points), moderate (9-11 points), or poor (0-8 points). Using the 2 data sources and Monte Carlo simulation, we estimated hazard ratios (HRs) for CVD, population attributable fractions, and the number of CVD events that could be prevented annually if all US adults achieved optimal CVH.

Results:
An optimal level of CVH was identified in 6.5% (95% CI, 4.5-8.5%) of US adults (Table) and was associated with a lower risk for CVD (HR [95% CI], 0.29 [0.17-0.43]). Our analysis suggests that 70% (95% CI, 55-82%) of all CVD events can be attributed to non-optimal levels of CVH. If US adults attained an optimal level of CVH, 2.0 (95% CI, 1.6-2.3) million CVD events could be prevented annually.

Conclusions:
The potential impact of achieving an optimal level of CVH in all US adults is considerable, and even a partial improvement would be beneficial. Population- and individual-level strategies to maintain or restore optimal CVH to reduce CVD event rates are highly desirable.
Abstract 41: The Effect Of Maternal Weight On Offspring Blood Pressure At 18 Years Of Age: A Causal Natural-effects Mediation Analysis
Authors: Brunton Nicole M , Dart Allison , Azad Meghan , McGavock Jonathan M
Published: March 2020

Objectives:
Examine the relationship between maternal pre-pregnancy body mass index (BMI) and offspring systolic blood pressure (SBP) at 18 yrs old.

Methods:
We performed multivariate regression and causal mediation analysis within 3700 mother - offspring pairs from a prospective birth cohort. The main exposure was maternal pre-pregnancy BMI categorized as healthy weight, overweight, or obese according to international criteria. The main outcomes were high-normal BP and hypertension defined as SBP between the 90-95
th
centile and >95
th
centile for height and sex at 18 years, respectively, as per 2017 AAP guidelines. Analyses were adjusted for social class, pre-eclampsia, sex, and maternal tobacco use during pregnancy. The Canadian Pediatric Endocrine Group R Shiny app was used to obtain age-standardized BMI Z-scores and latent class analysis (LCA) was used to quantify the mediating factor of offspring BMIZ trajectories from 7 to 18 yrs.

Results:
Before pregnancy 14% of women were overweight and 5% were obese. At 18 yrs, SBP (122 ± 12 vs 118 ±11mmHg, p < 0.001), DBP (67 ± 7 vs 63 ± 6mmHg, p < 0.001) and the odds of elevated BP (aOR: 1.6; 95% CI: 1.1-2.3) and hypertension (aOR: 2.1; 95% CI: 1.4-3.1) were higher in offspring from women that were obese prior to pregnancy compared to those that were normal weight. LCA identified five distinct offspring BMIZ trajectories shown in the figure. SBP (125 ± 12 vs 117 ± 10 mmHg, p < 0.001) and the odds of hypertension (aOR: 3.8; 95% CI: 2.8-5.1) at 18 years were significantly higher in offspring with sustained high BMIZ (teal) compared to sustained low normal BMIZ (green). Casual mediation analysis revealed that maternal BMI directly (OR: 1.14; 95% CI: 1.03-1.25) and indirectly through offspring BMIZ trajectories (OR: 1.12; 95% CI: 1.08-1.15) increased offspring SBP at 18 years of age.

Conclusion:
Maternal obesity prior to pregnancy is associated with an increased risk of hypertension in offspring at 18 yrs of age, partly mediated by an elevated BMIZ score trajectory throughout childhood and adolescence.
Abstract 42: Development And Validation Of The B
2
AND
2
SV
2
ASc Score For Prediction Of Stroke One Year After Transcatheter Aortic Valve Replacement
Authors: Ndunda Paul M , Tadros Peter , Wiley Mark , Muehlebach Greg , Zorn George , Okut Hayrettin , Ablah Elizabeth , Eid Freidy , Fanari Zaher
Published: March 2020

Introduction:
Stroke after transcatheter aortic valve replacement (TAVR) increases the risk of 1-year mortality three-fold. It is also associated with a higher risk of disability and increased health care costs. A validated tool for predicting 1-year stroke after TAVR is lacking and is needed for pre-procedural risk stratification to guide clinical management and research. The purpose of this study was to develop and internally validate a new risk prediction score for predicting stroke within one year of TAVR.

Methods:
This was a retrospective cohort study using data from the TAVR program of a midwestern academic medical center. Patients who underwent TAVR from 2012 to the first quarter of 2018 who had one-year follow-up data were included in the study. The association between candidate variables and stroke was estimated using the Firth multivariable logistic regression method. Integer points for variables that were included in the score were calculated based on the model βcoefficients, using a commonly used method described by Sullivan et al. Internal validation was performed using the bootstrapping method. The model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (c-statistic) and the Hosmer-Lemeshow test respectively.

Results:
Stroke occurred in 3.4% of the 664 patients included in the study. Eight variables were included in the score, forming the acronym B
2
AND
2
SV
2
ASc. The number of points for each variable in the score is shown in parentheses as follows;
B
icuspid/unicuspid valve (2),
A
ortic valve area of <0.5 cm
2
(1),
N
umber of diseased coronary vessels ≥2 (1),
D
iabetes mellitus (2), prior
S
troke/transient ischemic attack (1), peripheral
V
ascular disease (2), body surface
A
rea ≤1.75 m
2
(1), and
S
ex
c
ategory [female] (1). The score had a c-statistic of 0.709 (0.640 on internal validation) and a Hosmer-Lemeshow χ
2
p-value of 0.146.

Conclusion:
The B
2
AND
2
SV
2
ASc score had a good discrimination and calibration for the prediction of stroke within one year of TAVR.
Abstract 50: Associations of Dietary Saturated Fatty Acids With Incident Coronary Heart Disease Depend on the Food Sources: EPIC-CVD Prospective Case-cohort Study in Nine European Countries
Authors: Steur Marinka ,   EPIC-CVD Consortium
Published: March 2020

Introduction:
The associations of dietary total fatty acids and the classes saturated, monounsaturated, and polyunsaturated fatty acids (SFAs, MUFAs, and PUFAs) with coronary heart disease (CHD) remain contentious. Moreover, the role of isocaloric macronutrient substitutions and specific food sources of SFAs, particularly in European context, is unclear.

Hypothesis:
We evaluated the hypothesis that associations of dietary fatty acids vary depending on specific macronutrient substitutions and food sources of SFAs.

Methods:
We conducted case-cohort analyses including 10,529 incident CHD cases and a random subcohort of 16,730 men and women selected from 385,747 eligible participants in nine countries of the European Prospective Investigation into Cancer and Nutrition Study. Habitual diet was assessed using country-specific dietary questionnaires, and macronutrient intakes were estimated using standardised nutrient databases. Country-specific HRs (95% CIs) per 5% energy intake from dietary total fatty acids, SFAs, MUFAs, and PUFAs were estimated using Prentice-weighted Cox regression models and pooled using random-effects meta-analyses, with and without considering isocaloric macronutrient substitutions. The associations of dietary SFAs from different food sources, including specific macronutrient substitutions, with CHD were also investigated.

Results:
There was no evidence of associations of dietary total fatty acids, SFAs, MUFAs, or PUFAs with incident CHD, regardless of the substitution macronutrient. Each 1% higher energy intake of SFAs from yoghurt, cheese, and fish were associated with a 7% (95% CI 1-12%), 2% (0-4%) and 13% (0-25%) lower CHD incidence, while SFAs from red meat and butter were associated with a 7% (2-12%) and 2% (0-4%) higher CHD incidence, respectively.

Conclusions:
There was no evidence of associations of dietary total fatty acids, SFAs, MUFAs, and PUFAs, with CHD incidence, regardless of the substitution nutrients, within the range of intakes in this European population. The opposite direction of associations of SFAs from different food sources such as red meat versus fermented dairy products suggests that public health recommendations should consider foods and overall diets, alongside the macronutrients they contain.
Abstract 56: Blood Pressure Control in the Real World - Early Evidence From a National Blood Pressure Surveillance System
Authors: Cooper-DeHoff Rhonda M , Fontil Valy , Carton Thomas , McAuliffe Kathryn , Smith Myra , Choi Sujung , Todd Jonathon , Chamberlain Alanna M , O'Brien Emily , Faulkner Madelaine , Maeztu Carlos , MURAKAMI LINDA , Wozniak Gregory , Rakotz Michael , Shay Christina M , Pletcher Mark J
Published: March 2020

Background:
The Patient-Centered Outcomes Research Institute (PCORI) funded National Blood Pressure Surveillance System (BP Track) is a new national system that generates quarterly metrics of blood pressure (BP) control and BP-related quality metrics for participating healthcare systems from electronic health record (EHR) data.

Methods:
Queries against standardized EHR data in the national Patient-Centered Clinical Research Network (PCORnet) Common Data Model format produce a set of quality metrics relevant to improving BP control, including Controlling High BP (NQF 0018) and Improvement in BP (CMS65v7), and eight process measures specific to clinical management and treatment practices for improving BP control (
Table
). The metrics, aggregated overall and by health system are reported back to health systems via user-friendly Tableau dashboards, and allow for observation of metric trends.

Results:
To date, 19 datamarts have contributed EHR data from 1,177,232 patients who met the eligibility criteria for the BP Control measure and 4,454,729 encounters that included a BP measurement during the measurement period. Average age was 62 years; 10% were young adults (<45 years), 17% were African American, 52% female, 28% had diabetes, 15% had coronary heart disease, and 14% had depression. Results demonstrate substantial opportunity for improvement in overall BP control (60% with BP<140/<90 mmHg, range: 42-72%), and many healthcare processes, including medication intensification (12%, 0.6-22%) and use of fixed dose combination medications (24%, 0-88%,
Table
).

Conclusion:
Major opportunities exist for improving BP control, especially in improving the frequency and quality of BP medication prescribing for patients with high BP. The BP Track National BP Surveillance System will track these metrics, by demographic subgroup and over time, and will generate data that can guide and focus quality improvement initiatives aimed at effective BP management.
Abstract 57: Vulnerable Populations, Disparities, and the U.S. Tobacco Endgame
Authors: Levy Douglas
Published: March 2020

Background:
Since 1964 when the first Surgeon General’s report on smoking was published, the decline in smoking has been steepest among those with the most education. As smoking has become denormalized, it is increasingly concentrated in vulnerable populations that are marginalized by socioeconomic status, mental health, race/ethnicity, or sexual orientation. This analysis uses the National Health Interview Survey (NHIS) to assess current trends in cigarette smoking among vulnerable vs. non-vulnerable populations.

Methods:
Current cigarette smoking among adult NHIS respondents was tracked from 1999-2018. Vulnerable populations were defined by low socioeconomic status (<100% federal poverty level, <high school education, Medicaid recipient), low mental health (Kessler 6 score≥5), or race/ethnicity with elevated smoking (American Indian, multiracial). Sensitivity analyses added food insecurity and minority sexual orientation (non-straight), available starting 2013, to the definition of vulnerability. Regression analysis projected future smoking trends.

Results:
Smoking rates in all sub-groups declined from 1999 to 2018. Among the non-vulnerable, smoking declined from 19.2% to 9.7%; among the vulnerable, smoking rates were 10 percentage points higher, declining from 30.5% to 19.5%. Smoking rates among vulnerable populations are now double the rates in non-vulnerable populations. The proportion of smokers classified as vulnerable increased from 47.7% to 58.6%; the proportion of cigarettes consumed by vulnerable smokers increased from 50.1% to 60.4%. Expanding the definition of vulnerability to include those food insecure and in sexual minorities, the proportion of smokers classified as vulnerable (2018) was 61.63%. The most common vulnerabilities in the population (2018) were low socioeconomic status (25.5%) and poor mental health (22.0%); (7.8% were both). In 2018, as the number of vulnerabilities increased (0, 1, 2, ≥3), so did the smoking rate (9.4%, 14.6%, 21.7%, 31.7%, respectively, p<0.001). Using linear regression to extrapolate current trends, non-vulnerable populations will eliminate cigarette smoking in 2037, vulnerable populations in 2060.

Conclusion:
Existing public health policy and social trends are reducing smoking rates among all smokers, but absent concentrated effort to reduce smoking in vulnerable populations, health disparities from disproportionate tobacco use will increase and reverberate for decades.
Abstract MP05: Impact of Gentrification on Cardiovascular Risk Factors and Outcomes in England: 2004-2018
Authors: Bhavsar Nrupen A , Li Danying , Ramos Miguel , Richman Laura
Published: March 2020

Introduction:
Dynamic changes to neighborhoods due to forces such as gentrification impact the health of residents. Much of this research has been conducted within the United States, where racial disparities and access to healthcare impact risk for health outcomes. Internationally, other factors may play a more prominent role in the association between gentrification and cardiovascular risk factors and outcomes.

Hypothesis:
Residents living in gentrified vs. non-gentrified neighborhoods will have lower odds of diabetes (DM), hypertension (HTN), depression and cardiovascular disease (CVD).

Methods:
We defined gentrification using changes in domains of the Index of Multiple Deprivation (IMD) at the level of the Lower Layer Super Output Areas (LSOA) in England from 2004-2010. We used all IMD domains (income, employment, education, crime, barriers to housing, and living environment), except the health domain, from 2004 and 2010 to define LSOA deprivation. The IMD for each LSOA was standardized to the mean IMD of England using z-scores. LSOAs were eligible to be gentrified if they had a positive z-score in 2004 and were considered to gentrify if they had a negative change in the transformed IMD from 2004 to 2010. We linked these data to individual participants in the Understanding Society Study (USS). The USS is a nationally representative cohort study of 60,000 United Kingdom residents started in 2009 with follow-up ongoing. We limited the analysis to residents in England who lived in top and bottom 25% deprived LSOAs (n=8782). We used multivariable logistic regression to calculate the odds ratio for self-reported DM, HTN, depression, and CVD in residents in neighborhoods that did and did not gentrify, adjusting for race, sex, length of residence (LOR), baseline IMD score, and baseline prevalence of health conditions. Results were stratified by age (<65 & >=65 years) and median LOR (<13 & >=13 years).

Results:
At baseline, 8782 participants had a median age of 43 years, 4% were black and 55% were female. There was no significant difference in the prevalence of DM, HTN, depression, or CVD at baseline. At follow-up, overall, there were no significant difference in the odds of DM, HTN, or CVD between residents living in gentrified vs. non-gentrified neighborhoods. Residents in neighborhoods that gentrified had a 39% lower odds of depression as compared to participants living in neighborhoods that did not gentrify (p=0.01). Results were not significantly modified by age or length of residence.

Conclusions:
Residents living in gentrified neighborhoods did not have differential risk for most CVD risk factors and outcomes as compared to residents living in neighborhoods that did not gentrify. However, the impact of gentrification on health is not uniform across all conditions. The positive health impact seen may suggest gentrification increases access to resources not present prior to gentrification.
Abstract MP07: Automated, Personalized Feedback and Behavioral Nudges to Improve Workplace Food Choices and Prevent Weight Gain: Choosewell 365 Randomized Controlled Trial
Authors: Thorndike Anne N , McCurley Jessica L , Gelsomin Emily D , Rimm Eric B , Chang Yuchiao , Porneala Bianca , Anderson Emma , Johnson Charles , Levy Douglas E
Published: March 2020

Importance:
Workplace health promotion programs often have limited reach and effectiveness because they are time-intensive and not integrated with the work environment.

Objective:
Conduct a randomized controlled trial testing an automated intervention combined with workplace cafeteria traffic-light labels to prevent weight gain and increase healthy food choices.

Methods:
602 hospital employees who regularly used 6 on-site cafeterias and paid with their ID were randomized in 2016-18. Cafeteria labels identified healthy (green), less healthy (yellow), and unhealthy (red) items. Participants completed visits, surveys, and dietary recalls at baseline and 12 months (end of intervention). The intervention group received personalized emails (2/week) and letters (1/month) that were automatically generated by a software platform that integrated cafeteria sales, health, and survey data. Emails included a log of weekly purchases (item, traffic light label, and calories) and health tips. Letters included social norm comparisons and small incentives for healthy purchases. The control group received standard lifestyle advice in monthly letters. A Healthy Purchasing Score was calculated by weighting purchased items by traffic light labels (red=0; yellow=0.5; green=1) using 12 mo of purchases during both baseline (pre-intervention) and intervention. Differences in differences in health outcomes, purchases, and dietary quality were compared, with missing values imputed.

Results:
Participants were 43.6 years (mean), 79% female, and 81% white. The intervention group increased healthy purchases compared to control, but changes in BMI and health outcomes were not different (see Table).

Conclusion:
An automated intervention linked to the workplace food environment increased healthy food choices but did not prevent weight gain. To improve health, this scalable healthy eating intervention could be augmented with additional technology to improve other health behaviors, such as physical activity, both at work and home.
Abstract MP12: Lay- vs Professional-led Weight Loss Interventions for Overweight and Obese Youth: A Systematic Review and Network Meta-analysis
Authors: McGavock Jonathan M , Boissoneault Sara , Klaprat Nika , Rabbani Rasheda , Abou-Setta Ahmed
Published: March 2020

Context:
In this network meta analysis, we examine the short and long-term effects of professional and lay-led behavioural interventions for obese youth.

Objective:
The appropriate approach for weight loss among overweight and obese youth remains unclear. We evaluated the comparative effectiveness of behavioural pediatric weight loss interventions led by lay persons and professionals.

Data Sources:
MEDLINE, Embase, the Cochrane Library, and CINAHL between January 1996 and June 2019.

Study Selection:
Randomized controlled trials of behavioural lifestyle interventions that enrolled overweight and obese children and adolescents (5-18 years old) administered for at least 12 weeks.

Data Extraction:
A network meta-analyses using a Bayesian framework and Markov-chain Monte-Carlo simulation methods were used to combine direct and indirect evidence. The immediate and sustained change from baseline in weight (kg) and body mass index (BMI; kg/m2) were primary outcomes.

Results:
Of 34,384 citations retrieved, we included 78 RCTs (4,556 participants), delivered for 12 to 104 weeks. Compared to standard care, professional-led weight loss interventions were associated with a significant reduction in body weight [-1.6 kg, 95% credible interval (CrI) -2.3, -0.99, 64 trials] that was not sustained long-term [-1.02 kg, 95% CrI -2.2, +0.34, 21 trials]. There was no evidence of a meaningful weight loss for lay-led interventions in the short-term [-1.4 kg; 95% CrI -3.0, +0.26; 5 trials], or long-term [-0.98 kg, 95% CrI -3.6, +1.8, 1 trial] compared to standard care. Direct comparisons revealed expert and lay-led interventions yield similar effects (-0.25 kg, 95%CrI -1.9, +1.3, 5 trials).

Conclusions:
Professional-led weight loss interventions are the most effective for achieving and sustaining weight reduction among overweight and obese youth. There is a need for high quality trials of lay-led weight loss interventions for obese youth.
Abstract MP19: Impact of Change in Bedtime Variability on Body Composition: Secondary Findings From the Go Red for Women Strategically Focused Research Network
Authors: St-Onge Marie-Pierre , Campbell Ayanna , Zuraikat Faris M , Cheng Bin
Published: March 2020

Variability in daily sleep duration and unstable bedtimes are emerging sleep-related factors that have been linked to metabolic syndrome. For example, in longitudinal studies, the odds of developing metabolic syndrome over 6.3 y median follow-up are 1.36 for every 1 h increase in sleep onset variability (standard deviation of bedtimes measured over 7 nights of actigraphy) in fully adjusted models. However, whether reducing bedtime variability improves markers of disease risk has not been tested. Here, we assessed whether body composition was impacted by changes in bedtime variability over a 6-wk period during which women were instructed to maintain healthy, habitual sleep patterns. This was a single arm of a randomized trial originally designed to test the impact of sleep restriction on cardiometabolic risk factors. Women, aged 20 y and older and with body mass index 20-33 kg/m
2
were recruited. All women were required to have adequate sleep duration of 7-9 h/night, determined over 2 wk using wrist-worn actigraphy. Upon randomization, women were given bed and wake time prescriptions aligned with their average screening bed and wake times in order to ensure maintenance of adequate sleep duration over the 6 wk study phase. The alternate phase required women to delay their bedtimes to achieve sleep restriction. Only data from the adequate sleep phase were used for the present analyses. Bedtime variability and body composition data were available for 37 women (age 34.9±12.4 y, BMI 24.7±2.9 kg/m
2
, screening sleep duration 7.58±0.49 h/night). Body composition was measured at baseline (0 wk) and endpoint (6 wk) using magnetic resonance imaging. Bedtime and sleep data were collected weekly using wrist actigraphy. Change in bedtime variability was calculated as the difference in the standard deviation of bedtimes measured during the 2-wk screening period and the 6-wk study phase. Sleep duration did not differ between screening and the average of 6 wk of the sleep phase (-4.8±24.7min, P=0.24). Average percent change in bedtime SD was 24.4±25.2% in those who increased their bedtime variability and -39.9±23.5% in those who reduced their bedtime variability. Results showed that, compared to women who increased or did not change (n=8) bedtime variability, women who reduced their bedtime variability (n=29) during the intervention had significant reductions in total (reduced: -0.52±0.98 vs increase/no change: 0.63±0.41 L, P<0.001) and subcutaneous adipose tissue (reduced: -0.48±0.86 vs increase/no change: 0.56±0.31 L, P<0.001). Thus, results provide novel preliminary information showing that reducing bedtime variability can improve body composition over time. Given that bedtimes are highly individualized, this may provide an easy public health message to maintain healthy sleep hygiene, particularly stable bedtime routine, to achieve better weight management and reduced CVD risk.
Abstract MP26: Mediterranean Diet And Brain Magnetic Resonance Imaging Measures In Young And Older Adults
Authors: GU YIAN , Mensing Ashley , Stern Yaakov
Published: March 2020

Introduction:
Accumulative evidence has suggested that higher adherence to a healthy dietary pattern, such as Mediterranean diet (MeDi), is associated with preservation of brain structure and less cerebrovascular events. Little is known for these associations across lifespan.

Hypothesis:
We hypothesized that MeDi was associated with brain atrophy or small vessel pathology measured using magnetic resonance imaging (MRI) in a cohort of healthy adults aged 20-80.

Methods:
This cross-sectional study included 375 healthy, non-demented adults recruited from market mailing within a 50-mile radius of Columbia University Medical Center in New York City. The participants age ranged 20-80 years old (mean 55, SD=16); had on average 16 (SD=2.3) years of education; 210 (56%) were females; 67% were Whites, 20% African-Americans, and 13% others. MeDi score (range 0-9) was calculated based on food consumption information collected through food-frequency questionnaire. Total brain volume (TBV) and white matter hyperintensity (WMH) were derived from high-resolution structural MRI scans. We examined the association of MeDi with TBV (milliliter, adjusted for intracranial volume) and WMH (milliliter, log transformed) using regression models adjusted for age, gender, race, education, and total caloric intake. Stratified analyses were performed among young (20-45), mid-age (46-65), and older (65-80) adults.

Results:
In multivariable-adjusted linear regression models, one unit increase in MeDi score, indicating consumption of one more food meeting the desirable level, was associated with larger TBV (β=2.79, p=0.027) and of less WMH (β= -0.058, p=0.041), corresponding to roughly 1.8 years and 1.3 years of less aging (β=-1.54 for age on TBV and 0.044 for age on WMH), respectively. Furthermore, we found the association between MeDi and TBV was similar across age groups, while the association between MeDi and WMH was only significant in the young adults (b=-0.189, p=0.002).

Conclusions:
Higher MeDi adherence was associated with healthier brain, indicated by larger brain volumes and less white matter lesion burden. These findings suggest that following a healthy diet may help maintain brain health across life span. To our knowledge, this is the first study to examine the relation of MeDi adherence to brain measures in healthy adults of all ages. The novel findings, especially the finding of MeDi and WMH in young adults, are worth of further confirmation in larger and longitudinal studies.
Abstract MP28: Egg Consumption is Positively Associated With Ischemic Stroke: The Million Veteran Program
Authors: Djousse Luc , HO Yuk-lam , Treu Timothy , Aparicio Hugo J , Seshadri Sudha , Cho Kelly , Wilson Peter W , Gaziano J. M ,   on behalf of the Million Veteran Program
Published: March 2020

Background:
While observational data suggest a higher risk of coronary artery disease with frequent egg consumption, only limited and inconsistent data are available on the relation of egg consumption with stroke.

Objective:
To test the hypothesis that egg consumption is positively associated with the incidence of ischemic stroke among Veterans.

Methods:
The Million Veteran Program is an ongoing observational study designed to study genetic determinants of chronic diseases among Veterans (2011 to now). Egg consumption was self-reported at baseline using validated Willett food questionnaires. We used ICD 9 codes 433, 434, 436, 437.0, and 437.6 and ICD 10 codes I63, I65, I66, I67.2, I67.6 and I67.8 to identify ischemic stroke using previously validated algorithm and multivariable Cox proportional hazard model to estimate relative risks.

Results:
A total of 234,032 Veterans provided data on egg consumption and were free of stroke at baseline. Mean age at baseline was 65.6 (SD: 11.7) years and 91.6% (214,373 of 234,032) were men. Median egg consumption was 2-4 eggs per week. During a mean follow up of 3.2 years, a total of 5,747 new cases of fatal or non-fatal acute ischemic stroke occurred. Crude incidence rates for acute ischemic stroke were 6.5, 7.2, 7.1, 7.4, 8.0, and 8.3 cases per 1000 person-years for egg consumption of <1/month, 1-3/month, 1/week, 2-4/week, 5-6/week, and ≥ 1/day, respectively. Corresponding adjusted hazard ratios (95% CI) were 1.00 (ref), 1.10 (0.97-1.25), 1.10 (0.97-1.25), 1.13 (1.00 -1.27), 1.19 (1.04-1.37), and 1.25 (1.09-1.44) controlling for age, sex, ethnicity, body mass index, education, smoking, alcohol intake, and overall diet quality (p linear trend 0.0007). The egg-stroke relation was not modified by body mass index, sex, or diabetes status.

Conclusion:
Egg consumption is positively associated with incidence of acute ischemic stroke among Veterans.
Abstract MP34: Acceleration of Kidney Function Decline After Incident Hospitalization With Cardiovascular Disease: The Stockholm Creatinine Measurements (scream) Project
Authors: Ishigami Junichi , Trevisan Marco , Lund Lars , Jernberg Tomas , Coresh Josef , Matsushita Kunihiro , carrero juan jesus
Published: March 2020

Background:
The cardiorenal syndrome suggests a bidirectional relationship between worsening kidney function and cardiac dysfunction. However, to our knowledge, no studies have quantified changes in slopes of kidney function decline before and after the incidence of major cardiovascular disease (CVD) subtypes.

Methods:
We compared the individual slopes of estimated glomerular filtration rate (eGFR) decline in the 2 years before vs. after the incident hospitalization with heart failure (HF) (n=20,420), coronary heart disease (CHD) (n=18,152), and stroke (n=1,808) using data from the complete laboratory data collection of Stockholm healthcare (Sweden) between 2006 and 2011. Using mixed effect models with unstructured residual correlation matrix, we examined changes in individual slopes of eGFR decline before and after incident CVD in the overall population, and by index eGFR strata (≥60, 30-59, <30 ml/min/1.73m
2
).

Results:
Incident hospitalization with HF and CHD, but not stroke, was significantly associated with a subsequent acceleration of eGFR decline, with a faster eGFR decline and greater slope change after HF than CHD. The pre-event vs. post-event eGFR slope (ml/min/1.73m
2
per year) were -1.67 (-1.77 to -1.57) vs. -2.76 (-2.82 to -2.71), with Δslope of -1.09 (-1.16 to -1.02) for HF; -1.09 (-1.20 to -0.98) vs. -1.87 (-1.92 to -1.81), with Δslope of -0.78 (-0.85 to -0.70) for CHD; and -1.00 (-1.37 to -0.63) vs. -0.99 (-1.19 to -0.78), with , Δslope of 0.02 (-0.24 to 0.27) for stroke (
Figure
). The accelerated eGFR declines after HF and CHD were consistently observed across eGFR strata, with pre-event eGFR slopes steeper in lower eGFR (e.g., pre-event eGFR slope for HF -0.64 (-0.76 to -0.53) for eGFR ≥60, -1.43 (-1.57 to -1.30) for eGFR 30-59, and -2.42 (-2.71 to -2.12) for eGFR <30 ml/min/1.73m
2
).

Conclusions:
Incident hospitalization with cardiac diseases (ie, HF and CHD) was significantly associated with a subsequent acceleration of eGFR decline.
Abstract MP36: Changes in High-density Lipoprotein (hdl) Subclasses and Particle Size Over the Menopause Transition are Associated With Higher Levels of Complement Proteins C3 and C4. The Study of Women's Health Across the Nation Hdl Ancillary Study
Authors: El Khoudary Samar R , Chen Xirun , McConnell Dan , Brooks Maria M , Orchard Trevor , Billheimer Jeff , Matthews Karen A
Published: March 2020

Objective:
High density lipoprotein (HDL) is emerging as a key player in modulating inflammation-related response impacting atherosclerosis development. HDL carries multiple proteins with direct roles in complement system activation including C3 and C4. Postmenopausal women have higher levels of C3 than premenopausal women suggesting a role of the menopause transition (MT) in modulating complement proteins. Preliminary work showed significant declines in large HDL particles (HDL-P) and overall HDL particle size, but increases in small HDL-P during the MT. Whether these changes contribute to higher levels of C3 reported after menopause is not known. Our objectives were to test whether C3 and C4 increase around the final menstrual period (FMP) and whether changes in HDL subclasses over the MT associate with C3 and C4 levels in midlife women.

Design:
We evaluated 558 women (at baseline: age 49.9(2.8) years; 86.6% perimenopausal) who had nuclear magnetic resonance spectroscopy HDL subclasses, C3 and C4 measured up to 5 times over the MT. Piecewise linear mixed-effects models were used to estimate and compare yearly changes in C3 and C4 at 3 time segments relative to the FMP. Linear mixed effect models were used to test associations between changes in each HDL subclass and overall HDL particle size with C3 and C4 separately.

Results:
Adjusted annual changes in C3 and C4 varied by time segments relative to FMP with significant increases only observed within 1 year before to 2 years after the FMP (
Figure
). These changes were significantly greater than changes in the other 2 time segments. Greater decreases in large and increases in small HDL-P concentrations and decreases in the overall size of HDL-P were independently associated with higher levels of C3 and C4 over time (
Table
).

Conclusions:
Complement proteins C3 and C4 significantly rise around menopause with C3 showing the steepest rise. Changes in HDL subclasses and overall size over the MT may play role in modulating inflammation responses known to be related to atherosclerosis.